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Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns

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Rigid dietary control, flexible dietary control, and intuitive eating: Evidence for their differential relationship to disordered eating and body image concerns

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This study aimed to replicate and extend from Tylka, Calogero, and Daníelsdóttir (2015) findings by examining the relationship between rigid control, flexible control, and intuitive eating on various indices of disordered eating (i.e., binge eating, disinhibition) and body image concerns (i.e., shape and weight over-evaluation, body checking, and weight-related exercise motivations). This study also examined whether the relationship between intuitive eating and outcomes was mediated by dichotomous thinking and body appreciation. Analysing data from a sample of 372 men and women recruited through the community, this study found that, in contrast to rigid dietary control, intuitive eating uniquely and consistently predicted lower levels of disordered eating and body image concerns. This intuitive eating-disordered eating relationship was mediated by low levels of dichotomous thinking and the intuitive eating-body image relationship was mediated by high levels of body appreciation. Flexible control predicted higher levels of body image concerns and lower levels of disordered eating only when rigid control was accounted for. Findings suggest that until the adaptive properties of flexible control are further elucidated, it may be beneficial to promote intuitive eating within public health approaches to eating disorder prevention. In addition to this, particular emphasis should also be made toward promoting body acceptance and eradicating a dichotomous thinking style around food and eating.

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... Significant feelings of guilt and food craving have also been reported by those with a high Disinhibition [44] and high EE [35], where the craving was subsequently related to binge eating and obesity. Furthermore, Disinhibition has been found to be negatively associated with intuitive eating and body appreciation [74]. Thus, a pattern of behaviors associated with disturbed eating patterns and poorer mental health for those with a high Disinhibition emerges, which is compounded by a lower tolerance to adverse emotional states. ...
... The association of Restraint with higher eating disordered attitudes is not always expressed in energy restriction; evidence suggests that in female students, Restraint resulted in sub-optimal energy consumption relative to physiological need as a result of higher physical activity rather than energy restriction [28]. In support of this, Linardon and Mitchel [74] found that both Flexible and Rigid Restraint predicted exercising for weight loss and body checking, while Rigid Restraint predicted over-evaluation of weight and shape. In this study, Restraint was found to be a strong predictor of both disordered eating and negative body image [74]. ...
... In support of this, Linardon and Mitchel [74] found that both Flexible and Rigid Restraint predicted exercising for weight loss and body checking, while Rigid Restraint predicted over-evaluation of weight and shape. In this study, Restraint was found to be a strong predictor of both disordered eating and negative body image [74]. Surprisingly, no relationship between mindful eating and Restraint has been found [34]. ...
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Purpose of Review Literature from the past five years exploring roles of Three-Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition in relation to adult obesity and eating disturbance (ED) was reviewed. Recent Findings Restraint has a mixed impact on weight regulation, diet quality, and vulnerability to ED, where it is related detrimentally to weight regulation, diet, and psychopathology, yet can serve as a protective factor. The impact of Disinhibition is potently related to increased obesity, poorer diet, hedonically driven food choices, and a higher susceptibility to ED. Summary Restraint and Disinhibition have distinct influences on obesity and ED and should be targeted differently in interventions. Further work is required to elucidate the mechanisms underlying TFEQ eating behavior traits.
... In particular, restrained and emotional eating have been found to be associated with elevated weight status and poor mental health (Mitchison et al., 2017;Vlahoyiannis & Nifli, 2020). In contrast, intuitive eating has been associated with lower weight status and psychological well-being (Avalos & Tylka, 2006;Lindardon & Mitchell, 2017;Ruzanska & Warschburger, 2019). This study expands this research by examining the extent to which these eating styles are related to psychological well-being (i.e. ...
... to be associated with greater weight stability and lower weight status among adults (Ruzanska & Warschburger, 2019), body satisfaction, body appreciation (Avalos & Tylka, 2006;Linardon & Fuller-Tyszkiewicz, 2021;Lindardon & Mitchell, 2017), self-esteem (Tylka, 2006;Tylka & Wilcox, 2006) and overall mental health (Soulliard & Vander Wal, 2019). Those who appreciate their body have been shown to be more aware of their bodily needs such as internal hunger and satiety signals, which seems to lead to both intuitive eating and well-being (Gillen & Markey, 2015;Linardon & Fuller-Tyszkiewicz, 2021). ...
... Finally, the cross-sectional nature of these data prevent causal and temporal interpretations. Our findings are consistent with the Acceptance Model of Intuitive Eating (Augustus-Horvath & Tylka, 2011) and past research (Lindardon & Mitchell, 2017;Tylka & Wilcox, 2006), but it is possible that individuals with higher self-esteem or body satisfaction find themselves more easily motivated to maintain adaptive, more intuitive eating habits, for example. Since individuals with higher BMIs were found to report lower body satisfaction, we cannot rule out the possibility that BMI contributes to the association between eating styles and body satisfaction or self-esteem. ...
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Introduction: Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample. Method: Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey. Results: Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries. Conclusion: Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.
... Flexible restraint, however, reflects a more graded approach to dieting, defined by behaviors such as allowing oneself to eat a wide variety of food types while still paying attention to weight/shape, and opting for "healthier" foods if "unhealthier" foods were consumed earlier. When controlling for rigid restraint, several cross-sectional studies have reported inverse relationships between flexible restraint and binge eating (Linardon & Mitchell, 2017;Smith, Williamson, Bray, & Ryan, 1999;Westenhoefer et al., 1999), and increases in flexible restraint during BED treatment have been associated with binge eating abstinence (Blomquist & Grilo, 2011), suggesting that a flexible form of restraint may be a healthier alternative to a rigid form. ...
... First, behaviors and cognitions that are characteristic of rigid restraint seem to increase risk for, or correlate highly with, binge eating patterns, whereas intuitive eating and flexible restraint behaviors seem to decrease this risk. Second, prior work has reported strong bivariate correlations between flexible and rigid restraint (e.g., Linardon & Mitchell, 2017;Tylka et al., 2015), indicating that these purportedly distinct restraint forms may co-occur to some extent, although the unique contributions of these variables in prior regression models demonstrate that this co-occurrence is variable. As it stands, research on the role of different dietary and intuitive eating patterns has only focused on examining their unique contributions to binge eating behavior. ...
... Internal consistency (α > .77) and construct validity of the eating subscale of the DTES have been established in a general community sample of adults (Linardon & Mitchell, 2017) ...
Article
Objective: Previous research has shown that certain eating patterns (rigid restraint, flexible restraint, intuitive eating) are differentially related to binge eating. However, despite the distinctiveness of these eating patterns, evidence suggests that they are not mutually exclusive. Using a machine learning-based decision tree classification analysis, we examined the interactions between different eating patterns in distinguishing recurrent (defined as ≥4 episodes the past month) from nonrecurrent binge eating. Method: Data were analyzed from 1,341 participants. Participants were classified as either with (n = 512) or without (n = 829) recurrent binge eating. Results: Approximately 70% of participants could be accurately classified as with or without recurrent binge eating. Intuitive eating emerged as the most important classifier of recurrent binge eating, with 75% of those with above-average intuitive eating scores being classified without recurrent binge eating. Those with concurrently low intuitive eating and high dichotomous thinking scores were the group most likely to be classified with recurrent binge eating (84% incidence). Low intuitive eating scores were associated with low binge eating classification rates only if both dichotomous thinking and rigid restraint scores were low (33% incidence). Low flexible restraint scores amplified the relationship between high rigid restraint and recurrent binge eating (81% incidence), and both a higher and lower BMI further interacted with these variables to increase recurrent binge eating rates. Conclusion: Findings suggest that the presence versus absence of recurrent binge eating may be distinguished by the interaction among multiple eating patterns. Confirmatory studies are needed to test the interactive hypotheses generated by these exploratory analyses.
... Rigid behaviors like fasting prospectively predict (Agras and Telch, 1998), and in cross-sectional research are linked, with binge eating among women with bulimia and binge eating disorder (Masheb et al., 2011). In weight loss cohorts, there are links between rigid restraint and binge eating, shape/weight overvaluation, body dissatisfaction, disinhibited eating, dichotomous thinking, depressive and anxiety symptoms, and poorer wellbeing (Linardon, 2018;Linardon and Mitchell, 2017;Smith et al., 1999;Timko and Perone, 2005;Tylka et al., 2015;Westenhoefer et al., 1999). In contrast, flexible restraint is linked with lowered disordered eating, body image concerns, body weight, and psychological distress (Shearin et al., 1994;Smith et al., 1999;Westenhoefer et al., 1999Westenhoefer et al., , 2013 and increases in flexible control are associated with binge eating abstinence, greater weight loss in the course of therapy (Blomquist and Grilo 2011), and in one study, predicted long-term weight maintenance among women with obesity (Teixeira et al., 2010). ...
... While flexible restraint may be more adaptive, adverse outcomes are occasionally associated with it (Linardon and Mitchell, 2017;Timko and Perone, 2005;Tylka et al., 2015). This may stem from overlapping behaviors among categories of restraint, as surprisingly, flexible control is highly correlated with rigid control (r's > .50). ...
... This calls into question how separate these components are, suggesting promoting flexible control could unintentionally prompt rigid practices (Timko and Perone, 2005;Westenhoefer et al., 2013). Indeed, flexible restraint is associated with positive outcomes only when its shared variance with rigid restraint is removed (Linardon and Mitchell, 2017;Tylka et al., 2015). However, it is unclear how to distinctly prescribe flexible rather than rigid control to avoid potential harm (Tylka et al., 2015). ...
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The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.
... Disordered eating refers to maladaptive eating behaviours focused on body image dissatisfaction (Linardon & Mitchell, 2017). Although the terms disordered eating and eating disorders are often used synonymously, they are different. ...
... Young college-aged women who eat intuitively are happier with their bodies, have higher self-esteem and are less likely to eat when emotional, stressed or tired. They also show higher positive mental health and exhibit lower rates of disordered eating (Linardon & Mitchell, 2017;Wilson et al., 2020). These findings suggest that intuitive eating could be beneficial in reducing disordered eating behaviours, and decrease poor mental health outcomes, in women with young children. ...
