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Intuitive Eating and Eating Disorders

By Gretchen Newmark, MA, RD

Explore too Eating Disorders as a Source of Meaning, Religion and Ritual: Ritual in Eating Disorders.pdf

My journey into intuitive eating was both a personal and professional one. In my 20’s I

experienced the spectrum of eating disorders: had I been seen by a trained professional, I

would have been diagnosed first with anorexia nervosa, then eventually bulimia, and finally

binge eating disorder. Neither of the latter two of these conditions even had names, much less

people skilled to treat them. I had to find my way out on my own in a process of trial and mostly

error. Looking back, what guided me to freedom from that morass was a combination of yoga,

meditation, the principles of Gestalt therapy, and a book, Fat is a Feminist Issue by Susie

Orbach. (1) It contained the seeds of what now is called intuitive or mindful eating.

Three threads of intuitive eating

Intuitive eating is a term created by two dietitians, Evelyn Tribole and Elise Resch, in their book

by the same name. (2) It describes a way of discerning food choices by inner cues: hunger,

satiety, food preferences and true desire, rather than by trying to control eating through

externally imposed rules and/or diets. So for example, someone who has been trying

unsuccessfully to achieve a goal through dieting might instead begin to “listen” inside for their

body’s signals of needing to eat or to stop eating, and to be very honest about what they are

actually hungry for. This approach is spectacularly controversial. Despite the fact that diets are

notoriously unsuccessful, we have a multi-billion diet industry within and outside of our health

care system that clings to the simplistic notion that weight loss is just a matter of variations of

“calories in vs. calories out.” This ignores the complex web of genetic, environmental and

psychological factors that influence body weight. (3) Intuitive eating actually incorporates three

threads: the “Non-diet Approach, “ “Health at Any Size,” and “Mindful Eating.”

The non-diet approach reflects the reality that only a very few people are able to lose weight

permanently through dieting. Weight loss diets must be judged by their long-term benefit, and so

far, no diet (or medication) of any kind has been demonstrated to give lasting results in long-term

follow-up. All but some 1-5% of people who lose weight through dieting have regained all

the weight they lost, and often more, by one or two years, and certainly by the five-year mark.

Rena Wing, PhD and her group keep a “weight loss registry” of 5,000 people who have lost

weight and maintained it. However, her self-reported sample of participants, (who report

exercising for at least an hour seven days a week, and constantly restricting their food intake,) is

far less than 1% of the millions of people who have dieted, and are likely the exception, not the

rule. (4) It is common for people to bounce from the deprivation of diet-imposed food restriction

into a pattern of “weight cycling” which is physically destructive and psychologically devastating.

Regaining weight engenders shame, a feeling of failure and learned helplessness and increases

the risk of cardiovascular disease. (5) People can develop a pattern of bingeing on “bad” foods

they are trying to avoid, and aversion to “good” foods they think they “should” eat. They lose

touch with what they actually like and dislike, whether they are hungry or not, and the many

pleasures of eating. The more they try to restrict their eating and force themselves to exercise,

the more sedentary and out of control they become.

So what to do? Failed dieters can re-learn how to eat, by a process of noticing when their body

needs to eat, and what, if anything, they feel hungry for. This is much easier said than done, but

gradually over time, many people can return to eating as young children do—when they are

hungry, until they are satisfied, with foods they enjoy. In this approach success, rather than

being measured in pounds lost, becomes instead quality of life: giving the body the food, rest

and movement it needs and wants so that it becomes “metabolically fit.”

Health at Any Size describes the physical reality that risk factors for degenerative diseases like

heart disease and diabetes are more influenced by fitness than by size. Researchers and care

providers are as likely to be biased against larger people as anyone else. Therefore, the health

risks of obesity are greatly exaggerated, despite many scientific studies that suggest otherwise.

