• Dr Carine El Khazen

The Risks of Dieting and Eating Disorders | Carine El Khazen

Clinical psychologist Carine el Khazen (DESS, DEA), specialized in the treatment of eating disorders and obesity, shares insight into the struggles that accompany eating disorders, offering some tips for both preemption and recovery.


Eating disorders kill. In fact they are the deadliest of all mental health disorders: five to 20% of eating disorder sufferers will die from it. The causes of eating disorders are numerous and are usually an interplay of several factors including biological vulnerability, psychological traits and cultural and social pressures that usually act as triggers. Among those triggers, dieting is the number one risk factor for developing an eating disorder. All eating disorders start with a diet and 35% of normal dieters will develop an eating disorder.


I am a clinical psychologist and I specialize in the treatment of Eating Disorders. Every day, patients come to see me because they want to treat “their emotional eating.” Every single one of them is convinced that they are binge eating because “of emotional problems.” Yes, perhaps it is the case, but it’s not only—, and surely not primarily an emotional eating problem. The first reason for binge eating is dieting (food restriction). It is your body’s physiological reaction to hunger (low blood sugar) that will trigger (for survival purposes) a hormone (NPY) that will make you go look for food (cravings). It is also the psychological deprivation caused by dieting (food rules, food labelling: “good/bad”) that causes you to crave all the “bad food” you are not allowed to eat, food that you might not even like. It is how the human body/mind works.


Look at the healthy, non-eating disordered young males that the American physiologist Dr. Ancel Keys recruited for his starvation experiment in the 1940s. They were put on a supervised 1600 kcal/day diet, when a weight loss diet is usually around 1200 calories/day! It is called the starvation experiment (n.b. we talk about starvation when our bodies are receiving LESS than their daily requirements). Starvation developed as soon as the food restriction started, instigating intense food cravings, food obsessions, body image problems and long lasting binge-eating and excessive rebound weight-gain (exceeding their initial intake weight).

So, before blaming the emotional reasons that cause us to binge eat, we should stop for a second and consider the role of our weight loss attempts in our binge-eating problems. I often tell my patients: “You are gaining (or not losing) weight because you are binging, and you are binging because you are trying to lose weight. In order to achieve the desired weight loss, you need to stop binging and in order to stop binging, you need to stop your weight loss attempts.”


Psychotherapy can help you implement nutritional rehabilitation, but there is no emotional strategy that can work on your binges if you are starved. Only after you are well fed can you start with psychotherapy that will tackle the emotional reasons underlying your eating disorder. With around 20% of my patients suffering from binge eating, the nutritional rehabilitation is enough to stop the binging. With ninety percent of them, it is enough to reverse all the adverse psychological symptoms (depression, anxiety, cognitive disturbance) due to dieting and chaotic food intake without any other intervention. Food is medicine and sometimes the only one you need. The best way to fight your eating disorder is to pick up your fork and structure your meal plan and never let yourself get hungry: structured, prescribed, mechanical, regular meals and snacks whether you’re hungry or not, whether you have time or not.


And the best way to prevent an eating disorder (anyone) is to never diet and to work on implementing a sustainable enjoyable lifestyle aimed at health, rather than weight loss. Weight stabilisation will be a natural consequence of this recourse. For food: follow most of the time the 80-20% ratio (i.e. 80% nutrient-dense food, 20% play/fun food). Enjoy your food and think of it as the fuel your body needs to function. Eat slowly, mindfully and intuitively (—but not if you are already struggling with an eating disorder). Move regularly.


Just take the time to re-examine your current strategies (dieting) and see that not only are they not working but they are most importantly destroying you. And understand that it is truly “insanity” to repeat the same behaviours and expect different outcomes. Diets don’t work. It’s time to try something different: a normalised relationship with food. If you understand that, then yes: It Gets Brighter!


Carine el Khazen (DESS, DEA) is a clinical psychologist specialized in the treatment of eating disorders and obesity. She has worked in the UK (Institute of Psychiatry-The Maudsley Hospital), France (Sainte-Anne Hospital, Paris), Lebanon (St Georges University Hospital), and most recently Dubai (General Medical Center) since 2004. Carine is also the Chief Operations Officer and UAE head representative of the Middle East Eating Disorders Association (MEEDA), the first non-profit organization dedicated to raising awareness, providing support and offering guidance to those suffering from eating disorders.