... Items were totalled and averaged to provide an overall intuitive eating score with higher scores suggesting greater intuitive eating. Prior studies provide evidence of good reliability ranging from .56 to .85 (Hawks et al., 2005), and the scale has been validated in research in adult women (Linardon & Mitchell, 2017;Wilson et al., 2020). Cronbach's alpha in this study was 0.91. ...
Article
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Objectives Pressure to lose weight can increase the risk of developing disordered eating behaviours, negative body image and depressive symptomatology. Eating intuitively may counteract these negative outcomes. This research examined the unique relationship between intuitive eating and disordered eating on body mass index (BMI), body image and depressive symptoms for women of young children.MethodsA survey of women with a child aged between six and 48 months, included the Intuitive Eating Scale, Eating Attitudes Test-26, Body Shape Questionnaire and Edinburgh Postnatal Depression Scale. Multivariate analysis of variance (MANOVA) was conducted as an omnibus test to estimate the effect of intuitive and disordered eating on BMI, negative body image and depressive symptoms.ResultsOf the 419 sample (M age = 32.06), 32% were classified with disordered and 32% with intuitive eating. MANOVA and regression analysis found disordered eating positively associated with depressive symptoms, (β = 0.303) and negative body image (β = 0.318). Intuitive eating was associated with lower depressive symptoms (β = − 0.183) and negative body image (β = − 0.615). Disordered eating (β = − 0.194) and intuitive eating (β = − 0.586) both contributed to lower BMI, with the association stronger for intuitive eating.Conclusion The early parenting period involves a high risk for developing disordered eating behaviours. Eating patterns are modifiable factors, illustrating the potential for positive and preventive health outcomes through adopting intuitive eating behaviours. There is an opportunity for healthcare professionals to promote physical and psychological health including for women in the early parenting period.
... A IC e o desejo de apresentar um corpo magro são fatores que contribuem para o risco de TA, 19 assim como demonstrado no estudo desenvolvido por Kessler e Poll 15 com universitárias de 18 a 48 anos de idade, em que foi utilizado o instrumento BSQ para avaliar a frequência da preocupa-ção e descontentamento com a imagem corporal, sendo classificada como ausente, leve, moderada ou grave. Foi encontrado que as mulheres com o peso na faixa de normalidade do IMC eram mais insatisfeitas com o corpo, se comparado com aquelas que apresentavam baixo peso ou sobrepeso; entretanto, a IC moderada e grave foi maior nas mulheres com excesso de peso. ...
... Também foi encontrado que o medo de engordar está presente na maioria das meninas, independentemente da classificação do IMC. 22 Um terceiro estudo, comandado por Duarte et al. 19 e realizado com meninas de 14 a 18 anos de idade, obteve que 71,23% e 61,37% das adolescentes desejavam perder peso e possuir uma silhueta menor, respectivamente. Com esses estudos fica claro a decepção com a aparência física e vontade de perder peso, inclusive nas mulheres saudáveis. ...
... 21 Comprovado Desse modo, pode-se perceber que a imagem corporal interfere tanto no comportamento quanto na alimentação, sugerindo que se o indivíduo se enxergar de um jeito negativo, pode ser que tome atitudes inadequadas a fim de obter o corpo considerado ideal. 15 Thais Baldo Patrício; Iza Oliveira Hoff As regras impostas à alimentação podem ser adotadas como um método para o controle do peso, mas podem comprometer o comportamento alimentar e ser um risco para TA. 19 Como demonstrado no estudo de Linardon e Michell, 16 desenvolvido com indivíduos dos 18 aos 65 anos de idade, no qual o controle rígido da alimentação foi relacionado com altos níveis de TA e imagem corporal negativa, enquanto o comer intuitivo associou-se com níveis menores de TA, mediado por baixos níveis de pensamento dicotômico sobre alimentos. Além disso, o comer intuitivo foi relacionado inversamente com distúrbios da imagem corporal, mediado por altos níveis de apreciação corporal. ...
Article
Analisar como a insatisfação corporal e o comportamento alimentar inadequado se relacionam entre si e o impacto que causam na manifestação dos transtornos alimentares em adolescente e adultos de ambos os sexos.O estudo foi realizado por meiode uma revisão literária de artigos científicos publicados entre 2009 e 2019, que envolvessem o tema, nas bases eletrônicas SCIELO, PUBMED e LILACS, depois foi desenvolvido uma tabela para resumo das informações e os resultados foram interpretados e comparados entre eles.A insatisfação corporal interfere nos hábitos alimentares inadequados, como a restrição alimentar, a compulsão alimentar eos métodos compensatórios por meio das pressões externas, podendo causar distúrbios emocionais e, consequentemente, os transtornos alimentares.É preciso ficar atento com os fatores de risco para os transtornos alimentares e ter uma visão crítica a respeito dos padrões estéticos considerados ideais,com a finalidade de reduzir níveis de insatisfação corporal.
... Intuitive eating has been found to be associated with less pressure for thinness, dieting and disordered eating, and more positive emotional functioning and body image, which seems to suggest intuitive eating as an indicator of flexible, adaptive and positive eating (e.g., Bruce & Ricciardelli, 2016;Dalen et al., 2010;Tylka, 2006). In fact, intuitive eating has been consistently linked to numerous positive health outcomes, including lower levels of disordered eating, negative affect, body image concerns, food preoccupation, lower body mass index (BMI) and higher positive affect, body appreciation and interoceptive awareness (Bruce & Ricciardelli, 2016;Linardon & Mitchell, 2017;Tylka & Wood-Barcalow, 2015;Van Dyke & Drinkwater, 2013). According to Avalos and Tylka (2006) individuals who are more aware of and eat according to their hunger and satiety cues are more likely to value, respect, and appreciate their body. ...
... The current model suggested that intuitive eating and body image flexibility are significative mediators in this relationship and seem to support the need to develop prevention and intervention approaches for the promotion of body image flexibility and intuitive eating as adaptive competencies to manage negative affectivity and healthy eating, especially among women. The present findings, that emphasize the importance of the promotion of intuitive eating within the prevention and intervention of eating psychopathology are in line with Linardon and Mitchell (2017) and with Schaefer and Magnuson (2014) who also show the important role of intuitive eating. ...
Article
Negative affect is associated with body image and eating‐related problems. Nonetheless, research on mediating emotional processes in this relationship is scant. The present study explored a path model testing the effect of negative and positive affect (PA) on disordered eating symptoms, via its effect on intuitive eating and body image flexibility, while controlling for the effect of body mass index. Participants included 273 women, aged between 18 and 45 years old, who completed an online survey with self‐report measures. The tested model showed an excellent fit to the empirical data and explained a total of 64% of the variance of disordered eating attitudes and behaviours. This model revealed that the impact of negative and PA on disordered eating symptoms depends on the level of intuitive eating and body image flexibility, even when controlling for the effect of body mass index. This study contributes to the understanding of the adaptative and mediational role that intuitive eating and body image flexibility play in the link between affectivity and eating‐related difficulties. Indeed, these emotional regulation processes seem to play a protective role against disordered eating, by reducing reactivity and impulsive eating in response to negative and PA. The study findings suggest that prevention and intervention programs focused on body and eating‐related difficulties should promote a more aware and adaptative pattern of eating and body image flexibility, which seems especially relevant to deal with Western societies' body and eating‐related paradoxical messages.
... The results of the current study suggest that the mean score of IES-2-Chi items in the obese population with primary hypertension is lower than IE scores of community citizens in Australia (2.98±0.75 vs. 3.32±0.89) [32] . Combined with the correlation analyses of IE, restrained eating, external eating, and emotional eating, this difference may be attributed to multiple reasons. ...
... Additionally, higher IE scores were found in the subjects with a higher body image scores. Body image [32] refers to the degree to which individuals accept, respect, and appreciate their bodies. Due to an unsatisfying physical pro le, obese patients with hypertension may pay excessive attention to a change in their body image and ignore the body's physiological hunger and satiety cues. ...
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Intuitive eating (IE) is largely considered to be engaging in behaviors consistent with eating in reaction to one’s physiological appetite and fullness signals instead of environmental stimuli and emotional cues. The Intuitive Eating Scale-2 (IES-2) was developed in order to assess the outlook and behaviors of eating on four subscales: unconditional permission to eat (UPE), eating because of physiological as opposed to emotional reasons (EPR), dependence on physiological hunger and satiety cues (RHSC), and body-food choice congruence (B-FCC). Obesity is a frequent comorbidity in Chinese patients with hypertension and nearly 3/4 of such patients have eating problems. The current study intended to validate the psychological measurement properties of the IES-2 Chinese Version (IES-2-Chi) in an obese population with hypertension. For the IES-2-Chi, Cronbach's ɑ = 0.947, split-half reliability was 0.850, the test-retest reliability was 0.889, chi-square/degree of freedom ratio (χ2/df) = 1.318, root mean square error approximation (RMSEA) = 0.040, root mean square residual (RMR) = 0.053, goodness-of-fit index (GFI) = 0.902, comparative fit index (CFI) = 0.982, Tucker-Lewis index (TLI) = 0.978, incremental fit index (IFI) = 0.983, and normal fit index (NFI) = 0.932. The secondary study objective was to evaluate IE levels of obese Chinese patients with hypertension. IE was correlated positively with self-efficacy, body image, and frequency of eating vegetables and fruits, but negatively with body mass index, hemoglobin, diastolic blood pressure, hematocrit, total cholesterol, low-density lipoprotein, and frequency of eating fast food.Conclusion: The current study demonstrates that the IES-2-Chi has good reliability and validity in obese patients with primary hypertension and can be used to evaluate IE levels of these patients. Based on the current study results, future studies may be designed to develop intervention strategies using IE to utilize its influential factors in obese patients with primary hypertension.
... The SMD was used when an outcome was reported with heterogeneous units, and the mean difference was used if all studies reported the outcome with identical units. The SMD was calculated using Hedges' g as an effect size and can be interpreted as follows: less than 0. 40 Meta-analysis was performed using follow-up scores and sample sizes with the inverse variance method. Change scores from baseline were included only if they were the only form of outcome measure available. ...
