Running head: DIETARY RESTRICTION IN BINGE EATING 1

The Role of Dietary Restriction in Binge Eating

Student: Sofie Widdershoven (i6215632)

Tutor: Jolien Pieters-Spijkerman

IPN/PSY 2144

Word count: 2208

Assignment due date: 17.5.2021

Maastricht University
DIETARY RESTRICTION IN BINGE EATING 2

Abstract

Binge eating is a very common criterium in different eating disorders. A generally accepted

explanation for binge eating is that it follows from dietary restraint. However, there is a

substantial amount of evidence that contradicts this explanation. This paper contains the

different studies, theories and views on the role of dietary restraint in binge eating. There is

no main conclusion that can be drawn from the literature, but recommendations for future

research are given.

DIETARY RESTRICTION IN BINGE EATING 3

The Role of Dietary Restriction in Binge Eating

Eating disorders are very severe, often chronic mental disorders with high suicide and

mortality risks (Janssen, 2016). The 12-month prevalence of binge-eating disorder in adults in

the united states is 1,6% for women and 0,8% for men. For Anorexia Nervosa the 12-month

prevalence is about 0,4% in young women and for Bulima Nervosa the prevalence is 1% -

1,5% in young women. The prevalence of Anorexia Nervosa and Bulimia Nervosa is higher

in women compared to men with a ratio of (10:1) (American Psychiatric Association, 2013).

Anorexia Nervosa, Bulimia Nervosa and binge-eating disorder are usually seen as separate

disorders. However, most individuals who initially meet the criteria for one of these disorders

seem to migrate between these disorders. As a matter of fact, many individuals meet some

criteria of multiple eating disorders, without meeting the full criteria of one eating disorder.

In this case these individuals may be diagnosed with other specified feeding or eating

disorder (Nolen-Hoeksema, 2020).

Only a minority of individuals diagnosed with an eating disorder succeeds in

restricting their food intake permanently. These are the anorexia nervosa patients of the

restricting subtype (Jansen, 2016). For other individuals diagnosed with an eating disorder

(anorexia nervosa binge eating/purging type, bulimia nervosa and binge eating disorder)

binge eating is an important criterium. Why do individuals who want to restrict their food

intake to lose weight, often struggle with binge eating episodes? To answer this question, we

need to understand the underlying mechanisms of binge eating (Janssen, 2016). The World

Health Organization (WHO) defines an episode of binge eating as eating, in a discrete period

of time, an amount of food that is definitely larger than most individuals would eat in a

similar period of time under similar circumstances. The excessive food intake must be

accompanied by a sense of lack of control to call it binge eating. The lack of control can be

indicated by the inability to stop while eating or to restrain eating (American Psychiatric
DIETARY RESTRICTION IN BINGE EATING 4

Association, 2013). Some individuals report that there is no longer an acute feeling of loss of

control but rather a more generalized pattern of uncontrolled eating when they experience

binge-eating episodes. The binge-eating episodes can also be planned in some cases

(American Psychiatric Association, 2013). The type of food consumed during the episodes

varies both across individuals and for a given individual. Binge eating is more about

excessiveness in the amount of food instead of a craving for specific food (American

Psychiatric Association, 2013; World Health Organization, 2019).

There is a considerable amount of evidence which suggests a causal role of dietary

restriction1 in binge eating (Janssen, 2016; Howard & Porzelius, 1999). However, the

different studies on the role of dietary restriction in binge eating show some contradictory

results. This can be quite confusing. This paper serves to clarify the different viewpoints and

to organise the research that is already done. The different theories and viewpoints on the role

of dietary restriction in binge-eating will be discussed in this paper. First, the restraint theory

explains restraint as a critical determent in binge-eating behaviour. Following this theory,

restrained eaters2 are more prone to binge-eating than unrestrained eaters (Howard &

Porzelius, 1999). Second, the three factor model is a more complex model discussing three

critical factors in binge-eating behaviour (Howard & Porzelius, 1999). These critical factors

are: the frequency of dieting and overeating in the past, current dieting and weight

suppression. Third, a more recent view contradicts the restraint theory and the three-factor

model. The aim of this paper is to answer the following question. What is the role of dietary

restriction in binge-eating episodes as part of an eating disorder?

