Most health and fitness professionals know diets don't work.
Numerous studies have shown that dieting is ineffective at best and counterproductive at worse, with up to two-thirds of dieters regaining more weight than they lose (Mann et al. 2007). Dieting is linked not only to weight gain (Pietiläinen et al. 2012) but also to higher incidences of depression, body dissatisfaction and poor self-esteem (Ackard, Croll & Kearney-Cooke 2002; Gillen, Markey & Markey 2012). It's therefore no surprise that health and fitness professionals are looking for better ways to help their clients adopt healthier eating strategies.
One option is intuitive eating (IE), which forgoes dieting and focuses on driving long-term improvements in people's relationships with food. "Intuitive eating is the ability to read, interpret and follow your internal cues regarding the right amount of food for your body," says Krista Scott-Dixon, PhD, curriculum director at Precision Nutrition. "It's the antithesis to eating by the rules."
No rules? While that may sound too good to be true, IE is not a license to eat without regard to health. IE encourages people to base their eating on hunger and fullness cues rather than prescriptive regimens, and to seek satisfaction in the eating experience. Naturally, this raises concern about the potential to overeat unhealthy foods, but research suggests IE may be a promising way to maintain a normal body weight and a healthy relationship with food.
A study published in Eating and Weight Disorders examined the relationship between eating behaviors and body mass index (BMI) in college students. The study associated dietary restraint—intentionally limiting calories to control weight—with both higher BMIs and higher levels of disordered eating, whereas IE is strongly linked to lower BMI (Anderson et al. 2016). Another study, in Obesity, measured IE levels in 52,163 men and women in France, using a standardized IE scale, and found a strong correlation between IE and lower odds of overweight or obesity (Camilleri et al. 2016). While this research doesn't prove that IE reduces obesity, the authors argue that IE may be useful for preventing and treating obesity.
Cornell Food and Brand Lab at Cornell University came to a similar conclusion after studying people who have been "effortlessly slim" their whole lives, says Camille Finn, MS, who manages the lab's Healthy Weight Registry. "We found that many of these effortlessly slim individuals make food decisions based on feelings of hunger or physiological desires for certain foods, rather than based on restricted diets. If their inner cues tell them to eat a lot, they know that it is right for their body at that time. Moreover, they don't feel guilty, because they believe their body will moderate its desires later." These behaviors are common to intuitive eating.
Such research findings are promising, but how can health and fitness professionals use IE to help clients? Though the practice may sound simple, it's surprisingly complex.
Many argue that IE is biologically ingrained. Consider children—they ask for food when they're hungry, regardless of the time of day, and naturally stop eating (to the frustration of many parents) when they've had enough. While IE may be innate, cultural norms that promote dieting, restriction, supersized portions and hyperpalatable food often hamper our ability to eat intuitively.
Authors Evelyn Tribole, MS, RD, and Elyse Resch, MS, RDN, outlined ways to confront these challenges in their book Intuitive Eating: A Revolutionary Program That Works (St. Martins 2012). The following strategies—included in the book and widely practiced by dietitians—can guide health and fitness professionals in helping clients get off the diet rollercoaster and build healthier eating habits that last.
Ditch the Diet Mentality
"Only 5% of dieters maintain weight loss after 5 years," says Victoria Jarzabkowski, MS, RDN, a Washington, D.C., area dietitian. "When we say 'dieters,' we aren't just referring to crazy intense diet fads (such as the Master Cleanse). The term 'dieters' includes pretty much anyone—paleo, vegan, low calorie, low carb, etc.—who is trying to reduce, restrict or otherwise alter their diet for weight loss." Jarzabkowski explains, "Despite what the aggressive and oftentimes misleading diet marketing would have you believe, food restriction doesn't work for most people long term."
"Stress that there is no 'end point' when embarking on a diet," Jarzabkowski says. "Whatever you do to lose weight, whether it's counting carbs, working out twice a day or juicing all your food, that behavior must be maintained, and usually amplified, to keep weight off." Explaining this to clients can help them stop cyclical dieting, which may be harming their health. "Weight regain and yo-yo dieting are associated with loss of muscle tissue and an increase in visceral fat, which adversely affect our health and metabolism," says Jarzabkowski.
