Intuitive Eating: Strengths, Confusion, Criticisms, Nuance

Intuitive eating has gained popularity over the last few years, but there are areas of confusion that lead people to be skeptical about this nutrition tool.

Before I dig in, I want to say up front that I use intuitive eating (IE) as a foundational component of my work with clients. I view IE as an essential tool to help clients seek neutrality around food (moving away from “good” or “bad” labels). While some foods have more nutrient density than others, there is value in foods outside of their nutritional content (e.g. birthday cake, chips at a Super Bowl party or pie at Thanksgiving).

As a dietitian who uses both IE and integrative & functional nutrition (IFN) principles, I realize these may seem conflicting, counterintuitive or even impossible. But, I actually think that the Venn diagram of IFN and IE has more intersection than you’d think. For one, one purpose of IE is to help you become familiar with your body’s signals. In IFN, one of the main goals is eat foods that help you feel your best. When we listen to our bodies’ signals, then we can find the foods that help us feel well. This is why I see IE and IFN as complementary approaches when applied appropriately. So, what is IE, exactly?

What is Intuitive Eating?

Intuitive eating (IE) is an evidence-informed, weight-neutral, and mind-body approach to eating created by two registered dietitians, Elyse Resch and Evelyn Tribole. (1) The first book, Intuitive Eating, was published in 1996 with the subtitle, “A Recovery Book for the Chronic Dieter. Rediscover the Pleasures of Eating and Rebuild Your Body Image.” IE is comprised of 10 Principles (listed below) that the authors explain in detail within the book.

I noticed IE gaining popularity over the last few years with promotion on social media primarily by dietitians who use a “non-diet” approach to nutrition. I use quotations because there isn’t a well-accepted definition of the term “non-diet”. (2) It’s also used in tandem with principles of health at every size (HAES) and “weight neutral” nutrition counseling.

I won’t go into depth about non-diet, HAES or weight-neutral nutrition today, but if you’re interested in reading more about them and how they fit into the greater context of the nutrition landscape, please let me know in the comments below. This is a publicly available article, and I will leave comments open to all.

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The 10 Principles of Intuitive Eating

1. Reject the Diet Mentality

2. Honor Your Hunger

3. Make Peace with Food

4. Challenge the Food Police

5. Discover the Satisfaction Factor

6. Feel Your Fullness

7. Cope with Your Emotions with Kindness

8. Respect your Body

9. Movement—Feel the Difference

10. Honor Your Health—Gentle Nutrition

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Intuitive Eating can help users learn to listen to the messages their bodies communicate (pain, discomfort, hunger, fullness, cravings, fatigue, etc.). If someone dieted for years or hasn’t been introduced to the idea that they can choose to eat because they are hungry—versus what time the clock says or the number of calories in a given food or meal—then IE has a lot to offer.

You can become a Certified IE Counselor or Lay Facilitator, which requires a minimum of a bachelors in a health-related field or to be formally certified as a coach or trainer. I am not formally certified, but I first learned the principles in college and have used IE principles since I started practicing as a dietitian in 2010.

Strengths of Intuitive Eating

Increased awareness of diet culture: Growing up in the United States, we are born into diet culture. It would be hard to identify diet culture outside of just regular American culture. It’s like fish swimming in a pond—unaware they’re in water. That’s diet culture in America. Intuitive eating can help you become aware and think critically about the diet and nutrition cultural norms that shouldn’t be so normal.

Development of a healthy food and body relationships: As a byproduct of diet culture, many of us are taught to question our own bodies and rely on external rules (e.g. diets) to determine when we feel like we “can” and “can’t” eat. Intuitive eating helps us tune into our bodies, learn how to eat in a way that fulfills us both from nutritional standpoint and purely for the enjoyment of the food. Intuitive eating is neutral to weight loss or gain. It doesn’t mean that weight change might happen, but IE isn’t a tool for weight loss.

Another purpose of IE is to remove morality from food choices, meaning certain food choices aren’t inherently “right” or “wrong.” A person isn’t “good” for eating their greens, just like they aren’t “bad” for eating a brownie.

