Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study

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.

Association between intuitive eating and health outcomes in outpatients with type 2 diabetes: a cross-sectional study

PURPOSE

To evaluate the association between intuitive eating and health outcomes in patients with type 2 diabetes in a cross-sectional study.

METHODS

Consecutively, outpatients attending at university hospital underwent clinical, laboratory, lifestyle, and eating behavior evaluations. Intuitive eating was assessed using the Intuitive Eating Scale-2 (IES-2), and the Three Factor Eating Questionnaire-21 was adopted as a confirmatory tool for disordered eating behavior. Optimized health outcomes were considered according to the American Diabetes Association criteria for BMI, HbA1c, lipid profile, and blood pressure values, and the International Diabetes Federation criteria for waist circumference. Considering the answers of the IES-2 items, patients were grouped by latent class analysis, and their characteristics were compared by appropriate tests.

RESULTS

In total, 267 patients were evaluated: 62.2% women, with 60 (53-65) years, BMI 31.9 ± 5.4 kg/m², diabetes duration of 16 ± 9 years, HbA1c 8.5 ± 1.5%, and an IES-2 total score of 58 (50-67)%. Three intuitive eating groups were identified: higher intuitive eating, nonemotional-oriented coping, and lower intuitive eating. Patients with higher intuitive eating have higher chances of having optimized BMI and serum triglycerides values compared to patients with lower intuitive eating. Also, the 10-point increase on IES-2 was associated with a 0.62 kg/m² reduction on BMI values (95%CI -1.18;-0.06), 1.90 cm on waist circumference (95%CI -3.26;-0.54), and 23 mg/dL in serum triglycerides values (95%CI -38.27;-7.40) after adjustment for age, sex, psychotropic drug use, medication effect score, smoking, and BMI.

CONCLUSION

Intuitive eating seems to be associated with optimized health outcomes and may contribute to better personalized interventions in nutritional treatment that promote adaptive behaviors in diabetes management, but should be tested.

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.

Higher morning cortisol is associated with lower intuitive eating in midlife women

BACKGROUND

Stress is associated with negative health outcomes in adults, including increased adiposity. Eating behaviors to cope with stress can have a negative effect on adiposity. There is limited research on positive eating behaviors, such as intuitive eating (IE), and their relationship to stress and adiposity. Thus, this study aimed to examine the association between stress and adiposity and to assess whether IE is a mediator of that pathway.

METHODS

Data were analyzed from a cross-sectional study of 114 women between 40-64 years of age. Participants completed in-person visits and self-reported questionnaires, including the Intuitive Eating Scale and Perceived Stress Scale. Adiposity was assessed using dual energy x-ray absorptiometry. Measurements included total body fat percentage and android/gynoid (AG) ratio as a measure of abdominal adiposity. Participants provided ten salivary cortisol samples over two days, collected upon waking, 30-, 45-, and 60-minutes after waking, and prior to bed. Several methods were used to characterize cortisol secretion and exposure, including the diurnal cortisol slope and the cortisol area under the curve with respect to ground (AUCg). Linear regression was used to assess the associations between perceived stress and IE and between features of diurnal cortisol and IE. Mediation models were tested to examine the indirect effects of IE on the relationship between perceived stress and adiposity and to test the indirect effects of IE on the relationship between cortisol measures and adiposity.

RESULTS

Linear regression analyses indicated that higher cortisol AUCg was associated with lower scores on the eating for physical reasons subscale (β: -0.01, p = 0.008). After adjusting for covariates, neither higher perceived stress nor diurnal cortisol were associated with intuitive eating. There was no evidence of mediation of the association of stress on adiposity through IE.

CONCLUSION

Our findings demonstrate a relationship between higher overall morning cortisol and lower scores on the eating for physical reasons subscale of the Intuitive Eating Scale. Future research should seek to understand how intuitive eating may be used as a technique for individuals who engage in emotional eating to cope with stress, and to prevent excess adiposity resulting from stress in midlife women.

Interoceptive sensibility, intuitive eating, binge, and disordered eating behavior among individuals with obesity: A comparative study with the general population

The present study assessed the links between interoceptive sensibility, binge, disordered (emotional, restrained, and external) and intuitive eating among individuals with obesity (n = 57) and normal weight (n = 29). Individuals with obesity presented lower "attention regulation," "body-listening," and "trusting" interoceptive dimensions. When age was controlled, group differences on "trusting" remained significant. Individuals with obesity showed lower intuitive eating, higher emotional, and binge eating compared to controls. Higher "body listening," "eating for physical rather than emotional reasons," and "reliance on hunger and satiety cues" predicted lower binge eating whereas "external eating" predicted higher binge eating among individuals with obesity. Eating for physical reasons and reliance on hunger and satiety had protective mediating roles in the relationship between external and binge eating in both groups. Interoceptive sensibility and intuitive eating should conjointly serve as psychotherapeutic targets for disordered eating, obesity, and weight management.

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).

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.

Higher intuitive eating is associated with lower adiposity in midlife women

OBJECTIVE

Intuitive eating (IE) is consistently associated with a lower body mass index, though its relationship with adiposity, specifically abdominal adiposity, is unknown. Given that midlife women often experience increases in adiposity during midlife, our objective was to examine the association between IE and adiposity in midlife women. We also aimed to validate the factor structure of the Intuitive Eating Scale (IES) in a sample of midlife women.

METHOD

We analyzed data from a cross-sectional study of 116 women between 40 and 64 years of age. Participants completed in-person visits and self-reported questionnaires, including the 21-item IES. Adiposity was assessed using dual energy x-ray absorptiometry. Measurements included total body fat percentage and android/gynoid (AG) ratio as a measure of abdominal adiposity.

RESULTS

Confirmatory factor analysis of the IES demonstrated a poor fit to the data. Thus, we conducted an exploratory factor analysis which resulted in a 15-item scale with five items on each subscale, and demonstrated improved fit. Higher intuitive eating was associated with lower total body fat percentage (β = -6.77, p < 0.0001) and lower abdominal adiposity (β = -0.09, p = 0.0005). Higher scores on eating for physical reasons and reliance on internal hunger and satiety cues were associated with lower total body fat and lower abdominal adiposity.

CONCLUSIONS

Our findings suggest that higher intuitive eating is associated with lower total body fat percentage and lower abdominal adiposity. These results may have public health implications to promote intuitive eating in midlife women, a population at risk of weight gain and changes to body fat distribution.

Sex differences in intuitive eating and its relationship with body mass index among adults aged 18-40 years in Saudi Arabia: a cross-sectional study

Introduction

Intuitive eating (IE) is eating without judgment, relying only on physiological hunger and satiety. Sex differences in IE have been reported; however, none of the studies have explicitly examined IE and its relationship with body mass index (BMI) in the Saudi Arabian population. Thus, this study aimed to investigate sex differences in IE and its relationship with BMI in the Saudi population.

