Tag Archives: intutive eating

Are you doing intuitive eating wrong?

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He Said

First, a word about what intuitive eating is. In our culture, we are often taught that we cannot trust ourselves to guide our food choices. Instead, we use apps to track our calories and macronutrients, food models and sections of our hands to dictate portion sizes, and various books and online resources that tell us which foods to eat and which ones to avoid.

Eating based on external factors is problematic and often unnecessary. These behaviors instill and reinforce issues of guilt and deprivation regarding our food choices, and they also give the impression that some algorithm knows better than our bodies how we should be eating, which is typically nonsense.

Our bodies are actually quite good at guiding our eating behaviors – young children, for example, are generally great at knowing when, what, and how much to eat (that is, until we screw them up by teaching them to override these cues). We just have to get back to listening to and trusting our bodies again, and that is what intuitive eating is about.

The way I sometimes explain it to patients is to recall Maslow’s hierarchy of needs and discuss that in nutrition we have a similar structure. At the base, someone needs food. Period. If food security is an issue – and such scarcity can be brought on by external issues like finances or access, or they can be self-imposed, such as by dieting – then not much else matters. At the very top is medical nutrition therapy, which is how we eat in order to manage issues with our health, such as high blood pressure.

The middle layer is comprised of our relationship with food: How do we decide what, when, and how much to eat? People oftentimes want to jump right to the top, which is understandable. After all, if someone is concerned about a medical condition, of course they want to dive right in and talk about how they can help the issue through food. The problem, though, is that if we ignore the middle layer, then we do not have a proper context for incorporating the medical nutrition therapy, which can consequently come across as a diet.

Situations do exist in which jumping right to the top is the best course of action. If someone comes in with Celiac disease, for example, discussing matters like safe and unsafe foods, hidden ingredients, and cross-contamination will be high on our to-do list. The difference between this kind of scenario and most others is that with Celiac disease, the issue is more black and white: unsafe foods for this person really do exist and the patient must completely abstain from them. The same could be said for someone who comes in with a life-threatening food allergy.

In contrast, most nutrition-related conditions, including high cholesterol, high blood pressure, and blood sugar concerns, exist in a gray area. We have guidelines, but not rules, so the patient is going to have to make food decisions every single time they eat. Do they really want to be relying on some app, meal plan, or an oversimplified list of “good” and “bad” foods to tell them what to eat for the rest of their lives, or do they want to develop a healthier relationship with food that will enable them to incorporate the medical nutrition therapy in a way that still honors their hunger/fullness cues and cravings? That is why we focus on intuitive eating as a precursor to medical nutrition therapy.

With all that said, the most common way I find that people misuse intuitive eating is the belief that if they eat when they are hungry, stop when they are full, and eat the foods that their bodies seem to be asking for, they will automatically lose weight. This belief is understandable; after all, the idea of energy balance (calories in versus calories out) is so pervasive in our society that people just assume that if they reduce how much they eat, then of course they will lose weight.

In reality, while energy balance is certainly true from a thermodynamic point of view, our bodies are complex open systems, and the math is not as straightforward as our apps would have us believe. If someone consumes a 100-calorie slice of bread, the number of calories he actually absorbs from it will depend on factors such as his genetics and his gut microbiome, whereas someone else could eat that same slice of bread and absorb a different amount of calories. Furthermore, calories consumed affect our calories expended (Think of someone whose metabolism slows as a result of restriction.), so the two sides of energy balance are not as independent as many believe.

Despite my warnings, some patients still believe that if they just learn to eat intuitively, they will lose weight. Thus, they treat intuitive eating as a diet, which is a setup for failure. Time and time again, I have seen such people develop some basic intuitive eating skills early on, but their progress stalls as soon as their weight loss does. Someone might be able to keep one foot in the weight loss and intuitive eating worlds for a short while, but quickly this straddling leads to stumbling.

In order to extensively rediscover our intuitive eating skills, we absolutely must ditch any expectations regarding physical changes, such as weight or body composition, that our bodies will make as a consequence of our pursuits. In other words, if you are using intuitive eating to lose weight, then really you are just dieting, and the results are probably going to be as dismal as they would be with any other weight loss pursuit.

