Intuitive eating and its psychological correlates: A meta-analysis

Broaching body size and sizeism: Input from specialized clinicians

Broaching issues of identity and power with clients in the context of their mental health care is affirmed as an effective multicultural and social justice counseling skill by a growing evidence base. Considerations for broaching body size, including size difference and sizeism, with clients has not yet been studied, thus clinicians lack guidelines for facilitating these conversations. In this consensual qualitative research study, we present themes involved in broaching body topics based on our interviews with nine clinicians specialized in treating clients with eating disorders and body-related counseling concerns. Themes addressed counselor development, conceptualization of broaching, clinical-decision-making, practice, and impact of broaching body topics in session. Clinicians identified professional and personal developments they pursued and would advocate for training future clinicians to better serve clients. Descriptions of unique and shared aspects of broaching clients' intersectionality and body-size specifically depict avenues for tailoring broaching conversations. Specific examples of effective and ineffective broaching conversations, including language used and psychoeducational components, provide recommendations for practice and connect to observed impacts on the client, counselor, and counseling process.

A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.

The Intuitive Eating Scale-3: Development and psychometric evaluation

Intuitive eating has been found to protect against disordered eating and preserve well-being. Yet, there are methodological (length), conceptual (inconsideration of medical, value-based, and access-related reasons for food consumption), and psychometric (item wording) concerns with its most common measure, the Intuitive Eating Scale-2 (IES-2). To address these concerns, we developed the IES-3 and investigated its psychometric properties with U.S. community adults. Across three online studies, we evaluated the IES-3's factorial validity using exploratory factor analysis (EFA; Study 1; N = 957; Mage = 36.30), as well as confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), bifactor-CFA, and bifactor-ESEM (Study 2; N = 1152; Mage = 40.95), and cross-validated the optimal model (Study 3; N = 884; Mage = 38.54). We examined measurement invariance across samples and time, differential item functioning (age, body mass index [BMI], gender), composite reliability, and validity. Study 1 revealed a 12-item, 4-factor structure (unconditional permission to eat, eating for physical reasons, reliance on hunger and satiety cues, body-food choice congruence). In Study 2, a bifactor-ESEM model with a global intuitive eating factor and four specific factors best fit the data, which was temporally stable across three weeks. This model also had good fit in Study 3 and, across Studies 2 and 3, and was fully invariant and lacked measurement bias in terms of age, gender, and BMI. Associations between latent IES-3 factors and age, gender, and BMI were invariant across Studies 2 and 3. Composite reliability and validity (relationships with disordered eating, embodiment, body image, well-being, and distress; negligible relationship with impression management) of the retained model were also supported. The 12-item IES-3 demonstrates strong psychometric properties in U.S. community adults. Research is now needed using the IES-3 in other cultural contexts and social identity groups.

Intuitive eating was associated with anxiety, depression, pregnancy weight and blood glucose in women with gestational diabetes mellitus: a prospective longitudinal study

Background

Outside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit.

Methods

Data from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight.

Results

The cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p < 0.05). In longitudinal analyses, the EPR eating behavior in the first visit for GDM predicted lower levels of anxiety and depression in the second GDM visit, whereas the RHSC eating behavior in the first visit for GDM was associated with lower FPG in the second GDM visit (all p < 0.01).

Conclusion

These results suggest that practicing intuitive eating may be beneficial and that higher intuitive eating adherence can lead to lower levels of anxiety and depression and more ideal gestational weight and blood glucose values.

Intuitive eating in the COVID-19 era: a study with university students in Brazil

BACKGROUND

The recurrence of weight gain is attributed to the homeostatic regulation of hunger and satiety signals, influenced by metabolic state, nutrient availability, and non-homeostatic mechanisms shaped by reinforced consequences from experiences. In response, Evelyn Tribole and Elyse Resch proposed Intuitive Eating (IE) in 1980, countering restrictive diets. IE, inversely correlated with Body Mass Index (BMI), binge eating, and anxiety/depression symptoms, fosters mind-body-food harmony by recognizing hunger and satiety cues. IE encourages meeting physiological, not emotional, needs, permitting unconditional eating, and relying on internal signals for food decisions. Amidst university students' stress, exacerbated during the COVID-19 pandemic, understanding their eating behavior, particularly intuitive eating levels, becomes crucial.

OBJECTIVE

This study aimed to assess the IE level of Brazilian students during the COVID-19 pandemic.

METHODS

This cross-sectional study, the first to analyze the Intuitive Eating of students in Brazil during the pandemic, was conducted using an online questionnaire.

RESULTS

The sample comprised 1335 students, most of whom were women (82.17%), with a mean age of 26.12 ± 7.9 years, and a healthy nutritional status (57.58%). The mean IE score was 3.2 ± 0.6. A significant association was found between the confinement situation, the type of housing unit, and the IE subscale-Unconditional Permission to Eat (p = 0.043). However, there was no association between the other subscales and the total IE scale. Regarding self-reported mental and eating disorders, the most frequent were anxiety (21.2%), depression (6.5%), and binge eating disorder (BED) (4.7%). IE was negatively associated with BED (B =  - 0.66; p < .001), bulimia nervosa (B =  - 0.58; p < .001), body mass index (BMI) (p < .001) and self-reported anxiety (B =  - .102; p = 0.16). The male sex showed a higher IE score compared with the female sex (p < .001).

CONCLUSION

While no significant association was found between IE and the confinement situation, a significant association was found between housing type and the Unconditional Permission to Eat subscale.

Motivational profiles for eating behavior and their associations with intuitive eating

Intuitive eating is an adaptive eating approach shown to have positive psychological and physical health outcomes. Understanding the motivation behind eating behavior can provide valuable information for why some women eat intuitively and others do not. Using self-determination theory (SDT), this study aimed to identify motivational profiles for eating behavior and examine differences in intuitive eating across these motivational profiles. A nationally representative sample of New Zealand women (n = 1447) aged 40-50 years (M = 45.4; SD = 3.2) completed questionnaires assessing motivation and intuitive eating. Latent profile analysis identified five profiles characterized by varying levels of the global and specific forms of behavioral regulation described by SDT. The self-determined profile, characterized by high levels of global self-determination, had higher intuitive eating scores. The internalized profile, characterized by high levels of identified and integrated regulation, had average intuitive eating scores. The conflicted profile, characterized by high levels on most forms of behavioral regulation, and the unmotivated profile, characterized low levels on all forms of behavioral regulation, had a mix of high and low intuitive eating subscale scores. The amotivated profile, characterized by very high levels of amotivation, had lower intuitive eating scores. A motivational profile characterized by higher levels of self-determination and lower levels of the extrinsic forms of behavioral regulation appears to be beneficial for intuitive eating. Therefore, SDT-informed eating behavior interventions that enhance women's self-determined motivation should be created to facilitate intuitive eating in midlife women.

