Incorporating Intuitive Eating Principles into Eating Disorder Recovery
“Intuitive eating is an evidenced-based, mind-body health approach, comprised of 10 Principles. It is a weight-neutral model with a validated assessment scale and over 90 studies to date (Tribole 2017).”
Intuitive eating empowers each person to better understand and respond to the signals their unique body is sending them on a regular basis. Many things can interfere with a person’s ability to hear, feel, and listen to the signals their body sends them. Part of the process of working toward being able to intuitively eat again is to get curious about the different barriers that run interference in you hearing and listening to your body cues. Some common barriers include, but are not limited to, malnutrition and not eating enough, diet culture beliefs, fatphobia, dieting, eating disorders, having off-limits foods and fears around eating them, losing trust in your body, trauma, anxiety, and perpetually ignoring signals your body sends you.
Something important to recognize about intuitive eating is that it is centered around being able to nourish yourself pleasurably, adequately, and flexibly. Intuitive eating is not rule-based, restrictive, or focused on controlling weight. Unfortunately, diet culture has become aware of the effectiveness of intuitive eating on both mental and physical health and tries to “sell” versions of intuitive eating and package it up in the form of a diet. It is important to keep your eyes peeled for these versions of intuitive eating.
To read more about Intuitive Eating, click on this blog post and visit the resources at the bottom of this post.
To help understand what the journey back to Intuitive Eating can look like it is helpful to discuss what Intuitive Eating IS and what it IS NOT:
Eating disorders strip away the ability to intuitively eat. So much so that a person can become malnourished, further pushing them away from their ability to intuitively eat. In recovery from an eating disorder, a person can work on many principles of Intuitive Eating right from the start, while working towards the ability to eventually be able to practice all 10 Intuitive Eating principles fully. It is important to note that it is strongly recommended that a person is working with a treatment team when recovering from an eating disorder.
When someone is in the throes of an eating disorder and their body has undergone nutritional trauma, a structured meal plan of some sort is often needed for a period of time (this period of time varies from person to person and often reflects the intensity and duration of a person’s eating disorder). A structured meal plan when re-nourishing the body supports a person in healing from malnutrition, repairing any damages that occurred internally from the malnutrition, rebuilding body trust, normalizing adequate eating patterns, ensuring adequate nutrition for healing, and regulating satiety cues.
When malnutrition is present, a person’s body responds by slowing down different organs, a person’s gastrointestinal tract being one of them. This can lead to gastroparesis, or delayed gastric emptying (food sits in the stomach longer than normal). Because food sits in the gastrointestinal tract longer a person will experience early onset fullness. If a person were to listen to these early onset fullness cues and stop eating when full in the early phases of their recovery, they would be failing to nourish their body adequately. With malnutrition a person's “satiety meter” (the ability to feel hunger, fullness, and satiety accurately) is broken and needs to be fixed for them to have the opportunity to feel these cues authentically again. For a person who has lost weight in the throes of their eating disorder, full weight restoration is the first step to healing these cues. The body needs to get back to a place where it can fully re-nourish, heal, and stabilize for a consistent period of time. The body needs to trust it will get fed enough food, consistently, and that it will not be restricted again. This has to happen for the body to go back to functioning at its top capacity. Then, and only then, a person’s “satiety meter” has the opportunity to heal and be felt authentically. This means there is a period of time where an individual is following their meal plan, despite what their hunger and fullness cues are telling them. This is another reason why a meal plan is often necessary for a period of time in the recovery process.
Check out the principles below for more guidance on what, when, and how a person can incorporate the Intuitive Eating principles into their eating disorder recovery.
Principle One: Reject the Diet Mentality.
This principle can absolutely and should be worked on right from the start in eating disorder recovery. It is important to understand what diet culture is and what it is rooted in. It is necessary to understand in more detail why diets and restriction do not work and are harmful, both mentally and physically. Increased awareness around diet culture and the diet mentality can help to externalize the messages diet culture imposes in your day-to-day living rather than internalizing them and blaming yourself.
It is also very important to further understand how malnourishment from eating disorders severely harms a person’s body and mental state.
Principle Two: Honor you Hunger.
This principle can be honored in some capacity right from the beginning of your recovery and in other capacities can be practiced further along in your recovery, once you are fully re-nourished, weight restored, and your appetite cues have resurfaced regularly and authentically.
Hunger is a signal your body sends to help you meet your own, unique nutritional needs. It is not there to trick you and it is important to respond to this cue when it is present. You can read more about hunger here.
As discussed earlier in the article, early phases of recovery require eating despite lack of appetite and early onset fullness to support the body in healing from malnutrition and regulating appetite cues once again. This means that in the early phases of recovery you cannot rely on “eating when hungry” and likely will need a meal plan to support you in adequately meeting your nutritional needs for healing.
The most helpful way to practice this principle right from the start in eating disorder recovery is to work with a Registered Dietitian to create a plan that includes regular times and amounts to eat throughout the day. If hunger comes up in between these set times, practice honoring that cue. Honoring that cue will only further help you to heal your mind-body connection.
Lastly, you can also work on this principle by listening for and satisfying your cravings. Cravings are a form of hunger. So, if something sounds good, see if you can practice allowing yourself to honor this craving. Click the bolded link to read more about the importance of honoring your cravings in healing your relationship with food and body.
Principle Three: Make Peace with Food.
This principle can absolutely be worked immediately in eating disorder recovery. Often the process of making peace with food includes identifying what foods feel challenging or “off-limits”, learning more about what fear-based thoughts are associated with them, bettering your understanding of why these foods are okay to eat, practicing talking back to these fear-based thoughts regularly, and allowing yourself to include these foods in your day-to-day eating routine.
