Can everyone achieve "health?"

We all want to be happy with our food and “eat well.” However that  means something different to everyone – eating for a health goal, in alignment with our spiritual/cultural values, and/or in relationship to our taste preferences.

But eating well isn’t simply a choice. If it were that easy, we’d all be doing it! Other circumstances and situations can make it hard. Many people “make the decision” only to find it hard to make it last more than a meal or two. What gives?

​I often reference at Maslow’s Hierarchy of Needs in my work. Essentially, all humans have basic needs that must be met in order to function at a higher level. Namely these are food, water, rest, and warmth (aka shelter). When any of these areas are compromised, more complicated tasks such as nurturing relationships with yourself and others become difficult.

Ellyn Satter adapted Maslow’s Hierarchy as it applies to food security and choices (image below). Essentially, people have to have enough food in a reliable way before they can become selective about that food. The model focuses more on those with food insecurity (whether due to financial, behavioral, or environmental circumstances).​

Ellyn Satter Hierarchy of food needs

Neither models claims that higher level tasks are impossible but instead stress the importance of a solid foundation before working on details. Look at it this way, you can paint and decorate a house with a cracked foundation and still make it look gorgeous - masking the crack. But as the foundation continues to crack and crumble, the aesthetics become more difficult to maintain. (And of course PLENTY of people live with a cracked foundation and no harm comes of them).  ​

Adapting the models for counseling...

I found it necessary to begin thinking about my counseling and people's relationship with the world (and themselves) in this way. So many people come to me seeking decorating recommendations – “I want to be vegan / vegetarian / have more energy / lower blood sugar / eat more / eat less / be healthy etc.”  However, if the foundation has cracks, wholes, or is built on limestone (eg, food insecurity / poor mental / emotional health / poorly nourished / socially isolated / chronically stressed), decorating is not the priority and isn’t always coming from a place of health.

So here’s a work-in-progress model I’ve developed based upon what I’ve learned in my studies of health behavior theories, Intuitive Eating, eating disorder counseling, and in my studies as a certified diabetes educator.

​It’s a blend of worlds that helps me recognize aspects that might be cracking someone's foundation and ability to make lasting change.  

Foundational: Physical, financial, and emotional security and safety

Similar to Maslow and Satter, I’ve found that people need to feel financially stable (“I have enough money to buy enough food – regardless of quality”); physically safe (“I have a place to call home"; "People won’t harm me in my home”); and emotionally secure (“I have skills / tools to help me with my mental health").

​When I see a patient with a chronic health condition (eg, diabetes, high cholesterol) who is homeless, unemployed, in an abusive relationship, and/or has a chronic mental health condition like schizophrenia, my job is not to put them on a restrictive diet.  Instead, I work to connect them to the resources they need to make it through today.

For example, I have patients who drink 1-3 liters of soda a day. However, that soda plays a vital role in their survival - they use it to quiet the voices in their head. Others need it to stay awake because they’re afraid to sleep at night on the street. If they don't have a tool to replace soda, then what? 

Sense of security may extend beyond the present moment. Those struggling with trauma and PTSD may appear safe in their current place, but their mind exists in an unsafe place making it harder for them to focus on self care. If that isn't recognized, we are asking people to make changes that set themselves up for failure - that doesn't help their physical, mental, or emotional health.  ​​

Physical: Eating every 3-4 hours ● Adequate protein, fat, carbohydrate

● Hydration ​​● Physical and emotional rest

Next, it’s important to me that the person has a well fed and rested mind / body. Dieting and skipping meals is not fueling the body. When the body isn’t fed and/or lacks key nutrients, it changes our physical and emotional reaction and decision making abilities (eg, we have more cravings; harder to recognize physical vs emotional hunger; emotions are heightened; reactions are more extreme). If you doubt this, check out the work by Ansel Keys.

I cannot emphasize the importance of  physical and emotional rest enough. Inadequate sleep and excessive physical / emotional stress similarly shift our food preferences and ability to properly recognize hunger / fullness cues as well as internally motivated food preferences.

