the HAES® files: Social Barriers to Intuitive Eating

by Health At Every Size® Blog

by Daxle Collier

I’m going to be outlining some of the social barriers to intuitive eating, but before beginning, I’d like to make a disclaimer. When talking about social justice, it is important to know whose voice is being prioritized, and whose voices are not. I identify as a thin, white, pansexual, cis female. I have experienced periods of poverty and food scarcity but I currently feel financially secure. I have experienced firsthand some of the barriers I’ll be discussing, but want to acknowledge that I have not experienced all of them. I have drawn additional information and perspectives from coaching clients past and present; books; classes; discussions; and more, but believe that the discussion would be richer and more meaningful with the voices of those who live with these barriers.

I’m inspired to take this challenging topic on for several reasons. ASDAH is going through a bit of an upheaval, attempting to expand its focus to include relevant social justice issues. As discussed in a previous blog, the HAES® principles have been revised to reflect this shift. There has been discussion amongst both members of ASDAH and non-members as to whether intuitive eating (“IE”) should remain part of the HAES principles, in part because it can be inaccessible for a variety of reasons. As an intuitive eating coach, I am very aware that becoming an intuitive eater requires knowledge, support, and other resources that many people don’t have access to. However, I also believe IE is the best way to develop an optimal relationship with food, and so it makes more sense to examine the barriers so we can begin working to reduce them than it does to discard such a powerful tool.

So, now that you know where I’m coming from, let’s begin looking at some relevant social barriers. Every social barrier to intuitive eating exists on a continuum with some individuals being disproportionately disadvantaged compared to others. Intersectionality and the complex web of cause and effect make it difficult to sort out the root causes of barriers and meaningful solutions. For example, experiencing oppression of any kind (due to race, gender, age, socio-economic status, size, sexual orientation, etc.) often leads to chronic stress, which in turn, alters hunger and fullness signals in the body, food cravings, and the entire digestive process—all essential aspects of intuitive eating. The “personal responsibility” model of health would conclude that marginalized people need training in stress reduction techniques, which may be helpful to an extent, but insultingly ignores the wider context in which the stress is occurring.

One of the resources that marginalized people typically lack access to is high quality health care. Even when accessible, mainstream health care typically does not operate from a Health at Every Size® framework, more often from lack of knowledge than considered rejection of the HAES paradigm. People with BMIs currently classified as overweight or obese are advised to lose weight, typically through restricted diet and exercise, regardless of the reason(s) they are seeking medical care, and despite overwhelming evidence that these recommendations are unnecessary and unhelpful. For people whose medical issues are typically (though sometimes incorrectly) addressed through dietary changes, health care providers may be aggressively against an intuitive eating approach.

Because IE and HAES principles are not yet integrated into mainstream health care, it can be difficult for people to find out about our approach, and to find health professionals using our approach. IE and HAES oriented health professionals are typically in private practice, which may make them financially inaccessible to those relying on either private or public health insurance to meet healthcare costs. Potential clients may also have difficulty connecting with IE and HAES professionals because they do not perceive them to be peers who can understand and relate to their concerns.

Those classified as overweight by health care providers struggle with additional social barriers to intuitive eating because size discrimination is woven into every aspect of western culture. Even for a person who has access to HAES supportive healthcare and community, the effects of relentless size discrimination make transitioning to an intuitive eating practice very challenging. Despite awareness of the ineffectiveness of restrictive diets and the unlikelihood of permanent weight loss, there can still be a powerful draw to the empty promise of a diet that will provide relief from oppression due to size discrimination.

In addition to health care, food justice issues may also be significant barriers. Considerations that fall under this heading include:

  • Proximity to, and ability to access, a full service grocery store;
  • Food budget and dependency on government-based food assistance;
  • Knowledge of nutrition, meal planning and cooking;
  • Access to a functional kitchen and time to prepare food;
  • Access to providers of affordable and nutritious prepared meals;
  • Cultural expectations around food and eating; and
  • Prior or current experience of chronic hunger and food scarcity.

In other words, you can’t crave a food you’ve never had the chance to try, and you can’t cater to your cravings if you don’t have access to what you crave.

