Intuitive eating and person-centred therapy
I have been reflecting on the various different places I draw from in my work as a therapist in addition to person-centred theory and practice and I have recently realised how much the intuitive eating movement aligns with person-centred theory.
A bit of personal history - like many people I was a yo-yo dieter for much of my adult life. In my case from my early 20’s until my late 30’s. Throughout my formative years in the 80’s and 90’s and my young adulthood in the early 2000s, diet culture and the pursuit of thinness was such a central part of the culture there were simply no other options visible. I would lose then regain (and then some) the same few pounds or couple of stone. There came a point in my late 30’s when I remember looking the mirror and thinking ‘what is the point of all this effort, I have been doing this for 15 years now and I am fatter than when I started’. In that moment a penny dropped for me. I wondered what would happen if I just…stopped - stopped trying to lose weight, stopped the endless treadmill of diets. I googled “how to be happy and fat” and as this was 2015 I quickly discovered the health at every size movement, body positivity and intuitive eating. It was a pivotal moment for me - I stopped trying to change my body into a shape it was not ever going to be stable at and spent the following years embracing intuitive eating and learning body acceptance instead (written like that it sounds like an easy and quick process, but in reality it is a longer and more complex process that I am still working on).
Finding alternatives to the diet-culture world was revelatory and I hoovered up everything I could find at the time. I learned about earlier iterations of this movement (for more background here is a brief history of the fat acceptance movement which had not reached the mainstream until the body positivety movement become well known. I will list some of the useful resources at the end of this article.
I grieve for the years of wasted time and energy that 15 years of dieting took from me - time and energy that I could have spent on much more valuable things than pursuing an impossible dream of a thin body. Most people who lose weight regain what they have lost and and more - a fact I wish I had known a lot sooner. I grieve for the impact it has no doubt had on my body, pushing up my set-point. But it is the lost time and energy I grieve the most. There are a million more valuable things to spend this precious life on than trying to be smaller.
I didn’t at the time connect just how person-centred the intuitive eating movement was but I resonated with it instantly in the same way I did the person-centred approach to therapy. Person-centred therapy is based on a fundamental belief that people have the ability to sense what is right for them (this is called the ‘organismic valueing tendency’) and move towards growth, even if the conditions are not ideal (the ‘actualising tendency’). Rogers used the analogy of potatoes, persistently trying to grow towards any light. I often picture a tree growing in a sheltered valley vs a tree growing on exposed moorland - both grow in the best way they can for their conditions and the results can look quite different.
In therapy the ‘organismic valueing tendency’ is often experienced as feelings, sensations or other instinctive ways of knowing what we need that we can tune in to to inform our choices in life. However, there is nothing so fundamentally innate as our bodies ability to express hunger and gain satisfaction through eating (a caveat that there are things that make this harder, such as interoceptive differences experienced by neurodivergent people). Intuitive eating is about learning to reconnect with and trust the bodies cues both of hunger and satiety in order to allow the bodies innate wisdom to be a guide on what, when and how much to eat. It is a biological as well as psychological process. Therefore we can absolutely equate the ‘organismic valuing tendency’ of person-centred therapy with a non-disrupted hunger and satiety system, which is what intuitive eating aims to develop. People who are naturally slim and/or have never dieted may eat this way. For many others it can seem inconceivable.
I say non-disrupted as the impact of how western culture approaches food and diet massively disrupts people’s relationship with food and bodies in a way that means that many people don’t believe that trusting ones hunger is in any way a safe or reasonable way to eat. Control is prioritised. Dieting, disordered eating or even the seemingly less harmful general beliefs about what constitutes ‘healthy’ eating, all are based on the belief that left to our own devices, we would not eat in a way that is good for us and we need to micromanage or control that based on external rules (diets) rather than using our bodies inbuilt signals. Eating disorder behaviours are normalised, bodies are policed and assumed to be unhealthy based on size. Yo yo dieting is normalised. We are so used to this that so many of it goes unquestioned but when you actually step back and take a critical view of it is all deeply harmful and unnatural.
