April 2020 Issue
Intuitive Eating: Four Intuitive Eating Myths
By Carrie Dennett, MPH, RDN, CD
Today’s Dietitian
Vol. 22, No. 4, P. 12
Why This Eating Model Isn’t a Free-for-All
Intuitive eating isn’t a particularly new concept—dietitians Evelyn Tribole, MS, RDN, CEDRD-S, and Elyse Resch, MS, RDN, CEDRD-S, FIAEDP, FADA, FAND, wrote the first edition of their book Intuitive Eating in 1995, with a fourth edition publishing in June—but it’s been gaining momentum in the past few years.1 The International Food Information Council Foundation even named intuitive eating as one of its five food trends for 2020.2
Tribole says the idea for that first book didn’t just come from thin air. “There was actually a lot of theoretical basis behind it,” she says. “It’s a well-defined, evidence-based model with a validated assessment and 10 principles,” she says.
In 2006, Tracy Tylka, PhD, a researcher at The Ohio State University, used the principles to develop the Intuitive Eating Assessment Scale, which provided the first means to validate the intuitive eating model.3
In 2007, Tribole and Resch started certifying health professionals in intuitive eating after they noticed their work being used in ways they didn’t intend, including for weight loss. Today, more than 900 health professionals in 23 countries are Certified Intuitive Eating Counselors, and there are more than 100 published research studies on intuitive eating.4
In spite of that, there are many myths and misconceptions about intuitive eating, which Tribole and Resch discussed at FNCE® 2019 in October. Following are four myths plus the facts about this evidence-based model for eating.
Myth #1: Intuitive Eating Is All Instinctual
One dictionary definition of intuitive is that it’s “instinctive,” but Resch says we can’t eat by instinct alone and that the true definition of intuitive eating is “the dynamic interplay of instinct, emotion, and thought.” She says our brains have three integral systems: the “instinctual” reptilian brain governs primal instincts and impulses, the “emotional” mammalian brain is responsible for feelings, and the “rational” human brain (the neo-cortex) generates thoughts.5
Resch says eating based on instinct alone wouldn’t work well for us “because we aren’t dinosaurs, we’re human beings.” She says one important aspect of the highly evolved neo-cortex is that it can monitor and influence people’s instincts and emotions, for better or for worse. If individuals don’t have much of an appetite because they’re anxious, the neo-cortex can remind them that they should probably eat anyway, but it also can act as the internal “food police,” telling them to ignore their hunger cues or that they’re “bad” because they ate a cookie.
Resch says many clients who describe themselves as compulsive, emotional, out-of-control eaters find that once they “challenge the food police” and “make peace with food”—two of the 10 principles of intuitive eating—by letting go of rules and judgments about “good” and “bad” foods, most of their emotional eating ends.6 “I’ve even had some clients who literally stopped eating emotionally because so much of their emotional eating was because they felt bad about their eating,” she says.
Although “cope with emotions without using food” is a principle, Resch emphasizes that because life is emotional, we’ll sometimes eat emotionally. “Food is comforting. It’s fine to comfort ourselves with food, it’s just at what level we do,” she says.
Myth #2: Intuitive Eating Means Eating Whatever You Want, Whenever You Want
Part of making peace with food is having unconditional permission to eat, something that Tribole says frequently is misunderstood. Intuitive eating pairs that unconditional permission with attunement to the physical sensations that arise from within the body,7 which includes states such as hunger and fullness, as well as the physical sensations that accompany emotions.8 The ability to perceive these sensations is called interoceptive awareness, which research shows is higher in intuitive eaters.9
“I think interoceptive awareness is our superpower,” Tribole says. “When we have a connection to the felt sense of our body, we have a treasure trove of information to get our needs met.”
Resch says the fear that someone eating “intuitively” will eat nothing but French fries is common, but that if this happens initially, it won’t last, because of attunement. “You’re listening to the signals your body gives you, so it’s not just about what your tongue wants. You want to look at, ‘How will this food make me feel? How will I feel afterwards? How will I feel while I’m eating it?’” she says. “It’s not just the instinct. It’s using the rational part of the mind to say, ‘How is this going to work for me?’”
Resch says that the more someone makes peace with all foods, the less allure formerly forbidden foods will have. “That food might be delicious, but you’re able to stop when you have enough,” she says.
