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Outcomes of intuitive eating interventions: a systematic review and meta-analysis
Abstract
Intuitive eating (IE) is an approach to health promotion that fosters a positive relationship with food and the body. The objective of this review was to aggregate and analyse the literature on IE interventions, thereby offering an early investigation of methodological approaches to intervention. This review was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA) guidelines. Searching was conducted in four electronic databases. Studies were eligible for inclusion if they delivered an IE intervention and used the Intuitive Eating Scale (IES). Nine studies were included in this review. Six were eligible for meta-analysis, though only outcomes on the IES were examined; all other measures were examined individually. All interventions led to improvements on measures of IE, with a large pooled effect size (1.50 [1.15, 1.85]) and positive changes on a variety of other outcomes relating to health. This pattern preliminarily suggests that IE interventions change psychological processes as intended and can be useful in promoting health behaviour. The present review offers a synthesis of existing approaches to IE interventions and an evaluation of which specific variants appear to be more effective. This paper provides a basis upon which future interventions can be developed to improve approaches to psychoeducation.
Clinical Implications
• Interventions contributed to improvements in measures of IE lasting up to 6 months.
• Interventions contributed to positive changes on outcomes such as quality of life, body image, and body appreciation.
• Self-management through IE-based interventions may be feasible and effective.
... Studies of intuitive eating interventions are promising and suggest that such interventions improve physical and psychological health outcomes and that these improvements are sustained long term (e.g., up to two years post-intervention in a sample of female chronic dieters with obesity, Bacon et al., 2005). Additionally, intuitive eating interventions have lower attrition rates compared to traditional weight loss interventions (Babbott et al., 2022;Bacon et al., 2005;Clifford et al., 2015;Mensinger et al., 2016;Schaefer & Magnuson, 2014). ...
... Over a third of participants described positive perceptions of intuitive eating, including anticipating finding it easy to follow and making them feel good. This finding is in line with intervention studies indicating that individuals tend to like this approach to eating (Babbott et al., 2022;Boucher et al., 2016). Of note, participants in our sample were reporting only anticipated facilitators and it may be that their attitudes could change if they were to be engaged in an intuitive eating program, especially given the literature demonstrating the link between dietary restraint and body discontentment with decreased intuitive eating (Messer et al., 2021;Smith et al., 2020). ...
... Other studies have also shown that even after following a well-liked 14week intuitive eating intervention, group members still reported difficulty with eating intuitively due to fears of weight gain and continued engagement with behaviors associated with dieting (Barraclough et al., 2019). Therefore, it may be that certain barriers are more entrenched and difficult to address, although further research could identify ways of lessoning their impact along with identifying which individual characteristics are associated with the most difficulty in adopting an intuitive eating style (Babbott et al., 2022). Some perceived barriers appeared to be misperceptions as to what intuitive eating is, and they might be resolved by taking care to describe intuitive eating components more clearly, such as by stressing the fact that intuitive eating emphasizes following hunger and satiety cues but does not prohibit individuals from eating craved foods. ...
Background:
Intuitive eating involves following internal cues of hunger and satiety to guide eating choices as opposed to responding to external signals, strong emotions, or dietary rules. This style of eating has consistently been shown to be related to better physical and psychological health indicators, and more interventions are being designed and studied to promote this eating style. The current study aimed to identify anticipated facilitators and barriers to following this style of eating among a group of college students enrolled in a larger study of intuitive eating.
Method:
Following a week of tracking their current eating as part of a larger study, college students read a description of intuitive eating. They then answered three open-ended questions about following intuitive eating including facilitators, barriers, and perceived ability to follow long term. Responses were coded using thematic analysis to identify themes across responses.
Results:
Among 100 participants, 86 % were female, 46 % were Hispanic (41 % non-Hispanic White, 13 % other race/ethnicity), mean age was 24.3 years, and mean body mass index was 26.2. The most commonly anticipated participant-reported facilitators of intuitive eating were being in touch with the body's needs and hunger cues, positive perceptions of intuitive eating, and health considerations. The most commonly anticipated barriers were logistical constraints (e.g., busyness and mealtimes), difficulty with hunger cues and reactions to food, and negative perceptions of intuitive eating. The majority of participants (64 %) would consider following this style of eating long term.
