CME INDIA Presentation by Dr. Anuradha Kapoor, MD, Diabetologist, Mumbai and Dr. Akash Kumar Singh, MD, MSc (Diabetes).

Heal your relationship with food

Intuitive eating is a self-care eating approach that was created by two registered dietitians, Evelyn Tribole and Elyse Resch, in 1995. Intuitive Eating is an evidence-based model with a validated assessment scale and over 100 studies to date. Intuitive eating is a non-diet approach to health and wellness that helps you integrates your instinct, emotion, and rational thought. And tune into your body signals, break the cycle of chronic dieting and heal your relationship with food. From a nutrition professional perspective, intuitive eating is a framework that helps us keep nutrition interventions behaviour-focused instead of restrictive or rule-focused.

10 principles

It’s a personal and dynamic process, which includes 10 principles:

1. Reject the Diet Mentality
2. Honour Your Hunger
3. Make Peace with Food
4. Challenge the Food Police
5. Respect Your Fullness
6. Discover the Satisfaction Factor
7. Honour Your Feelings without Using Food
8. Respect Your Body
9. Exercise—Feel the Difference
10. Honour Your Health with Gentle Nutrition

The principles work in two key ways:

1. By helping you to gather information of the physical sensations that arise from within your body to get both your biological and psychological needs met and
2. Removing the obstacles and disruptors which usually come from the mind in the form of rules, beliefs, and thoughts imposed by society and family.

Gain your inner intuitive eater

We are all born natural intuitive eaters. Small kids when they are hungry, they cry and they stop crying when they eat and then stop eating until they’re hungry again. Kids innately balance out their food intake from week to week, eating when they’re hungry and stopping once they feel full. Some days they may eat extra food and other days they may eat barely anything. As we grow older and rules and restrictions are set around food, we lose our inner intuitive eater. So, because of social and family influences we learn many new food habits like finish everything on our plate. As a kid we learn that dessert is a reward, or can be taken away if we misbehave. We are told that certain foods are good for us and others are bad – causing us to feel good about ourselves when we eat certain foods and guilty when we eat others.

It honours both physical and mental health

The process of Intuitive Eating is not a diet. In fact, it’s exactly the opposite, it is a practice, which honours both physical and mental health. Intuitive Eating is aligned with Health at Every Size, because the pursuit of intentional weight loss is a failed paradigm, which creates health problems: including weight stigma, weight cycling, and eating disorders. All bodies deserve dignity and respect.

• There’s no counting of calories and
• No making certain foods off limits.
• It’s not about following a meal plan or measuring out your portions

Instead, it’s about

• Re-learning to eat according to our physical and mental needs as we are born with
• Putting the focus on our internal cues like hunger, fullness and satisfaction, and
• Moving away from external cues like food rules and restrictions.

Unconditional permission to eat whatever you want

But intuitive eating is not the ‘hunger-fullness diet.’ Intuitive eaters give themselves unconditional permission to eat whatever they want without feeling guilty. They rely on their internal hunger and satiety signals and trust their body to tell them when, what and how much to eat. They know when they want to eat veggies and also when they feel like having dessert (and don’t feel guilty or have any regrets with either choice).

What are the benefits of intuitive eating?

• Higher HDL (“good”) cholesterol
• Lower triglycerides
• Lower rates of emotional eating
• Lower rates of disordered eating and eating disorders
• Higher self-esteem
• Better body image
• More satisfaction with life
• Optimism and well-being
• Proactive coping skills

Do not bypass the complex thoughts and emotions of a human being

Note that IE has benefits to both physical and mental health. We often talk about nutrition and health in a very clinical way, forgetting that there are people with complex thoughts and emotions who are doing the eating. Mental health is health too, and any dietary change that negatively affects mental health probably isn’t actually making you any healthier. With a non-diet approach like intuitive eating, you’re also removing negative health effects associated with dieting, including the following:

• Food and body preoccupation
• Weight cycling (i.e. yo-yoing)
• Lower self-esteem
• Eating disorders
• Weight stigma/discrimination
• Focus on weight vs. sustainable health promoting behaviours

