When people come to Signe Darpinian desperate to lose weight, they usually have tried the popular diets -- Atkins, South Beach or the calorie-counting plans.
Darpinian is one of a growing number of health professionals who urge clients to forget dieting rules. Her therapy includes simple messages like "eat when you are hungry." Clients trust their bodies to tell them when to eat, what foods they are craving and when to stop.
The process called intuitive eating, which involves homing in on the internal feelings of hunger and fullness, has been around for decades. Its champions include Geneen Roth, the author of "Feeding the Hungry Heart" and a well-known teacher in the field of eating disorders.
Although intuitive eaters seem to have a healthy outlook, there is little scientific proof it works better than the latest diet.
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Darpinian, a marriage and family counselor in Modesto, is joining with researchers in the Eating Disorders Program at Lucile Packard Children's Hospital at Stanford in an intuitive eating study involving adolescents. The 16-month study, which could start in January, will track the young people for weight loss, but also determine whether they keep the pounds off and have healthier bodies and minds.
Darpinian runs the Meghan's Place Eating Disorder Center in Modesto, which counsels young people struggling with anorexia and bulimia. She said she's had success teaching intuitive eating to adults, and her work caught the attention of the Stanford researchers.
Dr. Rebecka Peebles, an instructor in adolescent medicine at Stanford School of Medicine, will conduct the study and Dr. James Lock, director of the eating disorder program at Lucile Packard, will oversee it.
Peebles said she works with obese children who need to control their weight for health reasons but can't seem to stay on a diet.
"We are trying to get them to use more intuitive approaches," Peebles said. "These kids want to lose weight and have tried all kinds of desperate measures or diets they found on the Internet. ... I really want to see how this works in a research setting."
With obesity at epidemic levels in the United States, the stakes are high in finding an effective approach to healthy eating. The relapse rates and sense of failure created by dieting have spurred interest in nondieting approaches.
The general idea is that humans are born with instincts to regulate food intake. But cultural obsessions with body image, food, dieting and a fast lifestyle cause people to lose touch with their physical hunger.
Must deal with emotions
People sometimes eat in response to emotions. They dig into that quart of ice cream because they're upset, sad, lonely, bored or they need to celebrate.
Darpinian said dieting manuals teach people to ignore the sensations of hunger. Dieters lose weight and then put it back on because they are not dealing with the emotional issues behind food, she said.
"People are so used to having someone else tell them how to eat, they are not used to responding to their inner bodies," she said.
When clients begin the therapy, she asks them not to eat at regular meal times for a few days, so they get in touch with their hunger. Clients learn to eat when they are hungry and to listen to their appetites, which tell them what foods their bodies need. Do they want something creamy, chewy, crunchy, sweet, salty, cold or hot?
A second guideline is eating what appeals to you. Intuitive eating has no list of forbidden foods. People can trust their bodies to want a balance of protein, carbohydrates and other nutrients, she said.
"Your body is not going to crave lousy foods," she said.
Another guideline is eating in a calm environment, so eaters can pay attention to how the food feels in their bodies. Darpinian has her clients rate their hunger on a scale of 1 to 10. One is no hunger cues, three is grumbly (the first stage of hunger), six is satisfied but there is room for more and 10 is stuffed.
The fourth guideline is eating until you are satisfied. It is the hardest to follow, she said, because the mind wants to keep eating when the body is through.
The therapy doesn't focus on weight or how many pounds are shed. Clients are encouraged to feel comfortable with their bodies, which are more healthy because they are eating better, Darpinian said.
In time, the weight starts coming off and proponents say it tends to stay off, as intuitive eaters deal with the emotions that drive excessive eating. Instead of eating to tamp down an emotion, they may soothe themselves by going to an art show, playing with their dog, or calling a friend to go to a movie.
Darpinian also has them get absorbed in a physical activity such as swimming or belly dancing.
"People are always asking me how I measure success," she said. "I measure success by quality of life: When you have more directed energy around food, when you feel more control around food, when you have more peace around your natural body shape and authentic body type."
She incorporates intuitive eating in treatment for clients with anorexia nervosa to help them eat normally. After depriving themselves of food, they lose their sense of hunger, so she has to wait until they return to a healthy weight and their hunger cues come back.
Eat ice cream, lose weight
Rhonda Golkin of Modesto has been in an intuitive eating group at Meghan's Place for two years. She tried dieting most of her adult life, but none of the programs helped her realize why she was bingeing.
"A lot of it was physical pain and the depression from that; I had a lot of health issues," she said. "I didn't do a lot of self-soothing. I wasn't taking time to be healthy, as far as daily meditation, gratitude for life or forgiveness."
She was surprised to learn she still could have Haagen-Dazs chocolate chip ice cream and not feel guilty. She has lost 35 pounds and not gained it back, she said.
"When you are in tune with your body, you want to put things in your body to make you feel good," she said.
Carol McKay is a group leader for Weight Watchers in Modesto, which is known for giving members a point system based on fiber, calories and fat content as a guide for selecting foods.
She said Weight Watchers doesn't take issue with intuitive eating concepts. The company does not use the term, she said, but one of its plans talks about eating when you're hungry and eating until satisfied.
"Part of the reason that diets don't work is that they're restrictive," she said. "Weight Watchers really isn't a diet, it's about lifestyle change."
In November, Darpinian plans to open a second center, My Weigh, in Oakland's Jack London Square to draw on a larger population for the study. She'll split her time between her Oakland and Modesto centers. Knowledge from the study will be brought back to Modesto and shared, she said.
Peebles said each participant will receive an initial assessment to measure blood pressure, insulin levels, weight and metabolism. The participants will be tracked and their outcomes evaluated at the end of the study.
She doesn't expect to see dramatic weight loss in teens who have been gaining 30 pounds a year. Her evaluation will consider whether their bodies are more healthy and they have a better quality of life.
"There is nothing radical about intuitive eating," Peebles said. "It is a smart way to eat, a smart way to live. It is an approach that seems promising."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.