We need to talk about intuitive eating

People sitting around a table eating burgers and chips

To the naked eye scrolling Instagram, intuitive eating is no more than the latest iteration of wellness culture. At the time of writing, there are 831,968 #intuitiveeating posts, featuring a mix of generic, anti-diet advice and bird’s-eye view shots of ostensibly ‘healthy’ meals: smoothie bowls, avocado, and meal preparation involving salmon.

When that same eye turns to Twitter, intuitive eating appears as the stuff of conflict. Some dismiss it as simply a fad, at worst, calling it ‘anti-science’. Others advocate for an evidence-based approach and open mind to the benefits of intuitive eating, calling out the ‘us’ vs ‘them’ mentality among healthcare professionals.

Among all this noise, it’s hard to get a feel for the truth.

Intuitive eating is a thought system and approach to nutrition based around 10 principles that teach us to identify and respond intuitively to our body’s natural hunger cues. This thinking honours what our bodies are telling us they need while investigating the basis of negative thoughts and pressures attached to food and weight. It’s a solid message, but how does it translate into clinical practice?

“At our clinic, we are dieticians and nutritionists and we work with people trying to manage a whole host of diet issues through the lens of intuitive eating,” says Laura Thomas, PhD, registered nutritionist and certified intuitive eating counsellor. People who are chronic dieters may see particular benefit from intuitive eating, she explains, along with those who have had a disordered relationship with food.

“In the case of eating disorders, many clients will feel very ‘merged’ with their illness and will be unsure which of their thoughts belong to them and which are derivative of an ‘unwell voice.’”

Intuitive eating is not a ‘quick fix’ nor a catch-all solution to any problems a person may have with food, and rather provides guidelines for clinicians to craft bespoke plans for their clients’ needs. And, depending on the person seeking care, they may also require other types of intervention, such as therapy or work with their GP.

This means that there may be a degree of ‘pre-work’ required before someone is ready to engage with the principles of intuitive eating.

Dietician Priya Tew talks about intuitive eating with her clients from the start of their journey with her. Priya works mainly with eating disorders and depending on the person, she will draw on the principles of intuitive eating to guide a bespoke treatment plan. In some cases, they may not be ready or able to forge an intuitive relationship with their body.

“My approach changes as the patient progresses. If someone is really struggling and you are working on weight restoration, you can’t rely on intuitive eating because they aren’t necessarily in tune with their body’s signals,” she says. “I don’t necessarily even call it intuitive eating, but what we know is that there is no right or wrong where it comes to food.”

If a client can’t yet rely on their internal cues, Priya will work on having them think critically about what hunger means and feels like for them, to help identify when they might be hungry. Due to the often complex nature of what her clients are seeking to overcome, ideally, she likes for them to be undergoing therapy alongside their work with her.

Emmy Brunner, psychotherapist and founder of eating disorder and body dysmorphia outpatient service The Recover Clinic, includes intuitive eating in her practice alongside psychoeducation, which is the process of educating clients about their illness and how it might be impacting them. This works to separate people from their symptoms, she explains: “In the case of eating disorders, many clients will feel very ‘merged’ with their illness and will be unsure which of their thoughts belong to them and which are derivative of an ‘unwell voice.’

“We are always certainly working toward our clients eating intuitively but it takes time to chip away at the illness. People cannot suddenly ‘let go’ of destructive thoughts and behaviours. It takes time to heal those wounds.”

“What I don’t want women to do is to look at influencers and then create a set of criteria that they can fail at”

Intuitive eating is an active area of research, and there are now around 100 studies investigating its impacts in practice. A 2005 study looked at intuitive eating in relation to the ‘health at every size’ (HAES) model, as opposed to weight loss. While the sample size was small (78), the HAES/ intuitive eating approach was found to enable long-term change where dieting did not.1 Almost a decade later, another study found that intuitive eating was positively related to an individual’s ability to perceive and process bodily signals, which mediated the negative relationship between a reliance on hunger cues and eating for physical rather than emotional reasons.2

Despite the potential of these studies, intuitive eating has been dismissed as another ‘fad’ by some healthcare professionals and commentators. This may be, in part, because the new attention around it invites misreporting and misinterpretation.

