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Dismantling Diet Culture: How Naturopathic Doctors are Helping Women Improve Relationships with Food

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When Naturopathic Doctor Sylvi Martin noticed her female patients often expressed guilt or shame about the foods they ate, she was inspired to help them break free from old patterns. We sat down with Dr. Martin, ND, to learn how she combines naturopathic care with intuitive and mindfulness-based eating to help women develop better relationships with food and improve overall health.

When Eating Brings Guilt and Shame

Martin’s naturopathic patient base is about 90% female-identifying.  With a focus on mental health, she works with women experiencing anxiety, depression, other mood disorders, and hormone fluctuations. 

But in her first decade of practice, she noticed a troubling pattern. When she asked her female patients to write down what they ate, certain phrases came up time and time again— like, “‘I blew it; I ate a row of cookies,’ or ‘I had pizza, and I feel terrible about it.’ Many women expressed guilt and shame for the foods they ate and passed judgment about how they thought they should be eating. Many thought I was going to judge their eating!” Martin recalls. “But I don’t bring judgment into the room; I assess. I’m not there to pass or fail patients about their eating.” 

As an evidence-based practitioner, Martin knew she had to dig deep into the research. “Why are we associating guilt and shame with eating? These patients didn’t meet the criteria for eating disorders, but they were not ‘OK’ with their relationship with foods,” Martin explains. 

Benefits of Mindful and Intuitive Eating

Her explorations first led her to the field of mindful eating—a practice of slowing down and using the senses to connect with our food and our bodies to create a more positive relationship with food.   

She was so impressed with the research that she undertook further training to become a mindfulness-based eating facilitator. “It helps people get rid of the guilt and shame narrative and pay more attention to their hunger, fullness, and satiety. I loved incorporating that into my naturopathic practice,” says Martin.  A 2021 study published in the international research journal Appetite concluded that even one short mindfulness exercise could substantially improve the ability to feel hunger. 

As she continued to explore weight-inclusive approaches to wellness, she noted the power of intuitive eating principles (such as challenging our internal food police and rejecting the diet mentality) to change eating behavior effectively. She undertook yet more training to become a Certified Intuitive Eating Counselor. A 2021 study published in the Journal of Nutrition Education and Behavior revealed that intuitive eating could boost fruit and vegetable intake. 

Over time, Martin got to the heart of the issue. “Meal plans don’t matter if you don’t have a good relationship with food and you label certain foods as bad. I love poutine. I don’t eat it five times a day, but when I do, I don’t feel bad about it,” Martin explains. “What’s the difference between me and someone who feels bad when they eat poutine? We need to explore that more.”

Racism and Diet Culture

Our cultural norms have significant impacts on racialized women who may have darker skin and a different body type than the Eurocentric thin, white ideal. Martin points to the roles of racism and colonialism. “It came from this white Puritan approach of European immigrants coming to North America and deciding that an ideal, pure woman with good morals looks a certain way,” Martin explains. “It stems from racism. Someone that likes to eat or has a larger body is criticized and automatically deemed lazy.” These issues of intersectional care are discussed in the book Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings, Ph.D., a book that Martin highly recommends to anyone wanting to understand the racist roots of diet culture and fear of weight gain.

For Martin, this additional training supports the naturopathic approach of getting to the root cause. “I don’t want patients to come to see me, lose weight, and then be on their way without building a better relationship with food,” notes Martin. “I want to get to the underlying concern. These two avenues have really helped me do that with patients.” 

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How Diet Culture Impacts Relationships with Food

Diet culture is about pursuing the thin ideal. And this approach paves the way for diet trends aplenty. “At first, it was the Atkins diet. Now everyone is doing the Ketogenic diet, intermittent fasting, or full days of fasting,” Martin explains. “And it’s not necessarily for health reasons. It’s to try and control our body, shape, and weight. It’s really toxic.”

Drawing on her background as a mental health nurse, Martin understands the importance of learning where unhealthy relationships with food begin. “Most women start dieting before their 20s. I see women in their 70s who were put on diets at 11 years old. They were shamed by their family for putting on weight in times of grief and despair or for eating more after a period of food scarcity,” Martin explains. “What are we doing? Puberty-aged women should not be dieting. We’re teaching women that it’s unacceptable for the body to change—that’s what diet culture is.” Instead of celebrating the natural changes that come with pregnancy and aging, women are expected to maintain this unrealistic, thin ideal throughout their lives. 

