Nutritional Solutions CNE Intuitive Eating & Body Kindness The Mindful approach to Healthy Eating

Transcription

1 Nutritional Solutions CNE 2018 Intuitive Eating & Body Kindness The Mindful approach to Healthy Eating

2 HOUSEKEEPING Mobile phones Breaks Toilets Handouts/ Resources / References Interactive workshop - be involved as much as you feel comfortable to do! Q & A

3 What s in a name? Managing Expectations Intuitive Eating a look at the evidence Intuitive Eating Stages Body Kindness Mindful Eating Weight Stigma and Weight Bias Case Study 10 Principles of Intuitive Eating Mindful raisin practice ( time permitting) Summary Q/A Resources / References OUTLINE

4 MANAGING EXPECTATIONS

5 Nutritional Solutions CNE 2018 Intuitive Eating & Body Kindness The Mindful approach to Healthy Eating

6 INTUITIVE EATING Published in 1995 ( 3 rd edition) Process based approach 1 st edition to 3 rd edition not a weight loss focussed approach. 10 core principles More than 70 published studies showing benefit of IE. Intuitive Eating Pro Skills course 2011 and supervision 2016

7 INTUITIVE EATING 10 PRINCIPLES 1. Reject the Diet Mentality 2. Honour Your Hunger * 3. Make Peace with Food * 4. Challenge the Food Police * 5. Respect your fullness * 6. Discover the Satisfaction Factor * 7. Honour your feelings without using food 8. Respect your body * 9. Exercise feel the difference 10. Honour your health * * Principles that complement mindful eating practices / body kindness OBJECTIVES / AIMS A process based approach To teach patients how to have a healthy relationship with food and their bodies. To empower patients to trust their ability to meet their needs To distinguish between physical & emotional feelings To develop body wisdom *

8 TRAITS OF INTUITIVE EATERS Validated assessment scale ( brief assessment in practice ) Unconditional permission to eat Eating primarily for physical rather than emotional reasons Reliance on internal hunger, fullness and satiety cues.

9 INTUITIVE EATING is associated with Meta analysis 24 studies (2016) Greater body appreciation & satisfaction Positive emotional functioning Greater life satisfaction Unconditional self regard & optimism Greater motivation to exercise when focussed on enjoyment rather than guilt or appearance Psychological hardiness Improved blood pressure, blood lipids & dietary intake. ( 2014 Lit Review) Glycemic control in type 1 diabetes ( Wheeler 2015) Decreased risk of problematic eating (Van Dyck 2016) Scan s Pulse 2017 (36) Intuitive Eating: Research Update

10 INTUITIVE EATING PROCESS DIET ROCK BOTTOM ( REJECT THE DIET MENTALITY) EXPLORATION Hyper-conscious, mindful, make peace with food stage, honour your hunger CRYSTALLIZATION Less obsessive food thought, more responsive to biological signals, building trust INTUITIVE EATER AWAKENS Positive non judgemental thoughts, managing emotions, 5 THE FINAL STAGE INTUITIVE EATER RECLAIMED

11 BODY KINDNESS What do you feel? (choices about food, movement, sleep etc) How do you feel? (exploring emotions) Who you are? (know your personal values as a basis from which one can set goals) Where you belong? (body loving support from others)

12 MINDFUL EATING Conscious food choice Awareness of physical vs psychological hunger & satiety cues Meditation / breathing exercises to improve awareness Eating healthfully in response to those cues Intention Attention to eating experience Non Judgment Warren J et al ( 2017) Review

13 Position on Mindful Eating & Weight Concerns TCME does not endorse any philosophy or program that includes or promotes weight loss measures or procedures because evidence does not support that it deepens or improves an individual s mindful eating practice. The intention of mindful eating is to remain in the present moment by promoting acceptance, nonjudgment, and curiosity about an individual s direct experience. It is not outcome-based and does not promote any specific body shape or size. Based on scientific research, TCME expresses caution and concern about engaging in mindful eating exercises for weight loss. A weight focus and related stigmatization may exacerbate psychological issues such as guilt and shame and may keep individuals caught in an unbalanced eating cycle.