... 39 The inverse association between intuitive eating and disordered eating behavior is hypothesized to be mediated by low levels of dichotomous thinking about food and eating. 40 The results of this review are consistent with this hypothesis, as weight-neutral practices actively teach a reduction of dichotomous thinking about food. ...
Article
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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.
... They found that greater TFEQ-D was significantly associated with higher body mass index (BMI), low levels of physical activity, low levels of self-esteem, and predictive of weight regain after weight loss. Interestingly, higher scores on the TFEQ-D subscale and higher scores on the TFEQ-R subscale have been related to greater eating disordered pathological behavior, such that greater disinhibition has been linked to binge eating disorders, and higher restraint has been related to greater disordered eating and less intuitive eating [19][20][21]. ...
... While much research suggests that cognitive restraint, specifically rigid control, relates to eating disordered behaviors, the results of this theory are mixed. Interestingly, a study by Linardon and Mitchell [20] found that the subtypes of cognitive restraintrigid control and flexible control-were both significantly related to disordered eating, body appreciation, and body image concerns, including body checking. However, researchers found that rigid control more strongly predicted over-evaluation of body weight and shape compared to flexible control. ...
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Background The purpose of this study is to examine three-factor eating questionnaire (TFEQ) scores at baseline and post-intervention (6 months) on successful weight loss and weight maintenance in an 18-month behavioral weight management intervention for adults with overweight and obesity. Methods TFEQ and weight were assessed at baseline, 6, and 18 months. Logistic regression models were used to examine scores at baseline on disinhibition, restraint, and perceived hunger factors in the TFEQ on 5% body weight loss at 6 months and 6-month scores to predict 5% weight maintenance at 18 months while controlling for age, sex, and baseline weight. Results Participants (n = 287; age = 43.8 ± 10.36 years; female = 64.1%; weight = 222.5 ± 39.02 pounds; BMI = 34.73 ± 4.56) were included for analysis. Dietary restraint at baseline was the only significant predictor of 5% weight loss at 6 months. None of the TFEQ subscale scores at 6 months predicted 5% weight maintenance at 18 months. The model examining weight loss at 6 months accounted for 7% of the variance of the outcome and 11% of the variance of weight maintenance at 18 months. Conclusion Dietary restraint is a unique eating behavior associated with weight loss at 6 months beyond other eating behaviors measured by the TFEQ in an adult sample enrolled in a weight loss intervention. No other subscale scores were significant at 6 months or at 18 months. Future research should consider how to promote flexible control and discourage adoption of rigid restraint behaviors since the latter is associated with disordered eating patterns.
... As this theory closely mirrors the spiral model of chronic dieting [6], the protective associations observed in the present study may be explained in part by mechanisms that explain associations of dieting with adverse psychological and behavioral health outcomes. In support of this idea, a less dichotomous thinking style around food and dieting (e.g., not buying into "good" versus "bad" foods or "successful" versus "failed" diets) has been found to mediate the inverse association between IE and disordered eating behaviors [46]. However, IE may confer additional benefits beyond removing dieting failures from the equation. ...
... However, IE may confer additional benefits beyond removing dieting failures from the equation. For example, IE has been found to be associated with body appreciation [46], suggesting that an IE approach may facilitate accepting, valuing, and respecting one's body and its internal cues. Future research should aim for further understanding of the mechanisms by which IE may confer psychological and behavioral benefits. ...
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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; Mage = 14.5 years) into young adulthood (follow-up; Mage = 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.
... Empirical studies exploring this relationship have consistently found internalization of the thin ideal, social pressures to be thin, history of dieting, weight suppression, and body image disturbance are all significantly predictive of future ED onset [4]. Similarly, rigid dietary control (i.e., inflexible, dichotomized "all or nothing" dietary rules dictating what, when, and how one should eat) has reliably been linked with disordered eating [5,6]. ...
... While theoretically, this process is in line with those posited by ACT interventions, longitudinal replication of our analyses and research specifically examining cognitive defusion as a process mechanism in interventions for EDs is needed to support this notion. To date, there is a small but growing body of evidence suggesting that ACT is effective in decreasing ED symptom severity and body image concerns [6,50], and that among a sample of overweight/obese adults, led to significant improvements in the eating for physical rather than emotional reasons component of IE from pre-to post-intervention. However, to our knowledge, no studies have explicitly examined the use of ACT-based interventions targeting body image-related fusion within individuals with eating disorders, or examined this as a possible therapeutic mechanism of change that may promote adaptive eating behaviors, such as IE within these populations. ...
Article
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Purpose This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms. Methods This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility. Results ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually. Conclusion Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment. Level of evidence Level V, cross-sectional analysis from descriptive study.
... More specifically, athletes' athletic identity is a major risk factor of eating disorders, which can affect social relationships severely (McGannon & McMahon, 2019). Other variables, such as taking small portions of food every meal, compensating for healthy foods after consuming unhealthy foods, having a strict meal plan, and other body checking and weight control behaviors, predict disordered eating and negative body image (Linardon & Mitchell, 2017). ...
... Further, in treating general psychopathology online, it should only measure one problem at a time to prevent a lapse between one problem and another (Cameron et al., 2015). Therefore, programs focusing on media literacy, psychoeducation, cognitive dissonance, social context-based, internalization of body shape and weight concerns, mindfulness, and self-esteem enhancement (Juarascio et al., 2015;Landry et al., 2018;Le et al., 2017;Lewis & Nicholls, 2016;Linardon et al., 2019Linardon et al., , 2018Linardon & Mitchell, 2017;Luethcke, McDaniel, & Becker, 2011;Schwartz et al., 2019) must be included independently. The most important program is psychoeducation on binge-eating, purging, and restricting to be able to minimize the use of performing these maladaptive eating behaviors. ...
Thesis
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Eating disorder has been comprehensively reported in different contexts. Assuming it can also exist in the Philippine context, the exponential in data, from another context, suggests that if eating disorders are not addressed, this can be alarming to the society that an illness could lead to its fatality. Online treatments are widely accepted as a first step in treating eating disorders. This study included four non-sequential phases divided into two aspects: (1a) descriptive; (2a) qualitative; (3b) design; and (4b) evaluation. The study was guided by the Self-Affirmation Theory and Theory of Planned Behavior. The baseline in developing a mobile-based prevention program was explored and enriched for future development. Results indicated that the mobile-based application would be highly feasible and acceptable to both symptomatic individuals and clinicians; and the suggested improvements were noted. The study aims to increase awareness of eating disorders in the Philippines. Recommendations concerning the methodology, psychological program, and technical improvements, and program compliance were discussed.
... In contrast, no curvilinear relationship emerged regarding the other two facets of intuitive eating, namely Eating for Physical Rather Than Emotional Reasons and Unconditional Permission to Eat, nor any of the facets of eating competence. It is noteworthy that these latter aspects of positive eating are characterized by flexible attitudes toward eating a variety of foods and not restricting intake based on any criteria [8]. Given that restrictive eating behaviors, albeit due to health preoccupation, is one of the hallmark features of ON symptomatology [6], it is perhaps unsurprising that these facets did not reveal such curvilinear relationships. ...
Article
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Orthorexia nervosa (ON) has emerged as a new pattern of disordered eating behaviors characterized by preoccupations related to diet quality and health concerns, rather than driven by weight and shape concerns. A growing body of cross-sectional empirical data has documented associations between orthorexia nervosa symptoms and other indicators of disordered eating. However, little attention has been paid to the potential relationship between ON symptoms and indicators of healthy eating or positive eating behaviors. The aim of the present study was therefore to evaluate the relationships between ON symptomatology and the different facets of intuitive eating and eating competence. A sample of n = 605, 19% male, college students from the USA completed an online survey assessing orthorexia nervosa behaviors, the four facets of intuitive eating, and eating competence. Overall, orthorexia nervosa behaviors were found to be associated with lower levels of positive eating attitudes and behaviors. However, among men, curvilinear convex relationships emerged for two facets of intuitive eating, Body–Food Choice Congruence and Reliance on Hunger and Satiety Cues, such that the highest levels of intuitive eating were reported by those with mid-range levels of orthorexia nervosa behaviors. Taken together, these findings suggest that broadly, patterns of eating characterized by restriction, albeit for health reasons, are associated with less positive eating behaviors particularly among women. Further work focused on evaluating how drive for a healthy diet can be associated with flexible and positive eating patterns is warranted. Level of evidence Level V descriptive cross-sectional study.
... Results from this study expand upon prior work (Leong, Gray, Haszard, & Horwath, 2016;Tylka & Wilcox, 2006) by examining longitudinal associations between intuitive eating and engagement in various forms of weight control behaviors among a large population-based sample of both men and women. Prior cross-sectional studies have shown that intuitive eating is related to lower disordered eating behaviors (Anderson, Reilly, Schaumberg, Dmochowski, & Anderson, 2016;Bruce & Ricciardelli, 2016;Linardon & Mitchell, 2017). However, the cross-sectional designs limit interpretation, and in their review Bruce and Ricciardelli (2016) also note weak generalizability due to an overrepresentation of university students. ...
Article
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 = 1,660) 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.
... Araştırmalar; sezgisel yemenin daha düşük beden kitle indeksi (BKİ) (10)(11)(12)(13), daha iyi kilo kontrolü (14), daha düşük kolesterol ve kan basıncı (15,16) ve daha iyi glisemik kontrol (17)(18)(19) ile ilişkili olduğunu göstermiştir. Ek olarak sezgisel yeme daha düşük yeme bozukluğu (20,21), daha düşük beden görünüşü endişesi (22), daha düşük içselleştirilmiş kilo ön yargısı (23), daha yüksek psikolojik iyi oluş (9,24,25) ve daha yüksek vücut memnuniyeti (26,27) ile ilişkilidir. Sezgisel yemenin sağlıklı yeme davranışını geliştirdiği (28) ve daha iyi diyet kalitesi ile ilişkili olduğu da çalışmalarda belirtilmiştir (29,30). ...