It’s so common that someone comes to see me with excessive life stress and inadequate rest (working multiple jobs; caring for family members on top of work; high demand work schedule with long / irregular hours). We only have so much energy we can put into our day and lives and sleep / leisurely activities often take a back seat putting the body’s stress response on high alert.

​Curious what stress does to the body? Click here to learn more about stress response  and here to learn about the effects of chronic stress.

Emotional: Honor feelings ● Emotional connection ● Family history 

When the body and mind are in a more balanced place, it becomes possible to start to explore how emotions, relationships with ourselves and others, as well as our history play a role in food behaviors and choices. This stage isn’t necessarily about making changes, but instead understanding how emotions affect choices and behaviors.

Take for example family history. Most people in the United States and the world aren’t too far away from a state of starvation – wars, depressions, and famines aren’t far down the line in many families.  When food / types of food are rationed, we are forced to stop eating before feeling satisfied. Then when food is available, we eat beyond the point of comfort because you never know when the next meal will be.  Both circumstances make it hard to make “choices” about food. When our upbringing comes from a place of poor foundation, it’s helpful to recognize those circumstances don’t still exist. (side note: sounds a little like dieting, right?)

External triggers: Diet mentality ● Media ● Social circles / norms ●

​Cultural influences 

Once we get in touch with how emotions and family history, it becomes possible to explore how external influences shape behavior and choices.

For example, if your social media feed is full of sweet potato and kale salads, you’re going to feel more pressure to eat those foods (even if you don’t really want them). The media and people we surround ourselves with often dictate what we perceive to be normal and acceptable. If all of your friends hate their body, you’re going to feel pressure to find something about yourself to dislike – even if it’s not rooted in truth. If you’re watching the Food Network all day, you’re probably going to feel pretty hungry.

This stage (and really every stage) is  not about judgement, criticism, or shame but rather questioning and understanding. Our  behaviors go beyond cognition and choice – they are rooted in our socio-cultural-environmental circumstances. The goal is to identify, recognize, and decide whether that’s a behavior that’s in line with your own truth and values. ​​

Internal cues: Internal hunger and satiety cues 

When all of the external and environmental issues have been addressed, it’s becomes possible to honor your body’s voice “hey…I’m hungry!” or “I’m good on that.” We start to notice what foods we genuinely prefer and in what amount and the subtly of satisfaction. 

Function: Select foods for physical, cognitive, or spiritual needs

​It’s funny how the end of the journey is where everyone wants to start. With a strong foundation of physical and emotional health, food becomes fun and experimental – it’s possible to tweak your nutrition for a physical goal such as performing well at a race, experimenting with vegan / vegetarian dishes, or controlling blood sugar to name a few. When the foundation is strong, it’s possible to recognize when a goal is coming from a place of self love or hate and make adjustments accordingly. With a strong foundation, change becomes a personal choice - not one of fear or dictation. It’s possible recognize and accept that your body can change and that not all changes are meant to be permanent (eg, my Ironman body is not my winter body and that’s ok). Because how and what we eat can be flexible and seasonal and doesn’t define who we are as people.

Moral of the story…

This isn't a step-wise model. Many people work on fixing the foundation while also painting the living room :) My point is that we can't ignore the foundation or expect to succeed in redecorating when our house is about to crumble. It’s not about mastering levels, but rather recognizing that we also need to work on self discovery, understanding, and compassion.

Life is not linear. Sometimes life happens and puts a crack in the foundation (eg, losing a family/friend; changes in money / work; health conditions). This can make higher levels more challenging than they were. I propose that instead of punishing yourself for "failing" at eating broccoli every day, recognize that deeper issues are making it challenging and give yourself some compassion and flexibility to change that goal as life allows. Food (and our relationship with food) is complicated and goes so much deeper than “eat this, not that.”

So next time I ask you “how are you?” I’m not judging the morality of your food choices or behavior. I’m genuinely asking, “how’s your life?” Because that's the foundation I'm building on. 

Stay nourished friends!