Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach

By Evelyn Tribole, M.S., R.D. and Elyse Resch, M.S., R.D., F.A.D.A.

Make peace with food.
Free yourself from chronic dieting forever.
Rediscover the pleasures of eating.

The go-to resource––now fully revised and updated––for building a healthy body image and making peace with food, once and for all.

When it was first published, Intuitive Eating was revolutionary in its anti-dieting approach. The authors, both prominent health professionals in the field of nutrition and eating disorders, urge readers to embrace the goal of developing body positivity and reconnecting with one’s internal wisdom about eating—to unlearn everything they were taught about calorie-counting and other aspects of diet culture and to learn about the harm of weight stigma. Today, their message is more relevant and pressing than ever. With this updated edition of the classic bestseller, Evelyn Tribole and Elyse Resch teach readers how to:

• Follow the ten principles of Intuitive Eating to achieve a new and trusting relationship with food
• Fight against diet culture and reject diet mentality forever
• Find satisfaction in their food choices
• Exercise kindness toward their feelings, their bodies, and themselves
• Prevent or heal the wounds of an eating disorder
• Respect their bodies and make peace with food—at any age, weight, or stage of development
• Follow body positive feeds for inspiration and validation

. . . and more easy-to-follow suggestions that can lead readers to integrate Intuitive Eating into their everyday lives and feel the freedom that comes with trusting their inner wisdom—for life.

• Language: English
• Publisher: Macmillan Publishers
• Release date: Jun 23, 2020
• ISBN: 9781250758286

Evelyn Tribole, M.S., R.D.

Evelyn Tribole, MS, RDN, CEDRD-S is the author of 10 books, her newest book, Intuitive Eating for Every Day: 365 Inspirations and Practices. Evelyn enjoys training health professionals on how to help their clients cultivate a healthy relationship with food, mind, and body. To date there are over 1,500 Certified Intuitive Eating Counselors in 37 countries.

Book preview

Introduction

If you could cash in every diet like a frequent-flyer mileage program, most of us would have earned a trip to the moon and back. The global weight-loss industry market is expected to reach $278.95 billion by 2023, which could finance the trip for generations to come. Ironically, we seem to have more respect for our cars than for ourselves. If you took your car to an auto mechanic for regular tune-ups, and after time and money spent the car didn’t work, you wouldn’t blame yourself.* Yet in spite of the fact that up to 95 percent of all diets fail, you tend to blame yourself, not the diet! Isn’t it ironic that with a massive failure rate for dieting we don’t blame the process of dieting?

But what does failure really mean? It has traditionally referred to the fact that the majority of people who go on diets and lose weight gain it back, with many gaining even more weight. (Studies show that up to two-thirds of folks will regain more weight than they lost!) To focus on weight loss as the definition of failure fails to address the root issue: Why are people so focused on losing weight? Why is there a valuing of thinner over fatter bodies? Why do people value themselves based on the number on the scale? The failure of dieting is that it promotes weight stigma by not recognizing that people come in all sizes and shapes and that each individual is worthy just as they are. In this book, we want to provide you with information that may let you stop blaming yourself and your body. We’ll present some new ideas that will help you value your individuality and everything that makes you your authentic self.

Initially, when we ventured into the world of private practice, we did not know each other. Yet separately, we had remarkably similar counseling experiences that caused us to rethink how we work. This led to a considerable change in how we practice and years later was the impetus for this book.

Although we practiced independently of each other, unknowingly each of us got started by making a vow to avoid the trap of working with weight control. We didn’t want to prescribe a process that was only set up to fail. But while we tried to avoid weight-loss counseling, physicians kept referring their patients to us. Typically, their blood pressure or cholesterol was high. Whatever their medical problems, weight loss was thought to be the key to treatment. Because we wanted to help these patients, we embarked on the weight-loss issue with a commitment to do it differently: Our patients would succeed. They would be among that small 5 percent success group. Clearly, our consciousness had not as yet been raised to even question the whole focus on weight that pervades much of society. Also, at that time there was not the body of research that we have today, which shows dismal failure rates and harm from dieting.

We created beautiful meal plans according to our patients’ likes and dislikes, lifestyles, and specific needs. These plans were based on the widely accepted exchange system, commonly used for diabetic meal planning and weight control. We told them that this was not a diet, for even back then we knew that diets didn’t work. We rationalized that these meal plans were not diets, because patients could choose among chicken, turkey, fish, or lean meat. They could have a bagel, a muffin, or toast. If they really wanted a cookie, they could have one (not five!). They could fill up with free foods galore, so that they never had to feel hungry. We told them that if they had a craving for a particular food, they could go ahead and eat it without guilt. But we also reinforced, gently yet firmly, that sticking to their personalized plans would help them achieve their goals. As the weeks went by, our clients were eager to please us and followed their meal plans. We weighed them each week (something we would never do now!), and, finally, their weight goals were met.