Article
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Z 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<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<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<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. Anahtar Sözcükler: Tip 2 diabetes mellitus, sezgisel yeme, glisemik kontrol. ABSTRACT Aim: The aim of the study was to determine the relationship between intuitive eating and eating attitude and glycemic control in patients
... The main concepts of intuitive eating focus on trusting one's own hunger and satiety signals and feeling the freedom and enjoyment of eating as proposed by Tribole and Resch (2020). Intuitive eating is beneficial because it is associated with lower levels of body mass index (BMI) and reduced disordered eating compared to other eating patterns, including dieting (Linardon & Mitchell, 2017;Tylka & Wilcox, 2006;Van Dyck et al., 2016). ...
Article
Women with breast cancer are at risk of being overweight/obese which may consequently increase mortality. Intuitive eating is an adaptive eating behavior which might be beneficial for weight outcomes. The present study validated the Persian Intuitive Eating Scale-2 (IES-2) among overweight/obese Iranian females with breast cancer. Women who were overweight/obese with breast cancer (n = 762; mean ± SD age = 55.1 ± 5.7 years) completed the following questionnaires: IES-2, General Self-Efficacy Scale (GSE-6), Hospital Anxiety and Depression Scale (HADS), Short Form-12 (SF-12), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale-2 (BAS-2), and Eating Attitudes Test (EAT-26). Confirmatory factor analysis (CFA) and Rasch analysis were applied to examine the psychometric properties of the IES-2. Associations between IES-2 score and other scale scores were assessed. CFA and Rasch analysis suggested that the Persian IES-2 had robust psychometric properties and all IES-2 items were meaningful in their embedded domains. The four-factor structure of the Persian IES-2 was confirmed. Concurrent validity was supported by the positive correlations between the IES-2 score and scores on the GSE-6, SF-12 mental component, and BAS-2. Negative correlations were found between the IES-2 score and the HADS (anxiety and depression subscales), WBIS, and EAT-26. The present study demonstrated that the Persian IES-2 is a well-designed instrument and is applicable for women who are overweight/obese with breast cancer.
... However, a comprehensive biopsychosocial assessment identified divergent phenotypes that may warrant different nutrition interventions. While no trials have been reported using targeted nutrition interventions for FA, several studies have shown that non-diet approaches such as intuitive eating can be effective in reducing dietary restraint [199][200][201]. The present review suggests that it would be effective to identify FA phenotypes based on the presence of other psychiatric disorders such as ED, AUD/SUD, PTSD, depression, anxiety, and ADHD as part of a comprehensive biopsychosocial assessment, and to assign nutrition treatment based on the relative strength of the FA signal amidst the noise (true versus false positive). ...
Article
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Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
... Treatment approaches that aim to de-pathologise the body and eating are associated with improved psychological wellbeing, including weight stigma resistance, body acceptance/appreciation, intuitive eating, weight-neutral and Health-at-Every-Size (HAES®) models (Bacon, Stern et al. 2005, Gagnon-Girouard, Bégin et al. 2010, Mensinger, Calogero et al. 2016, Linardon and Mitchell 2017, Meadows 2018, Hall 2019, Dugmore, Winten et al. 2020, Hazzard, Telke et al. 2021, O'Hara, Ahmed et al. 2021, Raffoul and Williams 2021. A new paradigm has also been applied as a call to action for public health bodies and health professionals regarding discrimination and weight stigma; with Indigenous ways of knowing and body sovereignty, and the HAES® model (Cyr and Riediger 2021). ...
Conference Paper
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Weight-stigma and internalised weight-stigma are risks for EDs and suicidality. Suicidal ideation in current and lifetime EDs is directly and indirectly effected by perceived-burdensomeness. Similarly, research has linked weight-based discrimination with perceived-burdensomeness and increased suicidal ideation. Weight self-stigma has been linked with weight change, indicating the negative effects of weight self-stigma, and emphasising the central role of fear of being stigmatised by others in this process. Self-discrepancy and negative self-schemas may also include fear of an imagined fat/larger self, or fear of returning to a larger/fat body weight. Considering these factors in the relationship between weight stigma, fear of fatness, and disordered eating, it may be that fear-of-fatness and perceived burdensomeness in EDs more closely align with fear of weight-based discrimination. Pervasive, systemic devaluation of individuals in fat/larger bodies may foster internalised beliefs that one is worthless or a burden on society that praises thinness, dehumanises, pathologizes, and positions larger bodies as a moral/personal failure. This may compound minority stress and weight bias internalisation for those who face intersectional oppressions and experiences of their bodies and identities as a marginalised other. Fear of additional (weight-based) marginalisation may influence ED vulnerability for certain populations, including those who may experience intersectional marginalisation, and those in larger bodies. Insecure attachment, social anxiety, and fear of negative evaluation are also highly prevalent in EDs. It may be that these factors relate to increased awareness of the threat of weight-based marginalisation and therefore, heighten ED risk. This paper will explore the literature on ‘fear of fatness’, ‘feeling fat’, and negative ‘fat talk’ in EDs as related to internalised weight stigma, marginalisation (i.e., race/ethnicity, genders, sexualities, disability), perceived burdensomeness, and fear of stigmatisation. It will argue for the consideration of ‘fear of fatness’ and ‘feeling fat’ as central to ED within a broader context of body politics, weight-based discrimination and disordered eating as a means of coping with fear of (further) social discrimination.
... ;Grilo, Ivezaj, & White, 2015;Harrison, Mitchison, Rieger, Rodgers, & Mond, 2016;Linardon, Fuller-Tyszkiewicz, de la Piedad Garcia, Messer, & Brennan, 2019;Linardon & Mitchell, 2017;, longitudinal ...
... Other high-sugar, low-nutrition foods, such as candy, should also be considered prime candidates for reduction. Regardless of the intervention strategy, excessive restriction (e.g., the banning of all sugar products) would likely prove counter-productive, inasmuch as restrictive dietary patterns are associated with disordered eating [141]. Moreover, there is some early evidence that reducing sugar intake can actually increase its reinforcement value-an important caveat for investigators to bear in mind during the development of novel dietary interventions [142]. ...
Article
Added sugars are ubiquitous in contemporary Western diets. Although excessive sugar consumption is now robustly associated with an array of adverse health consequences, comparatively little research has thus far addressed its impact on the risk of mental illness. But ample evidence suggests that high-dose sugar intake can perturb numerous metabolic, inflammatory, and neurobiological processes. Many such effects are of particular relevance to the onset and maintenance of depressive illness, among them: systemic inflammation, gut microbiota disruption, perturbed dopaminergic reward signaling, insulin resistance, oxidative stress, and the generation of toxic advanced glycation end-products (AGEs). Accordingly, we hypothesize that added dietary sugars carry the potential to increase vulnerability to major depressive disorder, particularly at high levels of consumption. The present paper: (a) summarizes the existing experimental and epidemiological research regarding sugar consumption and depression vulnerability; (b) examines the impact of sugar ingestion on known depressogenic physiological processes; and (c) outlines the clinical and theoretical implications of the apparent sugar-depression link. We conclude that the extant literature supports the hypothesized depressogenic impact of added dietary sugars, and propose that an improved understanding of the effects of sugar on body and mind may aid in the development of novel therapeutic and preventative measures for depression.
... 81 A healthy, sustainable diet does not exclude certain foods or food groups, as promoting food restriction can contribute to a negative relationship with food and body image concerns. 82 Avoidance of certain food groups, such as wholegrain carbohydrates or dairy, may also increase risk of disease. 83,84 An assessment of physical activity, using tools such as the Baecke ...
Article
With the increasing prevalence of overweight and obesity worldwide, there is a reciprocal increase in the global economic burden and ill‐health from obesity‐related chronic diseases. Primary healthcare services have a role to play in ensuring early detection of weight issues and in directing patients towards evidence‐based care to slow this progression. Research shows that many people with obesity are motivated to lose weight and want their clinician to initiate a conversation about weight management and treatment options. However, this conversation rarely occurs and there is a significant delay in treatment, resulting in an increased burden on the individual, healthcare system and society. In this paper, the components and rationale for the clinical assessment of adult patients with overweight or obesity, including anthropometric measurements and pathology tests, are described. Recommendations to ascertain the potential factors influencing the development of obesity in the patient, such as lifestyle factors (diet and physical activity) and mental health, are also provided. The potential sequelae of obesity that may be present and the necessary assessments for diagnosis are also addressed. These assessments are vital to ensure the patient is referred to the appropriate allied health services and/or specialists.
... While total score for mIES-2 was not significantly associated with BMI, several subscales of the mIES-2 were negatively associated with BMI. Our findings partially support previous literature that similarly show a negative association between intuitive eating and BMI (Saunders et al., 2018; or body-image dissatisfaction (Bacon et al., 2005;Linardon & Mitchell, 2017;Spoor & Madanat, 2016). It is important to note however, that our construct validity testing was limited to these two measures with several null findings between BMI and the mIES-2 subscales, potentially reflecting that the mIES-2 is not adequately measuring what is intended. ...
... Cognitive-behavioral models consider negative body image (e.g., shape and weight concerns and body dissatisfaction) as the core of disordered eating symptomatology (Fairburn et al., 2003). However, before directly targeting negative body image (during, for instance, cognitive-behavior interventions), it is suggested to indirectly reduce its influence by targeting other disordered eating symptoms, such as restrictive eating, overeating episodes, and emotional eating (Fairburn, 2008;Linardon and Mitchell, 2017). Intuitive eating can be defined as having a strong connection with one's own internal signals of hunger and satiety cues, and consequently eating in response to these signals (Tylka, 2006;Messer et al., 2021). ...
Article
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Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors (i.e., restrictive eating, emotional eating, and overeating) and negative body image (i.e., shape and weight concern, and body dissatisfaction) among a community sample of women during the COVID-19 pandemic (October 2020-May 2021). Furthermore, we explored the possible relation between body image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs.
... Individuals who eat intuitively trust and rely on their internal hunger and satiety cues to guide their eating behavior, avoid labelling foods as forbidden, eat for physical reasons rather than as a way of coping with emotional distress, and make food choices which support or enhance their body's functioning [28]. Intuitive eating has been found to be associated with lower levels of binge eating, drive for thinness, situational eating, emotional eating, food anxieties, food preoccupation and rigid dietary constraint [29][30][31][32][33][34][35][36][37]. Furthermore, there is a strong body of evidence to support that indices of positive body image, namely, body appreciation, functionality appreciation and embodiment, are psychological resources that enhance intuitive eating by promoting the awareness of, and appreciation for the functions of the body [38][39][40][41][42][43][44][45][46]. ...
