A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women

Motivation to regulate eating behaviors, intuitive eating, and well-being: A dyadic study with mothers and adult daughters

Intuitive eating, defined as relying on physiological cues to determine when, what, and how much to eat while maintaining a positive relationship with food (Tribole & Resch, 1995), has gained a lot of research attention in the last two decades. The present study sought to determine how motivation for regulating eating behaviors is related to intuitive eating and well-being outcomes in dyads of mothers and their adult daughters (n = 214). Structural equation modelling revealed that controlling for dieting and desire to lose weight, both mothers' and daughters' autonomous motivation was positively associated with their own intuitive eating while their controlled motivation was negatively associated with intuitive eating. In turn, intuitive eating was positively associated with well-being in both mothers and daughters. Interestingly, mothers' intuitive eating was also positively related to their daughters' well-being. The analysis of indirect effects suggests that mothers' motivation to regulate eating behaviors has an indirect (mediating) relationship with daughters' well-being through mothers' intuitive eating. The implications for women's health and well-being are discussed.

Revisiting the impact of Health at Every Size® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta-analysis

AIMS

To (1) synthesise evidence from Health at Every Size® interventions on physical and psychological health in people with overweight and obesity and (2) report between-group differences within interventions evaluating the impact of Health at Every Size® interventions on health and health-related outcomes.

METHODS

Six databases (Medline, Embase, Cochrane, PsychInfo, CINAHL, and Scopus) were searched from inception until November 2022. Included studies were conducted in adults with overweight or obesity, used Health at Every Size®-based interventions compared with control interventions and reported dietary, physical and/or psychological outcomes, including diet quality, anthropometry, or quality of life. Data on between-group differences were extracted. Risk of bias was assessed using ROB2. Random-effects meta-analyses were undertaken for outcomes with at least three studies reporting the same or comparable data.

RESULTS

From 128 studies identified, 19 full-text articles (10 unique studies, 6 published since 2017), were included. Meta-analysis found a significant reduction for susceptibility to hunger in Health at Every Size® intervention groups relative to controls (p = 0.005), with no significant difference (p > 0.05) between Health at Every Size® interventions and control groups for anthropometric, psychological or cardiometabolic outcomes (total cholesterol, HDL cholesterol, triglycerides, systolic or diastolic blood pressure).

CONCLUSION

Health at Every Size® interventions had similar results compared with weight-based interventions on anthropometric outcomes and cardiometabolic outcomes. Health at Every Size® interventions had a significant benefit for reducing susceptibility to hunger. The decision to use a Health at Every Size®-based intervention should be personalised to individual needs. Further research in more diverse populations is required using standardised outcome measures to facilitate future meta-analyses.

Associations between body image, eating behavior, and diet quality

Background: Weight-neutral interventions that promote adaptive eating behaviors are becoming a growing area of practice. Understanding whether adaptive eating behaviors are associated with improved diet quality is essential. Body image may be an important factor in this relationship given its close connection to eating behaviors. Aim: The purpose of this study was to develop an understanding of the relationships between positive and negative body image, adaptive and maladaptive eating behaviors, and diet quality. Methods: We recruited 288 adults 18 years and older who were living in the US using Prolific Academic. Participants completed an online survey including measures of positive and negative body image, adaptive and maladaptive eating behaviors, and a dietary screener questionnaire (DSQ). We ran a hierarchical linear regression and tested whether body image and diet quality were mediated by eating behavior. Results: Body image and maladaptive eating behaviors were not associated with diet quality. Body-food choice congruence (B-FCC), an adaptive eating behavior, was associated with diet quality. B-FCC mediated the relationship of positive and negative body image to diet quality. Conclusions: Our findings provide additional support for weight-neutral or adaptive eating interventions as a mechanism to promote diet quality. Additional research may benefit from exploring indirect effects of body image on diet intake, the relationship between eating behavior and diet quality using qualitative data, and the comparison of weight-neutral or non-diet interventions with traditional behavior change interventions.