Practicing Interoceptive Sensitivity as a Couple: A Mixed-Methods Acceptance Analysis of a Dyadic vs. Single Pilot Randomized Controlled Trial

Training interoceptive sensitivity (IS) might be a first step in effectively promoting intuitive eating (IE). A dyadic interoception-based pilot randomized controlled trial was conducted to increase IE among couples aged 50+. The training consisted of three exercises, a Body Scan (BS), a hunger exercise (HU), and a satiety (SA) exercise. This study explored how spouses accepted the (dyadic vs. single) training. In a mixed-methods convergence design, the findings of a survey (n = 68 couples) and focus groups (n = 4) were synthesized. Moderate general acceptance (e.g., regarding feasibility and low burden) and a hierarchical gradient in favor of the BS (e.g., pleasantness and improved sleep quality) emerged. Barriers concerned a perceived lack of the exercises' usefulness and a limited understanding of the training purpose. A wish for regular feedback and exchange with the study stuff and other participants was expressed. Spousal training involvement was experienced as being rather beneficial. Previously harmonized dietary practices and daily routines appeared as constructive pre-conditions for the joint training. This study highlights the potential and implications of training couples in IS. Future interventions should involve a regular exchange and closer guidance by study staff to promote a better understanding of the processes and goals of IS and IE.

Pride and body image among transgender and nonbinary adults: the mediating role of body appreciation between gender identity pride and intuitive eating

Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (Mage = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.

Explaining the prospective paths from body appreciation to intuitive eating facets: Does body image flexibility serve as a mediator?

Initial evidence suggests that body appreciation prospectively predicts intuitive eating. However, the limited number of longitudinal studies focused solely on girls and women, with a lack of evaluation among men. Furthermore, the underlying mechanisms explaining this relationship remain poorly understood. The present study examined whether body appreciation prospectively predicted intuitive eating facets among women and men in Germany. We also tested whether adaptive affect regulation skills (i.e., body image flexibility) mediated these relationships. We analyzed data from 1436 women and 704 men across three time points: Baseline (T1), 6-month (T2), and 12-month (T3) follow-up, using latent variable path models to assess direct and indirect effects. Among women, T1 body appreciation directly predicted T3 body-food choice congruence. Additionally, body appreciation indirectly predicted unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety cues at T3 via its effect on T2 body image flexibility. Among men, T1 body appreciation indirectly predicted T3 eating for physical rather than emotional reasons via T2 body image flexibility. Our findings suggest that body image flexibility plays a pivotal role in explaining why individuals who appreciate their bodies are more likely to eat intuitively.

Hormonal contraceptive use and women's well-being: links with body image, eating behavior, and sleep

The goal of the current study was to examine associations between hormonal contraceptive use and indicators of well-being including body image, eating behavior, sleep and energy level. Drawing on a health protection framework, we expected that individuals who use hormonal contraceptives would be more attuned to health and report more positive health attitudes and behaviors on these dimensions. Undergraduate college women (N = 270; M = 19.39 years, SD = 2.43, range 18-39 years) from diverse racial/ethnic and sexual orientation groups completed a survey online. Measures included hormonal contraception use, body image, weight control behavior, breakfast consumption, sleep behavior, and daytime energy level. Nearly 1/3 (30.9%) of the sample reported current hormonal contraceptive use, with most users reporting use of birth control pills (74.7%). Women who used hormonal contraceptives reported significantly higher appearance orientation and body surveillance, lower average energy, more frequent night awakenings, and more naps. Longer duration of hormonal contraceptive use was significantly related to higher body surveillance, and engaging in more unhealthy weight control behavior. Hormonal contraceptive use is not related to indicators of greater well-being. Rather, hormonal contraceptive use is related to greater attention to appearance, lower daytime energy, and some indicators of poorer sleep quality. Clinicians who prescribe hormonal contraceptives should attend to body image, sleep and energy concerns among users.

Associations between screen use while eating and eating disorder symptomatology: Exploring the roles of mindfulness and intuitive eating

Screen use while eating has been recently identified as a highly common and potentially important specific setting of screen use in relation to eating disorder symptomatology. However, given this area of research is still in its infancy, how screen use while eating may be related to eating disorder symptomatology remains largely unexplored. To fill this gap, the present study probed the potential roles of mindfulness and intuitive eating in the association between screen use while eating and eating disorder symptomatology. A large sample of Chinese adults (N = 800, aged 18-67 years old) recruited through a Chinese survey platform, Credamo, completed questionnaires assessing screen use while eating, eating disorder symptomatology, mindfulness, and intuitive eating. Structural equation modeling was used to test the proposed model. Results confirmed our hypotheses that the association between screen use while eating and eating disorder symptomatology was partially explained by mindfulness and intuitive eating, after adjusting for covariates (e.g., gender, age, body mass index, total screen time, and social media use). That said, higher screen use while eating was associated first with lower mindfulness and then with lower intuitive eating, which in turn were related to higher eating disorder symptomatology. The findings underline the importance of including eating-specific screen use for future research on eating disorder symptomatology and also have implications for an integrative intervention of mindfulness-based approaches and intuitive eating for mitigating the adverse effects of excessive screen use on eating behaviors.

Eating disorder symptom dimensions and protective factors: A structural network analysis study

Eating Disorders (EDs) and related symptoms pose a substantial public health concern due to their widespread prevalence among both genders and associated negative outcomes, underscoring the need for effective preventive interventions. In this context, deepening our understanding of the interplay between ED symptoms and related protective factors appears crucial. Therefore, this study employed a structural network analysis approach considering both ED symptom dimensions (i.e., drive for thinness, bulimic symptoms, and body dissatisfaction) and related protective factors (i.e., body and functionality appreciation, intuitive eating, and self-esteem) to shed light on how these factors are interrelated. A community sample of 1391 individuals (34.4% men; Mage = 26.4 years) completed a socio-demographic schedule and self-report questionnaires. The network showed that the nodes with the highest positive expected influence were body and functionality appreciation, while those with the highest negative expected influence were eating for physical rather than emotional reasons and unconditional permission to eat (i.e., two components of intuitive eating). Crucially, the most relevant bridges between the conceptual communities "ED symptom dimensions" and "Protective factors" were the negative relations between (a) eating for physical rather than emotional reasons and bulimic symptoms, (b) unconditional permission to eat and drive for thinness, and (c) body appreciation and body dissatisfaction. Finally, age, gender, and body mass index did not moderate any edge in the network. The practical implications of these findings are discussed, especially in terms of preventive interventions for ED symptoms.

The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV)

OBJECTIVE

Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating.

METHODS

Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors.

RESULTS

Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors.

