Intuitive eating and its association with psychosocial health in adults: A cross-sectional study in a representative Canadian sample

Mediating effect of depression between self-esteem, physical appearance comparison and intuitive eating in adults

The first aim of the study is to clarify the associations between intuitive eating, self-esteem, physical appearance and psychological distress; and second, to assess the mediating effect of psychological distress on the relationship between self-esteem/physical appearance comparison and intuitive eating. A total of 359 Lebanese participants from several Lebanese governorates were enrolled in this cross-sectional study between September and November 2022. The data was collected through an online questionnaire that included the following scales: Intuitive Eating Scale‑2, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale, and Physical Appearance Comparison Scale. The results of the mediation analysis showed that depression partially mediated the association between self-esteem / physical appearance comparison and intuitive eating. Higher self-esteem was significantly associated with lower depression; higher depression was significantly associated with more intuitive eating. Also, higher self-esteem was directly and significantly associated with more intuitive eating. On another hand, higher physical appearance comparison was significantly associated with higher depression; higher depression was significantly associated with more intuitive eating. Finally, higher physical appearance comparison was directly and significantly associated with less intuitive eating. The current study shows how significantly intuitive eating, an adaptive eating pattern, and psychological variables are interrelated and possibly affect each other. It helps shed light on intuitive eating, a somewhat unfamiliar eating pattern within the Lebanese population. These findings allow practitioners to promote healthy eating behaviors and psychological health by educating and guiding patients and clients about intuitive eating.

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.

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.

Profiles of intuitive eating in adults: the role of self-esteem, interoceptive awareness, and motivation for healthy eating

OBJECTIVE

Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach.

DESIGN

Cross-sectional study.

SETTING

Lebanese governorates.

PARTICIPANTS

359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES).

RESULTS

Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015).

CONCLUSIONS

Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating.

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.

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.

Construct validity and reliability of the Canadian Eating Practices Screener to assess eating practices based on 2019 Canada's Food Guide recommendations

For the first time since its introduction, the 2019 Canada's Food Guide (2019-CFG) highlighted specific guidance on eating practices, i.e., recommendations on where, when, why, and how to eat. The Canadian Eating Practices Screener / Questionnaire court canadien sur les pratiques alimentaires was developed to assess eating practices based on the 2019-CFG healthy eating recommendations. The objective of this cross-sectional study was to assess the construct validity and reliability of the Canadian Eating Practices Screener. From July to December 2021, adults (n = 154) aged 18-65 years completed a sociodemographic questionnaire and the screener. Construct validity was assessed by examining variability in screener scores, by comparing screener scores among subgroups with hypothesized differences in eating practices, and by examining the correlation between screener scores and fruit and vegetable intake. Reliability, i.e., internal consistency, was assessed by calculating Cronbach's coefficient alpha. Screener item scores were summed to provide a total score ranging from 21 to 105. The mean screener score was 76 (SD = 8.4; maximum, 105), ranging from 53 (1st percentile) to 92 (99th percentile). Differences in total scores in hypothesized directions were observed by age (p = 0.006), perceived income adequacy (p = 0.09), educational attainment (p = 0.002), and smoking status (p = 0.09), but not by gender or health literacy level. The correlation between screener scores and fruit and vegetable intake was 0.29 (p = 0.002). The Cronbach's coefficient alpha was 0.79, suggesting acceptable to high internal consistency. Study findings provide preliminary evidence of the screener's construct validity and reliability, supporting its use to assess eating practices based on the 2019-CFG healthy eating recommendations.

Compensatory health motivations and behaviors scale: Development, evaluation, psychometric properties and a preliminary validation

The "Compensatory Health Beliefs" scale assesses the degree to which one believes that unhealthy behaviours can be compensated through healthier ones. However, no validated scale to assess compensatory weight-related behaviors exists. The study's objective was to develop (Study 1) and validate (Study 2) a questionnaire measuring compensatory health motivations and behaviors (CHMB) and to assess their associations with body mass index (BMI) and psychological weight-related measures. An initial 34-item measure was constructed based on a target sample's (Study 1, n = 158) suggestions and refined based on expert feedback. The measure was then tested in a representative Canadian adult sample (N = 1400, 48.7% male). The sample was stratified by sex and age and then randomly split into two (N = 701 for exploratory factor analysis; N = 699 for confirmatory factor analysis (CFA) cross-validation). Fit indices, standardized Cronbach's alphas and the associations between the CHMB model with cognitive restraint, weight concerns, and BMI were assessed in multiple linear regression models controlling for age and sex. The final CHMB model (n = 17 items) consisted of four subscales: (1) motivation, (2) use on special occasions, (3) general use, (4) compensatory health beliefs. Fit indices (Goodness of Fit Index = 0.922) and Cronbach's alphas were good (α = 0.88). In multiple linear regression models, all CHMB subscales were associated with greater cognitive restraint in eating. Compensatory behavior use on special occasions was associated with greater weight concern (B = 0.12, p < .0001), while general compensatory behavior use was associated with lower weight concern (B = -0.07, p < .05). None of the subscales were associated with BMI. The validated CHMB scale allows for the assessment of compensatory health motivations and behaviors in a Canadian population. Research on whether this scale can predict weight changes and general health is needed.

