10 Eating Disorders Recovery Today • Winter 200910

How do you honor your health when you have permission to eat anything? How can french fries or a candy bar, for example, be considered adequate choices? These questions are a source of confusion for many of my patients, their families, and even practitioners. My message to them is that healthy eat-ing includes having a positive relation-ship with food of all kinds. This means that meals are not a moral dilemma resulting in feelings of guilt and shame, but rather a place to practice tuning into one’s inner needs and fulfilling those needs in a healthy, nurturing way. In my work, I call this practice, intuitive eating.

While there are many ways of incor-porating this process, there are three core characteristics:

Intuitive Eating: Can You Be Healthy and Eat Anything?

Evelyn Tribole, MS, RD

•Unconditional permission to eat.

•Reliance on internal hunger and satiety cues.

•Eating for physical, rather than emotional reasons.

Although most chronic dieters and disordered eaters have lost touch with these skills, the good news is that they can be relearned through attunement—a process of listening and responding to your body cues, rather than focusing on rigid food rules. This means making decisions about eating based on what your body is experiencing. For example, upon experiencing a grumbling stom-ach (one of many hunger cues), you might respond by eating a snack, rather than withholding food because of a rigid rule stating, “It’s not okay to eat

between meals.” Being able to eat intuitively takes

practice. How long depends on many factors, such the length of time you have been at war with food and your body, and your motivation to change. Ultimately, recovery from an eating disorder means learning how to eat normally, which includes the ability to eat a variety of foods, including “fear foods,” which are perceived as fatten-ing and/or unhealthy. It’s important to work with your treatment team to determine when and how to implement intuitive eating.

Intuitive Eating ResearchMany people fear that intuitive eat-

ing is synonymous with a junk food diet and poor health. On the contrary,

11Eating Disorders Recovery Today • Winter 2009

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studies show that trusting and satisfying one’s physical hunger causes an increase in well-being, both physically and mentally. For example, Brigham Young University researchers looked at the relationship between intuitive eating and the quality of the diet in 343 col-lege students. Their results did not in-dicate poor nutritional choices. Rather, these stu-dents had a greater d ive r s i t y in eating, more sat-isfaction, and health-i e r b o d y weights.

In 2006, a larger study on nearly 1,300 college women by Tracy Tylka from Ohio State University, demon-strated similar findings. Intuitive eat-ers were found to be more optimistic, had better self-esteem, a lower body mass index (BMI), and were less likely to internalize our culture’s unrealistic thin ideal.

While these results may seem surpris-ing, it is something that the French are well known for—they regularly consume foods considered “fattening” or “unhealthy” by American standards. Ironically, the French also have some of the lowest rates of obesity and heart disease.

In 1999, Paul Rozin from the Uni-versity of Pennsylvania explored how food functions in the minds and lives of people from four countries: USA, Japan, Belgium, and France (Japan was chosen because the Japanese have the longest life expectancy). Rozin found that Americans have the greatest concern about health and the most dissatisfac-tion with eating. They worry the most about fattening effects of food and asso-ciate it most with health and least with pleasure. But the French were found to be the most pleasure-oriented and least health-oriented (hence the popular term French Paradox). These attitudes may be an important, yet overlooked contributor to overall happiness.

Rozin concluded that worries and obsessions regarding diet might be counterproductive. Several studies

have also demonstrated that anxiety increases stress chemicals in the blood, which has a wide-range of negative ef-fects on the body, from inflammation to depression.

Applying Intuitive Eating to Your Life

So, how do you balance creating a positive re-lationship with food, while also cons ide r -ing nutri-tion? Sev-eral factors c o m e t o mind:

•Getting in touch with your in-ternal satiety cues of hunger and fullness.

•Discovering satisfaction in eat-ing.

•Using nutrition information with-out judgment.

Many times, “healthy eating” or “better nutrition” is code for dieting. Consequently, if you focus solely on these factors, without considering your internal body cues of what would best satisfy hunger, you can easily feel de-prived. This in turn may increase crav-ings and thoughts of food, overeating, dieting, and heighten anxiety around snacks and meals. Try to answer these questions when considering what to eat: If I eat this food or meal now, will it satisfy and sustain me? Is my body meal-hungry or snack-hungry? How do I want to feel physically afterwards? What have my past experiences shown me?

