Friday, April 12, 2013

Intuitive Eating is not for you—maybe not just yet, and maybe not ever.

“Have you lost your mind? You, the anti-calorie-counting dietitian, the believer in legalizing all things chocolate and trusting that everything will be okay? Are you suggesting I should start dieting now, or head to the nearest Weight Watchers meeting and start counting points? Or doing the Paleo thing?”

Nothing of the sort! I’m prompted to write this following two experiences I had at the MEDA conference, that wonderful eating disorder conference held in the Boston area this past weekend. And this pertains to those of you with anorexia as well as those struggling with overeating—compulsive or otherwise.

So I was casually walking in the hall after the keynote presentation by Dr. Roberto Olivardia just killing time until the next break when I’d be selling my book. And I overhear two women, representatives from two respectable eating disorder programs chatting up their programs. “We use an intuitive eating approach with our patients”, she stated. “We don’t use meal plans, but instead have them listen to their body…” Ok, anorexic readers and eating disorder professionals, anything strike you as a bit problematic here? Let’s start with a handy, wiki definition:

“Intuitive eating is a nutrition philosophy based on the premise that becoming more attuned to the body's natural hunger signals is a more effective way to attain a healthy weight, rather than keeping track of the amounts of energy and fats in foods. It's a process that is intended to create a healthy relationship with food, mind and body, making it a popular treatment for disordered eating and eating disorders…”

For starters, to learn to be more attuned to your hunger, to begin to trust it, you need to be able to sense it. Most individuals, by the time they make it to see me, no longer really notice their hunger—not if they’re restricting and not if they are frequently binge eating. With the metabolic slowdown characteristic of food restrictors, hunger gets suppressed, and so that handy cue to get you to eat, that signal you’re supposed to be trusting—it’s largely disappeared! And that “healthy relationship with food” which we all aspire to is just not going to happen with all those unhealthy and distorted thoughts about food and eating and your appearance. Further, if you’ve never had a healthy relationship with food—never trusted your hunger because you went from overeating to undereating, it’s mighty challenging to just start trusting yourself. And for good reason, given your past experience with food and self-regulating.

When I shared my opinions (you didn’t expect I’d just casually stroll past, did you?) the program rep agreed, acknowledging that intuitive eating is an approach they address much later in recovery. We both agreed that normalizing eating under someone else’s direction (a dietitian with eating disorder expertise, for instance), needs to happen first, much before an intuitive eating approach. You can’t expect to be an intuitive eater when you can’t discern hunger and fullness, or when the disordered or diet thoughts are so loud that you can’t trust your physical sensations.

But wait, there’s more.

There were two experiences I wanted to share, remember? The second involves the presentation by Dr. Olivardia, mentioned above, who spoke about ADHD and eating disorders. He highlighted that a very high percentage of obese individuals have undiagnosed ADHD, and identified characteristics of this condition that make it oh-so-challenging to just do it, to follow seemingly reasonable nutrition and behavior recommendations.

For instance, impulsivity. Perhaps if you don’t have ADHD it’s challenging, but manageable, to take a break and have an internal discussion about whether or not you really want to be eating the whole package of cookies, to not respond to your impulse to eat. But in those with impulse control, that discussion comes a bit late. If you struggle with this, you may find yourself eating mindlessly before you’ve even gotten to check in with your signals. And if you eat rather fast, as is typical, you’ll take in a lot of extra calories before the signal of fullness has hit.

Then there’s boredom. Are you still with me? Those with ADHD have a much harder time tolerating boredom. If you struggle with sitting with feeling bored, it may be more difficult to simply acknowledge that you’re not hungry and redirect. Eating to manage this boredom might be the action of choice. Not a very intuitive eating supportive choice!

And while we often think those with attention issues as struggling to stay focused, Dr. Olivardia points out that these very individuals also get hyper-focused on the things they are interested in. This can explain the failure to listen to their hunger, perhaps when they are over-focused on other things. By the time they do respond to their physical hunger they may be ravenous, contributing to overeating. Or maybe there’s an OCD component, with a focus on calories and calorie counting, which may stand in the way of responding to physical cues. Again, making intuitive eating quite a challenge.

To be a successful intuitive eater, you need to be mindful of what you are consuming. Not so easy of you have ADHD and your norm is to multitask! My typical recommendations to separate eating from distractions may not be realistic for those living with ADHD, those for whom multitasking is simply the norm.

What now?

For the record, I am a big advocate of intuitive eating and for years have recommended a fabulous book on the subject by RDs Evelyn Tribole and Elyse Resch. Do take a look for more guidance on learning to be an intuitive eater.

