Intuitive Eating & Eating Disorders:

Attunement of Mind & Body

Evelyn Tribole, MS, RD
Co­author Intuitive Eating
August 7, 2009

www.EvelynTribole.com
 Objectives
 When & how to Implement
 Overcoming Barriers
 Identifying Readiness
 New Intuitive Eating research
 Attunement
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 Attunement
Internal External

http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp
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 Mis­Attunement
Internal
•Unfilled Appetites
•Eating Struggles
•External­Based

http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp

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External Over­valued

Extreme Makeover

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Disconnect 
Problem

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      “Interoception  is the    
perception of sensations from inside the body 
and includes the perception of physical 
sensations related to internal organ function, 
such as heart beat, respiration, satiety, and 
autonomic nervous system activity related to 
emotions.  ”
Mehling WE et al. 2009 Body Awareness: Construct and Self-Report Measures. PLoS ONE 4(5):
e5614. doi:10.1371/journal.pone.0005614
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Walter H. Kaye et al . New insights into symptoms and neurocircuit function of anorexia nervosa
Nature Reviews Neuroscience. published online 15 July 2009; doi:10.1038/nrn2682.

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Walter H. Kaye et al . New insights into symptoms and neurocircuit function of anorexia nervosa.
Nature Reviews Neuroscience. published online 15 July 2009; doi:10.1038/nrn2682.
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 What the Research Shows 

Intuitive Eating Scale:
l Unconditional Permission to Eat
l Eating for Physical Not Emotional
l Reliance on Internal Hunger/Satiety
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Tylka, TL. J. Counseling Psychology 2006;53:226­240.
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 What the Research Shows
2008 BED Study
5

3
8 Weeks
2

Binge Frequency
 Intuitive Eating Intervention
1

 n=31 DSM-IV BED criteria

CBT, IP, DBT
0

P r e - t r e a t m e n t O u t c o m e F o l l o w - U p

Smitham, L. Evaluating an Intuitive Eating Program for Binge Eating Disorder: A Benchmarking Study 
(Dissertation).University of Notre Dame. 26 November 2008

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 What the Research Shows 
What the Research Shows
Intuitive Eater Characteristics
  BMI
  Wellbeing
   HDL
  Triglycerides
  Self esteem
  Thin idealization

*Tylka, TL. J Counseling Psychology. 53(2):226, 2006.    Smith TS & Hawks, SR. Am J Health Edu. 2006;37(3):130.
www.IntuitiveEating.org
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 Intuitive Eating 
Principles
1. Reject Diet Mentality 6.  Discover Satisfaction
l Honor Your Hunger 7.  Cope without Food
l Make Peace w/Food 8.  Respect Your Body
l Challenge Food Police 9.  Exercise­Enjoyable Feel
l Feel Your Fullness 10. Honor Your Health­ Gentle Nutrition

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Our “Story” & Influences 
 LL Birch
 Hirschmann & Munter 
 Geneen Roth
 Ellyn Satter
 Habituation
 Restraint Theory

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Brief History
• 1995 Intuitive Eating, first ed.
• 2003 Intuitive Eating, 2nd ed.
• 2005 Linda Bacon JADA
• 2005 Stephen Hawks
• 2006 Tracy Tylka
• 2006 Wikipedia
• 2006 People Magazine
• 2008 Univ. Notre Dame
• 2009 JADA (in press)

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 Attunement Barriers
In Eating Disorders
• Primal Hunger Issues
 “Hunger Meter Broken”
 “Satiety Meter Broken”
• Rigid External Rules & Beliefs
 Food
 Nutrition
 Body

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 Attunement Barriers
In Eating Disorders
• Exercise­External Based
 Calories burned vs intention
 “Satiety Meter Broken”
• Trust Issues
 Self
 Body

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Getting Basic Needs Met?

• Self­care
• Sleep
• Transition Time
• Friendships
• Boundaries

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Patient Expertise
Thoughts
Feelings
Experiences
Missing Factors
Trust
Empowerment
Acceptance
Mindfulness
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Readiness for Intuitive 
Eating
• Biological Restoration
• Balance
• Recognition­­ED not 
about weight or food

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Readiness for Intuitive 
Eating
Ability & Willingness:
• Deal with Feelings
• ID Wants and Needs
• Take Risks

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What’s Your Thermostat?
 Pleasant?
 Unpleasant?
 Neutral?

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 Intuitive Eating Principles 
1. Reject Diet Mentality 6.  Discover Satisfaction
l Honor Your Hunger 7.  Cope without Food
l Make Peace w/Food 8.  Respect Your Body
l Challenge Food Police 9.  Exercise­Enjoyable Feel
l Feel Your Fullness 10. Honor Your Health­Gentle Nutrition

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 PRINCIPLE 1:
REJECT DIET MENTALITY

• Primal Hunger
• Biology
• Psychology

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 PRINCIPLE 2: 
HONOR YOUR HUNGER

Primal Hunger
• Regular Meals
• Biological Balance
• Timing

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“I can’t be hungry…”

Reframe Context
• “Meal Hungry”
• Exercise
• Last Meal/snack

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 Guided Activity
HUNGER  AWARENESS

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 PRINCIPLE 5: 
FEEL YOUR FULLNESS

• Rate 1­10
• Not Sure?
• Pain vs. Comfort

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Fullness Nuances Comfortable & Nourished

“Gap”

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Satiety Cues Exceptions
• Stress
• Illness
• Mood Disorder
• Eating Disorder
• Intense Exercise

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 PRINCIPLE 3:  
MAKE PEACE with FOOD            
MAKE PEACE with FOOD
• Take Risks
• Add New Foods
• When Ready
• ID Vulnerability
• Baby Steps
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Food Habituation Studies
  Exposure
   Response

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 Habituation & Dieters 
• No Habituation Experience
• Instead, Food is:
Exciting & Scary
Must be controlled
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What To Expect
• Excitement
• Every meal
• Every day
• Normal
• Wanes
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 PRINCIPLE 4:  
CHALLENGE FOOD POLICE
Remove:
✔ Morality
✔ Judgment
✔ Shame

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“I feel guilty because I ate…” 

Lunaea Weatherstone

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 PRINCIPLE 9:  
JOYFUL EXERCISE

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When Does Nutrition Fit In?  
Readiness
Free From:
• Morality in Eating
• Dichotomous Thinking
• One­Bite­Away 
Disaster

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 PRINCIPLE 10: 
 GENTLE NUTRITION
• Not Rigid Rules
• Not Knowledge Issue

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 Resources

Intuitive Eating Practices Audio CD
Intuitive Eating Pro­­ Skills Training

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