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Intuitive Eating: Relearning How to Eat for Life
The objective of teaching intuitive eating to the eating disorder sufferer is to return the patient to a time when they ate to live and didn't live to eat. A child has a healthy relationship with food and honors their body in an appropriate manner. By recognizing and responding to hunger, a child is able to adequately fuel their body whether they are growing, highly active, or at rest. Most people are born with the ability to keep themselves healthy and alive without an external locus of control regarding food. Of course food needs to be available but by listening and trusting one's body, a person can live a healthy life, at a healthy weight, without obsessing about food, weight, body, calories, and fat.
Teaching Intuitive Eating
Eating disorder patients have an excellent knowledge of food. Some of that information has been warped into promoting eating disorder behaviors. Intuitive eating has little to do with the knowledge of food, it has to do with increasing their knowledge and trust of themselves. Recovering from an eating disorder is like being reborn. A lot of basic functions, such as hunger and fullness need to be relearned. The number one factor to patients becoming successful with intuitive eating is trust. First, trust in the system, and second, to learn to trust themselves. Many patients feel they are broken and that it won't work for them. Many patients have had experience using the exchange system. To them, this is another diet, a way to control themselves with a plan, it also promotes their belief that they are broken and will never be able to be normal again.
Seven Steps To Learning Intuitive Eating
First Step: Trust Someone Else, Rather Than The Eating Disorder
Patients need to be able to commit without reservations, maybe a few at first, that they are tired of their eating disorder and willing to give it up and try things differently even if they gain weight. If patients commit full heartedly, then weight gain is very limited. Their motivation to have a life without an eating disorder can be seen if they are able to say, "It's okay if I gain weight." If a patient is a re-admit, and has tried the exchange system, or has tried to eat normally on their own, they seem more willing to try things differently and accept intuitive eating.
Second Step: Establish the Basic Framework
Some patients are used to grazing all day, restricting until they are numb, or eating until they are numb. They ignore their hunger and fulness. Even though there is a basic structure in intuitive eating, nothing is wrong, abnormal, or bad. Food is food, we all eat differently and nobody's way is better than another person's. It's all okay. Willpower has nothing to do with food intake and they can never fail because there is no right or wrong.
At Center for Change, patients have meals and snacks at specific times throughout the day. Biologically, the human body needs food every 3-4 hours. The starved body needs time to get readjusted to food and to feel comfortable in a stable food environment.
In planning for discharge and with outpatients, there are some logical times to eat. The may choose their first meal before work/school. Second meal at lunch-time and their third meal after work/school. They should take food with them so it is always readily available. The goal is to never get hungry. Three meals a day are minimum and some patients may choose to eat six or more meals a day.
Third Step: Recognize Hunger / Fullness
Eating disorder victims are not broken, they have just become comfortable with ignoring their bodies' needs.
It is slightly embarrassing for some patients to admit how vulnerable they are in this area. They know a lot about food but are unable to feed themselves and can't distinguish exactly when they are hungry or full. Letting patients know that it is not an exact science is helpful. When their stomachs hurt they have waited too long to eat or have eaten too much. Using their senses to recognize hunger is also helpful. If it looks, smells, or tastes good, then they may be hungry. Patients at the Center monitor their hunger and fullness on a scale of 1-10. They rate hunger/fullness for meals but not specific foods. This assignment helps to prompt the patient to pay attention to their body. This step also closely parallels their acceptance of their body. It is very difficult to trust something they hate.
Fourth Step: Eat a Balanced Diet
After food is broken down, the body doesn't know where the protein, carbohydrate, or fat come from. It cannot tell if the carbohydrate, fat, protein mix came from a cookie and milk or salad with meat and cheese. However, the body needs a mix of these three fuels in order to function well. For balance, we ask that patients consume carbohydrate, protein, and fat at major eating times during the day (at least three).
First meal: Pizza
Snack: Cookies and milk
Second meal: Salad with cheese and meat
Third meal: Granola cereal with yogurt
Snack: Candy bar and milk
Clients have an extremely good knowledge of food. I feel that it is a disservice to teach them about food when they need to be learning to trust themselves. It is also important for patients and their families to avoid any traditional beliefs that they have regarding food. Just because it is a "meal", don't assume that certain types of foods or specific amounts are necessary or present.
Fifth Step: Make Peace with Food
Food is just food. There is no good or bad food. Every food is okay and nourishing in some aspect. Patients may experience a period of time where they eat large amounts of what would traditionally be considered "unhealthy" foods. This is a time for them to reacquaint themselves with "forbidden" foods. They need to learn that it is only food and it is okay to enjoy food without guilt and that their worst nightmares do not come true. This is a time when they relearn what they like, what foods feel good in them physically, and how much is too much or too little.
Sixth Step: Learn to Savor the Eating Experience
"Knowing what you like to eat, and believing that you have the right to enjoy food, are key factors in a lifetime of weight control without dieting." (Intuitive Eating by Tribole and Resch).
Seventh Step: Use the Following Tips to Prevent Lapses
1. No scales, measuring tapes, measuring spoons, or cups.
2. No label reading, counting calories, or planning menus.
3. Never diet again.
4. Do not label foods as good or bad.
5. Participate only in forms of exercise that you enjoy and that help you to feel good.
6. Eat what you like and savor the eating experience. Taste your food, relax, check out the taste in the middle of the meal. Does it still taste good? If it doesn't taste good, don't eat it, and if you love it, savor it.
7. Eat at least three meals a day.
8. Regarding food: be more cautious about under-doing it than over-doing it. Over-doing it evens out more easily in the long run. Under-doing it sets you up for the restrict/binge/purge cycle.
Learning to eat intuitively takes a lot of faith and practice. It is not a quick fix or magic pill. It is a long term approach that is definitely worth all the hard work put into it.