Healthy Mind, Healthy Body

Pay attention - listen and observe your body, without judgment

Have Patience - many people have been following diets or influenced by diet culture for years and years. It can take a long time to unlearn and begin to trust your body again.

Practice - progress is not linear, it does not always go in a straight upward line. There are bumps in the road, and sometimes it can feel like you are taking two steps forward and one step back. The process of becoming an intuitive eater encourages you to have a mindset of curiosity, rather than judgment. So when there are periods of returning to old habits, you can learn and grow from them.

disordered eating

emotional eating

Body dissatisfaction

Binge eating or loss-of-control eating

Lower blood pressure and Triglycerides

Self-esteem and body appreciation

Well-being, life satisfaction and optimism

Pleasure from eating

Variety of foods eaten

HDL (“good”) cholesterol

Principle 1 - Reject the Diet Mentality

Principle 2 - Honor Your Hunger

Principle 3 - Make Peace with Food

Principle 4 - Challenge the Food Police

Principle 5 - Discover the Satisfaction

Principle 6 - Feel Your Fullness

Principle 7 - Cope with Your Emotions with Kindness

Principle 8 - Respect your Body

Principle 9 - Movement - Feel the Difference

Principle 10 - Honor Your Health with Gentle Nutrition

genetics and biology

access to quality healthcare, availability of healthcare providers that are culturally and linguistically competent

environmental factors like air quality, water quality, crime level, job opportunities, access to healthy food and recreation

Social factors like having social connectedness and community support, income level, inclusion or discrimination, education level and occupation

Individual behavior like smoking habits, diet patterns, sleep patterns, physical activity patterns, and stress management

What do you think about this type of approach?

How do you think Intuitive Eating can help you?

What concerns do you have?

What do you think some challenges will be in going through this process?

For the activity, you’ll need a piece of paper and a pen, and a quiet environment without distractions

Start by writing your name on the paper, using your dominant hand (for most people, this is your right hand). Notice how the pen feels in your hand as you write.

Then, switch hands. Place the pen in your non-dominant hand (for most people, this is your left hand). Take your time, and write your name below where you wrote with your dominant hand. Pay attention to how the pen feels in your hand.

Compare the two names you wrote. Is there a difference between them? How so?

How did it feel to hold the pen in your non-dominant hand? Was it awkward? How did it physically feel when you wrote your name with your non-dominant hand? How did that feeling compare with writing with your dominant hand?

What were your thoughts when you were writing?

What were your feelings when you were writing?

Did you have the belief that your writing should have been the same with your non-dominant hand, even though that hand has less experience with writing?

Learning to become an intuitive eater is a lot like learning how to write with your non-dominant hand. It takes practice and patience. You already know how to eat, just like you know how to write your name. But you’re tapping into a different skillset, flexing different muscles, and challenging old beliefs about food and eating. Paying attention and listening to your body will help you to be patient throughout this process.

Intuitive Eating Assessment - what section stood out to you? Were you surprised by any of your responses?

Intuitive Eating Principles - which principle(s) are you most interested in exploring? What questions do you have about the principles?

Handwriting Activities - What did you learn from this activity?

The reason why this principle is first is because rejecting diet culture is so valuable in allowing yourself to trust your body and become an intuitive eater. Dieting and diet culture tells us that our bodies can’t be trusted, and that we need external rules about when, what, and how much to eat. But your body can absolutely be trusted.

Diets do not work for the vast majority of people. Studies have shown that dieting increases the risk of gaining more weight. When we go on a diet, the cells of our body interpret this as a kind of starvation or semi-starvation. Your body doesn’t know you’re doing this intentionally, so it acts on instinct to survive. Your body will slow down your metabolism to avoid losing weight, will increase your hunger and cravings to try and get you to eat more. And when you come off your diet, your body will rejoice by increasing your appetite and storing extra fat to protect itself from future diets.

There is a lot of talk in healthcare about a ‘healthy weight’, but this term is really a myth.

The Body Mass Index (BMI) scale promotes the myth that there is a specific weight that is best or healthiest for a person. But, the BMI scale was never meant to be a metric for saying how healthy a person is. It was created and first called Quetelet’s Index about 200 years ago by an astronomer named Adolphe Quetlet, who was not a doctor. He studied the weights and heights of French and Scottish participants to determine averages for these populations. It’s upsetting to know that Quetlet’s racist beliefs meant that he used the index to talk about the ‘ideal man’ proportions, and that people of color were inferior. Read more about the history of BMI here

In the 20th century, life insurance companies began using this index to help determine how much to charge for life insurance policies. The index was renamed to the Body Mass Index, and while further research was meant to see if it could be used to estimate how much fat a person has in their body, it turns out it’s not a very good indicator for that either

To further show how arbitrary the cutoffs in the BMI index are, in 1998 the cutoff from “normal weight” to “overweight changed from 27 to 25. So, overnight, millions of people who were classified as “normal weight” with a BMI of 25 or 26 became “overweight”. Their health didn’t change overnight, just how they were classified according to the BMI scale.