Do Mindful Eating and Intuitive Eating Affect Beverage Preferences? A Cross-Sectional Survey

Intuitive eating involves following body signals to guide eating decisions and avoiding restrictive diets. Mindful eating is paying full attention to sensory experiences and fostering nonjudgmental awareness. We aimed to elucidate potential relationships between beverage intake and intuitive and mindful eating scores. This cross-sectional exploratory study (October 2021-December 2022) enrolled adult male and female participants who provided sociodemographic and health-related information and subsequently completed the Beverage Intake Questionnaire, the Mindful Eating Questionnaire (MEQ-30), and the Intuitive Eating Scale (IES-2). Bidirectional relationships were observed between beverage intake and intuitive and mindful eating scores. The total beverage intake of males was double compared with that of females, with the intake being mainly derived from sugar-sweetened beverages (p = 0.000). Increased total water intake was positively correlated with IES-2 and its subscale scores and was negatively correlated with MEQ-30 scores in both sexes (p < 0.05). Alcoholic beverage intake was associated with reductions in IES-2 and MEQ-30 scores, whereas unconditional permission to eat increased by 18.3% in males. In females, the consumption of milk-based beverages decreased the IES-2 scores. Understanding the complex relationships between beverage intake and intuitive and mindful eating may deepen our understanding of individual dietary behaviors and inform dietary interventions.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Associations between mind-body practice engagement and diet quality: Exploring the mediating roles of eating behaviour traits and regulation styles for eating behaviours in the PREDISE study

While engaging in Mind-Body Practices (MBPs) may be related to better diet quality, its association with eating behaviours is unclear. This cross-sectional study explores whether eating behaviour traits and regulation style of eating behaviours mediate the association between MBP engagement and diet quality. A total of 418 women and 482 men, aged between 18 and 65 years and recruited as part of the PREDISE study cohort, reported whether they currently practice one or more MBP (e.g., yoga or meditation). Canadian Healthy Eating Index (C-HEI) was calculated from three 24h dietary recalls. Intuitive Eating Scale (IES-2), and Regulation of Eating Behaviour Scale were completed online. Mann-Whitney tests were conducted to compare C-HEI scores of individuals who currently engage in MBPs (practitioners) to those who do not (non-practitioners). Multiple regression analyses and bootstrapping were performed to test whether eating behaviours and regulation style of eating behaviours mediate the association between MBPs and diet quality. Overall, 88 women and 43 men were practitioners. They had higher C-HEI scores than non-practitioners (62.9 ± 13.0 vs. 55.6 ± 14.3; p = 0.001). Parallel mediation model showed significant indirect effects of the IES-2 subscale relating to Body-Food Choice Congruence (β = 1.57, SE = 0.41, 95% CI: 0.86, 2.43), self-determined motivation (β = 1.51, SE = 0.39, 95% CI:0.81, 2.32) and non-self-determined motivation (β = 0.39, SE = 0.21, 95% CI: 0.03, 0.85) on the association between practitioner status and C-HEI. These findings suggest that the current practice of MBPs is associated with better diet quality, mainly through practitioners' higher intuitive eating skills and more self-determined regulation of eating behaviours. Further studies should investigate the potential impacts of MBPs on the development and maintenance of positive eating habits.

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.

Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation

Implementation integrity is known to be critical to the success of interventions. The Health At Every Size® (HAES®) approach is deemed to be a sustainable intervention on weight-related issues. However, no study in the field has yet investigated the effects of implementation on outcomes in a real-world setting.

Healthy orthorexia vs orthorexia nervosa: associations with body appreciation, functionality appreciation, intuitive eating and embodiment

PURPOSE

Current conceptualizations and measures of orthorexia nervosa may not be accurately distinguishing between the healthy vs pathological pursuit of a healthy diet, leading to very high prevalence rates and risking the pathologizing and stigmatizing of healthy eating more generally. Recent research has identified healthy orthorexia as a novel construct conceptually distinct from orthorexia nervosa, which represents the non-pathological pursuit of a healthy diet. In light of the strong body of evidence supporting the role of positive body image in eating behavior, the current study aimed to examine the associations between healthy orthorexia, orthorexia nervosa, intuitive eating and indices of positive body image.

METHODS

The current study employed a cross-sectional design. An online community sample (N = 835; 62% women; M_age = 40.24, SD = 14.45) completed self-report questionnaires including the Teruel Orthorexia Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Intuitive Eating Scale-2, and Experience of Embodiment Scale.