Make Peace With Food
When we tell ourselves we "can't" or "shouldn't" have a particular food, it often backfires with feelings of deprivation, uncontrollable cravings, and binging episodes—as emerged in Ancel Key's Minnesota Starvation Experiment. Designed to help famine sufferers during World War II, the study put 36 healthy men on a semistarvation diet for 6 months in 1945. They were fed only potatoes, turnips, rutabaga, bread and macaroni, to mimic a wartime diet. The men had strong cravings and fantasized about food. When the diet ended, they experienced intense hunger pangs and episodes of binging, and it took months for their eating behavior to normalize (Kalm & Semba 2005). This early study revealed what many dieters discover: Restricting specific foods often leads to overconsumption when those foods become available (Mathes et al. 2009).
"Give permission," says Scott-Dixon. "Explicitly state that no foods are off-limits or bad." She recommends taking an exploratory approach with clients' forbidden foods. Ask, "What happens when you eat this food?" or "What do you notice feeling before? After?" When eliminating food restrictions, clients may initially overconsume foods that were once off-limits. "They might go through a few days of eating ice cream for breakfast," says Scott-Dixon. "Then they'll wake up on day 3 and think, 'I just want a bowl of oatmeal.' "
"Many people wonder, 'Won't I gain weight if I allow myself to eat whatever I want?'" Jarzabkowski says. "The short answer is, 'Probably not.' That's the funny thing about restriction and forbidden foods—once they're fair game, eating them becomes innocuous, and consumption typically goes down."
Focus on Satisfaction
Tribole, co-author of Intuitive Eating, says satisfaction may be the most important component of IE. "Many people aren't used to having pleasant eating experiences," she says. "When you eat foods that satisfy you, it takes much less to feel you've had enough. When you focus on satisfaction, you find that it isn't truly satisfying to overeat."
In Intuitive Eating, authors Tribole and Resch describe the three S's of satisfaction: slow, savor and sensual. By slowing down and savoring, we can notice the enjoyable qualities of food and recognize when we're comfortably satiated. Encourage your clients to eat slowly, periodically putting their utensils down and pausing between bites to assess hunger. Urge clients to focus on the sensual experience of eating—tastes, textures, temperatures, smells and the filling capacity of food—which can allow them to enjoy what they're eating and help them feel satisfied with less.
Cope With Emotions Without Using Food
Eating is emotionally laden. From meals at family holiday gatherings to celebration dinners with friends to a bowl of rocky-road ice cream after a stressful day, food connotes meaning far beyond its nutritional value. Because we give food such significance, we often eat to manage emotion. Not surprisingly, emotional eating is highly related to binge eating and weight issues (Sevincer & Konuk 2013).
"Often, a client's relationship with food is affected by his or her emotional or physical health, self-esteem and even possible abuse or trauma," Jarzabkowski says. "The best thing a health and fi tness professional can do is to be an empathetic listener if a client comes in with emotional eating issues." She also recommends referring out to appropriate mental-health professionals when necessary.
Scott-Dixon says emotional eating is the biggest issue she encounters in her practice. She asks clients to be not only mindful but also "body-ful" when eating. "When clients struggle with emotional eating, encourage them to notice all thoughts, feelings, physical sensations, relationships, and environmental contexts and cues that arise." She suggests clients write these down to recognize patterns they can discuss with their practitioners. Also, she advises fostering self-compassion in clients. "Help them build an explicit program of self-care," Scott-Dixon recommends. "Th is can be structured by the client, or by the coach if the client isn't ready to build a program of self-care." Self-care can include meditation, walking, taking a bath, connecting with friends, or any other activity a client finds comforting. These habits can help clients learn to recognize and soothe their emotions without turning to food for comfort.
