Table 3.

Summary and implications for treatment and future research

1. Eating disorder presentations and prevalence have increased over the last 50 years in parallel with the obesity epidemic.

2. The introduction of NOVA-4 ultra-processed foods containing combinations of high-sugar, high-fat and additives not found in nature have transformed food consumption, initially in Western countries and spreading worldwide, gradually replacing natural foods.

3. Ultra-processed foods have been shown in both animal and human experiments to promote overeating, obesity, insulin resistance, and metabolic disorders.

4. The obesogenic environment has resulted in widespread dieting, which is a well-known risk factor for eating disorders.

5. Many features of eating disorders, such as fat phobia, calorie counting, dieting, and exercise, are constantly reinforced not just by the food and weight-loss industries, but also by dietary guidelines, which encourage such reinforcement.

6. The multiple complex metabolic responses to ultra-processed foods are likely to contribute to abnormal eating and the development of eating disorders.

7. The high rate of comorbidity between diabetes and eating disorders suggests shared underlying pathomechanisms relating to impaired carbohydrate metabolism and insulin regulation.

8. High-carbohydrate and processed foods override the brain satiety mechanisms and are, therefore, unlikely to be helpful for patients with tendencies to binge, regardless of the diagnostic categories.

9. Existing treatment models recommend following current dietary guidelines, which continue to advocate low-fat and ultra-processed foods. Considering the effects of these foods on the individual patient would improve engagement and outcomes.

10. Recent research shows that there is wide variation in blood glucose response in the population and that exploration of individual glucose response to food with CGM may be helpful as a psychoeducational tool.

11. There have been no studies exploring the effects of different dietary approaches in the treatment of eating disorders: these are long overdue.

12. An HFLC diet may be beneficial for patients with various eating disorders, particularly for patients with BN and BED and comorbid diabetes. It could improve satiety, metabolic health and body composition, and blood glucose levels. Such a diet may also be beneficial for careful refeeding programs for patients with AN and lead to a reduction of refeeding complications.

Abbreviations: AN, anorexia nervosa; BED, binge eating disorder; BN, bulimia nervosa; CGM, continuous glucose monitoring; HFLC, high-fat, low-carbohydrate