RESULTS

Intuitive eating and indices of positive body image were significantly positively associated with healthy orthorexia and inversely associated with orthorexia nervosa. A hierarchical multiple regression analysis found that intuitive eating and indices of body image were uniquely associated with 13.3% of the variance of healthy orthorexia above and beyond that accounted for by orthorexia nervosa. Intuitive eating moderated the relationship between healthy orthorexia and orthorexia nervosa.

CONCLUSION

The findings of this study provide support for intuitive eating and indices of positive body image as worthy of further exploration as important factors which distinguish between healthy orthorexia and orthorexia nervosa.

LEVEL OF EVIDENCE

V, descriptive study.

Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review

INTRODUCTION

Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality.

METHOD

PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively.

RESULTS

Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed.

DISCUSSION

Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

Sex at every size: A content analysis of weight inclusivity in sexual functioning research

Sexual functioning research has been slow to address sizeism within its volumes. Much of the sexual health science has adopted a weight normative model rather than a weight inclusive model. The purpose of this study was to, through systematic literature review, describe the sexual functioning research landscape with respect to weight inclusivity. The review included three databases (Google Scholar, Medline and Ebsco) between 2010 and 2020. Each article was double coded for weight inclusivity and sexual functioning. Sixty-seven articles met the criteria and were included in analysis. The articles, overall, only endorsed weight inclusive tenets 16 % of the time. Articles were most weight inclusive when discussing sexual satisfaction (22.5 %). Meanwhile, when discussing sexual arousal, the articles were the least weight inclusive (16.7 %). These findings suggest there is needs to be greater education and intention for sex educators, therapists, and clinicians, to explore and enhance body positivity and sexual health.

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.

Intuitive Eating Behavior, Diet Quality and Metabolic Health in the Postpartum in Women with Gestational Diabetes

Little is known regarding intuitive eating (IE), diet quality and adherence. We investigated the associations between IE, diet quality and metabolic health after gestational diabetes (GDM), who have an increased diabetes risk. Data from 179 women with GDM from MySweetheart trial (NCT02872974) were analyzed. IE was assessed using 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. Metabolic outcomes included weight, central body fat and insulin resistance. Diet quality was calculated using the Alternative Health Eating Index (AHEI) and compliance with national recommendations was evaluated. Both IE subscales were associated with lower BMI and fat mass (BIA) at 1-year postpartum (all p ≤ 0.034). The EPR subscale inversely correlated with fat mass (DXA) and visceral adipose tissue (both p ≤ 0.028), whereas RHSC with higher insulin sensitivity (Matsuda, p = 0.034). RHSC during pregnancy predicted increased AHEI (p = 0.043) at 1-year postpartum, whilst EPR predicted lower fat mass and insulin resistance (HOMA-IR) (all p ≤ 0.04). In longitudinal analyses, both subscales were associated with increased adherence to dairy and fiber intake recommendations (both p ≤ 0.023). These data suggest IE may be an interesting approach to improve diet quality and metabolic outcomes in women with GDM.

Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles

INTRODUCTION

Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity.

METHODS

This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted.

RESULTS

Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps.

CONCLUSION

The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.

Intuitive eating and dietary intake

Intuitive eating has been associated with positive health benefits, yet the research investigating intuitive eating with dietary intake is minimal, inconsistent, and may differ by sex and food security status. The purpose of this study is to identify relationships between intuitive eating and dietary intake in adults living in the US and explore differences by sex and food insecurity status. We recruited 308 adults 18 years and older living in the US to complete an online survey including demographic data, intuitive eating, a diet screener questionnaire, and food insecurity status. We used structural equation modeling to analyze relationships between intuitive eating subscales, calcium, whole grains, added sugars, vegetables, and fruits. Then, we explored differences by sex and food security status. Unconditional permission to eat was associated with a higher intake of added sugar, while body-food choice congruence was associated with a lower intake of added sugar and calcium, and a higher intake of vegetables and whole grains. Eating for physical rather than emotional reasons was associated with a higher intake of calcium and vegetables. Intuitive eating differed by sex and food security status. While intuitive eating is not consistently related to the intake of more nutritious foods, eating for physical rather than emotional reasons and body-food choice congruence may promote diet quality in a community sample. Men and food secure adults scored higher in intuitive eating suggesting tailored intuitive eating interventions may be essential to increase effectiveness.

