The tough truth about diets

Patrick Boyle:

I spent all my teenage years, either on a diet or being encouraged to diet. Not being active and sporty, and thin, was a problem.

Shreen:

I went on a diet that led me to an eating disorder, and I nearly lost all those things too—as a result of my eating disorder.

Kate Reid:

It was a real shock to the system, and it led, I’d say pretty quickly, towards depression. The depression eventually ended up leading to my diagnosis of anorexia.

Sam Ikin:

This is the Butterfly Podcast from your friends at Butterfly, your national voice for eating disorders and body image issues. I’m Sam Ikin. In this episode, we’re going to find out the truth about diets. Now, we can’t get around the fact that this is going to be a controversial issue. Diets and dieting are complex and often very personal issues. What works for one person won’t necessarily work for another. When we refer to ‘diets’ in this episode, we’re largely looking at the eating patterns prescribed by the health and fitness industry.

Sam:

We’re certainly not suggesting you ignore the advice of a doctor, for example. Like most kids in Australia, I grew up thinking that diets were just part of a healthy lifestyle. I can’t really think of a time since my early teens when I haven’t been on a diet, about to go on a diet, or having just come off a diet. Which is why it’s so surprising to me when I’m speaking to experts who suggest that dieting is a bad idea, but that’s what more and more dieticians are starting to say.

Shane Jeffrey:

In the eating disorder world, it’s fairly commonly accepted that eating disorders, when you look at risk factors, dieting is definitely right up there. We know that dieting is a significant risk factor.

Fiona Willer:

When you prescribe weight loss to somebody, or when you suggest that weight loss might be a good thing for somebody to strive for, what you’re actually doing is committing them to a path that ends up with them being heavier than they started.

Sam:

For decades, our society has told us that we need to look a certain way, and if we don’t look that way, we have to restrict what we eat and ramp up the exercise. It’s a simple equation. You see calories in versus calories out. If it’s not in deficit, you’re eating too much. We’re told it’s that simple. To get in deficit, you just need to go on a diet.

Sam:

But if it’s so simple, why are obesity statistics continuing to rise, and rise quickly? It’s not like everyone hasn’t heard that message. It’s not a lack of education. It comes down to the simple fact that diets, as we know them, often don’t work. When it comes to eating disorders and body image issues, dieting is more likely to make the problem worse. That can cause life-threatening problems.

Fiona Willer:

Insufficient energy intakes and not eating enough to satisfy your body’s metabolic requirements can trigger eating disorder cognitions in otherwise well people. For some of those people, that will lead them down the rabbit hole of an eating disorder.

Sam:

Research tells us that when we go into a state of starvation, it can change your brain patterns and worsen a negative relationship with food.

Fiona:

My relationship professionally with eating disorders in my field really came about because of my lived experience, of somebody with an eating disorder. I’m Fiona Willer, I’m an advanced, accredited practicing dietician, and I’m also a Fellow of the Higher Education Academy. So, basically I’m a dietician who is an academic now, after years in private practice. I had quite a common experience of training to be a dietician many years ago now, as part of my search to help myself, but I ended up helping myself in a way that I did not expect when I enrolled.

Sam:

Fiona is one of the country’s leading dieticians. She has a long list of qualifications, including a Ph.D. in nutrition and dietetics. She’s a director on the Board of Dieticians, Australia.

Fiona:

When we look at long-term studies and we do weight loss trials in the long term—I’m talking two to five years plus—we then see the reality that actually sending somebody down the path of intentional weight loss, more often than not—and far more often than not—results in them ending up in that two to five-year timeframe being heavier than they were to start with, even when they started that weight loss plan.

Fiona:

When you prescribe weight loss to somebody, or when you suggest that weight loss might be a good thing for somebody to strive for, what you’re actually doing is committing them to a path that ends up with them being heavier than they started. Apart from these statistical outliers, who end up writing books about it.

Sam:

Traditionally, Australian society has been very unforgiving about obesity or being overweight. It’s been one of the few appearance-based traits that’s still fair game for ridicule or shaming anywhere from the playground to the workplace. Size discrimination is still rampant. It tends to be justified because they say being fat is bad for you, and by not accepting it, society’s encouraging affected people to do something about it. Why don’t we have a look at how that’s going for us?