Decreased risk for disordered eating (1, 3): Disordered eating behaviors like restricting, purging, or binging aren’t eating disorders themselves, but disordered eating behaviors can increase risk for developing an eating disorder. Evidence from research on IE principles suggests that IE can decrease risk of disordered eating behaviors. (3) Thus, IE may be a promising, low-cost approach to decreasing risk for development of eating disorder. This is especially heartening since eating disorder rates are on the rise. (4, 5)

Improved awareness of body signals: Evidence suggests that IE improves interoceptive awareness/accuracy, which is being able to accurately assess physical sensations in one’s body. (1, 6) When we are able to monitor our internal sensations, we may be able to better trust our bodies when we experience hunger, fullness, satiety, cravings, appetite, etc. Intuitive eating can help us learn and practice responding to our bodies appropriately and in a nourishing way.

No risk of failure. Diets typically have a set of rules to follow that we can feel like we’ve failed if we don’t adhere to them “perfectly.” While IE has a set of 10 principles, it is impossible to fail at applying them.

Confusion Around Intuitive Eating

Exposure to only 1 or 2 principles: If you only hear that IE is about “eating whatever you want” or “eating when you’re hungry and stopping when you’re full”, then you miss out on the complexity and depth of the tool. This may lead you to assume that IE doesn’t consider nutritional quality. If you only learn one or two IE principles, you may not know that IE teaches about emotional eating or how to enjoy physical activity without using it as punishment.

Eating Disorders: With eating disorders like anorexia or bulimia nervosa, signals of hunger and fullness are often distorted or confusing. Those with anorexia may ignore symptoms of hunger or may feel full or bloated as a symptom of the condition. People with anorexia have increased risk for digestive symptoms like irritable bowel syndrome, bloating and other digestive symptoms. (7) Attempting to apply principles of IE may be challenging or confusing with an eating disorder because symptoms of hunger and fullness may be distorted. For this reason, it’s important to work with a dietitian or other specialized health care professional who is aware of the challenges and digestive symptoms that are common among people with eating disorders.

Severe digestive symptoms: This is an area of confusion but also warrants a conversation around specialization in nutrition. I would say that IE offers great tools for a person to identify that they have digestive problems and maybe even help them notice patterns like “when I eat X, I notice I get gassy afterwards” or “when I eat Y, I get a headache” or “A couple hours after eating Z meal, I feel tired and need to take a nap.” Those are all examples of interoceptive awareness (being in touch with feelings within your body). However, if a coach who is working with a client doesn’t know how to “treat” digestive conditions or symptoms, then their client might miss out on important dietary interventions that a dietitian or doctor could catch and guide. I’m sure there are coaches who are excellent at identifying when a client’s needs are out of their scope and refer to another professional, but that isn’t always the case. This can leave people who need medical or nutrition intervention without the help they require.

Nutritional quality differences between foods: I notice sometimes when dietitians discuss IE, they appear to put all foods on the same level, nutritionally speaking. My understanding is that the intention of this is to not discount the nutritional quality differences between foods but to help you remove the moral judgement on foods. This can be confusing because someone might assume that a dietitian is suggesting that broccoli and brownies are the same in terms of nutritional qualities. I don’t want to speak for other dietitians, but I would guess that they understand that a brownie is different than broccoli from a purely nutrient-based perspective. If we’re asking the birthday girl what she wants for dessert, we wouldn’t assume she is going to pick broccoli, but who knows! Foods have different nutritional qualities, but they aren’t purely for the purpose of nutrients.

“Eat whatever you want!” This idea causes discomfort for many. If you can supposedly eat anything you want then who’s to stop you from eating the whole bag of chips or entire tub of ice cream? While some people do struggle with eating binges or binge eating disorder, most would not likely eat that much of a food at one time. And once you learn and practice IE in its entirety, you’ll find that eating large amounts of those foods don’t typically make you feel great, physically. By testing out a wide variety of different foods (from whole to processed), you’ll learn how different foods and meals make you feel. When you give yourself full permission to eat anything, then you don’t have to eat your “last meal” and swear of sugar forever because you can always have more tomorrow (or not).

Intuitive eating vs. mindful eating: While IE and mindful eating are similar, mindful eating is more about learning to be fully present and enjoying food from all senses, without judgement. (8) Mindful eating is about applying the ancient principles of mindfulness to the experience of eating. Intuitive eating is also about mindful eating but also teaches about diet culture, enjoyable physical activity, and addresses nutritional quality of food.

