You are not a before picture

I was incredibly privileged to have contributed to the Sunday Times bestseller You Are Not a Before Picture, which was released in June. It was written by a patient of mine, Alex Light, who describes her journey of recovery from a long-standing eating disorder, and how she improved her relationship with food and her body and found true food freedom as a result. The book is an inspirational guide to help tackle diet culture, find self-acceptance and make peace with one's body.

Hundreds of patients have walked through my clinic door with a diagnosed eating disorder that was triggered by a history of dieting. So I wanted to write about the importance of ditching diets, because this is fundamental in improving one's relationship with food.

Why diets don't work

Most diets are attractive because they promise rapid and dramatic weight loss. Typically, when one starts a diet one sees changes right away, especially if carbohydrates are reduced or cut out, which forces the body to use up its stored fuel (known as glycogen). Much of that early change is water, not fat.

To create the energy deficit diets rely on, they often forbid certain foods or even whole food groups, or replace actual food with unsatisfying shakes.

When the human body is deprived of energy, it ramps up hunger hormones in an effort to get the fuel it needs to function, making it difficult to stick to the diet. One also feels deprived psychologically of one's usual tasty and satisfying meals. Over time, this physiological and psychological deprivation inevitably leads to someone 'falling off the wagon', and to abandoning the diet altogether. So fad diets can lead to short-term change, but the problem is that they are not sustainable in the long term.

When one does 'fall off the wagon', the floodgates of previously forbidden food open. Hundreds of patients in my private practice have told me they had their first binge after dieting. Most dieters regain what they lost. This isn't because dieters aren't trying hard enough; the problem is that diets don't work. What this suggests is that people need a more sustainable plan than simply going on a diet.

If one eats too little for a sustained period of time, the body adapts by slowing down its metabolism, which is simply a physiological response to starvation. People can then panic and believe they need to eat even less, depriving themselves of nutrients and putting themselves at risk of all sorts of health problems, like fatigue, light-headedness, poor concentration, hair loss, weakened bones, loss of periods, reduced fertility and mood fluctuations. I have seen hundreds of patients where a history of dieting has led to a full-blown eating disorder, and the diet has contributed not only to a fear of foods but also to physical and mental health problems.

From a psychological perspective, diets promise control in an out-of-control world, and they make decisions for someone who is overwhelmed by decisions. They provide the illusion that there are simple answers to complicated problems. The language of dieting uses words like 'cheat' and 'guilt', which reinforces the narrow thinking an individual may already have developed.

Diets have an extremely low success rate, yet advertisements for diets promise quick fixes and magic results, and when they fail the consumer is blamed for a lack of willpower. This can then exacerbate depression and low self-esteem, and for someone who is already feeling powerless, a diet reinforces those feelings.

My top 3 steps to improving your relationship with food

It is possible for everyone to develop a healthy relationship with food, even those who have been stuck in the diet cycle for many years, or someone with a diagnosed eating disorder. My top three steps to kick-start the process are:

1. Ditch the diet.
2. Establish a regular eating pattern. This helps prevent you from becoming overly hungry, which risks overeating or bingeing. Regular eating also helps your hunger and fullness cues become more reliable again after a period of dieting or being underweight.
3. Acknowledge that all food groups play a role in the body, and include each one in the right proportions.

I have seen hundreds of patients in my private practice switch to this way of eating, which has helped them to recover from disordered eating or an eating disorder, to feel more satisfied after meals and more in control of their eating.