DISCUSSION

Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

Psychometric network analysis of the Intuitive Eating Scale-2 in Chinese general adults

The Intuitive Eating Scale-2 (IES-2) is a measure of intuitive eating behaviors that has been extensively validated, with traditional latent variable modeling approaches, in youth and adults from many different populations, including college students in China. However, there is still a lack of research on the psychometric properties of the IES-2 in adults from the Chinese general population. Moreover, psychometric network analysis, as a complement to traditional latent variable modeling approaches, has not been used for examining the psychometric properties of the IES-2. Thus, the present study used a psychometric network approach to evaluate the psychometric properties of the IES-2 in Chinese adults from the general population. A sample of 700 Chinese general adults (50% women; Mage = 31.13 years, SD = 9.19) recruited online were included in the present study. Psychometric network analysis was performed. Exploratory graph analysis (EGA) identified four dimensions, which were well separated in the estimated network. The network structure showed excellent stability and metric measurement invariance (i.e., network loadings) across men and women. Furthermore, several items on the IES-2 were identified as key nodes in the network of the IES-2 that may be important for the development and maintenance of intuitive eating. For example, two items (i.e., "I trust my body to tell me when to eat," and "I trust my body to tell me when to stop eating") related to reliance on body cues were the most impactful nodes in the complete network. The findings of our study provide a greater understanding of the IES-2 from the perspective of network analysis and have implications for applications of intuitive eating interventions for general populations.

From Restriction to Intuition: Evaluating Intuitive Eating in a Sample of the General Population

Intuitive eating (IE) is a non-dieting approach that promotes listening to internal cues of hunger and satiety, rather than adhering to external dietary restrictions aimed at weight loss. However, the role of IE in dieting behaviors related to weight-loss approaches is still unclear. To address this issue, the aim of this study was to compare IE levels between dieting and non-dieting individuals, exploring the relationship between IE and dieting-related psychological and physical factors. A sample of 2059 females was recruited via social media and self-reported questionnaires were administered to measure IE, eating psychopathology, self-efficacy, and quality of life. Individuals with a history of dieting exhibited lower IE levels, a higher BMI, and a greater eating psychopathology, as well as a reduced self-efficacy and quality of life, compared to non-dieters. IE showed a protective effect against dieting behaviors, with higher IE levels being associated with a lower likelihood of dieting. Additionally, higher BMI and eating psychopathology were predictors of dieting. Promoting IE could represent a relevant clinical target strategy to address disordered eating and enhance overall well-being, underscoring the need for interventions that foster a healthier relationship with food and bodily internal sensations.

Testing general sociocultural and coach-related appearance pressures as the factors associated with disordered eating in competitive female athletes participating in various sports

The aim of the present study was to test the sociocultural Petrie and Greenleaf's (2007) model of disordered eating (DE) in competitive female athletes. Specifically, we tested a model of general sociocultural and coach-related pressures towards body weight and appearance of female athletes as the factors associated with athletes' DE through the mediators such as internalization of appearance ideals and overweight preoccupation. 515 athletes participated in this study. The mean age of the sample was 19.0 ± 5.9 years. Athletes were provided with study measures on general sociocultural and coach-related appearance and body weight pressures, internalization of appearance ideals, overweight preoccupation and DE. Path analyses showed that general sociocultural pressures were associated with DE directly and through internalization of appearance ideals and overweight preoccupation. Pressures from coaches were associated with DE through overweight preoccupation and through the internalization of appearance ideals and overweight preoccupation. The models were invariant across body weight sensitivity in sports and age groups. These results inform DE prevention for female athletes. It is important to increase resistance to sociocultural pressures and pressures from coaches in DE prevention programmes for female competitive athletes of all ages and participating in sports irrespective of sports group (weight-sensitive or less weight-sensitive).

Mitigating Weight Bias in the Clinical Setting: A New Approach to Care

Weight bias toward patients in larger bodies is pervasive among health care providers and can negatively influence provider-patient communication, as well as patients' behavior and health outcomes. Weight bias has historical roots that perpetuate thinness and Whiteness as the cultural norm. Although weight bias remains socially acceptable in US culture, contributing factors to an individual's body size are complex and multifactorial. Providers and health care systems also consistently use body mass index (BMI) as an indicator of health status, despite its limitations and harmful effects in the clinical setting. This state of the science review presents 8 evidence-based strategies that demonstrate how to mitigate harm from weight bias and improve quality of care and health outcomes for patients living in larger bodies. Person-centered approaches to care include (1) eliminating clinical recommendations to lose weight; (2) shifting from a focus on weight to health; (3) implementing a size and weight-inclusive approach; (4) engaging in weight bias self-evaluation; (5) creating a welcoming environment for patients of all sizes; (6) seeking permission and learning the patient's story; (7) using weight-inclusive language; and (8) re-evaluating clinical guidelines and policies based on BMI. Midwives and other health care providers may benefit from training that re-imagines the delivery of health care to patients in larger bodies.

Positive self-beliefs mediate the association between body appreciation and positive mental health

Previous work has supported direct, positive associations between body appreciation and positive mental health, but has largely neglected to examine possible indirect mechanistic pathways. Here, we propose one relevant mediational pathway, wherein body appreciation is associated with positive mental health via positive self-beliefs (i.e., cognitions that lead individuals to view themselves, their lives, and/or their futures under a positive outlook). To test this hypothesis, we asked an online sample of 496 adults (249 women, 247 men) from the United Kingdom to complete measures of body appreciation, positive self-beliefs, and positive mental health. Participants also completed measures of self-efficacy and resilience, and provided their demographic information. Correlational analysis revealed significant, positive, and strong associations between body appreciation and facets of positive self-beliefs and positive mental health, respectively. Structural equation modelling showed that positive self-beliefs mediated the association between body appreciation and positive mental health after controlling for self-efficacy and resilience. This model was robust across women and men separately, and the mediational effects remained intact in sensitivity and robustness analyses. We discuss ways in which greater body appreciation may help individuals develop and maintain positive self-beliefs, which in turn shape mental health outcomes.

Reversibility of disturbed pituitary function in pediatric conditions with psychological stressors: implications for clinical practice

The complex communication network between the central nervous system and the hypothalamic-pituitary axis forms the basis of endocrine functional plasticity, which facilitates adaptation to changing internal and external conditions, but also makes it vulnerable to the negative effects of stressful psychological factors. Herein, clinical conditions such as functional hypothalamic amenorrhea, eating disorders, growth faltering, post-traumatic stress disorder, and pubertal disorders that may emerge during childhood or adolescence, their origin possibly including psychological stressors, are analyzed regarding their genetic susceptibility and reversibility of endocrine function. A discussion on the optimization of therapeutic management defined by managing stress and maximizing the degree and rate of reversibility follows.

Assessment of Intuitive Eating and Mindful Eating among Higher Education Students: A Systematic Review

BACKGROUND

The role of mindful eating (ME) and intuitive eating (IE) in improving eating behavior, diet quality, and health is an area of increasing interest.

OBJECTIVE

The objective of this review was to identify the instruments used to assess ME and IE among higher education students and outcomes related to these dimensions.