The truth is that weight or BMI is not an accurate predictor of how healthy someone is. You can be healthy at any size. Even with medical conditions that are often associated with being in a larger body size, it does not mean that a larger body size caused those problems. There are slim people who have high blood pressure, diabetes, arthritis, and heart disease. Simply living in a larger body does not mean that you are destined to be unhealthy.

Let’s watch this video (3 min) called Poodle Science, that helps illustrate this point. <WATCH VIDEO> What are your thoughts on this?

Research has shown that dieting negatively affects our physical and emotional well-being

Physical - dieting often leads to weight cycling, or ‘yo-yo’ dieting, where weight is lost, then gained, then lost again, and gained again. Research shows that this pattern of losing and gaining weight is more harmful to our health than being in a larger body. Read more about weight cycling here.

Weight cycling is associated with:

Emotional - dieting can affect our emotional well-being by leading to feelings of guilt and shame when eating foods that are considered ‘off limits’ by the diet, and when a diet is abandoned because it was too strict to begin with.

Weight Stigma - Diet culture promotes an ideal thin body in our society, which leads to discrimination and stigma against people in larger bodies. Being discriminated against is harmful to our health and can make receiving basic healthcare very difficult and stressful. Read more about weight stigma here.

Tell me a bit more about your history with dieting? When did you first go on a diet? What was that experience like?

What trends do you see with your body weight since you first started dieting?

Currently, do you find it difficult to stay on a diet?

In what ways has dieting negatively affected your life? Physically, socially, emotionally?

What are your beliefs about weight loss, in general and about yourself?

Where did those beliefs come from? Was weight mentioned often during your childhood?

How do you imagine your life might change if you were to lose weight?

What are your feelings about putting weight loss ‘on the back burner’ while working on improving your relationship with food?

What would your life be like if you never went on a diet again? How much time would you save? Money? Stress?

BMI - https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb

Weight Cycling - https://www.nationaleatingdisorders.org/weight-stigma

Weight Stigma - https://www.nationaleatingdisorders.org/weight-stigma

How has dieting affected your social life?

How has dieting affected your eating habits?

How has dieting affected your mood or emotional health?

What physical consequences have you seen from dieting?

How much of your time do you spend thinking about food or dieting?

Here are some of the common tools of dieting. Review this list and mark off which of these you currently use.

Review the list of tools that you currently use. Select 2 or 3 that you feel ready to let go of.

With each that you feel ready to let go of, write down one step you could take to let go of it (for example, deleting a calorie-tracker app; or removing your bathroom scale from the bathroom and into a closet)

Dieting Tools

The second principle of Intuitive Eating is ‘Honor Your Hunger’. With this principle, you’ll learn how to listen to your body’s natural hunger signals, and how it feels to honor, rather than avoid or suppress them.

Often, dieting involves pushing past hunger, ignoring it, or reframing hunger as a ‘positive’ sign that your diet is “working”. But hunger is a natural biological sign that your body needs fuel.

Intuitive eating centers around a concept called interoceptive awareness, which means being able to sense things that are going on inside your body and respond to them

By tuning into what’s going on inside your body, you will have a greater connection to your body, be able to better give your body what it needs, and feel your body saying ‘thanks so much!’ after it gets what it needs.

An excellent way to tune into interoceptive awareness is with the heartbeat activity. Let’s do it together now.

Let’s get relaxed and comfortable in our chairs. Take a few deep breaths to help feel even more relaxed. Now, place your pointer and middle finger on the side of your neck or on your wrist, in order to feel your pulse. Do you feel it?

Once you can detect your pulse, I’m going to start a timer for 30 seconds. Go ahead and count how many times you feel your heart beat in that time. I’ll do it with you.

<30 seconds>

How many beats did you count?

Now, let’s try it again, but this time, without touching your neck or wrist. It’s tricky. You might not be able to do it at first, and that’s ok. We’ll try it together. Let’s take a few deep breaths, find out pulses, and count.

<30 seconds>

How many beats did you count?

How was that experience?

What did you notice about counting your heart beats without touching your neck or wrist? Could you feel your heart beat? Where did you feel it in your body?

It’s interesting, you know your heart is beating, so even when you cannot detect it, you still know that you are alive, you know that it’s beating. You don’t doubt it. But often with our hunger signals, when we can’t perceive them, we assume we cannot be hungry.

If you’ve spent a lot of time around babies or young children, you’ve probably noticed that hunger signals start off small and then grow. Babies express their hunger subtly at first, by turning their head from side to side or moving their lips. As their hunger grows, they might bring their fists to their mouth, and wiggle around more. And when their hunger becomes more intense, they cry and wail.

