Integrating intuitive eating into professional practice

Transcription

1 Integrating intuitive eating into professional practice RD, PhD Private practice The opinions expressed in this presentation are that of the presenter and do not necessarily reflect those of Dietitians of Canada. Further, this presentation should not be reproduced in full or in part without the express written consent of the presenter. Les opinions exprimées dans cette présentation sont celles de la présentatrice et ne reflètent pas nécessairement celles des Diététistes du Canada. Par ailleurs, cette présentation ne devrait pas être reproduite, que ce soit en partie ou dans son intégralité, sans le consentement écrit exprès de la présentatrice. 1

2 Financial Interest Disclosure (over the past 24 months) Commercial Interest ÉquiLibre Producteurs de lait du Québec Producteurs laitiers du Canada Artic Gardens Relationship Trainer Expert in their FAQ Speaker Author of a blog post Acknowledgments Dietitians of Canada Regroupement des diététistes francophones du Canada (RDFC) Roxane Bertrand, RD Lisa Rutledge, RD Josée Sovinsky, RD 2

3 Intuitive eating in media Objectives 1. Describe the foundations of intuitive eating and review its 10 principles 2. List the many benefits of intuitive eating supported by recent scientific literature 3. Identify practical ways to integrate intuitive eating into professional practice 3

4 Context In Canada, most women (80%) want to lose weight Kalergis, 2011 Among these women, 56% have a healthy weight measured with BMI 45% of women who use weight-loss products or services make more than two attempts per year to lose weight People who limit their dietary intake may experience a sense of deprivation Gravel, 2013 Regain of lost weight What percentage of people regain the lost weight, two years or more after the end of a weight-loss diet? a. 6 to 14% b. 26 to 34% c. 46 to 54% d. 66 to 74% e. 86 to 94% Ayyad C et al. 2000, Sarlio-Lähteenkorva S et al. 2000, Mann T et al

5 About dieting Counting calories, points or portions, is a diet Risks of repeatedly ineffective diets : increased body dissatisfaction and decreased self-esteem Wadden TA et al. 2002, Rapport d expertise ANSES 2010 Estimated revenue of the weight-loss industry in Canada in 2019: $10,64 billion CA Marketsandmarkets, 2015 Food behaviors 5

6 Reflection If food had no influence on your weight, how would you eat differently? About intuitive eating Works within the Health at Every Size philosophy Uses signals of hunger and satiety to regulate food intake Measures the outcome of the process through eating behaviors rather than weight loss Value attributed to food is nutritional, but also psychological, cultural and sensory 6

7 1/ Reject the diet mentality Stop believing that it is possible to lose weight quickly, effortlessly and permanently. Only changing food behaviors can lead to lasting changes. Stop waiting... Principle 1 in practice What are your reasons for wanting to lose weight? If you have ever tried to lose weight, what are the means you have used? What are the results you have achieved? If your strategy did not work, what are the reasons? How do you feel when you think about weight-loss diets or about wanting to lose weight? 7

8 2/ Honor your hunger Adapted from Tribole E et al. Intuiitive eating, 3rd ed, Principle 2 in practice Am I hungry? What is my level of hunger? When I'm hungry, what do I feel in my body and in my head? If I eat without being hungry, what are the most common reasons? When I feel hunger, do I tend to delay the time to eat? Do I eat too much because of a hunger that is too intense? 8

9 3/ Make peace with food Restricting certain foods can lead to a sense of deprivation This sentiment promotes obsessive thoughts towards food, cravings and guilt Unconditional permission to eat: In the presence of hunger, the desired food Principle 3 in practice Make a list of foods I love Give yourself permission to eat a forbidden food in the list and plan a tasting If I am afraid of losing control over this food, I buy a small quantity or a small size If the food tastes as good as I had imagined, I grant myself permission to eat it again in the future 9

10 4/ Challenge the food police Principle 4 in practice Reflect on biased thoughts and beliefs about food and body weight Identify harmful thoughts that unnecessarily occupy your head and maintain a confrontational relationship with food and body Develop helping thoughts by teaming up with your body 10