METHODS

This review was carried out according to the PRISMA statement, through systematic searches in PubMed, Web of Science, PsycInfo, and Scopus. The inclusion criteria selected for higher education students, levels of ME and/or IE reported, and observational and clinical studies. The exclusion criteria selected against reviews, qualitative studies, and case studies. Quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

A total of 516 initial records were identified, from which 75 were included. Cross-sectional studies were the most common research design (86.7%). Most studies were conducted with samples that were predominantly female (90.7%), White (76.0%), aged 18 to 22 years (88.4%), with BMI < 25 kg/m2 (83.0%), and in the United States (61.3%). The Intuitive Eating Scale (IES), the Mindful Eating Questionnaire (MEQ), and their different versions were the most used instruments. The outcomes most studies included were eating behavior and disorders (77.3%), anthropometric assessments (47.8%), mental health (42.0%), and body image (40.6%). Regarding the quality of studies, 34.7% of studies were assigned a positive, 1.3% a negative, and 64.0% a neutral rate.

CONCLUSIONS

IES and MEQ were the most used instruments. RCT and cohort studies are scarce, and future research with a higher level of quality is needed, especially on the topics of food consumption, diet quality, and biochemical markers.

Intuitive eating has reduced the chances of being overweight in university students during the COVID-19 pandemic

Introduction

University students have been particularly affected during the COVID-19 pandemic, and several sociodemographic and behavioral factors may be associated with the risk of overweight in this population. The aim of this study was to assess the impact of the pandemic on the eating behavior and nutritional status of university students, and the factors associated with these changes, especially the role of intuitive eating in this process.

Methods

This is a repeated measures observational study with data collected in the first and third year of the COVID-19 pandemic in Brazil, from students over the age of 18 in the undergraduate programs of a federal university in southeastern Brazil. The survey was conducted using an online form. Eating behavior was assessed using the "Intuitive Eating Scale-2".

Results

251 university students took part, most of them female with a median age of 22. There was an increase in body mass index (BMI) and intuitive eating score between the two periods. In the first year of the pandemic, being female and using tobacco reduced the chances of students being overweight. Living in a marital relationship, worrying about weight gain and body dissatisfaction increased the chances of this outcome. In the third year of the pandemic, it was observed that practicing restrictive diets, having inadequate body perception, worrying about weight gain and living in a marital relationship increased the chances of students being overweight. Being female and eating more intuitively, in line with bodily needs, reduced these odds, demonstrating a protective role in this scenario.

Conclusion

There was an increase in BMI and intuitive eating score during the pandemic. Sociodemographic, lifestyle and behavioral variables had both a positive and negative influence on nutritional status. Intuitive eating was shown to be a protective factor during this period, reducing the chances of being overweight in this population. Thus, more intuitive eating may favor greater weight stability, and may, therefore, have helped to reduce the impact of the pandemic on weight gain. In this way, people who ate more intuitively partially resisted the context that favored weight gain (stress, changes in diet and physical inactivity).

Eating behavior during pregnancy mediates the association between depression and diet quality--a new strategy for intervention in pregnancy

Background

Depression can result in changes in eating behavior and decrease the quality of eating. It has been shown that maternal depression during pregnancy can result in malnutrition, which can have adverse effects on the pregnancy and the offspring. There is currently no clear association between depression and diet.

Methods

Five hundred and forty-nine pregnant women recruited from Danyang Maternal and Child Health Hospital in Jiangsu Province participated in this study and were administered the Intuitive Eating Scale-2 (IES-2), Edinburgh Post-natal Depression Scale (EPDS), Pregnancy Stress Scale (PPS), Self-rating Anxiety Scale (SAS), and Dietary Guidelines Adherence Index for Pregnant Women during Pregnancy (CDGCI-PW). The nutritional software collected dietary records for three consecutive days in mid-pregnancy to calculate dietary intake and nutrients that support energy production. The mediation analyses were conducted using SPSS 24.0 macro PROCESS.

Results

The relationship between depressive symptoms during pregnancy and diet quality was moderated primarily by two aspects of eating behavior, "Reliance on Hunger and Satiety Cues" (RHS) and "Body-Food Choice Congruence" (BFC). Depressive symptoms (EPDS scores) showed a negative correlation with RHS, BFC, and RHS, and BFC showed a positive correlation with diet quality, yielding a significant specific indirect effect. The multiple mediation model explained 14.7% of the variance in the diet quality.

Conclusion

This study highlights the important role of eating behaviors during pregnancy in the relationship between depressive symptoms (EPDS scores) and diet quality, and provides preliminary evidence for feasible ways pregnant women with depressive symptoms can improve diet quality, promote maternal and child health, and reduce depression.

Linking biomarkers with healthy lifestyle outcomes after stroke: Supplementary results of a 12-month randomized controlled trial

BACKGROUND AND AIMS

Participation in a healthy lifestyle intervention such as the Diabetes Prevention Program Group Lifestyle Balance-adapted for stroke (GLB-CVA) may reduce stroke burden. Identifying biomarkers associated with lifestyle changes may enhance an individualized approach to stroke recovery. We investigated metabolic biomarkers related to cardiovascular and neurological function in individuals with stroke in the GLB-CVA study and healthy (non-stroke) individuals.

METHODS AND RESULTS

Participants with chronic (>12 months) stroke were recruited to this wait-list randomized controlled trial if they were overweight (BMI ≥25 kg/m2). Participants were randomized to (1) the GLB-CVA program to complete 22 educational sessions addressing behavioral principals of dietary and physical activity or (2) a 6 month wait-list control (WLC). Biomarkers [Plasma irisin, vascular endothelial growth factor, lipoprotein-associated phospholipase A2 (Lp-PLA2), insulin-like growth factor 1 and brain-derived neurotrophic factor (BDNF)] were collected at baseline, 3, and 6 months. Age-matched healthy individuals were recruited for biomarker assessment. Compared to healthy adults (n = 19), participants with stroke (GLB-CVA = 24; WLC = 24) at baseline had higher tHcy levels (p < 0.001) and lower PLA2 levels (p = 0.016). No statistically significant interactions were observed for any biomarkers between the GLB-CVA and WLC or between people who achieved 5% weight loss and those who did not.

CONCLUSION

Participation in a 6-month healthy lifestyle program did not result in statistically significant changes to select metabolic biomarker levels for our participants with chronic stroke. However, participants with stroke demonstrated a unique biomarker profile compared to age-matched healthy individuals.

Association between body weight perception and intuitive eating among undergraduate students in China: the mediating role of body image

Background

The association between body weight perception and intuitive eating among undergraduate students in China remains insufficiently understood. In the present study, we were aimed to examine the correlation between body weight perception, body image, and intuitive eating and determine whether the link between body weight perception and intuitive eating was influenced by body image.