In many ways, our adult bodies are no different. Your body sends out subtle hunger signals at first, but if those signals are ignored, they get louder and louder.

We often think of hunger signals as those in your stomach, like gurgling or grumbling. But some people don’t experience these hunger signals at all! You might experience hunger in other parts of your body, such as:

There are many situations where you might not be able to notice your hunger, or it’s tricky to honor your hunger. Some of these situations might be:

Through the work of being more mindful of your hunger, you will start to notice patterns in your natural hunger, and how you physically and emotionally feel when you honor your hunger.

For example, some people find that they naturally have a slump of energy halfway through the afternoon. There could be many reasons for this, but by listening to hunger signals, you might find that your body needs to re-fuel with a snack to fill the stretch between lunch and dinner. Noticing how your body feels with this snack will give you the confidence to trust your body’s hunger cues and honor them, rather than pushing through hunger out of worry that you’re “not really hungry”

Let’s take a look at this Hunger and Fullness scale, in a handout from Boston Children’s Hospital

Imagine that your hunger and fullness exists on a scale from 1 to 10, where 1 is extreme unpleasant hunger, and 10 is extreme unpleasant fullness. 5 is in the middle, neither hungry nor full.

In this handout, the boxes shaded in blue (numbers 3 through 7) might represent feelings that are more pleasant, or enjoyable. And the extremes, 1 or 2 on the hunger side, and 8 to 10 on the fullness side, might represent more unpleasant feelings.

Note that the numbers that are pleasant or unpleasant should be unique to you and your experience. Some people really dislike the feeling of hunger, so for them a number 3 might already feel unpleasant, and that’s ok. Other people might enjoy a feeling of fullness more, and perhaps a number 7 still feels pleasant to them. That’s ok too. The shading in this worksheet is just an example.

Pick a quiet day or two to practice observing your hunger feelings. Starting from when you wake up, take a brief pause every hour or two during the day to check in with your body. Ask yourself where you fall along this hunger and fullness scale. You might want to set a reminder on your phone or a recurring alarm to go off so you remember to check in.

Simply observe, without judgment.

In addition to rating your hunger and fullness on the 1 to 10 scale, also see if you can rate the quality of your feeling, either as pleasant, unpleasant, or neutral. That will give you some clues as to what is an ideal time to start and end a meal.

Go through this process, and see what you notice. See what patterns emerge, and what subtle signs of hunger your body sends to you before the more intense signals rise up.

Pick a quiet day or two to practice observing your hunger feelings. Starting from when you wake up, take a brief pause every hour or two during the day to check in with your body. Ask yourself where you fall along this hunger and fullness scale. You might want to set a reminder on your phone or a recurring alarm to go off so you remember to check in.

Simply observe, without judgment.

In addition to rating your hunger and fullness on the 1 to 10 scale, also see if you can rate the quality of your feeling, either as pleasant, unpleasant, or neutral. That will give you some clues as to what is an ideal time to start and end a meal.

Go through this process, and see what you notice. See what patterns emerge, and what subtle signs of hunger your body sends to you before the more intense signals rise up.

At which number on the hunger scale did you usually feel hunger?

By the time you noticed your hunger, would you describe the feeling as pleasant, unpleasant, or neutral?

What trends did you notice with your hunger rating?

At which level of hunger did it feel just right to you?

For some people this principle, making peace with food, can be the most challenging, but also the most rewarding.

Making peace with food means that you can start to look at food as food, not as a moral judgment on your worth or value as a person.

Food marketing messages and our overall diet culture try to paint different foods as being morally “good” or “bad”. For example, foods that are labeled as ‘sinfully delicious’ - as if it’s a sin to eat it. Or foods that are ‘guilt-free’, as if you should feel guilty for eating a different version of that food.

When you make peace with food, you can eat it because you enjoy it, without guilt or shame

Making peace with food involves giving yourself unconditional permission to eat a food. It’s trusting yourself enough to say “go ahead, I can eat as much of this food as I want”. And really, truly meaning it.

When you truly give yourself permission to eat a food, you can taste it and experience it, without the influence of diet thoughts like “am I eating too much” or “how many calories is in this” or “this isn’t good for me, I should stop”. Instead, you can ask yourself questions like “Do I like how this tastes?” or “Is this food meeting my expectations?” or “Do I like how this food feels in my body?” and “Do I want to eat this again in the same way?”

Dieting is a form of deprivation, whether it’s through limiting food groups, portion sizes, counting calories, or earning food through restraint or exercise.

There are many ways that going on a diet, or coming off a diet, influences our food choices in ways that might not be in alignment with what our bodies really want. Some of these examples are:

Whenever we experience some form of deprivation, it’s human nature to desire that thing we are deprived of.