Subjects/methods

A cross-sectional online survey of 360 participants (18 years or older) with self-reported weight and height was conducted. IE was measured using the Intuitive Eating Scale-2 (IES-2). Separate multiple linear regression analyses were conducted to determine if total IE and its subscale scores differed across sexes. It was also conducted to assess the relationship between IE and BMI across sexes.

Results

Women had higher total IE score, eating for physical rather than emotional reasons (EPR), and body-food choice congruence (BFCC) scores compared to men (p = 0.013, p = 0.01, p <0.001, respectively). The analysis showed a significant negative association between total IE, BFCC, EPR scores, and BMI in women compared to men (p = 0.023, p = 0.01, p = 0.003, respectively).

Conclusion

The data on the sex differences in IE and its subscales and their different association with BMI encourage tailing nutrition-related recommendations in the context of intuitive eating based on sexes. Future studies are needed to explore how intuitive eating functions differently in women compared to men and explore the causal relationship between IE and BMI in this population.

Effect of a Nutritional Behavioral Intervention on Intuitive Eating in Overweight Women With Chronic Kidney Disease

OBJECTIVES

This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent women with chronic kidney disease and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group.

DESIGN AND METHODS

This is a prospective noncontrolled clinical trial of a behavioral multisession group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale 2, translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey questionnaire was applied to assess health-related quality of life.

RESULTS

Of the 33 patients who began participation in the study, 23 patients (median [interquartile range]: age = 62.0 years [58.0-68.0]; 52.2% with diabetes; body mass index = 32.6 kg/m² [30.2-39.3]; estimated glomerular filtration rate = 28.0 mL/min/1.73 m² [22.0-31.0]) completed the intervention. Except for the IE subscale Body-Food Choice Congruence, the IE total score and all its subscales (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) improved after the intervention. In a cross-sectional analysis, more intuitive eaters were older and had better scores for health-related quality of life.

CONCLUSIONS

The nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of chronic kidney disease patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.

An experimental approach to training interoceptive sensitivity: study protocol for a pilot randomized controlled trial

BACKGROUND

Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one's own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples.

METHODS

The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50-80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants' overall acceptance of the training and its feasibility.

DISCUSSION

By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS), no. DRKS00024903. Retrospectively registered on April 21, 2021.

Weight-normative messaging predominates on TikTok-A qualitative content analysis

Tiktok is a social media platform with many adolescent and young adult users. Food, nutrition, and weight-related posts are popular on TikTok, yet there is little understanding of the content of these posts, and whether nutrition-related content is presented by experts. The objective was to identify key themes in food, nutrition, and weight-related posts on TikTok. 1000 TikTok videos from 10 popular nutrition, food, and weight-related hashtags each with over 1 billion views were downloaded and analyzed using template analysis. The one-hundred most viewed videos were downloaded from each of the ten chosen hashtags. Two coders then coded each video for key themes. Key themes included the glorification of weight loss in many posts, the positioning of food to achieve health and thinness, and the lack of expert voices providing nutrition information. The majority of posts presented a weight-normative view of health, with less than 3% coded as weight-inclusive. Most posts were created by white, female adolescents and young adults. Nutrition-related content on TikTok is largely weight normative, and may contribute to disordered eating behaviors and body dissatisfaction in the young people that are TikTok’s predominant users. Helping users discern credible nutrition information, and eliminate triggering content from their social media feeds may be strategies to address the weight-normative social media content that is so prevalent.

The relationship between intuitive eating and eating attitude and glycemic control in patients with type 2 diabetes mellitus

Amaç: Bu çalışma, Tip 2 Diabetes Mellitus (T2DM) hastalarında sezgisel yemenin yeme tutumu ve glisemik kontrol ile ilişkisini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Araştırmanın örneklemini; 18 Kasım 2019 – 12 Mart 2020 tarihleri arasında Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı Polikliniği’ne gelen T2DM tanılı ve dahil edilme kriterlerini karşılayan 385 birey oluşturmuştur. Çalışma verileri; bireylerin demografik bilgilerine, sağlık bilgilerine ve biyokimyasal verilerine yönelik sorular ile Sezgisel Yeme Ölçeği (IES-2) ve Yeme Tutum Testinin (EAT-26) yer aldığı bir form kullanılarak yüz yüze görüşme yöntemi ile elde edilmiştir. Bulgular: Çalışmaya katılan bireylerin yaş ortalaması 59,12±9,78 olup %62,6’sı kadındı. Sezgisel yeme ile bireylerin vücut ağırlığı, BKİ değeri, bel çevresi ve trigliserit değeri arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki saptandı (p&lt;0,05). EAT-26 puanı ile IES-2 alt ölçeklerinden olan “duygusal sebeplerden ziyade fiziksel sebeplerle yeme” alt ölçeği arasında istatistiksel olarak negatif yönde ve zayıf düzeyde anlamlı bir ilişki belirlendi (p&lt;0,05). Ayrıca EAT-26 puanı ile “açlık ve tokluk işaretlerine güven” alt ölçeği arasında istatistiksel olarak pozitif yönde ve zayıf düzeyde anlamlı bir ilişki bulundu (p&lt;0.05). Sonuç: Çalışma sonucunda; sezgisel yeme ile T2DM’li bireylerin antropometrik ölçümleri, trigliserit değerleri ve yeme tutumları arasında zayıf düzeyde anlamlı ilişki olduğu belirlenmiştir. Sezgisel yemenin yeme tutumu ve glisemik kontrol ile arasındaki nedensellik ilişkisini daha iyi belirleyebilmek için ileri çalışmalara ihtiyaç vardır.

Like parent, like child? Intuitive eating among emerging adults and their parents

Intuitive eating (IE) emphasizes relying on hunger and satiety cues to guide eating, and is associated with positive mental health and health-promoting behaviors. Although parents' own eating patterns often shape those of their children, no known research has explored familial associations of IE. The purpose of this cross-sectional, population-based study was to examine IE concordance between emerging adults and their parents, and whether concordance differed across sociodemographic characteristics and weight perceptions. The analytic sample included 891 emerging adults (M age = 22.0) and their primary parent (M age = 50.4) who participated in the population-based, longitudinal EAT and F-EAT 2010-2018 studies. Parents and emerging adults were grouped into dyads based on IE concordance: (1) neither are intuitive eaters; (2) only the emerging adult is an intuitive eater; (3) only the parent is an intuitive eater; (4) both are intuitive eaters. Dyads differed across socioeconomic status (SES), race/ethnicity, and weight perceptions. Concordant dyads who ate intuitively were more likely to be at higher SES and perceive their weight as "about right" than concordant dyads who did not eat intuitively. Asian emerging adults were most likely to belong to concordant non-intuitive eater dyads. Emerging adults who shared their parent's perception their weight was "overweight" were less likely to be intuitive eaters (even if their parents were). In this sample, sociodemographic characteristics and weight perceptions were related to IE concordance among emerging adults and their parents. Lower SES might be an intergenerational barrier to IE disproportionately impacting communities of color, though longitudinal data are needed. Results also suggest rather than motivating healthful eating, perceiving one's weight as "overweight" could hinder IE. Differences across sociodemographic variables likely intersect in meaningful ways, which is an important future research direction.

