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Thread: The Western diet: a blind spot of eating disorder research?a narrative review

  1. #1

    Default The Western diet: a blind spot of eating disorder research?a narrative review

    The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research
    The full text of the paper downloads from the above link. The lead author is a Consultant Psychiatrist working for the NHS in Oxford specialising in eating disorders.

    Table 3 Summary and implications for treatment and future research
    1. Eating disorder presentations and prevalence have increased over the last 50 years in parallel with the obesity epidemic.
    2. The introduction of NOVA-4 ultra-processed foods containing combinations of high-sugar, high-fat and additives not found in nature have transformed food consumption, initially in Western countries and spreading worldwide, gradually replacing natural foods.
    3. Ultra-processed foods have been shown in both animal and human experiments to promote overeating, obesity, insulin resistance, and metabolic disorders.
    4. The obesogenic environment has resulted in widespread dieting, which is a well-known risk factor for eating disorders.
    5. Many features of eating disorders, such as fat phobia, calorie counting, dieting, and exercise, are constantly reinforced not just by the food and weight-loss industries, but also by dietary guidelines, which encourage such reinforcement.
    6. The multiple complex metabolic responses to ultra-processed foods are likely to contribute to abnormal eating and the development of eating disorders.
    7. The high rate of comorbidity between diabetes and eating disorders suggests shared underlying pathomechanisms relating to impaired carbohydrate metabolism and insulin regulation.
    8. High-carbohydrate and processed foods override the brain satiety mechanisms and are, therefore, unlikely to be helpful for patients with tendencies to binge, regardless of the diagnostic categories.
    9. Existing treatment models recommend following current dietary guidelines, which continue to advocate low-fat and ultra-processed foods. Considering the effects of these foods on the individual patient would improve engagement and outcomes.
    10. Recent research shows that there is wide variation in blood glucose response in the population and that exploration of individual glucose response to food with CGM may be helpful as a psychoeducational tool.
    11. There have been no studies exploring the effects of different dietary approaches in the treatment of eating disorders: these are long overdue.
    12. An HFLC diet may be beneficial for patients with various eating disorders, particularly for patients with BN and BED and comorbid diabetes. It could improve satiety, metabolic health and body composition, and blood glucose levels. Such a diet may also be beneficial for careful refeeding programs for patients with AN and lead to a reduction of refeeding complications.

    Abbreviations: AN, anorexia nervosa; BED, binge eating disorder; BN, bulimia nervosa; CGM, continuous glucose monitoring; HFLC, high-fat, low-carbohydrate
    Pubmed search for Agnes Ayton Always interesting to see the background of a researchers other work. She seems to be working hard to make changes in NHS policy regarding eating disorders.

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    Interesting paper Ted. Thanks.
    Gilli - DLTBGYD but more importantly KCHO

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    Should obesity be recognised as a disease? Rapid Response: Re: Should obesity be recognised as a disease? 07 August 2019 Agnes Ayton
    Found this rapid response from Agnes Ayton to a BMJ article. The numbers refer to the papers she cites that are listed at the above link.
    Obesity rates are unprecedented in human history and should be regarded as a public health emergency.

    The obesity epidemic started in the 1970s, initially in the US and subsequently spreading worldwide.1 Approximately 60-80% of adults, and 20-30% children in most Western countries are now overweight or obese, which is unprecedented in human history.2-4 Should this change be regarded as a consequence of individual choices (on a mass scale) or a disease affecting the population, and a public health emergency?

    Obesity is not just a cosmetic or lifestyle problem. In parallel to the obesity epidemic, we have seen an increase of metabolic diseases, such as diabetes, non alcoholic fatty liver disease, not just in adults, but also in children.5 Currently, the global prevalence of diabetes is 8.8% and pre-diabetes is much higher.6 Additional physical complications include osteoarthritis, cardiovascular disease and several cancers.7 Furthermore, the prevalence rate of eating disorders has also been increasing, and is now the highest among those with class III obesity.8 9 A recent population-based Australian study examined the trends from 1995 to 2015 and found significant increases in the prevalence of both obesity (19 to 33%) and binge eating (3 to 11%). The highest increases were in the prevalence of obesity with comorbid binge eating (7.3-fold), or obesity with comorbid very strict dieting/fasting (11.5-fold) 10

    Despite intensive research, the causes of the obesity epidemic remain much debated.3 11 The prevailing view has been that this is a question of energy imbalance between input and expenditure. Whilst this may be true in principle, the calorie in and out hypothesis does not explain the reasons for the overconsumption that affects approximately 80% of the population.

    The biological and metabolic effects of modern foods have been studied using the ‘cafeteria diet’ model in animals, in which researchers replace standard chow with human cafeteria foods: cookies, cereals, cheese, processed meats, crackers, all high in sugars, vegetable oils and additives. Animals fed on these foods exhibit voluntary hyperphagia, which results in dramatic weight gain. Furthermore, cafeteria diet feeding promotes a prediabetic condition with elevated glucose, insulin, and nonesterified fatty acids, accompanied by decreased insulin tolerance. In addition, chronically inflamed liver and adipose tissues and distorted pancreatic islet architecture develop. 12 13 Furthermore, the cafeteria diet has a profound impact on the gut microbiome, which, may be driving important features of metabolic syndrome14 by influencing host metabolism and can also affect brain function and behaviour through the microbiota-gut-brain axis.15 16

    These experimental data mirror the human experience: since the introduction of ultra-processed foods, the majority of the population overeat. Furthermore, the same increase of low grade inflammation is seen in human metabolic disorders, and binge eating disorder.17

    A recent, carefully controlled human trial confirmed that participants consumed 500kcal/day in excess when they were placed on an ad libitum, ultra-processed diet, as compared with a minimally processed one, with profound changes in metabolic parameters.18 The appetite-suppressing hormone peptide tyrosine tyrosine (PYY) increased during the unprocessed diet as compared with both the ultra-processed diet and baseline. In contrast, the hunger hormone ghrelin, fasting glucose and insulin levels were increased during the ultra-processed diet. This is a groundbreaking randomised controlled trial, demonstrating that ultra-processed foods lead to overeating in humans through altering multiple endocrine pathways.

    The decades of guidelines promoting reduced calorie intake and increased exercise have been ineffective in halting the obesity epidemic,19 despite this message being amplified by the diet and weight loss industries. The ‘eat less and exercise more’ message may have also contributed to the increasing rates of eating disorders, which affect now 4-6% of the population. A recent large study showed since the 1980s BMI has increased for both genetically predisposed and non-predisposed people, confirming that the environment remains the main contributor to the obesity epidemic.11

    Recognising obesity as a disease can transform public health policies, and clean up the food environment, which is harming the health of millions of people, and it can be cost effective for the economy by reducing health care costs.

  4. #4
    Super Member roseymary's Avatar
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    May 2014
    Melbourne Australia


    Thanks for the short versions Ted, IMHO obesity is a disease of addiction, alcoholism for years was not recognised as a disease but people being week willed. To me there are so many parallels between overeating processed foods and alcoholism that it's extraordinary so few doctors/researchers have recognised it. Dr Robert Cywes being the only one I can think off.
    One is too many a thousand not enough.


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