My Intuitive Eating Icks (i.e. Critiques)

Are you ready to challenge everything you thought you knew about intuitive eating and the anti-diet movement? As someone who has been a huge fan of intuitive eating, lately I've started to see some flaws in it.

Have you ever questioned the cherry-picked data and misleading narratives these intuitive eating coaches push? And what about the contradiction between intuitive eating's support for body autonomy and its rejection of intentional weight loss? These are just two of the 5 icks I open up about in today's episode.

As a reminder what I share is just my take, it might not hit home for everyone who's into intuitive eating, anti-diet vibes, or Health at Every Size. These are just my general observations and I'd love to hear what you think too!

Resources mentioned:
Blog post (find all the references / research mentioned here)
Email me
Deep dive episode on Health At Every Size

TOPICS COVERED 👇 
Ick 1: The overcorrection around food morality (00:01:01) 
Ick 2: Cherry-picked and misleading data (00:07:50)
"95% of diets fail" (00:09:06)
Starvation mode (00:13:33)
The concept that obesity does not negatively impact health (00:22:27)
BMI and Body Fat Percentage (00:34:09)
Ick 3: Intentional weight loss debate (00:36:28)
Ick 4: Feelings vs. Facts (00:43:15)
Ick 5: Concerns about intuitive eating coaches (00:46:59)
Why I struggle supporting Intuitive Eating (00:49:28)

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Transcript

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Michelle (00:00:01) - It's no secret that I love the framework of intuitive eating, and I've used it heavily with my clients in the past and in the present. However, when you're around something for long enough, you start to see some flaws and become a little disillusioned. Maybe you've even noticed that it like a job that you've been at for a long time, or an organization that you've been a part of that's kind of happening with me and, and this whole intuitive eating and anti diet space. I'm going to try and break down five of the main issues that I have with the intuitive eating slash anti diet space. Because frankly I feel like we need to talk about them. Now before I jump in I want to give a big shout out to anyone who has left a review or rated the show. It really does support me and the show. I'm not just saying that it seriously does. When you leave a review or a rating, it helps me be able to break into those top 100 charts, maybe even top 50, top 25.

Michelle (00:01:01) - We'll see. Maybe someday. And if you've been a listener and you enjoy the show and you haven't left a rating yet, please take a second and do that. It's super easy to do that. On Apple Podcasts, all you do is go to the shows main page and then swipe all the way to the bottom. If you're on Spotify, you can rate there as well by tapping on the three dots on the show's homepage and then tap rate. Even if you don't feel up to writing anything necessarily, even just a simple star rating is incredibly helpful. Okay, back to our topic today. Intuitive eating, my intuitive eating critiques, or my intuitive eating ICS, if you will. Let's get into it. Okay, so my number one and I talked about this on my Instagram stories a few weeks ago is the overcorrection that we seem to have around food morality. So before I get into it, let's let's lay some context out. So first of all, of course you guys know that I'm a dietitian.

Michelle (00:01:55) - If you don't, and this is your first episode ever. Hi, my name is Michelle. I'm a registered dietitian. I have my master's in health psychology, and I love the intersection between nutrition and psychology and how that relates to many people's disordered relationships with food and navigating behavior change and in creating healthy habits and all of that. So, of course, as a dietitian, I agree that nutrition matters when it comes to our health, but it doesn't matter as much as most of the things that we see online lead us to believe specific foods don't even matter. It's patterns that matter and net effects that do things to us. In the end, the intuitive eating framework and I are in agreement about that as it focuses heavily on moving away from labels like good or bad, and even healthy and unhealthy, which I don't personally have a big issue with those. But like, I get it right. I think the overall effect of this does help individuals get to a place where they can have a better relationship with food that is more nutritious, without overanalyzing food ingredients, because at the end of the day, those things just really don't even matter.

Michelle (00:03:04) - Like I said, it's overall patterns that matter. Of course, it does matter if you have allergies, but we're not talking about that right now. However, what I see happen a lot is a fear of discussing anything when it comes to nutrient profiles of foods, health promoting foods, healthy habits, etc. because we're too afraid of quote unquote diet culture. Now, of course, with intuitive eating, this is proposed to be an anti diet approach. And so there's this big anti diet movement happening that I'm sure if you just simply search anti diet on social media you'll see hundreds of accounts pop up and content about that. And so this whole concept is like we are against diet culture. We are defying diet culture. But what can happen in the meantime is we become so incredibly fearful of assigning any morality to food, which I agree, we shouldn't assign morality to food. Food is food, but what ends up happening is we lose the discussion completely, then of nutrient profiles of food and in my opinion, an overcorrection of never talking about nutrient profiles is not a solution either.