Changes in food reward and intuitive eating after weight loss and maintenance in former athletes with overweight or obesity

OBJECTIVE

This study aimed to explore the following: 1) the impact of Champ4Life's intervention on intuitive eating and food reward; and 2) associations between changes in eating behavior and changes in body composition.

METHODS

A total of 94 former athletes (mean [SD], BMI = 31.1 [4.3] kg/m² , age = 43.0 [9.4] years, 34% female) assigned to intervention (n = 49) and control groups (n = 45) underwent 4 months of active weight loss (WL) followed by 8 months of WL maintenance. Intuitive eating and food reward were assessed by the Intuitive Eating Scale and the Leeds Food Preference Questionnaire, respectively.

RESULTS

The WL was -4.8% (4.9%) and 0.3% (2.6%) for the intervention and control groups, respectively. Participants reported a decrease in fat bias for explicit/implicit wanting and explicit liking after 4 months and 1 year. For intuitive eating, the unconditional permission to eat decreased after 4 months, and the body-food choice congruence increased after 1 year. Changes in unconditional permission to eat and in body-food choice congruence were positively and negatively associated with both Δweight and with Δfat mass, respectively. Changes in explicit wanting for fat and taste bias were associated with Δweight.

CONCLUSIONS

Food reward decreased after a moderate WL intervention. Participants successfully maintained their reduced weight, and most of the changes in eating behavior remained significant at the end of the follow-up period. Lifestyle interventions aiming at WL should also consider intuitive eating and food reward.

Intuitive eating: associations with body weight status and eating attitudes in dietetic majors

PURPOSE

Intuitive eating (IE), an adaptive eating pattern characterized by eating in response to physiological hunger and satiety cues, has been associated with positive psychosocial and physical health outcomes. This study aimed to determine associations between IE behavior with body weight status and eating attitudes in dietetic students and dietitians, who are a risky population for disordered eating and body dissatisfaction.

METHODS

Participants (n = 785) completed a self-administered questionnaire which featured socio-demographic characteristics, the eating attitudes test 26, the three-factor eating questionnaire, and the intuitive eating scale-2 with four facets unconditional permission to eat (UPE), eating for physical rather than emotional reasons (EPR), reliance on hunger and satiety cues (RHSC) and body-food choice congruence (B-FCC).

RESULTS

When controlled for potential covariates in the multivariate regression analysis, greater total IE and all subscale scores were associated with reduced BMI in dietetic majors having a BMI of ≥ 18.5 kg/m² (p < 0.05). Participants with a high IE score had 41%, 74%, and 89% lower risk of developing an eating disorder, uncontrolled eating, and emotional eating, respectively (p < 0.001). While higher UPE, EPR, and RHSC scores were associated with lower odds of disordered eating (p < 0.001), EPR, RHSC, and B-FCC scores were inversely related to the risk of uncontrolled eating and emotional eating (p < 0.05).

CONCLUSION

Considering these inverse associations, IE may be helpful for weight management and a useful skill to reduce eating disorder symptomatology among the dietetic community.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18-30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3-3.7] and PR = 3.1, [95% CI = 2.0-4.7], respectively) and lower intuitive (β = -0.4, [95% CI = -0.7, -0.2] and β = -0.5 [95% CI = -0.8, -0.3], respectively), and mindful eating scores (β = -0.3, [95% CI = -0.6, -0.1] and β = -0.5 [95% CI = -0.8, -0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Adverse experiences as predictors of maladaptive and adaptive eating: Findings from EAT 2018

Adverse experiences, such as childhood abuse and other violence victimization, are associated with problematic eating. However, whether different types of adversity relate to both maladaptive and adaptive eating behaviors is unclear. This study examined the associations of different adverse experiences with maladaptive (i.e., overeating and binge eating) and adaptive (i.e., intuitive eating and mindful eating) eating by gender. Data were derived from the EAT-2018 (Eating and Activity over Time) study (N = 1411, aged 18-30 years in 2017-2018). Modified Poisson regressions were used to examine the associations between adverse experiences and the prevalence of maladaptive eating. Linear regressions were used to examine the associations between adverse experiences and adaptive eating scores. Each adverse experience was associated with greater prevalence of maladaptive eating and lower adaptive eating scores. Among women, intimate partner sexual violence was strongly associated with more overeating (PR = 2.1 [95% CI = 1.4-3.1]) and binge eating (PR = 2.4 [95% CI = 1.5-3.9]), and less mindful eating (β = -0.6, [95% CI = -0.8, -0.3]); being attacked, beaten, or mugged was most associated with less intuitive eating (β = -0.5, [95% CI = -0.8, -0.2]). Among men, being attacked, beaten, or mugged was strongly associated with more overeating (PR = 2.1 [95% CI = 1.2-3.5]) and binge eating (PR = 3.2 [95% CI = 1.6-6.5]); intimate partner physical violence was strongly associated with less intuitive eating (β = -0.6, [95% CI = -0.9, -0.2]); childhood emotional abuse was strongly associated with less mindful eating (β = -0.8, [95% CI = -1.0, -0.5]). To improve eating behaviors, adverse life experiences and the potential impact on maladaptive and adaptive eating should be considered.

Is addictive-like eating an overlooked stroke risk factor? A study case

PURPOSE

While stroke is already considered a nutrition-related disease, the prevalence of the broad array of disordered eating behaviors is under-reported in this disease. We describe the case of a stroke in a young woman following a recent food addiction to fatty-sweet food.

METHODS

She was diagnosed with a Night-Eating-Syndrome, with a loss-of-control exclusively towards sugary carbohydrates used to manage her insomnia and distress, and her consummatory behaviors were investigated.

RESULTS

This case report illustrates a self-medication of a significant psychological distress by shifting from a healthy diet to an overconsumption of hyper-palatable foods, triggering an addiction disorder. The related hypertriglyceridemia, on top of chronic smoking, contributed to the development of an atherosclerotic plaque and thrombus formation.

CONCLUSION

Food addiction might be considered as an emerging stroke risk factor. We suggest it fosters the need to take into consideration addictive-like eating behaviors and associated mental disorders in the primary and secondary prevention of stroke. This may be particularly relevant for the prevention of stroke in women as they are more prone to comfort their emotions with food.

LEVEL OF EVIDENCE

V, descriptive study.

Body image concerns and intuitive eating in older women

Intuitive eating has been described as representing a positive relationship with food that can support health. However, to date, most of the extant research on intuitive eating has been conducted among young women, limiting our understanding of how intuitive eating can contribute to supporting health in aging women. This study aimed to bridge this gap by exploring body image and eating correlates of intuitive eating in older women. The hypotheses were that among older women, intuitive eating would be significantly associated with lower disordered eating, weight and shape concerns, and fewer depressive symptoms, and that an indirect relationship between BMI and intuitive eating via weight and shape concerns would exist. Community women aged 60-75 (N = 200) completed questionnaires assessing intuitive eating, disordered eating, body concern, depressive symptoms and body mass index (BMI). Higher intuitive eating global scores were associated with lower restraint, lower eating concern, lower body concern, fewer depressive symptoms, and lower BMI. An indirect relationship between BMI and intuitive eating via weight and shape concern emerged, suggesting that being preoccupied by one's appearance hinder the ability to practice intuitive eating. These results suggest that intuitive eating is associated with positive outcomes among older women and might be a useful target for interventions designed to increase healthy aging.