Habituation means that a food is less ‘novel’, ‘special’, and ‘overly exciting’. There are lots of examples of how we experience habituation in other areas of our lives like: <NOTE: use examples depending on what would be beneficial to the patient>

Dieting gets in the way of us becoming habituated to a food, because it always keeps it in that ‘special’ category. A food stays a ‘forbidden fruit’ because it’s meant to be avoided

Making peace with food takes time. The goal is not to ‘burn out’ on a food by eating it so much that you get sick of it. It’s to eat it several times, mindfully, observing your thoughts and experience of that food. Some people do find that when making peace with a food, they eat more of it than feels good. That’s normal. It can take time for you to really trust that you are giving yourself permission to eat.

To start to make peace with food, consider making a list of foods that you avoid, are fearful of eating, or feel out of control with.

Rank those foods depending on how great your fear or concern is.

Choose a food to start with that is not ranked very high on your list.

Choose a time when you are not too hungry, and a day where your mood will be generally good (probably not during a stressful day). Think about other types of support that will help you in this process, like having the support of a friend or family member, or some extra self-care prior to eating the food.

When you’re ready to start eating a food, take a moment to think about your thoughts and feelings before you start eating. Are you excited? Curious? Fearful?

While you’re eating, really notice the taste, texture, and feeling of the food in your body. Are you enjoying it? Is it meeting your expectations?

Allow yourself to eat as much of the food as you desire. Remind yourself that this food will be available again whenever you want it again.

After eating, evaluate how it went. Did the experience meet your expectations? Would you do anything differently next time?

Practice reminding yourself that you can have that food again as often as you desire.

To start to make peace with food, consider making a list of foods that you avoid, are fearful of eating, or feel out of control with.

Rank those foods depending on how great your fear or concern is.

Choose a food to start with that is not ranked very high on your list.

Choose a time when you are not too hungry, and a day where your mood will be generally good (probably not during a stressful day). Think about other types of support that will help you in this process, like having the support of a friend or family member, or some extra self-care prior to eating the food.

When you’re ready to start eating a food, take a moment to think about your thoughts and feelings before you start eating. Are you excited? Curious? Fearful?

While you’re eating, really notice the taste, texture, and feeling of the food in your body. Are you enjoying it? Is it meeting your expectations?

Allow yourself to eat as much of the food as you desire. Remind yourself that this food will be available again whenever you want it again.

After eating, evaluate how it went. Did the experience meet your expectations? Would you do anything differently next time?

Practice reminding yourself that you can have that food again as often as you desire.

We use the term “Food Police” to talk about unreasonable and harsh rules that diet culture has created. Food Police talk can come from diets directly, from the media, food companies, and even from our family, friends, and ourselves. Often, Food Police talk is so ingrained in our minds, we might accept those thoughts as facts without even realizing it.

In the process of becoming an intuitive eater, recognizing and challenging Food Police talk is helpful to be compassionate towards ourselves, and to form your own thoughts and opinions about food, without the harsh criticism and judgment of the Food Police.

Let’s review some of the common beliefs about food. See which of these you tend to agree with or believe is true:

Pick one or two of the beliefs above. Let’s talk about where these beliefs come from. Where do you think these beliefs came from in your life?

What negative thoughts do you have that stem from these beliefs? For example, “I should avoid carbs during the day, even if I’m craving them” or “I should not eat past 7pm at night, even if I’m hungry”

Now, let’s debate ourselves about these food police thoughts. Can you ask yourself a question, to play the other side of this debate. For example:

What are some actual experiences from your life that can help give evidence to these food police thoughts? Let’s reframe them based on the evidence that you’ve collected and observed. For example:

You can practice this activity of examining food beliefs, challenging them, and reframing them based on your experience and evidence.

Similar to examining our food beliefs is to take a trip down memory lane to some of the food rules that we’ve grown up with.

What do you think about talking about what food was like for you growing up? Would that be ok with you? <NOTE: for patients with a history of trauma, this might understandably be a topic that could be very sensitive or triggering. Ask permission before going into these questions.>

We might find that food rules from childhood stick with us into adulthood. Or, perhaps, sometimes our adult selves rebel against rules that were imposed on us from childhood.

Think about the way you talk to yourself about food and your food choices. Let’s go through some examples, and see how it feels.

If you say to yourself:

How would that self-talk make you feel?

Now, what if the self-talk went something like this:

How would that self-talk make you feel? Do you feel the rebellious energy from a child or teenager coming up?

How, what about this more neutral, observant self-talk:

How would that self-talk make you feel?

Sometimes, we use harsher language to ourselves than we would use with other people. And when we use harsh or negative words toward ourselves, it feels awful.

That rebellious inner voice, that’s protection. It’s your body protecting your autonomy, your control over yourself. It’s your body standing up for itself. When we use harsh language toward ourselves, it can lead to that inner rebellious voice coming up.