Family cohesion and intuitive eating in Chinese college students: A serial mediation model

Improving intuitive eating can effectively prevent emotional eating, restrained eating, and overeating, and help improve people's physical and mental health. Based on the acceptance model of intuitive eating, ecological systems theory, family stress model, and transactional model of stress and coping, the present study aimed to explore the relationship between family cohesion and intuitive eating and its underlying mechanisms through a cross-sectional study design. A random sample of 702 college students from 29 provinces in China, aged from 18 to 26 years (54.56% male, M age = 21.12 years), voluntarily participated in the survey. Demographic variables, family cohesion, intuitive eating, perceived stress, and coping style were measured. The results indicated that family cohesion was significantly positively correlated with intuitive eating and the direct effect between them was significant. Meanwhile, there was a significant indirect effect of family cohesion on intuitive eating through perceived stress and positive coping styles. Moreover, perceived stress and positive coping styles, rather than negative coping styles, acted as serial mediators in the association between family cohesion and intuitive eating. The findings shed light on the prevention and intervention for disordered eating and obesity and provided a new theoretical perspective for the mental health education of college students. In addition, implications and directions for future research were also discussed.

Sex and ethnic/racial differences in disordered eating behaviors and intuitive eating among college student

Introduction

Eating behaviors encompass disordered eating behaviors (e.g., overeating, binge eating, and associated symptoms of binge eating) and intuitive eating. Certain disordered eating behaviors, including binge eating, are more prevalent among female and ethnic/racial-minority college students than male and/or non-Hispanic White college students. However, sex and ethnic/racial differences among college students with other disordered eating (e.g., associated symptoms of binge eating) and intuitive eating behaviors remain unclear.

Methods

In 2022, 887 college students (Mage = 20.9 ± 2.6 years) self-reported their sex, ethnicity/race, disordered eating behaviors (e.g., overeating, binge eating, associated symptoms of binge eating), and intuitive eating. To examine sex and ethnic/racial differences among these students, we used modified Poisson regressions for students who reported disordered eating and linear regressions for students who reported intuitive eating.

Results

Except for overeating, disordered eating behaviors were more prevalent among female [adjusted prevalence ratio (aPR) = 1.3-1.8] than male college students after adjusting for sociodemographic variables, whereas intuitive eating scores did not differ by sex. Across ethnic/racial groups, disordered eating was more prevalent among all ethnic/racial-minority college students (aPR = 1.2-2.3) than non-Hispanic White college students after adjusting for sociodemographic variables. Moreover, non-Hispanic Black or African American college students had higher intuitive eating scores than non-Hispanic White college students (adjusted β = 0.7, 95% CI = -0.2, 1.6).

Conclusion

In our sample, notable differences emerged in the prevalence of disordered eating behaviors and mean scores by sex and ethnicity/race, while differences in intuitive eating scores emerged based on ethnicity/race.

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.

Psychometric properties of a Greek translation of the Intuitive Eating Scale-2 (IES-2) in adults from Cyprus

The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualized as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793), using exploratory structural equation modelling (ESEM) and beifactor analysis (B-ESEM), indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.

Intuitive eating in Greek-Cypriot adults: Influence of gender and body mass

Introduction

To date, research on eating behaviors has largely taken a pathological approach. Researchers are increasingly taking a positive approach to explore adaptive eating styles. One such style that has recently received much research attention is intuitive eating. Recent work examining intuitive eating and its relationships with body mass and gender has yielded mixed findings. The current study explored the differential effects of gender and body mass on intuitive eating scores in a sample of Greek-Cypriot adults.

Method

A total of 1,312 adult participants (women n = 655; M _age = 34.49) completed the Intuitive Eating Scale-2 and provided demographic information.

Results

Our analyses revealed that men reported significantly higher intuitive eating scores than women. Body mass was significantly inversely associated with intuitive eating in both men and women. Additionally, a multivariate analysis of variance (MANOVA) indicated significant interaction effects between gender and body mass on intuitive eating. These interaction effects were explored for each of the four subscales of intuitive eating, identifying differential associations for intuitive eating and BMI between men and women.

Discussion

Both gender and body mass are important factors which influence intuitive eating levels in Greek-Cypriot adults. Discussions of how these findings can inform future research, theory and practice are presented.