One of my patients is reading The Fuck It Diet, by Caroline Dooner, for the first time, and I am rereading it to refresh my memory so the two of us can discuss it. This book has become one of my go-to volumes for patients who are interested in reading about intuitive eating. Do not let the title fool you; while The Fuck It Diet is indeed a casual, informal, and humorous read, its substance is generally on point. Sure, sometimes I take issue with what the author writes, but that is true pretty much anytime I read anything, including my own writing, as my typical reaction to revisiting my blogs from last decade, last year, or even last month is wishing that I had better expressed myself.
Having said that, one of the upsides of The Fuck It Diet is that Ms. Dooner directly addresses the pitfalls and misunderstandings that people commonly encounter while traveling down the intuitive eating path. For example, she points out the tendency for people to warp intuitive eating into yet another diet. “Most of us think that if we can just ‘eat intuitively,’ we will eat like a bird and become naturally thin and happy versions of ourselves. So many of us try to heal our eating without changing our relationship to weight [italics are the author’s own emphasis] as well. Ignoring how closely our feelings about eating and weight relate to each other is our big mistake.”
While I completely agree with Ms. Dooner on that front, one of our points of divergence is the use of a hunger/fullness scale as part of relearning how to intuitively eat. For those of you who are unfamiliar with what a hunger/fullness scale is, essentially it is a numerical continuum, sort of like a ruler, where the number at one end represents extreme hunger, the number at the opposite end represents extreme fullness, and all of the numbers in between represent more moderate degrees of hunger or fullness. Different versions of the hunger/fullness scale exist with most of them utilizing a 1-10 scale on which 1 represents extreme hunger and 10 represents extreme fullness.
Ms. Dooner is seemingly not a fan of hunger/fullness scales. A couple of quotes stood out to me. “But again, true intuitive eating does not happen by rating your hunger on a rating scale . . . . You do not need a hunger scale to learn whether you are hungry or not.” On one hand, she makes some good points, and I think I understand where she is coming from, as some people do turn intuitive eating into a sort of hunger-and-fullness diet in which they set rules that their hunger must reach a certain number for them to eat and that they must stop eating when their fullness reaches a particular number. Also, sometimes people do become hyperfixated on the number as if a precise bite exists at which ending the eating experience will yield the perfect level of satiety. If someone is utilizing their hunger/fullness scale in one or both of these ways then, yeah, the scale is doing more harm than good.
On the other hand, some people do find a hunger/fullness scale to be a helpful tool for relearning how to intuitively eat. Probably the most helpful aspect of utilizing a hunger/fullness scale is, strangely enough, just taking the time to construct one. Rather than giving people a scale that is already completed, I prefer to start with a bare-bones outline and help them to flesh it out based upon their own experiences. After all, while some commonalities may exist regarding how we feel a given level of hunger or fullness, we also have individual differences. For some people, sitting down to create their own scale is the first time that they give much thought to what hunger and fullness feel like in their body. The extreme ends are usually the easiest points to describe while the intermediate points are more challenging, but that is absolutely fine because it creates a learning opportunity to go forth and pay attention to what those levels feel like.
Use of a hunger/fullness scale gives us a shorthand that makes discussing hunger and fullness easier and also enables a person to more efficiently check in with their body. We could say that someone is of great or more than average height especially relative to their width, but isn’t it just easier to say that they are tall? And isn’t taking paper money with us easier than carrying around the gold that those bills represent? Similarly, assigning a numeric value to represent a more complex description of a level of hunger or fullness simplifies the process of thinking about and discussing hunger and fullness.
Ms. Dooner makes some great points, which is why I love her book and oftentimes recommend it to patients, but some people are able to constructively make use of a hunger/fullness scale without falling into the traps that she discusses. When considering whether or not to utilize a scale with a particular patient, I will typically raise for discussion the pitfalls that Ms. Dooner points out so we can gauge how confident we are that the patient in question can avoid them. From there, we mutually decide if we want to use a hunger/fullness scale or if we should follow Ms. Dooner’s lead and skip it.