Answers to these questions will guide you on making the best food choices based on your body’s needs. Whatever you decide to eat, take note if it met your expectations, which helps to cre-ate a meaningful learning experience. For example, if you were meal-hungry and choose to drink a smoothie—did it sustain you until your next meal? Given the same circumstances and what you learned, would you make a similar choice? Paying attention to these ex-

periences will also help you build trust with your body.

When you are attuned to your body, as well as armed with the knowledge that you can truly give it what it needs, you will possess the clarity to make ef-fective choices. You will be able to ask yourself: If I am meal-hungry, would bags of potato chips truly satisfy and feel good physically? If I am ravenous, would only a salad meet my body’s needs? If I have a sweet tooth, would raspberries really curb my craving?

When you can enjoy food with uncon-ditional permission, the process of eating becomes emotionally neutral—and you do not feel good or bad based on what you eat. You also understand that one meal will not make or break your health, or your weight. All too often, there is a negative perception regarding eating certain foods, resulting in guilt. But when judgment (and guilt) is removed, if you’ve eaten the wrong thing or too much, it is not a catastrophe from which to recover and/or perform nutritional penance. You are no longer caught up in these thoughts. Ultimately, intuitive eat-ing feels good, which is self-reinforcing. Remember, when you can truly eat in-tuitively, it doesn’t take much chocolate to satisfy a sweet tooth.

Sources:Hawks, ST et al. The relationship between

intuitive eating and health indicators among college women. Am. J. Health Educ. 2006;26:322-324.

Rozin, P. et al. Attitudes to Food and the role of food in the life in the USA, Japan, Flemish Belgium and France: Possible Implications for the Diet-Health debate. Appetite, 1999 (33):163-180.

Tylka, TL. Development and psychomet-ric evaluation of a measure of intui-tive eating. J Counseling Psych, 2006; 53(2):226.

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Evelyn Tribole, MS, RD, is co-author of Intuitive Eating 2nd ed (2003) and the new audio companion with added material and guided practices: Intuitive Eating: A Practical Guide, released in January 2009.

Intuitive eaters were more optimistic, had better self-esteem, and were less

likely to internalize our culture’s unrealistic thin ideal.

Nibbles, by Hunter

© 2009 by Eating Disorders Today

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“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing which you think you cannot do.” — Eleanor Roosevelt

EATING DISORDERSRECOVERY

Pregnany ProblemsWomen with a history of eating disorders are at higher risk of major adverse perinatal outcomes. A study at King’s College Lon-don that compared adjusted birth weight, preterm delivery, and miscarriage history has concluded that individuals with bulimia nervosa had significantly higher rates of past miscarriages and individuals with anorexia nervosa delivered babies of significantly lower birth weight than the general population.

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Fat Cells Die and Are ReplacedIt does not matter if you are fat or thin or have gained or lost weight, 10 percent of your fat cells die and are replaced with new fat cells,

according to a study in Sweden that was reported in the journal Nature. Fat cells can only change in size, not in number. Obese people who underwent weight loss surgery had as many fat cells two years after surgery as before it.

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Forgiving Feminists?In a New York Times article, dated March 25, 2008, the author reports that women who describe themselves as feminists are more forgiving than other women when assessing the attractiveness of women who are either very underweight or very heavy. This finding added evidence to the argument that these women also might be less likely to be taken

Teen Boys at Growing RiskEating Disorders rose significantly among American boys between 1995 and 2005, according to a study that examined weight control behaviors among high schoolers. The increased weight control behavior noted in males suggests growing social pressure for males to achieve unrealistic body expectations, thus increasing the risk of body dissatisfaction and eating disorders, the study authors said.

—International Journal of Eating Disorders

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Barbie’s won a TOADY!On the eve of the world’s most famous doll’s fiftieth birthday, the Campaign for a Commercial-Free Childhood announced that Mattel’s Barbie Dallas Cowboy Cheerleader Doll won its inaugural TOADY (Toys Op-pressive and Destructive to Young Children) Award for the worst toy of the year. In an online vote by more than 6,000 members, Barbie handily beat four other nominees. For more information on why these toys were nominated, visit www.commercial-freechildhood.org.

in by the idea that the most important thing for women is to be thin. His conclusions were based on a 2008 study led by Viren Swami of the Uni-versity of Westmin-ster in London. The author of the article, Eric Nigourney, as-serts, “If beauty is in the eye of the beholder, then try to be beheld by a feminist.”

“If you hold for a minute, the doctor will carefully choose the best diet for you.”