Discussion:
This study provides information that can be used to improve efforts aimed at promoting intuitive eating to college students, including marketing intuitive eating interventions, and clarifying misunderstandings of its key tenets that might serve as barriers.
... Although different models can be described within this framework, such as intuitive eating or mindful eating, non-dieting approaches share a common goal of rejecting the dieting mentality, promoting self-acceptance and body positivity regardless of size. These approaches encourage eating based on recognizing and responding to hunger-satiety signals, developing personalized eating strategies (Babbott et al., 2023) and addressing psychological well-being alongside physical health. They also emphasize fostering a healthy relationship between food, mind and body, encouraging mindfulness and pleasure during meals, where weight loss is never the health outcome (Babbott et al. 2023;Bégin et al. 2019). ...
... These approaches encourage eating based on recognizing and responding to hunger-satiety signals, developing personalized eating strategies (Babbott et al., 2023) and addressing psychological well-being alongside physical health. They also emphasize fostering a healthy relationship between food, mind and body, encouraging mindfulness and pleasure during meals, where weight loss is never the health outcome (Babbott et al. 2023;Bégin et al. 2019). ...
Interest has arisen regarding different dietary approaches,namely prescriptive vs non-dieting approaches. Nonetheless, evidence on which individual factors orient professionalstoward either approach is currently lacking for dietetics stu-dents and registered dietitians (RDN). For this reason, the present study aimed at investigating personal and interpersonal factors associated with the adoption of such approaches indietary practice. This cross-sectional observational studyinvolved 174 participants through an online survey (responserate 74.41%, n = 128). Participants were recruited from two universities in Italy, encompassing both RDNs and dietetics students. The sample was then divided by self-reported dietary approach orientation and group differences were explored. Personal (such as previous history of dieting, personality factors,intuitive eating, eating experiences) and interpersonal factors(like areas of work interest, years of clinical expertise) potentially influencing dietary orientation were investigated. Group differences were estimated by Analysis of Covariance (ANCOVA) for continuous variables, after adjustment for age and gender, and by Chi-squared tests for categorical variables. Moreover, network structures for psychometric variables were estimated for both groups, employing a mixed graphical model, and computing a comparison between groups after bootstrapping (edge invariance test, n = 5,000). Results showed that openness to experience (F-value: 3.989 p-value: <0.05) and intuitive eating (F-value: 9.836, p-value: <0.01) were higher among participants which oriented toward non-dieting approaches. RDNs with more years of clinical experience (p-value: 0.004) and working within the field of eating disorders (p-value: <0.001) were more likely to be oriented toward non-dieting approaches. Current findings suggest that personal and interpersonal factors shape dietary orientations.
... On the other hand, research indicates that individuals who adopt a more positive relationship with food can make better dietary choices, assume more balanced eating habits, and have a better perception of their health status [7,8]. A beneficial relationship between individuals, their eating habits, and their bodies reduces the potential risks of psychopathologies related to eating behavior, including eating disorders [9]. ...
... It is known that depending on the sample studied, the latent traits of the construct may be influenced, as is the case with disordered eating behaviors in women compared with men [13][14][15][16]. Research shows that women present lower intuitive eating [9] and higher scores on disordered eating behaviors measures [13][14][15][16] when compared to men. Furthermore, differences in eating attitudes can be found between the young adult population and the average adult [13,15], those with a healthy health status versus those with health problems [13,16], and ethnical groups [16]. ...
Measures of beliefs and attitudes toward food have generally been limited to the measurement of more pathological eating attitudes (e.g., disordered eating). The Food Life Questionnaire (FLQ) and its short form (FLQ-SF) were developed to examine attitudes toward a broader range of foods; however, the factor structure of the FLQ-SF was not confirmed in any study with young women. In the present study, we performed a psychometric evaluation of the Brazilian Portuguese translation of the FLQ-SF in a sample of 604 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach. Results supported a four-factor structure (i.e., weight concern, diet–health orientation, belief in a diet–health linkage, and food and pleasure) with 18 items (χ²/df = 2.09; CFI = 0.95; TLI = 0.94; RMSEA = 0.05 (90% CI = 0.04; 0.06; p > 0.05); and SRMR = 0.08). Additionally, we found good internal consistency for all FLQ-SF subscales (McDonald’s ω = 0.79–0.89) and convergent validity with measures of feelings, beliefs, and behaviors involved in food attitudes. Collectively, these results support the use of the FLQ-SF in Brazilian women and provide a foundation to expand the literature on beliefs and attitudes toward food in this population.
