intuitive eating

Anorexia Recovery: The problem with “intuitive eating”

I’ll preface this blog post with this: this post is about intuitive eating and Anorexia recovery. If you don’t have Anorexia, go ahead and do all the intuitive eating that your intuition asks you to do —this post is not about you. I agree that intuitive eating may be a fantastic approach for a person without a mental illness that disrupts hunger cues and tries to make one starve oneself to death.

This post is not a general slur on intuitive eating, well, other than this first part 😉


Intuitive eating … I have to confess that writing that term makes me cringe. It is so … ugh. It’s not a far cry from “clean eating” and I’ll tell you why: There are no memes of intuitive eating that show a happy and healthy woman sitting in Five Guys with a double cheeseburger. (That was me yesterday — and yes I was happy)

This is the Tabitha Farrar Anorexia Recovery version of intuitive eating courtesy of Five Guys

 

Intuitive eating says “trust your body so long as your body wants to eat salad and not cheeseburgers.”

I know that intuitive eating fans will be shouting “no no, it’s not that!” But you have to see my point here? And if intuitive eating wasn’t originally meant to be that fine, but this is what it has turned into. And yes it may well have been hijacked along the way, but in this diet-obsessed, heath-obsessed, thin-obsessed world, what did you expect?

Intuitive eating is now no more than another label to aspire to. What was once supposed to be used to describe a natural way of eating has been turned into a fashionable category to place oneself in. Another way to be in the clean eating clique without actually saying clean eating anymore — as clean eating is no longer in vogue.

Okay, enough of my cranky opinion. Let’s have a look at the more logical reasons that intuitive eating should stay out of Anorexia recovery. Here’s the first line describing intuitive eating on an intuitive eating website I found:

“The basic idea of intuitive eating is learning how to recognize and respond to your inner hunger cues.”

Anorexia messes with hunger cues. Case closed.


Anorexia will disguise itself as intuition

Anorexia is a chameleon and it will slither its way into just about anything. Anorexia will tell you that intuitively you want the salad not the burger.  You cannot take the risk of even accidentally making the Anorexia-driven choice, so you need a default you can trust. The burger in this case.

intuitive eating
A very wonderful friend drew this. She is spot on.

In discussions I have had with adults in Anorexia recovery who have worked with dietitians who insisted on intuitive eating, it seems to be often the default response given by people who don’t really know what else to say, or want to express judgement but need a polite way of doing so. Maybe that is me being cynical. Possibly they are so smitten with the concept of intuitive eating that they honestly believe that it is the answer for all people, including people in recovery from a hunger-cue destroying illness such as Anorexia.

AN person: I don’t feel hungry

Dietician: Use your intuition to guide you as to your levels of hunger

AN person: How much do I need to eat?

Dietician: Use your intuition to guide you to knowing when you are full

AN person: I can’t decide if I want a second helping of dinner 

Dietician: Use your intuition to guide you to knowing if you should eat more

AN person: I don’t have any bloody intuition

Dietician: Use your intuition to guide your intuition


Here’s a discussion that an adult (let’s call her Jane, but that is not her real name) in the weight restoration phase of Anorexia recovery told me about last week:

Jane: I ate 3 scoops of ice cream last night and feel bad about it. Anorexia is screaming at me that I should have eaten less. Do you think that was too much?

Jane’s RD: Do you think that you were listening to your body? Maybe if you had been eating mindfully you would not have eaten so much as to make you feel guilty about it now.

Basically Jane’s RD just confirmed what Jane’s Anorexia wanted her to say. What Jane’s RD said translates to “you ate too much” in Anorexia speak. This person, Jane, is very underweight and fiercely battling a very entrenched eating disorder. Would it have killed her RD to drop the intuitive eating hat just for two seconds and have said: “No Jane, there is no such thing as too much food in Anorexia recovery.” ?

 

Anorexia distorts food perception 

When you tell a person in recovery from Anorexia to use intuitive eating, you are telling a person who possibly almost died of self-starvation to use their judgement about what size portion they should have. You are telling a person who once thought that half a sandwich was enough to feed her for a week, that she should trust her inner judgement on how much to put on her plate. You are telling a person who has a mental illness that distorts his hunger cues to “eat when hungry and stop when full.”

I’ve heard the “when we start off as babies we naturally know how to eat intuitively” story a million times and I don’t buy it for people with Anorexia. I mean, whoopie for babies and all that, but when I was a baby I didn’t have active Anorexia. It is not comparing like with like.

If a person has Anorexia, we cannot compare their eating goals to a person who doesn’t have Anorexia. Let’s not ignore the freaking mental illness and pretend it is not there! I find that slightly insulting actually. Being told I should eat intuitively like everyone else should regardless of the illness that could kill me if I were to even accidentally lose weight. Insulting because it belittles the seriousness of this illness. Unfair because I’m not on a level playing field when it comes to food.

I understand that the idea is that intuitive eating is supposed to remove all the food judgements and rules and reject the diet mentality and that I do like about it, but the whole build self trust with your body part puts this relationship on a pedestal. For those of us with mental illnesses such as Anorexia, it is wholly inappropriate. We need to learn to stay alive first. I’ll save bonding with my hunger cues for another life. In this one I’ll focus on not dying.

 

Intuitive eating relies on hunger cues

That should be all I have to say. But apparently it is not, because dietitians all over the world working with individuals in recovery from Anorexia are still telling them to eat when hungry and not eat when not hungry. As I explained in the recent podcast I did on hunger, people with Anorexia cannot trust hunger cues. We are often not physically hungry when we should be. We are often still mentally hungry when we are physically full. We often only actually experience hunger cues after having eaten.