11 5/ Feel your fullness Adapted from Tribole E et al. Intuiitive eating, 3rd ed, Principle 5 in practice What is my level of fullness after eating? Is it more my head or my body that helps me determine when I have eaten enough? What are the usual reasons that lead me to stop eating? If I can stop eating when I feel satisfied and satiated, what do I feel? 11

12 6/ Discover the satisfaction factor Decrease in food neophobia Reverdy C et al. 2008, Mustonen S et al and 2010 Satisfaction of food preferences Menneteau U et al Recognition and respect of hunger and satiety Menneteau U et al Decrease in ingestion rate Menneteau U et al Decrease in disinhibition Gravel et al Principle 6 in practice Do I consider my preferences when I make food choices? Does my pace of eating allow me to feel the pleasure of eating? Do I consider the sensory characteristics of food in the way I eat? What place do I give to the pleasure of eating? 12

13 7/ Cope with your feelings without using food Eating can give the impression of calming certain emotions and comforting = short term Food can serve as an outlet for emotions that are not expressed Eating in response to an emotion can be seen as an opportunity to get to know ourselves better, ask ourselves questions and to progress Principle 7 in practice Am I feeling physiological hunger or do I want to eat for a reason other than hunger? What is the emotion that is leading me to want to eat? What need do am I trying to fill with food? What can I do to adequately satisfy my need? 13

14 8/ Respect your body Avoid comparing your body because it can make it difficult to accept oneself and increase body dissatisfaction Stop denigrating your body and replace the derogatory comments with respectful comments Respect body diversity to avoid the stigmatization of one's own weight and that of others Principle 8 in practice Which parts of my body do I prefer? Which parts of my body can be changed and which ones cannot be changed? What has my body allowed me to accomplish throughout my life? 14

15 9/ Exercise Feel the difference Gradually integrate or increase physical activity in order to allow your body to adapt Be attentive to the sensations felt: stress, energy, sleep, well-being and compare with sedentary periods The important thing is to move and feel good Principle 9 in practice What are my motivations to practice physical activity? Do I consider my preferences in my choice of activity? Do I make sure that I progress gradually to reduce the risk of injury? How do I feel during and after practicing physical activity? 15

16 10/ Honor your health Gentle nutrition Variety: food groups, tasting a new food, cooking a new recipe Moderation: Avoid the extremes of "not eating at all" and "always eating" Balance: Recommendations = To be reached over a period of time Associations and correlations Is divorce caused by the consumption of margarine? 16

17 IE is inversely associated with : BMI Hawks SR et al. 2005, Tylka TL 2006, Smith T et al. 2006, El Madden C et al. 2012, Tylka TL et al. 2013, Schaefer JT et al. 2014, Van Dyke N et al. 2014, Camilleri GM et al. 2016, Warren JM et al Overweight and obesity Camilleri GM et al Rhythm of the food intake El Madden C et al Blood lipids : Total cholesterol, LDL cholesterol and triglycerides Bacon L et al and 2005 Systolic blood pressure Bacon L et al and 2005 Diastolic blood pressure Hawley G et al IE is inversely associated with : Symptoms of food disorders Tylka TL 2006, El Madden C et al. 2012, Bruce LJ et al Disinhibition Bacon L et al Body dissatisfaction Tylka TL 2006 Food anxiety and concerns Smith T et al. 2006, Provencher V et al. 2007, Tylka TL et al Restrictive food behaviors Bacon L et al et 2005, Provencher V et al Depression Bacon L et al et 2005, Smith T et al. 2006, Gagnon-Girouard MP et al