Michelle (00:04:16) - I personally feel like I should be empowering my clients to understand how their bodies work better, and how different foods impact them better, but doing so in a way that is free from obsessive food rules, being stressed out, feeling like their food choices or their weight makes them a good or bad person, right? Like we can talk about nutrition and health promoting behaviors without there being morality assigned to it. For example, if a client drinks soda every day and they really enjoy it and they don't want to eliminate it completely, but they ask me, should I consider switching to diet soda, I. I'm most likely going to say yes, as long as they don't mind that switch, right? If it's not going to like, ruin their quality of life and make them miserable, or even lead them to end up binging a bunch of soda later. The consistent intake of regular soda just isn't doing anything for them health wise, right? Quality of life, sure, if they really enjoy it. But if we can have this same quality of life by switching to something that is not harming them health wise, then yeah, let's do it.

Michelle (00:05:29) - And I know some of you right now are losing your mind because you're like,, diet soda. What about.

Michelle (00:05:34) - The artificial.

Michelle (00:05:35) - Sweeteners? And I that's another topic for another time. But basically that's a completely overblown concern. So anyway, the point is, there are situations where encouraging healthy eating is better for somebody whose overall health, including their mental health, if it makes them happier to physically be healthier. Right now, I don't think that this is directly discouraged by intuitive eating, but it's certainly not encouraged either. And some things just get lost in translation because of that. I think the intent in the heart is great, right? To get rid of this black and white thinking, and to see food as all on the same level in terms of morality and put them on the same plane. But at a point, I do disagree with the way that things are communicated, and particularly just some of the things that I see on social media from popular anti diet people just isn't like, I don't know, it just doesn't seem like it's overall improving public health.

Michelle (00:06:36) - And by the way, before I go into my second ick or my second critique, I want to be clear about something. And I probably should have said this at the beginning. I used to do all of these things that I'm going to talk about in this episode because I was very like, gung ho, jumping on the bandwagon, super passionate about everything, intuitive eating everything, anti diet everything, health at every size. Like that was totally something that I was all in on. And like I said in the beginning, when you're in something for long enough though, you start to see the flaws and the things that maybe aren't actually all that great. And so it's like taking some time for me to kind of realize what's actually evidence based. You know, the more that I research into things and then what's not and what's not really helping anybody or to see even just the long term effects that some of these mentalities can have on the public health. Now, this is a good segue. As I mentioned, things that are evidence based versus not to go into my second IC, which is cherry picked misleading data.

Michelle (00:07:50) - And I know this is like for anybody listening to this episode who is very like, I love the anti diet movement, I love intuitive eating, I love health at every size. This is probably where I'm going to lose you, but I also don't want to lose you through this because I feel like maybe you need to hear this because I needed to hear it. So there's a there's four different statements that gets said a lot throughout these movements. The first one is 95% of diets fail or even 98%. I've seen that as well. The second one is kind of related to that first one. And that's it's this myth of starvation mode. And this is the reason why diets fail is because of starvation mode. The third one, and this is going to ruffle a lot of feathers, is obesity does not negatively impact health. That's a big one. And then the fourth one is that BMI is completely and utterly useless. You might be surprised about some of the things that I have to say about these four different statements that are kind of big drivers of these movements and are honestly kind of the heartbeat of these movements.

Michelle (00:09:04) - So let's break them down one by one. 95% of diets fail. Let's dig into that. This is a statistic that I see all of the time when people are promoting intuitive eating, or they're trying to rally people into being anti diet and it's based on a study that was done in 1959 on a hundred people who were given a diet and then sent on their way. When I first learned this, I was like, wait, is this a joke? Is this really where we're getting this statistic from? And I asked a group of colleagues in the anti diet space like, hey, does anybody know of any more recent research that supports that specific statistic. And nobody could give me one. So yeah like this is what we're basing it off of is a study from 1959. In what worlds is that a study that we want to start citing statistics about. The author of the study actually said 40 years later that he doesn't understand why people keep citing his study. So, yeah, I mean, even though it might be true that a lot of diets fail, probably the majority of them to say a specific statistic.

Michelle (00:10:21) - As a health care professional, you need to be ready to back that up with a reference. I don't care if you say something general like, yeah, most diets fail, but if you're going to go into the territory of saying a statistic like 95% of diets fail, you need to be willing to back that up with a quality reference. And this is not it. This is not a quality reference. It's also just annoying how that blanket statement is used with no context. What do we mean when we say diet? What do we mean when we say fail? Let's look at the latter first, and what I typically think is meant when we say that 95% of diets fail and the word fail specifically. Usually failure with these people are suggesting is is just keeping the weight off for over a year. Sometimes I see people say like 2 to 5 years. So keep that in mind as I sidestep to the former question, what do we mean when we say diet in the context of this specific? Typically, what I see in most anti diet intuitive eating spaces is the people who say this mean that 95% of intentional weight loss attempts fail.

