Avoid extreme restriction, fasting, or purging to control weight
In a meta-analysis, people with anorexia nervosa had roughly 5.9 times the expected mortality for their age, with 5.1 deaths per 1,000 person-years; about one in five deaths was suicide. A three-year study across 44 schools found that girls who severely restricted food had 18 times the risk of developing an eating disorder compared with those who did not diet. The source favors physical activity over severe dietary restriction for adolescent weight control. This is not a recommendation to replace restriction with compulsive exercise.
What it takes
Nothing, and avoiding weight-loss products can save money.
What you may gain
A meta-analysis of 36 studies included 166,642 person-years of follow-up among people with anorexia nervosa. Their standardized mortality ratio was 5.86, with 5.1 deaths per 1,000 person-years, equivalent to about 5.1 deaths among 1,000 people followed for one year. About one-fifth of deaths were suicides. Standardized mortality ratios were 1.93 for bulimia nervosa and 1.92 for other eating disorders. A separate population cohort followed 14–15-year-olds in 44 secondary schools in Victoria, Australia, over three years and six survey waves. Girls' incidence of eating disorders was 21.8 per 1,000 person-years. Severe dieting was associated with 18 times the risk of no dieting; moderate dieting with five times the risk. After adjustment for prior dieting and psychiatric symptoms, BMI, exercise level, and sex no longer predicted onset. The authors concluded that adolescent weight control through exercise rather than dietary restriction appeared associated with lower eating-disorder risk.
Context & considerations
Here, severe restriction means persistently eating far less than the body needs, not simply skipping one meal or avoiding a late-night snack. Purging, intense guilt after binge eating, or uncontrollable repeated weighing warrant help from an eating-disorder professional, psychiatry service, or clinical psychology department. Eating disorders have established treatments and are not a failure of willpower. Chapter 2, entry 33 discusses BMI and mortality over the long term, rather than how to lose weight. BMI is weight divided by height squared.
Research & references
Arcelus J et al. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry. https://doi.org/10.1001/archgenpsychiatry.2011.74; Patton GC et al. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. https://doi.org/10.1136/bmj.318.7186.765