Criticisms of Intuitive Eating

Skepticism that “eating whatever you want” is healthy: The skepticism I hear is: if we’re given “food freedom” like IE promises, then people will always make the “unhealthy” choice: “If my kids are allowed to ‘eat whatever they want’ they’ll only and always choose ice cream, chips, pizza and cookies.” While this may be true about kids, we have to remember that as parents we get to decide what we offer our kids to eat. When kids are introduced to a wide variety of foods, they also learn how certain foods feel in their bodies before, after and while we eat them. This will likely help them develop interoceptive awareness. When we learn what feels good or energizing, it might help us make a food choice that we might not otherwise make: e.g. if we notice X meal helps us feel satisfied while Y meal makes us feel sluggish or gives us a stomach ache, then maybe we won’t always choose the “unhealthy” option.

Ultra processed foods can mix up signals of hunger/fullness/satiety. When we can eat whatever we want, if we eat primarily ultra processed foods (and possibly too little protein and fiber), then we miss out on some of the natural feedback signals we get from whole foods that help us detect when we are full. Ultra processed foods are designed by scientists to keep us wanting (and eating) more.

A New York Times article from 2013 about ultra processed foods revealed that food scientists for big food companies are hoping that the eater reaches a “bliss point” when eating their food products that essentially “helped food companies create the greatest amount of crave.” For example, chips or cheese puffs: you can eat an entire bag without feeling full—and possibly leave you wanting more—because they were designed that way.

Nuance and Final Thoughts

Intuitive eating won’t solve every nutrition or eating problem, maybe especially if someone has a digestive condition or has a condition that makes signals of hunger and fullness convoluted like an eating disorder. However, when IE is learned and applied in its entirety (using all 10 principles), I find it hard not see an upside to its use, especially when applied with the help of a dietitian or other trained healthcare professional.

While IE is about tuning into one’s own body to find out what the body can teach us, internally, there is a lot we can learn externally about our health and wellbeing. Nutrition information and knowledge or even lab tests can inform us about our bodies and our health. This information can be included as part of a full picture of our health status and trajectory. Objective information like cholesterol or blood sugar levels are best applied within the context of someone’s whole life and health goals. Intuitive eating can be part of a compassionate strategy and vocabulary to communicate health and nutrition information that isn’t charged with judgmental and shame-inducing language.

When applied in full, IE can help someone: A) build and sustain a healthy relationship with food, B) navigate diet culture with awareness, discernment, and peace, C) learn how to heed signals from their body (e.g. hunger, fullness, pain, bloating, satisfaction, etc.), and D) to understand that while food does have nutritional value, it can also hold value independent of its nutrient content. Food can be enjoyed solely because it tastes good.

References

1. Tribole E, Resch E. Intuitive eating: A revolutionary anti-diet approach. St. Martin's Essentials; 2020 Jun 23.

2. Clifford D, Ozier A, Bundros J, Moore J, Kreiser A, Morris MN. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: A systematic review. Journal of nutrition education and behavior. 2015 Mar 1;47(2):143-55.

3. Hazzard VM, Telke SE, Simone M, Anderson LM, Larson NI, Neumark-Sztainer D. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010–2018. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2021 Feb;26:287-94.

4. Radhakrishnan L. Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic—United States, January 2019–January 2022. MMWR. Morbidity and mortality weekly report. 2022;71.

5. Castellini G, Cassioli E, Rossi E, Innocenti M, Gironi V, Sanfilippo G, Felciai F, Monteleone AM, Ricca V. The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. International Journal of Eating Disorders. 2020 Nov;53(11):1855-62.

6. DeVille DC, Erchull MJ, Mailloux JR. Intuitive eating mediates the relationship between interoceptive accuracy and eating disorder risk. Eat Behav. 2021 Apr;41:101495. doi: 10.1016/j.eatbeh.2021.101495. Epub 2021 Mar 3. PMID: 33713922.

7. Hanel V, Schalla MA, Stengel A. Irritable bowel syndrome and functional dyspepsia in patients with eating disorders-a systematic review. European eating disorders review: the journal of the Eating Disorders Association. 2021 Sep;29(5):692-719.

8. Monroe JT. Mindful eating: principles and practice. American Journal of Lifestyle Medicine. 2015 May;9(3):217-20.