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Intuitive Eating - Part 3

Posted Feb 11 2009 3:28pm

Welcome back to our discussion of A Non-diet Approach... (see prior posts on this Topic: #1 and #2 ).

So far, we' ve looked at what Intuitive Eating is and have been introduced to some of the thinking behind this innovative approach by Elyse Resch, one of the authors of Intuitive Eating.

Today, let' s talk more about a non-diet appproach to eating, highlight an important caveat of using the approach too soon in eating disorders recovery, and explore some helpful resources and related concepts for the application of Intuitive Eating to clinical practice.

According to Ellen Satter, R.D., LCSW, normal eating is:

"being able to eat when you are hungry and continue eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it-not just stop eating because you think you should. Normal eating is being able to use some moderate constraint in your food selection to get the right food, but not being so restrictive that you miss out on pleasurable foods. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is three meals a day, most of the time, but it can also be choosing to munch along. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful when they are fresh. Normal eating is overeating at times: feeling stuffed and uncomfortable. It is also under-eating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your emotions, your schedule, your hunger, and your proximity to food."

(from Satter, E. (1999) Secrets of Feeding a Healthy Family ).

And author Karen Koenig, LCSW, says that "normal eaters":

  • <="<" li="li"> Eat when they are hungry or have a craving
  • <="<" li="li"> Choose foods they believe will satisfy them
  • <="<" li="li"> Stay connected to their bodies and eat with awareness and enjoyment
  • Stop eating when they are full or satisfied
  • Tune into their body' s signals that they need fuel or food
  • Respond to and respect their hunger, then choose foods based on what their body says it wants or doesn' t want
  • When they' ve had enough, they stop eating

(from Koenig, K. (2005). The Rules of Normal Eating ).

Sounds logical, and helpful. However, the trouble is that patients with eating disorders often cannot do this and would even go so far as saying they don' t know how.

In fact, studies show that people with eating disorders lack the interoceptive awareness to be able to distinguish hunger and satiety cues. This can be due to physiological causes, such as delayed gastric emptying and the physical effects of malnutrition, or from psychological causes (such as shame and mood disturbance ) that might lead to hunger suppression.

That' s where Intuitive Eating and other Appetite Awareness Resources come in. As part of a multidisciplinary approach to treatment, a non-diet approach can serve to help those in recovery develop the awareness of internal states that is needed to accurately and adequately judge one' s own hunger and satiety states.

A very important caveat: The authors of Intuitive Eating stress that the key is to introduce this type of approach after there has been sufficient weight-gain in re-feeding and/or a person in recovery has a sufficient understanding of physiological hunger  as being distinct from  "emotional reasons" for eating. Re-feeding and weight restoration for underweight patients must occur before an approach like this can be introduced. Likewise, symptom reduction for bulimia and binge eating is, quite obviously, a superordinate goal.

A helpful resource for encouraging clients to make the transitions necessary to a more "intuitive" style of eating is Real World Recovery: Intuitive food program curriculum for the treatment of eating disorders. In this user-friendly guide, nutritionists and other treatment team members will find materials for establishing and conducting an intuitive eating program. The Resource is divided into two sections, one for implementation in a full-time residential or inpatient facility, and the other for outpatient or part-time treatment. Practical worksheets, guidelines, experiential exercises, and handouts are included.

That' s our introductory look at a Non-diet Approach. Something to think about...

Future posts will explore related issues, such as the importance of set-point in weight regulation and restoration.

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