Unfortunately, however, some time later we started getting calls from some of these same people telling us how much they needed us again. Somehow, the weight had come back on again. Their calls were very apologetic. Somehow, they couldn’t stick to the plan anymore. Maybe they needed someone to monitor them. Maybe they didn’t have enough self-control. Maybe they just weren’t any good at this, and they felt guilty and demoralized.

In spite of the failure, our patients put all the blame on themselves. After all, they trusted us—we were the great nutritionists who had helped them lose weight. Therefore, they had done something wrong, not us. As time went on, it became clear that something was very wrong with this approach. All of our good intentions were only reinforcing some very negative, self-effacing notions that our patients had about themselves—that they didn’t have self-control, they couldn’t do it; therefore they were bad or wrong. This led to guilt, guilt, guilt.

By this time, we had both reached a turning point in the way we counseled. How could we ethically go on teaching people things that seemed logical and nutritionally sound, yet triggered such emotional upheaval? On the other hand, how could we neglect an area of treatment that could have such a profound effect on a patient’s future health? (Or so we had been trained to think!)

As we struggled with these issues, we began to explore some of the popular literature, as well as scientific studies that suggested a 180-degree departure from dieting of any kind (even dietitian-approved). Some of the founding professionals who paved the way via a non-diet approach and influenced us included Jane R. Hirschmann, CSW; Carol H. Munter; Lela Zaphiropoulos, CSW; Susie Orbach, PhD; Janet Polivy, PhD; C. Peter Herman, PhD; and Leann L. Birch, PhD; among others. They proposed a way of eating that allowed for any and all food choices but did not address nutrition. Our initial reactions were highly skeptical, if not downright rejecting. How could we, as nutritionists (registered dietitians), trained to look at the connections between nutrition and health, sanction a way of eating that seemed to reject the very foundation of our knowledge?

The struggle continued. The healthy meal plans were keeping people attached to diet culture, with the intermittent despair that came with it, yet the demand feeding described in the popular psychology books in the late 1960s through the ’80s seemed incomplete.

Eventually, we resolved the conflict by developing the Intuitive Eating process with ten principles. Special note to health professionals: We have come to realize that this conflict, or cognitive dissonance, is a common experience for health professionals, who have been trained in weight-centric health care—that a person’s weight determines their health. There’s a lot more to health than what you eat—your relationship with food, mental health, social determinants of health, to name a few. Besides, body weight is not a behavior. It becomes a journey of the great unlearning and it feels uncomfortable at first. Just know that you are not alone in this reckoning.

Our book became a bridge between the growing anti-diet movement and the health community. How do you reconcile forbidden food issues and still eat nutritiously, while not dieting? We will tell you how in this book.

If you are like most of our clients, you are weary of dieting and following rigid food plans yet terrified of eating. Most of our clients arrive in our offices uncomfortable in their bodies. Intuitive Eating provides a new way of eating that is ultimately struggle-free and healthy for your mind and body. It is a process that unleashes the shackles of dieting (which can only lead to deprivation, rebellion, and rebound weight gain). It means getting back to your roots—trusting your body and your signals. Intuitive Eating will not only change your relationship with food; it will change your life. In fact, many of the clients mentioned in this book came to us simply for the purpose of losing weight. Even though they may have mentioned physical discomfort in their bodies or emotional discomfort, believing that they were not good enough unless they lost weight, they eventually learned to find comfort and gratitude in the here and now.

We do not judge people for their desire to lose weight—it’s a consequence of diet culture, which is ubiquitous and problematic. It’s a societal system of beliefs, messages, and behaviors that places value on a person’s weight and appearance, rather than well-being, which unfortunately, has become common and normalized. Diet culture reifies thinness, equating it with health and moral virtue, while demonizing some foods and elevating others. It’s difficult to go even a single day without hearing conversations, seeing ads, scrolling through social media that involve some aspect of shrinking bodies. Health professionals are not immune to diet culture, as some health care professionals put patients on calorie-restricted or entire food group–restricted diets, even though there is not a single study to date showing that it’s sustainable or efficacious in the long run, or without harm. Sadly, research indicates that health professionals are one of the main perpetuators of weight stigma.