The relationship between intuitive eating, eating disorders, and body image perceptions in young adult women

BACKGROUND: The term intuitive eating is a new concept that has emerged in recent years. It is a way of eating that is based on responding to the body’s natural signals of hunger and satiety. OBJECTIVE: The study was conducted to evaluate the relationship between intuitive eating and eating disorders and body image perception in young adult women. METHODS: The study was conducted with 400 women aged 19–35 years. The data were collected with the Figure Rating Scale, the Intuitive Eating Scale-2 (IES-2), and the Eating Attitude Test-26. RESULTS: The mean body mass index was significantly higher in individuals who misperceived their body image. While 51.4% of the participants with normal eating behavior had appropriate body image perception, 38.8% of the participants with abnormal eating behavior had appropriate body image perception. The IES-2 total score was significantly lower in women with abnormal eating behavior and overweight/obese women. CONCLUSIONS: Our findings showed that intuitive eating is negatively associated with abnormal eating behavior and obesity in young adult women and that women with low intuitive eating inclinations misperceived their body image.

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.

Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs

Achieving women's health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women's preoccupations with their bodies by focusing outcomes toward achieving an "ideal" body size. Women's health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women's health. Seven themes resulted, of which five describe key empowering features (active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics (assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.

Use of the Healthy Eating Index in Intervention Studies for Cardiometabolic Risk Conditions: A Systematic Review

Researchers and counselors need diet-assessment tools that characterize diet at baseline and over time in diet counseling and coaching interventions. Among possible tools, the Healthy Eating Index (HEI) is of interest in cardiometabolic treatment as it has undergone significant validation and development. The objective of this study was to systematically review relevant intervention studies using the HEI and its adaptations to examine whether diet interventions improve diet quality as measured by the HEI and the magnitude of change in included diet-quality scores following dietary intervention. Two databases [Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed] were searched for articles published from January 1995 to December 2019. The review included intervention studies in adults presenting with overweight/obesity and obesity-related chronic disease (metabolic syndrome, diabetes, prediabetes, hypertension, dyslipidemia) who received education or counseling, and the HEI was evaluated from baseline to follow-up (US or Canadian version) or Alternate HEI. Study quality was assessed using Cochrane risk of bias for randomized controlled trials (RCTs) or Cochrane Risk of Bias for Nonrandomized interventions (ROBINS-I). A total of 25 studies were included: 15 RCTs, 3 quasi-experimental studies, and 7 pre-post studies. Eight different versions of the HEI were used. Results demonstrated that diet quality assessed by HEI and its adaptations improved to a clinically relevant degree, especially in studies where multiple food behaviors/food-behavior goals were the focus and where an intensive, long-term intervention was compared with a no-treatment control group. There was wide variation in magnitude of change in included diet-quality indicators. Use of the HEI and its adaptations and other diet-quality tools is promising for better characterization of diet-counseling interventions and results when multiple food behaviors are a focus. Additional development is encouraged.

Nondiet Weight-Neutral Curricula Limited in Current Accredited US Dietetic Programs

OBJECTIVE

Determine awareness and prevalence of, and interest in nondiet weight-neutral (NDWN) focused curriculum and factors associated with the presence in accredited dietetic programs throughout the US.

METHODS

Online cross-sectional survey sent to directors of US Coordinated Programs (n = 60) and Didactic Programs in Dietetics (n = 214).

RESULTS

116 programs (42%) responded, 95% reported knowledge of NDWN approaches to weight management like Health at Every Size. Most schools (72%) included NDWN in their curriculum, mostly in a single lecture (53%). Most respondents (74%) reported interest in an NDWN curriculum. Common factors for not including NDWN were: lack of trained and knowledgeable staff (35%) and insufficient space in the curriculum to incorporate additional topics (35%).

CONCLUSIONS AND IMPLICATIONS

Most knew of NDWN approaches and included in curricula but only as 1 lecture. Faculty training and curriculum flexibility may help support the increased incorporation of NDWN approaches.

