When most people think about “healthy eating”, they usually focus on what they eat. That might mean trying to eat more fruit and vegetables or less fast food, or counting calories.

But there’s a lot more to healthy eating than just dietary intake. Behaviours and attitudes around food are also important.

Take, for example, orthorexia nervosa, which is an obsessive preoccupation with consuming only “healthy” foods. If healthy eating only means ingesting healthy foods, then people with orthorexia are super healthy.

But people who live with this eating disorder often struggle with relationships and report poor quality of life, among other issues.

Research suggests that shifting the focus from food itself to our experience of eating can have a range of health benefits. Let’s take a look.

Why are we so obsessed with diet?

Equating “healthy eating” with “healthy diet” may have taken off in the early 1980s with panic over the “obesity epidemic” in Western countries – defined as a rapid rise in the prevalence of people in the population with a body mass index (BMI) of 30 or greater.

But causes of obesity are complex and poorly understood, with numerous possible explanations beyond simply what a person eats. And admonishing overweight people to eat “healthier” has done nothing to reduce population rates of obesity.

There is some evidence that this fixation on weight has resulted in increased rates of disordered eating and eating disorders – both of which involve problematic eating behaviours and distorted attitudes towards food, weight, shape and appearance.

Clearly, something needs to change in how we think about healthy eating.

Listening to your body

A growing body of research on intuitive eating has found this approach has an array of health benefits.

Intuitive eating means trusting internal body cues that tell us when, what and how much to eat. For example, tuning into your stomach growling telling you it’s time to eat, or noticing feeling full or satisfied, or that you may crave certain foods because your body wants specific nutrients (such as protein after exercising).

Studies have shown this approach can lead to better physical and mental health as well as better diet quality, and is associated with lower BMIs.

Research also shows eating at regular intervals and eating with other people also lead to better overall health and diet.

But if you find it hard, you’re not alone

Most of us are surrounded by food environments that make healthy eating difficult.

Unhealthy food environments promote overeating and encourage us to override our innate signals of hunger and fullness.

When we’re surrounded by cheap and accessible sugary snacks, fast foods and large portions – and lots of marketing – it can be hard to develop a positive relationship with food.

The issue is particularly acute for people in more disadvantaged communities.

For example, in our research with rural Australians about food and eating, most told us they wanted to eat more healthily, but found it difficult for many reasons, These included busy schedules and the cost of healthier food.

Habits and emotional eating can also make healthy eating difficult.

So, what works?

For most people, healthy behaviours and attitudes to eating mean a balanced, flexible and non-judgmental approach, without fear of “bad” foods. It means paying attention to hunger and fullness cues.

But it also means recognising that food is a source of social and cultural connection. A healthy attitude to food doesn’t ignore nutritional information – it incorporates this knowledge into a broader and more joyous approach to eating.

Here are three suggestions to get you started.

1. Recognising signs of hunger and fullness

These may differ from person to person. Can you hear your stomach start to growl or your energy begin to dip? Is it a while since you ate? And while eating, is there a point where the hunger has gone away and you no longer feel a strong desire to continue eating? Some people find using hunger and fullness scales useful.

2. Reframing “bad” foods

Is there a food you really like but don’t eat because you consider it “bad” or “forbidden”? Try incorporating a small amount into your next meal or snack. You may find that doing so brings greater joy to your eating while simultaneously taking away its power.

3. Eating with people

If you normally eat by yourself or “grab and go”, see if there’s a way to plan more time for meals and include other people – whether this is more family meals or group lunches with coworkers.

But some people have to follow a specific diet

People with medical conditions that require a particular type of diet – such as those with diabetes or coeliac disease – need to follow that advice. But they may still be able to have healthy behaviours and attitudes towards food even within these constraints.

For example, one 2020 study of people with type 2 diabetes found that more intuitive eaters had better control of their blood sugar levels.

The bottom line

So – if you don’t have a medical condition that prevents it – go ahead and have some of that birthday cake. And then listen to your body when it tells you you’ve had enough.

If you feel that you have an unhealthy relationship with food that is interfering with your life, please contact your GP to discuss your options. You may also want to contact the Butterfly Foundation for support.

Nina Van Dyke, Associate Professor and Associate Director, Mitchell Institute, Victoria University and Rosemary V. Calder, Professor, Health Policy, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social media and lifestyle magazines have turned gluten – a protein in wheat, rye and barley – into a dietary villain.

Athletes and celebrities have promoted gluten-free eating as the secret to better health and performance.

But our review in The Lancet published today challenges that idea.

By examining decades of research, we found that for most people who think they react to gluten, gluten itself is rarely the cause.