 

She Said

As many of you know, a lot of the work that Jonah and I do with our clients is around helping them become intuitive eaters. While on the surface the concept of intuitive eating seems quite simple – eat what you are hungry for in the amount that feels comfortable and satiating to your body – there are a number of complicating factors that can get in the way of an individual being able to do this. In some cases, even though an individual might truly want to be an intuitive eater, they might not really be able to do so. The clearest example of this is when I am working with patients struggling with eating disorders (ED).

When an individual engages in eating disorder behaviors, such as restriction, bingeing, purging, or overexercise, oftentimes this will take a toll on their digestive system and their ability to distinguish hunger and fullness cues. As such, I have heard from many patients that they either never feel hungry or never feel full (or in some cases, they cannot even describe what hunger/fullness feels like to them). Since being an intuitive eater depends on the individual being able to not only recognize their hunger and fullness cues but also be able to attend to these cues appropriately, those individuals with ED can find it to be nearly impossible to eat intuitively.

Patients who come to see me and are early on in their recovery process will often bring in with them a meal plan they have been following. In general, I am not usually a fan of meal plans, as I discuss here, but in some cases, they are necessary to help individuals with EDs reestablish their hunger and fullness cues. Making sure that the body is receiving 3 meals and a few snacks throughout the day helps to undo some of the damage that the ED has done to these cues. The body comes to expect that it will be fed at regular intervals; therefore, you will feel hungry at certain times. Feeling hungry periodically is a normal body process, a survival mechanism that tells you when your energy stores are low and your body needs fuel. When a patient with an ED goes long periods of time without eating or not eating enough, the body actually habituates to its hunger signals, and eventually the individual cannot even recognize or feel hunger. Meal plans are an essential step (for some) to get their body back into a natural rhythm of fueling their body when they are hungry.

Sometimes when I have been working for a short while with a patient struggling with ED, they will express the desire to try eating intuitively. While helping my patients become intuitive eaters is the ultimate goal in my work, it is not something I often dive into headfirst with my ED patients. On a number of occasions, I have had individuals try to eat intuitively too soon in their recovery process, and they will find themselves either not eating enough (as they still do not have accurate hunger cues) or eating more than their body is asking for due to a fear of getting hungry.

I like to encourage these patients to try out an approach that is halfway between meal plan and intuitive eating. To achieve this, I will use a “modified” intuitive eating meal plan as a stepping stone to intuitive eating. The plan typically involves having the patient eat every 3-4 hours (during waking hours, of course!) and making sure that they have carbohydrate, protein, fat, and either a fruit or vegetable at each meal. Instead of specifying that the patient needs to have X number of carbohydrate exchanges, I give more of a range (e.g., “have 2-4 carbohydrate exchanges at breakfast”) as this gives the patient some flexibility to eat more if they are hungry for it or eat a bit less if they are not. In a way, it is giving the patient some intrinsic choice around their food while still giving them the structure that their body needs. Once the patient has mastered this “in-between” meal plan for a substantial period of time, we would discuss trying to work on eating more intuitively.

In the end, the goal is to help my patients learn to trust their body’s innate wisdom – that it will tell them when they are hungry, what they are hungry for, and how much is enough to satisfy them. As long as the individual does not jump into intuitive eating too quickly (i.e., before they are ready), they will be well on their way to developing a healthier relationship with food and their body.

Wins and Losses: Old Habits Die Hard

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The following piece was written by one of Jonah’s patients who wishes to only be identified as a 36-year-old male.

Befitting the New Year, you would think I’d be writing about my resolutions for 2017, but I have a win from this past Thanksgiving that I’d like to share.

A little about me

I was a dancer as part of a performing arts group, and I traveled throughout the world dancing and performing in various venues — some as big as football stadiums and others as intimate as a small conference room. I was very fortunate to have this experience growing up (I began performing at the age of 16 and “retired” at the age of 26.) and feel grateful to have the talent and courage to pursue this sort of lifestyle. I’ve been to almost every U.S. state (excluding Alaska and the Dakotas) as well as various cities around the world — Paris, Amsterdam, Taiwan, Yokohama, Toronto, etc. I loved seeing all the different cities and how different cultures interacted within themselves, with other cultures, and even with their surroundings.

