My relationship with food and exercise in the post-natal period and how it relates to new year’s resolutions: Part 2

Dr Breanne Kunstler (BBiomedSci, BHealthSci, MPhysio, PhD).

Physiotherapist, behaviour change scientist and run coach.

This is part two of my blog post on the tendency for people to set new year’s resolutions that involve weight loss, rather than focusing more broadly on achieving good health. This post was inspired by my personal reflection on my relationship with food and exercise since giving birth to my daughter four months ago. If you haven’t read that post yet, then please read it here as I will be referring to it throughout this post.

Let’s pick up where we left off

Let me return to the question I ended yesterday’s post on.

How do we focus on ways of eating, exercising and participating in other behaviours that can support physical, mental and social wellbeing (“health”) instead of just taking the mental shortcut and focusing on becoming thin?

I believe it requires a shift in our thinking from eating to lose weight, which involves surrendering to that thin ideal that diet culture promotes, to eating to nourish and fuel our bodies (self-care). We must re-learn how to respond to our internal cues around hunger, fullness and satiation. I say ‘re-learn’ because we began life responding to our internal cues. Any readers who have had a newborn or have spent time around a newborn will know that they cry when they are hungry and, provided food is all they needed, they will stop crying once they are full as they have satisfied that internal hunger cue. People who have been chronic dieters or have focused on restriction throughout their lives have likely learnt to ignore internal cues like hunger and associate fullness and satiation with guilt and shame, giving food moral value (Image 1). This is a learned behaviour and something that must be overcome to get back in touch with internal cues and eat for nourishment.

Image 1: Eating cake is socially acceptable, burning down an orphanage is not. Don’t get them confused (credit: Sarah Herstich)

Getting in touch with internal cues requires us to act on intuition: The Health at Every Size model

So, let’s return to my question of ‘how do we do this?’ Let’s talk about intuitive eating, intuitive exercise and health at every size.

Health at every size (HAES) is a model of promoting self-care and health through specifically addressing individual health behaviours without stigmatising people based on their body size, weight, ethnicity, gender identification, sexual orientation or socioeconomic status. So, the focus is on changing behaviours to support health (such as eating more vegetables), as opposed to simply advising someone to diet or lose weight (and, in the process, telling ‘diet culture’ to get stuffed in an evidence-based way).

The principles behind HAES (Figure 1) are not anti-weight loss, they just don’t focus on weight loss as the end goal (HAES is considered ‘weight neutral’). Instead, achieving good health and a healthy lifestyle by participating in healthy behaviours (many of which I mentioned in my first post) is the end goal and weight loss might or might not happen in the process.

Researchers and clinicians are talking more about shifting their attention away from a conventional weight loss focus on health and towards using HAES, accepting the model as a way to help people improve their health regardless of their size, leaving weight loss, diets and stigma out of the equation and still getting the health outcomes they seek. Despite research into the efficacy of HAES at improving health outcomes at the individual and public health levels still being in its infancy (most published research only began in the year 2000), some studies have demonstrated that using the HAES approach has resulted in several objective health improvements and maintenance. Importantly, the HAES approach has led to improved psychological and behavioural outcomes compared to dieting interventions, while not resulting in weight gain (a common fear of people trying the HAES approach instead of dieting). These psychological and behavioural impacts suggest that HAES can assist in reducing dieting and disordered eating behaviours (e.g. poor body image and body dissatisfaction, restricted eating behaviours and bulimia), thereby supporting people to break free of diet culture while also improving their physical and mental health. I think one of the most exciting findings supporting the HAES approach is that it has been shown to successfully support people to make long term behaviour changes, like committing to participating in more exercise long after they decided to become more active, which is something conventional dieting approaches fail to do.

Figure 1: Principles underpinning HAES (credit: Association for Size, Diversity and Health)

Re-learning how to listen to and respond to our body: Intuitive eating and intuitive exercise as important components of the HAES model

Intuitive eating and intuitive exercise are components of the HAES model and have received significant attention in the past few decades in both the research space and in books. Intuitive eating encourages people to respond to internal cues of hunger, fullness and satiety to govern their eating behaviours instead of external cues like set meal times, food quantities or weighing foods, and dictated meal types (e.g. meal replacement drinks, low calorie meals etc.). Intuitive eating therefore aims to support people in leaving the misery of dieting and diet culture behind to focus internally on what their body needs when it needs it. This weight neutral approach to addressing weight and health concerns for people with a BMI over 25 is becoming attractive to dieticians working in the area of weight loss, possibly because several positive long-term health outcomes can be achieved even if weight loss isn’t always one of them. It has been reported that the loss of our ability to respond to internal cues to eat and instead relying on external cues can increase an individual’s risk of developing an eating disorder or becoming overweight or obese. So, maybe we need to channel our inner newborn and re-learn how to eat?

Re-learning what hunger, fullness and satiation feels like to us, and trusting that our bodies are capable of telling us these things, are important components of intuitive eating (Figure 2). In addition to identifying these feelings, we might also need to re-learn how to respond to them. We can respond by eating when hungry or when we feel we need food (e.g. when we have a grumbly tummy, feel weak or feel “hangry”) and stopping when we are full (instead of eating beyond fullness just because it’s Christmas and everyone else is), satisfied or simply not enjoying eating anymore for any reason. This sounds so simple: just listen and respond to what your body is telling you. We go to the toilet when we need to and stop when we are finished, why can’t we do the same with eating food? Like any behaviour change, learning how to eat intuitively might be difficult in the beginning but it can be done.