1
The deliberate restriction of food intake
2
People who restrict their food intake
DIETARY RESTRICTION IN BINGE EATING 5

Restraint theory

The restraint theory provides an explanation for the overeating behaviour of many obese

individuals (Howard & Porzelius, 1999). Nisbett (1972) argued that there is a preconditioned

or genetic set point which is defined as a specific point/weight that is physiologically

acceptable for someone. This set point was thought to be higher in obese individuals.

Following this reasoning, it is harder for an obese individual to reach a certain weight which

he or she thinks is acceptable than it is for normal weight individuals. Obese individuals

losing weight struggle between the physiological tendency to eat and the psychological

restraint to these tendencies. In this context restraint is defined as a process of self-imposed

food deprivation used to achieve a weight below one’s physiological set point (Howard &

Porzelius, 1999).

Herman and Mack (1975) included normal weight individuals following a diet into this

theory. Their hypothesis was that individuals following a diet have similar eating patterns in

comparison to obese individuals who want to lose weight and thus fight against a

physiological set point. In their study they asked their participants to rate different flavours of

milkshake in two separate conditions. In one condition they gave their participants a

milkshake before the flavour test and in the other condition there was no preceding

milkshake. The result of this study was that both normal weight individuals and obese

individuals ate more after breaking their diet than they would in a situation where they didn’t

have to break their diet (Herman & Mack, 1975). Herman & Mack concluded that restraint is

the critical determent in eating behaviour instead of obesity. This means that the restraint

theory not only applies to obese individuals, but also to normal weight individuals. They

suggest that the self-imposed restraint against food will go away when high restraint eaters

break their diet.

DIETARY RESTRICTION IN BINGE EATING 6

The restraint theory has been used to explain binge eating in normal weight individuals

diagnosed with Bulimia Nervosa, as similarities were seen between the overeating behaviour

of restrained eaters and binge eating in Bulimia Nervosa. This theory may also apply to binge

eating behaviour in binge eating disorder (Howard & Porzelius, 1999).

Three-factor model

Dieting and dietary restraint might seem equivalent, although some studies question the

similarity between these terms (Lowe et al., 1991). The hypothesis of Lowe et al. (1991) was

that dieting and dietary restraint are separate, independent variables. They found that there is

a difference between restrained eaters currently dieting and those who are not currently

dieting (Lowe, 1991). As the name suggests, there are three factors in this theory. The first

factor is the frequency of dieting and overeating in the past. The second factor is current

dieting which refers to the constant effort to restrict the intake of food. Lastly, the third factor

includes weight suppression.

The first factor contributes to future binge-eating episodes in two ways. Dietary

restraint in combination with binge-eating episodes in the past can impair someone’s sense of

hunger and satiety. Furthermore, unsuccessful attempts of dieting in the past can lower

someone’s self-esteem. Both are predictors of future binge-eating episodes. The second

factor, current dieting, contributes to future binge-eating episodes in a different way.

Someone who is currently dieting is consciously restricting his or her food intake and eating

less than he or she needs. Negative affect (e.g. Disappointment) or low arousal (e.g.

Boredom) makes it difficult for current dieters to ignore the urge to eat. Binge-eating

episodes often occur in these circumstances (Howard & Porzelius, 1999). The third factor is

weight suppression. Weight suppression refers to individuals who maintained their successful

weight loss for a period of at least 1 year. This factor won’t be discussed in detail as it is not

directly relevant to the research question.

DIETARY RESTRICTION IN BINGE EATING 7

There is one main difference between the restraint theory and the three-factor model.

The restraint theory doesn’t distinguish between current dieting and past dieting history,

while the three-factor model does make this distinction (Howard & Porzelius, 1999). The

three-factor model can be seen as a different way of conceptualizing dieting and dietary

restraint, which is more useful in explaining current eating behaviour. The three-factor model

is also slightly more recent than the restraint theory. However, that doesn’t make the three-

factor model a better explainer than the restraint theory (Howard & Porzelius, 1999).

According to Howard and Porzelius (1999), both of these models can be used to explain the

onset of binge-eating episodes and even eating disorders.