Health professionals' perceptions of weight loss programmes and recommendations for future implementation: a qualitative study

OBJECTIVE

Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional's perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities.

DESIGN

A phenomenological-hermeneutical qualitative study was performed using semistructured interviews.

SETTING

Thirty-two Danish municipalities were weight loss programmes are developed and conducted.

PARTICIPANTS

Thirty-five health professionals with experience conducting weight loss programmes.

RESULTS

Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life.

CONCLUSION

Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.

Strategies designed to increase the motivation for and adherence to dietary recommendations in patients with chronic kidney disease

Chronic kidney disease (CKD) often requires several dietary adjustments to control the disease-related disturbances. This is challenging for both patients and healthcare providers, and particularly for dietitians, who deal closely with the poor adherence to dietary recommendations. Factors associated with poor adherence within the CKD scenario and the need for a shift in the paradigm have already been indicated in several studies; however, rarely are any different and/or potential strategies actually formulated in order to change this paradigm. In this review, we aimed to explore the concepts and factors surrounding adherence to dietary recommendations in CKD and further describe certain potential strategies for a nutritional counseling approach. Such strategies, while poorly explored within CKD, have shown positive results in other chronic disease scenarios. It is timely, therefore, for healthcare providers to acquire these new counseling skills; nevertheless, this would require a rethinking of the traditional attitudes and approaches in order to build a partnership, based on a nonjudgmental and compassionate style in order to guide behavior change. The reflections presented in this review may contribute towards enhancing motivation and the adherence to dietary recommendations in CKD patients.

How is intuitive eating related to self-reported and laboratory food intake in middle-aged adults?

As intuitive eating (IE) is characterized by eating in response to internal cues of hunger and satiety and by monitoring the effect of food on the body, it has been hypothesized to lead to healthy food intake. Evidence concerning its link to food intake is scarce. This experimental study investigated the relationship between IE and food intake in middle-aged adults. Fifty-five participants aged 50-70 years completed the Intuitive Eating Scale-2 to measure IE. Usual consumption frequency of fruits, vegetables, snacks and sweets was assessed as a measure of healthy self-reported food intake. A taste test of apples, carrots, coated peanuts and chocolate was conducted as a measure of healthy and total laboratory food intake. Regression analyses were performed using Frequentist and Bayesian methods of inference. In line with our hypothesis, IE was associated with healthier self-reported food intake (medium effect size: f² = 0.24). The data were 49.80 times more likely under H₁ than under H₀. Contrary to our hypotheses, IE was neither associated with healthy nor total laboratory food intake in classical regression analyses. The accompanying Bayes factors revealed inconclusive evidence. Data only allow drawing cautious conclusions about the different relationship between IE and the self-reported consumption frequency of the foods vs. the amount of these foods consumed in a single test situation. Future studies combining different measures of IE (e.g., behavioral paradigms) and self-reported (e.g., diet quality, portion sizes) and laboratory (e.g., repeated taste tests with pre-selected foods) food intake are warranted to further explore their relationship.

Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: a systematic review and meta-analysis

Context

Weight-neutral approaches for health are emerging therapeutic alternatives to traditional weight-loss approaches. The existing literature base comparing these approaches has not yet been systematically evaluated by a meta-analysis.

Objective

This review aims to determine if weight-neutral approaches are valid alternatives to weight-loss approaches for improving physical, psychological, and behavioral health outcomes.

Data Sources

Embase, Scopus, PsycINFO, PubMed, CINAHL, and the University of Queensland Library databases were searched.

Study Selection

Peer-reviewed, experimental, or quasi-experimental studies that included weight-neutral and weight-loss arms and reported physical, psychological, or behavioral outcomes were eligible. A total of 525 studies were identified through initial database searches, with 10 included in the final analysis after exclusion criteria were applied.

Data Extraction

Screening and eligibility assessment of studies followed the PRISMA protocol. The following outcomes were extracted: weight, body mass index, lipid and glucose variables, blood pressure, eating behavior, self-esteem, depression, quality of life, physical activity, and diet quality.

Data Analysis

Studies were graded per the National Health and Medical Research Council (NHMRC) level-of-evidence tool and the Academy of Nutrition and Dietetics quality-evaluation tool. Effect sizes were examined as a meta-analysis of standardized and mean differences using a random-effects inverse-variance model with 95%CIs. Practice recommendations for each outcome were graded per NHMRC body-of-evidence guidelines.