Interoception, eating behaviour and body weight

BACKGROUND

Interoception refers to the process of identifying and listening to internal bodily signals, which may be a modifiable determinant of appetite regulation and weight gain. The objective was to examine whether the extent to which self-reported interoception is associated with higher BMI is explained by eating behavior traits.

METHODS

UK adults (N = 1181, 49% female, 53% with overweight/obesity) completed validated self-report measures of interoception, habitual tendencies to eat in response to satiety signals (intuitive eating), emotional over-eating and other eating traits.

RESULTS

Poorer self-reported ability to detect interoceptive signals (deficits in interoceptive accuracy) was predictive of higher BMI (r = - 0.07 (95% CI -0.13; -0.01), p < .05). In parallel mediation analyses, participants with poorer interoceptive accuracy were significantly less likely to report considering satiety signals when eating and this explained the cross-sectional association between interoceptive accuracy and higher BMI. There was also some evidence that participants with poorer interoceptive accuracy were more likely to report emotional overeating and this also in part explained why interoceptive accuracy was predictive of higher BMI.

CONCLUSIONS

Deficits in interoception may decrease the likelihood that satiety signals are integrated into eating behaviour related decision making and in doing so contribute to higher BMI.

Orthorexia Nervosa in Turkish dietitians and dietetic students

OBJECTIVES

Orthorexia Nervosa (ON) is characterized by a pathological obsession with healthy eating, and dietetic majors may have a potential risk of developing ON due to their occupation that necessitates consideration of optimal food choices. This study aimed to determine the prevalence of ON among a large sample of dietitians and dietetic students in Turkey and to investigate the association of ON with socio-demographic features and eating attitudes within the whole sample.

METHODS

Participants (n=1429) completed a self-administered online survey that featured socio-demographic characteristics, the Orthorexia Nervosa Questionnaire (ORTO-11), and the Eating Attitudes Test-26 (EAT-26). Scores on the ORTO-11 and EAT-26 determined the prevalence of ON and disordered eating behaviors, respectively.

RESULTS

The prevalence of ON among Turkish dietetic majors was 59.8% with a higher ratio in dietetic students (63.8%) than dietitians (52.9%) (P<0.001). While graduation was associated with 33.1% lower odds of ON (P=0.006), eating disorders could increase the ON risk approximately five times (P<0.001). Furthermore, the greater total and subscale (dieting, bulimia, and oral control) scores of EAT-26 were associated with higher ON tendency (P<0.001), even after adjustment for potential confounders.

CONCLUSIONS

Our findings may shed light on the relevance of developing strategies to reduce the prevalence of ON in the dietetic population but need to be supported by further longitudinal and prospective studies.

Intuitive Eating is Associated With Higher Fruit and Vegetable Intake Among Adults

OBJECTIVE

Assess how intuitive eating relates to dietary intake.

METHODS

Survey data were collected in Project Eating and Activity in Teens and Young Adults, the fourth wave of a longitudinal cohort study (weighted n = 1,830, 49% women; mean age = 31 years). Intuitive eating was assessed using a 7-item scale adapted from the Intuitive Eating Scale and Intuitive Eating Scale-2. Dietary intake was measured via a semiquantitative food frequency questionnaire. Mean servings were stratified by gender and intuitive eating quartiles and adjusted for sociodemographic characteristics and caloric intake.

RESULTS

Women and men in the top intuitive eating quartile consumed 0.6-0.3 servings more fruit and 0.4-0.6 servings more vegetables daily, respectively, compared with the bottom quartile, whereas men in the top quartile also consumed 0.6 servings fewer whole grains (all P < 0.05) than the bottom quartile.

CONCLUSIONS AND IMPLICATIONS

Intuitive eating shows promise as a healthier alternative to practices such as dieting.

Are anthropometric measurements an indicator of intuitive and mindful eating?

PURPOSE

Intuitive eating and mindful eating are new approach eating behaviors. Assessing the relationship of some anthropometric measurements to intuitive eating and mindful eating.

METHODS

Cross-sectional descriptive study. Adults aged 19-45 living in the center of Ankara the capital of Turkey. 250 volunteers (68 men and 182 women) aged 19-45 years. Data were collected through face-to-face interviews using a questionnaire contained the Intuitive Eating Scale (IES-2), Mindful Eating Questionnaire (MEQ-30) and Eating Attitudes Test (EAT-26). Anthropometric measurements were performed by the researchers themselves. Between-group analyses were performed to test statistical differences and relationships.

RESULTS

There was a positive correlation between IES-2 and MEQ-30 scores (r = 0.477; p = 0.000), indicating that the higher the IES-2 scores, the higher the MEQ-30 scores. IES-2 scores and BMI were negatively correlated (p < 0.05) and also MEQ-30 scores were negatively correlated with waist-to-height ratio and BMI (r = - 0.143; p = 0.024, r = - 0.159; p = 0.012). The higher the "disinhibition" and "control of eating," the lower the body weight, waist circumference, waist-to-height ratio and BMI was found.

CONCLUSIONS

It was concluded that the more the intuitive eating, the more the mindful eating. And also it is suggested that anthropometric measurements might be an indicator of intuitive eating and mindful eating.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Intuitive eating is associated with glycemic control in type 2 diabetes

PURPOSE

The intuitive eating approach has shown promise, but studies on its association with diabetics are scarce. The aim of this study is to identify the association between intuitive eating and glycemic control in individuals with type 2 diabetes mellitus.

METHODS

This is an observational cross-sectional analytical study in patients at the endocrinology service of a university hospital in Vitória/ES, Brazil. For data collection, a semi-structured questionnaire was used and intuitive eating was assessed by Intuitive Eating Scale-2.

RESULTS

A total of 179 individuals, mostly female and elderly, and predominantly taking oral antidiabetic drugs without association with insulin were evaluated. In adjusting for the total scale score, the most intuitive eating was associated with lower chances of patients presenting inadequate glycemic control by 89% (OR = 0.114; CI 0.024-0.540; p = 0.006), and a higher score on the Body-Food-Choice Congruence subscale was associated with lower chances of participants presenting this inadequacy by almost 66% (OR = 0.341; CI 0.131-0.891; p = 0.028), regardless of their body mass index.

CONCLUSION

Eating intuitively, especially in accordance with body needs may be associated with lower chances of type 2 diabetics having inadequate glycemic control.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010-2018

PURPOSE

To examine longitudinal associations of intuitive eating (IE), defined as eating according to internal hunger and satiety cues, with psychological health outcomes and disordered eating behaviors.

