DIET & LIFESTYLE
Intuitive eating in context: barriers and limitations
Leanne Thompson RD
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ntuitive eating (IE) has become increasingly popular, with many healthcare professionals embracing it as a non-diet framework and individuals affected by the psychological effects of chronic dieting adopting it as an alternative approach. There is strong evidence to support the use of IE as an alternative to restrictive eating, with reported benefits such as improved psychological well-being and reduced disordered eating behaviour. As a registered dietitian with a history of disordered eating myself, I strongly support IE and advocate for its use where appropriate. However, it is not a universal solution and may not be appropriate in every context. IE is an evidence-based framework developed in 1995 by dietitians Evelyn Tribole and Elyse Resch.1 As a non-diet approach to eating behaviour, it aims to strengthen interoceptive awareness, which is the ability to detect and process internal bodily sensations. This helps individuals respond to hunger and satiety cues, rather than regulating food intake around weight-loss goals. The IE framework is built around 10 principles that support individuals to move away from rigid dieting behaviours and rebuild trust between the mind and body. 1. Reject the diet mentality 2. Honour your hunger 3. Make peace with food 4. Challenge the food police 5. Discover satisfaction 6. Feel your fullness 7. Coping with emotions 8. Respect your body 9. Enjoy movement 10. Gentle nutrition Over the past decade, IE has gained attention as an alternative to weight-focused dieting, particularly as awareness has grown around the potential harms associated with chronic dietary restriction. Dieting has been
linked to a higher risk of eating disorders and poorer well-being outcomes, including low self-esteem and dietingrelated stress. In contrast, IE has been associated with lower levels of psychological stress and body image disturbance, while avoiding weightcentric goals.2 IE offers many benefits; however, it may have unintended consequences if introduced without careful assessment. EATING DISORDER RECOVERY Recovery from an eating disorder varies from person to person, but the principal goal is to promote metabolic stabilisation and, if appropriate, weight restoration. This is achieved by reducing restrictive eating behaviours to ensure adequate nutritional intake. IE may appear to be a suitable framework to follow. However, IE relies on an individual’s ability to build upon and implement interoceptive awareness, helping them to rely on their internal cues to drive eating behaviours. In people with eating disorders, this awareness is often significantly impaired, which can make hunger and satiety more difficult to recognise accurately, resulting
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in inadequate intake. A structured approach, described as ‘mechanical eating’, can ensure regular eating, which improves outcomes for those in the initial stages of eating disorder recovery. This involves relying on external cues, such as setting alarms or organising eating episodes to prompt eating. The REAL Food Guide (Recovery from Eating disorders for Life) is a framework created specifically for those in eating disorder recovery. It considers the challenges this patient group faces while providing adequate nutrition to meet recovery goals.3 However, impaired interoception is not the only barrier to applying IE. External factors, such as food insecurity, can also make its principles difficult to apply. FOOD INSECURITY (FI) FI refers to the lack of consistent access to adequate nutritious food due to financial factors. Interestingly, evidence suggests FI is associated with specific disordered eating behaviours; for example, those living with food insecurity are more likely to experience binge eating behaviours.4