In your primary care practice, you have surely seen a substantial demand for weight-loss medications like GLP-1s, though you and some patients may choose to pursue conventional weight-loss methods first.

One possible alternative to medications for patients’ weight-loss goals could be the intuitive eating method. 

Intuitive eating is a non-dieting philosophy that focuses on “better understanding and respecting the body’s hunger and fullness cues to make ‘peace’ with food,” said Kasey Goodpaster, PhD, clinical psychologist and director of behavioral services Cleveland Clinic Bariatric & Metabolic Institute. “Patients are encouraged to explore eating and physical activity through a lens of curiosity to discover what works for them as unique individuals, rather than to adhere to strict one-size-fits-all food rules.” 

The philosophy touts how foods are not placed into “good” or “bad” categories, and perfection is not the goal. “The focus is on finding balance and developing a healthier relationship with food long-term,” Goodpaster said.

More Accessible to Avoid Pitfalls

Intuitive eating is considered a more sustainable approach that prevents diet/binge cycles that often arise from more restrictive weight-loss methods, Goodpaster said. Often, when patients eliminate entire food groups (such as carbohydrates), cravings and feelings of deprivation increase, which can in turn lead to overeating those “forbidden foods” when dietary restraint is inevitably broken, she said.

“When foods are not deemed either good or bad and patients give themselves unconditional permission to eat foods that diets would typically prohibit, they naturally habituate to those foods, and they become less tempting over time,” said Goodpaster.

Cues to Set and Follow

The intuitive eating approach encourages patients to become more mindful and tune into hunger and fullness. One helpful strategy, Goodpaster said, is to give patients a hunger/fullness scale (eg, 1= “Thanksgiving full,” 10 = “Dangerously hungry”) and encourage them to check in with their hunger and fullness throughout the day, with the goal of eating when hungry (but not waiting to become “dangerously hungry”) and stopping when satisfied, but not when painfully full. 

Her recommendation to patients is to aim toward the middle of the hunger/fullness scale. Typically, this may necessitate eating at more regular intervals throughout the day, slowing the pace of eating, and removing external distractions that could detract from the ability to detect food cues. 

“This approach can help patients to feel satisfied with smaller amounts of food, including those stimulating foods that otherwise may have been over-consumed,” Goodpaster said.

Share the Benefits With Patients

When discussing intuitive eating with your patients, share these advantages for encouragement.

Intuitive eating is associated with positive body image. While diets tend to start from the premise that higher body weight is a problem to be fixed ASAP, the intuitive eating approach encourages self-love and self-compassion regardless of body size, said Goodpaster. “Therefore, eating and physical activity changes are motivated by a desire to improve health and well-being, rather than being driven by internalized weight bias or self-hate,” she said.

Intuitive eating promotes self-reliance. A noted benefit of intuitive eating, according to the research, is psychological health. Across several studies, intuitive eating has been associated with higher self-esteem, use of more adaptive coping strategies, lower anxiety, and lower depression. 

Intuitive eating can introduce new methodology for patients. Intuitive eating is a gradual journey that involves learning to trust your body's signals over time, said Kristen Smith, MS, RDN, spokesperson for the Academy of Nutrition and Dietetics, who is also the manager of bariatric surgery and service line development at Piedmont Healthcare in Atlanta. “To start practicing intuitive eating, begin by identifying and letting go of the ‘diet mentality’ and its rigid rules and restrictions,” Smith said. “Instead, prioritize tuning into your body’s natural hunger and fullness signals and develop a balanced relationship with all types of food.”

Primary Care Is Where It Starts 

As with discussing any weight-loss approach, primary care doctors should keep in mind that patients have likely tried a plethora of diets, and being on that rollercoaster of ups and downs with weight can have serious physical and mental health consequences, said Goodpaster at the Cleveland Clinic. Before mentioning weight-loss options, ask permission to discuss, she said.

“If patients are receptive to a discussion about weight management approaches, inquire about what approaches they have already tried, what worked well, and what barriers tend to get in the way,” she said. Be sure to stay gentle, curious, encouraging, nonjudgmental, and supportive as they share about their eating and weight history, she said. 

Can It Help With Obesity? 

Although intuitive eating is considered a weight-neutral approach, studies have found that intuitive eating is associated with lower BMI. “It is thought that weight loss is often a natural consequence of having a healthier relationship with one’s body and with food,” Goodpaster said.

And, if some patients are shying away from GLP-1s, intuitive eating could be a viable starting point. 

“Although patients are unlikely to experience the degree of weight loss using intuitive eating alone as they would using a GLP-1, it may be a good starting point to help them address emotional eating, reduce portions, and develop mindful eating skills that would be useful in improving long-term outcomes regardless of whether they ultimately choose to add additional treatments such as antiobesity medication or bariatric surgery in the future,” Goodpaster said.