METHODS

Data from a diverse sample of 1491 participants (54.1% female, 19.7% non-Hispanic white) followed from adolescence (baseline; M_age= 14.5 years) into young adulthood (follow-up; M_age = 22.2 years) came from the population-based EAT 2010-2018 (Eating and Activity over Time) study. Logistic regression models predicting psychological health outcomes and disordered eating behaviors at follow-up simultaneously included baseline IE and change in IE from baseline to follow-up as predictors, adjusting for demographic covariates, body mass index, and outcome at baseline.

RESULTS

Greater baseline IE and increases in IE from baseline to follow-up were both associated with lower odds of high depressive symptoms, low self-esteem, high body dissatisfaction, unhealthy weight control behaviors (e.g., fasting, skipping meals), extreme weight control behaviors (e.g., taking diet pills, vomiting), and binge eating at 8-year follow-up. Particularly strong protective associations were observed for binge eating, such that a one-point higher IE score at baseline was associated with 74% lower odds of binge eating at follow-up, and a one-point higher increase in IE score from baseline to follow-up was associated with 71% lower odds of binge eating at follow-up.

CONCLUSIONS

These results indicate that IE longitudinally predicts better psychological and behavioral health across a range of outcomes and suggest that IE may be a valuable intervention target for improving psychological health and reducing disordered eating behaviors, particularly binge eating.

LEVEL OF EVIDENCE

Level III, cohort study.

Longitudinal associations between intuitive eating and weight-related behaviors in a population-based sample of young adults

Intuitive eating has been associated with markers of better health in cross-sectional studies, but less is known about long-term associations between intuitive eating and subsequent eating and weight-related behaviors. This study assessed how intuitive eating in early adulthood is related to weight status, dieting, healthy and unhealthy weight control behaviors, and binge eating with loss of control five years later. Young adults (N = 1660) were asked about intuitive eating as part of the 2008-2009 third wave of the Project EAT (Eating and Activity in Teens and Young Adults) longitudinal cohort study. Weight status, dieting, healthy and unhealthy weight control behaviors, and binge eating with loss of control were assessed during both the third (EAT-III: mean age 25.3 ± 1.5) and fourth (EAT-IV mean age 31.1 ± 1.5) waves. In analyses adjusted for sociodemographic characteristics, both male and female intuitive eaters had a lower prevalence of high weight status and lower engagement in dieting, unhealthy weight control behaviors, and binge eating at the 5-year follow-up, compared to non-intuitive eaters. Among women, after additional adjustment for EAT-III values for the respective outcome measures, intuitive eating was unrelated to any of the behaviors studied at 5-year follow-up. Among men, intuitive eating predicted a lower likelihood of engaging in unhealthy weight control behaviors (intuitive eaters: 30.0% vs. non-intuitive: 41.9%, p = 0.002) and binge eating (intuitive eaters: 0.9% vs. non-intuitive: 1.5%, p = 0.046) independent of participating in these behaviors at EAT-III. In a population-based sample of young adults, intuitive eating was associated with better markers of eating and weight-related behaviors five years later, suggesting intuitive eating may have potential long-term benefits.

Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with "natural" products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.

The Romanian version of the Intuitive Eating Scale-2: Assessment of its psychometric properties and gender invariance in Romanian adults

The construct of intuitive eating is most often measured using the 23-item Intuitive Eating Scale-2 (IES-2). Here, we examined the psychometrics of a Romanian translation of the IES-2. Eight-hundred-and-thirty Romanian adults completed the IES-2 along with measures of positive body image, symptoms of disordered eating, and psychological well-being. Exploratory factor analyses (EFAs) with a split-half subsample (n = 420) indicated that IES-2 scores reduced to three factors in women and four in men, both of which diverged from the parent model. Confirmatory factor analysis with a second split-half sample (n = 410) indicated that the parent model had poor fit indices, whereas fit of the EFA-derived models were acceptable but not uniformly ideal. Scores on the 3-factor model - which had comparatively better fit of the models tested - had adequate internal consistency and evidenced scalar invariance across gender. However, evidence of test-retest reliability after four weeks (n = 205) was poor and evidence of construct validity, assessed through correlations with additional measures included in the survey, was weak at best. Based on these results, we question the degree to which the construct of intuitive eating can be applied to nations undergoing nutrition transitions.

Preference for Intuition and Deliberation in Eating Decision-making: Scale validation and associations with eating behaviour and health

OBJECTIVES

Two distinct lines of research separately regard either deliberately regulated eating or intuitive eating as most beneficial for health. The present research aims to integrate these seemingly contradictory findings by investigating the relationships between Preference for Intuition and Deliberation in Eating Decision-making (E-PID) and subjective and objective health-related parameters using a newly developed scale.

DESIGN

Study 1: online survey; Study 2: cross-sectional community cohort sample.

METHODS

Study 1 (N = 699) assessed E-PID, intuitive, restrained, and external eating, motivation to eat healthily, domain-unspecific Preference for Intuition and Deliberation, and general self-control. Study 2 (N = 1,212) assessed E-PID, positive eating, intention to eat healthily, eating behaviour, and objective health risk factors (BMI, waist circumference, blood pressure, fasting serum glucose, HDL cholesterol, triglycerides).

RESULTS

Study 1 confirmed a two-factor structure and provided evidence for construct validity: A higher preference for intuition was positively related to intuitive eating, while a higher preference for deliberation was associated with increased dietary restraint. In Study 2, preference for deliberation was positively related to the intention to eat healthy, healthy eating behaviour, and health parameters. Preference for intuition was generally unrelated to health parameters, although a higher preference for intuition was related to a somewhat unhealthier eating pattern.

CONCLUSIONS

Preference for intuition and deliberation when making food choices are two distinct decision-making styles: The former focuses on internal cues, while the latter focuses on cognitive regulation of food intake. Despite these differences, neither decision-making style was shown to be detrimental.

A Motivational Pathway Linking Physical Activity to Body-Related Eating Cues

OBJECTIVE

To explore the motivational transfer between physical activity (PA) and body-related eating cues, through self-determined motivations to exercise (SDM Ex) and regulate eating (SDM Eat).

DESIGN

Cross-sectional.

SETTING

Participants completed an online inventory on PA and eating behaviors and motivations in 2017-2018.

PARTICIPANTS

A convenience sample of 300 adults (71% women; 34.4 ± 10.7 years; 23.2 ± 3.4 kg/m²), recruited through Facebook and cooperating Portuguese gyms.

VARIABLES MEASURED

Moderate-to-vigorous physical activity (independent), SDM Ex and SDM Eat (mediators), and body-related eating cues (dependent) variables assessed through validated self-reported measures.

ANALYSIS

Structural equation modeling and serial mediation procedures were used to test the hypothetical model.

RESULTS

Physical activity was positively associated with SDM Ex, which was, in turn, associated with SDM Eat, which in turn positively predicted reliance on hunger/satiety cues and (more strongly) body-food choice congruence. The path through exercise and eating motivations was the leading mediating path in the PA and body-food choice congruence association.