Both Priya and Dr. Laura express concern that intuitive eating will become another buzzword, obscuring the nuance of its principles.

For therapist and author Sally Baker, who specialises in resolving triggers for emotional eating, intuitive eating has already reached ‘catch-phrase’ status. While she believes that the intuitive eating principles are solid, she does not explicitly include them in her practice. Amidst the buzz it’s generated, Sally recognises the danger of people misunderstanding intuitive eating as a new set of rules to follow.

“What I don’t want women to do is to look at influencers and then create a set of criteria that they can fail at,” says Sally. In cases like these, she believes that versions of the intuitive eating principles could enable unhealthy behaviour. “It would almost definitely enable the critical voice,” she adds.

Back on social media, dissenting voices are sceptical about the ambiguity surrounding what counts as ‘intuition’, to the tune of: if I have problems with self-control and my mental health, telling me to listen to myself won’t help.

Sally echoes this critique: “All of the solutions within intuitive eating are front brain, fully conscious decisions. Our triggers and attitudes towards food are subconscious drives.”

Newfound interest in intuitive eating follows a line of dangerous wellness trends, such as clean eating, that can all appear as aesthetically similar on social media

But, say certified intuitive eating practitioners, attitudes like these are down to a lack of training and education.

While intuitive eating is now gaining mainstream attention, it is almost 25 years old. Developed by California-based dieticians Evelyn Tribole and Elyse Resch, its principles seem simple enough at face value, but should be worked into multidisciplinary treatment plans by clinicians who are properly qualified, says Dr. Laura.

“The things that I would be looking for would be registered dieticians or registered nutritionists, or a therapist who is certified in intuitive eating, who has done some CPD around intuitive eating specifically,” she says. “If I were a client, I would be looking to make sure that the clinician is receiving supervision and training.”

Different clinicians are only qualified to play certain roles in a treatment plan. For example, while registered dieticians, registered nutritionists, and therapists can make recommendations to a doctor, only a doctor should diagnose an eating disorder. This goes for mental health, too: while certain mental health conditions may impact your relationship with food, such as bipolar disorder, they must be diagnosed by a properly qualified mental health professional.

To practice as a dietician in the UK, you must be registered with the Health and Care Professions Council (HCPC), while therapists and registered nutritionists should be certified intuitive eating counsellors. Registered nutritionists should also be registered with the Association for Nutrition (AfN).

It is easy to see why intuitive eating has taken off in the way it is. The principles align nicely with the way culture is shifting, carrying positive messages of self-love and care that challenge toxic diet culture. It’s on-brand for feminists and progressives, arguing for the removal of the moral baggage that comes with being ‘healthy’.

It is also easy to see why many are sceptical. Newfound interest in intuitive eating follows a line of dangerous wellness trends, such as clean eating, that can all appear as aesthetically and ideologically similar on social media.

But the issue many seem to take with intuitive eating is semantic, overstating its application as a one-stop-shop for any and all issues with food. Intuitive eating will not ‘cure’ an eating disorder, but may form, or guide, part of that person’s treatment plan at some point.

As an intervention within a broader care plan, research has demonstrated the benefits and potential of intuitive eating. While more research needs to be done, I hope to see interest in intuitive eating shift from posting stylish pictures of porridge to constructive discussions about how it might, or might not, fit within the complete context of a person’s care.

Page last updated January 2019

References

1. Bacon, L. et al., Size acceptance and intuitive eating improve health for obese, female chronic dieters, Journal of the American Dietetic Association, June 2005, vol 105, issue 6, pp 929-936

2. Herbert, B.M. et al., Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index, Appetite, November 2013, Vol 70, pp 22-30

Monica Karpinski

Founder & Editor, The Femedic

Monica is the Founder and Editor of The Femedic. Against a journalism background and after years of leading content marketing projects in the healthcare space, it became clear that health information out there for women simply wasn’t good enough. No-one had bothered to look deeper into the ways women were searching for information, or consider the depth of what they actually needed to know. Instead of waiting for the perfect publication to approach her, she created The Femedic.

Monica has been named one of The Drum’s 50 under 30 for influential women in digital 2018 and was shortlisted for Female Entrepreneur of the Year in the 2018 British Business awards. She speaks and writes widely on gender and health inequality.

View more

More posts like this