As you can probably imagine, traveling the world was glorious, but it was not easy by any means. I lived out of a suitcase for 6 months at a time; missing family events while I was on tour was the norm; and our sense of “home” was based on how long we would be staying in Anytown, USA. We were also at the beck and call of the directors and the schedules they created. Rehearsals every day, 7 days a week from 9am to 6pm (or some days even later if we didn’t have a show); additional performances that really strained every minute for “ME” time; and when and what to eat (and usually how much to eat) were always decided for us. It’s not as bad as I just made it seem. Like I said, it was quite glorious. It was nice to not think about the outside world — everyday tasks were managed for me. It really allowed me to focus on why I was there: to be the best performer I could be.

Perfection is attainable…right?

Dancing, much like any other sport, is really tough on the mind, body, and spirit. To be the best, you really have to work hard and be committed to the craft (not to mention have good genes and be somewhat of a natural talent). After all, the producers don’t give solos to the 2nd-best dancer. Dancing is also very specific — there is only one correct way to stand in first position. Any slight variation thereof is, well, simply incorrect. One might perfect their skills in other sports (i.e., one might work hard enough to make 9 out of 10 free throws), but in dance, there is always something that can be improved. So the idea of dancing “perfectly” does not exist. Yet, to be accomplished in dance, you constantly strive for this perfection. The struggle to jump higher is real. Turn faster. Turn faster! TURN FASTER! Even though these pressures mainly came from within myself, I became so worried (and obsessed) about being the best that nothing I did was ever good enough. Somehow, I thought I could achieve something better than perfection.

This battle bled into all aspects of my life: from personal relationships and self-confidence to body image and diets. Especially the latter. I distinctly remember a moment during the high point of my career. We were in dress rehearsal, putting together the finishing touches before our big opening night. At this point, we were all dancing 7 days a week for 6 to 7 hours per day. I was in peak fitness. I also wasn’t eating much because there was a portion of the performance where the men had to perform shirtless, and well, I was self-conscience about that since I wanted to look perfect. I mustn’t have weighed more than 130 pounds (I’m 5’10”.). My director approached me and suggested I watch my diet for the next few days because I would be standing next to some of the other men. She glanced over at the skinniest performer. She didn’t need to say the words, “and you are bigger than he is,” as the look was enough for me to really think about what I was doing and, more importantly, why I was doing it.

That moment was so pivotal to my career as a dancer. For me, dancing was like having a relationship with a double-edged sword. I loved to dance and was so passionate to share that with the world. I was enamored by the craft, while being pricked by both ends, as dancing created an environment that allowed me to neglect healthy eating and nutrition choices. I have trouble dealing with and embracing my own body image (The constant critiques towards a dancer are never-ending.); I struggle with the concept of working out to live a healthy life versus exercising to burn calories/lose weight; and even more, I have a hard time figuring out how to tune in to my body to find what I want to eat, when to eat it, and, more importantly, when to stop eating because I’ve reached an acceptable level of fullness.

Now (over 15 years later), my life is completely different. I’m not dancing anymore, so there’s that. I knew I wasn’t going to be able to dance into retirement, so I decided to pursue a different career and won’t bore you with those details now…just know that my life as a world traveler is much less exciting. What is exciting though is that I’m the leader of my own ship. I am in control of how my story goes, and I’ve come to love this freedom in most aspects of my life.

Setting expectations

Years following, I had the hardest time staying “in shape” — I would try any sport that would help me keep the pounds off: yoga, running, triathlons, obstacle course races. And even though all the training helped to maintain my body shape, I was still unhappy with the results I was experiencing. After talking to my sister-in-law about her nutritionist, I thought I’d give it a shot.

You should’ve seen me in my first session with Jonah — looking back now, I think it was quite comical — I came into the office, strong and confident, ready to establish expectations for our future work. I said, “Listen, you can put me on any kind of diet, but I won’t give up my sweets. I love them too much!” I didn’t realize I had the experience all wrong — it wasn’t about the sweets. I would then be educated about the different theories of nutrition, their applications, and the work I had ahead of me.

During our sessions, we would work on binge eating, recognizing fullness, honoring my hunger, and celebrating my relationship with food. We talked about embracing my body image and what that meant for me. We formalized strategies for upcoming occasions where my old habits would challenge my new relationship with food. Most importantly, we didn’t give up my sweets!

So…about that win!

As I mentioned earlier, I have trouble accepting my level of fullness. I went from being told what to eat to complete eating freedom, so you can imagine the binge eating every Thanksgiving, year after year, leaving the dinner table filled to the brim with stuffing, cranberry sauce, and mashed potatoes. You name it, I would eat it — if I didn’t really like the taste — or even if I was already full — or because there was something about missing out on the taste that I couldn’t let go — or because I didn’t want to upset the host by not eating the food they’d so lovingly prepared for us that day.