Methods

A total of 1,050 undergraduate students completed the survey. Participants provided self-reported demographic details and completed two structured scales. The Body Esteem Scale for Adolescents and Adults (BESAA) and the Intuitive Eating Scale-2 (IES-2) were employed to assess body image and intuitive eating. Analysis of the mediation model was conducted using version 4.1 of the PROCESS Macro. Results with a value of p less than 0.05 were deemed statistically significant.

Results

The average age of the participants was 20.08 years (SD = 1.64). Among the students, 837 (79.7%) were female, and 212 (20.3%) were male. Body image (r = -0.429, p < 0.001) and intuitive eating (r = -0.313, p < 0.001) exhibited significant negative associations with body weight perception. Furthermore, body image showed a significant positive correlation with intuitive eating (r = 0.318, p < 0.001). Significant mediating effects of body image were identified concerning intuitive eating and body weight perception in the right weight (95% bootstrap CI = 0.007, 0.040) and overweight groups (95% bootstrap CI = -0.048, -0.009). The indirect effects of body image constituted 12.19% and 15.33% of the total effects of intuitive eating in these two groups.

Conclusion

Although the indirect effects were not substantial, these outcomes shed light on the partial understanding of how body weight perception impacted intuitive eating via body image. Importantly, our findings emphasized the significance of body image and body weight perception, offering a novel insight for prospective interventions targeting undergraduate students.

Intuitive eating and its influence on self-reported weight and eating behaviors

Intuitive eating (IE) is an adaptive eating behavior that involves paying attention to the body's physiological signals, including eating when hungry and stopping when feeling full. A growing body of literature has examined the effect of IE on the development of maladaptive eating behaviors and body weight, even though IE is not centered around the latter. However, longitudinal observation studies among the general population are still rare. Therefore, this study aimed to longitudinally examine the links between IE and changes in body weight, maladaptive eating behaviors (reward, external, restrained eating), and overeating frequency over time. For this purpose, we used data from the first (2017) and the fourth waves (2020) of the Swiss Food Panel 2.0 survey, which included 1821 randomly selected Swiss participants. The same participants completed a self-administered questionnaire annually, measuring their self-reported eating behaviors and weight status. IE was measured with the Intuitive Eating Scale-2. Results showed that women with high IE scores were more likely to maintain their body weights (within ±2 kg) and less likely to gain weight (>2 kg) than women with low IE scores. No such effects were found for men. Furthermore, IE was linked to a reduction in maladaptive eating behaviors and overeating frequency over time in both genders. Results suggest that IE may counteract maladaptive eating behaviors, which can promote weight stability over time. Therefore, the encouragement of IE patterns seems to be a promising strategy to address problematic eating behaviors and the challenges associated with controlling food intake and prevention of overeating.

Weight-inclusive, intuitive eating-based workplace wellness program associated with improvements in intuitive eating, eating disorder symptoms, internalized weight stigma, and diet quality

INTRODUCTION

The use of weight-inclusive programming within a workplace wellness context remains understudied.

METHODS

The present study is a pilot/feasibility study of a 3-month, virtual, weight-inclusive, intuitive eating-based workplace wellness program. Program participants (n = 114), who were all employees at a large public university in the Midwest, received weekly emails with a link to an instructional video related to intuitive eating and were encouraged to meet virtually with their health coach. Participants provided self-report data on behavioral and psychological outcomes including intuitive eating, internalized weight stigma, eating disorder symptoms, and diet quality at baseline, post-intervention (3 months from baseline), and follow-up (6 months from baseline). Changes in behavioral and psychological outcomes from baseline to post-intervention and follow-up were examined using paired t-tests, with Cohen's d effect sizes reported. Generalized linear models were used to examine whether participant characteristics and program engagement were associated with program outcomes.

RESULTS

Increases in intuitive eating and decreases in internalized weight stigma and eating disorder symptoms were seen from baseline to post-intervention (Cohen's d = 1.02, -0.47, and -0.63, respectively) and follow-up (Cohen's d = 0.86, -0.31, and -0.60). No changes in dietary quality were seen at post-intervention, but a significant reduction in intake of added sugars, fast food, and sugar sweetened beverages were observed at follow-up (Cohen's d = -0.35, -0.23, -0.25).

CONCLUSIONS

This study provide preliminary support for the acceptability and potential impact of a weight-inclusive workplace wellness program that should be tested in a rigorous randomized trial.

Challenges and opportunities for conceptualizing intuitive eating in autistic people

Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE's prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach. Public Significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.

Intuitive Eating Scale-2-EA: Psychometric properties and factor structure of the adapted IES-2 for early adolescents

PURPOSE

Intuitive Eating (IE) is an approach to eating characterised by attunement to intrinsic cues, and using those cues to guide behaviours related to food and eating. Tylka and Kroon Van Diest's (2008) Intuitive Eating Scale (IES-2) is well-validated in adults, but not yet among early adolescents. The current study was designed to adapt and validate a version suited for use in early adolescence (IES-2-EA).

METHODS

Data collected from two independent samples of adolescents aged 11 to 13 (N = 471) were structurally examined using exploratory factor analysis (EFA), with a subsequent confirmatory factor analysis (CFA) to confirm hypothesised model fit. Relationships between scores on the IES-2-EA and validated measures of actual-ideal body size discrepancy, body appreciation, interoceptive awareness, and psychological distress were also examined.

RESULTS

The adapted 17-item IES-2-EA had a three-factor structure with several key differences from the original version developed for adults. Moderate-to-strong correlations were found between scores on the IES-2-EA, body appreciation, interoceptive awareness, actual-ideal body size discrepancy, and psychological distress in the first sample of adolescents (n = 245). Secondary CFA showed good model fit in the second sample of adolescents (n = 226).

CONCLUSION

The IES-2-EA is well-suited to measure intuitive eating behaviour among early adolescents. The 17 items reflect a three-component structure similar to that seen in adults completing the IES-2. These early data suggest the adapted IES-2-EA has evidence of reliability and validity; it may be an effective measure for research and clinical use.

How Parental Feeding Practices Relate to Young People's Intuitive Eating: Cross-Sectional and Longitudinal Associations by Gender and Weight Concern

PURPOSE

To evaluate cross-sectional and longitudinal associations between controlling parental feeding practices in adolescence (i.e., restrictive feeding and pressure-to-eat [PE]) and intuitive eating (IE) in adolescence and emerging adulthood; and explore child gender and parental concern about child weight as moderators.

METHODS

The sample included participants (N = 1,383) from the population-based EAT 2010-2018 study who provided data in adolescence (14.4 ± 2.0 years) and emerging adulthood (22.0 ± 2.0 years) and had at least one caregiver complete surveys in adolescence. Generalized estimating equations evaluated cross-sectional and longitudinal associations between restrictive feeding and PE in adolescence and IE in adolescence and emerging adulthood. Interactions with gender and parental concern over child weight in adolescence were explored.