Sam:

Data from the Australian Institute of Health and Welfare tells us that in 2018, 31% or roughly a third of Australian adults were considered obese. In 1995, it was 19% or just under a fifth. We’ve seen about a 34% increase in two decades. Surely that tells us that whatever approach we’re using collectively isn’t helping. Fortunately though, things are beginning to change. Fiona Willer is a strong advocate of the weight-neutral approach. I’ll explain what that is in more detail shortly. She’s not alone.

Shane:

Dieting in any form, from my perspective, is something that should definitely be avoided. My name’s Shane Jeffrey. I’m a dietician based in Brisbane with River Oak Health. We provide a private practice dedicated to the treatment of eating disorders; eating, weight, and body image concerns; and we also do quite a bit of work with disordered eating in athletes as well.

Sam:

Shane also advocates for what we call a weight-neutral approach. By weight-neutral, we’re not ignoring the health advice that being overweight or obese has health risks. If we go back to the data from the Institute of Health and Welfare, more than 8% of disease in Australia is attributable to an increased BMI. A weight-neutral approach doesn’t ignore these facts.

Sam:

It accepts them while also acknowledging that obsessing over weight rather than overall health usually makes the problem worse rather than better. Essentially, it incorporates human nature along with the cold, hard facts. When it comes to eating disorders and body image issues, weight-focused dieting is even more likely to exacerbate problems, and even lead to life-threatening ones.

Shane:

In the eating disorder world, it’s fairly commonly accepted that eating disorders, when you look at risk factors, dieting is definitely right up there. We know that dieting is a significant risk factor. Part of that is because most diets tend to structure food into this idea that there’s good and bad, or there’s healthy and unhealthy.

Shane:

So once a diet gets concocted in whatever form it may be, it usually gets accompanied by a lot of dietary rules that people then need to feel a compulsion to follow in order to follow the diet. Because if they don’t follow the diet, then that introduces a sense of guilt for a lot of people, negative feelings. So, the whole cycle tends to roll around.

Sam:

Does that mean that everybody who goes on a diet is at risk of developing an eating disorder? The short answer is “no”, but that doesn’t tell you the whole story.

Fiona:

There’s a whole heap of genetic factors that are rippling along underneath the surface of humans in terms of eating behavior. They’re not turned on to an eating disorder until there’s insufficient energy intake in the mix.

Sam:

Humans have evolved to deal with insufficient food by changing their behavior. This is why our brains work differently when we’re in starvation mode. For prehistoric humans, it might’ve worked really well, but in the Western world where food is rarely hard to come by, these inherited traits are the root cause of disordered eating patterns.

Fiona:

We’re not a simple calorimeter. A human body is actually quite complicated. People don’t recognize that when you don’t put sufficient energy in, the energy outside of it, the amount of energy that we need to fuel the body, reduces. It’s a very rational thing, the human body, because its whole existence is around surviving, right? If there’s not enough energy coming in, the body will assume that there isn’t enough energy available in the environment to eat.

Fiona:

Whether or not you’ve put yourself on the latest juice cleanse or whether there’s literally not enough food to go around in your family, either way, the body perceives that as a problematic situation. So it reduces the amount of energy it needs to continue to function. There’s risk of eating disorders developing as well, as we’re literally saying, “You need to do these disordered behaviors because we think that your weight’s more important than your mental health.”

Sam:

Yes.

Fiona:

It’s not really right.

Shreen El Masry:

My primary school teacher asked me, “You know, if you had a genie in a bottle, what would you wish for?” I’d wish to be skinny, because I believed as a little girl that being skinny would bring me all the things that I saw in the movies. Like career, friends, travel, a husband. Ironically, I had actually achieved all these things before I went on the diet that led me to an eating disorder, and I nearly lost all those things too as a result of my eating disorder. My name is Shreen El Masry, and I’m a body-inclusive personal trainer and certified intuitive eating counselor.

Sam:

Watching Shreen’s personal training sessions, the first thing you notice is that they’re fun. She’s more focused on personal wellbeing rather than weight loss, and her clients keep coming back because they enjoy themselves and they feel better.