It is heartbreaking to hear of people being put on diets from age 4, or even younger. Being bullied by family members for their bodies/eating patterns, growing up with the constant stress that their bodies and appetites are wrong or dysfunctional. This permanently impacts their relationship with their very self - destroying self-esteem, deeply disrupting the developing relationship between appetite, hunger and fullness and is a huge predictor of eating disorders and lifelong yoyo dieting.
People pursue weightloss because they are constantly told that they are not worthy of love or anything good in life if they are not thin, which places this battle squarely in the realms of therapy and ‘mental health’ and as a profession we have been far too slow to make this connection and address fatphobia, weight stigma and the very real impact it has on people’s entire lives. When I first started talking about this in counselling spaces online I felt like a bit of a lone voice in the wilderness, now 10 years later I am happy to see lots more therapists are getting on board with this approach.
Even eating disorder treatment and recovery spaces are often still based around fatphobic assumptions, including that fat people can’t be anorexic or that recovery means maintaining a specific weight. One of the reasons I don’t offer eating disorder support as yet is because I have yet to find a training that is neurodivergent affirming and centres weight neutral/fat positive values. (if you know of one please let me know).
This is of course, a deeply complex area. I am not expert in nutrition or the science of weight but there are many good resources here if you want to learn more. The Health at Every Size framework is very science based. The intersections of fatphobia with racism, gender/sexuality etc. are also very complex. The social determinants of health are not addressed enough. Many in the anti-diet and fat acceptance field argue that weight stigma, as much as the physical impact of weight is potentially responsible for much of the the health impacts of being at a higher weight and anyone who works with marginalised folk should well aware of the very real impact of stigma and minority stress on mental and physical health. Amidtst this complexity though what does seem simple to me though is that no-one should be traumatised and oppressed for their body size (or indeed any other ways bodies vary). Fatphobia is oppression and systemic violence - Sonya Renee Taylor has called this ‘body terrorism’ and we need to address this in the field of therapy and move to health and mental health that supports and values individuals wherever they are at. At the moment that means sitting with individuals who are currently being deeply harmed by a very fatphobic culture, learning how to not perpetrate that in our work and finding liberatory and congruent ways to engage with this from an anti-oppressive stance.
So back to intuitive eating. It is essentially ‘person-centred’ eating, in that it promotes a return to the individuals own bodily sensing of what is right and offers a way to unlearn all the mental and physical imbalances that arise from years of dieting or otherwise disordered eating patterns. There are principles and steps one can follow on the journey to intuitive eating (set out in the original Intuitive Eating book) or you can embrace the overall approach in a less structured way like I did. Some people have promoted a less structured approach, probably because many people were so attached to diets that they were co-opting the steps of intuitive eating and making them into just another set of diet rules (for example the “hunger and fullness diet”).
When I work therapeutically with people around their eating, using the intuitive eating framework offers a shared paradigm that we can both work within. Then it is about exploring what comes up when people choose to step away from dieting: fear of weight gain, self-esteem, trauma from bullying/rejection based on their body size, relationship/intimacy issues, how to deal with the people around them who may be still working from a diet culture frame of reference, navigating fatphobia in the wider culture, dealing with the stress of being stigmatised due to body size, and trying to develop positive or at least accepting self identity around the body they do have. This is where the work becomes deeply personal and follows the individual process, very much as general person-centred therapy does, especially person-centred work with people who are marginalised.
It is a real privilege to support people on this journey - one I have walked myself and continue to walk - so if you are interested in therapy or supervision around intuitive eating then please get in touch.
Here are some really great resources if you would like to learn more:
The Body is not an Apology by Sonya Renee Taylor
You Have the Right to Remain Fat by Virgie Tovar
Aubrey Gordon What We Don't Talk About When We Talk About Fat and “You Just Need to Lose Weight”: And 19 Other Myths About Fat People and the podcast Maintenance Phase
Body Bositive Power by Megan Jayne Crabbe
Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon
Anti Diet by Kristy Harrison and the podcast Food Psych
Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings
Jes Baker Things No One Will Tell Fat Girls and Landwhale
Eat the Rules Podcast with Summer Innanen
Centre for Body Trust (various resources)
Photo by Charis Gegelman on Unsplash