Surely it’s not hopeless if you fit the descriptions above. To become a more intuitive eater requires more organization to your eating, including preplanning eating times and even meals. Organizational skills may not come so easy, so use tools like alarm reminders, such as on your phone or computer, and make shopping lists. Arrange eating times with friends or family for greater accountability, too. Utilize simple, easy-to-follow cookbooks, where close-to-immediate gratification occurs (with recipes taking 20 minutes or less, for instance.) Yes, Food to Eat fits the bill! And seek the guidance of an ADHD expert like Olivardia, along with an RD with a behavioral focus.

And please be realistic—and less harsh—if you’re prone to berate yourself for being lazy. There may be good reasons why you’re falling short with your follow-through with intuitive eating.

Thoughts? Comments? I’d love to hear what you’re thinking.


  1. what do you recommend to someone who is new to treatment, suffering, wanting to eat like a "normal eater", but very fearful of gaining weight, unable to stop weighing self or looking in the mirror?

    1. First, have someone move the scale if you can't do it yourself. Next, recognize that maintaining your current ways is not allowing you to function and feel well. Get support from experienced providers--RD, therapist, psychopharm if needed, to help manage the anxiety around change. Once you start making the recommended changes by starting witha leap of faith, then you'll be able to begin to trust that that it's going to be ok.
      It's challenging, but it's worth getting through!

    2. Lori's advice is so great, and as a person who was exactly where you are now, wanting to recover but absolutely terrified and doubtful that it was possible for someone as "messed up" as me for so long to ever have a happy, normal life and relationship with food, I just want to give you hope! It took many hard months, a whole lot of trust in my dietitian and some faith in my body, but I can't even describe how worth it it is! I now have a recovered relationship with food that is beyond what I ever could have expected. So take hope, recovery is possible!

  2. Excellent blog Lori - as usual! What you say strikes many chords with me, and the way I work with people who want a more normal relationship with food. Learning how to trust your body and the signals it gives you is possible but takes time and the support of someone qualified to help. It is something I leave till the client and I can be sure they are ready, which includes feeling as sure as we can that the therapeutic relationship is strong enough to manage this challenging stage.

  3. This was a great validation for me of something I figured out recently on my own (through some work with my therapist), which is that I am not a in place where intuitive eating is an option for me yet. I am not yet able to gauge my hunger and satiety after many, many years of compulsive overeating, followed by periods of being "good" (which, for me, was basically following my diet plan obsessively to a "T"), which eventually gave way again to compulsive overeating. Intuitive eating seems like such an amazing tool for those who can recognize their cues, but for me, when I tried no longer calorie counting, what resulted looked a lot like compulsive overeating again. I think I have a lot of work to do regarding the reasons beyond my disordered eating, but the fact that this is true means that maybe I should be giving myself a break and not beating myself about the fact that I was a "failure" at intuitive eating. Thanks for writing this!

  4. I really like this post. I feel a lot like I resemble the over eater with ADHD. I've talked to my counselor a bit in therapy about the possibility of my having ADHD and how it can affect other areas of my life. This is another interesting perspective.

  5. I am so happy I found this page! I have been working really hard at IE, and have long felt that my ADHD causes difficulties others might not have. When I ask 'experts' about it, they don't seem to understand what I mean. If you have any resource suggestions for IE and ADHD, please let me know. Thanks!

  6. I have (had?) ADD/ADHD and I successfully was able to overcome my ED with Intuitive YES, people who have ADD and people that are anorexic, can use IE to recover. It worked very, very, very well for me. I realize that, like everything, this approach isn't for everyone, but I want to let you know that it is possible with enough guidance and support.
    all my best-

  7. I just found this excellent blog today and, as an adult diagnosed with ADHD, was very pleased to read this. First, acknowledgement of ADHD as a real disorder is hard to find among many "healthy eating" blogs (perhaps because they're not written by RDs). Too many just blame sugar or food colorings despite there being no scientific evidence that supports this relationship.

    I've been a lifelong impulsive/bored overeater who has been overweight/obese (varies, but never not one of those two) since childhood. Strangely, though, I never made that connection between ADHD and my overeating. When most adults are diagnosed with ADHD, they have often been struggling against a life of low self-esteem, thinking they're just "lazy," "crazy," or "stupid." I always viewed my failures with diets as just another sign I was a screw-up and gave up. Any time I tried to implement a healthier lifestyle, there was always a voice in my head saying "This will end like all the other attempts! Ha ha!" It is hard to make big changes when you're preparing not to succeed.

    In seeing my past with more understanding about how my brain works, I've been able to slowly let go of this self-defeating way of thinking. Drawing this connection between ADHD and my weight is as valuable as the first time I drew that connection between ADHD and my tendency to misplace things or forget to do the chores I promised. So, thank you for sharing this.

    1. I'm so glad it was valuable for you! Hope you'll continue to follow!

    2. I'm so glad it was valuable for you! Hope you'll continue to follow!