Shreen:

90% of the women I work with, who’ve had really negative experiences with both gyms and personal trainers, either with personal trainers trying to weigh them or measure them, or force dieting on them when they don’t even want to lose weight, or just made them feel really bad about their body, or try to push unsustainable dieting on them.

Shreen:

Gyms are just not very accommodating. You walk into a gym and a lot of the marketing is always just thin, muscly, lean people. There’s no diversity, no body diversity. People want to see real people. They want to see real bodies and they’re intimidated by that environment, and they feel like they can’t go there.

Sam:

One of the unique things that Shreen brings to her work is her lived experience. She knows the importance of understanding, compassionate, professional care, which she says can help people avoid the traps associated with diets and dieting.

Shreen:

I was about 27 years old at the time. My counselor said to me, she said, “Oh, I’m going to section you under the Mental Health Act.” I was like, “Oh, you can’t do that.” she’s like, “Yes, I can.” I didn’t know that was a thing, so that was my turning point. I threw myself into recovery.

Shreen:

I just learned everything that I could about health and wellbeing. That’s where I discovered intuitive eating, and health at every size, and this whole non-diet community. When I got better, I just wanted to help. Help others who’d either been through something similar, or who just struggled a lot with dieting and body image.

Sam:

Quite a few of the people with the lived experience who we’ve spoken to on this podcast have related to my experience of the plate. In my mind, the plate is to the dietician as the stethoscope is to a doctor. The plate is an actual plate, but it’s much smaller than a regular dinner plate.

Sam:

It has lines drawn on it to show you the recommended portion sizes for all the various food groups in the meal that I’m supposed to be eating three times a day. The thing is, it always seems to be less than half the size of a meal that you’d get at a restaurant or a cafe, and it didn’t matter if I was training hard in sport or just working in an office job, I always needed to follow what was on the same-sized plate.

Fiona:

I apologize for my entire profession. I’m very sorry about that.

Sam:

The ideals that were put across was so very out of touch and so very unrealistic.

Fiona:

Yes. The intentions have always been good. I think I need to put that out there. No matter, unfortunately, how accidentally harmful things have ended up being, the intentions of dieticians have always been in the right place. It’s just that we-

Sam:

Yup.

Fiona:

… as a profession, in previous years certainly, have been from a quite narrow demographic of the community, so not really representative of the populations that we serve. That’s changing, which is great. I’m trying to encourage that as well.

Shane:

People often ask us, how much of this food should I be eating? Our first question or my first response back to them is often, “How much would you give another person?” The reason for this is because I think what happens is, a lot of people who diet, they sometimes carry two different frameworks around how eating is structured. So that there might be the eating that’s structured on their own belief systems and their intuitive eating. Then you’ve got eating which is constructed around dieting, which is usually constructed around rules.

Sam:

You’ve probably heard of intuitive eating before. It’s essentially the process of developing a healthy relationship with food. It’s a mindful approach that involves listening to our body, and becoming aware of the cues that it gives you. Unfortunately, for many reasons, intuitive eating isn’t something that comes intuitively. Most of us have to learn and practice before it becomes an instilled habit.

Shane:

One of the reasons we ask people, “What amount of food would you give another person,” is because we’re trying to get them to engage with that value as part of their approach to food. So we might have, I don’t know, say a mother who we’re seeing as a client, who might be feeding carbohydrates to her children on the premise that they need carbohydrates because they fuel the body, and they need them for energy and they’re growing.

Shane:

But she might avoid carbohydrates herself because she feels they’re bad or because she’s trying to lose weight. So, you end up with this dichotomy of belief systems. With that dichotomy, you then can start to open up a discussion around the discrepancies and where those ideas come from, and what approach would be more helpful moving forward in terms of the person’s good relationship or positive relationship with food.

Sam:

One of the things they are up against is this massive industry, which is so deeply ingrained in our society, that intentionally manipulates and trades on our psycho-emotional insecurities.

Patrick Boyle:

I feel like the vast majority of the, air quotes, ‘toxic diet culture’, end air quotes, is just built on shaming people through advertising and through really cooked imagery in the media. It’s just targeting people’s biggest fears and shames, and issues of self-esteem, in order to make money off us all hating ourselves.

