ENCORE: The Science Behind Intuitive Eating & Weight Inclusive Care

The Innovative Therapist

Episode 121. One of the questions I get most often from people when they learn that I’m aligned with the Health at Every Size® movement is some version of this:

“But I’ve worked for many years in XX setting and I’ve seen how people suffer when they have excess weight on their bodies. How can we really say that people can be healthy at every size?”

Today’s encore episode is a replay of my conversation with Dr. Jillian Murphy that answers this question incredibly well. I can’t wait to share it with you!

What To Expect in This Interview:

We cover the following topics:

• Why Health at Every Size® is not just a social movement, but an evidence-based movement rooted heavily in science. She breaks this down in a way that I truly haven’t heard before, so make sure you stay tuned to really understand why and how this isn’t just a “don’t judge people for their body size” movement (though that’s of course very important, too!)
• We talk about her training as a Doctor of Naturopathic Medicine and where her focus is, as well as the ways that her training, just like pretty much all standard training programs, were steeped in diet culture beliefs.
• Her experience with orthorexia and how she finally fully cut the diet culture cord.
• We talk about her work learning about competent eating through the Ellyn Satter Institute and the power of this approach for kids and adults. I’m SO excited for this part of this conversation, because we talk about a nuanced approach to moving towards a flexible, healthy, sustainable relationship with food called Competent Eating that can be really helpful for people who want more structure than Intuitive Eating provides. Super cool.

What You Need to Know About Weight Inclusivity, Health at Every Size®, and How You can Immediately Start Improving Your Health

1. The weight-inclusive Health at Every Size® movement is social. All bodies deserve dignity and respect and we don’t current provide that. This is well documented and incredibly harmful.
2. The weight-inclusive Health at Every Size® movement is scientific. Not that social and science are separate per se, but there is immense amounts of evidence that the link between weight and health cannot be fully causal, for many of the reasons that Dr. Murphy outlines so well. She talks about the fact that thinner people have all the conditions we blame on weight (heart disease, diabetes, cancer, PCOS) so for that reason alone we know it can’t only be weight that is the problem. We cannot establish a causal relationship with weight causing the health problems it’s blamed on (e.g., heart disease, diabetes, PCOS, cancer, etc). This doesn’t mean there aren’t co-relations, but we know it isn’t as simple as “fat causes X” as so often is the assumption. There could also be underlying genetic causal relationships that are causing the weight gain and the disease process.
3. We don’t currently have consistently effective ways to lose weight long-term without sacrificing well-being. We don’t cover bariatric surgery at all in this interview, although frankly I’d love to hear Dr. Murphy’s thoughts on that, but when talking about long-term significant weight loss (more than just a handful of pounds, although this depends on current body size), without surgery or medications, the odds of that happens without collateral damage is quite low. So, even if we could establish a causal relationship (e.g., excess weight causes disease), we don’t currently have effective ways to help people lose weight and keep it off, without a sacrifice to well-being, physically and emotionally.
4. There is a much wider arrange of body diversity than the medical community currently allows for. Body diversity is a fact. This results in significant problems including lower quality of care, weight stigma, bad advice, and leaves most people increasingly losing faith in themselves, versus recognizing that the system fails to improve health in the vast majority of folks with these struggles.
5. You deserve to have full autonomy over your body. One of the reasons the anti-diet movement can feel so loud, is the attempt to try to counteract the loudness of the diet culture and weight centric BS. But it’s normal and understandable to still desire weight loss and smaller bodies because there are social privileges that you will get, including more acceptance, belonging, and even better health care with less judgment and bias. But once you know the data, you can be empowered to make the choice that’s best for you.
6. Competent Eating is another way to re-learn to trust yourself and build a flexible healthy relationship with food and your body. By providing some structure, we can actually achieve more freedom. Have you noticed this in other areas of your life? The trick is, depending on how entrenched your body image and eating struggles are, you must be truly honest with yourself about this throughout the process. I was thinking after this interview that this really is an example of how we often work with binge eating disorder in cognitive behavioral therapy too, typically focusing on providing structure, but the fact that Intuitive Eating works for some, and a model of competent eating works for others, means that we need to attend to each individual person and how the approach feels for them. Tying back to motivation theory, if it’s increasing autonomy it will likely lead to feelings of improving flexible control and positive self-care and health outcomes. If it feels controlling, like diet mentality or like rigid rules, it’s unlikely to work. We can take a set yourself up for success mindset. I specifically talk about this in my free 3 day Hunger and Satisfaction Journal, “if eating without structure freaks you out,” and give some suggestions for what to do about this. You can grab that here.

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