That Intuitive Eating Study
In one of the most colossal failures to interpret Intuitive Eating to the masses, Gretchen Reynolds reported in The New York Times magazine on this study which concluded that intuitive eating was not any better than calorie restriction for shedding pounds.
Are you effing kidding me?! There really is nothing that will put me in a rage more than someone trying to take one of the few, weight-loss-mentality free, diet-free philosophies on earth and trying to turn it into a weight loss diet.
In case you don’t want to read the article or the study – though if you do, please come back here for a complete breakdown of how this is just so wrong from top to bottom – I’ll sum it up here. Researchers took 16 men and women and put half on a diet, and gave the other half “instructions” in intuitive eating and after 6 weeks the dieters lost around 5 pounds and the intuitive eaters, while initially losing weight, did not show nearly as much weight loss as the calorie restriction group. Neither the article nor the abstract mention average weight change for the IE group, but I suspect it was insignificant and I’ll explain why just as soon as I finish banging my head against the wall over here.
There are three huge problems that I can see with this study. The first is the fact that intuitive eating was not designed with the intention to produce weight loss. Straight from IntuitiveEating.org, it is “an approach that teaches you how to create a healthy relationship with your food, mind, and body.” Nowhere on the website is weight loss promised. It’s simply not about that – it’s about becoming a no-drama eater, unlike how most people eat while on diets (total drama). In the process, a person’s weight may stabilize as a result of eating according to inner hunger/fullness cues, but that doesn’t necessarily mean weight loss, and in some cases it might even mean some weight gain if a person has been maintaining below their natural set point. And yes, some people may lose weight, although this is not a scientifically proven outcome. Which is why the end point of intuitive eating is a relaxed, healthy relationship to food and eating – not weight loss.
So comparing intuitive eating to dieting to produce weight loss is like comparing apples and…watermelons, it’s just that different. Other than being about eating, they are not at all the same thing. But that didn’t stop the study authors from making the comparison.
The second big problem is how intuitive eating was executed (with all the accurate imagery that word evokes) in this study. All participants, including the intuitive eaters, were all weighed. So while one of the principles of intuitive eating is not “throw out your scale,” rejecting the diet mentality is the first principle, and weighing is an integral part of weight loss dieting. Many intuitive eating practitioners I know won’t weight their clients because it is counterproductive to becoming reacquainted with their internal eating regulation. Why? Because stepping on the scale may trigger the expectation of weight loss, and that expectation, whether met or not, can mess with developing true body trust. It becomes about reliance on external outcomes, not internal cues.
But these study participants were indeed weighed. How effective, then, do you think their practice of intuitive eating during the study was? Do you think they were truly able to trust their internal signals of hunger and fullness when they stepped on a scale and were reminded of the expectations around weight change? I doubt it. I call that a big study flaw.
And the third problem is this: the participants were instructed in intuitive eating at the beginning of the study and then at the midpoint. The study was a randomized controlled trial so I’m going to assume most of the participants were new to this non-diet philosophy. Were they dieters before? Had they ever tried to lose weight? Were they chronic over- or under-eaters? Because here’s the deal: just getting some basic instruction in intuitive eating once or twice, especially if someone has been a chronic dieter, does not necessarily an intuitive eater make. For many of us, the journey from anguished eater to intuitive eater is a process – sometimes long, sometimes complicated. It can take weeks, months or years. In my personal experience, the first few weeks of non-diet eating does not feel intuitive at all. As Carly from the blog Snack Therapy writes, intuitive eating initially
“…involves a whole lot of thinking about food. And this is true… at first. It’s kind of like when you break up with a partner; you have bitch and moan to your friends/therapist/mom/other therapist/person handing out free samples at Whole Foods/cat in order to get over him or her and forget about your dysfunctional relationship. It’s the same thing with food. You have to analyze why you’re eating what, and when, and why, and how, and with whom. You think about how you feel after certain meals. You might spend a lot of time dreaming about what you’re going to eat tomorrow, because you’re finally allowing yourself to eat good food. So it’s true: if you decide to start eating intuitively, it probably won’t be very intuitive at the beginning. It’ll be a lot of checking in with yourself: (‘Carly, why did you eat that bowl of ice cream? Was it because you were hungry? Was it because you needed comfort? Was it because you saw a commercial for some and you had a craving? Was it because the moon is in the 7th house? Was it because you read that article about how some people develop lactose intolerance later in life, and so you should probably eat the ice cream now just in case you wake up tomorrow with a crippling dairy allergy?’). It’ll be a lot of thinking. A whole lot of thinking.”