Think about what you can say to yourself in those moments, to remind yourself that you have compassion and the authority to do what you want.

One of the most important elements to becoming an intuitive eater is developing compassion towards yourself.

Many people have spent years judging yourself for your food choices, and that judgment and negative self-talk is hard to talke.

With all our work in intuitive eating, try to approach it with CURIOSITY and OBSERVATIONS.

For example, when observing your feelings of hunger during the day, you can say to yourself:

When examining your Food Police thoughts, take a similar approach, saying to yourself:

Intuitive Eating is a journey, a learning process. Sometimes it will feel like you’re taking two steps forward and one step back. That’s ok. It’s part of the process. By having a curiosity mindset, you can take a pause and learn from those periods where it feels like you’re moving backwards, instead of being filled with feelings of judgment and criticism.

What was food like for you as a kid?

What were some of the rules your parents/caregivers had around food?

Were there any rules at mealtimes? Did you have to clean your plate, or eat a certain amount of something to get a dessert?

Were there any rules around snacks?

Did your parents/caregivers go on diets frequently?

Were you ever put on a diet as a kid?

It seems like we are always multitasking. Our busy schedules often mean that when we focus on only one thing at a time, it feels like we’re being lazy or unproductive.

But, with eating, focusing on your meal and practicing mindfulness can help you enjoy your food more, and feel your fullness

When you are able to feel your fullness and truly enjoy your food, you will be better able to listen to your body to know when it’s time to end your meal or snack.

There are many barriers to feeling your fullness when eating. Let’s go through some, tell me which of these you tend to do:

Distracted Eating - eating while watching TV, looking at your phone, or reading; working through lunch; doing chores; driving; talking on the phone; eating while standing up

Cleaning your plate - this could be from a childhood rule perhaps, or having difficulty throwing out food, not wanting to waste food, not wanting to hurt someone’s feelings by leaving too much on your plate.

Feeling overly hungry - sitting down to eat when you’re overly hungry, unpleasantly hungry, might lead you to eat very fast, barely tasting your food.

Just as there are many different ways people experience hunger, there are also different ways that people experience fullness. Here are some:

Keep in mind that your body will need different amounts of food at different times, so it won’t always take the same amount of food to feel full after a meal. Some reasons why you might feel more or less full are:

Remember our goal for intuitive eating is not to be perfect, and not to turn intuitive eating into another diet with strict rules. When it comes to mindful eating, there are lots of different practices you can try. Some might work for you, others not so much. That’s ok. You do you. It’s also not necessary to try and eat 100% mindfully at every single meal. That’s probably not realistic, and can cause more stressy

Rather, think through which of these mindful eating ideas sounds interesting to you, and try them out. Approach these as experiments, see how you feel when you try it at your meal. If you see benefits, and those benefits are meaningful to you, you’ll be more likely to want to continue with these practices… most of the time.

<NOTE: being able to eat mindfully is a privilege. As providers, we must acknowledge our privileged identities, and recognize that many of our patients might hold marginalized or multiple marginalized identities. The goal of mindfulness is to help a person get more enjoyment out of their meal, in whatever is meaningful to them.>

Here are some mindful eating practices to explore:

The staying power of different foods

What food comparisons did you try? What did you expect to happen?

Which meal or snack filled you up more easily? Which kept you full for longer?

How do you think you’ll approach that meal or snack in the future?

When is the last time you really, truly enjoyed a meal? Describe what the meal was like, the environment, the mood, the food itself.

Diet culture wants you to think that eating food that is enjoyable, pleasurable, is somehow a bad thing. It must be unhealthy if it tastes that good!

But really, food is essential for life. It makes perfect sense why food is and should be pleasurable. If food wasn’t pleasurable, the human species would have died out a very long time ago.

What happens when we eat food that isn’t pleasurable, isn’t satisfying? Have you ever had the experience of having a craving for something, but not allowing yourself to have it, choosing something else instead? For example, you’re craving a cookie, but are trying to avoid sweets, so instead, you might have a piece of fruit. But that isn’t really hitting the stop, so you might have something else, maybe some crackers. That isn’t doing it either, so maybe you have… some cheese…. Then something else… and so on. How do you think it would have felt to give yourself permission to have what you really were craving?

Or, maybe, you don’t really even know what food you like anymore. Dieting is all about rules, and many diets have specific meal plans, menus, or recipes to follow. Yes, there is an allure to this, it makes it so there is one less decision you have to make during the day. It can take some time to get back in touch with what your body really wants to eat. But when you are able to choose foods that are nourishing and satisfying, you can feel content with your meals and better listen to your body’s feelings of hunger and fullness.

The question “What do I really want to eat?” may be a tricky one to answer.

