Dieting and the development of eating disorders in obese women: results of a randomized controlled trial.
BACKGROUND
Some investigators fear that dieting may precipitate binge eating and other adverse behavioral consequences.


OBJECTIVE
The objective of the study was to examine whether dieting would elicit binge eating and mood disturbance in individuals free of these complications before treatment.


METHODS
A total of 123 obese women were randomly assigned to 1) a 1000 kcal/d diet that included 4 servings/d of a liquid meal replacement (MR); 2) a 1200-1500 kcal/d balanced deficit diet (BDD) of conventional foods; or 3) a nondieting (ND) approach that discouraged energy restriction. All women attended weekly group sessions for 20 wk and biweekly sessions from week 20 to week 40.


RESULTS
At week 20, participants in the MR, BDD, and ND groups lost 12.1 +/- 6.7%, 7.8 +/- 6.0%, and 0.1 +/- 2.4% of initial weight, respectively (P < 0.001). During the first 20 wk, there were no significant differences among groups in the number of persons who had objective binge episodes or in reports of hunger or dietary disinhibition. Symptoms of depression decreased significantly more (P < 0.001) in the MR and BDD groups than in ND participants. At week 28, significantly more (P < 0.003) cases of binge eating were observed in MR participants than in the 2 other groups. No differences, however, were observed between groups at weeks 40 or 65 (a follow-up visit). At no time did any participant meet criteria for binge-eating disorder.


CONCLUSIONS
Concerns about possible adverse behavioral consequences of dieting should not dissuade primary care providers from recommending modest energy restriction to obese individuals.
Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA. wadden@mail.med.upenn.edu
Thomas A
TA
Wadden
Gary D
GD
Foster
David B
DB
Sarwer
Drew A
DA
Anderson
Madeline
M
Gladis
Rebecca S
RS
Sanderson
R V
RV
Letchak
Robert I
RI
Berkowitz
Suzanne
S
Phelan
D000328:Adult; D000704:Analysis of Variance; D001828:Body Image; D002032:Bulimia / Q000209:etiology* / Q000523:psychology*; D004038:Diet, Reducing / Q000009:adverse effects* / Q000523:psychology*; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy* / Q000523:psychology; D011446:Prospective Studies; D012649:Self Concept; D013997:Time Factors; D015431:Weight Loss