... However, emotional eating has been associated with higher cardiometabolic risk scores in adolescents (Zhang et al. 2023) and with the metabolic syndrome in adults (Park et al. 2020), while cognitive restraint has been associated with elevated levels of salivary cortisol, a biomarker of stress (Bozovic et al. 2013) which has been associated with abdominal obesity (Anderson et al. 2002), a key component of the metabolic syndrome (NCEP 2001). Furthermore, intuitive eating, which is eating based on one's hunger and fullness signals while honouring individual food preferences, has been associated not only with health indicators such as lower blood pressure and cholesterol level (Van Dyke and Drinkwater 2014), but also with quality of life, body image, and body appreciation (Babbott et al. 2023). ...
... This profile was also characterized by a higher intuitive eating score, which has been associated with better diet quality (Hensley-Hackett et al. 2022), and in many studies with a lower BMI Van Dyke and Drinkwater 2014;Anderson et al. 2016). Interestingly, in a study of Belon et al., an intuitive profile combined with a higher diet quality was associated with lower psychological distress, BMI, and disordered eating (Belon et al. 2022) and also with a more positive body image, less eating pathology, and higher self-esteem (Belon et al. 2022;Babbott et al. 2023). Also, the relatively higher dietary restraint observed in this profile was characterized by being flexible rather than rigid. ...
The aim of this study was to identify eating-related latent profiles based on diet quality and eating behaviours within a population characterized by a body mass index (BMI) of at least 25 kg/m², and to compare metabolic variables between profiles. This analysis was conducted in a sample of 614 adults (45.6% women; 44.8 ± 12.9 years) from the cross-sectional PREDISE study. Participants completed the Three-Factor Eating Questionnaire, the Intuitive Eating Scale-2, the Regulation of Eating Behavior Scale, and three self-administered 24 h food recalls. Waist circumference, blood lipids, blood pressure, and fasting glucose were measured to identify carriers of the metabolic syndrome. A latent profile analysis was performed, and cases of metabolic syndrome were compared between profiles. A three-profile solution was found. Profile 1 (22.8%) was characterized by lower diet quality, lower self-determined motivation for eating, lower restraint, and higher intuitive eating. Profile 2 (44.5%) was characterized by higher diet quality, higher self-determined motivation for eating, higher restraint, lower disinhibition, and higher intuitive eating. Profile 3 (32.7%) was characterized by intermediate diet quality, higher non-self-determined motivation for eating, higher restraint and disinhibition, and lower intuitive eating. We found fewer cases of metabolic syndrome among participants in profile 2 than in the other profiles (p = 0.0001). This study suggests that a profile characterized by a lower disinhibition and higher levels of restraint, intuitive eating, self-determined motivation, and diet quality is associated with a better metabolic health among individuals with a higher BMI.
... Entering university can be a moment in life marked by great social pressure, with situations and challenges that increase the levels of stress, anxiety, and depressive symptoms [12], contributing to an increased risk of dysregulation of eating and worsening of eating behaviors [13] and body image perception, leaving university students more vulnerable to eating disorders [14]. In this context, ME and IE are useful approaches to promote improvements in eating and mental health by helping students to focus on their own cues of hunger and satiety, rather than following fashion trends or giving in to social pressure [15,16]. ...
... It is still uncertain whether students can benefit from the effects of these approaches based on results from other studies conducted with the general population [103]. In terms of psychological aspects, IE has been inversely associated with multiple indices of pathological eating, body image disturbances, and psychopathology and positively associated with positive psychological constructs such as positive body image, self-esteem, and well-being [15,104]. According to a meta-analysis of clinical trials, mindfulness-based interventions have resulted in improvements in mindfulness scores and binge eating symptoms [105,106]. ...