[Repeated dieting below set point can create a new, higher set point. So, Dieting predicts weight gain, Ref-5]

Myths and misconceptions about intuitive eating

• You’ll lose weight with intuitive eating. No, you can lose, you may not loose or you may stay as before, so intuitive eating is not for losing weight!
• Intuitive eating is only for people with eating disorders. Many of the practitioners who use intuitive eating have a background in treating eating disorders, probably because they are more likely to be exposed to it, and have the professional experience that would prime them for it. But intuitive eating is for everyone, eating disorder history or not. Keep in mind, you don’t have to be diagnosed with an eating disorder to struggle with your relationship with food – 75% of women engage in disordered eating behaviours.
• Intuitive eating is not for people with eating disorders. No, it can be used for them also.
• You can’t do intuitive eating if you have a dietary restriction. Not. There are many non-diet reasons one might have a dietary restriction, for example celiac disease, a food allergy, religious or cultural practices, or other ethical beliefs. These restrictions, or practices really, can and should be honoured within the framework of intuitive eating.
• Intuitive eating is anti-health/nutrition. No, it’s not like that. intuitive eating is one of the most powerful tools we have in taking care of our health. Intuitive eating is not anti-health, it simply takes a broader view of health, considering mental health as equally important as physical health. While sometimes making peace with food means putting nutrition on the back burner for a bit, that’s simply one step in self-moderating and figuring out how you’d like to engage with gentle nutrition.
• Intuitive Eating means eat whatever you want: No, it’s not like that. There’s this belief that Intuitive Eating means eat whatever you want, anytime you want. But that’s not exactly the case. With Intuitive Eating, you have permission to eat what you want, anytime you want, but that doesn’t mean you always do that. Hunger, fullness, satisfaction, how food makes us feel – those are all important; but Intuitive Eating also means using your brain and life experience. Once you work through the process of getting rid of the diet-y and restrictive voice, you can listen to your brain and make a decision on what to eat that is based on self-care, and one that honours your health and your body’s needs.

CME INDIA Learning Points

• Dieting has been shown to predict 5-year weight gain. It has also shown to increase activation of brain regions responsible for attention and reward in response to food.
• A non-dieting approach referred to as intuitive eating (IE) was developed and has attracted increasing attention.
• Deliberate food restriction (or dieting) has limited long-term success for weight management. It can contribute to increased food preoccupation, binge eating.
• Available research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health.
• IE shifts the focus from body weight to wellbeing, encourages letting go the idea of ‘forbidden’ or ‘bad’ foods and promotes unconditional permission to eat when and what food is desired.
• IE interventions have produced improvements in wellbeing (psychological and physical) and behavioural outcomes.
• One study showed that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. (Nina Van Dyke & Eric J Drinkwater).

Further Reading:

1. Barraclough EL, Hay-Smith EJC, Boucher SE, Tylka TL, Horwath CC. Learning to eat intuitively: A qualitative exploration of the experience of mid-age women. Health Psychol Open. 2019;6(1):2055102918824064. Published 2019 Feb 1. doi:10.1177/2055102918824064
2. Tribole E, Resch E. (2012) Intuitive Eating: A Revolutionary Program That Works. New York: St. Martin’s Griffin.
3. Van Dyke N, Drinkwater EJ. Relationships between intuitive eating and health indicators: literature review. Public Health Nutr. 2014 Aug;17(8):1757-66. doi: 10.1017/S1368980013002139. Epub 2013 Aug 21. PMID: 23962472
4. A systematic review of the psychosocial correlates of intuitive eating among adult women. Bruce LJ, Ricciardelli LA.Appetite. 2016 Jan 1;96:454-472. doi: 10.1016/j.appet.2015.10.012. Epub 2015 Oct 22.PMID: 26474781 
5. Bacon, L., Aphramor, L. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutr J 10,9 (2011). https://doi.org/10.1186/1475-2891-10-9

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