Bridging The Gap Part 1: Intuition In Training & Eating

Updated: Mar 5

An Article By Dr. Gabrielle Fundaro, PhD, CISSN, CHC

in collaboration with Shannon Beer, LLB, MNU-Certified Nutritionist

“Seek first to understand, then be understood.” –Covey

In the past year or so, a chasm has formed between some groups in the health industry. Many people have strong opinions about Health at Every Size (HAES), Intuitive Eating, weight neutrality, anti-diet culture, and body positivity, often despite having read none of the books or literature. Let me be clear: I have seen misinformed, extremist voices yelling from both sides of this divide. I also have respected colleagues and friends in both camps. While I’m sure that we as practitioners have good intentions, we also need to provide good information and content. We need to operate from a place of awareness and understanding for the context and nuanced ideals of these paradigms. We serve no one but ourselves when we dig our heels in and refuse to acknowledge that both sides make relevant points. We certainly aren’t doing any favors when we form opinions without adequate evidence to support them. It is my hope that this series of articles, written in collaboration with Shannon Beer, will serve to improve the dialogue and the industry as a whole by bridging the divide with shared meaning and a deeper understanding of weight-neutral approaches to health. In this first installment, I will first explain the Intuitive Eating framework and skill subset of mindful eating to establish clear definitions and meaning. I’ll clarify some of the common concerns and misconceptions around weight-neutral approaches to health. In order to illustrate the commonalities between Intuitive Eating, mindfulness and athletic endeavors, I’ll explain the ways we as athletes and coaches implement intuition and interoceptive sensitivity (recognition of internal physical cues) to enhance the efficacy of training. The subsequent series articles will serve to contextualize Intuitive Eating processes in the fitness industry, bringing light to oft-neglected risk of dieting, and how we might best set clients up for long-term success through more conscientious approaches to coaching.

INTUITIVE EATING: NOT JUST ANTI-DIET DIETING Overview of Intuitive Eating Although Intuitive Eating (IE) is promoted in the media as the ‘anti-diet diet,’ this is a significant misnomer with a myopic view of the paradigm. Intuitive Eating is a framework of self-care principles, including: ●      Improving relationships with food ●      Removing moral judgments around food ●      Building awareness of hunger fullness cues ●      Emphasizing emotional & physical wellness over pursuit of lower weight or smaller size, ●      Advocating for removal of weight stigma It is aligned with Health at Every Size (HAES), which promotes the concepts of: ●       Weight inclusivity ●       Health enhancement ●       Respectful care ●       Eating for well-being ●       Life-enhancing movement Contrary to popular belief, HAES does not state that health is present at every size; rather, the central tenant of the paradigm is simply that a person’s size should not prevent them from engaging in health-seeking behavior. They accurately assert that weight is not predictive of health status and focus on health-seeking behaviors rather than outcomes (such as weight loss). Both HAES and IE are weight-neutral, which is not synonymous with anti-weight-loss. Indeed, weight loss—or gain, or stability—may occur as a result of engaging in health-seeking behaviors. However, intentional weight loss is not the goal; rather, weight loss could be one of the many outcomes of a lifestyle change that focuses on mental, emotional, and physical self-care. HAES establishes the need to focus on the “How” instead of the “What” for patient-centered care. Informing a client or patient that they need to lose weight is just as ineffective as informing them that they need to reduce their blood pressure. The oft-maligned statistics about long-term diet success are, arguably, misrepresented by both camps. In reality, both weight-loss-focused and weight-neutral programs result in very little weight loss after 6-9 months of intervention. However, both realize positive health outcomes such as improvements in cardiometabolic risk factors, and weight-neutral approaches also boast improvements in psychological health outcomes. This isn’t to say that weight loss isn’t beneficial; clearly, evidence illustrates that it can be. But the “How” is, arguably, more important than the “What,” and if we can help our clients achieve better health with less harm, isn’t that something worth exploring? Also contrary to popular belief: IE is not simply a break from dieting. It is a non-linear process and collection of principles intended to break cycles of harmful eating behaviors and challenge the beliefs that precipitate them. It addresses cognitive distortions that lead to negative self-perception and chronic dieting, and it is indeed and evidence-based practice with an extensive body of literature in individuals with overweight, obesity, and binge eating disorder. Emerging literature is examining its use in a variety of other populations, as well, and the results are promising. IE describes the cycle of chronic dieting as phases of deprivation, rebellion, and rebound weight gain, resulting in subsequent deprivation. A diet, in this context, refers to a way of eating for the intention of reducing body weight (a definition that serves as a major point of contention which will be addressed later). Many individuals may reduce IE to the internet memes of eating cookies and “pink donuts” (as one of the authors, Evelyn Tribole chuckles in her recent podcast appearance on Dan Harris’s 10% Happier show) and assume that it’s simply a phase of uninhibited eating. Unfortunately, the combination of ingrained diet culture and misunderstanding leads people to fear and vilify the entire paradigm at the thought of weight gain and eating ‘without rules or reason.’ A deeper dive into the principles illustrates that any individual embarking on this journey will be doing far more internal work than the internet might have you believe. The principles of IE emphasize satisfaction as the focal point during mealtimes, enjoyable physical activity, rejection of the diet mentality, using nutrition information without judgment, and respecting one’s body even in the presence of negative feelings about how it might look. It is a dynamic, integrative process that appreciates the connections between our thoughts, feelings, and behaviors around nutrition and physical activity in order to facilitate positive, production relationships with our food, physical activity, and selves. The book “Intuitive Eating: A Revolutionary Program That Works” was first authored by dietitians Evelyn Tribole, MS, RDN and Elyse Resch, MS, RDN, CEDRD-S, FIAEDP, FADA, FAND in 1995, and has since undergone several modifications, with a fourth edition to include weight stigma and diet culture due out in June 2020. It covers ten main principles of self-care around food, physical activity, and mental health. They are briefly summarized as follows:

  1. Reject the Diet Mentality

●       The false hope of losing weight quickly, easily and permanently ●       The lie that weight regain is failure ●       The promise that there’s a new or better diet that will work for you

2. Honor Your Hunger ●       Remain biologically fed through adequate energy intake to prevent excessive hunger that may lead to overeating and counter your intentions to eat moderately and consciously ●       Learn to respond to biological hunger to rebuild your trust in self around food ●       Eating when hungry, rather than in response to a specific set of rules

3. Make Peace with Food ●       Unconditional permission to eat in prevents feelings of deprivation and subsequent bingeing (also known as the abstinence violation effect) ●       Habituation through regular exposure dilutes the alluring quality of forbidden foods whereas rigid rules trigger rebellion ●       Eating without obligatory penance

4. Challenge the Food Police ●       Reject the idea of “good or bad” foods (also known as binary thinking) and food morality to reduce guilt after eating ●       Ignore inappropriate comments from others and liberate yourself from justifying food choices to others (or yourself)

5. Feel Your Fullness ●       Listen for signals that tell you you’re no longer hungry ●       Pause mid-meal to reassess your enjoyment and fullness ●       Practice conscious (mindful) eating

6. Discover the Satisfaction Factor ●       Eat what you really want, in an inviting environment, and focus on the pleasure of the meal in concert with your biological cues ●       Savor your meal so you aren’t left seeking other foods to ‘hit the spot’

7. Cope with Your Emotions Without Using Food ●       Truly assess and meet your emotional and mental needs without food ● Food can’t fulfill emotional or mental needs; applying it this way may only add the discomfort of overeating to those difficult emotions and you’ll have to deal with the discomfort of the overeating and those emotions

8. Respect Your Body ●  Recognize and accept your genetic blueprint and predispositions ●  It is difficult to reject the diet mentality if you are overly critical of your body shape and unrealistic about your expectations ● Respecting your body means taking care of your health, treating it with dignity and meeting its basic needs

9. Exercise (Feel the Difference) ●  Replace militant exercise with enjoyable physical activity ● Focus on the benefits of movement rather than the calorie bur ●  Focusing on your enjoyment of the opportunity to move—rather than an external motivator like weight loss—will be a stronger motivator in the moment

10. Honor Your Health with Gentle Nutrition ●       Make food choices that honor your health, taste buds, and digestive comfort so they feel good ●       You don’t have to eat a “perfect” diet to be healthy; no single food is inherently going to make or break a healthy lifestyle ●       Emphasize moderation, balance, and a variety of fruits and vegetables, nutrient-dense foods, protein-rich foods, quality fats, and whole foods; processed foods are generally less nutrient-dense ●       Balance is something to be achieved over a period of time, and it does not have to be reached at each meal; focus on consistency and progress ●       At times it is appropriate to prioritize the nutritional qualities of foods and eat intuitively Tribole and Resch also characterize potential types of ‘dieters’ based on common beliefs and habits. The Careful eater is militant and diligent, enforcing strict rules that, when broken, lead to bingeing behaviors. The Professional eater may have more content knowledge than the Careful eater, but applies it for the purposes of weight loss, and may rapidly shift from one diet to the next. An Unconscious eater is a multitasker, eating without awareness of hunger or satiety cues, often cleaning the plate or perhaps eating emotionally. The Intuitive Eater eats in response to biological cues, making choices