I wanted this Thanksgiving to be different from previous years, however. This year, I came to dinner with a plan on how I was going to eat during this meal, and I was determined to stick to it! (Spoiler alert: I did!)

Plan of attack

Through my work with Jonah, we were able to formulate a plan, and it was simple (in theory). I was going to take an inventory of the available foods during our Thanksgiving feast. As I walked around, I recognized foods that were appealing to me — I really tried to tune in to my intuitive eating skills — and what foods I could skip out on. I say “in theory” because by doing inventory, I also had to accept the foods that were appealing and give myself permission to eat those foods without guilt (For the record, I love bread and butter…lots and lots of butter.).

The result: I don’t really like all three varieties of stuffing, I don’t need to eat them all, and no one was going to heckle me about trying them all. Most everyone else was too busy serving themselves anyway. This quick walk-through allowed me to really honor and respect my hunger. It gave me the opportunity to carefully select the foods I was so excited to eat — it was Thanksgiving after all.

For the first time I can remember, I left Thanksgiving dinner feeling comfortable in my own skin (and clothes) by not overeating. I am still on the high from this win, and it helps give me confidence going in to whatever meal comes next. It might not be the most exciting win, nor does it mean I am over battling my other eating issues. But it is a “W” in my column.

Don’t get me wrong

I have good days and bad days. There are days where I eat multiple times throughout the day without ever consulting my intuitive eater. There are times when I feel like I really need to get to the gym to burn off that cookie I had earlier. Even though my day-to-day’s nutrition success fluctuates, what I’ve realized is that it’s a work in progress, and I won’t deny myself (and you shouldn’t either) the ticks in the “W” column (the everyday wins). I’ve earned that “W” and proudly display it on my sleeve (Ok, not literally. I am writing this anonymously, so if I wore a “W” on my sleeve, it might give me away.). You should too. No matter how big or small.

Psychology

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At a large family gathering over the weekend, a distant relative asked me about my work. Upon hearing that I am a dietitian, he smiled, leaned in, and asked me one of the most common initial questions that dietitians field, “So, do you practice what you preach?”

Whenever this question comes my way, I experiment with different permutations and phrasings of the same core truth in order to see which version best resonates with people. In this instance, I told him that what I “preach” might not be what he imagines, and that in reality a large chunk of what I do involves helping people to listen to and honor their internal cues regarding hunger, fullness, and food cravings.

His eyes wandered elsewhere as I spoke, and I could tell that this version of my answer was most definitely not resonating with him. When I finished, he reflected back to me, “That sounds like psychology.” He is not alone in his confusion, as other people have reacted similarly upon hearing a summary of intuitive eating. However, reconsider my answer within the framework of the following examples.

When a diabetes educator discusses the symptoms of low blood sugar with his or her patient, is that psychology?

When a physical therapist instructs a patient on how to modify an exercise in response to pain or discomfort, is that psychology?

When a primary care physician listens to his or her patient recount the side effects he or she experienced on a particular medication, is that psychology?

When a personal trainer talks with his or her client about the difference between the temporary discomfort that sometimes accompanies exertion and warning signs of injury, is that psychology?

Of course not, none of these examples are psychology; they are just examples of various discussions that take place between patients and practitioners regarding the feedback that our bodies give us in particular situations.

Yet when a dietitian engages in a similar discussion with a patient, whoa, suddenly it is seen as psychology. What does it say about how disconnected our culture teaches us to be from our internal signals regarding eating that an approach that encourages us to pay attention to said signals triggers connotations of therapy?

Dietitians are not psychologists, psychiatrists, or social workers (Well, some are, but the vast majority do not hold such a license in conjunction with their dietetic credentials.) and we know our professional boundaries. Discussions of said internal signals are not only within the realm of our work, they are critical to its success.

Just as my relative expected a more concrete and specific answer that would have put some label on my personal style of eating, new patients often expect that a similar external structure, such as a meal plan or a calorie recommendation, will drive their care. Nutrition is not that simple. In fact, long-term success often hinges on paying less attention to external cues regarding what and how much to eat and putting more focus on the internal signals that our bodies give us. Does that sound like psychology to you?