Renee Little, R.D.
Book Review: Intuitive Eating 4th Edition
Recently authors Evelyn Tribole and Elyse Resch updated Intuitive Eating: A Revolutionary Anti-Diet Approach to a 4th edition. I've seen a lot of questions in online groups and some individuals have submitted questions to me via social about the new version. Therefore, I decided to answer the top 3 questions and well....it ended up being a long article. So, if you only have a few minutes maybe bookmark it for continued review when you have a bit more time at a later date.
In this article I answer the questions:
"Which book should I buy?"
"How are the 3rd and 4th editions different?"
"If I have the 3rd edition, should I buy the 4th edition?"
I have tried to be neutral in opinion about the book revision and instead present the factual differences. One section which I do give my opinion is at the end of the blog post to answer the question on if you own the 3rd edition (or previous editions), should you buy the 4th edition.
Which Book Should I Buy?
The new version of the book is the 4th edition green/yellow cover. If you are going to purchase the Intuitive Eating book for the first time you will want to purchase the green/yellow 4th edition and not the pink/yellow version.
How do the 3rd and 4th Editions Differ?
There have been significant shifts in language and an acknowledgement of privileges both with the Intuitive Eating process and of the authors perspectives.
Shifts in Language & Acknowledgement of Privilege
Weight Stigma/ Fat Phobia
The most significant shift I've identified in the new edition is in how the authors acknowledge and discuss fat phobia and weight stigma. A lot of the language in the 3rd edition (pink) was stigmatizing and the shift demonstrates not only how far the authors have come in their own internal work with weight stigma but also the shift we are seeing as a collective during the last 15 years.
One example of the language change is in the "Challenge the Food Police Chapter." In this chapter there is a cognitive behavior therapy exercise of reframing thoughts. The "half empty" language included "I feel fat." In the 3rd edition (pink) the half full response or reframe was "I'm feeling better about myself." In the 4th edition the reframe was "Fat is not a feeling, but it is a form of body shaming, rooted in diet culture and weight stigma. I am appreciating all the things my body can do." (Page 147)
Another example presents on page 180 in the previous edition (pink), page 214 in the 4th edition (green) the section on "Friends don't let friends fat-talk" was completely removed. There does continue to have one area where the O-word is still utilized which is on page 214 in the Health At Every Size(TM) description.
The authors acknowledge that intuitive eating is a privilege and not accessible for everyone especially those with food insecurity. A statement was also added for the authors declaring of their privilege as cis-gendered white women with thin and able bodies.
Gender Language Shifts
A noticeable shift is use of more traditional men's names have been used for sharing of client stories and gender neutral language used in other case scenarios. One example is on page 105 where the example states "one client revealed that when they were young, they had little money and the thought of buying a new car gave them a deep thrill." Previously the bulk of the language included traditionally women's names or used "she" or "her" in the descriptions of the client scenarios.
Details on Chapter Changes
Most chapters have language changes as described above, some have seen an increase in text and research reviewed and others moved around as to where they are in the book. Below I have reviewed the bulk of the book and provided an overview of the main changes. I do skip some chapters which have language updates but the majority of the text remains the same.
Chapter 1 : The Science Behind Intuitive Eating
This chapter has moved from the end to the beginning of the book and a larger section added on interoceptive awareness. This section now expands and discusses the topics of interceptive sensitivity and interoceptive responsiveness.
Chapter 2 : Hitting Diet Bottom
In my perspective this is the chapter with the most significant volume of new information. I have bulleted these changes because there are so many to make it easier for you to read and follow.
The authors have added information on the following:
The medical and political history of weight stigma and reasons for the pursuit of thinness.
Why weight loss continues to be prescribed by clinicians despite the overwhelming evidence it causes harm.
A correlation between diet advertisements and eating disorder rates.
The role of media, magazine, movies on body dissatisfaction and pressure to be thin.
The result of decades of dieting and weight stigma.
A description of diet culture which includes the accepted definition by Christy Harrison, MPH, RD, CDN.
Examples provided on the impact of diet culture and stigma in individuals lives.
A change in the table titled "Dieting increases your risk for gaining more weight" and shifted to "Dieting increases your risk for weight cycling." The title and also content have been updated to include research on the negative impact of weight cycling.
Chapter 7 : Honor Your Hunger
The authors have added a section discussing the negative physical implications of the ketogenic diet when used for a weight loss method. Under the "Hunger Silence" section there have been additions to the reasons hunger may be silenced. Additions include trauma history, stress and basic needs are not being met. Previously this list only consisted of numbing, dieting, chaos and skipping breakfast. The research on "Can you really be addicted to food" was moved to this chapter from the original housing spot of the "Make Peace with Food" chapter. The general content included in the food addiction section remains the same.