Michelle (00:11:33) - That's kind of how they translate the word diet is to intentional weight loss. And I'm going to talk about intentional weight loss in IG number three by the way. But it's just simply not true that 95% of people who try to intentionally lose weight don't keep the weight off for the next 2 to 5 years. In a study done on over 5000 overweight people, half of them lost and maintained over 5% of their weight, and a quarter of them lost and maintained 10% of their weight for over eight years. Maybe at times when people use that statistic, they're just referring to your classic restrictive diets like Optavia, SlimFast, Noom, Jenny Craig, Weight Watchers and I wouldn't argue, like I said earlier, that most attempts at weight loss through those methods do usually fail, but we don't have any data to say that 95% statistic specifically. And we shouldn't pull statistics out of nowhere, especially if we're health care professionals. Like a lot of these people are. So to say that 95% of diets fail is cherry picking data to support your view.

Michelle (00:12:46) - It's a poorly designed and outdated study, and it's ignoring other important data that we have on the matter. That is like exactly what cherry picking is. I'm not saying that highly restrictive dieting is a good idea, by the way. I'm saying that if we're going to talk about the act of intentional weight loss through reasonable evidence based methods, it is certainly possible to lose the weight and keep it off. And to say that it's not is just incorrect. More on that later, though. Let's talk about the second thing. That is pretty cherry picked and misleading. So this is the concept of starvation mode, which as I said earlier, is a lot of times used as a means to support the 95% of diets fail statistic. So many people in the anti diet crowd say, all right, sustained weight loss impossible because of this thing called starvation mode. If you haven't heard of this yet, it's basically the idea that if you over restrict your calorie intake, your metabolism shuts down and you'll hit a weight loss plateau and you can never recover from it, you're going to gain all the way back, plus more, because now your metabolism is slower.

Michelle (00:13:58) - Typically, those who say this often cite two studies to support their claims the Minnesota Starvation Experiment and the Biggest Loser study. I want to dig into those two studies to show why they're not the best reference for concepts like this. And first, let me say that metabolic adaptation or adaptive thermogenesis is absolutely real, but it's not nearly as drastic or permanent as some would lead you to believe. Who talk about this concept of starvation mode. It's mainly the result of a body getting smaller, therefore having less overall tissue that is requiring energy. Evidence shows that every living tissue requires calories to function daily. Muscle burns about 13 calories per kilogram per day. Our organs require hundreds of calories per day. Even fat burns four and a half calories per kilogram per day. So as our body gets smaller as the result of maybe dieting and losing weight, we now have less tissue to maintain. Less energy required means lower energy needs from food aka we don't need to eat as much, aka a lower metabolism. This is just adaptation.

Michelle (00:15:18) - This doesn't mean that your metabolism is broken or that it will never go back up. If you were to then have more tissue on your body, right? Nor do we see proof other than these two examples, that there can be more of a drop in metabolic rate beyond what's expected from standard adaptation. In other words, starvation mode is a myth. The only way we can support it is through these specific studies. And these specific studies are very extreme. If you don't know much about the Minnesota Starvation experiment or you haven't heard of it before, it was basically a group of men in the 1950s who volunteered to have their food intake cut in half for six months. These men were lean to begin with, as they were only about an average of £154, or 70kg. By the end, most of the men lost more than a quarter of their body weight, and they were suffering from severe side effects like disordered eating, food obsession, extreme weakness, edema, fatigue, anemia, and they exhibited physical signs of malnutrition.

Michelle (00:16:20) - Interestingly, their metabolic rates appeared to drop more than you would expect from standard metabolic adaptation. The estimated amount of adaptation should have only been about 200 calories a day, but instead they had a decrease of their resting metabolic rate by approximately 600 calories a day, which is triple the amount we would normally expect. So put a pin on that, because I'm going to circle back to it with some more thoughts after we discuss the second study that's often cited. The Biggest Loser. The Biggest Loser, if you don't know, is a reality show where obese individuals compete to see who can lose the most weight the fastest. In the specific study that was done looking at this show, that contestants lost about 40% of their body weight and subsequently saw an average decrease of 664. Salaries when it comes to their resting metabolic rate, which is more than the anticipated 370 calories of metabolic adaptation, right? Similar to the Minnesota Starvation Experiment. We expect some adaptation as a result of losing weight, but in these cases, their metabolic rate was dropping even more than what we would typically expect.

Michelle (00:17:29) - Not only that, but six years later, in a follow up study on, the contestants there showed a persistent metabolic decrease of about 700 calories a day, with 500 of those being due to metabolic adaptation. Despite this is the interesting part, having regained £90 on average. So not only did the metabolic rate continue to decrease, but it decreased regardless of their bodies getting bigger again. So what gives? I mean, based on these two studies, it seems like your metabolism can crash and burn and it'll bring down the whole Amazon forest with it. Well, there's something really important to note here. These are the only two studies we have exhibiting anything like this. Plus, we have a lot of other research trials showing that this doesn't typically happen in those who sustain weight loss. And we have some more findings on the Biggest Loser study that is often not talked about. A secondary analysis by Kevin Hall showed that weight regain was not linked to metabolic adaptation. Those who had the greatest little level of adaptation regained the least amount of weight.