14 FIRST IMPRESSIONS personality occupation health status other thoughts

15 WEIGHT STIGMA / BIAS HEALTH CONSEQUENCES. Induces physiological stress Increased caloric consumption Increased emotional distress (depression, low self esteem, body dissatisfaction) Disordered Eating Lower physical activity level Long term effect weight gain Weight bias internalization Uconn Rudd Center for Food Policy & Puhl RM : Obesity (2018) 26, Journal of the Academy of Nutrition & Dietetics (Oct 2015) Vol 115 (10):

16 MISS A Female age 37, single. Non smoker, social alcohol < 1 month Medical Hx: cholesterol, iron deficiency anemia, pre-diabetes. Previous reflux problem 4 5 years ago. Medication: Was on Aspavor stopped, Glucophage 500mg - but got side effects so not taking it regularly, Chelofer. Not using any vitamins Family History: Both parents and grandparents had Diabetes. Mom diagnosed late with colon cancer and passed away. Dad passed away from CVD. Psychosocial: Single. Moved to Jhb from CT the previous year for work. Seeing a psychologist ( grief counselling ) Worried about her health but feels she cannot go on diet RED FLAGS: fasting glucose, glucose tolerance test, fasting lipogram, fbc anemia

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19 INTERPRETATION OF I.E SCALE YES YES STATEMENT INDICATES AREA THAT NEEDS WORK YES STATEMENT INDICATES AREA THAT NEEDS WORK NO UNCONDITIONAL PERMISSION TO EAT EATING FOR PHYSICAL RATHER THAN EMOTIONAL REASONS NO STATEMENT INDICATES AREA THAT NEEDS WORK NO STATEMENT INDICATES AREA THAT NEEDS WORK RELIANCE ON INTERNAL HUNGER SATIETY CUES FOOD BODY CHOICE CONGRUENCE

20 INTUITIVE EATING 10 PRINCIPLES 1. Reject the Diet Mentality 2. Honour Your Hunger * 3. Make Peace with Food * 4. Challenge the Food Police * 5. Respect your fullness * 6. Discover the Satisfaction Factor * 7. Honour your feelings without using food 8. Respect your body * 9. Exercise feel the difference 10. Honour your health * * Principles that complement mindful eating practices / body kindness OBJECTIVES / AIMS Personal process based approach that honours health by listening & responding to the direct messages of the body to meet physical & psychological needs. INTEROCEPTIVE AWARENESS perceive physical sensations from within the body. To distinguish between physical & emotional feelings. INTEROCEPTIVE RESPONSIVENESS OR ATTTUNEMENT the way in which a person values & responds to the cues. The hook for patients is the satisfaction they experience along the journey. To restore a positive relationship with food and their body.

21 REJECT THE DIET MENTALITY PRINCIPLE # 1

22 MISS A Female age 37 Hindu diet ( no red meat, no chicken,no beef) was not overweight ( 62 kg ) Binge eating began when she moved to CT to study ( 85kg) Since her dad passed away ( 105 kg) Comes from a family of small women so in comparison was large. Told she was fat growing up Likes to drink water 1, 5 litres, no hot beverages, no fruit juice, no coldrinks, no vitamin water. Erratic eating pattern, misses meals often, frequent take aways. Exercises 4 days per week for 1 hour and walks with friend 2 x week

23 THE VICIOUS DIET CYCLE Feel bad ( physical/ psychological) DIET (restriction, rules, good vs bad food) Overeat safe foods and /or binge on the forbidden foods ASSERTION OF AUTONOMY STRUGGLE * Deprivation ( physical/ psychological Rebel (feel angry, frustrated, resentful, deprived) * Samdal et al ( 2017 )

24 EVIDENCE Herman P & Polivy J ( 1975) restrained eating studies. [limiting calories to lose weight] 40 dieters vs 40 non dieters ( milkshake/ice cream) Dieting is associated with impulsivity, lower selfesteem, greater psychological dysfunction, as well as with body dissatisfaction.

