by David Preyde
The areas of diet and nutrition are a minefield. It’s almost impossible to reach a consensus, as there are so many different — and contradictory — theories, ideas, and values. If you are a healthcare professional, it can be hard to know how best to serve your clients.
One idea that’s gained a lot of traction recently is intuitive eating. It’s a pretty great concept: instead of worrying about the different components of food, how often to eat and how much, you simply pay attention to what your body is trying to tell you. If you eat when you’re hungry, it’s supposedly easier to maintain a healthy relationship with your body. In addition to being a great tool for clients, it also makes your job less complicated.
Allow me to ruin this for you.
I have Asperger’s Syndrome, and like so many people on the autism spectrum, my relationship with my body is — to use a clinical term — utterly bollocksed. My sense of taste, texture, and smell are all much more sensitive than usual, which means there are a lot of things I can’t eat. And my sense of hunger and thirst are practically non-existent. I can’t reliably tell when I’m hungry. A lot of people with autism share this experience. It’s a common problem, which can lead to both overeating and undereating.
When I lived with my parents, I didn’t recognize that I had this issue. I ate when my family members did, and — for the most part — ate the same things they did. However, when I moved out, my diet went haywire. Like many autistic people, I have the tendency to get lost in my own world. In the morning I’d wake up, check my e-mails, maybe do a bit of writing, and before I knew it I was feeling dizzy and having a hard time concentrating. I’d look at the clock and realize it was already 1 P.M. and that I hadn’t had a full meal in well over twelve hours.
Despite my tendency to accidentally starve myself, I gained fifteen pounds within a year of moving out of my parents’ house. This was because I often waited to eat until I was on the verge of collapsing from hunger, so I over-relied on fast food, candy, and other highly-processed foods that took little time to prepare.
I didn’t know about intuitive eating until I met my partner. She was appalled by how much fast food I was eating, and I shrugged and said, “Well, what’s the alternative?” She explained the principles of intuitive eating. I said, “But how am I supposed to know when I’m hungry?” She was confused by this question. I was confused as to why she was confused.
This happens a lot to autistic people. Our brains and bodies work differently, and it doesn’t automatically occur to us that we’re the deviation. Why would it? I can’t imagine being able to intuitively understand that I’m hungry, and I always assumed that other people were the same way.
So I’ve gone through life eating whatever, whenever, and — when left to my own devices — I don’t eat until I start feeling dizzy, because that’s the first indication I have that I’m hungry.
Miraculously, I’ve never had any health problems, and I’ve always maintained a weight that falls within the narrow perimeters of what’s considered “healthy”. A lot of people on the autism spectrum aren’t as lucky. Some get traumatized by well-meaning doctors who, instead of recognizing their patients’ challenges with appetite and food, push weight loss, restrict access to food, and just generally make things worse.
But realistically, how many autistic clients are you going to have? Is this a problem you’re going to have to deal with?
Yes, and more often than you might think.
Apparently, a disproportionate number of people on the autistic spectrum have eating disorders. This isn’t a well-known fact; I had no idea until my partner — a health psychologist — told me. But it didn’t come as a surprise.
In addition to being out of touch with our bodies, autistic people are often rigid, perfectionistic, and gravitate toward extremes. Because autism is a social disability, we’re often isolated or socially anxious. This can complicate mealtimes, which are often social activities. We’re also often sensitive to sound, touch, taste, smell, and visual stimuli. All these factors can contribute to feelings of anxiety and depression, as well as a desire to tightly control the few things we’re capable of controlling.
I don’t mean to imply that all or even most autistic people have eating disorders, but we are at higher risk. And unfortunately, intuitive eating — one of the best strategies for people with eating disorders — doesn’t work for many people with autism. If you treat your autistic clients the same way your treat your other clients — and especially if you present intuitive eating as the only option — you will likely exacerbate their health problems and potentially discourage them from seeking healthcare.
So what are you supposed to do? Honestly, I don’t think anyone has figured that out yet. There aren’t enough people who have done research on the links between autism and eating disorders, and everyone with autism is so different that it’s difficult to establish patterns of behaviour and predict what we’ll respond to.
But to some extent, you’re probably used to this. As I’ve said before, the areas of diet and nutrition are a minefield, and there’s no consensus on what works and what doesn’t. We’re all stumbling around a dark room looking for a light switch that might not even be there.
The difference between the rest of your clients and your autistic clients is that autism presents a different dark room and a differently placed light switch.
I simply encourage you to be open to the possibility that what works for some clients won’t work for others. In the end, your empathy, compassion, open-mindedness, and willingness to collaborate with your client will allow you both to find the solutions they need.
Even if the route you take is not intuitive.
David Preyde is a freelance writer who writes about the difficulties of being human. His pieces often explore topics related to disability justice, autism, relationships and sexuality. He has been published in Disability Horizons, peer-reviewed disability journals, and short-story anthologies. He is also an emerging playwright and produces plays that challenge notions of normality and convention. You can follow his blog at firstname.lastname@example.org or contact him at email@example.com.