Michelle (00:18:42) - So even though their adaptation might have been large and they had a really low metabolic rate compared to when they started, it didn't necessarily mean that they were the ones that regained all the weight. So even though some of these people had a greater than expected metabolic adaptation, it didn't actually worsen their outcomes. And I know I'm quoting a lot of data here. I'm referencing a lot of studies. Don't you worry. I've got all my receipts. I'm putting all of this into a blog post for you that will be linked in the show notes, and you can go find all of these studies and do all the research that you want for yourself. The notion of metabolic adaptation, where your metabolic rate falls below what is expected from your body mass, can happen in extreme scenarios where people lose huge amounts of weight, or in severe eating disorder patients. However, the effects of metabolic adaptation for the average person are massively exaggerated. There's a systematic review of 33 different studies that showed that in better design trials, metabolic adaptation from weight loss was tiny or just no longer significant.

Michelle (00:19:57) - We see this concept further in a small study that was done on 107 individuals. So even though this is a small study, I think it's really interesting. And I wanted to share who they were split into three different categories. Those who were actively maintaining a weight loss amount of about 13.5kg or more for the last year. The second group was those who were a normal weight control and had a similar BMI to those who had maintained weight loss, and then the third group was those who were overweight or with obesity that had a similar BMI to the maximum of those in that first group who were the weight loss maintainers. So like I said, it was a small study, but it did show some interesting results. Those who were actively maintaining weight loss did not have a significant difference in their resting energy expenditure compared to those who were not actively sustaining weight loss but were of a similar body size. So even though those who had lost a lot of weight got down to around the same size as somebody who had not lost a lot of weight and just was naturally at that same size, they didn't have a significantly different metabolic rate from those who were the same size as them, which is what we're kind of led to believe would happen if this starvation mode concept were true.

Michelle (00:21:18) - We would think that they had a really broken metabolism, and they were sure to then regain the weight and go back to being a larger size than those who were similar to them. There are even more studies supporting this, which were even more controlled for making sure that all participants were completely weight stable when measuring their metabolic rate. And I'll link those studies in my article that all link in the show notes. So yeah, it's just it's not a proven concept. It's overblown, and it's trying to support a statistic that isn't even a valid statistic in the first place. So let's move on to this concept that obesity does not negatively impact health. And this is potentially one of the most controversial things I could ever utter out of my mouth into a microphone and put out for the world to see. But we need to be honest about. Stuff like this and and discuss what the data actually says and highlight some of the misleading things that are being said on social media and even in practitioners offices. So this is where a lot of people come to a hard stop when it comes to intuitive editing.

Michelle (00:22:27) - They think it's a great concept, but once they get to this point, they're like, oh no, I'm not on board because that's not evidence based. Intuitive eating, as many of you know, is is closely entangled with the health of every size movement, the health of every size movement or has is,, it relies heavily on this basis that obesity does not negatively impact health. And they say that correlation doesn't equal causation. And we don't actually have any proof that this is true. There's no long term studies of diets working. You know, rewind ten minutes to hear my response to that. But it's just it's not true. Before I dig into the data on this, if you do want to know more about health at every size as its own like subject and just kind of do a deep dive onto that and the implications of it and the nuances and the highlights and lowlights. Check out my episode from December 5th, 2023 with doctor IDs. On this topic, we do a really big deep dive into health of every size.

Michelle (00:23:27) - And of course we have receipts. So okay, let's dig into the data., for this episode on this topic though, first of all, we have an umbrella review that shows an umbrella review if anybody doesn't know what that means is like a massive review of a massive amount of studies, it's not like, oh, there was this one study done on a hundred people. It's like, this is reviewing hundreds, sometimes thousands of different studies, which means hundreds of thousands at points. Even millions of people are underneath this umbrella review. So it's it's a very. I mean, if we have a well-designed umbrella review, it is very good quality evidence and we have an umbrella review showing obesity is causative, not just correlated, but causative of stroke, heart disease and pulmonary embolism. And first, I want to say really quick for anybody listening to this episode who is in that BMI category of having obesity or being overweight or anything, this is like I think that a lot of times what's tricky about this is people feel like if we're discussing these things, that it's like they should feel ashamed for how much they weigh.

