This approach is well suited to people practicing different eating styles—vegetarian or kosher, for example—as long as their orientation to food is based on philosophical or religious principles and not on the desire to lose weight. Conscious nutritional considerations—as long as they aren't diets in disguise—are well-adapted to intuitive eating. For example, one client felt that putting soy in her diet would contribute to her physical well-being and decided that a glass of soy milk in the afternoon would coincide with her body's need for protein. If your client receives advice from her doctor to make dietary changes that can positively affect a health issue, such as reducing saturated fats to lower cholesterol or understanding the effects of sugar consumption in the case of diabetes, and she's able to follow these recommendations, there's no problem. Unfortunately, many people report that a visit to their doctor in which they were instructed to restrict food triggered overeating.
Most of these clients aren't self-destructive or unmotivated to become healthy. Rather, the dynamics of the diet/binge cycle render them extremely sensitive to perceived deprivation, especially when accompanied by the familiar advice to lose weight. Additionally, if clients frequently turn to food for comfort when experiencing anxiety, the scare tactics or dire warnings used to convince clients to restrict their diets create fear that puts them at greater risk of overeating. Learning to become an intuitive eater of all foods, by contrast, makes it easier to adopt dietary changes as a means of good self-care, without the sense of deprivation that often triggers dysregulated eating.
I believe that most clients can't begin to explore their use of food for affect regulation until they have an internal system of physiological self-regulation in place. When people are caught in the diet/binge cycle, thoughts about eating and weight create anxiety, draining mental energy and making it even harder to face the uncomfortable feelings that may drive them to binge. But once they're no longer in the throes of the diet/binge cycle and have developed a consistent and reliable structure to feed themselves, they're in a much stronger position to explore the relationship between eating and their emotions.
Sasha knew that she overate in response to a wide range of feelings—anger, sadness, loneliness, boredom, and even happiness. It wasn't the feelings themselves that activated her overeating: it was her inability to tolerate a particular feeling that prompted her to turn to food for self-soothing. Clients often use words like numbing, comforting, and distracting to describe how they feel when they eat. This process is often unconscious. Sasha doesn't say to herself, "I'm feeling angry with my husband, but I can't tolerate this feeling, so I'll go eat something to calm myself." Instead, she finds herself at the refrigerator, reaching for food, even when she isn't hungry. She may be aware that she's trying to push away her anger; or, like many clients, she may not even be aware that something is bothering her. This action sets off a chain of events that takes her further away from whatever negative emotion first threatened her.
As she continues to eat, Sasha begins to criticize herself, declaring that she's out-of-control, fat, and disgusting. In the past, these reprimands would have led her to conclude that she must go on a diet to lose weight; however, she now understands that losing weight won't solve the real problem, though she may not yet be conscious of what that problem is. Instead of denigrating herself, she speaks to herself with compassion, saying, "I'm reaching for food and I'm not hungry. Something must be bothering me, and this is the best way I have to deal with it right now. I look forward to the day when I no longer need to turn to food."
Four months into therapy, Sasha could report that most of her eating was now in response to feelings of physical hunger. She was ready to work on the emotional aspects of overeating. Gradually, when she found herself reaching for food even when she wasn't physically hungry, she learned to ask herself, "Can I wait?" When the answer was "No," because she felt too anxious in the moment without this form of self-soothing, she gave herself permission to eat anyway, since the objective was for her to outgrow her need to use food for comfort, rather than to exert control over her eating. She learned to give herself gentle nudges in the direction of waiting to eat, by reminding herself that food tasted and felt better when she was physically hungry and becoming curious about what was really bothering her at that moment. Her goal was to feel that she was in charge of her eating—to make mindful decisions that left her comfortable and satisfied—as opposed to controlling her eating, which meant using restraint fueled by guilt.