The problem is that any focus on weight loss will sabotage your ability to reconnect with your body’s Intuitive Eating signals. When you focus on weight, it places your attention on external measures for eating—such as the portions of foods, the macros of food—rather than connecting you with your internal cues. (That’s why we like to say that Intuitive Eating is an inside job.) Instead, focusing on your day-to-day progress—such as getting more satisfaction from your meals and staying more present in eating and life—will give you a sense of connection, which can lead to feelings of joy and well-being.

But before we go on, we want to mention a caveat. This book was written by two cis-gender white women with thin privilege who feel grateful for the many privileges each acknowledges. Neither of us has dealt with food insecurity or the weight stigma that is experienced by many who may be reading this book.

It will be important to work with a practitioner who is trained both in Intuitive Eating and in the specialty issue affecting you, including but not limited to: trauma, medical nutrition therapy, eating disorders, and mental illness. In addition, some people don’t have access to the resources they need in order to learn this process, and that needs to be acknowledged. We acknowledge that we don’t even know all the reasons that might prevent people from accessing these resources. Intuitive Eating is a privilege.

We wish that the suffering that so many experience in this world did not exist. We will keep working toward making this a better world—one in which Intuitive Eating can be accessible to all bodies. Intuitive Eating is one tool, and we are constantly learning and striving toward radical inclusivity.

Intuitive Eating is a compassionate, self-care eating framework that treats all bodies with dignity and respect.

We care deeply about the relationship you have with your body and the relationship that may form between us as the authors and you as the reader. We are humbly open to feedback on how we can do better.

We hope you find that Intuitive Eating will make a difference in your life; it has for our clients. In fact, when our clients learned that we were writing this book, they wanted to share some specific turning points with you:

• Be sure to tell them that if they have a binge, it can actually turn out to be a great experience, because they’ll learn so much about their thoughts and feelings, as a result of the binge.

• Tell them that taking a time-out to see if they’re hungry doesn’t mean that they can’t eat if they find they’re not hungry. It’s just a time-out to make sure that they’re not eating on autopilot. If they want to eat anyway, they can!

• When I come to a session, I feel as if I’m going to the priest for confession. That comes from all the times I used to go to the diet doctor, and I would have to tell him how I had sinned after he had weighed me. This isn’t coming from you, but the inner Food Police.

• I feel like I’m out of prison. I’m free and not thinking about food all the time anymore.

• Sometimes I get angry, because food has lost its magic. Nothing tastes quite as good as it did when it was forbidden. I kept looking for the old thrill that food used to give me until I realized that my excitement in life wasn’t going to come from my eating anymore.

• With permission comes choice. And making choices based on what I want and not on what somebody else is telling me feels so empowering.

• After giving up bingeing, I ended up feeling pretty low some of the time and even rageful at other times. I realized that the food was covering up my bad feelings. But it was also covering up my good feelings. I’d rather feel good and bad rather than not feel at all!

• When I saw how much I was using dieting and eating to cope with life, I realized that I had to change some of the stress in my life if I ever wanted to let go of food as a coping mechanism.

• Sometimes I have hungry days, and sometimes I have full days. It’s so nice to eat more sometimes and not feel guilty that I’m going against some plan.

• I get so exhilarated when I see a food I used to restrict. Now I think—it’s free, it’s there, and it’s mine!

• I’m so glad you’re writing this book; it will help me explain what I’m doing. All I know is that it works!

• When I’m in the diet mentality, I can’t think about the real problems in my life.

• This is the best I’ve ever taken care of myself in my life.

Note: We recognize that gender is a spectrum, and in this version of Intuitive Eating we will be gender inclusive by using gender-neutral language and pronouns, unless we are referring to a specific person who has specified their pronoun.

Chapter 1

The Science Behind Intuitive Eating

When we cultivated the premise of Intuitive Eating, we reviewed evidence from hundreds of studies, which, in addition to our clinical experience, ultimately formed the basis for the ten Intuitive Eating principles. Today, the research on Intuitive Eating itself is robust, with more than 125 published studies showing benefits—with the growing recognition that IE is an adaptive eating style, which influences positive psychological and physical well-being. We’ve decided to begin by highlighting some of the studies validating the process, benefits, and characteristics of Intuitive Eating, in order to give you a glimpse of the changes that may occur in your life when you rediscover your inner Intuitive Eater.

For a complete list of the studies, see the References: Intuitive Eating Studies.

MEDIA IGNITES PUBLIC AND SCIENTIFIC INTEREST

Although our book was originally published in 1995, the tipping point for both research and public interest in our work occurred ten years later, triggered by the publication of two different studies on Intuitive Eating, which sparked global media attention.