Intuitive eaters also have “body–food choice congruence,” a term Tylka created to reflect the “honor your health with gentle nutrition” principle, which is about choosing foods that feel good and energize the body.10 However, Tribole says many people who have a history of chronic dieting or who are trying to recover from an eating disorder find it hard to experience what’s happening in their bodies because they’re stuck in their heads. Accordingly, the 10 principles help improve interoceptive awareness by either increasing sensitivity to biological cues or removing obstacles to noticing those cues, such as negative thoughts and beliefs about food and body.11
Myth #3: The Ultimate Goal Is Weight Loss
Two of the best-known principles—”honor your hunger” and “feel your fullness”—are frequently co-opted as a sort of “hunger-fullness diet,” especially since several research studies have found that scoring high on intuitive eating assessments is inversely associated with having a BMI in the “overweight” or “obese” range.12-17 However, Tribole says that intuitive eating isn’t about weight loss.
“Intuitive eating is about healing your relationship with food, mind, and body. If you put the focus on weight loss, it interferes with the process of interoceptive awareness,” she says. “You’re focusing on external—on the scale, on the calories, on the macros. It’s outside, and we want people to be inside the body.”
Resch says that food deprivation, whether due to food insecurity, dieting, or holding on to negative ideas about food, makes it difficult to stop eating when full. “Who’s going to stop eating if you think this is your only opportunity?” she says.
Similarly, deprivation can lead to “primal hunger,” which makes it easy for the instinctual part of the brain to simply take over. This ties into the principle of “discover the satisfaction factor,” which Resch says informs all the principles. Moderate hunger makes food more satisfying than primal hunger; gentle fullness feels more satisfying than being overfull; and feeling bad about what you’re eating dims satisfaction.
“We’re not opposed if someone loses weight, that just can’t be the intentional agenda,” Tribole says. “Different bodies will have different outcomes. Some bodies will lose weight on intuitive eating, some bodies will gain weight, some will stay the same.”18
Myth #4: You Can’t Use Intuitive Eating When Treating Anorexia
Intuitive eating certainly seems incompatible with patients who are out of touch with hunger and fullness cues and may be undernourished due to anorexia nervosa.19 However, Resch says more and more treatment centers are successfully using intuitive eating to help heal clients and emphasizes that even when using hunger and fullness as guides isn’t appropriate, there are eight other principles that are.20,21
“Let’s help people make peace with food, try some of the foods that they’re not allowing themselves to eat. Let’s help them be more respectful to their bodies and talk to themselves nicely,” she says, adding that fullness signals may not be accurate due to the slowing of the gastrointestinal tract that accompanies anorexia, but clinicians can teach clients that if they feel hunger, they can always trust it, and help them get to the point where they can enjoy and find satisfaction in food.
Similarly, Tribole says that MNT is compatible with intuitive eating because intuitive eating doesn’t ignore nutrition or health.22,23 “But don’t create rigid rules,” she says. “They need to have autonomy and agency over their body.”
Bottom Line
Resch says intuitive eating includes respecting the body and accepting individual genetic blueprints for size and shape, from both a personal and provider perspective.
“We know that green jellybeans don’t have as much nutritional value as broccoli does. However, it’s how we react to the food, how we can help our clients have a very neutral and emotionally equivalent reaction to all foods,” Resch says. “Without full peace with food, they’re never going to become free.”
— Carrie Dennett, MPH, RDN, CD, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Holistic Guide to Optimal Wellness.
References
1. Tribole E, Resch E. Intuitive Eating: An Anti-Diet Revolutionary Approach. 4th edition. New York, NY: St. Martin’s Essentials; 2020.
2. Intuitive eating and the “un-diet”; sustainability (finally!) takes shape; new food tech gathers momentum. International Food Information Council Foundation website. https://foodinsight.org/2020-trends/. Published January 6, 2020.
3. Tylka TL. Development and psychometric evaluation of a measure of intuitive eating. J Couns Psychol. 2006;53(2):226-240.
4. Studies. The Original Intuitive Eating Pros website. https://www.intuitiveeating.org/resources/studies/
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21. Richards PS, Crowton S, Berrett ME, Smith MH, Passmore K. Can patients with eating disorders learn to eat intuitively? A 2-year pilot study. Eat Disord. 2017;25(2):99-113.
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