Dietary restraint in bulimia nervosa

As said earlier in this paper, the three-factor model and the restraint theory can be used to

explain the onset of eating disorders (Howard & Porzelius, 1999). There is a substantial

amount of evidence suggesting that dietary restraint can cause binge eating problems in

individuals with bulimia nervosa. Johnson et al. (1983, 1986) found a higher score on

measures of dietary restraint in normal-weight females diagnosed with bulimia nervosa

compared to individuals not diagnosed with this disorder. Moreover, other studies found a

strong positive correlation between the level of dietary restraint and the severity of binge

eating in individuals with bulimia nervosa (Leon et al., 1993; Ruderman, 1985). There is also

some contradictory evidence. Mussell et al. (1997) found that many individuals with bulimia

nervosa reported binge eating before a period of dietary restraint. They concluded that dietary

restraint can be a risk factor, but it is not per definition the cause of binge eating. The findings

of Mussell et al. (1997) were the first to question the causal role of dietary restraint in binge

eating supported by the restraint theory and the three factor model. This contradictory

viewpoint is expanded in more recent studies (e.g. Jansen, 2016). These recent studies will be

discussed in the following section.

DIETARY RESTRICTION IN BINGE EATING 8

Recent view

It is generally accepted that dietary restraint causes binge eating and even eating

disorders (Howard, 1999; Polivy&Herman, 2002; Jansen, 2016). In contrast to other

researchers, Jansen (2016) argues that there are a couple of things wrong with this

explanation. First, dietary restraint was never the manipulated variable in the experiments that

lead to this conclusion (Jansen, 2016). It cannot be concluded that dietary restraint causes

binge eating as long as dietary restraint is not the manipulated variable (e.g. the milkshake

experiment by Herman and Mack) (Jansen, 2016). Second, the self-report scales used to

select restrained eaters were no pure and valid measures of actual food restriction. These self-

report scales appeared to be cognitively biased (Jansen, 2016).

Recent studies did manipulate dietary restraint and tested whether calorie restriction

causes binge eating (Jansen, 2016). A study conducted by Anton et al. (2009) tested the effect

of 6-months of caloric restriction on appetite in healthy overweight men and women. The

results of this study showed no increase in appetite during caloric restriction in comparison

with a control group. Some studies even showed an increase in eating control and a reduction

of appetite after a period of calorie restriction (Redman et al., 2008; Williamson et al., 2008).

In all of these studies there were no signs of eating disorder symptoms (Jansen, 2016).

Jansen (2016) argues that well controlled experiments and clinical interventions lead

to the conclusion that dietary restraint does not naturally cause binge eating or other eating

disorder symptoms. The studies indicating a causal relationship between dietary restraint and

binge eating were retrospective or correlational (Jansen, 2016). Jansen (2016) suggests

another explanation for the association between dietary restraint and binge eating. This

explanation refers to dieting as a result of binge eating instead of the other way around. This

explanation was further supported by Jansen et al. (2003) and Lowe (1993). These studies

concluded that the intentions to restrict food intake follow from binge eating.
DIETARY RESTRICTION IN BINGE EATING 9

Conclusion & discussion

For a long period of time researchers generally accepted the idea that binge eating

followed from dietary restriction. The older studies discussed in this paper relied on the

restraint theory and the three-factor model which are both based on this idea. Conversely,

Mussell et al. (1997) was the first researcher that questioned the causal role of dietary

restriction in binge eating. He qualified dietary restraint as a risk factor of binge eating. In

later research this idea expanded. The aim of this paper is to give an answer to the question:

What is the role of dietary restriction in binge-eating episodes as part of an eating disorder?

Considering all of this evidence, it seems that we cannot give a main conclusion.

There are a few limitations in this paper that need to be addressed. First, there

is no concrete answer to the research question. It is not entirely clear which role dietary

restraint plays in binge eating, although there are ideas which can be used for future research.

Second, some of the references used in this paper are dated. Therefore, the models and

theories discussed in this paper may be superseded.

As mentioned earlier, there is no main conclusion in this paper. However, the more

recent studies were well-controlled experimental studies, while the older studies were mostly

retrospective or correlational (Jansen, 2016). Therefore, it seems plausible to believe that

dietary restraint does not necessarily cause binge eating episodes, but there needs to be more

evidence to conclude this. There is also another explanation which seems plausible for the

role of dietary restriction in binge eating. This other explanation is that binge-eating causes

dietary restraint instead of the other way around (Jansen, 2016). There are 2 studies that

supports this hypothesis, but there has to be more evidence. These are both ideas for future

research.
DIETARY RESTRICTION IN BINGE EATING 10

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