Article
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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; Mage = 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.
... Los sujetos españoles, no contaron, por lo general, con esta ventaja, presentando niveles educativos mucho más diversificados en lo referente a los niveles máximos de formación alcanzada. La búsqueda de información nutricional en sujetos sanos y con bajo nivel educativo en alimentación como los descritos, suele ir más encaminada hacia la obtención de una imagen corporal determinada y no tanto a la obtención de la salud a largo plazo, de modo que comúnmente puede adoptarse la falsa creencia de identificar el primer término con el segundo (34). ...
Article
Introducción: La pérdida de patrones de alimentación tradicionales a favor de otros más occidentales redunda en un descenso de calidad de la dieta alrededor del mundo. Muchos aspectos determinan la calidad dietética, aunque en general pueden resumirse en una dieta moderada, variada, equilibrada y adecuada para cada individuo. Estos aspectos son evaluados por el Diet Quality Index-International (DQI-I). Objetivo: Comparar la calidad de la dieta de población mexicana y española mediante un índice de calidad internacional de la dieta, determinando que factores son en mayor medida responsables de la pérdida de calidad. Material y métodos: Estudio observacional transversal sobre una muestra representativa de sujetos adultos residentes en Querétaro (México) y de sujetos de la misma franja de edad procedentes de la Región de Murcia, en la cuenca mediterránea española. Se recogieron datos sociodemográficos, antropométricos, de frecuencia de consumo de alimentos y de ingesta con 3 recuerdos de 24 horas y se valoró el DQI-I en la población. Resultados: Se encontraron diferencias para el gasto energético y el DQI-I en todos sus aspectos con valores de calidad superiores para la población mexicana. La variedad fue la dimensión más castigada para todos los sujetos, presentando los mexicanos mejores cifras de consumo de vegetales pero peores para las fuentes proteicas. Conclusiones: La muestra mexicana mejoró las cifras de calidad de la española, tal vez por una mayor influencia de conocimientos en nutrición. El 86% de la población podría mejorar sus puntajes de calidad en el DQI-I ajustando sus frecuencias de consumo de alimentos.
... kg/m 2 ), with 43% with overweight or obesity. Mean levels of IWS in the current sample (2.66 ± 1.33) are lower than those reported in a national online sample (3.36 ± 1.51; Puhl et al., 2018), and mean intuitive eating (3.37 ± 0.63) was similar to an undergraduate sample (3.32 ± 0.89; Linardon & Mitchell, 2017) and slightly lower than in a sample of women yoga practitioners (3.5 ± 0.53; Dittmann & Freedman, 2009). ...
Article
Internalized weight stigma (IWS) is independently associated with less intuitive eating (i.e., eating based on endogenous hunger/satiety cues) and higher Body Mass Index (BMI), and intuitive eating training is commonly conceptualized as protective against the effects of IWS on poor behavioral health. The 3-way relationship between IWS, intuitive eating, and BMI has yet to be examined, and it is unclear whether the link between IWS and BMI is buffered by high intuitive eating. This secondary preliminary analysis examined baseline data of stressed adults with poor diet (N = 75, 70% female, 64.1% White, 42.7% with overweight/obesity) in a parent clinical trial that tested the effects of yoga on diet and stress. Validated self-report surveys of IWS and intuitive eating were analyzed with objectively-assessed BMI. Moderated regression analyses using the SPSS PROCESS macro tested whether intuitive eating moderated the IWS-BMI link. The analysis revealed IWS was positively associated with BMI except among people with high intuitive eating. Results extend observational findings linking intuitive eating to lower BMI, and offer preliminary support for the hypothesis that this link may hold even among those with greater IWS. It's possible that individuals with lower BMI and greater IWS may gravitate more towards intuitive eating than those with greater BMI, and/or intuitive eating may be an important target for ameliorating the adverse association of IWS with behavioral and physical health indicators linked to BMI. Continued work is warranted in larger, more generalizable samples using causal and prospective designs.
... Cognitive-behavioral models consider negative body image (e.g., shape and weight concerns and body dissatisfaction) as the core of disordered eating symptomatology (Fairburn et al., 2003). However, before directly targeting negative body image (during, for instance, cognitive-behavior interventions), it is suggested to indirectly reduce its influence by targeting other disordered eating symptoms, such as restrictive eating, overeating episodes, and emotional eating Linardon and Mitchell, 2017). Intuitive eating can be defined as having a strong connection with one's own internal signals of hunger and satiety cues, and consequently eating in response to these signals (Tylka, 2006;Messer et al., 2021). ...
... The routine restraint subscale assesses the perceived routine restriction of energy intake to control weight, which may reflect rigid control of energy intake, whereas the compensatory restraint assesses the intentional restriction of energy intake following an episode of overeating, reflecting a more flexible control of energy intake. Research shows that flexible and rigid controls of dietary intake have differential relationships to disordered eating and BMI [25]. Flexible control of dietary intake was negatively associated with BMI, whereas rigid control was positively associated with BMI [26][27][28]. ...
Article
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Valid and reliable measures are needed to identify individuals at risk of dietary restraint, emotional and external eating, and to customize weight loss education for more effective weight management. This study aimed to develop and validate a Chinese version of the Weight-Related Eating Behavior Questionnaire (WREQ-C) for assessing dietary restraint, emotional eating, and external eating. In stage one, the linguistic validation of the original English version of the WREQ (WREQ-E) was conducted. In stage two, the psychometric properties of the WREQ-C were first evaluated by item response theory-based (IRT) analyses. The reduced scale was then examined for convergent validity, structural validity (using a confirmatory factor analysis), population invariance, and test–retest reliability. The study included 1007 adults aged between 18 and 71 years. The IRT analysis optimally shortened the original WREQ-E from 16 to 13 items. A convergent validity analysis showed significant correlations between the WREQ-C subscales and the Chinese version of the Dutch Eating Behavior Questionnaire subscales (r = 0.63–0.82). The 13-item WREQ-C demonstrated good reliability (Cronbach’s α = 0.74–0.89) and validity for assessing the psychological aspects of eating behavior, including routine restraint, compensatory restraint, susceptibility to external cues, and emotional eating in Chinese adults.
... Altered interoceptive processes are observed among 55 individuals exhibiting subthreshold disordered eating behaviors (Anderson et al., 2016;Brown et 56 al., 2010;Young et al., 2017) and those recovered from an eating disorder (Fischer et al., 2016;57 Jenkinson et al., 2018). Importantly, much of this research uses general measures of 58 interoception that do not distinguish between biological systems (e.g., gastric, cardiac, 59 respiratory), despite evidence that dysfunctional processing of hunger and satiety cues is 60 particularly important to disordered eating (e.g., Anderson et al., 2016;van Dyck et al., 2016, 61 4 tend to have higher scores on facets of disordered eating, including dietary restraint, binge eating 68 frequency, and body image concerns (Anderson et al., 2016;Camilleri et al., 2015;Carbonneau 69 et al., 2016;Linardon & Mitchell, 2017;Romano et al., 2018). Similarly, individuals diagnosed 70 with an eating disorder reported less reliance on hunger and satiety cues compared to healthy 71 controls (van Dyck et al., 2016). ...
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Dysfunctional interoceptive processing of hunger and satiety cues is particularly relevant to disordered eating behaviors. However, researchers often rely on general measures of interoceptive sensibility (IS¹; self-reported experience of internal bodily cues) which conflate interoceptive processes across biological systems (e.g., gastric, cardiac) when assessing the role of interoception in disordered eating. Participants (N = 213; 50% female, age M = 20.77 years) were recruited from a large southeastern university for this online study and completed the Intuitive Eating Scale-2 (hunger/satiety-specific), the Multidimensional Assessment of Interoceptive Awareness-2 (general), and the Eating Disorder Inventory Interoceptive Awareness Subscale (general) as measures of IS. The Eating Pathology Symptoms Inventory was used to assess disordered eating attitudes and behaviors. Controlling for sex and body mass index, hunger/satiety-specific IS was associated with binge eating, purging, and cognitive restraint over and above general IS measures and emerged as the dominant predictor of each. Hunger/satiety-specific IS did not predict restricting behavior. Dysfunctional processing of hunger and satiety cues may be a particularly important risk factor to target in screenings and interventions for disordered eating. Findings highlight the importance of careful selection of IS measures in research and targeting hunger/satiety-specific IS in clinical interventions for disordered eating.
... eating = 2.82), the conditional T A B L E 6 Intercorrelations between intuitive eating and six measures of physical and mental health as a function of gender These results identify BMI as a non-moderator of the relationship between intuitive eating and body esteem for women. In addition, given prior evidence that body esteem might mediate the association between intuitive eating and various outcome variables, 25 we conducted four simple mediation analyses using PROCESS macro v3.3 to test whether body esteem mediated the relationships between intuitive eating and BMI (men and women), psychological distress (men) and self-esteem (women), each of which remained statistically significant in the multiple regression analyses. As the multiple regression analyses indicated that intuitive eating was the only independent variable in the BMI (men and women) and psychological distress (men) models that reached statistical significance, these mediation analyses were run without any covariates. ...
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Introduction: Rural Australians have comparatively higher rates of overweight and obesity, as well as some mental health issues. Intuitive eating has been shown to be positively associated with an array of physical and mental health indicators. Few studies, however, have been conducted with general populations, and none has explicitly examined intuitive eating among rural residents. Objective: To investigate the prevalence of intuitive eating, and associations between intuitive eating and indicators of physical and mental health, among a general population of rural adults. Design: Cross-sectional telephone survey of 200 randomly selected, non-metropolitan, English-speaking Australian residents aged 18 or older. Findings: The prevalence of intuitive eating in the sample was 17.6%, with a higher level of intuitive eating among men than women (26.1% vs 9.1%). Bivariate associations between intuitive eating and each of the six health indicators were all positive and mostly statistically significant. Particularly strong was the correlation between intuitive eating and self-esteem for women (r = 0.533). After controlling for indication of an eating disorder and demographics, the associations between intuitive eating and the outcome variables held for body mass index (BMI), psychological distress and body esteem for men, and for BMI and self-esteem for women. Post hoc analyses found that BMI did not moderate the relationship for women between intuitive eating and self-esteem and that body esteem mediates the relationships between intuitive eating and BMI and psychological distress for men, and between intuitive eating and self-esteem for women. Discussion: Consistent with most prior research, this study finds that intuitive eating is positively associated with several indicators of both physical and mental health among non-metropolitan residents in Australia. Practice of intuitive eating in this population, however, is low. These findings may help allied health professionals guide rural populations to better health, and may be a particularly effective approach for people for whom the barriers to seeking out health services are high. Conclusion: Intuitive eating appears to have substantial correlations with mental health indicators, and to some extent, physical health indicators, among rural Australians and therefore should be further investigated for its potential to inform public health policy targeted to similar populations.
