The Science of Intuitive Eating

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With chronic illness on the rise, health professionals are looking for ways to encourage people to eat healthier, lose weight, and just generally live a healthy lifestyle. For a long time, the traditional answer was to restrict calories (or said another way – “go on a diet”) and increase exercise.

However, studies point to this type of restriction and dieting leading to the opposite effect, with weight gain over time more likely, and higher BMIs linked with more episodes of dieting. Restriction also increases the risk of disordered eating behavior and eating disorders, which come with health concerns of their own.

Since the mid-1990s, intuitive eating has become very popular, with one 2017 study showing that the majority of registered dietitians, especially those who worked in weight management, used intuitive eating over traditional weight management practices.

What Is Intuitive Eating?

The foundation of intuitive eating is to eat when you are hungry and stop when you are full; this addresses a person’s relationship with food, his or her body image, and getting rid of the concept of good or bad foods. It is distinct from flexible control and is the opposite of restrictive eating patterns. With its focus on removing the potentially harmful psychosocial concepts around food and dieting, it should come as no surprise that intuitive eating decreases disordered eating behaviors and dysfunctional relationships with food that increase the risk of eating disorders, especially compared to rigid dietary control and restraint.

Intuitive eating is also associated with having a more positive body image and emotional functioning. Some of the benefits can also start early, with intuitive eating helping to moderate the potentially damaging relationship between maternal concern about child weight and restricted feeding, with practices that have been linked to long-term weight problems and a higher risk of disordered eating behavior.

The vagus nerve, a key part of the parasympathetic nervous system, may also play a role in the benefits of intuitive eating. One study found an inverse association between resting vagal activity and the subscale Unconditional Permission to eat on the Intuitive Eating Scale (IES). Those with higher activity in the vagus nerve during resting state were more likely to think of certain foods as forbidden and be less willing to consume them. More work is necessary to determine what if any role the vagus nerve may have. Those who score higher on the IES also score higher on interoceptive awareness, or awareness of the body, such as one’s heartbeat.

Does It Work?

Learning to eat based on your own hunger and satiety cues sounds great, but does it lead to a healthier individual? Let’s see what the literature has to say.

Weight Loss

Although the philosophy of intuitive eating may take away the focus from losing weight and body image and put it on health and wellness, many studies that look into its efficacy use weight loss as one of the outcome measures, with many studies pointing to a positive effect.

In one cohort study, intuitive eating was inversely associated with being overweight or obese in both men and women. Another study found that for every 10-unit increase in the intuitive eating score based on a validated scale, there was a 5.1 percent decrease in BMI. This was slightly mediated by binge eating frequency. There may also be a correlation between intuitive eating and internal motivation for physical activity and exercising for pleasure rather than health reasons.

One cross-sectional study using the Intuitive Eating Scale-2 (IES-2) to measure intuitive eating in women after bariatric surgery found an association between weight loss and intuitive eating. For every one-point increase in the IES-2 score, there was a 2.6 percent reduction in BMI. When reviewing the subscores for intuitive eating, the one with the greatest association was “eating for physical rather than emotional reasons,” compared to “reliance on hunger and satiety cues” and “unconditional permission to eat.”

Another systematic review compared mindful and intuitive eating studies and found that, compared to non-intervention, there was a significant improvement in weight loss in those who incorporated intuitive eating. However, compared to conventional weight-loss strategies, there was no difference. Another study found that intuitive eating was associated with weight stability while restrictive eating, either flexible or rigid control of diet, was more associated with instability in weight.

One study found that intuitive eating played an important role in self-regulation, supporting the indirect relationship between self-regulation and BMI. Thus, it could also be used as a tool to enhance self-regulation and thus support a healthier BMI, although additional studies are needed to look more closely at the relationships between the three.

Thus, although intuitive eating may not be superior in the short-term to conventional weight loss programs for BMI reduction, it can be compatible, and when you add in that it leads to longer weight stability and better psychological outcomes, especially in terms with eating behavior, it starts to become preferable to conventional restrictive dieting.

Additional Health Improvements

Weight loss is not the only physical benefit of intuitive eating; cardiovascular and metabolic markers have also undergone improvements in studies.