25 ACTIONS for MISS A Reflect on all the previous diets and outcomes. Clean up social media Experiment how it feels to eat what you feel like versus what you think you should eat. Be a curious observer of yourself ( food anthropologist) Journal keep record ( optional) Parting note.think about how often you run on empty or hang out in the full zone. Samdal et al ( 2017) NB self monitoring of behaviour

26 Honour Your Hunger PRINCIPLE # 2

27 MISS A RELIANCE ON INTERNAL HUNGER/SATIETY CUES I trust my body to tell me when to eat I trust my body to tell me what to eat I trust my body to tell me how to eat I rely on my fullness ( satiety) signals to tell me when to stop eating I trust my body to tell me when to stop eating

28 ATTUNEMENT Disrupters/ Enhancers LIFESTYLE FACTORS TO EXPLORE Sleep Movement ( intention intensity) Eating habits restrained eating Medication / Recreational drugs Smoking Caffeine intake / Alcohol intake Stress Management Tools

29 OVER FULL NORMAL EATING RANGE VERY HUNGRY HUNGER SCALES Pleasant / Unpleasant/ Neutral 0 PAINFUL HUNGER 1 IRRITABLE, RAVENOUS ANXIOUS TO EAT 2 VERY HUNGRY 3 READY TO EAT NOT URGENT 4 SUBTLE HUNGER 5 NEUTRAL 6 BEGINNING TO FEEL FULLNESS EMERGE 7 COMFORTABLE FULL 8 A LITTLE TOO FULL 9 VERY FULL BLOATED 10 PAINFUL FULL SICK Samdal et al ( 2017) NB self monitoring of behaviour

30 Miss A follow up Energy levels poor, iron levels low. Highlighted dietary sources of iron Observations: Craving avo, salmon and chickpeas ( CVD, DM) Aware that she often allows herself to get too hungry and no food options available at work Made an effort to make food More selective about the type of take aways purchased Basic menu education using her food choices.

31 Make Peace with Food PRINCIPLE # 3 UNCONDITIONAL PERMISSION TO EAT IS VITAL

32 INTUITIVE EATING PROCESS vs Journey 1 ROCK BOTTTOM INTUITIVE EATER

33 REFERENCE : INTUITIVE EATING WORKBOOK Are you able to eat without guilt? I can clearly identify biological cues of hunger I have an environment in which I am able to eat unrushed without distraction? ASSESS READINESS

34 EXPLORE FEARS MISS A eats but with restraint: Bread, pasta, curry is fattening Feels safe to eat fruit so has a lot of it FEARS/ THOUGHTS If I eat this then I ll get fat and if I am fat then I am not worthy, ugly, different, lazy FOODS I FEEL SAFE TO EAT (? Overeat them) FOODS THAT I AVOID x FOODS THAT I EAT WITH GUILT/SHAME/ RESTRAINT FOODS I DESIRE TO EAT BUT AM TO AFRAID TO TRY x

35 STRATEGIES Combine avoid food with a safe food. Include the foods you eat mindlessly as part of a meal e.g crisps with main meal. Focussed attention Systematic Habituation Exercise Journal observations PERMISSION / (DEPRIVATION) Have what you feel like when you feel like eating it. Food acceptance Variety in diet RESPONSIBILITY / (GUILT) Context ( when, where, why) Pay attention while eating ( how)

36 Challenge the food police PRINCIPLE # 4

37 WEIGHT BIAS INTERNALIZATION BEHAVIOUR BELIEFS THOUGHTS Puhl RM : Obesity (2018) 26, Linarden : Eating Behaviours ( 2017)

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39 INTUITIVE EATING PROCESS vs Journey

40 Feel your fullness PRINCIPLE # 5

41 STRATEGIES Conscious eating ( mindful eating) Eating without distraction Pause button am I still loving the taste of it? Permission to leave food on the plate or permission to have as many helpings as you need. Body kindness - what feels comfortable and right for my body..learning to say NO.