(6) Fat people can be as healthy as fit thinner people, with comparable blood pressures, lipids

and blood sugars, if they are neither over nor under eating a variety of “nutrient dense” foods,

and exercising enough. This state of health at every size is referred to as “metabolic fitness.” (7)

Mindful Eating is the tool that enables one to begin to reconnect with one’s true food needs

and desires. Eating in Western culture is based on external cues about when, what and how

much to eat. We eat because it’s mealtime, or we see food, or we have a habit of eating. We

might try to stop eating because we think we will look “undisciplined” or because we have

reached our “calorie limit,” not because we are satisfied. We puritanically describe foods as

“good” or “bad” and try to choose foods because someone deems them “healthy” not because it

is what we really want. We gradually learn to ignore the body’s signals about how much fuel it

actually needs, and our mind’s desire for what foods we truly enjoy. We become dishonest

eaters, hiding the truth from ourselves in an attempt to conform to an external idea about eating.

Eating goes from being a natural pleasure to being an artificial exercise in attempted restraint,

the root of disordered eating.

Mindfulness is variously defined but includes deliberate, focused awareness of “direct and

immediate experience:” the phenomena that arise in the present moment, including thoughts,

feelings, sensations and outer events, free of judgment, attachment or aversion.

Mindfulness can be cultivated through a number of means such as hatha yoga, tai chi, aikido,

Mindfulness Based Stress Reduction training, (8) or meditation training of any kind. Mindfulness

is learned through practice. Any meditation method is, at the very least, an intentionally chosen

“object” for attention. One trains the mind by repeatedly noticing distraction and bringing one’s

attention back to this focus or object. Several books have been written on mindful eating,

including two by local writers (9, 10)

Goals and Expectations

Many people have very unrealistic weight loss goals. However, most adults are able to lose and

maintain only about 10-15% of their body weight without resorting to drastic, unsustainable

means. If a person is routinely over-eating and is sedentary, it is likely that he or she will lose

about this much weight once they learn to refrain from over-eating and exercise at least four

times a week. This much body fat loss can result in significant improvements in blood pressure,

blood sugar and lipids, but does not produce the cosmetic effect our culture demands. If the only

goal is weight loss, a 10-15% decrease can be very disappointing, despite the health benefits.

Therefore, it is very important that care providers gradually help clients recognize that it is their

quality of life, not pounds lost, that is the real “bottom line.” Quality of life might include such

things as sensually pleasurable exercise; feeling well rested and energetic; being able to eat

out, or even “feast” with friends and family; being able to eat the foods one truly desires;

freedom from food obsession; freedom from compulsion to eat; and/or a feeling of relaxed

pleasure around food. Quality of life might also include the feeling of mastery that comes from a

sense of control without rigidity or deprivation.

Finally, although most of us are born knowing how to eat, it can take time to rediscover this.

Anyone who has fed a baby or toddler knows that the child knows when, what and how much he

or she wants to eat. In some older people, it is as if this inner, biological knowing gets buried

under all the conflicting ideas about how one should eat, failed attempts and the resulting

deprivation and helplessness. To get to this jewel of authentic intuitive wisdom, one must peel

off layers of ideas and concepts, the “oughts and shoulds” or “diet mentality” that obscure it. For

a client who comes in with a fervent desire to “wear a size 4 by the reunion,” this process must

be revealed gradually and gracefully, as the client can receive it.

Contra-indications for Intuitive Eating

However, learning how to eat intuitively is not possible for every person, at least not right away.

No one will be ready to take on a process of un-layering like this until they are absolutely certain

that dieting won’t work in their own case. If someone still harbors the idea that the answer lies in

successfully dieting, it is my experience that they will just need to try the diet and give it their

best. I always wish that my clients will be successful with the diets they try—if it worked it would

be the easiest way. To win the freedom that is intuitive eating one must have seen for one’s self

that dieting does not provide sustainable changes in eating and exercise. Then the hard work of

discovering what WILL work can begin.

In addition, the internal signals of natural appetite can be unavailable. People who are

underweight and/or restricting calories, fat, carbohydrates, etc will feel a voracious hunger all

the time. The body is saying “FEED ME!!!” This feeling of limitless hunger will pass when the

body is better nourished but it can be terrifying in the meantime. People with anorexia nervosa

dissociate from their body’s experience, denying or not feeling the urge to eat, rest, hydrate and

even pee. Intuitive eating is not possible with such dissociation. Mindfulness training can help,

but only re-feeding will restore the natural mind/body communication.