Intuitive eating is often used in health-focused programs that take a weight-neutral approach. In one systematic review of these types of programs on cardiovascular disease risk factors, researchers found improvements in several markers, but they were not significantly better than conventional weight loss programs. Weight loss and cholesterol improvements were better in programs focused on health, not weight loss, (or weight-neutral programs), while blood pressure was better in the conventional programs.

What was statistically different was an improvement in body satisfaction and disordered eating behavior in the weight-neutral programs. Larger studies are needed to further explore whether one of these interventions is better than the others, but this does demonstrate that while some health parameters may be similar, relationship with food and eating behavior is better in the weight-neutral category, which may be more important in certain populations.

Another study compared a weight-neutral approach to health with a weight-loss approach. They found that the weight-neutral group experienced a greater decrease in LDL levels as well as improvement in intuitive eating scores. Those undergoing the weight loss program had greater reductions in BMI and weight. Both groups had positive changes to physical activity, intake of fruit and vegetables, waist-to-hip ratios, total cholesterol, self-esteem, and quality of life measurements.

Another study found that after six months of either a Healthy at Every Size program (a weight-neutral program that incorporated intuitive eating) or a more traditional diet program and 6 months of aftercare, the traditional weight loss group initially lost weight and had improvements in metabolic fitness, but after a year, most of the improvements were not sustained. Conversely, the Healthy at Every Size group maintained their weight and improved in all outcome variables even after the one and two-year follow up, demonstrating a more sustained behavior change.

This eating pattern approach can also be used in pregnant women with many benefits. In one study on postpartum women who had gestational diabetes, those who underwent intuitive eating during and after their pregnancy had a lower BMI, lower fasting glucose and HbA1c levels, and reduced weight retention after one year. The researchers found that intuitive eating was an effective intervention for blood sugar regulation and weight control in this population. Another study found that intuitive eating led to lower gestational weight gain, although it did not impact the birth weight of the child. This observational study used the IES and found that for every one-point increase in the score, there was a 1.7 kg lower gestational weight gain. Another study found that higher intuitive eating scores led to greater postpartum weight loss after controlling for breastfeeding duration, exercise, initial BMI, and BMI changes during pregnancy.

As with weight loss, intuitive eating may not have significantly better outcomes compared to traditional restrictive dieting, but studies do demonstrate that it can improve cardiovascular and metabolic markers, often for a more sustained impact, while reducing the risk of developing disordered eating behaviors.

Food Intake and Diet Quality

Some studies have focused on whether intuitive eating improved diet quality, since its main focus is on eating when hungry rather than the type of food one will eat. Studies have been mixed, with some subgroups of intuitive eating not improving diet quality, while others do.

For example, although fruit and vegetable intake was not correlated with overall intuitive eating scores in college students, some subsets were: Body-Food Choice Congruence and Eating for Physical Rather than Emotional Reasons. Another study found that those with higher subscores in the Physical Reasons category were less likely to eat sweets and fatty foods, and women in particular also consumed less meat, fish, dairy products, and eggs. Women in this category also consumed more dried and oleaginous fruits. The subgroup with higher scores in the cues subgroup also tended to eat less fish, eggs, dairy, and meat, and women in this group consumed more legumes and whole grains. Conversely, the group with higher permission scores consumed less whole grain products and fewer fruit and vegetables, and they also tended to consume more sweets and fatty foods as well as more fast food and pizzas.

One study looking at the use of a Healthy at Every Size approach (a non-diet approach that focused on holistic health changes along with self-acceptance) to health compared to a control found improvement in intuitive eating scores as well as diet quality after the intervention and at the one-year follow up in the group who underwent the program.

Thus, those who only seem to adopt the concept of unconditional permission to eat may not alter their diet quality, but those who focus on eating for physical reasons do seem to make more nutritious food choices.

Summary

Intuitive eating has many potential benefits for health, including improving eating behavior and relationship with food. However, it is not always simple to adopt, especially for those who already suffer from disordered eating or eating disorders. Working with a professional trained in intuitive eating who can support you through the work can help you to adopt this eating pattern for yourself, leading to a longer, more sustainable eating pattern for a healthier lifestyle and body.

 

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