Michelle (00:24:48) - And I don't want you to feel that way at all. The point of me discussing this data is to say, like, I actually don't think it's helpful for somebody with obesity to be lied to and said like, no, it has no impact on your health at all. There's no risk for your health at all. I don't think that's helping. I think we should be honest with our patients and give them accurate, up to date data, you know, like because we do care. But there's a way to treat our patients that is not shaming them for their weight. And I know that for many individuals with obesity or who are overweight, they are shamed for their weight and they're like repeatedly told over and over and over again that their weight is too high or that their weight is going up. And that's not helpful for them, because in general, they already know that it's something that they or they've already been trying to work on it, you know, so it's just not helpful to keep beating it into them if it's creating this sense of shame and guilt and, and whatever.

Michelle (00:25:55) - So I don't want this to be like a, oh, I need to feel guilty about what I weigh now. Like, not at all. Is that the purpose of this? I just want to present the data is in as a logical and unbiased civil way as possible so that you can know. The truth. And with that being said, you should always do what's best for you. If you're struggling with your weight and you need to take the focus off of your weight in order to heal your relationship with food and get to a place where you can actually create sustainable, healthy habits, then that might be the best thing for you. That's what I ask all the women to do. That work with me is like, hey, let's actually not talk about your weight right now because that's not helpful to you. You've been thinking about that and obsessing about that for way too long. And for other people, they can focus on it and it's totally fine. So it's just, yeah, like I, I'm going on a tangent right now because I just know there's going to be somebody listening to this who's like, oh my gosh, now I feel guilty all over again for what I weigh.

Michelle (00:27:01) - And that is not the point of this at all. It is just to be clear about the evidence that we do have. I'm not here to sugarcoat things or lie to you, so I'm going to be real. And this isn't this is an episode about my ex and the things that I think are inaccurate or untrue that we are often told in the intuitive eating space. And I think people deserve to know the truth. So anyway, I don't know if anybody needed to hear that, but I just wanted to put it out in the universe in case somebody is sitting there and did need to hear that. So let's get back to it. So simply put, the data just isn't there to support the claim that obesity has no negative effects on health. Yes, correlation doesn't equal causation typically in a single study, right. If we're just looking at one study. But it can when we have a mountain, even universe of evidence collectively saying the same thing. Keep in mind we know that obesity increases risk.

Michelle (00:28:02) - It does not automatically mean you will develop type two diabetes or heart disease or have a stroke, whatever. Right? Like what we're saying is that it is causative in the sense of it increases risk. It doesn't mean you automatically will have these issues. So that's another nuance that we need to keep in mind here. So here's some typical studies though, that I typically see when people are trying to stand their ground and really prove their point that obesity does not negatively impact health. So let's talk about them and debunk them. Because if you're trying to make this argument to,, whatever, like these things are going to come up right as you have this discussion with people. So some individuals will cite a study that that seems to suggest that individuals with obesity are still metabolically healthy. However, with this study, it was a snapshot in one point in time. And when we're talking about obesity negatively impacting health outcomes, we're talking about risk. We're not talking about one point in time. So what matters here is that we look at the risk.

Michelle (00:29:15) - We follow these people long term. And this study is not helping us with deciding that. And a study that did look at risk, we see that risk is still higher in metabolically healthy obese individuals versus metabolically healthy non-obese individuals. And this was a study done on 3.5 million men and women. And it followed them for five years. And it found nearly a 50% increase in cardiovascular disease risk and metabolically healthy obese individuals. So even though there's a random study somewhere that was like showing that at one point in time, individuals with obesity can still be metabolically healthy, that doesn't mean that they didn't have an increased risk, though, and that if you follow them for five years, they wouldn't have started to develop some problems so easily refuted with this very well-designed study on 3.5 million people. This is seen yet again in another study done that followed 380,000 people for 5 to 10 years and found that metabolically healthy obese individuals still had higher rates of diabetes, fatal heart conditions, respiratory disease, and all cause mortality or death.

Michelle (00:30:29) - Further, I've got more, don't you worry. A meta analysis of 14 studies showed that obese individuals, regardless of their metabolic health status, had a higher risk for type two diabetes and in another meta analysis with 22 studies, and showed that metabolically healthy individuals who were obese had a higher risk of cardiovascular events. So, yeah, there's a lot of well-designed studies that we can cite to refute this one poorly designed study that seems to suggest that individuals with obesity are still metabolically healthy, and yet another attempt to debunk that obesity has a negative impact on health. Some will say a study that was a meta analysis looking at intentional weight loss and unintentional weight loss and. NS, mortality rates. So they'll say that this study shows that weight loss is associated with a higher rate of death. However, the problem is that they're just misinterpreting the study. As the study says, which yes, it will be linked to my article. Intentional weight loss was not associated with all cause mortality. Rather, it was the unintentional weight loss, such as a situation where someone is at their end of life or has stage four cancer.