CONCLUSIONS AND IMPLICATIONS

This study lends support to the motivational transfer hypothesis between SDM Ex and SDM Eat in normal-weight adults, suggesting that more physically active individuals present higher SDM Ex and SDM Eat, and therefore, greater attentiveness to body-related eating cues and necessities. Encouraging PA might also improve individuals' eating self-regulation, especially if self-determined motivations are targeted in future interventions.

How full am I? The effect of rating fullness during eating on food intake, eating speed and relationship with satiety responsiveness

Modifying eating behaviours may be an effective strategy to limit excess food intake, such as eating slower and mindfully. We hypothesized that regularly rating fullness whilst eating a standard meal in one course would increase post-meal satiety and reduce intake in a subsequent course during the same sitting. A between-subjects design was employed (n = 65; 75% female; mean age = 26.7 (s.d. = 9.5); mean body mass index = 22.4 (s.d. = 3.3)), with three conditions of within-meal visual-analogue-scale ratings: 'Fullness' (rated fullness); 'Taste' (rated pleasantness of taste of food); 'Control' (rated comfort of room). Fasted participants ate a pasta meal (327 kcal) followed by cookies ad libitum. Appetite ratings were measured at baseline, following each course and for 3-h post-meal. Satiety responsiveness was measured using the Adult Eating Behaviour Questionnaire, Intuitive Eating Scale and by calculating the satiety quotient of the pasta course alone and the whole meal. The primary outcomes were fullness ratings post-pasta course [mean (s.d.): Fullness = 67.1 (21.9); Taste = 64.4 (13.7); Control = 60.2 (21.5)] and cookie intake [mean kcal (s.d.): Fullness = 249 (236); Taste = 279 (231); Control = 255 (208)]. Eating speed was included as a secondary, control outcome [mean (s.d.): Fullness = 59.3 (9.0); Taste = 59.2 (17.7); Control = 60.7 (19.6)]. No evidence for a difference in outcomes was identified between conditions (p > 0.05). Future work could involve testing the impact of rating fullness during multiple meals over a longer period. Secondly, this study explored whether levels of satiety responsiveness influenced the impact of the manipulation on outcomes; however only weak evidence for a relationship with eating speed was found. Finally, only a weak relationship was found between the satiety responsiveness measures, suggesting that different aspects of the underlying construct are being captured.

The Psycho-Affective Roots of Obesity: Results from a French Study in the General Population

The aim of the study was to examine the extent to which obese people differ in their emotionally driven and addictive-like eating behaviors from normal-weight and overweight people. A total of 1142 participants were recruited from a general population, by a web-based cross-sectional survey assessing anxiety/depression (Hospital Anxiety and Depression Scale), emotional eating (Emotional Appetite Questionnaire), food addiction (modified Yale Food Addiction Scale), and intuitive eating (Intuitive Eating Scale-2). The statistical design was based on analyses of (co)variance, correlograms, and mediations. A set of Body Mass Index (BMI) group comparisons showed that obese people reported higher levels of depression and emotional eating and that they experienced more severe and frequent food addiction symptoms than overweight and normal-weight people. Associations between anxiety, depression, food addiction symptoms’ count, and the difficulties to rely on hunger and satiety cues were found across all weight classes, suggesting that addictive-like eating may represent a unique phenotype of problematic eating behavior that is not synonymous with high BMI or obesity. Conversely, the interrelation between anxiety/depression, emotional eating, and the difficulties to rely on hunger and satiety cues was found only among obese participants, and negative emotional eating mediated the association between depression and anxiety and the difficulties to rely on hunger and satiety cues. This study emphasizes the necessity to develop more comprehensive approaches integrating emotional dysregulation and addictive-like eating behaviors to improve weight management and quality of life of obese people.

Eating behavior, non-food substance consumption and negative urgency in women

Objective

To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders.

Methods

Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms.

Results

The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating.

Conclusion

The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

Appetitive traits as targets for weight loss: The role of food cue responsiveness and satiety responsiveness

Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducted in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.

Intuitive eating is connected to self-reported weight stability in community women and men

Professionals working in eating disorder prevention, treatment, and public health aim to improve eating behaviors to stabilize weight, which is more adaptive for health and well-being than weight variation. However, it is unknown which eating behaviors are linked to weight stability in non-intervention samples. This study examines how intuitive eating and eating restraint (flexible and rigid control) are linked to retrospective reports of weight stability (i.e., maintained weight) and instability (i.e., lost, gained, or cycled weight) during the past year. Community women (n = 192) and men (n = 190) completed online self-report measures of eating behaviors and weight patterns. Intuitive eating was linked to greater weight stability, whereas rigid and flexible control were linked to greater weight instability. Additional research is required to assess the directionality of these associations. Nevertheless, these findings provide preliminary support and clinical implications for the promotion of intuitive eating in prevention and public health contexts.

Dimensional structure, psychometric properties, and sex and ethnic invariance of a Bahasa Malaysia (Malay) translation of the Intuitive Eating Scale-2 (IES-2)

The Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013) is a widely-used measure of facets of intuitive eating. We examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the IES-2 in a sample of Malaysian Malay and Chinese adults (N = 921). Participants completed a Malay translation of the IES-2 along with demographic items and measures of psychological well-being, positive and negative body image, and internalisation of appearance ideals. Exploratory factor analyses (EFAs) with Malay subsamples indicated that IES-2 scores reduced to 4 factors in women and 3 in men, both of which diverged from the parent model. Confirmatory factor analysis failed to confirm the parent 4-factor model, and indices for the EFA-derived models were acceptable but not ideal. Of the models tested, the EFA-derived 3-factor model had the best fit indices. Scores on this model had adequate internal consistency and were invariant across sex and ethnicity, but between-group differences in subscale scores were non-significant or negligible. Evidence of the construct validity of Malay IES-2 scores was mixed, particularly in men. These results lead us to question the degree to which intuitive eating as a construct is applicable to Malaysian populations specifically and non-Western populations generally.

Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study

INTRODUCTION

High pre-pregnancy weight and body mass index (BMI) increase the risk of gestational diabetes mellitus (GDM) and diabetes after pregnancy. To tackle weight and metabolic health problems, there is a need to investigate novel lifestyle approaches. Outside of pregnancy, higher adherence to intuitive eating (IE) is associated with lower BMI and improved glycemic control. This study investigated the association between IE and metabolic health during pregnancy and in the early postpartum period among women with GDM.

METHODS

Two-hundred and fourteen consecutive women aged ≥18, diagnosed with GDM between 2015 and 2017 and completed the "Eating for Physical rather than Emotional Reasons (EPR)" and "Reliance on Hunger and Satiety cues (RHSC) subscales" of the French Intuitive Eating Scale-2 (IES-2) questionnaire at the first GDM clinic visit were included in this study.