Your answer might be influenced by food rules (for example, always having a vegetable with dinner, or avoiding “bad” foods). In intuitive eating, we encourage you to give yourself permission to enjoy any food, without labeling it as “good” or “bad”

Here are some different considerations you can ask yourself when you’re trying to figure out what you really want to eat. Try to ask yourself these questions when you’re moderately hungry, rather than not hungry at all. If you feel comfortable, close your eyes and picture different foods in your mouth and stomach, to better help you sense what foods would be satisfying for you.

TASTE

TEXTURE

TEMPERATURE

AROMA

APPEARANCE

VOLUME

How do you see yourself using these questions and considerations when thinking about what to eat?

One activity you can do this week is use a Mindful Eating Script to try a food.

Another mindfulness activity is taking a pause during your meal to check in with your body.

One activity you can do this week is use a Mindful Eating Script to try a food. Select a time and place where you won’t have any distractions. Choose a food that is small and doesn’t require utensils, like dried fruit, chocolate, nuts, pretzels, fruit, etc.

Read through the script and follow along. You might want to read it through once in full before trying the food, so you can focus on the eating experience rather than keeping up with the script.

When you finish eating, take a moment to pause and reflect on how the experience went. What did you notice? Did the eating experience meet your expectations?

Practice this mindful eating activity a few times this week.

Eating is connected with emotions. Since the day you were born, food has brought you joy and comfort, helped you feel relaxed, and has been a part of celebrations and special events. This is not a bad thing. Remember the last principle, where we spoke about the joy and pleasure of food? That is not a bad thing.

The purpose of this principle, Coping with your Emotions with Kindness, is not to teach you that emotional eating is bad and you should never do it. That’s not what this is about. Sometimes, we can feel grateful for emotional eating. Imagine if there was a very tough situation going on for you, but there were no other coping mechanisms available except for food. How great that food IS available to help you cope with that difficult time. What would it feel like to have no coping mechanisms available at all?

This principle is to help you identify emotional or situational triggers that might cause you to eat to soothe these emotions, and then help you find other options for coping. Sometimes, food might be the coping mechanism that you choose, and that’s ok. But, other times, there might be better coping mechanisms to choose from, to better support you in tough times, or to better support your health. That’s what we’re looking for… options.

When we’re lacking in the self-care department, it can be tough to connect with our body and feel our hunger and fullness. Food might also be more rewarding. Let’s talk about some of the main elements of self-care.

SLEEP - getting enough sleep at night helps your body function its best, have energy to do all the tasks you want to do, and can affect your appetite. Research shows that when we don’t get enough sleep (less than 6 hours), we might crave more sweets, carbs, or comforting foods, to give us the energy that we need but didn’t get from rest. How is your sleep?

STRESS - what are some of the sources of stress in your life? What helps you cope with stress?

BALANCE - balancing work, family life, play, rest, movement, relationships can be tricky. Where do you feel like you might have some imbalance in your life (if at all)? What would you like to see more of in your life?

NOURISHMENT - eating consistent meals with enough energy helps keep you well fed and out of that overly-hungry state. When we are not eating enough, our body brain senses a semi-starvation state, which can lead to overeating or feeling out of control with food. Revisiting some of the ideas from Principle 2 - Honor Your Hunger, might be helpful.

Food can serve so many roles in our life, and can help soothe many different emotions. Let’s take a look at this emotion wheel, which can help you name a specific emotion that you’re feeling. https://thechalkboardmag.com/the-feelings-circle-chart-emotional-communication

What emotions trigger overeating for you?

What are some recent examples of emotional triggers?

There are three main ways to cope with your emotions without using food, let’s talk about each one

Our weight-centric, fatphobic society teaches us that there is something wrong or bad about larger bodies (when really, there isn’t). Our world is filled with body bashing and shaming, which can make us feel like our body isn’t deserving of respect if it doesn’t conform to a certain “ideal” appearance.

This principle is about cultivating respect for your body, and starting the work of separating your worth from your appearance.

Remember the video we watched from our earlier sessions, Poodle Science? Would it be helpful to watch that again? <LINK>

The majority of what determines our body weight and size are things that we don’t have control over, like genetics. By coming to a place of acceptance with our body, we can begin to show it respect and love, instead of trying to change it. We can respect our body and help it feel good, take care of our health, without that end goal being a specific number on the scale.

We use the word ‘respect’ here because many people describe it feeling like a more genuine word than ‘body kindness’ or ‘body love’. Sometimes, we just don’t like our body. That’s ok. But we can still show it the respect it deserves.

Here are some ways to think about showing respect to your body

Begin to recognize negative thoughts about your body. Pay attention to negative self-talk. How do these thoughts make you feel in the moment?

If a close friend told you that they had similar thoughts about their body, how would you respond? How is that response to a friend different from the way you speak with yourself?

How would it feel to speak with yourself with the same kindness and compassion that you would use with a friend?

