Intuitive Eating 101 PDF

Intuitive Eating 101 By: Julia Lévy-Ndejuru Dt.P., MSc, PhD candidate January 25th 2024 Overview of intuitive eating (IE) & important definitions Plan Dieting Diet culture 10 principles of intuitive eating IE in research Objectives 1.Define Diet culture, Dieting and their consequences 2. Def...

Intuitive Eating 101 By: Julia Lévy-Ndejuru Dt.P., MSc, PhD candidate January 25th 2024 Overview of intuitive eating (IE) & important definitions Plan Dieting Diet culture 10 principles of intuitive eating IE in research Objectives 1.Define Diet culture, Dieting and their consequences 2. Define IE 3. Describe the 10 principles 4. Summarize IE research findings How much do you know about intuitive eating (scale of 1-5)? 1) I know nothing! 2) 3) 4) 5) I know everything! https://pratiqueinclusive.com Have you ever heard of Health At Every Size®? 1) yes 2) no https://pratiqueinclusive.com Intuitive Eating Book (2020 edition/workbook 2016) Written by American RDs Evelyne Tribole & Elyse Resch Organized approach to develop healthy eating behaviours and habits by moving away from restriction/dieting & tuning into one’s body signals and unique preferences Focused on habit change NOT weight-loss Based on clinical expertise and scientific evidence (incorporated psychology of eating) 10 principles - NOT rules very flexible Formal certification exists Health at Every Size (HAES®) HAES® is an evidence-based alternative to the current weight/size-based paradigm. recognizing body diversity and rejecting pathologizing of specific weight and idolizing of specific weight Life-enhancing movement Weight inclusivity Health enhancement HAES® principles Eating for wellbeing not only physical aspect (emotional, economic, etc.) Respectful care not to fit in a particular body type acknowledging biases and work on them IE helps us apply HAES® principles as RDs Intuitive eating does not equal to weight loss “Intuitive Eating is very much HAES-aligned” “It would be a mistake to promote IE for weight loss, as it would undermine and interfere with the process, because IE is an internally based process, whereas a focus on body weight is externally based. It would also philosophically counter HAES® [...] and reinforce weight stigma” - Intuitive Eating 4th edition (Tribole & Resch, 2020) Definitions Intuitive eater: Someone who eats according to their internal signals (ex: hunger/fullness) and preferences, rather than in response to external pressures (ex: specific diets/food rules). Most of us were born intuitive eaters! know when we are hungry how can we preserve that from when we were younger before socialization ? Dieting: The pursuit of weight-loss or body modification, generally through the restriction of specific foods or calories (many other methods exist). IE is an alternative to dieting What’s the problem with dieting? Weight-loss studies*: Short-term weight-loss Within 2 to 5 years weight regain in most cases, 1/3 to 2/3 stabilize at weight higher than initial weight *Ayyad et al., 1999; Sarlio-Lähteenkorva et al., 2000; Mann et al., 2007; Nordmo et al., 2020; Pélissier et al. 2023 What’s the problem with dieting? Weight-loss studies*: Short-term weight-loss Within 2 to 5 years weight regain in most cases, 1/3 to 2/3 stabilize at weight higher than initial weight *Ayyad et al., 1999; Sarlio-Lähteenkorva et al., 2000; Mann et al., 2007; Nordmo et al., 2020; Pélissier et al. 2023 How prevalent is dieting? A study* conducted in March 2021 found that ____% of adult Quebecers had tried to lose weight in the past 12 months. 1) 18% 2) 34% 3) 47% 4) 60% How prevalent is dieting? A study* conducted in March 2021 found that ____% of adult Quebecers had tried to lose weight in the past 12 months. 1) 18% 2) 34% 3) 47% 4) 60% Why is dieting so widespread? Diet culture Definition: A culture based on a set of beliefs that (1)demonize certain foods while elevating others and (2)stigmatize certain body types (fatphobia) while elevating others. thin privilege It is upheld by the diet industry, the beauty/media/fashion industries and the public health messaging around the “obesity epidemic”. We ALL live in it Definition adapted from Christy Harrison Diet industry Includes all programs, products and interventions which promise sustainable weight-loss and body transformation Makes people believe that sustainable weight-loss is widely achievable and that if it’s not working = you are the problem Profits off people’s