Hunger cues are not reliable for people with Anorexia

I will repeat this one as it is important: we are often not hungry. There is an absence of hunger cues. While it may be argued that as a person moves forward in recovery that they have a return of their natural hunger cues, even this can be dodgy and unreliable at time for some of us.

Normally, when you average Joe begins to starve, neurochemical signals of hunger are elevated and signals for satiety and activity are lowered (G. H. Anderson & Kennedy, 1992; Leibowitz, 1992; Prentice et al., 1992). However, researchers have found that for people with Anorexia, most neuromodulators and hormones influencing hunger, satiety, and activity are present in unusual concentrations that are opposite to those found in normal starvation. In other words, people with Anorexia have funky happenings afoot with regards to hunger. 

These findings are all consistent with adaptations to turn off eating and turn on traveling — the theory that certain humans would have survived better in times of famine if they were able to direct energy to their limbs and walk to pastures new. They are also consistent with AN patients’ descriptions of their subjective experience of finding it very difficult to eat and feeling restless and driven to exercise.

 

Hunger cues and stress

I am a solid 7+ years recovered and have steadfast hunger cues. However, guess what is the first thing to disappear in times of stress? My hunger. Now, lack of appetite in stressful times is not uncommon. For “normal” people a couple days eating a little less is no big deal. For me however, that could lead to energy deficit and a relapse. If I were to follow intuitive eating, even this strongly recovered, I could risk relapse in times of high stress — or that time of the month when I feel super bloated due to my period. I’m not even going to dabble with my recovery. I’d rather just suck it up and eat.

One of the best decisions that I ever made in recovery, was that I would eat a certain amount or more every day and never less no matter what the circumstance. I have a mental picture in my head of what is adequate. For example, a snack is a giant cookie or a couple pieces of toast, not an apple. For example, a salad never counts as a full meal. For example, fruit is fine so long as I have it alongside — not instead of — a more substantial snack. For example, lunch and dinner always have a dessert alongside. etc, etc,. This is not a meal plan. It is a commitment to eating in a certain manner that I know keeps me safe. It is a commitment that I keep even on days when I don’t feel like it. Even on days I feel bloated and crampy and all PMT. On the days when I am not bloated and crampy, I don’t even have to think about it as I love to eat. It is a safety net rather than a ceiling.

So if intuitive eating is a little dodgy for someone like me, why the hell are people fresh out of IP being told to follow it? Yes, I kid you not, this happens.

 

Intuitive eating can make Anorexia recoverers feel hopeless

Dear dietitian, here is something that your client told me that he couldn’t bring himself to tell you: He came away from his appointment with you feeling hopeless because you told him to eat what he wants and follow his hunger cues. He felt hopeless because of the brain freeze that he sufferers when he thinks about food, and the blank space that comes up when he tries to decide what he wants to eat. He felt hopeless because his hunger cues are not always there. Sometimes, telling a person with Anorexia to follow hunger cues is like telling a blind person to follow the blue arrows.

For some people who cannot eat intuitively, this is just another thing that their eating disorder will use to tell them that they cannot “do” recovery. Most people already have quite enough of those thoughts of failure and don’t need any more.

Mindfullness when eating isn’t always a good thing

I spoke about this in a podcast discussing DBT for eating disorders. Mindfull eating, while a good practice for the general population, is not always a good idea for people with Anorexia.

In fact, for those of us who experience increasing stress and anxiety when we think about what we are eating, mindlessness while eating is a better approach. When I was navigating my own Anorexia recovery I worked out that the way to keep myself calm while eating was to distract and do a crossword at the same time.

Intuitive eating principles teach that each bite should be a mindful decision. Hell, if I had done that it would have taken me 24 hours to get though a plate of food.

In AEDRA’s meal support service, we have found that clients prefer distraction conversation to help them get through their meal. The last thing we have found to be helpful is talking about the food that they are eating.

 

Here’s why intuitive eating is dangerous for people with Anorexia

Here’s a revelation: sustaining Anorexia recovery regularly requires eating when one is not hungry.

As I mentioned above, some treatment centres have started trying to teach intuitive eating in PHP and OP programs. I believe this is irresponsible. One of reasons that I have been able to sustain a robust recovery is that I can force myself to eat when I don’t feel like it. I can and have to sometimes eat when I am not hungry. The last thing a person in recovery from Anorexia needs are these conflicting messages. You have to eat followed three weeks later by you only have to eat when you are hungry. 

This is feckless and also indicates that there is still the misunderstanding out there that weight restoration equals full recovery. A person can gain weight in a treatment centre, but if you tell them on leaving that they only have to eat when hungry, they will likely relapse. That is because weight restoration does not equal full mental or physical recovery. You can tell nothing about an individual’s state of mental health by looking at them.

Why take the risk?

This is the part that vexes me something chronic about all this. Why take the risk? If someone has Anorexia, why bother with the whole intuitive eating thing? Why not just play it safe and tell them to continue to eat a high minimum of food every day?

What is the benefit of telling a person with Anorexia to strive for intuitive eating?

I don’t get it.

Or maybe I do a bit. I think it might seem like a good idea because it leads to less conflict. But only because it appeases the eating disorder. I’ll take an ED tantrum any day if it means the person has a higher chance of getting and staying well.

I’ll make you a deal, intuitive eating. 

Here is my deal: I will eat intuitively so long as this is telling me to eat above and over the amount of food that I know I need to have every day.

My deal is that a person in recovery from Anorexia can follow intuitive eating so long as there is a safety net — and burgers — involved.

 

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