Michelle (00:31:46) - In those situations, the unintentional weight loss yes was associated with all cause mortality. So it's just like a poor argument to try and say that weight loss is increasing rate of death. When you're not looking at the difference between unintentional and intentional weight loss. So further support this. There's a meta analysis of 54 control studies exhibiting that intentional weight loss for obese individuals reduced all cause mortality by 18%. So yeah. And then just for the heck of it, there's two other meta analyses, too, that I'm going to put in my article to support that as well. So and then we can also look at the inverse and see that as little as 5 to 10% of weight loss for those with obesity can provide clinically meaningful improvement in health like blood pressure, cholesterol, fertility and those with PCOS and insulin resistance. And then there was also a study done on half a million people that showed that weight loss reduced the risk of many different diseases. So simply put, this study. So simply put, the data just isn't there to support the claim that obesity has no negative impacts on health.

Michelle (00:32:59) - Yeah, correlation doesn't equal causation in a single study and even in multiple studies. But it can when we have a mountain of quality evidence collectively saying the same thing. So keep in mind, like I said before, we know that obesity increases risk. It does not automatically mean that every single person that has obesity is going to develop type two diabetes or have a heart attack, so judging somebody based on their weight is not helpful. Discriminating people based on their weight is wrong. It's horrible and it's not helping anybody. So all of this data is out there just to show increased risk data. It's not to make anybody feel less than for their weight. Last one I'm going to say, in terms of cherry picked data and misleading claims is that BMI is useless. So this one I'm not too terribly mad about, by the way. I just think it gets too extreme at some points. The anti diet crowd always points out that the body mass index was created by. I think you say his name, Adolph Catlett, a statistician and astronomer.

Michelle (00:34:09) - So he was not a doctor or in the medical field at all. Right. But they also point out that the data was based on European affluent men making the BMI categories racist, sexist and ableist. And then of course we have the argument and elitist too. I forgot that one. And then we of course have the argument that BMI doesn't take into account muscle mass, which is a great argument to make. So the problem here is that all of these points are leaving out some important information, which is the data. There are a few papers that show association between BMI and body fat percentage, even though BMI doesn't specifically measure body fat percentage. So despite the fact that BMI doesn't take into account these different compositions of our body, there does seem to be some association regardless between BMI and body fat. So there was, and the interesting thing too, is that all of these studies were done on people of color. There's one study that was done on over a thousand South Asians. There was another one on over 400 North Indian females, and then another one that was done on over 1500 Nigerians.

Michelle (00:35:18) - So I'm not at all dismissing the fact that the origin of BMI disregarded people of color and women, and those of a lower socioeconomic status. But I am pointing out that despite that, we do still see associations between body fat and BMI, no matter where in the world you're from. The big caveat to this though, and that's why I don't like hate this argument all that much. It's only helpful for, again, looking at overall risk of big populations, not for examining the status of one individual's health at one moment in time. Whew! That was a lot of data. How are we doing, guys? You're doing okay. Oh, man. You know, I got to bring those receipts, so I hope you're not bored, because I'm going to move on to my third IC, and this one might start to ruffle feathers again. So if you were starting to feel your feathers get smoothed down, get ready. They might perk up again. And this is the notion that intentional weight loss is never okay.

Michelle (00:36:28) - This is my third intuitive eating IC. It is a big driver behind this anti diet movement. It's a big conversation. And this is it's a very polarizing conversation. And again let me remind you this is a bandwagon that I used to ride hard. And again I think the intention in the heart of it is totally fine. I understand that intentional weight loss is a big reason we have issues with eating disorders, right? But multiple things can be true at the same time. Those who try to intentionally lose weight may have an increased risk of an eating disorder, but but that doesn't mean that they are absolutely going to develop an eating disorder, and that it might not also be healthy for them. Right? Like both of these things can be true. We all know somebody who's lost weight in a perfectly reasonable and healthy manner, and their relationship with food and their body is fine. And in some cases they're even healthier for it. What I see all the time with anti diet and intuitive eating and health of every size practitioners is a statement of we support body autonomy but do not agree with intentional weight loss.

Michelle (00:37:43) - Okay. So you don't support body autonomy then? Like, if you can't stomach helping a client find a reasonable ways to lose fat, they're going to go find somebody else to who is probably going to feed them a bunch of harmful information. Because, let's be honest, the weight loss space is full of misinformation and is harmful in a lot of ways. So stop gaslighting people and trying to convince them that they shouldn't want to lose weight if they know in their heart of hearts that that would be healthier for them. Now, here's a big caveat I want to be clear about something. There is a difference between intentional weight loss that is helpful, and intentional weight loss that is harmful or just flat out unnecessary. There are people who want to lose fat and would benefit from it, but there are also people who it won't make any difference to their health or to their self-esteem, or that it might make a negative impact on their health and on their self-esteem. So we need to read the room when it comes to this.