Something that can also interfere with your ability to feel your hunger, fullness, and satiety cues (“satiety meter”) authentically is stress and anxiety around eating certain foods. When stress or anxiety is present, it can interfere with feeling appetite cues. Making peace with food further supports in the attunement process.
Principle Four: Challenge to Food Police.
This principle can also be focused on at the very beginning of your recovery process. Challenge the Food Police includes building awareness around rules or rigid thoughts that have been created around food and body and that often fuel eating disorder thoughts. Learning where this voice is coming from and also developing the strength to talk back to these thoughts through a self-compassionate, recovery-oriented lens helps with decreasing some fear, shame, and/or guilt that may be present around your eating.
Principle Five: Respect Your Fullness.
This principle has to be put on pause until you have fully and consistently worked on re-nourishing your body and have weight restored for some time. As written above, when someone is healing from nutritional trauma, they often feel early onset fullness related to gastroparesis (delayed stomach emptying). It takes eating past this early onset fullness to be able to heal the body from malnutrition and to wake up your metabolism.
Another reason that it is not helpful to focus on fullness is that often when a person is feeding themselves adequately and consistently and has progressed in the process of making peace with food and challenging the food police, fullness figures itself out without having to put much focus on it. Focusing on fullness too early in the recovery process can hinder progress and further feed into any intrusive thoughts or fears around fullness and eating.
Principle Six: Discover the Satisfaction Factor.
This principle can be practiced early in your recovery by learning to choose satisfying and pleasurable foods versus “safe” or “less feared” foods. Eating satisfying and pleasurable foods is necessary to feel our attunement cues authentically and get us the nutrition our body requires. Even within the structure of a meal plan, there is freedom to choose what you eat and to tune into your eating experience.
Later in the recovery process, when the body has been fully weight restored and has healed from malnutrition, it is important to learn to eat to a place of satisfaction AND fullness. Feeling satisfied after eating is necessary to be able to nourish yourself completely. There is a big difference between feeling satisfied after eating and feeling full. You can feel full without feeling satisfied. If you leave a meal full, but not satisfied, you are not meeting your needs completely. Feeling satisfied after eating means you met both your physical and emotional needs in that given meal. This is essential to working back to a place of intuitive eating.
Principle Seven: Cope with your Emotions with Kindness.
The mind-gut connection is very strong. Often when a person is experiencing emotions mentally, they are also experiencing them physically. One way emotions can physically manifest is in your gut and shows up through GI symptoms (gas, bloating, loss of appetite, etc.). This is normal. Learning to cope with your emotions AND still feed yourself adequately, is a key component of intuitive eating. Learning to do this without turning to harmful and/or restrictive behaviors will be essential to your healing.
Diet culture instills fear around the word emotional eating. Emotional eating is normal. I will say that again, emotional eating is normal. It is part of being an intuitive eater. It is not a bad thing. Emotional eating can become uncomfortable for many when eating feels like the only coping tool in the “toolbox” to deal with difficult emotions. Something that is necessary when learning to cope with your emotions with kindness is to normalize emotional eating and keep it as one tool in the toolbox along with the many others. Demonizing emotional eating often further keeps a person swinging back and forth from restriction to binging on an emotional pendulum of deprivation. It also intensifies fears, guilt, and shame around eating.
Principle Eight: Respect Your Body.
This principle can absolutely be practiced right immediately. Learning to operate from a place of “self-care NOT self-control”, a mantra coined by Christy Harrison, MS, RD, is essential. Every act of self-care is one step forward in healing our relationship with food and body. In early phases of recovery, this can mean meeting your meal plan to adequately nourish and heal your body. It can mean honoring a craving, setting boundaries, asking for help, finding comfort in the clothes you wear, the relationships you have, and even in the food you eat, and so much more.
Principle Nine: Movement Feel the Difference.
When you are medically stable, at a safe place in your recovery, and when you are feeling wanting and ready, introducing movement back in from a place of self-care and with the intention to feel good can be empowering. It will be important to explore your motivations behind exercise. One way you can do this is to hold Christy Harrison’s mantra “Self-care NOT Self-control” in your back pocket and to ask yourself if your motivation to move your body more is coming from a place of self-care or self-control. If noticing your desire to move is coming from a place of self-control, look a bit deeper to see if you can better understand what need or desire may be suppressed and coped with through controlling or punishing movement.
When adding movement back in, it is also important to make sure you are taking care of your body by increasing your nutritional needs to refuel your additional activity. This is self-care.
Principle Ten: Honor Your Health – Gentle Nutrition
Aspects of this principle will be worked on throughout recovery in that you will be working on adequately nourishing yourself with a variety of different foods. Variety in your eating is important to adequately nourish yourself and to feel satisfied and full after eating. Getting too hung up on nutrition facts or getting your eating “just right” interferes with recovery and a peaceful, non-stressful relationship with food. It may also reinforce orthorexic eating patterns.
Before putting too much emphasis on this principle it is essential you first make peace with all foods and feel comfortable allowing yourself to eat them regularly, in varying quantities, and in a pleasurable and satisfying way.
It is always recommended you work with a treatment team that specializes in eating disorders to support your recovery process and to help you work back to a place of intuitive eating, should that be a goal for yours.
Resources to learn more about Intuitive Eating:
Christy Harrison’s Website & Book, Anti-Diet
Article: Tribole, E. Intuitive Eating in the Treatment of Eating Disorders: The of Attunement. Perspectives. Winter 2010: page 11-14