On Nutrition

It’s been 25 years since registered dietitians Evelyn Tribole and Elyse Resch published the first edition of their book “Intuitive Eating,” introducing an approach to nutrition and health that rejects the diet mentality in favor of cultivating a positive relationship with food and the body. The fourth edition of this pivotal book was released in June, at a time when interest in this antidote to diet culture is gaining popularity among both dietitians and the public alike.

The book was born when Tribole and Resch realized that diets — even the “nondiet” weight-control strategies with meticulous meal plans that they offered their patients in their California private practices — didn’t work in the long term, and also had undesirable side effects — many of their patients regained weight, and were emotionally worse off in the process.

This ethical conundrum that Tribole and Resch found themselves in — how do you help people eat nutritiously without perpetuating diet culture? — became the 10 principles of their “Intuitive Eating” model. The principles begin with “reject the diet mentality” then move on to “honor your hunger,” “make peace with food,” “challenge the food police,” “discover the satisfaction factor,” “feel your fullness,” “cope with your emotions with kindness,” “respect your body,” “movement — feel the difference,” and finally, “honor your health with gentle nutrition.”

While the core of the new edition remains the same — a few principles have been renamed or reordered — the book has evolved along with the authors. The most significant updates in this edition include a new section on baby-led weaning in the “Raising an Intuitive Eater” chapter, new information about the impacts of weight stigma and a culling of statements about body weight and numbers that refer to weight or serving sizes. “We were so dedicated to not having anything that would be triggering or stigmatizing, even unintentionally,” Resch said. “We’ve always said diets don’t work, but we wanted to make it clear that diets promote weight stigma.”

Both Tribole and Resch are transparent about this process, because many people — both health professionals and the public — who have been trained that weight determines health experience a lot of cognitive dissonance when exposed to information that refutes that training. “It was very humbling to see how much we’ve evolved and grown,” Tribole said. “Sadly but truly, we’re all immersed in diet culture. We’ve learned more and now we’re doing it differently.”

Astute readers of previous editions will notice that “discover the satisfaction factor” now comes before “feel your fullness.” Resch said this reflects how she addresses these concepts with her own patients. “You have to be focused on ‘Is this food satisfying?’ before you can consider if it’s a good idea to stop eating when you are comfortably full. If you are paying attention to satisfaction, the point when you are comfortably full is most likely going to be the point when the food stops tasting as good.”

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The principle formerly known as “cope with your emotions without using food” is now “cope with your emotions with kindness,” a response to the fact that emotional eating has become pathologized to the point where people start shaming themselves for self-soothing, Tribole said. Instead of resisting the idea of emotional eating altogether, she said it’s better to consider, “What’s the kind thing for you, for your mind and your body?” Tribole and Resch also said that sometimes what people label as emotional eating is actually compensatory eating due to food restriction, or to other types of physical, mental and emotional deprivation.

Another simple yet significant tweak is using the word “movement” instead of “exercise” in the ninth principle.

Tribole and Resch explained that the concept of exercise has become so militant and tied up in weight loss that the very word can be triggering. They’ve also observed that many people exercise joylessly when they’re dieting, then stop exercising when they start practicing “Intuitive Eating,” because they feel like the two don’t mix. “We’re going to move our bodies throughout life, as all animals do,” Resch said, and Tribole points out that the idea of movement helps people connect with their bodies by choosing activity that feels good rather than what provides the most calorie burn.

While the original premise of “Intuitive Eating” was inspired by the authors’ review of evidence from hundreds of studies, today there are more than 125 studies on the actual “Intuitive Eating” model, 100 alone since the previous edition of the book came out in 2012. Much of this research is possible because of a validated Intuitive Eating Assessment developed by Ohio State University researcher Tracy Tylka in 2006, but Tribole also credits the growing body of intuitive eating research to the fact that more researchers are realizing that dieting doesn’t work. Research shows that intuitive eating has benefits for physical and mental health, including reducing disordered eating behaviors.

For example, a small pilot study published in June in the International Journal of Eating Disorders found that college-age women who exhibited disordered eating behaviors, but did not have diagnosable eating disorders, had a reduction in disordered eating following an eight-week “Intuitive Eating” training. A study published in January in the journal Eating and Weight Disorders followed 1,491 young women for eight years, from adolescence into early adulthood. Those who exhibited more intuitive eating traits at the beginning, or greater increases in intuitive eating over the course of the study, had better psychological health and fewer disordered eating behaviors. Most significantly, being an intuitive eater provided strong protection against binge eating disorder.

“We have to move past this reductionism that health is simply what you put in your body, and I think ‘Intuitive Eating’ captures that,” Tribole said.