We had such a lively discussion during this webinar “Supporting Clients Health through Intuitive Eating Webinar”! We could not get to all the questions, so the presenters have provided their answers in writing.
If you missed the webinar, you can still view the recording at https://oneop.org/event/79985.
Dietitians and Diet Technicians can earn 1.0 CPEU for up to 2 years post-webinar.
How does one encourage Intuitive (IE) when there may be pressures for weight standards within the service?
This is a great and very relevant question that I am sure most practitioners worry about when working with a military population. The bottom line is that we are here to support and feed our clients so that their mental and physical health is maintained throughout the rigors of military service. The normalized disordered eating and weight cycling that many military members are engaged in do not support optimal readiness and do an overall poor job of even maintaining body weight/composition in the long term.
Regarding the case study examples, how often/frequently were the meetings with the clients?
For Case study B, appointments were every two weeks. The frequency depends on the amount of support needed. Some clients do great with monthly visits when they have a workbook or other assignments. If someone is experiencing significant symptoms of an eating disorder, the recommendation is weekly appointments. Yes, this can be challenging given the typical busy schedule of care providers. It can be helpful to “triage” clients by spacing out the clients who are experiencing less severe symptoms.
Can you go over the scale on intuitive eating and discuss rating it?
Recommend using the scale found in either the Intuitive Eating book or workbook. The layout and scoring are easy to understand, and the questions are grouped by topic into four sections.
What the difference between a plate planner and a meal plan?
Plate planners generally have more flexibility as they provide a basic outline of macronutrients and food groups for each meal. Meal plans include specific foods and portion sizes. It is helpful to remind the client to listen to their body for the amount of food they need while using the plate planner to provide an overall balanced meal.
Do you think IE is appropriate for everyone with type 2 Diabetes Mellitus (DM)?
Generally, yes. IE supports a flexible yet supportive approach to DM management where no foods are off-limits. The principle of general nutrition includes awareness of carbohydrate amounts with regard to insulin dosing. It also supports the client’s autonomy in exploring how various foods make them feel.
Do you have any IE recommendations for cancer patients going through chemotherapy/radiation with side effects (taste changes, nausea, etc.)?
This one is undoubtedly tough. Honoring one’s hunger may look more nuanced in this circumstance. Taking a practical approach when internal hunger cues are dulled/absent can help support these clients. Also, sometimes clients read inaccurate online posts about food either curing or contributing to cancer, and they might mistakenly alter their eating based on misinformation. Intuitive Eating can aid providers in being consistent with evidence-based practice while helping guide the client with the principle of Gentle Nutrition.
How would you recommend advising an IE client to take better care of their gut & microbiome?
Research is continuing on the microbiome, and there is still a lot of information that is not yet well understood. What is known is that it can be dangerous to eliminate foods. As providers, we want to be careful with implementing elimination diets as they can trigger the neurobiological pathways of disordered eating/eating disorder in the brain. Also, staying on elimination diets for extended periods can cause more problems by limiting the diversity of the gut microbiome. This issue would be helped by the Gentle Nutrition principle in that the foods that might cause GI discomfort are not “bad”…it is more about how that individual is responding to the foods. For example, most people can eat all foods but may need to decrease the amount (such as foods containing lactose) to a level that their body can process. Or a person could cook the foods to break down some of the fiber if they are struggling with GI (gastrointestinal) upset after eating high-fiber foods, such as vegetables. Overall, the gut microbiome is helped by having a balanced diet, and these are a few strategies to guide someone to achieving balance.
How does a person’s reliance on high added sugar foods relate to IE, and can IE help them eat fewer of these types of low-quality nutrition foods?
Possibly. The goal of IE is not to ‘eat less’ of any particular food and holds all foods morally equal. However, suppose the individual was struggling with restriction (mental or physical). In that case, they may find that with unconditional permission to eat and making peace with food, they do not eat as much of certain foods because it is no longer ‘off-limits.’ High sugar foods have their place, especially in an active population. With some exploration, the client may tease out how they would like to include high sugar foods in their diet.
Also, Intuitive Eating does help clients understand the value of balance without rigidity. So, Intuitive Eating can help the client incorporate balance while improving their relationship with all foods, including fun foods. Many clients find that they will eat fewer fun foods as a side effect of integrating balance with their overall intake.
Is this more medically-based for individual appointments, or have you offered something like this as a class?
IE can be done individually and also taught in a group setting. Generally, in a class setting, you would do a series, as there is so much nuance and discussion that can be had with each one of the principles.
Can you review briefly again the difference between mindful eating and intuitive eating, please?