And on the other end of the spectrum, people who are insulin resistant may not experience true

hunger and satiety either. High levels of circulating insulin can cause hunger, even if the body

doesn’t actually need fuel, with cravings for sweets that mask what might be a true desire for a

treat with an insatiable urge to continuously eat sugary foods. And such conditions as insomnia

or the sleep disturbance associated with apnea can increase the feeling of hunger and diminish

satiety, as can dehydration. Certain medications, such as some anti-depressants and antipsychotics,

can cause insulin resistance and non-stop craving. Also, mindfulness can be

perverted into just another diet, so that one begins to feel they “should” eat mindfully, and

therefore resist it.

Furthermore, there are caveats to using this approach. Certain books, such as the classics,

Overcoming Overeating (11) and Breaking Free from Emotional Eating (12) suggest stocking

one’s home with the treats that one feels deprived of and binges on. However, the presence of

a food, particularly a “highly palatable” (i.e. yummy) one, will trigger eating even if the hapless

person isn’t actually hungry, or craving that food at the time. It makes sense that a feeling of

abundance--that all the foods one might want or need are right at hand--would restore a sense

of plenty, and could be healing. But in my experience, people tend to eat these foods just

because they are at hand, and then boomerang into bingeing. It works better for people to keep

such “trigger” foods out of their homes and offices, and go out to buy a serving at the time the

desire actually arises, as inconvenient as that might be.

Learning how to eat again, or intuitive eating, isn’t a quick route, despite the fact that it is most

people’s natural state. Making peace with food requires developing a sense of trust in one’s

body, learning to govern food choices compassionately, based on what the body and psyche

really need to feel best. I fervently wish there were faster, lasting ways to achieve this healthy

relationship with eating. But until then, re-learning intuitive eating is a process of coming to know

oneself through honestly listening inside. It is not a quick fix, but it can lead to lasting good

health, freedom and pleasure.

Gretchen Newmark, MA, RD is an expert in weight management and disordered eating and is

a Registered Dietitian in private practice in Portland. She guides clients to greater mindfulness

as a means of improving habits and lifestyle. Newmark is a writer in the field of nutrition and

health with articles appearing in a variety of newsletters and magazines.

Resources

1. Fat is a Feminist Issue

Susie Orbach

2. Intuitive Eating: A Revolutionary Program that Works

Evelyn Tribole and Elyse Resch

3. Rethinking Thin: The New Science of Weight Loss—and the Myths and Realities of Dieting

Gina Kolata

4. The Weight Loss Registry

http://www.nwcr.ws/

5. Medical, Metabolic, and Psychological Effects of Weight Cycling

Kelly D. Brownell, PhD; Judith Rodin, PhD

Arch Intern Med. 1994:154(12):1325-1330.

6. Big Fat Lies: The Truth about Your Weight and Your Health

Glenn A. Gaesser, PhD

7. Health at Every Size

http://en.wikipedia.org/wiki/Health_at_Every_Size

8. Mindfulness Based Stress Reduction (MBSR)

http://www.umassmed.edu/cfm/mbsr/

In Portland:

Jillayne Sorenson, Psy. D.

http://www.less-stress.us

9. Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food

Jan Chozen Bays, MD

10. Meal by Meal: 365 Daily Meditations for Finding Balance Through Mindful Eating

Donald Altman, LPC

11. Overcoming Overeating: How to Break the Diet/Binge Cycle and Live a Healthier, More

Satisfying Life

Jane Hirschmann and Carol Munter

12. Breaking Free from Emotional Eating

Geneen Roth

In addition explore Spiritual Hunger & Malaise: Why Do We Starve & How Can We Nourish Ourselves?

For a PDF file print off: Intuitive Eating, What Does That Mean Gretchen Newmark.pdf

              Copyright © 2001-2017 Bob Wilson BS, DTR  All Right Reserved. Articles are for personal use only. Please request permission for other uses. Thanks!