Julie A. Gast, PhD, CHES, and Steven R. Hawks, EdD, CHES
Much media attention has been given to the intuitive eating paradigm. This article presents an overview of this weight loss paradigm, discusses its potential benefits and limitations, and evaluates its usefulness in health education. While the proponents of intuitive eating each present their own unique perspectives, they share several basic principles.
Why People Overeat
The basic premise of the intuitive eating paradigm is that people become obese because they eat for non-physiological reasons. Individuals, it is argued, eat for three main reasons. First, they may eat due only to physical hunger cues—the most desirable motivation to eat. This classifies an individual as an intuitive eater. Second, individuals may eat due to environmental and social cues. For example, a person may eat even when not hungry at a social gathering where food is present or when there is pressure from others to eat. Third, an individual may eat for emotional reasons—for example, to temporarily relieve boredom or anxiety. For individuals to become intu¬itive eaters they must learn to pay attention to body signals and eat appropriate amounts of food for their physiological needs.
The paradigm does not question or disregard the role of human metabolism as related to weight gain. If an individual routinely eats for reasons besides physical hunger, this can lead to excessive calorie consumption and weight gain. The proponents of the intuitive eating paradigm believe that examining why an individual eats is an important starting point to weight loss. The goal is to eat for physiological reasons to meet calorie requirements as indicated by both hunger and fullness. It appears that people frequently eat for non-physiological reasons. A recent survey asked 500 nutrition counselors in the US to identify the top 10 reasons people overeat. Hunger was not on this list (1).
Psychologists have long recognized that individuals eat for reasons besides physical hunger. Both loss of appetite and overeating are considered a normal response to anxiety, anger, and sadness or an emotional crisis (2). Some individuals may resort to “external eating” or eating when food-related triggers are present regardless of lack of physical hunger (2). While the health psychology literature and the intuitive eating paradigm share this basic insight, they differ in numerous ways that will be discussed below.
How and Why People Eat
The intuitive eating paradigm is very different from other weight loss paradigms in that the way an individual eats his or her food is a central issue. No other weight loss paradigm directly addresses the issue of how an individual eats, and under what conditions a person should eat, as a primary focus of a weight loss
intervention. The intuitive eating paradigm suggests that one should be mindful while eating, with no distractions present such as television viewing. The purpose of mindful eating is to fully appreciate the satisfaction of eating, and then identify when physical fullness has been reached (3–6).
Behavior modification-based weight loss programs frequently use skills training similar to the concept of mindful eating (7–9). For example, patients are typically taught skills in identifying hunger, avoiding high-risk relapse situations, and identifying alternatives to eating. However, these skills are taught in order to maintain the diet and adhere to the caloric restrictions. This is an important philosophical difference between the intuitive eating paradigm and traditional behavior modification weight loss programs.
Since a person should eat only when physically hungry, it makes sense that one should stop eating when physically satisfied (6). Fullness rating scales are often recommended to aid the intuitive eater in determining the levels of both hunger and fullness. Typically the intuitive eater is asked to rate satiety on a scale ranging from one to 10, where one is feeling famished, and 10 is full to the point of physical discomfort. The goal is to eat when you are hungry but not famished, about a three on the scale, and to stop eating when you are satisfied but not overly full, about a five or six on the scale (5,6). According to the intuitive eating paradigm, eating when too hungry may result in an eating binge, and eating past full indicates a person is eating for reasons not related to physical need.
Another unique component of the intuitive eating weight loss paradigm is that consumers are told they should eat exactly what they want to eat. The individual should not restrict what foods they eat in any way. Food should not be a source of guilt or deprivation.
According to this paradigm, binge eating can occur when individuals deprive themselves of desired food over a lengthy period of time. For example, an individual may love pizza but avoid it in order to maintain a low-fat diet regimen. When dieters tell themselves they can never have pizza again, they may feel they must consume as much as possible when they get a chance. Encouraging the individual to eat whatever foods they desire is meant to eliminate the need to binge. Of course, one must stop eating once one has reached an acceptable level of physical fullness. This paradigm may be best suited to aid individuals who are overweight due to binge eating. However, if overweight individuals routinely eat for nonphysiological reasons but do not binge, the intuitive eating approach may still be helpful.
There is some evidence to support the hypothesis that dieting can be a causal factor in binge eating for some individuals (10). In their comprehensive review, Polivy and Herman reported that dieting increases the likelihood of binge eating for both physiological and psychological reasons (11). Wilson and colleagues found that binge eaters were more likely to desire taboo foods such as chocolate and other sweets (12). However, subsequent research has found that binge eating patterns develop prior to dieting behavior (10, 13–14). Other research suggests that maintaining a low-fat or low-calorie weight loss diet may be unrealistic over the long term in western societies where high fat-foods are the norm (15).
