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Extreme dieting? Don’t!

Cynthia Bulik is the director of Carolina’s Center of Excellence for Eating Disorders (CEED) and holds the nation’s first endowed professorship in eating disorders. She has been treating eating disorders since 1982.

Cynthia Bulik is the director of Carolina’s Center of Excellence for Eating Disorders (CEED). Photo by Max Englund of UNC Health Care.

[toc]Many people start the New Year with a resolution to lose weight. While it’s tempting to dedicate this time of year to dieting, Carolina’s expert on eating disorders advises: Don’t do it.”

Cynthia Bulik is the director of Carolina’s Center of Excellence for Eating Disorders (CEED) and holds the nation’s first endowed professorship in eating disorders. She has been treating eating disorders since 1982.

“I urge people not to make a New Year’s resolution to lose weight,” Bulik said. “Make a resolution to become more active regularly or to substitute water for sugar-sweetened beverages, but a resolution to lose weight is a recipe for failure.”

The danger of dieting

Not everyone who goes on a diet will develop an eating disorder, said Cristin Runfola, clinical assistant professor of psychiatry and a researcher at CEED. But, she said, dieting is one of the top risk factors for an eating disorder.[toc]

“Extreme diets never work,” she said. “This diet ‘failure’ can set someone up for major disappointment, especially if it’s tied to that person’s self-esteem. Extreme dieting can also put you at risk for serious physical or psychological problems.”

Eating disorders refer to the syndromes that appear in the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5): anorexia nervosa, bulimia nervosa, binge eating disorder and otherwise specified feeding and eating disorder (OSFED).

In the grayer area lies disordered eating.

“Disordered eating is a broader term and one that refers to an array of unhealthy behaviors and symptoms that occur widely in the community but do not reach the threshold for a diagnosis,” Bulik said.

It’s possible that disordered eating could lead to a full-blown disorder, she said. When restrictive eating is used as a dieting tool, biological and psychological responses might trigger binge eating, which overrides the body’s natural signals for feeling full or be the first step toward the starvation associated with anorexia nervosa. These behaviors can be a slippery slope for those predisposed to eating disorders.

Genetic, biological, psychological and societal factors all play a role in the development of an eating disorder. Eating disorders run in families and have been shown in studies with twins to be heritable. Researchers at CEED have been central to a number of global genetic studies that are working toward identifying which genes influence risk for eating disorders.

Environment also is influential, Bulik said.

“Childhood teasing, bullying about weight and the toxic food environment of large portion sizes and high-sugar, high-fat food all play a role,” she said. “The societal emphasis on ultra thinness can lead women and men to believe that it is realistic to try to make their bodies look like Photoshopped models.”

This obsession for the “perfect body” can be driven by the depiction of severely thin women and exceedingly masculine men in the media, especially when those images are paired with messages of success, power, sex and happiness, Runfola said.

“People may go to great lengths to change the way they look in attempt to fit society’s idea of beauty and gain the attention or success they desire,” she said.

When underlying genetic or biological factors meet environmental and circumstantial conditions, individuals are at risk of developing eating disorders. “Quite often, individuals might experience a short or prolonged period of sporadic symptoms that later coalesce into a full syndrome,” Bulik said.

Research that reaches everyone

Bulik started CEED when she came to Carolina in 2003 and joined the Department of Psychiatry. A handful of staff has grown to more than 100 people in various capacities working for the center, which has become an evidence-informed, comprehensive program that provides a high standard of care for individuals with eating disorders and their families.

“We are so proud of our faculty and trainees of all stages – from high school students to full professors,” said Bulik.

In the past, most of CEEDs patients were adolescents and young adults, but Bulik’s team has seen a demographic shift with both younger children and middle-age individuals of both sexes seeking treatment. Other new areas are couples-based treatment and research on eating disorders in the Latino community.

Translating CEED’s leading-edge science and research for all people is a mission Bulik holds dear. Her most recent book, “Midlife Eating Disorders: Your Journey to Recovery,” aimed to erase stereotypes and give hope to adults with eating disorders.

Exchanges, the center’s blog, is an arm of that mission.

Members of the center, including Bulik and Runfola, blog frequently on everything from hard science and current research surrounding eating disorders to issues of body image, prevention, recovery, family issues and advocacy.

“We are passionate about it and try to distill the science into user-friendly terms to keep our readers up to date on what is happening in the science of eating disorders,” Bulik said.

New beginnings that have nothing to do with food

Bulik and Runfola recommend a number of ways to bring on new beginnings that have nothing to do with food: Learn a new craft. Go dancing. Reward yourself with activities that don’t surround diets or eating.

“Try new things you’ve never dreamed you would try,” Bulik said. “Even if you don’t like it, give it a go, and try something else. Finding ways to have new experiences is an incredible and healthy way to grow as a person.”