RESULTS

Restrictive feeding was cross-sectionally associated with lower IE in adolescence (b = -0.04), though evidence of moderation by parental weight concern indicated this association was only observed in the context of low parental weight concern. Greater PE was associated with lower adolescent IE among boys but higher IE among girls. Longitudinally, the association between PE in adolescence and IE in emerging adulthood differed by parental weight concern; greater PE predicted higher emerging adult IE at high parental weight concern, but lower IE at low parental weight concern.

DISCUSSION

Controlling feeding practices in adolescence displayed differential associations with child IE in adolescence and emerging adulthood based on child gender and parental concern over child weight. Notably, PE was associated with greater IE among adolescent girls but lower IE among boys. Results suggest that parental feeding is a valuable intervention target.

Eating behaviour, body image, and mental health: updated estimates of adolescent health, well-being, and positive functioning in Aotearoa New Zealand

Introduction Body image dissatisfaction and its associated challenges have been related to poorer health outcomes among adolescents worldwide, including disordered eating behaviour, depression, and anxiety. However, current prevalence estimates of these issues in Aotearoa New Zealand or, relatedly, the estimates of positive attitudes and behaviours, such as intuitive eating and body appreciation are dated. Aim The primary aim of this paper was to provide updated estimates for a variety of constructs related to eating behaviours and body image, sourced from a diverse range of early adolescent participants. Methods For this report, a brief online survey was advertised to adolescents throughout Aotearoa New Zealand (n  = 893) via school and community noticeboards. Results Approximately one-in-three male participants and one-in-two female participants reported body image dissatisfaction. One in four participants reported clinically significant symptoms of depression and anxiety. Discussion Given such issues, there is clearly still much progress to be made in advancing positive health among early adolescents. Identifying potentially protective constructs such as intuitive eating and body appreciation may offer guidance into the best targets for prevention and early intervention.

The effects of brief diet and anti-diet social media videos on body image and eating concerns among young women

The effects of photo-based platforms on body image concerns are well documented, yet it is unknown whether these effects replicate across video-based platforms such as TikTok. Thus, this experimental study aimed to examine the relationship between video-based platform use and body image. Women aged 18 to 21 (n = 421) were randomly assigned to watch two brief, consecutive TikTok videos in one of three conditions: (1) diet culture, (2) anti-diet, (3) neutral. Participants allocated to the anti-diet condition reported greater increases in weight and shape satisfaction as compared to the diet culture condition, and greater increases in state body appreciation and state intuitive eating as compared to the neutral condition. In addition, those allocated to the diet culture condition reported greater increases in restriction and urges to exercise, and smaller gains in positive mood, as compared to those in the neutral condition. Social media related rumination and thin-ideal internalization potentiated these effects.

Longitudinal association between self-compassion and intuitive eating: Testing emotion regulation and body image flexibility as mediating variables

OBJECTIVES

Growing evidence suggests that intuitive eating is associated with numerous positive mental health and well-being constructs. Understanding factors that predict intuitive eating is necessary for identifying practical targets to enhance this style of eating, yet research identifying such predictors is scarce. Self-compassion is one variable that could enhance intuitive eating because it involves the practice of healthy emotion regulation skills that may disrupt the tendency to turn to food to cope during distressing situations. The present study tested for a longitudinal association between self-compassion and intuitive eating. We also tested whether this association was mediated by indices of emotion regulation (i.e., global emotion regulation skill scores and body image flexibility).

METHOD

Adult women (n = 3039) were invited to completed study measures at baseline (T1), 4-month follow-up (T2), and 8-month follow-up (T3). Path analyses were computed to test hypothesized indirect effects.

RESULTS

A direct path from T1 self-compassion to T3 intuitive eating emerged, such that higher self-compassion levels predicted increased intuitive eating over time. However, this association was not mediated by T2 emotion regulation skills nor body image flexibility.

CONCLUSION

Findings suggest that self-compassion may facilitate an intuitive eating style, which does not appear to be explained by certain emotion regulation skills.

Screen use while eating is associated with lower intuitive eating and higher disordered eating in Chinese adult men and women

OBJECTIVE

We aimed to explore the potential associations between screen use while eating and intuitive eating and disordered (thinness-oriented and muscularity-oriented) eating behaviors.

METHODS

Analyses included 600 Chinese adults (50% women; Mage  = 30.67, SD = 8.08) recruited online. The use of four major screen devices was captured, including cell phones, tablets, computers, and TVs. Three types of eating behaviors were examined, namely intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating. Pearson correlation and hierarchical regression analyses were conducted separately for men and women to examine the sex-specific associations between screen use while eating and intuitive eating, thinness-oriented disordered eating, and muscularity-oriented disordered eating.

RESULTS

In both men and women, more screen use while eating was significantly associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating, above and beyond total screen time and social media use.

DISCUSSION

We found preliminary evidence for the significant links between screen use while eating and intuitive eating and disordered eating. Given the global increases in screen use, continued research is warranted to further explore the role of screen use while eating in the development and maintenance of intuitive eating and disordered eating.

PUBLIC SIGNIFICANCE

Much remains unknown regarding screen use while eating and eating behaviors. We found that in both Chinese men and women, more screen use while eating was significantly and uniquely associated with lower intuitive eating, higher thinness-oriented disordered eating, and higher muscularity-oriented disordered eating. Findings highlight the importance of incorporating screen use while eating in future research on intuitive eating and disordered eating.

Retrospective Reports of Parental Feeding Practices and Current Eating Styles in Polish Adults

The role of childhood food experiences (CFEs) in determining future eating behaviors remains unclear. The aim of the study was to examine the link between CFEs and selected eating styles (ESs), i.e., intuitive (IE), restrained (ResEat) and external (ExtEat) eating, among 708 Polish adults aged 18-65 (477 women and 231 men). CFEs were measured with the Adults' Memories of Feeding in Childhood questionnaire. Polish versions of the Intuitive Eating Scale-2 and Dutch Eating Behavior Questionnaire were used to assess ESs. Mann-Whitney U test was used to compare ESs scores between those with lower and higher CFEs. In the total sample, "Restrictions" and "Pressure and Food Reward" parental feeding practices favored lower IE, while "Healthy Eating Guidance" and "Monitoring" practices predisposed higher levels of IE in adulthood. "Restrictions" were found to correlate with greater chances of ResEat, whereas "Healthy Eating Guidance" was linked with lower probability of ResEat. "Pressure and Food Reward" and "Monitoring" were associated with higher score for ExtEat. "Restrictions", "Child Control", "Monitoring" and "Healthy Eating Guidance" practices were differently linked to ESs in women and men. The findings suggest that education programs for parents should focus on the long-term consequences of feeding practices.

Intuitive and mindful eating to improve physiological health parameters: a short narrative review of intervention studies

OBJECTIVES

This brief narrative review aims to give an up-to-date overview of intuitive and mindful eating (I/ME) interventions with specific focus on cardiometabolic risk factors, including glucose, lipid profile, blood pressure and inflammatory markers.