18 IE is directly associated with : Weight maintenance Bacon L et al. 2005, Hawley G et al. 2008, Provencher V et al. 2009, Gagnon- Girouard MP et al. 2010, Van Dyke N et al Weight-loss Bradshaw AJ et al. 2010, Leahy K et al HDL cholesterol Bacon L et al. 2005, Hawks SR et al Vegetable consumption Ciampolini M et al. 2010, El Madden C et al Food variety Smith T et al Motivation to be physically active by pleasure Gast J et al Physical activity practice Carroll S et al IE is directly associated with : Positive body image Augustus-Horvath CL et al. 2011, Tylka TL et al et 2015, Van Dyke N et al. 2014, Bruce LJ et al Satisfaction Tylka TL 2006, Van Dyke N et al Self-esteem Bacon L et al et 2005, Tylka TL 2006, Gagnon-Girouard MP et al. 2010, Tylka TL et al. 2013, Van Dyke N et al Quality of life Gagnon-Girouard MP et al Optimism Tylka TL 2006, Tribole E et al. 2012, Van Dyke N et al Wellness Tylka TL 2006, Carroll S et al

19 Practical ways to integrate IE Support clients in fully exploring their past experiences with dieting Guide clients on how to rely on hunger and satiety cues Integrate intuitive eating gently and gradually Practical ways to integrate IE Teach clients to play an active role in their food decisions Be proud and clear when advertising your intuitive eating approach! 19

20 Take-home messages about IE Not a new method for weight loss Holistic and positive dietary approach May require effort but it is a long-term effective approach Our clients are the experts of their own body, emotions and food preferences Take-home messages about IE Treat our body as a friend, with compassion and kindness «Health-centered interventions have met ethical standards of beneficience and nonmaleficience by stopping weight stigma, honoring size diversity, and being constructed from a holistic focus where all aspects of health are considered.» Tylka TL et al

21 A wise person does not simply choose the largest amount of food but the most pleasing food. Epicurus ( BC) Recommended readings

22 Scientific references Augustus-Horvath CL et al. The acceptance model of intuitive eating: a comparison of women in emerging adulthood, early adulthood, and middle adulthood. J Couns Psychol 2011;58(1): Bradshaw AJ et al. Non-dieting group interventions for overweight and obese women: what predicts non-completion and does completion improve outcomes? Public Health Nutr 2010;13(10): Bruce LJ et al. A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite 2016;96(1): Camilleri GM et al. Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study. Obesity 2016;24(5): Ciampolini M et al. Sustained self-regulation of energy intake: initial hunger improves insulin sensitivity. J Nutr Metab 2010:1-7. Carroll S et al. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32(1): Scientific references Gagnon-Girouard MP et al. Psychological impact of a Health-at-Every-Size intervention on weight-preoccupied overweight/obese women. J Obes Gast J et al. Intuitive eating: associations with physical activity motivation and BMI. Am J Health Promot 2015;29(3):e91-e99. Gravel K. Manger avec sa tête ou selon ses sens : perceptions et comportements alimentaires. Thèse de doctorat Université Laval, 2013 : Gravel K et al. Sensory-based nutrition pilot intervention for women. J Acad Nutr Diet 2014;114 : Hawks S et al. The relationship between intuitive eating and health indicators among college women. Am J Health Educ. 2005;36(6): Hawley G et al. Sustainability of health and lifestyle improvements following a non-dieting randomised trial in overweight women. Prev Med 2008;47(6): Kalergis M, Leung Yinko S, Savoie N, et al. Canadian women's attitudes towards weight. Can J Diabetes. 2011;35(2):

23 Scientific references Leahy K et al. The relationship between intuitive eating and postpartum weight loss. Matern Child Health J 2017;21(8): Marketsandmarkets Research, Canadian weight loss and weight management market Forecast to Schaefer J et al. A review of interventions that promote eating by internal cues. J Acad Nutr Diet 2014;114(5): Tylka TL et al. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes Tylka TL et al. Is intuitive eating the same as flexible dietary control? Their links to each other and well-being could provide an answer. Appetite. 2015;95: Van Dyke N et al. Relationships between intuitive eating and health indicators: literature review. Public Health Nutr 2014;17(8): Warren JM et al. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutr Res Rev 2017;18:1-12. Contact karinegravel.com KarineNutrition Karine Gravel, nutritionniste et docteure en nutrition Karine Gravel, Dt.P., Ph.D. info@karinegravel.com 23