In 2005, a professor of health science at Brigham Young University, Steven Hawks, and his colleagues published one of the first studies exploring Intuitive Eating in college students (Hawks et al. 2005). It was a small study, in which women scoring high on an Intuitive Eating scale developed by Hawks and colleagues (2004) were shown to have lower fat levels in the blood and a reduction in the overall risk for heart disease, compared with participants who scored low. In other words, Intuitive Eaters were associated with better health indicators. This study caught the attention of the media.

Very soon afterward, Dr. Hawks and I (ET) appeared on the Today show, discussing Intuitive Eating. Dr. Hawks did several more interviews, including CNN, MSNBC, and the Washington Post.

SCIENTIFICALLY DEFINING AND MEASURING INTUITIVE EATING

In 2006, Dr. Tracy Tylka of Ohio State University published a seminal study on nearly thirteen hundred college women, which validated three key features of Intuitive Eating (Tylka 2006):

Unconditional permission to eat when hungry and what food is desired.

Eating for physical rather than emotional reasons.

Reliance on internal hunger and satiety cues to determine when and how much to eat.

Tylka’s research was a big undertaking, because in order to assess and validate the key components of Intuitive Eating, a series of four studies were conducted. In the first part of the study, Tylka created and validated the Intuitive Eating Scale (IES) to measure and identify Intuitive Eaters.

Next, the college women completed the Intuitive Eating Scale, along with a series of other tests, in order to evaluate the relationship between Intuitive Eating and several indicators reflecting mental health, body awareness, and eating disorder symptoms.

Women scoring high on the Intuitive Eating Scale were identified as Intuitive Eaters. Compared to women scoring low on this scale, Intuitive Eaters were found to have higher body satisfaction, without internalizing the thin ideal, which indicates that Intuitive Eaters are less likely to base their self-worth on being thin. Intuitive Eating Scale total scores were positively associated with self-esteem, satisfaction with life, optimism, and proactive coping.

In 2013, Tylka updated the Intuitive Eating Scale, with an even larger study of 1,405 women and 1,195 men. This study also validated a fourth characteristic of Intuitive Eaters—the Body-Food Choice Congruence, which reflects the Gentle Nutrition principle and how food feels in your body (Tylka and Kroon Van Diest 2013). Of note, this was the first time that the scale was validated for men.

Notably, Hawks and Tylka independently developed and validated different tools to assess Intuitive Eating characteristics. Hawks’s Intuitive Eating Scale (2004a) has four components:

Intrinsic Eating (eating is based on inner cues).

Extrinsic Eating (eating is based on external influence such as mood, social, and food availability).

Anti-Dieting (eating is not based on diets, counting calories, or desire for weight loss).

Self-Care (body acceptance, taking care of body regardless of size).

Today, Tylka’s IE scales are the most widely used in Intuitive Eating research. Of great significance, both of Tylka’s IE assessment scales found that Intuitive Eaters have higher interoceptive awareness. This is really an important concept, because it’s part of the scientific underpinning for the process of Intuitive Eating, so let’s unpack it.

Interoceptive Awareness Is Your Superpower: The Foundation for Intuitive Eating

Interoceptive Awareness. Interoceptive awareness is the ability to perceive physical sensations that arise from within your body. It’s a direct experience, a felt sense that happens in the present moment—it’s not the past or future, it happens right now. It includes basic states like feeling a distended bladder, hunger and satiety cues, and the felt sense of every emotional feeling. Every emotion has a unique physical sensation in the body. When you perceive bodily sensations, it gives rise to powerful information to help get your psychological and biological needs met. In fact, there is a growing body of research that shows interoceptive awareness is profoundly implicated in your physical and mental well-being (Quadt et al. 2018).

In his seminal book, How Do You Feel: An Interoceptive Moment with Your Neurobiological Self, scientist A.D. (Bud) Craig describes the very moment of the felt sense as our "global emotional moment," which is the current state of all our feelings that represent the sentient self. We think that’s part of the reason people describe Intuitive Eating as life-changing—they get reconnected to their sentient self on a very deep level.

Ultimately, IE is a personal process of honoring health by listening and responding to the direct messages of the body in order to get your needs met. The principles of Intuitive Eating work either by enhancing interoceptive awareness, or by removing the obstacles to perceiving and responding to the felt sensations in the body. The obstacles are usually from the mind in the form of rules, beliefs, and thoughts. (See Table 1.)