Honor Your Health
People commonly see food as a means to fix their bodies rather than as a source of nourishment. "We seem to think we'll be happy when we reach a particular size or look a certain way," says Marisa Molina, MPH, founder of Hello Beautiful Health, in San Diego. "In reality, dieting and food are often a distraction from what we actually need to deal with—how we feel about ourselves." Helping clients focus on and improve their self-esteem goes hand in hand with shifting their mindsets regarding food. By helping clients view food as a way to support and fuel their bodies, you can help them expand their view of food beyond something used solely for controlling their weight.
"Coaches must be careful in their language," says Scott-Dixon. "Using terms like 'nourishing' and 'function' can help." Emphasize the value of healthy foods, without labeling the food as good or bad. "Rather than saying, 'This is a good food,' tell clients, 'This food will give you lots of vitamins, which can help you heal faster.' "
Finally, seek out and emphasize clients' gains from the foods they're eating. "Highlight instances when they're feeling happier, calmer, more focused, better at problem solving, etc.," says Scott-Dixon. Recognizing the impact of nutritious food on well-being can help clients understand the functional value of their eating choices and make food less about weight and appearance.
IE may be an innate ability, but modern life makes paying attention to and trusting internal eating cues challenging. By guiding clients through IE, you can help them to take charge of their eating habits and to build a healthier, more sustainable relationship with food.
"I used to think I needed rules and rigid self-control. IE gave me a much more loving, wise and compassionate relationship with my body," says Scott-Dixon. "Improving your relationship with yourself is one of IE's greatest payoffs."
For more information on intuitive eating, visit www.intuitiveeating.com
It's no secret Americans eat too much. Since 1970, portion sizes have continually grown (Young & Nestle 2002), and environmental cues have encouraged us to overeat. Even misleading images on food packaging can spur overconsumption &lpar:Brand, Wansink & Cohen 2016). With these environmental drivers and large portion sizes, it's easy to override biological cues for fullness.
"Just as clients should be taught what it feels like to be hungry, clients need to be taught how to recognize their fullness, how long it takes to get there, and what foods increase/decrease that feeling," says dietitian Vicotria Jarzabkowski. Eating slowly can help clients distinguish fullness cues sooner, but it can be challenging. "I like to have clients start slowly eating one meal or snack a day at first, so they can get the hang of it in a way that doesn't feel too strenuous," says Jarzabkowski. "Then they gradually increase from there."
Strategies that help clients slow down, such as putting away distractions like cellphones or television, setting utensils down between bites, or periodically stopping to check in with hunger, can help clients feel and respond to their fullness cues sooner, reducing the likelihood of overconsumption.
Ackard, D.M., Croll, J.K., & Kearney-Cooke, A. 2002. Dieting frequency among college females: Association with disordered eating, body image, and related psychological problems. Journal of Psychosomatic Research, 52 (3), 129-36.
Anderson, L.M., et al. 2016. Contributions of mindful eating, intuitive eating, and restraint to BMI, disordered eating, and meal consumption in college students. Eating and Weight Disorders, 21, 83-90.
Brand, J., Wansink, B., & Cohen, A. 2016. Frosting on the cake: Pictures on food packaging bias serving size. Public Health Nutrition, 19 (12), 2128-34.
Camilleri, G.M., et al. 2016. Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Sant├® study. Obesity, 24 (5), 1154-61.
Gillen, M.M., Markey, C.N., & Markey, P.M. 2012. An examination of dieting behaviors among adults: Links with depression. Eating Behaviors, 13 (2), 88-93.
Kalm, L.M., & Semba, R.D. 2005. They starved so that others be better fed: Remembering Ancel Keys and the Minnesota Experiment. The Journal of Nutrition, 135 (6), 1347-52.
Mann, T., et al. 2007. Medicare’s search for effective obesity treatments: Diets are not the answer. The American Psychologist, 62 (3), 220–33.
Mathes, W.F., et al. 2009. The biology of binge eating. Appetite, 52 (3), 545–53.
Pietil├ñinen, K.H., et al. 2012. Does dieting make you fat? A twin study. International Journal of Obesity, 36 (3), 456–64.
Sevincer, G.M., & Konuk, N. 2013. Emotional eating. Journal of Mood Disorders, 3 (4), 171–78.
Young, L.R., & Nestle, M. 2002. The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 92 (2), 246–49.
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