Figure 2: The 10 principles of intuitive eating (credit: SlideShare)

Not classifying food as good or bad, but acknowledging that each food has consequences, is another important component of intuitive eating. A cake is not bad, nor does eating the cake make you a bad person (Image 1). But the cake will have consequences when and after you eat it. The cake might have good consequences; you might feel good because you really enjoyed the cake and you shared it with people you love. Alternatively, you might feel sick if you had seconds, thirds or even fourths. It’s the consequences of the food that we need to focus on, not the food itself. Enjoy your cake, or don’t. Just make sure you act on those feelings and honour them.

What about exercise?

Intuitive eating, despite the title, isn’t just about eating and the experiences around preparing and consuming food. It’s also about exercising intuitively, deciding what exercise you want to do and responding to internal cues (do you want to do a spin class at the gym or would you prefer to walk the dog?), rather than external cues (e.g. attending that pre-booked personal training session because it's booked, not because you actually want to). If you want to do a high intensity personal training session then do it, if you would prefer to go for a walk with your best friend instead, then do that. Use your intuition and respond to your internal cues.

For those thinking that a walk won’t be good enough to help you improve your health, that’s diet culture talking. Australia’s physical activity and sedentary behaviour guidelines say that something is better than nothing when it comes to physical activity and health because it is.

Diets have rigid rules that tell me what to do. I need rules because I can't be trusted!

Let’s talk about one of the biggest fears people have when trying intuitive eating and re-learning how to eat. People fear not being able to “trust themselves” around food. They assume that if they act on their internal cues then they will eat what they want, in excess, all the time. This is not the case in my experience. I love chocolate. I could theoretically eat chocolate all day, but will I feel good at the end of the day? No. Believe me, I have tested this. Just because I can eat all the chocolate and my intuition might tell me to do that, I am unlikely to last long only eating chocolate simply because I won’t feel good (even if I am doing it while in Switzerland, enjoying some of the best chocolate in the world). The consequence of eating so much chocolate was a negative experience for me and so I haven’t eaten that much again. In fact, reflecting on this experience makes me remember the first fresh vegetarian dish I had post-chocolate overdose with extreme fondness. I now often crave that vegetarian dish as it made me feel so good in contrast (and I'm a passionate meat eater!).

But I’m scared that I’ll gain weight if I stop dieting!

Some people also fear that they will gain weight if they stop dieting to try intuitive eating and intuitive exercise. This fear can be experienced by people of all sizes; people who are underweight, normal weight, overweight and obese can all fear gaining weight. I have mentioned several times throughout both posts in this series that: 1. diets aren’t successful at long term weight loss; and 2. following the HAES approach, which involves eating intuitively, is often weight neutral, where weight is neither gained nor lost. However, the studies I have found cannot be generalised to everyone. No one really knows how your body will respond until you give it a go. If you want to further explore the fears stopping people from trying intuitive eating then check out this webpage and linked podcast that goes into more detail about the myths of intuitive eating.

So, how does all this influence my new year’s resolutions?

I need to go back to basics. I never thought my almost four-month-old daughter could teach me what I need to do to maintain my health going into 2020. I’m not going to focus on diet and weight in the conventional sense anymore. Instead, I’m going to channel my inner newborn and focus on what my body is and is not telling me, which is exactly what I did during my pregnancy without really realising it. So, my resolutions look like this:

if I’m hungry, I will eat;
if I am full or satisfied, then I will stop eating;
if I crave chocolate, then I will eat the amount that will make me feel good, rather than over-eating so I feel bad and no longer enjoy the experience;
I will take time to savour my food so I can really learn how food and the quantities I consume make me feel, so I can change it up next time if I need to;
I’m going to trust my body to tell me what and how much I need to eat;
I will eat foods that will fuel my body, allowing me to be strong and healthy enough to look after myself and my family;
I’m going to allow myself to eat if my body is telling me that I need to, regardless of what time it is or what others are doing;
I’m going to allow myself not to eat, regardless of where I am or if it’s ‘meal time’; and
I’m only going to participate in physical activities that I enjoy.

In summary, I’m not going to diet in 2020.

Thanks for reading my blog post, especially if you managed to get through both parts. I hope you enjoyed reading my thoughts and that they helped to inform your new year’s resolutions for 2020.

Happy new year!

Additional resources and support

Disclaimer

This post is not intended to be interpreted as diet or health advice. I am not promoting HAES or intuitive eating as a solution for everyone or as a panacea for the world’s health problems. I am simply blogging about a model of promoting health that I think deserves discussion and attention as a method to address health concerns in the future, rather than simply prescribing diets and weight loss. I am trying to make the point that we need to stop thinking that dieting is the solution when it might indeed be the problem. Furthermore, I want to make clear that we as health professionals need to stop being lazy. The equation is more complex than diet = thin = healthy and the weight stigma we propagate by constantly promoting diet and weight loss to everyone with a BMI over 25 is only making weight gain more likely and people feel terrible about themselves. Let’s support our patients, and ourselves, to live healthier lives by embracing our inner newborn and inherent intuition.

I am not a nutritionist or dietician. I have degrees in health science and physiotherapy and work as a research fellow in behavioural science. I write this post as a personal reflection of my own experiences during the previous four months of my life since having my first child. If this blog post creates any questions for you or if you want to explore any of the principles I have discussed further, then please seek assistance from a qualified dietician or nutritionist.

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