The intuitive eating paradigm also shares similarities with the body acceptance/anti-dieting movement, which presents an alternative to promoting thinness. The body acceptance literature questions the assumption that obesity is a risk factor for poor health and suggests that diet composition and activity levels are more accurate predictors of disease risk. Individuals should not become fixated on losing weight, but rather learn to eat a healthy diet and incorporate exercise in their daily lives. Combining the basic ideas of the intuitive eating paradigm with body size acceptance may be a promising approach for optimal physical and mental health.
Limitations and Potential Benefits
The assumption of the intuitive eating paradigm is that the body wants to eat healthy food, and once diet restrictions have been removed the individual will crave and eat primarily nutritious foods. The intuitive eating paradigm is unique from other weight loss paradigms in that calories, fat, and physical activity are not central concerns. If the intuitive eater eats only what is physically wanted, pays attention to eating, eats only when hungry, and stops when satisfied, the intuitive eater will obtain enough nutrients and calories for their body’s needs and no more (6). The individual’s naturally thin body will begin to emerge; body wisdom will prevail.
Empirical research is needed to determine if intuitive eaters have healthier diets than the general population and if the assumption of the emergence of a naturally thin body is accurate. Empirical evidence is also needed to determine if weight loss will be maintained or at least stabilized by applying this new paradigm.
Similar to other weight loss perspectives, the intuitive eating paradigm does not ask us to examine the status quo related to the present culture of thinness. It places the responsibility for weight loss on the individual while disregarding genetic, sociological, and environmental variables that contribute to obesity. The intuitive weight loss paradigm ignores conventional advice and epidemiologic data about the harmful effects of a high-fat diet and sedentary lifestyle. It instead encourages individuals to eat any type of food desired and for the most part does not address the role of exercise as part of a healthy lifestyle.
Health educators and other health professionals have had limited success with long-term weight loss. The intuitive eating paradigm may be a successful alternative for people who have been unable to maintain weight loss using traditional methods. This paradigm may be especially useful for obese individuals who eat compulsively or for those whose excess weight is related to eating for nonphysiological reasons. If compulsive eaters can develop skills in identifying feelings of physical hunger and satisfaction, they may indeed consume fewer calories and fat grams and perhaps achieve a reduced body size. Compulsive eaters may also need to develop new coping skills to effectively manage emotions that lead to binge or compulsive eating. In addition, the concept of being able to eat whatever one wants and still lose weight may be liberating to individuals for whom counting calories and fat grams creates feelings of deprivation that lead to bingeing behavior.
Another benefit is that the intuitive eating paradigm, unlike other weight loss paradigms, addresses the issue that many individuals, especially women, have a problematic relationship with food. First, food may be used to cope with emotional issues in one’s life. This may be a good temporary distraction but does not offer a healthy, long-term method for meeting emotional needs.
Second, the calorie and fat restriction of other weight loss paradigms lead dieters to label specific foods as “good” or “bad” (13). Typically, good foods are valued for what they lack—fat and calories, rather than for high nutritional content or flavor. Bad foods would be all other foods. It can be argued that placing such value judgments on food choices results in guilt and shame when one does not stick with the prescribed diet. This may lead to future expectations of failure and decreased self-efficacy (16). The intuitive eating paradigm abandons the idea that food choice is a moral choice.
Third, when one is deprived of pleasant-tasting foods over a period of time, bingeing with the forbidden foods can result. Adhering to a restrictive diet followed by bingeing on forbidden foods is common and manifests itself in the practice of yo-yo dieting (11,12). Traditional dieting behavior may lead to binge eating for several reasons. The human body is very effective at survival. Our bodies are made to avoid famine when food intake is limited. When individuals are placed on very low-calorie diets, the body interprets this as a state of famine. When individuals then encounter high-fat foods, the body signals that a binge should take place so fat storage can occur in preparation for the next famine (or new diet). There may be psychological reasons for a binge to occur as well. It may be that when individuals believe that certain foods are off limits, these are exactly the foods they desire. When the dieter encounters a forbidden food, uncontrolled or binge eating may occur (11).
Conventional wisdom in health education assumes that given enough information about the risks and dangers of obesity, individuals will make a rational decision to avoid high-fat and high-calorie foods to maintain a healthy weight. This approach has not been successful for long-term weight loss. A primary benefit of the intuitive eating paradigm is that it may help compulsive eaters develop a more healthful and less antagonistic relationship with food. The individual may be empowered to stop dieting and start developing skills to listen to what their bodies both want and need. The individual who has not been successful dieting through means of deprivation may find this new approach liberating and more realistic than other weight loss paradigms. Current weight loss approaches do not allow individuals to eat what they desire but instead use behavior modification to help dieters to avoid taboo foods.
Health professionals can be cautiously optimistic about the potential benefits of intuitive eating while recognizing the need for empirical evidence to validate this paradigm.
Julie A. Gast, PhD, CHES is an Assistant Professor and Steven R. Hawks, EdD, CHES is an Associate Professor with the Department of Health, Physical Education, and Recreation at Utah State University.
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