Conclusions

Weight-neutral approaches resulted in greater improvement in bulimia (P = 0.02), but no significant differences were observed for any other outcome. Weight-neutral approaches may be as effective as weight-loss methods for improving physical, psychological, and behavioral outcomes. Limitations include inconsistent definitions of both approaches and variable time frames of follow-up.

Associations Between Intuitive Eating Behaviors and Fruit and Vegetable Intake Among College Students

OBJECTIVE

To assess associations between intuitive eating behaviors and fruit and vegetable intake among college students.

METHODS

Intuitive eating behaviors were measured with the Intuitive Eating Scale-2 (IES-2), which reports a total and 4 subscale scores. Fruit and vegetable intake was measured with the National Institutes of Health Eating at America's Table Fruit and Vegetable screener. Questionnaires were completed online.

RESULTS

Median age of participants was 20 years (n = 293; n = 72 male). Total IES-2 score was not correlated with fruit and vegetable intake. Body-Food Choice Congruence and Eating for Physical Rather Than Emotional Reasons subscales were positively associated with fruit and vegetable intake (r = .462, P < .001 and r = .177, P = .002, respectively). The Unconditional Permission to Eat subscale was negatively associated with fruit and vegetable intake (r = -.308, P < .001).

CONCLUSIONS AND IMPLICATIONS

Correlations between fruit and vegetable intake and intuitive eating behaviors differed by IES-2 subscale scores. If IES-2 is used in nutrition research, education, or counseling with the aim of increasing fruit and vegetable intake, addressing subscale behaviors individually might be considered.

Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach

INTRODUCTION

Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure.

OBJECTIVE

We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach.

DESIGN

The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis.

PARTICIPANTS

Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group.

RESULTS

Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating.

CONCLUSION

HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.

Intuitive eating and food intake in men and women: Results from the Swiss food panel study

Although intuitive eating (IE) interventions have consistently shown benefits for psychological wellbeing and some have shown improvements in physical wellbeing, there is scarce information on the relationship between IE and food intake. Given the popularity of IE as an alternative to dieting, it's important to explore its relationship with food intake. The relationships between IE, Body Mass Index (BMI), diet quality, self-evaluation of dietary intake and physical activity were investigated. A randomly selected sample of adults from the German and French-speaking parts of Switzerland (N = 5,238, 51% men, 20-100 years, BMI 15-62 kg/m²) completed a self-administered questionnaire comprising measures of a diverse range of eating related variables. Intuitive Eating was assessed with the IES-2. Food intake was measured with a semiquantitative food frequency questionnaire. Pearson correlations between the IES-2 and variables of interest were calculated for men and women separately. Although total IES-2 scores showed moderate negative correlations with BMI in men and women, the four IES-2 subscales showed different relationships with food intake. In contrast to the other subscales, unconditional permission to eat moderately correlated with poorer diet quality scores, and consistently showed associations with a more negative self-evaluation of eating behavior. The other three IES-2 subscales showed a few small positive and negative correlations with food intake, including small positive associations of diet quality scores in women, but not men, with eating for physical rather than emotional reasons and reliance on hunger and satiety cues. Further studies are needed to determine the impact of IE interventions on food intake.

Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec

Purpose:

To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting.

Design:

Quasi-experimental design evaluating eating behaviors and psychological factors.

Setting:

The HAES intervention is offered in Health and Social Services Centers in Québec (Canada).

Participants:

For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group.

Intervention:

The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating.

Measures:

Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up.

Analysis:

Group, time, and interaction effects analyzed with mixed models.

Results:

Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive–compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term.

Conclusion:

The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.