CONTENT

I/ME intervention studies in adults which measured at least one physiological parameter other than weight were identified from PubMed. The clinical trial/randomized controlled trial filters and publication dates 2001 through April 2021 with variations of the following keywords were applied: intuitive eating, mindful eating, weight neutral. Ten articles were identified.

SUMMARY AND OUTLOOK

Of the 10 studies, seven showed I/ME interventions were more effective than control in at least one cardiometabolic outcome, two showed significant I/ME within-group improvements but no between-group differences, and one showed neither within-group nor between-group differences. Specifically, I/ME improved glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with overweight or obesity, blood pressure among participants with overweight and inflammatory markers among post-menopausal women with obesity. However, the positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies: of the six studies that examined glucose regulation, two demonstrated positive outcomes for I/ME group, whereas four found no effect compared to control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements and one of two showed improvements in inflammatory markers. Given these mixed results, more research is needed to understand the possible effectiveness of I/ME to improve cardiometabolic health.

Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Stigma, Self-Care, and Intuitive Eating in Black Americans with Type 2 Diabetes

Type 2 diabetes is prevalent among Black Americans. Stigma associated with type 2 diabetes, both in general and specific to weight, is damaging to self-care, which is crucial for the effective management of diabetes. Family relationships may buffer the negative impact of stress, especially among Black Americans who have historically relied on informal support networks. Our goal was to investigate how type 2 diabetes stigma (H1) and weight stigma (H2) were related to self-care and intuitive eating - a non-restrictive approach to nutrition; H3 predicted that family relationship satisfaction would moderate the relationships predicted in H1 and H2. Black Americans diagnosed with type 2 diabetes (N = 225) were recruited via Qualtrics panels to complete an online survey of self-report measures. We used multiple linear regression to test our hypotheses. Both chronic illness and weight stigma were related as predicted to one subscale of intuitive eating (eating for physical hunger). Our moderation analyses revealed that family relationship satisfaction was protective against the harms of stigma at moderate to high levels. Intuitive eating is a promising non-restrictive treatment option for type 2 diabetes.

At the Same Table: A Delphi Consensus-Based Model of Health-Promoting Eating Behaviors

Eating behaviors and patterns are one of the key behavioral indicators of health, and as such these behaviors are a focus of interest across different areas of scholarship. Yet, to date, work in this area is impeded by the lack of a collective theoretical framework to conceptualize, assess, and intervene upon eating behaviors. The aim of this study was therefore to establish a consensus-based framework for health-promoting eating behaviors using a Delphi methodology. An initial systematic search identified constructs that yielded 150 items grouped into three topic areas: (1) the content, types of food and nutrition provided; (2) eating behaviors; and (3) thoughts and feelings related to eating and foods. Over the course of three iterative rounds of rating by a panel of n = 37 experts, a consensus was reached that included eight of the original items that represented the three topic areas. The findings from this study result in a novel consensus-based framework for health-promoting eating behaviors that can form the basis for collaborative work towards the integration of physical and mental health promotion.

What do people think of intuitive eating? A qualitative exploration with rural Australians

Evidence supports that intuitive eating is associated with many indicators of positive physical and mental health, with more recent longitudinal studies establishing causality. Most research, however, comprises either survey data or clinical trials. This study attempts to fill this evidentiary gap by using a qualitative methodology to explore people's understandings and reactions to intuitive eating, including perceived barriers and enablers to implementation. Three focus group discussions were conducted in a non-metropolitan region of Victoria, Australia, with a total of 23 participants. Focus group transcripts were thematically analysed using an inductive descriptive approach within a constructionist perspective. Findings indicate that the concept of intuitive eating was either unknown or misunderstood. Once intuitive eating was explained, most responses to implementing intuitive eating were negative. Participants felt that having complete choice around what they ate was unlikely to equate to a healthy or balanced diet, at least in the short term. They also argued that because everyday life was not intuitive in its structures, it would be difficult to eat intuitively. Despite these difficulties, participants appreciated that if they were able to overcome the various barriers and achieve a state of intuitive eating, they anticipated a range of long-term benefits to health and weight management. For intuitive eating to become a viable public health approach, this research suggests that intuitive eating needs to be much more widely publicised and better explained, and perhaps renamed. More significantly, people would need assistance with how to eat intuitively given the barriers identified.

When Eating Intuitively Is Not Always a Positive Response: Using Machine Learning to Better Unravel Eaters Profiles

BACKGROUND

The aim of the present study was to identify eaters profiles using the latest advantages of Machine Learning approach to cluster analysis.

METHODS

A total of 317 participants completed an online-based survey including self-reported measures of body image dissatisfaction, bulimia, restraint, and intuitive eating. Analyses were conducted in two steps: (a) identifying an optimal number of clusters, and (b) validating the clustering model of eaters profile using a procedure inspired by the Causal Reasoning approach.

RESULTS

This study reveals a 7-cluster model of eaters profiles. The characteristics, needs, and strengths of each eater profile are discussed along with the presentation of a continuum of eaters profiles.

CONCLUSIONS

This conceptualization of eaters profiles could guide the direction of health education and treatment interventions targeting perceptual and eating dimensions.

Examination of ecological validity of intuitive eating

BACKGROUND

Intuitive eating, which involves following internal cues of hunger and satiety to guide eating choices, would be better understood if studied at the individual momentary level instead of globally or cross-sectionally. The current study employed ecological momentary assessment (EMA) to examine the ecological validity of a popular intuitive eating measure, the Intuitive Eating Scale (IES-2).

METHOD

College males and females completed a baseline assessment of trait levels of intuitive eating as measured by the IES-2. Participants then followed a seven-day EMA protocol where they completed brief smart phone assessments about intuitive eating and related constructs while in their natural daily environments. Participants were asked to complete recordings before and after eating about their state level of intuitive eating at that moment.

RESULTS

Among 104 participants, 87.5% were female, mean age was 24.3, and mean BMI was 26.3. Baseline trait level intuitive eating was significantly correlated with state level intuitive eating reported across EMA recordings, with some evidence suggesting that correlations were stronger before eating compared to after eating. Intuitive eating generally was related to less negative affect, fewer eating restrictions, and more anticipated taste enjoyment before eating, as well as less guilt and regret after eating.

DISCUSSION

Individuals who reported high trait levels of intuitive eating also reported following their internal cues for hunger and satiety and had less guilt, regret, and negative affect surrounding eating in their naturalistic environments, thereby supporting the ecological validity of the IES-2.

Is intuitive eating a privileged approach? Cross-sectional and longitudinal associations between food insecurity and intuitive eating

OBJECTIVE

To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood.

DESIGN

Longitudinal population-based study. Young people reported IE and FI (two items from the US Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item US Household Food Security Module in adolescence.

SETTING

Adolescents (Mage = 14·3 ± 2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage = 22·1 ± 2 years).

