Pamela A. Popper, Ph.D., N.D.
Wellness Forum Health
The failure rate for weight loss programs – all of them – is very high. Frustrated, overweight and obese people who want desperately to be normal-weight enroll in or adopt program after program, hoping for better results, but usually ending up getting nowhere. Some even gain more weight over time instead of losing.
Studies can appear to make some programs “work” because most involve collecting data for short periods of time, and almost anything will work in the short-term. Tens of millions of Americans have been successful for 21 days, 30 days, or 90 days with a diet program, or several diet programs, but have never succeeded in permanently changing their habits or their weight.
Enter Intuitive Eating, a diet philosophy that teaches people how to develop a healthy relationship with food. So far so good; most overweight people do not have a healthy relationship with food. Proponents rightly state that diets don’t work. But they go on to say that in order to succeed, people should avoid dieting and instead learn to listen to their body’s cues since ”…you were born with all the wisdom you need for eating intuitively.”
Participants are taught to “trust themselves” and to “make peace with food” which involves applying several principles. One is that that you should not tell yourself that any food is forbidden since doing so will “…lead to such intense feelings of deprivation that build into uncontrollable cravings, and often bingeing.” Intuitive Eating coaches tell people that overeating and guilt follow the elimination of foods from the diet.
Another principle is to “Challenge the Food Police” who have made the “unreasonable rules” that have led to dieting failure. Overweight people are encouraged to “…eat what you really want in an environment that is inviting and conducive” which will lead you to the place where less food is needed in order for you to have “enough.”
Best-selling books have been written about the concept, health coaches advertise that they specialize in teaching intuitive eating concepts, but there is little research to back up the claims. The “evidence” consists mostly of people telling their stories of failing at dieting and finding “success” which is usually not measured or quantified in any way, with intuitive eating. This is essentially meaningless since almost all weight loss programs, no matter how bad they are, produce a few people who succeed, at least in the short term.
What can further make evaluation of diet plans confusing and somewhat useless is that often ineffective programs are compared with one another, after which one of the terrible programs is reported to be “better.” Members of the general public and even some health professionals don’t necessarily realize this, and are then led to believe that a poorly constructed and ineffective diet is actually superior and “works.”
Such is the case with a small study published in 2015 that compared calorie restricted diets with intuitive eating. Sixteen obese and sedentary men and women were assigned to eat either a diet with 1200-1800 calories (the amount depended on the individual’s metabolic rate), which represented an average reduction of 500 calories per day; or to practice intuitive eating. The intuitive eaters were not given calorie intake targets. All participants were instructed to exercise only in the lab three times per week to avoid increasing physical activity levels, which often accompany starting a new diet program, from influencing the results. At three weeks and six weeks, participants received additional counseling and encouragement.
At three weeks, the participants eating the restricted calorie diet had lost about 5.3 pounds, and the intuitive eaters had lost slightly more. But at six weeks the restricted calorie eaters had lost an additional 2.5 pounds, while the intuitive eaters had regained their weight. Some were heavier at the end of the six weeks than they were before they started.
Since studies have shown that calorie counting and calorie restriction do not result in permanent weight loss for most obese people, this study says more about the lack of efficacy for intuitive eating than how effective calorie restriction is.
People do like to hear good news about their bad habits, so it is not surprising that many overweight people love intuitive eating. Eating cinnamon scones in an “inviting and conducive setting” with no need for “rules” to guide the eating pattern can be very attractive to some people. Intuitive eaters don’t need dietary guidelines – they just listen to their bodies and eat what they want. If I did that I’d weigh 300 pounds. I want cinnamon scones.
There are many reasons why intuitive eating cannot work. While some people don’t want to hear this, there really are good and bad foods and good and bad dietary patterns. Cow’s milk was designed to help a baby cow grow from 90 pounds to 800 pounds in less than a year. It’s a bad food for people who want to be lean (or to avoid chronic infections, breast and prostate cancer, autoimmune diseases, constipation, acne and a host of other conditions). Eating cheese, no matter how inviting or conducive the environment in which the cheese is consumed in might be, will not result in optimal health.
Another issue is that in order for people to have success at weight loss or health improvement, prescriptive communication is required. Prescriptive communication involves giving people directions that are understandable, clear, and actionable, and intuitive eating lacks this specificity. Failure to deliver clear directions about what to do and how to do it has prevented dietary recommendations of many other groups from having much positive impact. Take the USDA for example. In addition to its dietary guidelines not being science-based, the USDA’s recommendations are delivered with instructions that are so vague as to allow almost anything to be included in the diet. “Eat less saturated fat” “keep sodium low,” “enjoy your food but eat less,” “choose whole grains more often,” and “cut back on some foods” are phrases that are virtually meaningless. Terms like “less” and “cut back” mean different things to different people and are often interpreted to favor their dietary preferences.
“Eliminate dairy,” “no oils,” and “treats are for holidays and birthdays” are clear directives. Admittedly, these don’t sound as good as telling people to essentially eat anything they intuit that their bodies might want at any time. But we have never been driven by a desire to tell people what they prefer to hear, or to publish garbage that panders to the public in order to sell books or programs.
The bottom line? Intuitive eating is a diet plan presenting itself as a “non-diet,” and there is no evidence that it is effective for weight loss.
Anglin J, Borchard N< Ramos E, Mhoon K. “Diet quality of adults using intuitive eating for weight loss – pilot study.” Nutr Health Jul 2013;22(3-4):255-264