Chapter 9 : Discover the Satisfaction Factor
This used to be Chapter 10 so it has been "bumped up" in priority in the book and now comes ahead of "Feel Your Fullness" which was chapter 9 and is now chapter 11. This switch does compliment the message in the chapter about how satisfaction is at the hub of intuitive eating.
Chapter 12 : Cope with Your Emotions with Kindness
This is the chapter with the most significant change in underlying philosophy from the authors which is reflected in the title change. The previous addition was titled "Cope with Your Emotions without Using Food."
The overall philosophy presented is to be kind and compassionate towards yourself when it comes to emotions and food. Included is a study which presents the history of how folks receive a label of an "emotional eater" and why it's likely a mislabel influenced by a diet culture mentality.
In the first few paragraphs the additions align with Christy Harrison's approach outlined in Anti-Diet. In her book Christy stated dieting itself can amplify emotions making them much more difficult to endure. In the new edition of Intuitive Eating, the authors also speak to this research and align with this perspective.
Chapter 13 : Respect Your Body
This chapter has changed quite significantly and includes changes/ additions of:
Identification of the main problem of a negative body image/ body criticism being a fat phobic culture and not the individual's thoughts or feelings towards their body.
The additions also include 2 paragraphs on how difficult it can be to heal from dieting in a fat phobic culture.
Update of current advocates, models and activists who have been leaders of fat liberation and body positivity movement/ advocacy (such as Sonya Renee Taylor, Tess Holiday, Lizzo).
Acknowledgements have been added of how difficult it can be to make peace with your body when having a chronic illness, disability or those who are transgender.
There was an acknowledgement about the challenge of buying clothing because most Americans are above a size 16 yet many companies do not carry above a size 14.
Within "Your Natural Body Weight" information on why the BMI is not a good tool to use to identify an "ideal body weight" was added and research presented as support.
On page 211-213, a section was added on weight stigma and fat phobia describing the definition and how it's harmful to folks.
Chapter 14: Movement - Feel the Difference
The most obvious change to this chapter is the title is new; the previous chapter was titled "Exercise - Feel the Difference" and now it's titled "Movement - Feel the Difference." This language is consistent throughout the chapter with any exercise term replaced with movement. A statement was also added to acknowledge that some individuals will feel intimated in the gym because of weight stigma.
Chapter 15: Honor Your Health with Gentle Nutrition
The importance of non-nutrition related health factors have been identified by the authors and included in this chapter. This is an addition which provides evidence for the importance of many factors outside of diet which influence health and longevity.
These factors include:
adverse childhood experiences
social determinants of health (including factors such as racism, poverty, access to healthcare)
The additions to the chapter bring attention to how the over-emphasis of nutrition's influence on health has created a society of guilty eaters and caused food phobia.
Chapter 16: Raising an Intuitive Eater
I'm going to caveat the review of this chapter with the fact that this is not my area of expertise so any nuanced changes may have been missed in my reading. I can see from a basic review that new evidence on baby-led weaning has been added to this section and stigmatizing language has been removed. An example is a shift from calling a child an "overeater" to using "a child who eats well beyond fullness."
Chapter 17: The Ultimate Path Toward Healing From Eating Disorders
The changes appear to be quite brief in this chapter. There has been an addition of "The importance of safety and trust" in the nutrition therapist and client relationship. Most of the chapter has remained consistent with the 3rd edition with language updated as per the rest of the book.
A new section has been added from pages 359-361 in the very last pages of the book which provides additional resources. The resources provided includes the Intuitive Eating website, the workbooks, social media accounts, the Certified Intuitive Eating Counselor Directory, intuitive eating online community, how to become a Certified Intuitive Eating Counselor and how to access the client worksheets.
If you have the 3rd edition should you buy the 4th edition?
I have to admit that initially when I skimmed through the book I didn't think it was worth it to upgrade from the 3rd to 4th edition. Then, when I dove into the details and read the entire new version the details in the content shifted my perspective.
I do think it is worth buying the 4th edition if:
you are feeling stuck in your intuitive eating process
you are a practitioner teaching intuitive eating to clients
The 4th edition highlights important intersections of social justice issues such as social determinants of health, racism, fat phobia and weight stigma. These are essential factors to healing from chronic dieting which were missing from the previous editions and will help to propel our collective understanding forward and continue to strengthen the anti-diet message.