Sam:

Patrick Boyle has a long-lived experience with eating disorders. It started, growing up, being taunted as the fat kid at school.

Patrick:

I was always a bigger kid throughout my whole primary school, high school life. Somewhere along the line, probably puberty-ish, it switched gears from seeming like a normal thing to being something to be shamed about, or to feel shame about. Yeah, and basically, I spent all my teenage years… most, if not all… either on a diet or being encouraged to diet and play sports more, despite the fact that sports made me feel bad about myself. I was always being made to feel as though not being active, and sporty, and thin, was a problem.

Sam:

As a young adult, Pat became obsessed with eating and exercise, and was diagnosed with an eating disorder, but it wasn’t until a serious cycling accident that he started to pull himself out of the obsessive cycle.

Patrick:

I got doored and broke my ankle. Just by way of spending a few months in bed and having a really great depressive episode for a year, I put on all this weight. Then had to reckon with this fact of, “Okay, you’ve spent the last 10, well, 15, 20 years, your whole life, you’ve linked yourself with your body. Let’s figure out how to lose the weight in a sustainable way, without it becoming a full-blown eating disorder again.”

Patrick:

The way I perceived my body, and my relationship to food and to fitness, was all totally wrong, and that not everyone feels this way about dieting, and punishing yourself, and food should be something you feel guilty about. That that wasn’t actually normal.

Sam:

Patrick says he’s now more interested in how exercise and food makes him feel, rather than what the scales say or what size of clothes he’s wearing, but is that approach the right one for everyone?

Shane:

There will certainly be health professionals out there who argue that weight loss is a reasonable goal to have, but my thoughts are that if you improve, if you look at the broader picture… and this is certainly our clinical experience, as well as being supported by some of the literature… is that if you support people to have a lifestyle where they’re moving in a way that they are able to sustain and enjoy, and you’ve got them in a place where they’ve got a more positive relationship with food, where they’re consuming food in a way that supports health, then that’s often enough for people. It’s just that people don’t really understand that’s an option for them, because it’s not often spoken about.

Shreen:

Everything that I do is from a place of nourishment and joy, rather than punishment. You move in a way that works for you. We have a lot of fun with movement, and it’s okay to take rest days or not to exercise if you don’t feel like it, and not do any exercise that you don’t like. It’s really about being in tune with your body and moving in a way that feels good to you.

Shreen:

Compared to maybe when you go to a gym or to a class, they might be shouting things at you, things about calories burned and fat blasting, and toning and things like that. None of that language is allowed in… or I would ever use myself. I have a strict “no” policy to talking about food or bodies in my classes as well.

Shane:

If weight is the primary target of intervention, that becomes your main measure. What weight is dependent on, in the broader sense of things, is intake and exercise. That’s the most common equation. The thing is, as people focus on weight, weight will move up and down. Nobody ever loses weight in a linear fashion, really.

Shane:

So, what happens is, as weight moves up and down, their intake and dieting becomes up and down as well. There’s no stability there, there’s no structure. So, the eating pattern can become quite chaotic. We often see that in people who diet, because they change their rating based on what their weight’s doing.

Fiona:

Laid among that is all of this social stuff, about the value of a smaller body related to a larger body size, and people trying to get ahead in their chosen career path. People do have this quite accurate, unfortunately, sense that, “If I look the part,” then I’ll get the job. The looking the part stuff is all societal prejudice. We’ve got a lot of that around appearance in general, and a lot of that around weight appearance.

Sam:

Before we wrap up this episode, I want to bring in one more guest, She was a little bit of a petrol head from a really young age. She got a taste for Formula One watching it with her dad, and eventually decided she wanted to work as an engineer on a Formula One team.

Kate Reid:

My name’s Kate Reid, I’m the founder and co-owner of Lune Croissanterie in Melbourne, Australia.

Sam:

That job title gives away the fact that the Formula One career didn’t work out quite as she hoped.