Focused on Outcomes, not Numbers on a Scale

Although Martin’s non-diet approach is crystal clear on her website, some patients fear that she may recommend a restrictive diet. Patients soon learn that Martin focuses on outcomes rather than numbers on a scale. Outcomes could include managing cholesterol and high blood pressure or simply learning to incorporate movement and get outside more. 

Her first step in assessing a patient’s relationship with food is prioritizing the red flags. “Often with binge eating, somebody has been restricting food during the day. Or, they don’t realize they haven’t been letting themselves eat regularly because they feel that food is bad,” Martin explains. “Then they get hangry and binge eat. When you stabilize food intake by having them eat at regular intervals, they realize that they’re binging less (or not at all) because they feel satisfied.”

Martin’s patients often comment that they no longer overthink their food. “Women spend so much time wondering if they should eat certain foods. Should they avoid all canned tuna because of mercury? If they’re eating 50 cans of tuna a week, we have to talk about potential exposure. But I want them to have a satisfying protein meal first before we worry about what else could be in that meal,” notes Martin.

For many women, it comes down to giving themselves permission to eat certain foods. “A patient may come in to never want to eat sugar again. But if you don’t let yourself have some sweet things, you’re going to give into a craving which turns into a binge, and then you’re going to feel awful about yourself,” Martin notes. “It’s about correcting that relationship with food and getting to their pain points. Let’s break that whole cycle and give permission.” A 2022 study published in the journal Current Opinion in Psychology observes that ‘giving in once in a while’ can help simplify relationships with food. 

Carving out the Time for Mindful Eating

Another common struggle? Many women don’t carve out the time to mindfully eat the foods they enjoy. Martin finds that her patients squeeze in meals when they can, grabbing hurried mouthfuls in the car between errands. “Even five minutes of sitting, enjoying food, and being present while eating can make a big difference. That’s one of the key components of mindful eating—just slowing down for even a few minutes. It doesn’t have to be an hour, and you don’t have to meditate before you eat.” 

At the first appointment, Martin asks patients to walk her through their day to learn when they typically stop for meals, snacks, and beverages. She then works with patients to figure out where to fit food into their day to keep them energized. According to a 2017 Dalhousie University study, women are three times more likely to skip breakfast than men. 

Group Program Benefits

Martin’s training in mental health nursing, naturopathic medicine, mindfulness-based eating, and intuitive eating gives her a unique clinical perspective. But in her virtual group treatment program, Nourish Wellbeing, she regularly sees the value of peer support. Women get support from other women who are struggling with similar issues. “A recent group noted that they could share things that they never talked to friends or family about because they didn’t know how to support them in a nonjudgmental way,” says Martin. 

Martin sets safety parameters in her groups to ensure no one accidentally judges someone else. “A major way that the groups are supportive is knowing that there are other people cheering them on. Everybody wins from everybody else’s success. And they’re there to hold space for each other when things get tough.”

Martin also builds self-compassion into her groups, so they can learn to truly love themselves. A 2021 study published in the journal Nutrients noted that higher levels of self-compassion among mothers are linked to healthier eating habits. Some participants are initially uncomfortable with this concept, thinking that self-compassion means being selfish. “But is it selfish to take care of yourself, so you can better care for others? No! Self-compassion is really just allowing ourselves to be comfortable with where we are in life, to be nonjudgmental, and to love ourselves as we would our best friend,” Martin explains. “It’s so important to be kind to ourselves and support ourselves as we learn new skills. It’s been really helpful for people to practice this in a group setting.”

Martin recalls one patient who wouldn’t stop for lunch and the impact of her implementing a 10-minute lunch break. “Permitting herself to eat in an uninterrupted way dramatically changed her life. Not every meal will be like that; sometimes, we eat on the go. But it’s so important for women to fit in uninterrupted eating daily.” 

