Innate Eating & Implications for Behavioral Health
By Julie Brake, MS, RDN, LD
Many of us have heard the term Intuitive Eating as it has become more well-known to the general public. There are several related concepts that I classify under the term Innate Eating, approaches that involve following the body’s innate cues to determine what, where, when, why, and how to eat. These philosophies include Intuitive Eating1, Mindful Eating2, and Eating Competence3. All of these models are based on evidence and research showing that innate eating improves nutritional intake and nutritional status. In addition, using these approaches in nutrition counseling decreases disordered eating. There are some implications for behavioral health that are important to consider. Should behavioral health practitioners use innate eating models? Are there any contraindications to innate eating? By reading this article, you can learn how innate eating applies to your patient or client population.
First, let’s look at an overview of these different but similar approaches to eating. Intuitive Eating is a term coined by Evelyn Tribole and Elyse Resch, the authors of the Intuitive Eating books. There are now several workbooks and resources available from the Intuitive Eating organization, including a website with links to several research articles supporting the methods. Intuitive Eating has ten principles that help one to consider what is getting in the way of sensing hunger and fullness cues and following them. The focus is on learning the body’s physical cues, sifting through diet culture messaging, and balancing nutrition by eating a variety of foods. Mindful Eating or Eating Mindfully focuses on the where, why, and how of eating, instead of the what and how much. Susan Albers has published a book and resources on Eating Mindfully. There are also many online resources for Mindful Eating through various institutions and universities. Mindful Eating encourages paying attention to what affects how we eat so that we can follow the body’s cues and have an enjoyable eating experience. Eating Competence was developed by Ellyn Satter to advocate for independent eating while supporting appropriate family feeding dynamics. The Satter Model is very clinical and specific in guidelines provided, which has enabled it to be researched, documented, and supported throughout the scientific literature. The Ellyn Satter Institute has a website with a plethora of resources for professionals and communities as well as many print publications that aid in applying the model.
Next, consider the benefits of these innate eating models. People who eat intuitively, mindfully, and/or competently are able to eat meals and snacks without anxiety or pressure. No special tools are required, just a sense of one’s own hunger and fullness cues. Knowledge of balanced nutrition is helpful but not necessary. Innate eating allows individuals to choose what they like and what they feel their body needs for each moment. Research has shown that those who eat innately have better nutritional status which translates to healthy weights*, less disordered eating, and less medical complications. The Satter Model specifically reduces strain on family relationships and promotes lifelong balanced eating attitudes and behaviors.
Yet we know that there are concerns with innate eating in the field of behavioral health. What are the implications of innate eating concepts in this population? Some who struggle with behavioral health issues may not be able to sense or follow hunger and fullness cues. Altered mental health can result in individuals who are not aware of the body’s cues or a large emphasis on aspects of survival that move hunger and fullness cues far down on the priority list of health. Diagnoses that affect sensing body cues include disordered eating, dissociative identity disorder or any dissociation, and obsessive-compulsive disorder. This can be further complicated by medications that may increase or decrease appetite. Suppressed or enhanced appetite may even lead to disordered behaviors and malnutrition, which will exacerbate mental health concerns. Another concern is patient safety at behavioral health facilities. Often inpatient care facilities find it easier to make meals and snacks more regimented, which can be directly contradictory to innate eating philosophies.
As dietitians, how can we work through these problems and advocate for our patients? Safety is absolutely essential, and some behavioral health concerns are amplified by patients with past traumas who feel unsafe. Eating and nutritional concerns may be on the back burner until a patient is safe and feels safe. Baby steps will bring about larger outcomes, and having different stages of treatment will lead to better results. We can come alongside our patients and collaborate with other professionals to promote and counsel toward innate eating.
Here are my suggestions to implement best practices. Start by allowing for a preliminary stage where the focus is on patient safety and adequate nutrition. Advocate for balanced nutrition from all of the food groups and high-calorie options to ensure adequate dietary fat intake. Have specific meal and snack times to assure patients that they will have food while preventing compulsive food behaviors and binges. In a facility setting, it may help to have a policy in place for when a patient is requesting more snacks. This can be managed through the staff to prevent overly restricted intake while maintaining patient safety. The time that food is offered is limited, but not the amount of food offered for that time. Once patient safety and stability are established, the next stage would be to offer various food options to allow for more autonomy in food choices. Work to provide different menu items from all of the food groups at each meal. When meeting one-on-one with patients, discuss adequate nutrition and start to explore hunger and fullness cues. As a patient is making progress, we can try to set up a system where certain patients can freely access snacks as desired. Each facility will need to determine how to fit this in to the overall policies and procedures. In the outpatient setting, assess whether a patient is able to accurately sense hunger and fullness. Consider whether the body’s cues have changed and how a patient might sense a need for nutrition before extreme hunger. Ask medication providers if it is possible to adjust the timing of medications to allow for improved nutritional intake. Advise patients to eat breakfast before taking morning medications and eat a meal or snack before taking evening medications. If the medication is suppressing appetite, a patient will often feel hungrier when the medication is at the lowest amount in the body, which is right before the next dose is taken. It is vital that dietitians also collaborate with therapists and counselors, especially if there are any dissociative or compulsive components to eating behaviors. Logging intake at meals and snacks can help in assessing adequacy and identifying patterns when altered mental status is involved. I recommend using an app that does not count calories or nutrients or using printed sheets that record each meal or snack separately. This prevents promotion of calorie counting which can easily lead to disordered eating behaviors. Food logs should be used minimally, and we should encourage patients to eat without logging once we know that eating behaviors are stable.
In summary, innate eating is supported by research and evidence, and dietitians need to make every effort to implement and support innate eating practices. There may be barriers to advocating for and using innate eating models in behavioral health settings. We can do our best to push past these difficulties for improved health outcomes.
Author Footnote: *A healthy weight is different for each individual and should not be based on body mass index (BMI) or height alone. It should be individually assessed based on growth history, medical diagnoses, and how one feels in their body.
References:
1. Intuitive Eating: www.intuitiveeating.org
2. Eating Mindfully: www.eatingmindfully.org
3. Ellyn Satter Institute: www.ellynsatterinstitute.org
#Eating Disorders