insecurities 2021 in Canada: 333 M dollars Definition adapted from Christy Harrison Beauty/Media/ Fashion industries Set unrealistic body standards and beauty ideals (models, plastic surgery, photoshop) not acknowledging body diversity Profit off people’s insecurities Public Health messaging around “obesity epidemic” Emphasize personal responsibility re: wt control Fear-inducing Black and white messaging about body weight and health Stigmatizing Things are changing in Québec Public Health messaging around “obesity epidemic” 2021: Collective vitale —> working group to create a consensus to communicate abt weight issues Guidelines to move forward Groupe de travail provincial sur les problématiques du poids Somes consequences of Diet Culture: widespread guilt around eating disordered eating exercise as means to control one’s body preoccupation about body size and shape Ppl don’t want to go on diet but still want to lose weight —> change of name for marketing Diet culture in disguise A note about ‘wellness culture’ The terms ‘weight-loss’ and ‘diet’ are not selling anymore New terms: ‘wellness’, ‘self-care’ ‘lifestyle change’ Example: from ‘Weight Watchers’ to ‘Wellness that works’  same program different name Go beyond the messaging: are they selling a body type/promising weight-loss? Reject the diet mentality Honor your hunger 10 principles of IE Make peace with food Challenge the food police Respect your fullness Discover the satisfaction factor Cope with your emotions with kindness Respect your body Exercise - Feel the difference Honor your health - Gentle nutrition Principle 1 Reject the diet mentality Learn about diet culture & fatphobia Understand that diets don’t work Recognize the damage that dieting caused Get rid of dieter’s tools (scale, diet Books, magazines, etc.) Develop self-compassion skills Principle 1 Reject the diet mentality - tool Restrict-Binge Cycle: Restriction leads to binging Loop: restriction, obsession, struggle, binge/overheat, guilt/shame, restriction… https://nutrifoodie.ca/blog/how-to-stop-binge-eating/ Principle 2 Honor your hunger Learn to eat when hungry (takes time) Learn to recognize signs of hunger 1st step of rebuilding trust with one’s body after restriction Unmet hunger can lead to eating past fullness (short-term) and preoccupation with food (long-term) it’s helping you listening, but not telling you that it’s mandatory IE is not a “hunger-fullness” diet Principle 2 Honor your hunger - tool Hunger fulness scale: Source: Intuitive Eating Workbook (2016) Principle 3 Make peace with food Unconditional permission to eat any food in the quantity desired Last supper: from tomorrow, I won’t be eating everything I want so tonight I’ll have my last supper (binging) WTH effect: tell yourself you can’t eat something and when you eat 1 (ex: cookies), you eat all of them Understand that foods are not good or bad-they serve different functions Move away from “last supper” mentality and “what-the-hell!” effect Can be done step-by-step ppl that were Often starts with “honeymoon” phase restricting will eat more of their «forbidden food » Allows to pinpoint real preferences as opposed to restriction-driven cravings to eat their forbidden food so will get used to it and think more Mechanism: habituation rationally (after honeymoon phase) Principle 3 Make peace with food “What is someone has to restrict foods or nutrients for health reasons?” How can we include as many foods as possible? Is the person eating forbidden foods in secret? If so, legalizing food is even more crucial. Source: Intuitive Eating Workbook (2016) Principle 4 Challenge the food police Food rules=Inner Food police FP comes from the years of conditioning by diet culture and people’s environments Identify FP rules and where they come from Food rules = feelings of guilt, “I should” Learn to challenge the FP rules with the “intuitive eater” voice (IE perspective) Principle 4 Challenge the food police - example FP rule: “If I eat past fullness I should restrict my food later in the day” IE perspective: “If I eat past fullness at a meal I can still honor my hunger later on during the day” Source: Intuitive Eating Workbook (2016) Principle 5 Discover the satisfaction factor Central to intuitive eating – each principle is meant to help maximize satisfaction Satisfaction= taste, quantity, environment, mix of food Mindful eating intuitive eating based on 10 principles (large approach with a lot of aspects), mindful