Do you think the participants of this study, in the first 6 weeks after their introduction to IE, were really accomplished intuitive eaters? Maybe, and also maybe not. Not that it matters much to the bottom line of weight loss – because again, that’s not what we’re expecting here in the real world. But if you’re gonna call it intuitive eating, you maybe want to start with a bit more than two quickie info sessions.
So…argh.
This is irresponsible science. It’s also irresponsible reporting. The investigation in this article was pretty damn piss-poor. All Ms. Reynolds had to do was toodle on over to IntuitiveEating.org – which she referenced in her article – to see that nowhere on the website is there a promise for weight loss. Where you can see that it doesn’t even mention weight loss as an outcome. That it is obvious it isn’t another fad diet craze that is to be used as a substitute for dieting in order to get your dream body. Nope nope and nope.
While intuitive eating might not produce weight loss it can give us so much more: peace of mind, a healthy relationship to food and eating and our bodies, a weight that is right and sustainable for each one of us. Putting it in the same category as weight loss dieting? Epic fail.
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Great post Glenys. Wow the researchers really did miss the point!
-Like you I found it was disturbing that they tried to compare intuitive eating with calorie counting and use weight change as a marker for effectiveness.
-A 6 week study – in my experience intuitive eating takes much longer.
-I doubt the authors have skills in eating intuitively themselves let alone teaching other people with potentially complex disordered eating fueled by chronic dieting. I noticed the authors either worked for government (Human Services) or university (mathematics and statistics) so it leads me to make the opinion they are not dietitian’s or other trained clinician to understand and guide the intuitive eating approach.
Agreed! I didn’t want to even get into how I thought the instruction in IE was probably inadequate…no proof, but that’s my gut feeling here. The thought seems to be, here’s another fat diet that you can learn in 5 minutes or less…Argh.
This is sadly hilarious. Well written response GlenysO. I will now judge whether or not it was worthwhile for me to read your blog post by determining whether I lost any weight while I was reading it.
However, the fact that the Tribole & Fiaedp book talks about how IT WORKS!!!! in neon letters on the cover means they are quite happy to profit from hating fat people (even if, in teeny tiny print, they say they don’t somewhere around page 112.) Why aren’t dieticians calling them out on this bullshit? If you’re marketing yourself as a anti-fat bigot diet pusher, you can’t get too upset when people think you’re selling a diet. There is nothing on the cover of that book that says anything about accepting fat people as normal or avoiding weight “loss” attempts, and there is plenty on there that says, “Buy me! I’m the DIET that will finally “WORK!!!!”” Call out these hypocrites on their bullshit. If dieticians did so en masse, they might actually listen. (Because, after all, who cares what fat people think.)
I disagree with you on several points here. Where it says “It works” – the book does not say anything about promoting weight loss, at least on the cover. Nor does it present itself as a way to lose weight. There is some suggestion that if you are over your set point weight, that some weight loss may occur if you start to eat more intuitively (that is true and has happened for some people however Tribole and Resch do not claim this as a guaranteed outcome of intuitive eating). There are many people who come to this book with messed up eating (usually thanks to diets) and who find they can normalize their eating through learning to eat intuitively, and I believe that is what the “It works” is referring to.
As a dietitian, I respect the work that Tribole and Resch have done immensely – they are early pioneers in the dietetics field (along with Ellyn Satter) to reject the idea of dieting and weight loss. I know people who work directly with Elyse Resch – fat people – and she is not anti-fat in any way.
I have long read the ongoing work of Evelyn Tribole, and there is nothing I’ve ever read that leads me to believe she is anti-fat.
Many of us non-diet, weight-neutral dietitians base our treatments on their work. I’m thankful for what they’ve done. One thing to be aware of is that HAES and Size Acceptance are two separate things. They go together well, but the work is different – one is a health model and the other is a civil rights issue. So while I think that if one is promoting non-diet philosophy that size acceptance should go hand in hand, you might not always see a lot of writing on that topic. I do feel the the book Intuitive Eating, however, does cover self-acceptance to some degree. I’m simply not seeing where they are coming across as anti-fat. Sorry.