Intermittent fasting: The impact on relationship with food

Intermittent fasting is a hugely popular practice again. Its benefits are celebrated widely on many a credible health podcast and it consistently trends on social media, described as an elixir to youth and offering benefits such as improved memory, heart health, fat loss, and autophagy.

What is intermittent fasting?

Intermittent fasting (IF) involves eating during specific time windows and there are various ways to practice this. The less intense approach involves a 12-hour fast and 12-hour eating window, whereas, more hardened fasters might restrict their eating to only eight, six or even four hours.

You may also have heard of the 5:2 diet, where fasters eat ‘normally’ for five days of the week while fasting on the remaining two (limiting calories to less than 800 on the fasting days).

In my eating disorder practice, I find increasing numbers of clients practising IF. Clients generally approach this with noble intentions, with goals of improving health and well-being. But for anyone with a sniff of disordered eating or eating disorder history, it can be an extremely slippery road to relapse.

I’m not just expressing concerns about the emaciated stereotype (anorexia nervosa sufferer) of eating disorders. Most people who practice IF will outwardly look ‘healthy’ and ‘normal’. Symptoms are often masked as the client is not underweight and their public eating is a perfect display of optimal health and well-being. Whereas, behind closed doors, bulimia and binge eating may run rampant, with understandable deep shame and isolation.

Clients will often describe a honeymoon period of fasting (as is often seen with many a conventional diet) where it felt that the ‘answer’ to eating difficulties had been discovered. However, weeks or months into fasting practices, old unhealthy patterns emerge such as extreme food restriction, binge eating, compulsive exercise and food preoccupation.

A recent study by Ganson and colleagues analysed data from nearly 3,000 young people between the ages of 16 and 30 years old. 47.7% of women, 38.4% of men and 52% of transgender/gender nonconforming participants had engaged in IF in the past 12 months. The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess eating disorder behaviours such as overeating, binge eating, purging and compulsive over-exercise. A higher EDE-Q score indicates greater levels of disordered eating behaviours.

In the study findings, engaging in IF in the past 12 months was associated with an increase in all eating disorder behaviours across all groups. Behaviours such as binge eating, purging, over-exercise and fasting were seen in women. Compulsive exercise and fasting were seen in men and fasting/restrictive eating in transgender/non-conforming people. All three groups showed higher EDE-Q scores.

As much as IF is glamorised and pedestaled as a practice of wellness and self-care, it is certainly not beneficial to all. IF does not consider the relationship with food and the deeper psychology of why people might restrict, or binge eat. Eating disorders/disordered eating are symptoms of underlying psychological distress. A focus on food and the body can bring safety, a sense of control, a numbing of feelings and/or a glimmer of self-worth when self-esteem is on the floor. IF can become a socially acceptable way to mask this.

So take care before you embark on an IF journey. It is not for everyone and that’s OK. Although it is highly regarded and talked about in exemplary ways, for many it is a catalyst back into disordered eating practices and a seductive fix to issues that ultimately merit a psychological approach.