Research Paper By Stephanie Karakantas
(Transformational Coach, UNITED STATES)
One of the main reasons a client often comes to a health coach is to lose weight. In the United States alone, 78.6 million adults, one third of the population, are considered obese. (1) This does not include the number of individuals seeking a health coach who are overweight or might want to lose a few pounds. Traditionally, individuals have sought out programs or popular diets that enocurage weighing out food, eliminating specific food categories, counting calories, tracking exercise and food intake along with weekly weigh ins. Despite being successful to lose weight intially utilizing many of these strategies, less than 20% of those who lost weight have been able to keep it off long term. (2)
While the health coach can use these tools to varying degrees to support the coaching process , there are limits to their usefulness. Many clients have been on the dieting roller coaster for years and find tracking food intake, relying on the number on the scale and eliminating favorite foods to be a detriment to their quality of life and ultimately, success. The literature highlights the pitfalls of chronic restrictive dieting as well as a physical, emotional and pychological backlash where failing at a diet reinforces guilt, binge eating and lack of self trust in making decisions about what to eat and reducing overall poor self-esteem. (3) Having spent the majority of my professional career as a nutritionist, I acknowledge that clients need more than the standard “go on a diet” approach and discovered intuitive eating as an alternative. Offering my clients ways to improve their relationship with food that could result in weight loss was welcomed by many as an escape from the dieting cycle.
What is Intuitive Eating?
It is difficult to discern exactly when intuive eating became a known approach to healthy eating. Several books emerged in the mid to late 20th century that encouraged eating for physical over emotional reasons with an emphasis on a non-diet philosophy. (4,5). Most recently in 1995, two dietitians, Evelyn Tribole, M.S., RD and Elyse Resch, M.S., RD published a book, Intuitive Eating.(6) Since that time, they have built a successsful clinical practice along with a certification program for health professionals and coaches in their specific method of intuitive eating. Research suggests that this can be an effective means in helping clients increase their overall wellbeing and reduce their weight. (7)
According to Tribole and Resch, intuitive eating is an approach that teaches the client to build a healthy relationship with food and where the client becomes the authority on their own hunger, satiety and food preferences, not relying on external measures to dictate hunger and foods to eat. The client is able to distinguish between physical and emotional hunger while gaining confidence in their own ability to trust their physical eating cues. No foods are forbidden and clients experience a deprivation free zone where they can learn to enjoy foods they may have considered off limits on a previous diet plan. The intuitive eating model they propose has 10 guiding principles that support a client through the intuitive eating process:
- Reject the Diet Mentality
- Honor your Hunger
- Make Peace with Food
- Challenge the Food Police
- Feel Your Fullness
- Discover the Satisfaction Factor
- Cope with Your Emotions Without Using Food
- Respect your Body
- Exercise: Feel the Difference
- Honor your Health: Gentle Nutrition
Like coaching, intuitive eating acknowledges that the client is the expert in their lives. However it can be a challenge to re-establish a healthy relationship with food, as there are many underlying beliefs, from familial, cultural, gender expectations on food and weight. Here is where a coach can engage a client to uncover these underlying beliefs while implementing intuitive eating practices to move the client towards freedom from dieting.
Suzi is a client who came to coaching five months ago with one and only one agenda brought to the table: to lose weight.
Our initial intake is as follows: Suzi has been a chronic dieter. She wanted to work with a health coach to lose approximately 30 lbs. She exercised regularly, weighed herself daily, kept copious food records, along with commentary about how “bad” or “good” she had behaved based upon her food choices. In addition, Suzi felt that people who could not lose weight were weak and undisciplined, including herself. She felt this particularly when she would eat foods not allowed on her self-prescribed diet.
Over our first few sessions, we worked with the structures Suzi had in already in place. Exploration of Suzi’s feeling around these structures and how they served her was important to begin making a shift away from external measures of eating to one that originated within Suzi herself. As these structures were entrenched in Suzi’s lifestyle, it was important as her coach to ask permission to explore the usefulness of these structures. Suzi was open to doing so and found that she became aware for the first time that her weight loss diet was more harmful than helpful.
Questions posed at this point in our coaching relationship:
- What if I said to you that over time restrictive diets do not work?
- What does weighing yourself daily achieve for you?
- What feelings come up for you when you weigh in?
- What would it feel like to not weigh in on a regular basis?
- What other ways besides could you define your progress in weight loss?
- What message is your body sending you when you are hungry?
- What can you imagine your body saying to you when you avoid eating when hungry?
- What benefits are there for you when you track all your food intake?
- How does it feel to track your food intake?
- What are the costs of tracking your food intake?
- What else could you do to have a better relationship with your food?
Suzi’s feedback during these early sessions highlighted much dissatisfaction around using the structures she had in place. Despite feeling initially that she needed these tools to keep her weight in check, she realized they were not supporting her to lose weight or feel positive about herself. She felt angry when she was hungry and would not allow herself to eat; stressed and anxious before weighing in and annoyed while recording her food intake because it was a constant reminder of her failure at weight loss. She also felt like a “cheater” when she would choose not to record foods that she ate which she judged to be prohibitive.
Suzi began to let go of the dieting tools through our coaching sessions. A large part of the process was letting Suzi vent her frustrations and express her fears about no longer using seemingly tried and true methods of weight loss. By her third session, Suzi chose only to weight herself when she went to her doctor. She agreed to only use a food journal if she was non-judgmental and to begin to identify her level of physical hunger instead. Although, she was not sure if she could truly be comfortable with this different approach but noted she felt more hopeful than she would have by continuing on with her previous plan.