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This cross-sectional study investigated the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI in men and women between 30 and 70 years old as delineated in the acceptance model of intuitive eating. Self-report measures were administered to a final sample of 522 individuals consisting of early-adult men (ages 30–44; n = 153), middle-adult men (ages 45–70; n = 108), early-adult women (ages 30–44; n = 135), and middle-adult women (ages 45–70; n = 126). Overall mean age was 45.03 (SD = 10.95). Structural equation modeling evidenced that, for both age groups of men and women, internal body orientation was positively associated with body appreciation and body appreciation was positively associated with intuitive eating. Internal body orientation was positively associated with intuitive eating in each group, except early-adult women. The associations among age and BMI with the aforementioned variables were inconsistent. Although evidencing measurement non-invariance among a number of parameters, multigroup structural invariance analyses showed that the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI were invariant across each gender and age. These results further confirm components of the acceptance model of intuitive eating among men and women in early-adulthood and middle-adulthood.
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Food choices and eating behaviors are influenced by a wide variety of factors. However, traditional dietary advice primarily addresses health-related reasons for eating. Lifestyle medicine outcomes may be improved by helping individuals become more aware of why they eat and support individuals to increase their skills in reconciling eating for health and nonhealth purposes. Intuitive eating aims to increase individuals’ awareness of why, what, and how much they eat through mindfulness. This framework and concepts such as flexible restraint can be used to teach individuals skills that may help them improve psychological well-being and manage their weight.
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Interpersonal sexual objectification experiences are pervasive in online communication contexts, and their influence on positive eating behaviors should not be ignored. Broad conceptualization of beauty refers to how widely women and girls define female beauty in terms of both internal and external characteristics, and body appreciation refers to loving, respecting, and holding a positive attitude toward the body. This study examined the association between online interpersonal sexual objectification (OISO) experiences and intuitive eating, as well as the mediating role of broad conceptualization of beauty and body appreciation. Participants were 1152 Chinese adolescent girls aged 11 to 15 years who completed a questionnaire survey measuring OISO experiences, broad conceptualization of beauty, body appreciation, and intuitive eating. The results showed a negative association of OISO experiences with broad conceptualization of beauty and intuitive eating. Mediation analysis using structural equation modeling showed a negative association of OISO experiences with intuitive eating through broad conceptualization of beauty and body appreciation. These results suggest that programs aiming to improve healthy eating behaviors could direct adolescent girls to criticize the appearance-focused mindset in online interaction and encourage them to focus on body functionality, such as health, creative endeavors, and communication with others.
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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.
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The 10-item Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015) is a widely used contemporary measure of positive body image that assesses one’s love for, acceptance and appreciation of, and respect for their body. Given the need for abbreviated measures to reduce participant burden and study cost, we aimed to generate a short form of the BAS-2 (BAS-2SF). Two versions of the BAS-2SF emerged: a 3-item version derived deductively from theory (items selected based on their unique contribution to the body appreciation construct), and a 2-item version generated empirically (items selected based on a genetic algorithm approach). Psychometric evidence was garnered across five studies, totaling 3114 participants. Both BAS-2SF versions correlated highly (rs = .93–.97) with the original 10-item BAS-2 and demonstrated internally consistent and stable scores. Factor analyses revealed high item-factor loadings, unidimensionality, and gender invariance of the 3-item BAS-2SF. Correlations with construct validity measures, as well as model pathways, were similar between both BAS-2SF versions and the 10-item BAS-2. BAS-2SF versions also evidenced incremental validity. Both BAS-2SF versions retain the psychometric integrity of the BAS-2 and are recommended for use; however, the 3-item BAS-2SF is an ideal option for researchers who wish to estimate a body appreciation latent factor.
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Aim: This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity. Methods: Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Results: Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m2 ), compared with single-session lifestyle education (+0.7 kg/m2 ); Studies 2 and 3 found no change in body mass index or body mass index z-score. Conclusions: Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.
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Our objective was to explore the socio-demographic, clinical, and nutritional factors of body appreciation in type 2 diabetics. This is a cross-sectional observational study with 179 adults and older adults (60 ± 10 years old). Most of the sample was female ( n = 133; 74.3%). Through logistic regression analysis, it was observed that being perceived as overweight was associated with a 91.6% lower chance of being satisfied with one’s body. Trusting hunger and satiety cues doubled the chances of body satisfaction. Thus, eating more intuitively, attending to the signs of hunger and satiety, is associated with greater body satisfaction in type 2 diabetics.
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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.
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Body weight dissatisfaction is associated with unhealthy dietary behaviours in young adults, but data are scarce regarding how this relationship evolves with age. The objectives of the present study were to assess the prevalence of body weight dissatisfaction and the association between body weight dissatisfaction, nutrient intake and diet quality in middle-aged and older women. We used data of a population-based sample of 468 middle-aged (50–64 y/o) and older (65–75 y/o) women, extracted from the cross-sectional 2014–15 Swiss National Nutrition Survey. Body weight dissatisfaction was assessed by questionnaire. Dietitians assessed dietary intakes using two non-consecutive computer-assisted multi-pass 24-h dietary recalls and performed anthropometric measurements. Nutrient intakes were calculated and compared with national dietary guidelines, and diet quality scored with the 2010 Alternate Healthy Eating Index (2010-AHEI). 41⋅1 % of women reported body weight dissatisfaction, and 49⋅8 % wanted to lose weight. Body weight dissatisfaction was associated with weight loss desire and a higher body mass index (BMI; P < 0⋅001). Women with body weight dissatisfaction consumed significantly less carbohydrates and dietary fibres, even when BMI was controlled for ( P < 0⋅05). They also fell short of national dietary guidelines for magnesium and iron. Body weight dissatisfied women obtained lower 2010-AHEI scores than satisfied women ( β −4⋅36, 95 % CI −6⋅78, −1⋅93). However, this association disappeared when the BMI was introduced in the equation. This highlights the importance of targeting both body dissatisfaction and unhealthy eating in obesity prevention and treatment at all ages.
Chapter
Dieting typically refers to individuals' attempts to lose weight by restricting the amount or types of foods that are consumed. The majority of men and women engage in dieting behavior at some point in their lives, typically pursuing different dieting strategies across multiple attempts at weight loss. The weight loss industry is a multi-billion-dollar industry, yet the vast majority of programs, plans, pills, and prescriptions do not actually result in weight loss. Psychologists and other medical professionals who understand dieting recommend that people do not pursue weight loss via dieting. For individuals concerned about their weight or health, increasing physical activity, getting at least 7–8 h of sleep per night, and eating more nutrient foods is encouraged.
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Internally regulated eating style, the eating style that is driven by internal bodily sensations of hunger and satiation, is a concept that has received increasing attention in the literature and health practice over the last decades. The various attempts that have been made so far to conceptualize internally regulated eating have taken place independently of one another and each sheds light on only parts of the total picture of what defines internally regulated eating. This has resulted in a literature that is rather fragmented. More importantly, it is not yet clear which are the characteristics that comprise this eating style. In this paper, we identify and describe the full spectrum of these characteristics, namely, sensitivity to internal hunger and satiation signals, self-efficacy in using internal hunger and satiation signals, self-trusting attitude for the regulation of eating, relaxed relationship with food, and tendency to savor the food while eating. With this research, we introduce a common language to the field and we present a new theoretical framework that does justice not just to the full breadth of characteristics that are necessary for the internally regulated eating style but also to the associations between them and the potential mechanisms by which they contribute to this eating style.
Chapter
Cultural ideals of attractiveness have shifted to become more out of reach for the average person, making body image a significant issue for many people in industrialized, western cultures. Body image concerns affect people of all ages, genders, sexual orientations, and races/ethnicities. These concerns originate from a complex interaction of sociocultural influences, and have significant implications for mental and physical health. Positive body image is a multifaceted concept different from negative body image and relates to positive indices of health and well-being. Options for improving body image typically include psychoeducational, cognitive behavioral, and ecological/activist approaches. Body image concerns are serious problems that demand effective responses.
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Eating disorders (ED) are complex mental illnesses and are not a result of personal choice. Full recovery from an ED is possible. The severity and inherent lethality of an ED is undisputed, and the role of the registered dietitian nutritionist (RDN) is essential. Clinical symptomology presents at varying developmental milestones and is perpetuated through a sociocultural evaluation of beauty and drive for ascetic idealism. ED are globally prevalent in 4.4% of the population aged 5 to 17 years, yet affect individuals across the entire lifespan, including all cultures and genders. The Behavioral Health Nutrition Dietetic Practice Group, along with the Academy of Nutrition and Dietetics Quality Management Committee, revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Eating Disorders. Including the RDN in ED treatment is vital for all levels of care. The RDN must be perceptive to negative symptoms indicative of psychological triggers when exploring food belief systems, patterns of disinhibition, and nutrition misinformation with clients. Through a conscious awareness of medical, psychological, and behavioral strategies, the implementation of the SOP and SOPP supports a dynamic and holistic view of ED treatment by the RDN. The SOP and SOPP are complementary resources for RDNs and are intended to be used as self-evaluation tools for assuring competent practice in ED and for determining potential education, training, supervision, and mentorship needs for advancement to a higher practice level in a variety of settings.