Michelle (00:38:47) - And for the women that I personally work with, I found that being focused on their weight usually isn't getting them anywhere in order to avoid the intentional weight loss being harmful or unnecessary. Sometimes we need to actually just stop worrying about our weight altogether. So we need to read the room when it comes to this. And for the women that I personally work with who struggle with their relationship with food and their relationship with their body, and they find all of these things very distressing, I found that focusing on their weight isn't actually getting them anywhere, and in the end, it ends up being actually harmful for them to focus on these things. Right now, it's taking them away from actually adopting healthier, sustainable habits. So in order to avoid the intentional weight loss being harmful or unnecessary, sometimes we need to actually stop worrying about weight altogether. To be honest, it just depends on the population of people that you're working with. One way to detach from this and to actually start making some progress in our health and in our wellness goals, is to see weight as a side effect, not as like the main thing.

Michelle (00:39:56) - And this is usually what happens. We're hyper fixating on the side effect. That's like someone with diabetes stressing out over their high blood sugar after every single meal and being pissed about it, but never actually looking at their carbohydrate intake that might have been causing the high blood sugar in the first place, right? The high blood sugar is a side effect of something else. Additionally, it's not just the carbs impacting their blood sugar. There's other things too, like stress medication, fitness level. There's multiple things that can impact and create this one side effect, right? It's the same thing when we're thinking about our weight. We often get so hyper fixated on that. And we just try to do like these quick fix ridiculous methods to try and fix that one thing without ever actually looking at, hey, what would actually be helpful and healthy in the long term? So when it comes to the work that I do with my clients, many of them are wanting to lose weight. Or rather, they want to lose fat, but are putting too much emphasis on the weight itself, and it's stressing them out to the point that their behaviors are actually making things worse.

Michelle (00:41:05) - And to be honest, to a lot of the women that I work with, it's not even about health risk, it's about aesthetics. It's about trying to look a certain way because of this pressure that's put on us from society, you know? So it's just like it's so. Necessary to take a step back and focus on the bigger picture and focus on other things. So in some sense, I am a weight inclusive practitioner, although people who are like in the weight inclusive crowd would say like, no, you're not. And that's fine. Like, I don't need to have a label. So in some sense, because of the clientele that I work with, I do align more with the anti diet and intuitive eating and health at every size and weight inclusive approaches when it comes to working with my clients. But. I'm still not going to sugarcoat things or buy in to data that that isn't good data. But yeah, I mean, like the women that I work with are particularly vulnerable to the topic of weight and, and fat.

Michelle (00:42:13) - And I get it because I've been there, you know, and what I really needed in those moments is to not be focused on my weight and to think about my weight as the least interesting thing about me, and also the least important thing about my health. Right. Like that was more healthy for me and for the women that I work with. That's generally true as well. But yeah, I mean, I'm not going to sugarcoat things either and just buy into things because somebody was really loud on the internet about it, you know? And then also as a side note, because I feel like this doesn't get said enough, everyone does need some body fat at some point. Fat loss is a bad thing. That's another reason that I asked my clients to stop fixating on it, because in some cases, it's not actually supportive for their health to go there. Everybody needs some body fat. It is not evil. It is like it is supposed to be there to some extent, right? Like we do not need to be trying to get rid of it completely.

Michelle (00:43:15) - These last two weeks are,, going to go quickly, so pay attention. Hahaha. My fourth ick is that feelings override facts a lot of times. Now, this is just an observation that I've made many people in the anti diet space and intuitive eating space choose to turn a blind eye to all of the evidence I and others have presented, because they are letting feelings kind of dominate their practice and and motivate their practice. So phrases like lived experience are used to justify using anecdotes to guide practices. Because let's think about I lived experience at the end of the day is just an anecdote. And if you know anything about research and science, anecdotes are not facts. So what I see a lot is that, you know, these practitioners would rather not be concerned with facts when it disputes how they feel. You know, in many cases, the arguments they make and the labels like anti diet, health in every size, fat, positive weight, inclusive, intuitive eating, it goes on and on become their identity and they cling on to it as tightly as they can.

Michelle (00:44:31) - And again like I've been there guys, I've been there. I'm like not trying to hate on these people. I'm just commenting on what I've noticed and what I find to be unhelpful for public health. And so what actually ends up happening a lot of times, and maybe you've noticed this, is that there's a lot of name calling from, from individuals that are in these groups. Right? Like if you don't agree with them then you're racist and you're you're too privileged and you're ableist, right? I mean, like fill in the blank with whatever career ending name you like. And yeah, if you disagree with somebody, you'll you'll probably get called one of those names, you know, like it's, it can be impossible to have discussions with these individuals and to have, you know, conversations because at some point what ends up happening is if you'll talk down to disrespected, many even feel downright bullied. I'd have. I mean, I've talked about this before over the years, and I've had many people reach out to me and say, you know, that they agree and they've noticed similar things, but they've been afraid to say anything because they don't want to be bullied by these crowds.