For those who have experienced hunger due to food scarcity, disconnection from hunger signals may not only be a physiological response, but also a psychological coping strategy. Reconnecting with hunger is then potentially traumatic without adequate resilience and support. It can also be difficult to transition from a basic survival mindset to a mindset of thriving with optimal self-care. Focusing on cravings, fullness, and satisfaction can feel strange and excessively self-indulgent. These feelings may then lead to feelings of guilt, especially for caretakers who are used to putting the needs of others before their own. In the process of becoming an intuitive eater, an individual can feel distanced from friends, family, and community to whom the experience and concept is foreign.

Becoming an intuitive eater is a deeply personal process, but it happens in a social context. Those of us who promote intuitive eating can begin to expand our social focus in some of the following ways: Supporting and participating in organizations like ASDAH and NAAFA; supporting local organizations that promote food justice; and organizing accessible intuitive eating support groups. Coaches can offer sliding scale payment options when possible (though coaching will still sadly be unaffordable for many). We can volunteer our services to local organizations that promote public health to offer HAES friendly materials and information to counter the promotion of restrictive diets.

The task of reversing the damage that has been done by the diet industry, medical-industrial complex, and media, is formidable. Just like intuitive eating, it is not something we can accomplish all at once, and it is not something we can accomplish alone. I am grateful for the ASDAH and HAES communities as well as related body acceptance and food justice communities and I’m hopeful about what we will accomplish together. I know that I have only briefly covered some issues that deserve a lot more coverage and missed some others entirely, in part to keep to the blog format, and also due to my limited perspective. I hope to see the discussion continue in the comment section.

 

2013_10_11_Daxle_080smallDaxle is an intuitive eating and HAES coach. She holds a master’s in health education with a specialization in nutrition. She enjoys leading workshops and discussions as well as giving presentations and creating online courses, but her favorite is one-on-one HAES coaching. You can find out more at www.presentperfectwellness.com.

 

8 Comments to “the HAES® files: Social Barriers to Intuitive Eating”

  1. Food insecurity (hunger, inability to afford appropriate food) can be caused by hidden expenses associated with a poor economy, expenses which often “don’t count” when applying for food assistance thus rendering the applicants ineligible for assistance. They also can affect people with relatively high incomes (on paper), people who may be extremely hesitant to apply to a food bank for help.

    For example, if there are no jobs locally, a person may have a long commute to find work. A person commuting 125 miles/day 5 days/week would spend $17,500 on commuting expenses each year, expenses that come off the top of take home income and which often “don’t count” when filling out applications for food assistance.

  2. This would be a great topic for a HAES Webinar!!! I would appreciate the opportunity to hear from practitioners that have experience in using HAES with food insecure or otherwise vulnerable populations.

  3. This is a brilliant column. I have rarely (but not never) experienced food scarcity issues myself, but when they existed, there was always light at the end of the tunnel for me. I think that Daxle’s list of food justice issues is especially good. I live out in the country, and anyone, no matter how poor, who doesn’t have a working vehicle, is basically screwed, for getting work and for getting to a grocery store. The better, less expensive stores are located in areas that are ONLY accessible by car. The few that can be reached by foot by a few who have homes in walking distance of the store, have noticeably higher prices and a poorer selection of the healthier foods. One new tire for the car can cost $50-$100 or more, and you might need four of them now and then. Gas is famously expensive. None of this is rocket science, and is known by most people, but the arrogance is appalling of those who assume that ignorance is the only reason that poor people don’t eat a better diet.

    Although the major food companies (big phood) would prefer that we were all more ignorant about their products.

  4. An excellent article, thank you! Regarding nutrition counseling for BED, I have worked with many clients who have a history of chronic dieting and food scarcity. For these people, fear of hunger and overeating issues appear more complex and more intense. It is bad enough to experience deprivation due to chronic dieting, but to also have had the experience of not knowing when/if the next meal would be while growing up adds a whole other aspect to hunger/eating issues. I guess this seems obvious, but it is has been really important to remain conscious of this and address it in the work.

  5. Hi Daxle et al., I just want to echo how awesome I think this article is – you brought to light an issue I think I intuitively knew existed, put was never able to quite put into words. I’m so glad this is being talked about! I work as an outpatient RD in a public hospital in a low-income/limited resource area, as well as in a private practice with an middle/upper class, well-resourced population. I am a big proponent of the HAES approach, but have certainly found it much more difficult to integrate it into my work with patients at the hospital, for many of the reasons you mention above, Daxle. Thank you so much for this thought-provoking piece!

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