Refocusing and shifting your negative body thoughts can be a helpful way to move past them. One way to shift your thoughts is to stop, and instead look around and narrate your surroundings. For example, you could say to yourself “I see my desk, I see my red notebook, I hear birds chirping outside, I hear a car honking…” Whenever you hear negative body thoughts come back in, observe them and shift your focus.

Another way to help refocus your thoughts is by acknowledging that two things can be true at the same time. You can be having a tough body image day AND still eat regular meals. You can be feeling negatively toward your body AND be grateful for parts of it at the same time.

What do you think you would need in order to show your body respect?

What positive behaviors are you thinking about trying to help show your body more respect?

Begin to recognize negative thoughts about your body. Pay attention to negative self-talk. How do these thoughts make you feel in the moment?

If a close friend told you that they had similar thoughts about their body, how would you respond? How is that response to a friend different from the way you speak with yourself?

How would it feel to speak with yourself with the same kindness and compassion that you would use with a friend?

Refocusing and shifting your negative body thoughts can be a helpful way to move past them. One way to shift your thoughts is to stop, and instead look around and narrate your surroundings. For example, you could say to yourself “I see my desk, I see my red notebook, I hear birds chirping outside, I hear a car honking…” Whenever you hear negative body thoughts come back in, observe them and shift your focus.

Another way to help refocus your thoughts is by acknowledging that two things can be true at the same time. You can be having a tough body image day AND still eat regular meals. You can be feeling negatively toward your body AND be grateful for parts of it at the same time.

What do you think you would need in order to show your body respect?

What positive behaviors are you thinking about trying to help show your body more respect?

We use the word ‘movement’ instead of ‘exercise’ here because so often exercise is used to describe a way to diet and lose weight, and there isn’t much joy in the word. So, we use the word ‘movement’ to describe a more joyful type of activity, one that fills you rather than drains you.

There’s no double that movement is helpful for your overall health and well-being. But when movement has been used solely for weight loss, or as a punishment for overeating, it makes sense why it’s not enjoyable and difficult to get started with.

When there are strict rules you have for yourself around movement, just like when there are strict rules with food, it’s our natural tendency to rebel against those rules. This principle involves getting back in touch with movement that is enjoyable, and observing the benefits that you get from moving your body.

What type of movement do you enjoy (if any)?

There are many benefits of movement that are not related at all to your weight. Here are a few:

What benefits have you seen from movement (if any)?

What benefits would you like to see from increasing your movement?

Even if you have experienced and desire the benefits of movement, there may exist very real barriers. Some barriers to movement include:

What barriers do you experience when it comes to movement?

Would it be helpful to explore some possible solutions to overcome these barriers?

<HELP PATIENT DEVELOP SMART GOALS FOR MOVEMENT>

Let’s talk some more about different kinds of movement you might enjoy.

What kind of movement do you currently enjoy (if any)?

Do you prefer to get movement with a group, or by yourself?

Do you prefer to be outside or inside?

What is your fitness level?

How do you want to feel after movement? What benefits are you looking for?

Since we’ve been exploring these ideas around movement, are there any types of movement that you think you would like to try?

What would you need to get started?

Sometimes, even talking about movement as “joyful” or “fun” might not feel genuine.

Let’s start by normalizing that feeling. It’s ok to not love, or even like to exercise.

It’s also ok to say “I don’t like this, but I like the benefits, so I’ll try it out”. This is what we have to do with other, unpleasant parts of our life. <NOTE: insert your own example. One example is flossing. I hate to floss, but I like how my teeth feel after, and I like not having cavities, so it’s worth it to me to do the unpleasant thing for those reasons>

It’s also ok to give yourself permission to not do an activity. While you may have the intention, let’s say, to go on a 20-minute walk during your lunch break, that doesn’t mean you will always want to do it at the moment. Increased stress, an injury, feeling tired, might make you feel like you aren’t up for the walk that day. That’s ok. Giving yourself permission to rest is another type of self-care. Or trying an activity for 5 minutes, then deciding if you’d like to keep doing it, is a nice way to respect your body.

Does this feeling ever come up for you? How would it feel to give yourself permission to not do an activity?

Throughout this Intuitive Eating framework, you might have noticed that we talk a lot about food, but not a whole lot about nutrition. It’s not because nutrition is not important. It’s because so much of nutrition is tied up in diet culture, that tackling nutrition too early on can feel like you still have one foot back in diet culture land.

We use the word “gentle” when we talk about nutrition to highlight that nutrition is not all-or-nothing. To quote Julia Child’s work for the American Institute of Food and Wine in 1990, called “Resetting the American Table: Creating a New Alliance of Taste and Health, ” she wrote “In matters of taste, consider nutrition, and in matters of nutrition, consider taste”

This is a key part of gentle nutrition. Consider nutrition, but don’t sacrifice taste.