Benatti F, Lopes de Campos-Ferraz P, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Macedo Rogero M, Toporcov TN, de Sá-Pinto AL, Gualano B, B. Scagliusi F. Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study

Health at Every Size® (HAES®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women. This was a prospective, seven-month, randomized (2:1), controlled, mixed-method clinical trial. The intervention group (I-HAES®; n = 39) took part in an intensified HAES®-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES®-based intervention. Before and after the interventions, participants were assessed for physiological, psychological, and behavioral parameters (quantitative data) and took part in focus groups (qualitative data). Body weight, body mass index, and waist and hip circumferences did not significantly differ within or between groups (P > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, even though the majority of the I-HAES® participants indicated that they were engaged in or had plans to include physical activity in their routines. I-HAES® resulted in improvements in eating attitudes and practices. The I-HAES® group showed significantly improved all Body Attitude Questionnaire subscale and all Figure Rating Scale scores (P ≤ 0.05 for all parameters, within-group comparisons), whereas the CTRL group showed slight or no changes. Both groups had significant improvements in health-related quality of life parameters, although the I-HAES® group had superior gains in the "physical health," "psychological health," and "overall perception of quality of life and health" (P = 0.05, 0.03, and 0.02, respectively, between-group comparisons) domains. Finally, most of the quantitative improvements were explained by qualitative data. Our results show that this new intensified HAES®-based intervention improved participants' eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels, showing that our novel approach was superior to a traditional HAES®-based program.

Development of the Health and Weight Attitudes Scale

OBJECTIVE

To develop and validate an instrument to assess attitudes toward Health at Every Size (HAES) principles.

METHODS

Survey items were generated based on 5 HAES principles. A panel of reviewers was recruited to establish content validity. A convenience sample of college students in health education was recruited for pilot survey administration. Internal reliability was assessed using Cronbach α and test-retest reliability was assessed with Pearson correlation.

RESULTS

Three panelists reviewed the instrument and provided feedback for revision. Cronbach α for the final instrument was .75 (n = 43) at pretest and .78 (n = 53) at posttest, and Pearson correlation was 0.85 (n = 39), indicating internal consistency and test-retest reliability.

CONCLUSIONS AND IMPLICATIONS

The instrument was determined to be both a valid and reliable instrument to measure HAES attitudes among college students in health education. Nutrition educators may find this instrument useful in other settings to assess HAES attitudes or as an alternative to other instruments measuring anti-fat attitudes.

Implementation Intention for Initiating Intuitive Eating and Active Embodiment in Obese Patients Using a Smartphone Application

This article describes a study protocol, which aims to explore and describe the feasibility of a mobile-phone application for initiating intuitive eating and intuitive exercising in patients who are following an ambulatory treatment for obesity. Intuitive eating refers to one's ability to make food choices based on one's awareness of his/her body's response. Intuitive exercising encourages people in finding enjoyable ways of being physically active. These two components will be trained using an implementation intention procedure, that is, behavioral plans that aim at creating a strong link between a specified situation and a response. We aim to recruit up to 80 overweight and obese patients over a period of 2 years. The smartphone application will be assessed on the basis of (i) data obtained through a 4-week use period, (ii) self-report measures taken before and after the use of the mobile application, and (iii) feedbacks from participants after the use of the mobile application. This pilot study will allow us to better understand the applicability of the use of mobile application within ambulatory treatment settings, and to adapt the design of the app necessary for building cross-sectional studies investigating its efficacy.

Influence of Nutrition Claims on Appetite Sensations according to Sex, Weight Status, and Restrained Eating

Nutrition claims may help people to adopt healthier eating habits, but little is known about the potential cognitive effects of such claims on appetite sensations. The main purpose of this study was to evaluate the impact of nutrition claims and individual factors on perceived appetite sensations. According to a three ("healthy" versus "diet" (i.e., satiating) versus "hedonic") by two (restrained or not restrained) by two (normal-weight or overweight/obese) by two (men versus women) factorial design, 164 males and 188 females aged 18-65 were invited to taste an oatmeal-raisin snack in a blinded and ad libitum context. Visual analog scales (150 mm) were used to evaluate appetite sensations before and over 1 h after consumption period. BMI and Restraint Scale were used to categorize participants according to their weight and restraint status. No main condition effect was observed for any of the four appetite sensations. However, subgroups analysis revealed significant differences among specific subgroups. A main effect of sex was also observed for all appetite sensations with men reporting higher levels of desire to eat, hunger and prospective food consumption, and lower levels of fullness than women. These findings highlight the importance of considering individual characteristics in interaction when studying appetite sensations.