Heard of the term intuitive eating and not sure what it means? Or, do you know a little about intuitive eating and aren’t sure how it can help you heal from your eating disorder? Well, I have a WEALTH of information for you in this blog post! I’ve asked three gifted San Diego eating disorder dietitians to articulate their thoughts on intuitive eating and how it can be an integral part of eating disorder (ED) recovery. These amazing women are Diana Wright, M.S., RD, CEDRD of Life Inspired Nutrition, Erika Salaman, RDN of Erika Salaman Nutrition, and Lindsay Stenovec, M.S., RDN, CEDRD of Nutrition Instincts. If you want to find out more about these passionate eating disorder dietitians, you can read about them in their individual blog interviews. Just click on their names throughout this post.
What is intuitive eating?
Diana: Intuitive eating, in a nutshell (I love a good food pun!), is honoring your needs, wants and preferences by making conscious food choices based on your hunger/fullness cues, environment, and context. This approach reduced externally driven food "rules," and it allows for people to make empowered, individualized, shame-free decisions.
Erika: Everyone is born knowing how to eat normally (with the exception of very few). We have an innate sense of what and how much will satisfy us. Babies and toddlers are great examples of intuitive eaters. As we get older many of us stop trusting our internal cues, believing that we must control our cravings. The principles of intuitive eating teach us how to get back in touch with our internal signals and how to trust and respond to those signals.
Lindsay: Simply put, Intuitive Eating is an approach that rejects dieting and teaches us to center our body's needs by listening to hunger and fullness. It supports us with making peace with food and our bodies, letting go of the scale, seeking movement that brings us joy and feels good in our bodies and learning how to re-define what "health" means to us. Evelyn Tribole and Elyse Resch wrote the book Intuitive Eating decades ago and established the ten core principles of the approach. They continue to provide education, training, and resources to the public and professional community. Since their book was published, it has undergone several revisions and there are now over 90 studies () exploring its efficacy.
Diana: When I worked in the diet industry several years ago, I learned about the concept of, "intuitive eating." However, I put the phrase in quotation marks because it was really dieting under the guise of intuitive eating, which is quite common with all the re-branding of diets as, "well-being," and "lifestyle changes." I had drank the kool-aid (the food puns continue), and thought I was helping people become healthier by essentially promoting restriction, all under the name of intuitive eating. Fast-forward years later, I observed that diets weren't working long-term and were promoting shame, power struggles surrounding food, and disordered eating. I then was introduced to the field of eating disorders, read Evelyn Tribole and Elyse Resch's Intuitive Eating (along with several other books), and it all clicked! I spent many years navigating away from and healing from diet culture, as well getting grounded in intuitive eating and Health at Every Size approaches.
Erika: When I was in graduate school pursing my masters in nutrition, a friend of mine mentioned that she was attending a supervision group with Elyse Resch, the co-author of the book Intuitive Eating. When my friend invited me to attend the group I became very intrigued by the concept of eating whatever you wanted (of course theres more to it). Elyse gave me her book and I read it quickly. At the time I was struggling with my own eating disorder and was in disbelief that anyone could be so relaxed around food. I started my own journey in recovery using intuitive eating and knew that I had to share this with others.
Lindsay: I was lucky enough to be introduced to intuitive eating when I was a dietetic intern. I interned with Katie Bartels, a dietitian in Orange County, California. She required that I read the book as part of my rotation with her. It changed my personal and professional life forever. I went on to pursue training with Evelyn Tribole, as many of us do in this field, and became a Certified Intuitive Eating Counselor.
How can intuitive eating be helpful for people in recovery from eating disorders?
Diana: Depending on the individual's recovery process, intuitive eating may be the long-term goal, or they may be taking active steps towards intuitive eating. It's helpful because it allows people to trust their bodies, as well as the messages their body communicates to them, which allows for flexibility. Essentially, intuitive eating is a premise of helping people become competent eaters (as discussed by Ellyn Satter), where they can effectively navigate various eating scenarios with minimal anxiety. They can learn what they need, regardless of what others may need, and focus on making sure those needs are met.