You may hear mindful eating and intuitive eating used interchangeably, but they are not the same. Mindfulness-based eating practices can complement intuitive eating. Intuitive eating has a set of 10 principles that incorporate mindfulness with our food and with our body. Overall, Intuitive Eating provides more guidance and structure with the 10 principles.
GI disorders often add another complexity to feeling hunger.
GI disorders can add some complexity, but the individual can still benefit from the Intuitive Eating principles. Many GI disorders benefit from a combination of stress management tools, such as Mindfulness-Based Stress Reduction, combined with Intuitive Eating. Gentle nutrition can help clients to understand how to incorporate balance with modifications for their specific GI struggles. For example, suppose an individual had Crohn’s disease. In that case, we could help them by incorporating balance with their overall nutrition and helping to manage the number of specific items, such as fibrous foods, that may trigger symptoms. Some clients benefit from reducing items, such as lactose, or cooking foods high in fiber, such as vegetables. It is also important to remember that other factors, such as smoking, sleep, and stress, can impact our gut function.
What about the elderly in “Honor your hunger”?
As we get older, we may sometimes experience alterations in our hunger cues. It is helpful to remember that Intuitive Eating is part science and part intuition. So, the science component of Intuitive Eating tells us that humans need to eat throughout the day. That means that sometimes, such as when we have alterations in our hunger cues, we need to eat even if we aren’t experiencing the sensation of hunger. Clients often benefit from education regarding the changes in hunger signals and the evidence for why it is still important to obtain nutrition. Many clients often benefit from planning specific food choices that they find appealing or a nutrition supplement beverage that can complement their dietary intake.
On honoring hunger – how do you deal with a patient who really insists they are not hungry until after work (or something similar)?
This is an excellent opportunity to validate that they are likely not experiencing the hunger signal because the body has stopped expending energy to send the signal due to the belief that it needs to preserve energy. Next, we could provide education about how the body might stop sending the signal if a person has a history of not feeding themselves throughout the day. By explaining the physiology and benefits of eating throughout the day, many clients can see the importance of reestablishing their hunger cues. Often, clients benefit from engaging in some “experiments” (if they are willing/able) to add food when it is most achievable for them while being curious about how they feel after doing this for a while. Gradually, clients can begin rebuilding their meals/snacks throughout the day and notice how they feel better, have more energy, are happier, etc.
How important do you consider eating slowly to allow your body time to signal your fullness?
Eating slowly is helpful for this but not always necessary or an option for clients. There is much nuance to fullness beyond feeling the sensation of a full stomach, so clients often find after time and exploration that eating slowly is not crucial to feeling one’s fullness at each meal. It is also helpful to remind clients that it is not always possible to “eat slowly” if we have had insufficient intake throughout the day due to the body believing that it is in a survival situation. Many clients try to limit food throughout the day and then “eat slowly” at the evening meal…this is likely not possible. The ability to eat mindfully in the evening relies on us nourishing our body throughout the day.
What age is appropriate for adopting Intuitive Eating? For example, I am thinking more about a 12-year-old.
Intuitive Eating is actually the default setting for our bodies. We are born intuitive eaters, so there is no age limit for learning and supporting individuals’ connection to their bodies. Recommend the Intuitive Eating Book Ch. 16 and Born to Eat by Leslie Schilling and Wendy Jo Peterson to learn more about this approach with babies/children/teens. Ellyn Satter is also an excellent resource for feeding children, and her Division of Responsibilities in Feeding is a best practice that the American Academy of Pediatrics has incorporated.
Are you aware of any curriculum for use with children?
Ellyn Satter provides guidance for parents of children. She also includes information on balancing meals/snacks while incorporating an All Foods Fit approach. For adolescents, the Intuitive Eating Workbook for Teens is a fantastic resource.
Is there a resource of IE Practitioners I could refer to both Veterans and private clients?
Yes, you can start by checking here: https://www.intuitiveeating.org/certified-counselors/.
Can people learn and follow these principles independently, or do they need to work with a Registered Dietitian (RD)?
Individuals can practice and learn about these principles independently. Many clients benefit from having a dietitian skilled in Intuitive Eating to clarify topics and answer questions.
Extension educator asking how would you recommend presenting on IE to community groups? Considering writing a lesson or series. Thanks for any ideas.
The Intuitive Eating Workbook has a wealth of topics that could be used to discuss in a group setting. The 10 principles could be divided into 10 lessons, and worksheets/handouts could be given to those attending the group. Some providers also divide Intuitive Eating into five lessons and do two principles per class.