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Dichotomous thinking is a propensity for individuals to understand events as opposites, in a binary way. There are currently two inventories that accurately measure this construct, the Dichotomous Thinking Inventory, and the Dichotomous Thinking in Eating Disorders Scale. The present study aimed to carry out a review process to compile all the empirical studies that have made use of either of these instruments. To achieve this goal, we carried out a scoping review. We conducted a search using the keywords “Dichotomous Thinking Inventory,” “Dichotomous Thinking in Eating Disorders Scale,” and “Thinking Style” in the databases PubMed, Science Direct, and PsycInfo. No limits were imposed on the review. We found 19 articles that met the pre-established criteria; the concentration of research occurred in the last 10 years. It was possible to clarify that the dichotomous way of understanding events occurs, in general, in the presence of maladaptive traits of personality.
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Using a prospective design, we investigated possible bi-directional relationships between intuitive eating and four empirically distinct components of negative body image: overvaluation (judgements of self-worth contingent upon weight/shape), dissatisfaction (general discontent with weight/shape), preoccupation (ruminative thinking about weight/shape), and fear of weight gain. We assessed adult women at baseline (T1) and four-month follow-up (T2), as prior work has demonstrated that this time lag is sufficient to detect change in intuitive eating scores. After adjusting for T1 intuitive eating scores and demographic confounds, higher T1 dissatisfaction was the only body image component to significantly predict lower T2 intuitive eating scores in both univariate and multivariate models. Higher T1 intuitive eating scores also significantly predicted lower scores on each of the four negative body image components at T2. Findings suggest that general body discontent may be one of the more important body image variables that lead to decreases in intuitive eating principles. Present findings also add to a growing body of evidence demonstrating the potentially adaptive role of intuitive eating on psychological health indices.
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PurposeThe aim of this study was to provide preliminary psychometric evidence for the Chinese version of the Inflexible Eating Questionnaire (C-IEQ) among a large sample of Chinese adolescents.Methods For testing the psychometric properties of the C-IEQ, a total of 2241 (Mage = 13.91 years; 46.4% boys) adolescents from mainland China responded to the survey. Confirmatory factor analysis (CFA) was used to examine the factor structure of the C-IEQ. Measurement invariance by gender was examined by both multi-group CFA and differential item functioning (DIF). Convergent validity of the C-IEQ was assessed via examining the correlations between the C-IEQ scores and theoretically related constructs (e.g., orthorexia nervosa symptomatology, eating disorder symptomatology, and body image inflexibility).ResultsThe unidimensional structure with correlated errors of the C-IEQ showed good model fit (χ2 = 1674.05, df = 44, p < 0.001; CFI = 0.93; TLI = 0.91; RMSEA = 0.13; SRMR = 0.06). The C-IEQ had an adequate internal consistency (α = 0.89) and demonstrated strong measurement invariance across genders. Moreover, the scores of the C-IEQ showed significant correlations with theoretically correlated constructs: orthorexia nervosa symptomatology (girls; r = 0.53 p < 0.001, boys; r = 0.45 p < 0.001), eating disorder symptomatology (girls; r = 0.32 p < 0.001, boys; r = 0.25 p < 0.001) body image inflexibility (girls; r = 0.41 p < 0.001, boys; r = 0.36 p < 0.001), suggesting good convergent validity of the C-IEQ.Conclusion The C-IEQ showed good psychometric properties in a sample of Chinese adolescents and can be used in future studies to assess eating-specific psychological inflexibility among Chinese adolescents.Level of evidenceLevel V, cross-sectional descriptive study.
Article
Objective To explore the health perceptions of Black women in emerging adulthood and the degree to which perceptions align with core Health at Every Size (HAES) principles. Design Semistructured interviews with Black women in emerging adulthood. Data were collected between June and July 2018 as part of a larger, mixed-methods study. Setting Southern California. Participants Forty-one Black women aged 18–24 years were recruited via a combination of convenience and respondent-drive sampling. Phenomenon of Interest Health perceptions of young Black women and alignment with core HAES principles. Analysis Data were analyzed using principles of inductive thematic analysis. Following analysis, data were further interpreted within the HAES framework. Results Participants’ insights resulted in 3 main themes: (1) health is multidimensional, (2) good health means taking care of yourself, and (3) systemic and environmental disparities affect Black women's health. These themes reflect 3 HAES principles of health enhancement, weight inclusivity, and eating for well-being. Conclusions and Implications Findings provide preliminary support for aligning HAES principles and perceptions and health for Black women in emerging adulthood. Prioritizing holistic well-being, attention to individualized health needs and access to needed information and resources in efforts to improve health outcomes among members of this demographic may be promising.
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Objective: Intuitive eating is an adaptive style of eating that has generated significant research attention. Theoretically, intuitive eating is a core construct that features prominently in the Acceptance Model of Intuitive Eating, a framework that explains how positive environmental influences can foster intuitive eating practices via body appreciation. Empirically, intuitive eating has been connected to a broad range of adaptive mental health indices. At present, a quantitative synthesis of intuitive eating and its correlates has yet to be conducted. This was the objective of the current meta-analysis. Method: Ninety-seven studies (89% cross-sectional) were included. Random effects meta-analyses were conducted on 23 psychological correlates, divided into three clusters: eating behavior and body image disturbances, positive body image and other adaptive factors, and general psychopathology. Meta-analytic path analyses were also computed to test the validity of the Acceptance Model. Results: Intuitive eating was inversely associated with multiple indices of eating pathology, body image disturbances, and psychopathology (rs = -.23 to -.58). Intuitive eating was positively associated with numerous positive psychological constructs, such as positive body image, self-esteem, and wellbeing (rs = .20 to .58). Men reported higher levels of intuitive eating than women (d = 0.39), with differences being largest in Caucasian samples. Meta-analytic path analyses strongly supported the hypothesized pathways specified in the Acceptance Model of Intuitive Eating. Conclusions: There is a strong evidence base for intuitive eating's connection to numerous adaptive psychological constructs. Attention should now shift toward prospective and experimental designs so that the temporal nature of these relationships can be identified.
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To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons. We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include 'intuitive eating' or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators. We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.
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The 21-item Intuitive Eating Scale (IES; Tylka, 2006) measures individuals' tendency to follow their physical hunger and satiety cues when determining when, what, and how much to eat. While its scores have demonstrated reliability and validity with college women, the IES-2 was developed to improve upon the original version. Specifically, we added 17 positively scored items to the original IES items (which were predominantly negatively scored), integrated an additional component of intuitive eating (Body-Food Choice Congruence), and evaluated its psychometric properties with 1,405 women and 1,195 men across three studies. After we deleted 15 items (due to low item-factor loadings, high cross-loadings, and redundant content), the results supported the psychometric properties of the IES-2 with women and men. The final 23-item IES-2 contained 11 original items and 12 added items. Exploratory and second-order confirmatory factor analyses upheld its hypothesized 4-factor structure (its original 3 factors, plus Body-Food Choice Congruence) and a higher order factor. The IES-2 was largely invariant across sex, although negligible differences on 1 factor loading and 2 item intercepts were detected. Demonstrating validity, the IES-2 total scores and most IES-2 subscale scores were (a) positively related to body appreciation, self-esteem, and satisfaction with life; (b) inversely related to eating disorder symptomatology, poor interoceptive awareness, body surveillance, body shame, body mass index, and internalization of media appearance ideals; and (c) negligibly related to social desirability. IES-2 scores also garnered incremental validity by predicting psychological well-being above and beyond eating disorder symptomatology. The IES-2's applications for empirical research and clinical work are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Intuitive eating (i.e., eating based on physiological hunger and satiety cues rather than situational and emotional cues) recently has gained recognition as an adaptive eating style. The present study explored a model of intuitive eating based on a foundation of acceptance with 2 samples of college women. Path analysis with the 1st sample (N = 181) revealed that the acceptance model provided an excellent fit to the data, and latent variable structural equation modeling with the 2nd sample (N = 416) cross-validated this model. Specifically, general unconditional acceptance predicted body acceptance by others, body acceptance by others predicted an emphasis on body function over appearance, body acceptance by others and an emphasis on body function predicted body appreciation, and an emphasis on body function and body appreciation predicted intuitive eating. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This article provides a survey of eating disorders in men, highlights the dramatic rise in eating disorders, identifies issues specific to males, and suggests areas for research and intervention. This survey concludes that men with eating disorders are currently under-diagnosed, undertreated, and misunderstood by many clinicians who encounter them. Ongoing research addressing these issues is expected to result in assessment tools and treatment interventions that will advance positive outcomes for men with eating disorders.
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The relationships of body satisfaction, self-esteem, dieting, and exercise were studied in 92 men and women. Men and women did not differ in degree of body dissatisfaction as assessed by three different measures. However, on the direction of body dissatisfaction, men were as likely to want to be heavier as thinner, whereas virtually no women wished to be heavier. Although overall body esteem was correlated with self-esteem for both men and women, measures of weight dissatisfaction were not associated with self-esteem for women. The normative nature of weight dissatisfaction for women today may serve to buffer its effects on self-esteem. Women reported exercising for weight control more than men, and exercising for weight control was associated with disregulated eating.
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We examined self-objectification in relation to well-being, and the potential moderating versus mediating role of body image coping strategies (appearance fixing, avoidance, positive rational acceptance). Undergraduate women from southern Ontario, Canada (Sample 1, n = 104; Sample 2, n = 314) completed measures of depression, disordered eating attitudes, subjective well-being, and body-image coping. Self-objectification was related to greater depression, disordered eating attitudes, and lower subjective well-being. A two-stage mediation model was supported: Body shame and body image coping strategies (appearance fixing and avoidance) partially mediated the associations between self-objectification and outcomes; appearance fixing and avoidance partially mediated the associations between body shame and outcomes. Body image coping strategies did not moderate any of the relations between body shame and outcomes.
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The statistical analysis of mediation effects has become an indispensable tool for helping scientists investigate processes thought to be causal. Yet, in spite of many recent advances in the estimation and testing of mediation effects, little attention has been given to methods for communicating effect size and the practical importance of those effect sizes. Our goals in this article are to (a) outline some general desiderata for effect size measures, (b) describe current methods of expressing effect size and practical importance for mediation, (c) use the desiderata to evaluate these methods, and (d) develop new methods to communicate effect size in the context of mediation analysis. The first new effect size index we describe is a residual-based index that quantifies the amount of variance explained in both the mediator and the outcome. The second new effect size index quantifies the indirect effect as the proportion of the maximum possible indirect effect that could have been obtained, given the scales of the variables involved. We supplement our discussion by offering easy-to-use R tools for the numerical and visual communication of effect size for mediation effects.