The challenge in today’s diet culture is that many people do not value, let alone trust, their body sensations. Instead, they eat based on externality—that is, eating according to rules and diet plans, which ultimately create confusion between mind and body. Interoceptive awareness is based on inner sensation, which is an inside job. That’s why using external methods to eat—such as counting macros, calories, or points—does not help you connect to your body.

Interoceptive Sensitivity. An excellent study out of Germany asked an important question: How do we know if someone is capable of Intuitive Eating (Herbert et al. 2013)? Since interoceptive awareness is the key mechanism of Intuitive Eating, the researchers decided to use the gold standard objective measure of interoceptive sensitivity, which is the perception of heart rate test. The operative word here is perception. The researchers hooked people up to electrodes, which independently monitored their heart rate. Meanwhile, they instructed the subjects to count their heart rate, by merely perceiving (no putting their fingers on their pulse). Indeed, those scoring higher on Intuitive Eating had higher accuracy at perceiving their heart rate. For those of you who want to read more about how to do this, we included a perceived heart rate activity in our Intuitive Eating Workbook. (An important caveat here: if you have experienced trauma and/or have been dissociated from your body, this will take more unpacking. It may be important to work with a specialist in trauma and Intuitive Eating, depending on your

Reviews for Intuitive Eating, 4th Edition

[booksfordinner · Rating: 4 out of 5 stars]

Lots of great stuff in here. Makes perfect sense. Now good luck doing it.In all seriousness, not sure I can do this 100%, but there are definitely elements of this. I can incorporate into my eating habits.

[moonlibrary · Rating: 5 out of 5 stars]

I genuinely kinda wish everyone would read this, but it’s not something I can really be pushy about because telling people what to do, re: their relationship with food is a major, major no-no. But yeah.Importantly, THIS IS NOT A DIET. It is about developing a healthy relationship with food that's right for you, and literally the first step is committing never to diet again.I cannot recommend this book highly enough.

[ssperson_1 · Rating: 4 out of 5 stars]

This was a very valuable book. I've been sort of headed in this direction on my own, but it was good to have the guidance this book offers. I skimmed over the "patient anecdote" parts, as I don't need those examples to understand what they're talking about. I'm sure I'll be pulling this off the shelf for refreshers for a long time.

[judygibson-1 · Rating: 4 out of 5 stars]

The authors aim to lead people away from a distorted relationship with food that is caused by a lifetime of dieting and obsession with weight loss and food fads. The book contains a lot of helpful information and many observations and points worth thinking about. I'm not sure that people with seriously disordered eating would be able to resolve the situation with this book--and certainly the authors don't mean to promote this--but it will certainly help me (not disordered, I swear!) develop a more relaxed and healthy attitude. The edition I got from the library was 15 years old; I think I'll buy a current edition for further study.

Edited to add: Yes, I did buy the current (2012, 3rd) edition and found it to be substantially updated from the 1995 first edition. If you're going to read it from a library or used book sale, please make sure you have a new edition.

[yoda1489 · Rating: 4 out of 5 stars]

The main concept I got out of this book is Intuitive Eating (IE) provides a new way of eating that is ultimately struggle-free and healthy for your mind and body. It is a process that releases the shackles of dieting (which can only lead to deprivation, rebellion, and rebound weight gain). In means getting back to your roots--trusting your body and its signals. IE will not only change your relationship with food, it may change your life.

[lisadean_1 · Rating: 5 out of 5 stars]

Intuitive Eating has become an important part of my personal library. It offers one of the most common sense approaches to weight loss among the avalanche of diet books on the market today. That's because Intuitive Eating is NOT a diet book. Instead of prescribing yet another regimented eating plan with a list of "good" and "bad" foods, this book encourages us to listen to our bodies and eat when hungry and stop eating when full. Though both of the authors are registered dietitians and acknowledge the importance of good nutrition, they are well aware that many of us use the rules of healthy eating as a stick to beat ourselves over the head with when we fall short of the standards. They stress that pleasure and satisfaction in addition to health must be a consideration in our eating habits. They point out that deprivation only leads in the end to overeating and weight gain and that foods we forbid ourselves to eat take on an exaggerated importance and lead to the overindulgence we try so hard to avoid. I read this book for the first time after going through a major weight loss and was struck by how many of the core principles I had used without knowing this book was on the market. I still read Intuitive Eating from time to time for inspiration when I get a little off track.This is a great book for anyone who is a serial dieter and has developed a difficult relationship with food.

[labelleaurore · Rating: 2 out of 5 stars]

Intuitive eating makes sense to me but how can I recognize intuitive eating after dieting for so many years and not trusting my intuitive anymore?Good theory in all but not for me...