Lindsay: Often we can think of intuitive eating as something someone is working toward in their recovery from an eating disorder. We may use certain principles earlier in treatment such as rejecting the diet mentality, challenging the food police, and respecting your body. Even though an eating disorder isn't a "diet," there are many cultural messages that reinforce the eating disorder or take on the "voice" of the eating disorder, so it makes sense to introduce those concepts early on. Many people think intuitive eating is only about eating in response to hunger and fullness cues, and frequently people suffering from eating disorders are not ready to jump into that process. Appetite cues are affected by many internal and external factors for all of us, but especially for those with eating disorders. Sometimes people with eating disorders are unable to perceive their cues, or the cues cause significant distress. For example, it's common for the somatic experiences (physical experiences in the body) of hunger and fullness to set off "alarm bells" in someone's brain - triggering a stress response. When someone is in this state, we need to start with some level of structure when it comes to their eating to reverse malnutrition and work toward feeling safer feeling these cues with exposure and learn how to care for themselves while in that state (which is a complex process that evolves through therapy, nutrition therapy, etc...). Some people in recovery do not feel that intuitive eating is something they want as part of their recovery, and we do respect that.
In what ways do you integrate intuitive eating in your eating disorder practice?
Diana: Intuitive eating is a core principle of my private practice and is always included in goal setting with clients. We focus on small, realistic behavior change goals that lead into intuitive eating. Sometimes this means clients try out uncomfortable experiments, such as checking in with hunger/fullness cues to determine the size of their snack (within a range discussed), and then we explore the outcome. We discuss how it felt to have some flexibility, whether the ED noise became present and, if so, how they navigated it, and additional tools they may continue to need. It's a gradual, individualized process where clients learn as they go, with guidance and support.
Erika: After a client is ready to begin working on healing their relationship with food (and they are no longer under-nourished), we begin by expanding permission to eat, exploring hunger and fullness, while increasing satisfaction and flexibility. A huge part of this is addressing body image concerns that inevitably pop up during the process. Only after a client has completely healed their relationship with food do we begin to chat about nutrition.
Lindsay: In my practice, our earlier work with clients is to (reasonably) stabilize eating before jumping into deeper appetite work. We want the body to get used to receiving consistent, adequate food on a regular basis - to the best of the client's abilities for their stage in recovery. However, we do introduce some creative appetite work quite early in the process. We may ask them to check in with what's going on around the eating experience, emphasizing there is no wrong answer. Sometimes clients say, "I don't want to check in," and my response to that is, "That's valuable information! You just checked in!" We also have a process to help clients develop their own "individualized hunger and fullness scale" where they're attempting to identify which levels of hunger and fullness they DO perceive. When a client is ready to start responding to cues, we have a variety of ways of easing them into this.
What can clients learning to eat intuitively expect in a session with you?
Diana: They can expect to collaborate with me on a plan that works for them. This typically starts by discussing different ideas and then doing experiential work, either meal/snack support, restaurant outings, grocery shopping exposures or home-cooking sessions. We then follow up with office visits to process how these exposures are going and discuss continued work.
Erika: Lots and lots of questions! Hahaha! What separates an intuitive eater from others is awareness. Awareness always comes from a place of non-judgement. Without awareness there isn’t an opportunity for a disruption in old patterns.
Lindsay: Working with a dietitian on intuitive eating is usually the opposite of what most people expect when they meet with a dietitian. Dietitians who don't do intuitive eating may not do this, but many clients expect us to provide them with a lot of education and instructions on what to eat and what not to eat. Clients can expect us to ask questions about their food and body story and how they think and feel about food, health, nutrition, etc. We do a thorough initial assessment (which is formally one visit but is ongoing) and then do a series of follow-ups that range in duration and frequency based on client need. They can expect us to ask questions that help them explore their experiences with food further and that we will centralize their needs and lived experiences. although the focus of each follow-up varies greatly, our goal is always to move clients forward with feeling calmer and confident with food and at home in their bodies.