eating is abt creating awareness (observing the present moment) Mindful eating = tool in intuitive eating Principle 5 Discover the Satisfaction Factor- tool Important question: “what would be satisfying right now?” Probe: salty or sweet? crunchy or smooth? aroma? Hot or cold? small medium or big quantity? discovering out what would feel good Once hunger is respected, fullness is usually respected as well Principle 6 Respect your fullness Recognize signs of comfortable fullness Pay attention to sensation of fullness during meals Pay attention to taste changes during meals Explore barriers to respecting fullness (habits, rules) Beware of dieting mentality (NOT a rule- must make peace with food first) Still eating past fullness regularly? Explore previous principles (hunger, restriction) or lack of satisfaction when eating usually when some of these needs are not met, eating past fullness Principle 7 Cope with your emotions with kindness Dealing with emotional eating Food is physiologically soothing (temporary) Food can be used to cope with difficult emotions/thoughts Emotional eating is NOT wrong Can be problematic if it is the ONLY coping mechanism Work on diversifying ways to self-soothe Refer to address underlying issues in therapy Principle 7 Cope with your emotions with kindness - tools Make a list of soothing activities (meditation, walk, call friend/family member, yoga) When the urge to eat emotionally arises: Allow yourself to eat mindfully, noticing the soothing effect Engage in an activity from the list Once soothed, address the underlying issues* * Referral to therapist Source: Intuitive Eating Workbook (2016) Principle 8 Respect your body → → → Diet culture Negative body image Desire for body control/modification Disordered eating Understand concept of body diversity Accept own genetic blueprint Meeting the body’s needs and treating it with respect (we are not talking abt love here) Principle 8 Respect your body - tools Write down all the things your body does for you (function not aesthetic) Wear clothes that fit (let go of “goal” clothes) Do not comment on other people’s weight or yours Notice the body diversity that surrounds you Unfollow social media accounts that make you feel bad about your body Source: Intuitive Eating Workbook (2016) Principle 9 Exercise - Feel the difference Joyful movement Intrinsic motivation makes it sustainable Focus on how the exercise feels instead of the calories burnt (ex. less stressed, energized, better mood) Every type of movement counts Principle 10 Honor your health: Gentle nutrition Work with weight-neutral goals: balanced diet for health, specific conditions Integrate nutrition knowledge Add nutritious foods to diet, avoid cutting out things Notice how body feels after eating different foods Find balance that feels good Nutrition and exercise should not interfere with other aspects of health (ex: mental health) IE in research https://pratiqueinclusive.com to measure intuitive eating IES-2 scale 23 questions 4 subcategories: Unconditional Permission to Eat, Eating for physical rather than emotional reasons, Reliance on hunger and satiety cues, Body-Food choice congruence Validated in several populations including French-speaking Quebecers https://pratiqueinclusive.com IE in research – observation studies Psychological correlates of intuitive eating Linardon, Tylka & Fuller-Tyszkiewicz, 2021 (n=97) Less disordered eating More positive body image & body appreciation More positive affect Greater self-esteem & self-compassion Less anxiety and depression symptoms * men have higher IES scores than women, esp caucasian https://pratiqueinclusive.com IE in research – observation studies Psychological correlates of intuitive eating Hazzard et al., 2020 Longitudinal predictor of better psychologicalhealth Lesser risk of: High depressive symptoms Low self esteem High body dissatisfaction Extreme wt control beh. Binge eating https://pratiqueinclusive.com IE in research – observation studies Associations between diet quality and intuitive eating Associated with higher fruit and vegetable intake in men and women AND lower whole grain intake in men (Christoph et al., 2021, Jackson et al. 2022) Associated with healthier self-reported food intake (Ruzanska & Warschburger, 2020) Differentially associated with IES subscales + gender differences (Horwath et al., 2019, Lopez et al., 2021, Jackson et al. 2022) https://pratiqueinclusive.com IE in research – observation