Intermittent Fasting is Disordered Eating Behavior?

**CW: Please skip this article if you are in active eating disorder recovery and/or content about diets is triggering.**

I posted this meme yesterday and it’s gotten a lot of feedback so today I’m unpacking where my reasoning came from and some research behind it:

First, I want to be very clear about a few things:

1. I am not talking about religious fasting which is a different subject.
2. I am discussing pop-culture intermittent fasting (you know, the kind you read about in Women’s Health magazine or hear about in a CNN sound bite). I will define intermittent fasting (IF) below.
3. Medically supervised IF may be part of one’s legitimate food allergy or digestive health plan which is different than using IF, for example, as a weight loss strategy or legitimizing disordered eating behavior. In this case, consult your doctor. (Side note: I’m also wary of medical professionals’ bias and weight stigma, so this one comes with a grain of salt).
4. Eating disorders are a mental health challenge (and the most deadly of all mental illnesses) that do not affect everyone; however, dieting behaviors listed by clients often qualify for unspecified eating disorders in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and can lead to an eating disorder.
5. I will use disordered eating to describe dieting and eating disorder behavior—they can often be one in the same and currently health professionals do not have a crystal clear distinction of criteria because diet behaviors have become so normalized in our culture. One big distinction between eating disorders and diets is the duration of certain symptoms (e.g. purging, prolonged restriction, nutritional deficits that impact health), but these same symptoms can develop in chronic dieters. In fact, when I see clients for diet recovery, I notice that most meet similar criteria for disordered eating as clients who have previously been diagnosed with a full-blown eating disorder.

(Some examples of disordered eating are: counting calories each meal, weighing oneself, counting down until meal times, avoiding social situations to manage food or exercise, avoiding certain foods without cause like a diagnosed allergy, body checking, increased self-criticism, fantasies of a better life at X weight, preoccupation/time/energy/money spent on food and/or fitness in comparison to other aspects of life, obsessive concerns about food intolerances and health).

IF is a way of eating in which folks cycle between times of eating and not eating (or fasting). Fasting involves not eating any food or beverages with caloric value. The idea behind IF is that some studies (mostly on rats and mice) show it may increase metabolism, lower weight, help with insulin resistance and cancer, and increase lifespan. There are a few versions:

1. 16/8 method: Fast for 16 hours a day and eat only between the hours of noon and 8pm
2. Eat-Stop-Eat: Fast for 24 hours once or twice a week
3. 5:2 method: During 2 days a week, eat a very, very restricted amount of food

Not all folks who engage in IF have eating disorders or will exhibit disordered eating after stopping it. If this is you, then great! You can stop reading. If you’re not sure where you stand, then read on and find out how diets like IF and food rules can turn into normalized disordered eating.

 Why do I find IF problematic (aka what’s with the meme)?

• One giant issue with IF is the lack of long term research done on humans. Most studies come from those on rats and mice then hypothesized to have similar effects on humans. The problem with this is that mice don’t live as long as humans, they don’t have the same physiology, and there are many, many extraneous factors that influence human bodies that mice and rats do not experience (e.g. poverty, lack of access to healthcare, systemic racism, weight stigma—all of which we know impact health and longevity oftentimes with greater effects than what or how much food one consumes).
• The most current literature review about the research only lists a handful of studies done on humans. (The best research studies are those with a sample size of over 100 participants that last for a year or more). Findings from the literature have only one study (Harvie, 2011) with 107 participants that lasted 6 months. Results were mixed with IF not being more effective than other diets. The other studies reviewed had small sample sizes and lasted 3 months or less with little follow-up. A review from Harvard showed no significant health outcomes via IF compared to other diets and noted that many studies actually had higher drop out rates (guessing because people got hungry). There also has been evidence that IF may increase the risk for Type 2 Diabetes. IF is not recommended for folks with diabetes, who have eating disorders, those still growing (children, adolescents), or who are pregnant and/or breastfeeding.

[Side note: I want to know what happened to participants after they stopped IF. Did they regain weight? Did those health markers like metabolism and insulin change stick with folks and improve their health beyond 2 years past the study’s end? What other factors could have contributed to weight gain or loss—was this accounted for in the control group? There is not enough research to be convincing. I’m willing to bet $100 that the majority gained the weight back after a couple of years.]

