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Does Intuitive Eating Work When Your Appetite Is Controlled?

Our motives for eating too much are complex.

An article in a recent issue of the Wall Street Journal asked whether the age of the weight-loss diet is over. The piece described the psychological hazards of diets that restrict certain food groups and may leave a dieter obsessed with eating those foods, or conversely, fearful to do so. The article also described the well-known phenomenon of weight gain in the year(s) following the end of the diet that often leaves the ex-dieter heavier than before the diet started. Although the article did not mention absurd diets that may make the dieter at risk for developing malnutrition, it is another reason to question whether people should follow weight-loss regimens. How long can one live on a diet consisting of apple cider vinegar and pepper, or watery cabbage soup? And the eagerness with which dieters consume the high-fat foods often promoted on keto diets makes one wonder whether a menu of mayonnaise, bacon fat, and whipped cream is the best way to lose weight without compromising cardiovascular health.

The article goes on to describe the popular Intuitive Diet, which is really a different approach to eating. The diet tells us to listen to what foods our bodies want us to consume, when to consume them, and how much should be eaten. In a best-case scenario, our bodies will yearn for nutritionally strong foods such as fat-free yogurt, kale, broiled fish, and oranges. Of course, our bodies may tell us to eat a fried sausage sandwich, fried onion rings, chicken nuggets, and buttercrunch ice cream. But presumably, if we pay enough attention to what our bodies tell us to eat, we will sooner or later “intuitively” select nutritionally correct foods in calorically correct amounts. In a sense, intuitive eating is Biblical: In Exodus (16: 18), the Israelites are given manna: "But when they measured it (the manna), he who had gathered much had no excess, and he who had gathered little had no deficiency; they had gathered as much as they needed to eat."

But there is no manna to be gathered today in quantities suitable for individual needs. And unfortunately many are gathering amounts of food in excess of what their bodies need, and/or making choices that will have metabolic and cardiovascular health consequences. Before starting such people on an intuitive diet, perhaps we should ask them why they are eating too much and/or why they are eating so many unhealthy foods. Is it that the foods they eat are so irresistible that they are compelled to eat them rather than healthier choices? What is the reason that they are not intuitively eating less of the bad stuff and more of the good?

The Wall Street Journal article did not mention one common reason for overeating: stress. Anger, exhaustion, worry, anxiety, fear, sadness, and a myriad of other emotional factors often cause people to eat too much, or too much of the wrong foods. Nor did the article talk about predictable short-lived changes in food cravings associated with the last days of the menstrual cycle or during the perimenopausal months. Women often crave carbohydrates and find themselves avoiding a dinner of baked chicken breast and cauliflower for a bowl of popcorn or French fries if they have PMS.

The article also did not mention the effect of psychotropic drugs on food intake. In the past 10-15 years, we've seen patients on these drugs gain substantial amounts of weight as they find themselves unable to control the need to increase their food intake. This side effects seen among those treated with anti-depressants, mood stabilizers, and atypical anti-psychotic drugs may lead to substantial weight gain. Although the mechanism is still not well understood, it seems that these drugs disrupt a patient’s control over food intake — both choice and amount. Often two meals are eaten, one after the other, because satiety is weakened by the drugs.

A craving for carbohydrates is also a side effect, and the carbohydrates chosen are often high in fat, such as ice cream or pastries. Patients gaining weight on such medications, or finding it hard to lose the weight even months after the treatment has stopped, are grouped with all other obese individuals. Very little advice is targeted for those who have become obese because of medication. Could intuitive eating help these individuals?

Also, could intuitive eating be affected by a change or absence in taste and smell? These are side effects experienced by chemotherapy patients and those who have had Covid as well as some neurological diseases. Can those whose sense of smell or taste is no longer reliable depend on their natural inclination to accept or reject foods if some foods now taste strange or make them nauseous?

An enduring problem associated with strategies aimed to reduce obesity, or at least to make the obese healthier, is the “one size fits all” approach. It is rarely cost effective to work with an individual patient to figure out why weight was gained or perhaps regained. It takes time to figure out how lifestyle may contribute to overeating. Does the patient get enough sleep, or eat to stay awake? Is the patient overwhelmed by work or caregiving, perhaps for an elderly parent or disabled spouse? Is the overeating a response to depression, anxiety, social isolation, marital, financial, or other problems — or simply loneliness?

The reasons for weight gain are not intuitive; nor, it seems, is the solution.

References

“The Death of the Diet,” Toy S, The Wall Street Journal, Thursday January 13, 2022.

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