studies Associations between health indicators and intuitive eating blood sugar levels Inverse relationship between A1C and IE scores in adolescents with type 1 diabetes + women with hx of GDM 1-year postpartum (Wheeler et al., 2016, Quansah, 2021) Inverse relationship between presentation of inadequate glycemic control and IE score in elderly women with type 2 diabetes (Lacerda Pires Soares et al., 2020) https://pratiqueinclusive.com IE in research – observation studies Associations between health indicators and intuitive eating Inverse relationship between A1C and IE scores in adolescents with type 1 diabetes + women with hx of GDM 1-year postpartum (Wheeler et al., 2016, Quansah, 2021) Inverse relationship between presentation of inadequate glycemic control and IE score in elderly women with type 2 diabetes (Lacerda Pires Soares et al., 2020) https://pratiqueinclusive.com IE in research – intervention studies No overlap between the 2 1st one: younger ppl 2nd: a bit more varied, diabetes, clinical population Systematic review & meta-analysis of IE intervention outcomes by Babbott et al. (2023) Interventions based on 10 IE principles (n=9) Non-diet interventions including IE as a component not included Systematic Literature Review of impact of IE interventions on Diet Quality by Hensley-Hackett et al. (2022) not based on 10 principles Incl criteria: “1) guidance on internal hunger-fullness cues, (2) awareness of eating for emotional rather than physical reasons (3) no restriction on food type or quantity” + measure of diet quality (n=14) IE in research – intervention studies Systematic review & meta-analysis of IE intervention outcomes by Babbott et al. (2023) Outcomes IES scores improved and maintained (3 wks-6mo) Body-Food Choice Congruence improved in most studies Less disordered eating, maintained Less binge-eating, improves over time Less emotional eating and restriction Some improvements in mental indicators (QoL, depression) with some regression over time Better body image + body appreciation, sustained No change or temporary reduction in BMI IE in research – intervention studies Systematic Literature Review of impact of IE interventions on Diet Quality by Hensley-Hackett et al. (2022) healthy eating index whole grains Outcomes Diet quality improved (HEI, F&V, WG) in most studies, stayed the same in some fruits&vegetables Increased positive eating behaviours (IES scores) Decreased disordered eating Decreased LDL Decreased HbA1c (Db interventions) No change in BP, BG/Blood insulin levels Stable BMI IES in research future studies Future studies should include Diverse populations More interventions IE - where to start Intuitive Eating Book (2020 edition) and Workbook (2016) Anti-Diet by Christy Harrison, MPH, RD The Non-Diet Approach Guidebook for Dietitians by Fiona Willer, RDN Motivational Interviewing in Nutrition and Fitness by Dawn Clifford and Laura Curtis Body Respect by Linda Bacon and Lucy Aphramor Updated Reference list of all IE studies on intuitiveeating.org More info on HAES® : sizediversityandhealth.org IE - where to start Podcasts : Food Psych, Body Kindness Podcast, Dietitians unplugged, The Mindful dietitian, Maintenance phase Facebook groups: Weight-inclusive dietitians in Canada, Diététistes-nutritionnistes anti-régime HAES® Instagram (Quebec): @mangerenharmonie @lespiedsdanslesplats @nutrition.bienveillante @lisarutledgerdn @jessicaprdnc @dixoctobre @grossophobie.ca IE certification intuitiveeating.org IE - where to start (French) Formation “Pratique Inclusive” @pratique.inclusive https://pratiqueinclusive.com/ Livre “Au-delà de la grossophobie: Redéfinir son bien-être et habiter son corps” EXTRA: Things IE savvy RDs want you to know Start an IE practice of your own IE is way more than using one’s intuition Go further than social media to understand how to work with IE. Read the book and get trained if you can. All IE principles are important IE is aligned with HAES ® IE can be scary for clients who are used to following rules. Guiding them requires patience and open communication to ensure sure that they feel secure and structured. IE is needs to be adapted to each person IE requires some level of privilege, particularly economic privilege EXTRA: What’s the problem with dieting https://www.youtube.com/watch?v=udvXZY5awGM THANK YOU! QUESTIONS? Email [email protected] [email protected] Instagram @julialevyndejuru @pratique.inclusive Website https://pratiqueinclusive.com