PARTICIPANTS

The analytic sample (n 1372; 53·1 % female, 46·9 % male) was diverse across race/ethnicity (19·8 % Asian, 28·5 % Black, 16·6 % Latinx, 14·7 % Multiracial/Other and 19·9 % White) and socio-economic status (58·6 % low/lower middle, 16·8 % middle and 21·0 % upper middle/high).

RESULTS

In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (P = 0·02) and emerging adulthood (P < 0·001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (P = 0·01). Those who remained food-insecure (P = 0·05) or became food-insecure (P = 0·02) had lower IE in emerging adulthood than those remaining food-secure. All effect sizes were small.

CONCLUSIONS

Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.

A qualitative exploration of perceived barriers and facilitators to following an intuitive eating style

BACKGROUND

Intuitive eating involves following internal cues of hunger and satiety to guide eating choices as opposed to responding to external signals, strong emotions, or dietary rules. This style of eating has consistently been shown to be related to better physical and psychological health indicators, and more interventions are being designed and studied to promote this eating style. The current study aimed to identify anticipated facilitators and barriers to following this style of eating among a group of college students enrolled in a larger study of intuitive eating.

METHOD

Following a week of tracking their current eating as part of a larger study, college students read a description of intuitive eating. They then answered three open-ended questions about following intuitive eating including facilitators, barriers, and perceived ability to follow long term. Responses were coded using thematic analysis to identify themes across responses.

RESULTS

Among 100 participants, 86 % were female, 46 % were Hispanic (41 % non-Hispanic White, 13 % other race/ethnicity), mean age was 24.3 years, and mean body mass index was 26.2. The most commonly anticipated participant-reported facilitators of intuitive eating were being in touch with the body's needs and hunger cues, positive perceptions of intuitive eating, and health considerations. The most commonly anticipated barriers were logistical constraints (e.g., busyness and mealtimes), difficulty with hunger cues and reactions to food, and negative perceptions of intuitive eating. The majority of participants (64 %) would consider following this style of eating long term.

DISCUSSION

This study provides information that can be used to improve efforts aimed at promoting intuitive eating to college students, including marketing intuitive eating interventions, and clarifying misunderstandings of its key tenets that might serve as barriers.

Associations among retrospective parenting styles, retrospective food parenting, and current eating behaviors in Chinese adults

The current study explored the relationships between retrospective parenting styles and food parenting in childhood (≤ 12 years old) and Chinese adults' current maladaptive and adaptive eating behaviors. We recruited 501 Chinese adults (50.30% men, aged 19-46 years). A set of questionnaires were used to measure retrospective parenting styles (i.e., emotional warmth, rejection, and overprotection), food parenting (i.e., parental concern, monitoring, pressure to eat, and restriction), and current maladaptive (i.e., disordered eating) and adaptive (i.e., intuitive eating) eating behaviors. Correlation and mediation analyses were employed to analyze these data. Results revealed that retrospective parenting styles and food parenting were significantly related to current maladaptive and adaptive eating behaviors in both Chinese men and women. Mediation analyses showed that higher retrospective parental warmth was related to higher retrospective parental concern which, in turn, was related to higher current disordered eating in men (indirect effect = 0.14, 95% CI 0.08, 0.24). Furthermore, higher retrospective parental overprotection was related to higher retrospective parental pressure to eat which, in turn, was related to higher current disordered eating in men (indirect effect = 0.06, 95% CI 0.01, 0.14). For women, higher retrospective parental warmth was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.04, 95% CI = -0.10, -0.01). Furthermore, higher retrospective parental overprotection was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.03, 95% CI = -0.08, -0.004). The findings indicate the importance of including childhood parenting styles and food parenting in future research and intervention of adults' current maladaptive and adaptive eating behaviors.

Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index

Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m² (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.

Body image explains differences in intuitive eating between men and women: Examining indirect effects across negative and positive body image

Intuitive eating is an adaptive and flexible form of eating. Men report higher rates of intuitive eating than women. Objectification processes are proposed to underlie this (binary) gender difference due to the intense body-related pressures that disrupt body image in women. The current study is the first known to test whether body image indirectly explains lower levels of intuitive eating in women relative to men. A cross-sectional sample of 498 adults aged 18-74 years recruited through Prolific completed an online survey assessing intuitive eating and negative and positive body image indicators. Women reported poorer body image and lower levels of intuitive eating compared to men. Significant indirect effects suggested body image explained gender differences in intuitive eating, controlling for age and body mass index. In women relative to men, greater body surveillance and lower aesthetic satisfaction explained lower total intuitive eating and reliance on hunger and satiety, greater aesthetic investment explained lower total intuitive eating and eating for physical reasons, and lower functionality investment explained lower body-food choice congruence. More research is needed, but findings suggest programs may benefit from decreasing critical views of appearance and strengthening functionality investment in women to reduce gender differences in intuitive eating.

Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature

From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one’s body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts—perceptual disturbances and dysfunctional eating attitudes and behaviors—in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.

Exploring the role of positive body image in healthy orthorexia and orthorexia nervosa: A gender comparison

Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; age M = 40.30, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.

Daily weight stigma experiences, and disordered and intuitive eating behaviors among young adults with body dissatisfaction

OBJECTIVE

The present study aimed to extend naturalistic weight stigma research by examining the following aims among young adults with body dissatisfaction and varied body mass indices (BMIs): (1) characterize the frequency of individuals' daily weight stigma experiences, and contextual variations, over a 14-day period; (2) examine whether BMI moderated daily associations between weight stigma experiences relative to eating disorder symptoms and intuitive eating behaviors.

METHOD

Women (n = 174) and men (n = 24) completed a 14-day daily diary protocol. Concurrent and time-lagged multilevel models examined associations between daily weight stigma, and eating disorder and intuitive eating behaviors among women only due to the small subsample of men.

RESULTS

Over the 14-day assessment, 43.94% (n = 87) of participants experienced weight stigma. Weight stigma rates varied based on how, where, and by whom weight stigma was expressed, and via BMI. Further, among women, multiple concurrent within-person associations were identified between women's daily weight stigma experiences and daily eating disorder symptoms (skipping meals, binge eating, and body dissatisfaction). Time-lagged associations also showed that women's weight stigma experiences on a given day were associated with a greater likelihood that they would limit the amount of food they consumed the next day. These associations did not differ via women's BMIs.

DISCUSSION

Collectively, these findings provide important information on how weight stigma experiences unfold in daily life among individuals with body dissatisfaction and varied BMIs, and the proximal and more enduring impact of women's daily weight stigma experiences on their use of multiple adverse eating behaviors that can promote poor health.

PUBLIC SIGNIFICANCE

The present findings provide important information on how, where, and by whom weight stigma experiences unfold in daily life among young adults with body dissatisfaction and varied body weights, as well as the proximal and more enduring impact of women's daily weight stigma experiences on their use of a variety of adverse eating behaviors that can promote poor health.