42 FEAR FACTOR FEARING FULLNESS How hungry was I before I started eating? Am I filling up on food I am enjoying the taste of? Is there external pressure to eat more? Was the last thing I ate a small snack or large meal? Do I need to refuel? Filling up but not feeling sustained e.g popcorn, coffee, water, xylitol coldrinks

43 Discover the Satisfaction Factor PRINCIPLE # 6

44 EXPERIMENTAL PHASE 1. What do I really feel like eating? 2. Taste, texture, aroma, temperature, mouth feel, appearance, volume, feel full factor? 3. Body kindness respect your individual taste buds! When you no longer love it leave it but if you love it.savour it. 4. Body Kindness pleasant meal environment, take time to eat 5. VARIETY ( habituation studies)

45 Cope with Emotions without using food PRINCIPLE # 7 RESTRICTION BINGE EATING UNCOMFORTABLE EMOTION

46 When you don t have a built in way of giving time and attention to yourself, food becomes the main source of sweetness in your life. You have to become your own advocate, not just with food, but in your life as well Geneen Roth

47 MISS A Am I hungry? NO... but I have an urge or desire to eat People pleaser, hard worker Pleasing others makes her feel good to nurture others Eats when emotionally vulnerable Attunement Barrier: Struggles to delegate or say NO What do I feel? What else do I need?

48 Respect Your Body PRINCIPLE # 8

49 R.E.S.P.E.C.T How I show respect to others? Speech Dress code Listen attentively Kindness Patience Objective

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51 Exercise feel the difference PRINCIPLE # 9

52 Focus on movement ( exercise) as an element of SELF CARE Focus on how it feels Change the intention to health / well being vs weight loss Challenge all or none thinking e.g if I cant train for 1 hour then not at all Be comfortable Remember to rest Referral to biokineticist or physiotherapist * * Samdal et al ( 2017)

53 Honour Your Health Gentle Nutrition PRINCIPLE # 10

54 ORTHOREXIA Turner, Lefevre ( 2017) Online survey ( n=680) Mean Age ( 24.7yrs) Higher instagram use associated with stronger orthorexic symptoms [ ORTO -15 questionnaire]

55 Enjoy a varied diet. Wholegrains when possible Add colour to the plate : fruit / veg Protein variety & plant legumes Acquire the taste for less fat/sweet gradual transition for both Finding balance 90% healthy 10% pleasure or play foods

56 Mindfulness Exercise Rossy L. The Mindfulness Based Eating Solution

57 SUMMARY Weight bias/ stigma/ internalization/ Instagram social media Intuitive Eating Process Body Kindness Mindfulness Educate and empower yourself ( see resource list)

58 REFERENCES Evelyn Tribole & Elyse Resch ( Intuitive Eating book 2012 / workbook 2017) Tylka TL. The Intuitive Eating Scale-2. Item refinement and psychometric evaluation with college women and men. Journal of Counselling psychology ( 2013) vol 60 ( 1), Tribole, E. Intuitive eating: Research Update. Sports, Cardiovascular and Wellness Nutrition (SCAN s Pulse) 2017 vol 36 (3) Scritchfield, R. Body Kindness ( Warren J et al. Structured Literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours : effectiveness and associated potential mechanisms. Nutrition Resarch Reviews ( 2017) 30, Mindfulness: [TCME] Puhl RM et al. Internalizing weight stigma: Prevalence and Sociodemographic considerations in US Adults. Obesity ( 2018) 26 (1) Houstan CA. Ethical considerations when students experience an active eating disorder during their dietetics training. Journal of the Academy of Nutrition & Dietetics Oct ( 10) Mills JS, Weinheimer, Polivy J, Herman P. Are there different types of dieters? A review of personality and dietary restraint. Appetite ( 2018) Free patient APP : clinician option which you pay for to access patient records Samdal et al. Effective Behaviour Change Techniques for physical activity and healthy eating in overweight and obese adults. Systematic review and meta-regression analysis. International Journal of behavioural nutrition and physical activity :42 Epstein LH et al. Habituation as a determinant of human food intake. Psychol Rev ( 2009) 116 ( 2) Satter, E ( 2008). Secrets of Feeding a Healthy Family ( Linardon J, Mitchell S. Rigid dietary control, flexible dietary control and intuitive eating. Evidence for their differential relationship to disordered eating and body image concerns. Eating Behaviours 2017 :26: Emotional Eating resource many books. Geneen Roth ( Turner P, Lefevre C. Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disorder ( 2017) 22: Rossy, L. (2016) The mindfulness Based Eating Solution ( )

59 OTHER RESOURCES Fiona Sutherland R.D facebook,/ podcasts