What are some of the challenges people face with intuitive eating?
Diana: One of the greatest challenges I see people face when it comes to intuitive eating, is wanting to start the process before they are truly ready. If an individual is not yet solid in their recovery, they may use, "intuitive eating," as a way to restrict or use symptomatic behaviors. It's really important that a meal plan is used as scaffolding during the recovery process, and then intuitive eating concepts are sprinkled in as they are ready. Like most things in the recovery process, gradual changes are incredibly important to ensure a stable and full recovery. Another challenge is when clients have a perfectionist, black-or-white mindset and want to somehow do intuitive eating "perfectly." By nature, intuitive eating is flexible and removes, "good versus bad," food beliefs. This can be a real challenge when clients want to do it, "right," or feel as though they have, "messed up" if things did not go as planned. I often remind clients there is no "good or bad" in intuitive eating, and I highlight the importance of self-compassion during difficult moments.
Erika: Some of the challenges we tackle in our sessions are:
Letting go of trying to control weight
Sadness of saying enough (when you’re full but the food tastes so good)
Trusting hunger signals
Incorporating foods that feel scary or off limits
Challenging old patterns (cleaning your plate, never throwing food away, never eating after 6p, etc)
Successfully making peace with emotional eating (yes, there is a proper way to eat emotionally)
Mindful eating in our age of cell phones and constant distraction
Challenging cultural expectations around eating (like when grandma always makes you eat even if you’re not hungry)
All or nothing/perfectionist thinking
Accepting/appreciating today’s body as-is (instead of hating your body!)
Lindsay: I think many people struggle with the fact that intuitive eating is not a weight-loss approach, and it does require people to shift their focus away from weight. When we're working with someone, we are with them every step of the way with that and always validating how difficult that shift can be. Our world is full of weight stigma and oppression, so we realize this can be a scary process, but we want people to know there is another option. People of all sizes can learn to respect and care for themselves without focusing on weight loss (which typically inflicts harm and is largely ineffective in the long-run) and we see our clients do this brave and empowering work all the time. I encourage individuals interested in this approach to read Intuitive Eating and reach out to a professional thoroughly trained in this approach. If you're a professional, I highly recommend seeking professional supervision and the IE Pro certification.
How do you handle these challenges?
Diana: We handle these challenges by slowly experimenting and assessing the results non-judgmentally. For instance, if an individual is working on assessing hunger/fullness cues and testing out a 10% meal "push away" (essentially whether or not to eat the last couple bites of the meal), but together we notice they are always choosing not to eat the last few bites and upon further exploration acknowledge that the ED has pressured them to restrict, then we would back up to 100% meal plan requirements. I would then offer to do meal support with the client to be present in the moment and help them retrain themselves to focus on their needs, wants, and preferences (versus the demanding "shoulds" of the ED). In other words, we keep exploring what challenges are coming up, normalize them (intuitive eating is hard, especially in our rules-driven society!), and troubleshoot by providing additional support.
Erika: Tissues and a good therapist! In all seriousness, these challenges are not easy to overcome. They take a lot of time to work through. I usually assign a client homework, and we outline specific goals that we are trying to achieve. For example if a client is working on incorporating foods that feel scary, we can work on reducing anxiety around the food by first smelling the food, then tasting, then eating. I try to challenge the client, but also make sure to meet them where they are at.
Lindsay: With support, validation, listening, education when necessary, questions to encourage exploration, worksheets to deepen that exploration between sessions, etc. We will also encourage them to explore messaging from the intuitive eating and weight-inclusive communities so that they may begin to shift from the constant consumption of diet culture messages to more empowering and body positive messaging. We also work with them to strengthen their critical thinking skills when it comes to diet culture messages they receive.