Paula Quatromoni, a nutrition expert and eating disorder researcher, gives a lecture in her new elective course, Eating Disorders Treatment and Prevention, now offered at BU College of Health & Rehabilitation Sciences: Sargent College. Photo by Cydney Scott

Nutrition

How Eating Competence and Intuitive Eating Can Improve Your Relationship with Food

BU nutrition researcher says “there are no foods off limits,” offers guidance for getting eating habits back on track if they’ve been derailed by the pandemic

Food can invoke all kinds of emotions, feelings, and memories. Cooking can be a way to practice self-care, bring loved ones together, or simply have time to sit down and enjoy a meal. But, with over a year of pandemic-related social isolation, record-breaking job losses, and compounding stress and anxiety, many people have had their relationship with food put to the test.

“It’s no surprise that the demand for eating disorder services, including mental health services and higher levels of care, is outpacing access to these professional services,” says Paula Quatromoni, a registered dietitian and Boston University College of Health & Rehabilitation Sciences: Sargent College associate professor who researches nutrition and eating disorders.  

Stress especially affects our ability to feed ourselves, Quatromoni says, and can cause people to lose touch with certain health-protecting habits, like sleeping enough and eating nutritious food. Calls to the National Eating Disorders Association are reportedly up 70 to 80 percent in recent months, related to the stress of the COVID-19 pandemic and the lockdowns it has prompted.

In her research, Quatromoni has found that social media use is a driver of eating disorder behavior, finding strong connections between social media use and eating disorder behavior in college athletes. Phrases that took off on social media last year like the “quarantine 15”—which was shared by millions to describe weight gained during COVID-19 isolation—may seem harmless to some, but are essentially repackaging the same old messages that promote diet culture and body-shaming that existed on social media before the pandemic. 

“Eating disorders are mental health diagnoses, so as emotional well-being deteriorates, eating disorder risk escalates,” Quatromoni says. “The fact that we’ve been in a pandemic and people are still worried about the number on the scale as a priority, and using that as an excuse to shame people over stress-related weight gain or an inability to exercise, is unconscionable to me.” 

Often, reaching for sugary, processed foods or other familiar comfort foods is a way of coping with difficulties. Stress and anxiety can especially make reward mechanisms in the brain go out of whack. As a registered dietitian who works with a range of people, from those recovering from eating disorders to those just looking to eat healthier, Quatromoni uses client-centered strategies to help reestablish a healthy relationship with food—something that may have been strained in the last 12 months. 

“This entails knowing that there are no foods off limits, knowing that all foods can fit into a healthy eating pattern, not having rigid food rules,” she says, which might sound counterintuitive to those who have used restrictive diets as a way to lose weight or try to eat healthier. 

For anyone feeling like their wellness goals fell off track this past year, she says a typical baseline for mending that relationship—or a goal to build towards—is to count on yourself to nourish yourself adequately and consistently, practicing “eating competence.” 

“The concept of eating competence involves being reliable in feeding yourself,” Quatromoni says. “That means that I can count on myself to feed myself today,” so not skipping lunch during the workday or ignoring body cues signaling hunger, like a churning stomach or headache. It’s a basic concept that stems from parenting research on teaching children to reliably feed themselves and attune to body signals, but the principles of eating competence are important reminders for adults, as well.

Eating competence and intuitive eating are alternative models for thinking about healthy eating behaviors. In contrast to diets, these models are not centered on being restrictive, or labeling food “good” or “bad,” which can start to damage a person’s relationship with food and lead to unhealthy behaviors, or disordered eating patterns. Intuitive eating is centered on trusting your body’s wisdom and understanding hunger and satiety cues, Quatromoni says, and relying on that trust to decide what to eat, how much, and when. 

For those recovering from an eating disorder, reestablishing that trust requires time and work in therapy, making these longer-term goals for her and her clients. 

“All foods are allowable, but part of the intuitive eating model means being informed,” Quatromoni says. “So, if I’m celebrating my friend’s birthday, of course I’m going to have chocolate cake. Is that a food I eat every day? No. I need information about what foods will nourish my body daily. Is cake a food I have to eat in secret and find myself feeling out of control when I encounter because I never allow myself to enjoy or celebrate with chocolate cake? That could be a sign of an eating disorder.” 

As part of being a competent eater, being open to trying and experimenting with new foods, or being a “flexible eater” is a part of maintaining eating competence. That could look like getting back to the kitchen and trying a new recipe, introducing a new ingredient, or sharing a meal with others.

“In the dieting world, it’s about restricting—the idea of running off calories consumed, punishing ourselves for indulging—yet a non-diet approach to wellness is instead about nourishing your body and finding joy in both food and movement,” Quatromoni says, which could be anything from walking, jogging, yoga, or any physical activity that makes you feel good. “Ditching the diet is a good place to start.” 

There are many external factors that can interfere with both eating competence and intuitive eating—which could be thought of as two goals to build up to. Working with a licensed registered dietitian nutritionist (RDN) could also be a great place to start, and intentionally setting “SMART”—short-term, measurable, achievable, realistic, and timely—goals. 

As difficult as the last year has been, Quatromoni says, a silver lining that has come out of the pandemic has been an increased access to licensed professionals through telehealth. And although there is an incredibly high demand for nutrition and mental health services, connecting with providers online has never been easier.  

Her last bit of advice for healthy eating is universal: practice gratitude every day. “Treating our bodies with respect and taking care of our health to the best of our abilities is always a really good priority,” she says. “We have to thank our bodies every day for getting us up and out of bed and for the range of our unique abilities.”