Michelle (00:45:47) - So it's just like you're either with them or you're not. There's no in between, you know? And that's why I don't really like putting the intuitive eating label on me, or the anti diet label on me anymore is because I don't want to be associated with people who are generally kind of bullies, you know. And then my last and final point is the intuitive eating coaches. So for those of you who don't know, you can become a certified intuitive eating counselor in six weeks through the Intuitive Eating website for a fee of $1,500. Of course, what I often see with these intuitive eating coaches is that they're often just regurgitating any data that's been provided by Intuitive Eating and Health at every size materials, without ever understanding how to interpret that data. And if you want to know what I mean by that, go back to my whole section about the cherry picked and misleading data. Worse, they're guiding others on how to heal their relationship with food, which is the very nature of intuitive eating. And as I've been doing this for a few years, I really believe that that should actually be reserved for trained and licensed professionals like registered dietitians.

Michelle (00:46:59) - And mental health therapist. And even further than that, those who have had additional training in eating disorders. And that's not what intuitive eating certification is. The crossover is just like it's unavoidable. Someone who struggles with their relationship with food is, by nature exhibiting disordered eating, and a lot of times they could probably fit an eating disorder diagnosis. I mean, you could easily give somebody an eating disorder diagnosis of just the, the,, kind of the catchall one, which is Edna's eating disorders not otherwise specified. Right. So it's just like, I don't know, like I kind of feel like this is an ethical issue in some ways, that these coaches end up being trained in the ways of intuitive eating and health at every size, and they're helping individuals who really need a trained professional and someone who also has training with eating disorders. And that's just not always the case. Sometimes it is the case individual who are licensed and trained professionals and have had eating disorder training are also intuitive eating coaches. You know, so it the crossover does happen.

Michelle (00:48:10) - I just think that that should be the only option. So what I end up seeing is, is these coaches are very trained in the ways of intuitive eating and health at every size. And so they're trained to be very angry at anyone that disagrees with them. That's just kind of the general vibe is is anger of that community. So okay, some final thoughts. Those are all my ICS and I got some final thoughts. So you might be surprised that I align myself with intuitive eating at all after all of these things that I had to say, which I would understand. And quite frankly, I do like if I'm being so honest with you at this moment in time and space, I do feel a little embarrassed to support intuitive eating these days. It's not that I don't agree with the core of it, or think that it provides incredibly valuable tools, or that that tool can be incredibly transformative in women's lives, because I do think that that's why I still use it with my clients, but it's just that there's so many flaws in it in individuals who have kind of just ruined it for me, you know? And as a professional, I've learned to take helpful pieces and apply them where applicable for my clients, but leave other pieces that aren't working or just aren't evidence based.

Michelle (00:49:28) - I'm super curious if you have felt similar to me on any of these points mentioned. I'd love to chat. I love having conversations about this. It's been some of my favorite ways to connect with colleagues over the years. Is just discussing some of these. Hard conversations and digging into how do we best support our clients in a climate like this? That's pretty feelings focused and has a lot of social implications. I'm so curious if you have felt similar to me on any of the points mentioned, whether you're a health care professional, like a dietitian or a therapist or a doctor or a physical therapist, or even just like a general coach. I'd love to hear your thoughts on this, but even if you're not in a helping profession and you're just somebody who is walking through their own relationship with food, trying to make more sense of it, trying to heal, and trying to get to a place that really makes sense for them and works for them. I'd love to hear your thoughts on these things too. I'm so open to it, and I know that this is like a complicated discussion with a lot of nuance, and it's a lot of it's really charged to write.

Michelle (00:50:44) - It's really emotionally charged. So I'm trying my best to have a logical kind of put together, levelheaded conversation about these things. And in being mindful of so many people that are in so many different places. But I'm going to fall short of that. So I'm sure I've heard somebody feel somebody's feelings at some point, and I apologize in advance of I have. I also apologize if I've just misrepresented anybody. So shoot me an email at Michelle at Ace nutrition.com. I'd love to hear your thoughts. And I also want to say, too, as one last kind of disclaimer, the feelings and opinions that I've expressed are my own, and they don't apply to everybody that aligns with intuitive eating or being anti diet, or being a part of the health of every size or weight inclusive space. This is like just general observations that I've seen again in general. Right. So I don't want you to go forward and be like, oh, anybody who uses the intuitive eating or anti diet labels is cherry picking data, making misleading claims, you know, like it's you do still need to look at people as people.

Michelle (00:51:53) - You know everybody is a human that has their own thoughts, opinions and beliefs. Give everybody a chance to be a part of your world. And then it's up to you whether you want to keep them in your world or not. I'll put my email in the show notes as well for anybody who wants to continue the conversation. And then please do share this episode with a friend who you think would like it. And as I said, I'll link my article in the show notes that has all of the references and and research data that I've mentioned in this episode. I hope you have a good day and we'll see you next time.