Our following sessions, focused on hunger cues and what foods Suzi really wanted to eat. Because of relying on online tracking programs that dictated the amount Suzi would allow herself to eat daily, Suzi often chose very low calorie, low fat foods that were not particularly satisfying. As noted earlier, she often ignored her hunger to keep her calories within the suggested daily amount as to avoid exceeding her allotted energy intake. We agreed to track her hunger from 1-5 (1- no hunger, 5-starving) and to begin noting her physical sensations of hunger.
Questions posed during these sessions included the following:
- What part of your body tells you you are hungry?
- What’s the first sign you are hungry?
- What would keep you from eating when hungry?
- What level of hunger is comfortable for you to begin eating a meal?
- What happens when you are a “5” before eating?
- What can you do to avoid feeling famished before a meal?
- What happens to your hunger as you take the first few bites of food?
Suzi surprised to identify a sense of lightheadedness and slight irritability when she was hungry. She also noted that she often felt thirsty and tired. She did experience hunger pangs in her stomach but felt the tiredness and lightheadedness first and was able to respond sooner to her hunger than before. She felt most comfortable at a “2” before eating and when she was a “5” she often ate quickly and overate her meal. In order to avoid getting to that “starving” point, Suzi began have snack foods available at work in case she was hungry before her next meal.
Questions posed to Suzi to help determine what foods she truly wanted to eat and how to eat them included:
- What tastes would satisfy you?
- What textures are appealing?
- What temperature of food is most desirable in the moment?
- What food would you eat if there no rules about eating it?
- What food is your favorite?
- What food(s) give you energy?
- What foods do you eat only because they are deemed healthy?
- What pace of eating is the most satisfying for you?
These sessions with Suzi were very interesting. She had many opinions regarding what foods were okay to eat and what foods were not. Although she felt that cheese and nuts may satisfy her hunger, she felt they were too high in calories to eat and only would choose fruits or low fat crackers, maybe a yogurt for a snack. At this point in our coaching relationship, Suzi chose to avoid some foods which she loved (chocolate, baked goods, cookies) at all costs. This is when we began to explore Suzi’s food rules and how to safely break them.
As often is the case with chronic dieters, forbidden foods possess a power unto themselves. Avoiding them is seen as being able to control your desires while eating them, shows you are weak. Suzi had food rules regarding the amount of calories a food had as well as not eating desserts. Most of these rules came from childhood experiences as well as all the diets she followed. Tribole and Resch call the inner diet critic the food police and Suzi’s food police taken residence very strongly within her thoughts. We began a process of quieting the food police while exploring the following questions:
- What message do you hear when you eat _________? (an identified forbidden food)
- What is true about that message?
- What nurturing message can you send to yourself instead?
- What would allow you to eat _______ unconditionally?
- What could you do to feel comfortable eating ___________?
- What choices can you make when given a dessert food as a gift?
- What fear arises when you think of eating this food?
- What can you do to stay in the moment and eat what you truly want with intention?
Suzi found that she had a fear of not being able to stop eating chocolate cake if she started to eat it and that she most certainly if she did eat it, she would gain weight. We explored how realistic that thought was and Suzi actually laughed at the idea that one piece of cake would cause a major jump on the scale. We went back to checking in with hunger cues and separating out physical hunger from emotions. Being able to identify physical hunger helped her to eat less in response to emotional cues.
The most recent area Suzi is exploring in coaching is when she feels full and satisfied. She had a history of overeating as well as not eating enough. Eating foods which were not satisfying her hunger also contributed to this.
Questions we began to explore recently include:
- What does it feel like to be full?
- What does it mean to take that last bite of food?
- What tells you that you are at a point when you are finished eating?
- What can you do to respect the feeling of being satiated even if you still have food in front of you?
- What can you do to savour each bite of food and fully enjoy the sensations?
Suzi is still learning how to detect when she feels that her meal or snack is complete. She finds if she is in a trying situation with her family that it is more difficult to slow down and taste her food. She finds it difficult to check in with how she is physically feeling in moments of stress. She is beginning to rate her fullness and feel more comfortable feeling full although she admits this is her biggest challenge since she decided to stop weighing herself.
Asking Suzi for feedback along the way about our coaching process was very helpful for me a novice coach employing intuitive eating skills for the first time in this context. She revealed that she internalized life changing concepts– food is not the enemy; any food can be eaten with intention and I can be okay with eating it; not stepping on the scale each day was actually a relief. Suzi feels more empowered in her food choices and in her words “more honest and relaxed about food”. She has yet to be weighed but has fit into clothes she has not worn in a while which for her is enough of an accomplishment. Her overall take away from our process thus far is that she can trust herself to choose the food that will respect her hunger with less judgment. Our next steps include more satiety awareness and addressing nutrition from a balanced perspective.
Moving forward in my transformational wellness coaching career, I plan to incorporate intuitive eating practices for those clients open to the journey. Witnessing the impact it had on Suzi and her self-esteem has been very rewarding. Her change in personal awareness and growing confidence has empowered me to offer primarily non-dieting approaches to my weight loss clients.
Centers for Disease Control and Prevention. Prevalence of childhood and Adult Obesity in the United States, 2011-2012. JAMA 2014; 311 (8): 806-814.
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