RESULTS

Participants' mean age was 33.32 ± 5.20 years. Their weight and BMI before pregnancy were 68.18 ± 14.83 kg and 25.30 ± 5.19 kg/m² respectively. After adjusting for confounding variables, the cross-sectional analyses showed that the two subscales of IES-2 at the first GDM visit were associated with lower weight and BMI before pregnancy, and lower weight at the first GDM visit (β = -0.181 to -0.215, all p ≤ 0.008). In addition, the EPR subscale was associated with HbA1c and fasting plasma glucose at the first GDM visit (β = -0.170 and to -0.196; all p ≤ 0.016). In the longitudinal analyses, both subscales of IES-2 at first GDM visit were associated with lower weight at the end of pregnancy, BMI and fasting plasma glucose at 6-8 weeks postpartum (β = -0.143 to -0.218, all p ≤ 0.040) after adjusting for confounders.

CONCLUSIONS

Increase adherence to IE could represent a novel approach to weight and glucose control during and after pregnancy in women with GDM.

Intuitive eating is associated with weight loss after bariatric surgery in women

BACKGROUND

Although the data on eating behavior after bariatric surgery are substantial, data on "intuitive eating" are lacking.

OBJECTIVE

The aim of this study was to evaluate the link between intuitive eating and weight loss after bariatric surgery.

METHODS

This cross-sectional study used a self-administered questionnaire freely available on social networks and targeted women who had undergone bariatric surgery. Intuitive eating was evaluated with the Intuitive Eating Scale-2 (IES-2). The 3 questionnaire subscores (Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Unconditional Permission to Eat) were also analyzed. The relation between IES-2 scores and the relative variation in body mass index [BMI (in kg/m2)] was assessed with linear regression models. Adjusted β (βAdj) and standardized β $( {{\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}} )$ were reported.

RESULTS

We analyzed the responses of 401 women with a mean age of 39 ± 11 y, a mean preoperative BMI of 45.5 ± 7.9, and a mean current BMI of 30.5 ± 7. The mean relative BMI loss was 32.7 ± 12.9%, and the mean IES-2 score was 3.3 ± 0.6. The total IES-2 score was associated with the relative BMI loss, with ∼2.6% BMI loss for each 1-point increase in the IES-2 score [PAdj = 0.007; βAdj = -2.57 (95% CI: -4.44, -0.70); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$= -0.12] after adjusting for elapsed time since surgery and type of surgery. Eating for Physical Rather than Emotional Reasons was the subscore most strongly associated with BMI change after adjustment [PAdj = 0.002; βAdj = -2.08 (95% CI: -3.37, 0.79); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$ = -0.14].

CONCLUSIONS

This study highlights a significant association between intuitive eating and BMI decrease after bariatric surgery. Furthermore, eating behaviors changed with increasing time since surgery. An intuitive nutritional approach may be complementary with bariatric surgery in the postoperative phase, which should prompt complementary prospective studies to evaluate the effectiveness of therapeutic education programs centered on intuitive eating in the postoperative period.

Trimester-Specific Intuitive Eating in Association With Gestational Weight Gain and Diet Quality

OBJECTIVE

To examine the associations between intuitive eating and trimester-specific gestational weight gain (GWG), and between intuitive eating and diet quality at each trimester.

DESIGN

At each trimester, participants completed the Intuitive Eating Scale-2 and 3 24-hour recalls from which the Healthy Eating Index was calculated. Trimester-specific GWG was calculated with interpolated weights.

PARTICIPANTS

A total of 79 pregnant women.

MAIN OUTCOME MEASURES

Intuitive eating, GWG, and diet quality.

ANALYSIS

One-way ANOVA was used to compare intuitive eating scores between GWG groups. Pearson correlation analyses were used to assess the association between the intuitive eating score and the Healthy Eating Index score.

RESULTS

In the first trimester, women within GWG recommendations had a higher total intuitive eating score compared with women above recommendations (3.9 ± 0.5 vs 3.6 ± 0.6; P = .04). The unconditional permission to eat subscale was associated with lower diet quality in the first trimester (r = -.26; P = .02) whereas the body-food choice congruence subscale was associated with better diet quality in the second and third trimesters (r = .26, P = .02 and r = .27, P = .01, respectively).

CONCLUSIONS AND IMPLICATIONS

The researchers found an association between higher levels of intuitive eating and adequate first-trimester GWG. Further research might investigate whether promoting intuitive eating among pregnant women favors healthy GWG.

Intuitive eating mediates the relationship between self-regulation and BMI - Results from a cross-sectional study in a community sample

Self-regulation is a dispositional skill of regulating attention and emotion to attain a certain goal. Poor self-regulation is associated with a higher body mass index (BMI) and is a risk factor for the development of obesity. Intuitive eating, an adaptive eating style characterized by eating in response to internal cues of hunger and satiety, is associated with a lower BMI. Using cross-sectional data, this study examined whether intuitive eating mediates the relationship between self-regulation and BMI in a community sample of adults. Participants (N = 530) completed the Self-Regulation Scale, the Intuitive Eating Scale-2 with its facets Unconditional Permission to Eat (UPE), Eating for Physical Rather Than Emotional Reasons (EPR), Reliance on Hunger and Satiety Cues (RHSC) and Body-Food Choice Congruence (B-FCC). They also self-reported their height and weight. Using percentile bootstrap resampling procedures, the simple mediation analysis showed an indirect relationship between self-regulation and BMI through intuitive eating. The multiple mediation analysis revealed that EPR and B-FCC, but not UPE and RHSC, mediated the relationship between self-regulation and BMI. Intuitive eating seems to play an important intermediating role in the relationship between self-regulation and BMI. Regarding weight management interventions, it could be useful to promote intuitive eating, especially for individuals with low self-regulation. Prospective studies are needed to explore the causal and temporal relationships among self-regulation, intuitive eating and BMI.

Fetal growth trajectories and their association with maternal and child characteristics

Background: The growth of the fetus is a complex process, influenced by genetic and environmental factors. Longitudinal patterns of fetal growth are required to fully understand this process, however to date, a paucity of data exists in this area.Objective: To identify fetal growth trajectories in-utero and to assess their association with maternal and child characteristics up to 5 years postnatal.Methods: Data from 781 mother-child pairs from the ROLO longitudinal birth cohort study were analyzed. The ROLO study was a randomized control trial of a low glycemic index diet in pregnancy to prevent recurrence of macrosomia. Fetal ultrasound measurements were recorded at 20 and 34 weeks gestation, and birth weight was recorded. Abdominal circumference (AC), weight (fetal weight, or birth weight), a standardized proxy for length (femur length or birth length, individually standardized), and AC:length ratio were examined for trajectory classes using latent class trajectory mixture models. Two-, three-, four-, and five-class models were evaluated for fit, using a linear (first order) trajectory over three time-points. ANOVA and chi-square tests were applied to test associations between trajectory membership and maternal and child characteristics up to age 5.Results: For AC, two fetal growth trajectories were identified, with 29% of participants on a "slow" trajectory and 71% on a "fast" trajectory. Those on a fast trajectory had higher rates of maternal impaired glucose tolerance (28.7 versus 16.5%, p<.001) and higher rates of mean child 5-year body mass index (BMI) centiles (64th versus 58th centile, p<.05) compared to those on the slow trajectory. For estimated fetal weight, four trajectories were identified, with 4% on a "very-slow" trajectory, 63% in a "moderate-slow" trajectory, 30% in a "moderate-fast" trajectory and 3% on a "very-fast" trajectory. Mothers with a fetus on the fastest trajectory had higher antenatal serum glucose levels (p<.05), and were more likely to deliver by cesarean section (59.1 versus 20%, p<.001). At 5 years of age, children on the fastest growth trajectory had the highest mean BMI centile (86th versus 60th centile, p<.05).Conclusions: This study shows that specific fetal growth trajectories may be associated with maternal serum glucose concentrations during pregnancy, mode of delivery and child BMI at 5 years of age. Diet and lifestyle measures that target maternal glucose levels during pregnancy may have lifelong benefits for children's BMI. Identifying those on an accelerated growth trajectory during fetal life provides a unique opportunity for antenatal and infant interventions that may have long-lasting health benefits.