Reconnecting with Feelings of Hunger and Satiety

When our gas tank runs low, we don’t hesitate to fill it up. But it’s not as easy for women to know when to refill the tank when it comes to food. “For women with a history of dieting, their hunger and fullness cues might not be as reliable. For decades, they may have been skipping meals or using diet pills and laxatives,” Martin explains. 

Martin helps patients reconnect to their bodies by using a variety of sensory-based activities. Some patients bring a snack to their appointment, and she guides them through a few eating activities. She also provides additional activities and resources to explore between appointments. “It’s about developing new patterns and new relationships with their bodies, food, hunger, and fullness. It’s where mental health counseling meets mood, and bringing it into the relationship with food.”

Ultimately, Martin wants women to know that they don’t have to struggle alone. “The answer isn’t in an online diet. It’s in working with clinicians who are trained to assess them and help them in a non-diet way that supports them as a whole person.” 

Martin also educates other Naturopathic Doctors on how to help patients improve their relationship with food. She recently spoke at the American Association of Naturopathic Physicians (AANP) Convention and the Ontario Association of Naturopathic Doctors (OAND) Convention.

Disclaimer: This article does not refer to patients with eating disorders. If you suspect that you have an eating disorder, talk to your doctor or contact the National Eating Disorders Association (NEDA) in the U.S. or the National Eating Disorder Information Centre (NEDIC) in Canada. 

References

Barraclough EL, Hay-Smith EJC, Boucher SE, Tylka TL, Horwath CC. Learning to eat intuitively: A qualitative exploration of the experience of mid-age women. Health Psychology Open. 2019;6(1):205510291882406. doi:https://doi.org/10.1177/2055102918824064

Carbonneau N, Holding A, Lavigne G, Robitaille J. Feel Good, Eat Better: The Role of Self-Compassion and Body Esteem in Mothers’ Healthy Eating Behaviours. Nutrients. 2021;13(11):3907. doi:https://doi.org/10.3390/nu13113907

Christoph MJ, Hazzard VM, Järvelä-Reijonen E, Hooper L, Larson N, Neumark-Sztainer D. Intuitive Eating is Associated With Higher Fruit and Vegetable Intake Among Adults. Journal of Nutrition Education and Behavior. 2021;53(3):240-245. doi:https://doi.org/10.1016/j.jneb.2020.11.015 

Fragmented food habits: New Dal study explores how Canadians eat. Dalhousie News. Accessed February 17, 2023. https://www.dal.ca/news/2017/05/19/dal-study-explores-eating-habits-across-canada.html 

de Ridder D, Gillebaart M. How food overconsumption has hijacked our notions about eating as a pleasurable activity. Current Opinion in Psychology. 2022;46:101324. doi:https://doi.org/10.1016/j.copsyc.2022.101324

Kristeller JL, Jordan KD. Mindful Eating: Connecting With the Wise Self, the Spiritual Self. Frontiers in Psychology. 2018;9. doi:https://doi.org/10.3389/fpsyg.2018.01271

MB-EAT. (2022), About Mindful Eating and MB-EAT, https://www.mb-eat.com/

Palascha A, van Kleef E, de Vet E, van Trijp HCM. The effect of a brief mindfulness intervention on perception of bodily signals of satiation and hunger. Appetite. 2021;164:105280. doi:https://doi.org/10.1016/j.appet.2021.105280

Strings, S. (2019). Fearing the Black Body: The Racial Origins of Fat Phobia. NYU Press. 

The Original Intuitive Eating Pros. (2022), 10 Principles of Intuitive Eating, https://www.intuitiveeating.org/10-principles-of-intuitive-eating/

Tylka TL, Annunziato RA, Burgard D, et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of Obesity. 2014;2014:1-18. doi:https://doi.org/10.1155/2014/983495


This article is provided by

The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform health care in the United States by increasing public awareness of natural medicine and access to naturopathic doctors. Naturopathic medicine, with its person-centered principles and practices, has the potential to reverse the tide of chronic illness overwhelming healthcare systems and to empower people to achieve and maintain optimal lifelong health. INM strives to fulfil this mission through the following initiatives:

  • Education – Reveal the unique benefits and outcomes of evidence-based natural medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research on this complex and comprehensive system of medicine

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