Dismantling the myth of "all foods fit" in eating disorder treatment.

Brewerton TD, Dennis K, Wiss DA. (2024) 12(1) May 17:60. doi: 10.1186/s40337-024-01017-9.

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Abstract:

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment.

Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients.

We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including
(1) food allergies, sensitivities, and intolerances,
(2) religious and spiritual preferences or doctrines, and
(3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality.

This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

FAB RESEARCH COMMENT:

Written by a dietitian experienced in both research and clinical practice in the field of eating disorders, and who also has expertise on the links between food and addictive behaviours - this article provides a clear and compelling argument for the need to abandon the dogma that 'all foods fit' in the management of these varied and complex conditions.

The links between food and behaviour work both ways - and yet all too often, theory and practice in the management of eating disorders has ignored the fundamental biochemical impact of food and nutrition on brain health, and therefore mood, cognition and behaviour.

As well as calling for the integration of findings from nutritional neuroscience and psychiatry - which increasingly point to ultra-processed foods as a major driver of disordered eating behaviours - the author also flags the clear need for clinicians to recognise and cater for individual differences, which again require a more flexible and pragmatic approach.

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