Intuitive eating in youth: Its relationship with nutritional status

ABSTRACT Objective To determine intuitive eating in young adults and the effects of factors such as gender, Body Mass Index and dietary intake, and dietary adequacy on intuitive eating. Methods This cross-sectional study was conducted with students at Gazi University in Ankara (N=665; 17.6% men; 82.4% women). The questionnaire, including the general characteristics, anthropometric measurements, Intuitive Eating Scale-2, and 24-H Dietary Recall sections, were applied to all participants. For the evaluation of the diet, Nutrient Adequacy Ratio and Mean Adequacy Ratio were used. Results The mean Intuitive Eating Scale-2 score was 3.2±0.33; men’s and women’s scores were 3.3±0.37 and 3.2±0.32, respectively (p<0.05). According to linear regression analysis, gender, age and mean adequacy ratio had an effect on the model for the score (p<0.05). In addition, there was a negative correlation between Intuitive Eating Scale-2 scores and Body Mass Index values in women (rp=-0.095, p=0.026). Conclusion The intuitive eating scores varied according to gender, dietary adequacy and age. Intuitive eating may be effective in the formation of long-term behavioral changes, which is beneficial for the treatment of obesity. The result of this study may encourage the development of this behavior in groups (may vary according to gender), that is thought to be effective by considering the changes of intuitive eating behavior.

Are emotionally driven and addictive-like eating behaviors the missing links between psychological distress and greater body weight?

There is now a large body of evidence suggesting a significant association between emotional discomfort management, disordered eating behaviors and weight status. In the field of overweight and obesity, emotionally driven eating habits that resemble addictive behaviors are considered as a risk factor. This study aimed to investigate in a large sample of French university students 1) the associations between self-reported levels of psychological distress (PD), emotional eating (EE), food addiction (FA) and Body Mass Index (BMI); and 2) the potential mediation effect of eating behaviors (EE and FA) between PD and BMI. The responses of 1051 students (76.3% females) to self-reports assessing PD (Perceived Stress Scale, Hospital Anxiety and Depression Scale), EE (Intuitive Eating Scale-2) and FA (modified Yale Food Addiction Scale) were analysed. Associations between variables (Spearman correlation) and group comparisons by sex and BMI categories (Student's t tests/ANOVA) were tested, followed by Structural Equation Modeling (SEM) by sex. Among females and males, EE and FA scores were positively inter-related and correlated with PD scores and BMI. Moreover, among females and males, SEM showed that both EE and FA acts as mediators between PD and BMI. Hence, among educated young adults, using food consumption for down-regulating negative mood places the individual at risk for overweight and obesity. This study further emphasizes the necessity to take into account emotionally driven and addictive-like eating behaviors in interventions for promoting healthy eating and weight management.

Associations between body weight status, psychological well-being and disordered eating with intuitive eating among Malaysian undergraduate university students

Intuitive eating, which can be defined as reliance on physiological hunger and satiety cues to guide eating, has been proposed as a healthy weight management strategy. To date, there has not been a published study on intuitive eating in the context of Malaysia. Therefore, this cross-sectional study aims to determine associations between body weight status, psychological well-being and disordered eating behaviors with intuitive eating among undergraduate university students. A total of 333 undergraduate respondents (21.3% males and 78.7% females) from three randomly selected faculties in a public university in Malaysia participated in this study. Respondents completed a self-administered questionnaire which featured socio-demographic characteristics, intuitive eating, self-esteem, body appreciation, general unconditional acceptance, body acceptance by others, body function and disordered eating. Body weight, height, body fat percentage and waist circumference were measured. The results from this study revealed that there was no difference (t = 0.067, p = 0.947) in intuitive eating scores between males (75.69 ± 7.16) and females (75.62 ± 7.90). Multiple linear regression results have shown that body appreciation (β = 0.385, p < 0.001) and disordered eating (β = -0.168, p = 0.001) were significant predictors of intuitive eating, which accounted for 19.6% of the variance in intuitive eating. Health promotion programs should highlight the importance of enhancing body appreciation and preventing disordered eating behaviors among university students in order to promote intuitive eating as one of the healthy weight management approaches.

Permissive flexibility in successful lifelong weight management: A qualitative study among Finnish men and women

Maintaining normal weight in the current obesogenic environment is a challenge. However, some people can do it. More insight is needed to understand how and why some people succeed in long-term weight maintenance. This study uses a rare, qualitative approach by describing the thoughts of successful weight management and self-perceived requirements for success in weight maintenance. We interviewed 39 individuals who have maintained normal weight for their entire lives (men and women). The content analysis revealed a main theme: flexible, permissive and conscious self-regulation, which was divided into two subthemes (eating-related behavior and weight-related behavior). The informants reported certain routines that supported their weight management: regular eating, sufficient meal sizes, eating in response to hunger, healthy and vegetable-rich diet along with moderate feasting and flexible eating restriction. Flexibility in routines allowed freedom in their eating behavior. In addition, informants regarded themselves as physically active, and they enjoyed regular exercise. Regular weighing was generally considered unnecessary. Normal weight was regarded as a valuable and worthwhile issue, and most of the informants worked to keep their weight stable. Although the perceived workload varied among informants, the weight management strategies were similar. It was crucial to be conscious of the balance between eating and energy consumption. Further, flexibility characterized their behavior and was the basis of successful weight management. Women were more aware of weight control practices and knowledge than men, but otherwise, women and men reported similar weight management methods and attitudes. In conclusion, the interviewees who have maintained the normal weight had created a personal weight-management support environment where weight management was a lifestyle.

Can patients with eating disorders learn to eat intuitively? A 2-year pilot study

The present article reports on a 2-year pilot study that evaluated the effectiveness of an intuitive eating program for patients in an eating disorder treatment center. Standardized measures of intuitive eating and eating disorder and psychological symptoms were administered. Psychotherapists and dietitians rated patients on the healthiness of their eating attitudes and behaviors. Preliminary findings indicated that patients can develop the skills of intuitive eating, and that the ability to eat intuitively is associated with positive treatment outcomes for each diagnostic category (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified). We conclude by offering recommendations about how to implement intuitive eating training safely and effectively in inpatient and residential treatment programs.