Kate:

I got there, and the perfect job that I dreamed about, the reality of it was nothing like that. I think I’d planned out my whole life. I wanted to be the first female technical director of a Formula One team. All of a sudden, I discovered that all these things, that I thought would make up the rest of my life, weren’t going to give me the fulfillment and satisfaction that I’d been looking for.

Kate:

It was a real shock to the system and it led, I’d say pretty quickly, towards depression. The depression eventually ended up leading to my diagnosis of anorexia. Rather than being able to control those elements of pushing myself forward with my career, I’ve just subconsciously turned this need for control to other things, which led to the anorexia.

Sam:

After five years of therapy, working towards recovery with a team of professionals, Kate found herself on a very regimented diet, which she obsessed over. But once she found a job that she was actually passionate about, life became more about enjoyment. She was able to ditch the diet and in time, ditch the eating disorder.

Kate:

I’d given up my engineering career. I didn’t want to have a part of it. I was not interested anymore. I was starting to feel my way around this real passion and interest for patisserie, but I wasn’t there yet either. Therefore, I had long days ahead of me where the thing that gave me structure around my day was this very prescriptive diet that my dietician had written for me.

Kate:

Then when I started to progress more with Lune and build this business, and suddenly I had this thing on my hands that I discovered that I loved and I was passionate about, and I was excited and I saw a future for it, and it started to consume those long hours in my day, running my business rather than worrying about following my prescriptive diet.

Kate:

As soon as my day wasn’t structured by the meals that I had to eat, and it was structured by the jobs that I had to do and the recipe testing, and going out and finding new customers, and doing my branding and my accounting, and everything, as soon as my mind was filled with all these other jobs that my business needed to move me on, suddenly my brain didn’t have room to think about this really prescriptive diet.

Sam:

How does Kate’s story fit in with this episode? She’s someone who was able to switch from living a life obsessed with what food she was going to eat and focus more on what makes her feel good. It’s easier said than done, but thanks to people like Shane and Fiona, help is out there.

Fiona:

There are a whole heap of health providers that can support people to transition from a weight-centric mindset to a body-positive mindset, so that if people are interested in accessing that, HAES Australia has a registry that has a whole heap of different types of health providers on there that can support you in this way.

Sam:

That’s HAES spelled H-A-E-S or Health at Any Size. We have a diet industry that’s bombarding us with unhealthy ideals, and it’s backed up by deeply entrenched cultural expectations. At this time of year, a lot of Australians are struggling with the diet that so many of us religiously started as a New Year’s resolution. We also know that most diets have failed by February. It can also be a very difficult time for people in the LGBTIQ-plus community.

Patrick:

Mardi Gras’s coming up soon. That’s a perfect example of the normalization of body shame and toxic diet culture in the gay male part of the community. Even in October of last year, you can hear people starting to talk about their Mardi Gras diets. It’s January now while we’re recording, and people are literally posting this stuff online to their friends about getting cut for Mardi Gras, as in getting your muscles and getting shredded for Mardi Gras. “Can’t eat till Mardi Gras.” The fitness part of my life is about mental health. It’s not punishment. It’s not related to dieting.

Sam:

Yeah.

Patrick:

It’s just a thing that I do to feel good.

Sam:

If you’ve found yourself in a point where you’re struggling with food, and you think you might need a little bit of support, the best place to start is Butterfly. There’s the National Helpline. The phone number is 1800-33-4673. Easy way to remember that, 1800-ED-HOPE. If you don’t like talking on the phone, that’s fine. They get that as well. You can chat online at butterfly.org.au. The new chatbot kit is available online 24/7.

Sam:

While you’re on that website, you can check out all the recovery resources that they have, including some really useful tip sheets. All of these services are 100% free and 100% confidential. The Butterfly Podcast is an Ikin Media Production for Butterfly Foundation. I’m Sam, I host, write, and produce it with the assistance of Camilla Becket and Belinda Kerslake.

Sam:

The theme music is from Cody Martin with additional music from Brakemaster Cylinder. Special thanks to our guests, Shane Jeffrey, Fiona Willer, Shreen El Masry, Patrick Boyle, and Kate Reid. If you’d like to support the Butterfly Podcast, the best thing you can do is share it with someone who you think is going to get value from it. It’s available wherever you get podcasts.