Q&A: Intuitive eating at Within

Q: What is intuitive eating? Is it different from mindful eating?

Intuitive eating is a self-care tool developed by Evelyn Troble and Eleys Resch in the 1990s as an alternative to traditional nutritional interventions.   Recognizing the cyclic nature of “diets” and the frustration that clients often felt, they set out to offer a revolutionary approach to nourishment. 

Since its conception, intuitive eating now has over 100 published research articles documenting its effectiveness in treating eating disorders.

Although mindfulness is a part of the intuitive eating approach, there are some notable differences. To be mindful is to be present in the current moment, without judgment. Regarding food, this may involve staying connected to the senses of the eating experience with neutrality.  

Eveln Triobole writes, “I consider intuitive eating a broader philosophy, which includes physical activity for the sake of feeling good, rejecting the dieting mentality, using nutrition information without judgment, and respecting your body, regardless of how you feel about its shape. There are 10 Principles of Intuitive Eating, but they can be boiled down to these three core characteristics, which were validated by the research of Tracy Tylka found in "Eat for Physical Rather than Emotional Reasons, Rely on Internal Hunger and Satiety Cues, Unconditional Permission to Eat.” ‍

Q: How is intuitive eating taught at Within?

At Within, we provide all patients with the Intuitive Eating, 4th Edition book and access to the digital workbook via their assigned dietitian. Principles of intuitive eating are also often explored in nutrition and therapy sessions.   

Patients may be asked to write about these concepts (as a reflection opportunity) or to engage in hands-on practice (experiential learning). For example, a patient may be tasked with listing all the food rules (Principle 1: Reject Diet Mentality), then work with their care team to start creating a new framework. This may be writing out loving guidelines for themselves, as well as actually having their “fear foods.”  

All of our patients attend a weekly core nutrition group where intuitive eating is referenced as one of the curricular subjects. They will also complete the Intuitive Eating Scale throughout their treatment. These sessions are recorded monthly and provide data and talking points for individualized goals.    

Patients also log meals and have a pre- and post-log that encourages them to consider their feelings and intentions. 

We also offer a weekly intuitive eating book club that is co-facilitated by a dietitian and a therapist. This time is used to dig deeper into the principles of intuitive eating and allow processing. Having led this group for nearly three years, I have been moved by the healing that comes from peers sharing their own experiences. The book club provides a safe space for patients to ask questions and share their opinions. Having both a certified intuitive counselor (dietitian) and a therapist facilitating provides a rich and unique space for our patients to get practical ideas as well as processing in the moment.  

Q: Where do you see common misunderstandings or “challenges” with intuitive eating?

One of the most common questions I hear from patients relates to the physical experience of hunger and fullness. Without fully understanding intuitive eating at large, it can be easy to fall into the “hunger and fullness” diet. Because many people with eating disorders have dysregulated feeding cues, they benefit from being reminded that there are several other principles that can be practiced while their body is healing.  

Three of my favorite principles to explore while in early eating disorder treatment are:

• P3: Make Peace with Food
• P1: Reject Diet Mentality
• P5: Discover the Satisfaction Factor.  

Another common sticky point revolves around the very nature of a highly structured eating plan that is often utilized in a higher level of care. Not only do patients frequently feel full, but they may feel like they are just swapping their diets for what they’re being told to eat. Providing validation as well as an explanation of why they are eating specific foods can be very useful to patients. 

There are also several ways for someone to practice being intuitive while following a highly structured meal plan. For example, they could start by considering whether they would prefer to eat outside or inside, or to have music on or not.  

Meals can also serve as a tool, reminding patients to check in with themselves throughout the day. These regular meals support intuitive eating practices and help patients view eating differently, as something that is not forced onto them. 

Finally, I see many patients now who do not connect with the term “diet.” Since they have never been on a traditional diet, this concept does not feel relevant to them. We often encourage people to consider any way of eating that creates a hierarchy, as a hope that the body can and will change, which leaves us feeling guilty.   

Common words patients seem to connect better with include:

• Wellness
• Reset
• Cleanse
• Clean
• Bio hack

Our culture has no shortage of trends that plant seeds of self-doubt and complicate our relationship with food. In “Principle 3: Make Peace with Food,” we are reminded that unconditional permission is the foundation for sustainable food peace.  

Q: How important is intuitive eating to the success of eating disorder treatment?  

Having experience and practice in connecting to oneself is a key factor in increasing interoceptive awareness. Given that multiple studies have been published on the benefits of interoceptive awareness and its relationship to food, I believe this is very important for eating disorder treatment.  

At its core, eating disorders create disconnection. Although becoming an intuitive eater may feel overwhelming, patients can start slowly weaving this into treatment early (as clinically appropriate).  

One way I suggest someone starts connecting to increased awareness is to start small and consider a sense other than taste. For example, they could begin by smelling three different spices and then consider which smell they enjoyed (if any) at that moment.  

They could also start by practicing making a choice within the structured meal plan. For example, they could decide whether they would rather have pasta or rice as the grain for their meal. 

The nutrition team at Within is well-versed in all principles of intuitive eating and works diligently to create space and experiences for our patients to practice skills.      

Q: How do Within patients improve on their intuitive eating practices from before to after treatment? 

Many patients come to Within feeling disconnected from their internal cues, but we’ve seen that thanks to the compassionate guidance and support of our expert clinical team, they can make meaningful gains in all areas of intuitive eating.

Our Clinical Research Director, Dr. Caitlin Shepherd, PhD, found that our patients typically experience significant improvements across all areas assessed by the Intuitive Eating Scale, including:

• Giving themselves unconditional permission to eat
• Eating in response to physical hunger rather than emotions
• Recognizing hunger and fullness cues
• Choosing foods that meet their body’s needs

Importantly, these increases in intuitive eating skills help explain, at least in part, why patients experience reduced eating disorder symptoms and enhanced quality of life by the end of treatment. In other words, embracing intuitive eating principles contributes to positive outcomes for our patients!

One key way patients build these skills is through intentional practice, such as consistently engaging in activities designed to increase awareness and comfort with internal cues. In fact, we’ve found that more frequent use of our Within app to complete both pre- and post-meal logs, is linked to stronger intuitive eating skills at discharge.