Bulimia Help

Introduction

The biological reality of our weights and weight control, and the effects of dieting, were clinically demonstrated more than 50 years ago in what remains the definitive research on the subject. The findings in this famous study, revolutionary at the time, have been replicated in the most precise, complicated metabolic studies of food intake behavior, energy expenditure and the biochemistry of fat conducted by the country’s top obesity researchers.

This classic study made the most important contributions to our understanding of dieting, yet surprisingly few consumers today have ever heard of it. It was led by one of the world’s most renowned scientists, Ancel Benjamin Keys, Ph.D., popularly known for inventing K-rations — those indestructible transportable foodstuffs of white crackers, greasy sausage, chocolate and candy — that kept our soldiers alive during World War II.

In the 1940s, when starvation was widespread throughout war-torn Europe, little was known about the effects of human starvation or how to best refeed people who’d suffered from such deprivations. Dr. Keys led the first scientific study of calorie restrictions, at the Laboratory of Physiological Hygiene at the University of Minnesota, for the War Department. The researchers wanted to understand the medical needs facing millions of starving war victims and how best to renourish and rehabilitate them to health after the war. Their study was known as the Minnesota Starvation Study and the results were published in the legendary two-volume, Biology of Human Starvation (Minneapolis: University of Minneapolis, 1950).

The study itself was so comprehensive and intense, however, that even Dr. Keys admitted no other human experiment quite like it will ever be done again because, given what we now know, it would be seen as too cruel and life-threatening. While the degree of suffering the participants underwent would violate what is seen as the ethical rights for human research subjects today, in one respect this study was different from obesity and weight loss research done today. These men were not volunteering because they felt they needed to lose weight for fear that their own lives were endangered, nor were the study authors motivated by personal gain or selling a weight loss program.

The experiment — the starvation syndrome

The 40 young male participants were carefully selected among hundreds of volunteers for being especially psychologically and socially well-adjusted, good-humored, motivated, well-educated, active and healthy.

They were put on calorie-restrictive diets of about 1,600 calorie/day, meant to reflect that experienced in war-torn regions, for 3 months. They dieted to lose 2.5 pounds a week to lose 25% of their natural body weight. The calories were more generous than many weight loss diets prescribe today!

What this study was actually studying, of course, was dieting and restrictive eating — our bodies can’t tell the difference if they’re being semi-starved involuntarily like war victims or voluntarily. During the 3-month nutritional rehabilitation period after the diet, the men were randomly assigned to various nutritional regimens, with differing levels of calories, proteins and vitamins. The men lived at the lab and everything they ate and did was closely monitored, as was their health with a battery of tests. Daily exercise was walking about 3 miles a day.

Physcial effects from the semi-starvation

As the men lost weight, their physical endurance dropped by half, their strength about 10%, and their reflexes became sluggish — with the men initially the most fit showing the greatest deterioration, according to Dr. Keys. The men’s resting metabolic rates declined by 40%, their heart volume shrank about 20%, their pulses slowed and their body temperatures dropped.

They complained of feeling cold, tired and hungry; having trouble concentrating; of impaired judgment and comprehension; dizzy spells; visual disturbances; ringing in their ears; tingling and numbing of their extremities; stomach aches, body aches and headaches; trouble sleeping; hair thinning; and their skin growing dry and thin. Their sexual function and testes size were reduced and they lost all interest in sex. They had every physical indication of accelerated aging.

Psychological effects from the semi-starvation

But the psychological changes that were brought on by dieting, even among these robust men with only moderate calorie restrictions, were the most profound and unexpected.

So much so that Dr. Keys called it “semistarvation neurosis.” The men became nervous, anxious, apathetic, withdrawn, impatient, self-critical with distorted body images and even feeling overweight, moody, emotional and depressed. A few even mutilated themselves, one chopping off three fingers in stress. They lost their ambition and feelings of adequacy, and their cultural and academic interests narrowed.

They neglected their appearance, became loners and their social and family relationships suffered. They lost their senses of humor, love and compassion. Instead, they became obsessed with food, thinking, talking and reading about it constantly; developed weird eating rituals; began hoarding things; consumed vast amounts of coffee and tea; and chewed gum incessantly (as many as 40 packages a day). Binge eating episodes also became a problem as some of the men were unable to continue to restrict their eating in their hunger.

The aftermath

The last part of the Minnesota Starvation Study revealed perhaps the most important effects. When the men were allowed to eat ad libitum again, they had insatiable appetites, yet never felt full. Even five months later, some continued to have dysfunctional eating, although most were finally regaining some normalization of their eating. As they regained their weights, their suppressed metabolism and energy levels returned, although even three months after ending the diet none of the men had yet regained their former physical capacity, noted Dr. Keys.

While it seemed the men were “overeating,” Dr. Keys discovered that their bodies actually needed inordinate amount of calories for their tissues to be rebuilt:

Our experiments have shown that in an adult man no appreciable rehabilitation can take place on a diet of 2,000 calories a day. The proper level is more like 4,000 kcal daily for some months. The character of the rehabilitation diet is important also, but unless calories are abundant, then extra proteins, vitamins and minerals are of little value

In other words, they weren’t really “overeating,” it was a biological, normal effect of hunger and weight loss. The men regained their original weights plus 10%. The regained weight was disproportionally fat, and their lean body mass recovered much more slowly.

With unlimited food and unrestricted eating, their weights plateaued and finally, about 9 months later, most had naturally returned to their initial weights without trying — giving scientists one of the first demonstrations that each body has a natural, genetic set point, whether it be fat or thin.

Despite the fear that with unrestrained eating everyone would continue to grow larger, it isn't true.