The other part of gentle nutrition is considering how food feels in your body, and being able to choose foods that both are pleasing and satisfying, but also help you feel your best.

What are your first thoughts about this concept?

Let’s talk more about this topic of gentle nutrition

Much of the work in intuitive eating is connecting with your body, tapping into your intuition. We talked early on about how hunger and fullness feels in your body, how the satisfaction of food feels, and how movement feels in your body.

The concept of gentle nutrition takes into consideration how different food affects how your body feels, how well you function when you eat it, and how it supports your overall health and wellbeing. This consideration can have equal weight to how food tastes and how pleasurable it is.

Some goals or thoughts you might have that could influence your food choices are:

What other thoughts or goals do you have that make you want to think about your food choices?

Recall Principle 6 - Discover the Satisfaction Factor, where we talked about different questions to ask yourself when trying to think about what you’d like to eat. With gentle nutrition, you can add a few more questions to the mix:

When you’re eating, listen to the messages your body is sending you about how a food is making you feel. You can ask yourself:

How are you feeling about this concept?

Are there any foods that come to mind where you already have a sense of how it feels in your body? Or, are there foods that you’re curious to explore how they feel in your body?

In intuitive eating, we don’t like to imply any moral superiority to food. That’s why we don’t use the labels “good” food or “bad” food, “junk” food, or even “healthy” or “unhealthy” food (because the term “unhealthy” implies that a food is actively doing harm)

The only food or foods that are “BAD” to eat are:

That being said, we know that there are nutritional differences between food. An apple has more vitamins than a cookie. But that doesn’t mean that you are a better person for choosing an apple over a cookie, or that you don’t value your health if you choose a cookie over an apple

The term “play food” can be used to describe food that is enjoyed more for its taste, pleasure, and the energy it provides, rather than for its nutritional value.

How does it feel to have this term “play food”?

This might mean

What are some recent examples where you’ve found yourself considering both taste and nutrition? What did you decide?

Depending on what the patient has shared about their health history, you can offer some specific medical nutrition therapy education to support them in managing any nutrition-related health conditions.

Focus on promoting the addition of foods, rather than the restriction of foods.

The HAES Health Sheets Library is a great resource for weight-inclusive nutrition education for a variety of medical conditions. https://haeshealthsheets.com/the-health-sheet-library/

How did my body feel after eating this food? Was this a good feeling?

Were there any feelings that weren’t so great, like bloating, gas, heartburn, headache, tiredness? Is this something I would want to experience again?

How was my energy after eating this?

Was I full and satisfied with this food? Did it keep me full for long enough?

Am I satisfied with my eating patterns? If not, what changes do I think I want to try making?

With your permission, let’s repeat the Intuitive Eating Assessment questions from our very first session together.

<ASK the 23 questions and score the assessment scale. Compare the results from the very first assessment. Point out areas where the patient has seen a lot of growth from the start of working together until now>

What have you noticed about changes in your relationship with food since we started working together?

What’s made the biggest impact for you?

It’s so helpful to take some time for reflection, to see what’s been most helpful for you, and what areas you’d like to continue to explore and learn about. Let’s quickly review the 10 different principles of Intuitive Eating. Tell me what learning about each of these principles has meant to you:

<NOTE: refer to patient’s specific health insurance plan restrictions to see if continuing to work together 1:1 is an available option>

There are lots of ways to continue on your intuitive eating path. You can

Changes in relevant labs (BP, serum cholesterol, fasting blood glucose, A1c, etc) depending on medical conditions like diabetes, hypertension, heart disease, etc.

Weight is intentionally excluded as an outcome to consider because intuitive eating is a weight-inclusive approach that abstains from using weight or BMI as an indicator of health. The weight-inclusive approach to health is supported by evidence by showing improvements in physical, behavioral, and psychological measurements (Tylka 2014)

Improved intuitive eating skills

Improved trust in their body

Greater ability to cope with their emotions without food

Greater reliance on personal satisfaction and gentle nutrition when making food choices, rather than diet rules

Greater body appreciation and self-esteem

Fewer episodes of overeating or feeling a loss of control while eating

Intuitive Eating Scale-2 - Dietitian has up on website to read to patient and take note of score

Handouts

Journal prompts

NutriQuiz or Food Frequency Questionnaire

Poodle Science YouTube Video - Dietitian to share screen and watch video with patient https://www.youtube.com/watch?v=H89QQfXtc-k&t=8s

Articles to send to patient after session

Journal Prompts

Handouts

Journal Prompts

Handouts

Journal Prompts

Handouts

Journal Prompts

Handouts

Journal Prompts

Handouts

Handouts

Handouts

Journal Prompts

Handouts

Handouts

Journal Prompts

Resource list *needs to be created*

NutriQuiz or Food Frequency Questionnaire