• Micromanaging food from an external source (e.g. food rules, dietary protocols, lifestyle “best practices”) actually prohibits our ability to tune into natural food and body needs. Normal eating is flexible eating! Psychology research is very clear about this idea: when you don’t trust your own hunger or learn to rely on outside rules, then there is an “I earned it” mentality about your next meal. Instead of coming into a meal with mild hunger pangs and eating until full (and maybe even throw away food), you arrive ravenous at mealtime and will usually eat everything on the plate (and more) because it’s what you’ve been allotted for the day/time. This may not happen to everyone HOWEVER it happens often with most restrictive diets.
• Beyond the research, IF has been co-opted as a diet protocol. Most diets in American culture use restrictive eating and over exercise as a way to lose weight—it seems like nothing is too extreme. Weight loss is not inherently bad, but it is the intention behind it that can be (e.g. fat phobia, body modification, needing acceptance, shame from medical professionals or parents with messages about thin=health).
• Restrictive food plans have become normalized and legitimized in our culture which makes it very easy for sneaky disordered eating to get passed off as having “willpower,” “determination,” or “wanting to get healthy” instead of recognizing that there are high risks associated with pursuits of the thin ideal. In fact, there have actually been funded research studies (?!) analyzing anorexic behavior and how it might be translated to diet protocol for people with higher BMIs. WTF. Folks are literally trying to prescribe eating disorders (which we know are harmful and deadly) to folks who look a certain way. I want you to stop and think about how fat phobic and damaging this is.

• There is a myth that weight loss is the solution to leading a happier, healthier life. [Please browse the Health at Every Size website to learn more about why this is a myth]. IF is often used as a way to restrict food intake in an effort to lose weight. It closely mirrors restrictive eating disorder behaviors such as waiting longer between meals, not eating when hungry, ignoring body cues, and labeling oneself as “good” for following the rules and “bad’ when breaking them. Behaviors like this can lead to negative beliefs about self and effect mood. Weight cycling after diets can lead to health outcomes that medical professionals often attribute to larger body size—in actuality, it’s more likely that decreased health outcomes like diabetes, weight change, and heart disease was a result of weight cycling than of existing in a larger body.

• Some folks suggest that IF can help digestive issues. Medical concerns about your gut are real, so get it checked out if you’re worried. However, research shows that diets and eating disorders can lead to gastrointestinal issues. Up to 98% of folks who have had an eating disorder will experience gut health problems. [Check out this science-y article for more]. Only 16% of folks who start with gut health issues will end up with an eating disorder. What this means is eating disorders and diets are often the cause of GI upset…not the other way around. GI upset is often another way folks excuse restricting food groups with disordered eating. If someone is predisposed to restrictive eating patterns, then it’s unethical and harmful to prescribe or engage in these behaviors.

• Some IF protocols also include “cheat days.” I’d argue that if you have to “cheat” on your meals, then you’re not getting what you need in the first place. What we also know is food becomes more desirable the less available it is (whether that’s psychologically or an actual lack of food availability). The label of cheating comes with a morality bias—if I’m not “cheating” then I’m “good” and vice versa. Putting food and bodies on a moral hierarchy is a breeding ground for shame, body violence, and diminishment of body trust.

• Restriction can lead to bingeing. IF is a form of restriction that creates calorie (read: energy) deficits, which is why people lose short-term weight. Binge behavior derives from restriction. The body will always resort to survival tactics (e.g. increased desire for higher calorie foods, release of hunger hormones, slowed metabolism, increased hunger signals, mood changes, irritability, headaches, nausea, etc.) to tell you “I NEED ENERGY!” Bingeing is not a moral flaw, not an indication that you are addicted to food, or that you’re not good enough. It is a survival tactic from the body preparing for famine. The body doesn’t know the difference between real and perceived lack of food availability.

• Last one (you made it!). If you learn to follow your body’s intuition instead of food rules, then you’d probably end up not eating all the time anyway. The body knows when it needs energy and when it doesn’t. We get into difficulty when we try to challenge our body’s (and mind and spirit) intuition. There is an abundance of research about intuitive eating and how attuning to your body can help ditch disordered eating and promote health. Feel free to check it out and look at the research.

Thanks for reading along! Give yourself a gold star for getting through all 2000 words. Drop me a comment if something sparked your interest. I’m glad to have discussion and please know mean-spirited, fat phobic, concern trolling comments will be deleted.