Symptoms but not coeliac

Coeliac disease is when the body’s immune system attacks itself when someone eats gluten, leading to inflammation and damage to the gut.

But people with gut or other symptoms after eating foods containing gluten can test negative for coeliac disease or wheat allergy. They are said to have non-coeliac gluten sensitivity.

We wanted to understand whether gluten itself, or other factors, truly cause their symptoms.

What we did and what we found

Our study combined more than 58 studies covering symptom changes and possible ways they could arise. These included studying the immune system, gut barrier, microbes in the gut, and psychological explanations.

Across studies, gluten-specific reactions were uncommon and, when they occurred, changes in symptoms were usually small. Many participants who believed they were “gluten sensitive” reacted equally – or more strongly – to a placebo.

One landmark trial looked at the role of fermentable carbohydrates (known as FODMAPs) in people who said they were sensitive to gluten (but didn’t have coeliac disease). When people ate a low-FODMAP diet – avoiding foods such as certain fruits, vegetables, legumes and cereals – their symptoms improved, even when gluten was reintroduced.

Another showed fructans – a type of FODMAP in wheat, onion, garlic and other foods – caused more bloating and discomfort than gluten itself.

This suggests most people who feel unwell after eating gluten are sensitive to something else. This could be FODMAPs such as fructans, or other wheat proteins. Another explanation could be that symptoms reflect a disorder in how the gut interacts with the brain, similar to irritable bowel syndrome.

Some people may be truly sensitive to gluten. However, current evidence suggests this is uncommon.

People expected symptoms

A consistent finding is how expecting to have symptoms profoundly shapes people’s symptoms.

In blinded trials, when people unknowingly ate gluten or placebo, symptom differences almost vanished.

Some who expected gluten to make them unwell developed identical discomfort when exposed to a placebo.

This nocebo effect – the negative counterpart of placebo – shows that belief and prior experience influence how the brain processes signals from the gut.

Brain-imaging research supports this, showing that expectation and emotion activate brain regions involved in pain and how we perceive threats. This can heighten sensitivity to normal gut sensations.

These are real physiological responses. What the evidence is telling us is that focusing attention on the gut, coupled with anxiety about symptoms or repeated negative experiences with food, has real effects. This can sensitise how the gut interacts with the brain (known as the gut–brain axis) so normal digestive sensations are felt as pain or urgency.

Recognising this psychological contribution doesn’t mean symptoms are imagined. When the brain predicts a meal may cause harm, gut sensory pathways amplify every cramp or sensation of discomfort, creating genuine distress.

This helps explain why people remain convinced gluten is to blame even when blinded studies show otherwise. Symptoms are real, but the mechanism is often driven by expectation rather than gluten.

So what else could explain why some people feel better after going gluten-free? Such a change in the diet also reduces high-FODMAP foods and ultra-processed products, encourages mindful eating and offers a sense of control. All these can improve our wellbeing.

People also tend to eat more naturally gluten-free, nutrient-dense foods such as fruits, vegetables, legumes and nuts, which may further support gut health.

The cost of going gluten-free

For the approximately 1% of the population with coeliac disease, avoiding gluten for life is essential.

But for most who feel better gluten-free, gluten is unlikely to be the true problem.

There’s also a cost to going gluten-free unnecessarily. Gluten-free foods are, on average, 139% more expensive than standard ones. They are also often lower in fibre and key nutrients.

Avoiding gluten long term can also reduce diversity in your diet, alter your gut microbes and reinforce anxiety about eating.

Is it worth getting tested?

Unlike coeliac disease or a wheat allergy, non-coeliac gluten sensitivity has no biomarker – there’s no blood test or tissue marker that can confirm it.

Diagnosis instead relies on excluding other conditions and structured dietary testing.

Based on our review, we recommend clinicians:

• rule out coeliac disease and wheat allergy first
• optimise the quality of someone’s overall diet
• trial a low-FODMAP diet if symptoms persist
• only then, consider a four to six-week dietitian-supervised gluten-free trial, followed by a structured re-introduction of gluten-containing foods to see whether gluten truly causes symptoms.

This approach keeps restriction targeted and temporary, avoiding unnecessary long-term exclusion of gluten.

If gluten doesn’t explain someone’s symptoms, combining dietary guidance with psychological support often works best. That’s because expectation, stress and emotion influence our symptoms. Cognitive-behavioural or exposure-based therapies can reduce food-related fear and help people safely reintroduce foods they once avoided.

This integrated model moves beyond the simplistic “gluten is bad” narrative toward personalised, evidence-based gut–brain care.

Jessica Biesiekierski, Associate Professor of Human Nutrition, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.