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Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
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Examine the association between components of restrained eating, cognitive performance and weight loss maintenance. 106 women, all members of a commercial slimming organisation for at least 6months (mean±SD: 15.7±12.4months), were studied who, having lost 10.1±9.7kg of their initial weight, were hoping to sustain their weight loss during the 6month study. Dietary restraint subcomponents flexible and rigid restraint, as well as preoccupying cognitions with food, body-shape and diet were assessed using questionnaires. Attentional bias to food and shape-related stimuli was measured using a modified Stroop test. Working memory performance was assessed using the N-back test. These factors, and participant weight, were measured twice at 6month intervals. Rigid restraint was associated with attentional bias to food and shape-related stimuli (r=0.43, p<0.001 resp. r=0.49, p<0.001) whereas flexible restraint correlated with impaired working memory (r=-0.25, p<0.05). In a multiple regression analyses, flexible restraint was associated with more weight lost and better weight loss maintenance, while rigid restraint was associated with less weight loss. Rigid restraint correlates with a range of preoccupying cognitions and attentional bias to food and shape-related stimuli. Flexible restraint, despite the impaired working memory performance, predicts better long-term weight loss. Explicitly encouraging flexible restraint may be important in preventing and treating obesity.
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This study investigated the construct validity of two dietary restraint subscales, flexible control (FC) and rigid control (RC), identified by Westenhoefer (1991; Appetite, 16, 45–55) as a subset of the restraint scale items from the Three-Factor Eating Questionnaire (TFEQ, Stunkard & Messick. [1985]. Journal of Psychosomatic Research, 29, 71–83). The subjects were 31 women on long-term personality disorder units. Based on the Structured Clinical Interview for DSM-III-R (SCID), 68% has past anorexia and/or bulimia diagnoses and 94% were borderline. The subjects completed the TFEQ and supplied weight and height data for body mass index (BMI) calculations. The results supported the validity of the two restraint constructs by showing that FC was inversely related to BMI and predicted an anorexia diagnosis. In contrast, RC directly predicted BMI when tested concurrently with FC. RC was also more associated with a history of bulimia and problems with weight fluctuations than FC was. Thus, the FC-RC distinction was valid and useful in this population of women. © 1994 by John Wiley & Sons, Inc.
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Objective Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior.Method Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales.ResultsRigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program.DiscussionRigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 53–64, 1999.
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To assess the effects of a "Health-At-Every-Size" (HAES) intervention on eating behaviors and appetite ratings in 144 premenopausal overweight women. Women were randomly assigned to one of the 3 groups: HAES group, social support (SS) group, and control group (N = 48 in each group). Interventions were conducted over a 4-month period, and measurements were taken before and after this period. Eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) were evaluated by the Three-Factor Eating Questionnaire. Appetite ratings (desire to eat, hunger, fullness, and prospective food consumption) were assessed by visual analogue scales before and after a standardized breakfast. More important decreases in susceptibility to hunger and external hunger were observed in the HAES group when compared with the SS group (p=0.05, for susceptibility to hunger) and the control group (p=0.02 and p=0.005, for susceptibility to hunger and external hunger, respectively). In addition, women from the HAES group had more important decreases in postprandial area under the curve for desire to eat (p=0.02) and hunger (p=0.04) when compared with the control group. The change in the desire to eat noted in the HAES group was also different from the one observed in SS group (p=0.02). Women from the HAES group experienced significant weight loss at 4 months (-1.6+/-2.5 kg, p<0.0001), which did not differ significantly from the SS and control groups (p=0.09). An increase in flexible restraint was significantly related to a greater weight loss in both HAES and SS groups (r=-0.39, p<0.01; and r=-0.37, p<0.05, respectively). A decrease in habitual susceptibility to disinhibition was also associated with a greater weight loss in HAES and control groups (r=0.31, p<0.05; and r=0.44, p<0.05, respectively). These results suggest that a HAES intervention could have significant effects on eating behaviors and appetite ratings in premenopausal overweight women, when compared with an SS intervention or a control group.
Article
Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches. To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention. Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006. Premenopausal overweight/obese women (n=144; mean age of 42.3+/-5.6 years), recruited from free-living, general community. Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48). Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost > or =1.2 k cal x kg(-1) x 15 minutes(-1) [> or =4.8 metabolic equivalents]). Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design. Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (-0.9+/-0.2 and -1.3+/-0.5, respectively) and the social support group (-0.4+/- 0.2 and -1.4+/-0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5+/-0.2 in HAES group vs 2.7 +/- 0.2 in social support group; susceptibility to hunger: 4.2+/-0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3+/-0.2 for situational susceptibility to disinhibition and 5.9+/-0.5 for susceptibility to hunger). These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.
Article
Objective: To assess the effects of a “Health-At-Every-Size” (HAES) intervention on eating behaviors and appetite ratings in 144 premenopausal overweight women.Research Methods and Procedures: Women were randomly assigned to one of the 3 groups: HAES group, social support (SS) group, and control group (N = 48 in each group). Interventions were conducted over a 4-month period, and measurements were taken before and after this period. Eating behaviors (cognitive dietary restraint, disinhibition, and susceptibility to hunger) were evaluated by the Three-Factor Eating Questionnaire. Appetite ratings (desire to eat, hunger, fullness, and prospective food consumption) were assessed by visual analogue scales before and after a standardized breakfast.Results: More important decreases in susceptibility to hunger and external hunger were observed in the HAES group when compared with the SS group (p = 0.05, for susceptibility to hunger) and the control group (p = 0.02 and p = 0.005, for susceptibility to hunger and external hunger, respectively). In addition, women from the HAES group had more important decreases in postprandial area under the curve for desire to eat (p = 0.02) and hunger (p = 0.04) when compared with the control group. The change in the desire to eat noted in the HAES group was also different from the one observed in SS group (p = 0.02). Women from the HAES group experienced significant weight loss at 4 months (−1.6 ± 2.5 kg, p < 0.0001), which did not differ significantly from the SS and control groups (p = 0.09). An increase in flexible restraint was significantly related to a greater weight loss in both HAES and SS groups (r = −0.39, p < 0.01; and r = −0.37, p < 0.05, respectively). A decrease in habitual susceptibility to disinhibition was also associated with a greater weight loss in HAES and control groups (r = 0.31, p < 0.05; and r = 0.44, p < 0.05, respectively).Discussion: These results suggest that a HAES intervention could have significant effects on eating behaviors and appetite ratings in premenopausal overweight women, when compared with an SS intervention or a control group.
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Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
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This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.
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A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
Article
This study was designed to test the hypothesis that different types of dieting strategies are associated with different behavioral outcomes by investigating the relationship of dieting behaviors with overeating, body mass and mood. A sample of 223 adult male and female participants from a large community were studied. Only a small proportion of the sample (18%) was seeking weight loss treatment, though almost half (49.3%) of the subjects were significantly overweight (body mass index, BMI>30). Subjects were administered questionnaires measuring dietary restraint, overeating, depression and anxiety. Measurements of height and weight were also obtained in order to calculate BMI. Canonical correlation was performed to evaluate the relationship of dietary restraint variables with overeating variables, body mass, depression and anxiety. The strongest canonical correlation (r=0.65) was the relationship between flexible dieting and the absence of overeating, lower body mass and lower levels of depression and anxiety. The second strongest canonical correlation (r=0.59) associated calorie counting and conscious dieting with overeating while alone and increased body mass. The third canonical correlation (r=0.57) found a relationship between low dietary restraint and binge eating. The results support the hypothesis that overeating and other adverse behaviors and moods are associated with the presence or absence of certain types of dieting behavior.
Article
Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior. Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales. Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program. Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.
Article
The correlates of rigid and flexible dieting were examined in a sample of 188 nonobese women recruited from the community and from a university. The primary aim of the study was to test the hypothesis that women who utilize rigid versus flexible dieting strategies to prevent weight gain report more eating disorder symptoms and higher body mass index (BMI) in comparison to women who utilize flexible dieting strategies. The study sample included women who were underweight (29%), normal weight (52%), and overweight (19%). None of the women were obese, as defined by BMI>30. Participants were administered a questionnaire that measures Rigid Control and Flexible Control of eating. Body weight and height were measured and measures of eating disorder symptoms and mood disturbances were administered. Our results indicated that BMI was significantly correlated with rigid dieting and flexible dieting. BMI was controlled statistically in other analyses. The study found that individuals who engage in rigid dieting strategies reported symptoms of an eating disorder, mood disturbances, and excessive concern with body size/shape. In contrast, flexible dieting strategies were not highly associated with BMI, eating disorder symptoms, mood disturbances, or concerns with body size. Since this was a cross sectional study, causality of eating disorder symptoms could not be addressed. These findings replicate and extend the findings of earlier studies. These findings suggest that rigid dieting strategies, but not flexible dieting strategies, are associated with eating disorder symptoms and higher BMI in nonobese women.
Article
The purpose of this study was to develop a brief self-report inventory to assess body checking behaviors. Using exploratory and confirmatory factor analyses, the 23-item Body Checking Questionnaire (BCQ) was developed. The BCQ measures the global construct of body checking behaviors with three correlated subfactors that assess checking related to overall appearance, checking of specific body parts, and idiosyncratic checking rituals. The BCQ was found to have good test-retest reliability (.94) and the subfactors had good internal consistency (.88, .92, and .83). The measure correlated highly with other measures of negative body image and eating disorders, demonstrating its concurrent validity. Additionally, the BCQ was found to differentiate normal controls and eating disorder patients, as well as nonclinical participants scoring high and low on a measure of concern with body size and dieting. Due to the potential role of ritualistic body checking in the maintenance of body dissatisfaction by directing excessive attention to body shape/weight, the BCQ may prove to be a useful clinical tool in the assessment and treatment of eating disorder patients.