Background: The role of mindful eating (ME) and intuitive eating (IE) in improving eating behavior, diet quality, and health is an area of increasing interest. Objective: The objective of this review was to identify the instruments used to assess ME and IE among higher education students and outcomes related to these dimensions. Methods: This review was carried out according to the PRISMA statement, through systematic searches in PubMed, Web of Science, PsycInfo, and Scopus. The inclusion criteria selected for higher education students, levels of ME and/or IE reported, and observational and clinical studies. The exclusion criteria selected against reviews, qualitative studies, and case studies. Quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Results: A total of 516 initial records were identified, from which 75 were included. Cross-sectional studies were the most common research design (86.7%). Most studies were conducted with samples that were predominantly female (90.7%), White (76.0%), aged 18 to 22 years (88.4%), with BMI < 25 kg/m2 (83.0%), and in the United States (61.3%). The Intuitive Eating Scale (IES), the Mindful Eating Questionnaire (MEQ), and their different versions were the most used instruments. The outcomes most studies included were eating behavior and disorders (77.3%), anthropometric assessments (47.8%), mental health (42.0%), and body image (40.6%). Regarding the quality of studies, 34.7% of studies were assigned a positive, 1.3% a negative, and 64.0% a neutral rate. Conclusions: IES and MEQ were the most used instruments. RCT and cohort studies are scarce, and future research with a higher level of quality is needed, especially on the topics of food consumption, diet quality, and biochemical markers.
... (8) Respect Your Body; (9) Movement-Feel the Difference; and (10) Honor Your Health with Gentle Nutrition (Tribole & Resch, 2012). Prior interventional research conducted among adults posits that IE is a modifiable skill and a worthwhile interventional target, evidenced by consistent reductions in measures of DE and improvements in indices of regulated eating, quality of life, body image, and body appreciation in prior meta-analytic work (Babbott et al., 2022). ...
... Further, there were distinct gender differences in the outcomes of preliminary efficacy testing; granular analyses revealed that changes to scores on the BAS-2 were significant for male participants only, and on the RHSC subscale in particular, the internal consistency was notably lower among male participants than it was among females, raising questions of reliability and necessitating cautious interpretation of results. It is not uncommon for interventional studies based on IE to have differential effects on male and female participants (Healy et al., 2015) and on the different elements of IE (Babbott et al., 2022), but understanding why this occurs is less clear. ...
Objective
Intuitive eating (IE) is an emerging health promotion framework which has shown promise in the prevention and early intervention of disordered eating (DE) behavior in adults. This study sought to extend this work by assessing the feasibility and preliminary efficacy of a 5‐week IE intervention, “Your Body is Your Home,” delivered in school classrooms for early adolescents aged 11–13.
Methods
The present study utilized a quasi‐experimental design. Eligibility criteria were defined a priori and published in a registered protocol. Four classrooms ( n = 128 student participants) were recruited into two streams, and self‐report questionnaires were administered at pre‐test, post‐test, and 4‐week follow‐up. The questionnaires included the Intuitive Eating Scale for Early Adolescents (IES‐2‐EA), the Body Appreciation Scale (BAS‐2), and the WHO Wellbeing Index (WHO‐5). Linear mixed models were used to conduct preliminary efficacy testing.
Results
The results indicate that a brief classroom‐based IE intervention is feasible and acceptable for both students and teaching staff; retention, fidelity, and attendance targets were achieved. Students and teachers rated all five sessions of the intervention as a highly feasible method of health promotion. Further, preliminary efficacy data suggest IE interventions aimed at early adolescents may be a feasible way of improving certain aspects of IE ( p < .001) in male and female participants, and body appreciation ( p < .001) in male participants.
Discussion
The study provides preliminary support for the implementation and evaluation of an IE intervention as part of school‐based health promotion and offers preliminary effect size estimates for a larger‐scale randomized trial.
Public Significance
Existing evidence suggests that IE may be a useful framework through which relationships with food and the body can be improved. The present study seeks to extend this work by adapting the framework for early adolescents (among whom the framework is not well understood) and examining feasibility, acceptability, and preliminary changes to several health and well‐being metrics following a 5‐week school‐based intervention.
... The portrayal of mostly young White females of average body type in this study reflects the lack of diversity on mainstream media and social media platforms. Similar demographic imbalance is evident in the literature [47], where the majority of participants recruited into intuitive eating interventions were White females with mean age 16-51 years. Notably, in one study exploring associations between intuitive eating and dietary intake [48], higher intuitive eating scores were reported in men (48% of participants) than women, highlighting the importance of gender-inclusive and tailored interventions. ...
... This is noteworthy since the content available on social media such as Instagram may influence young people's nutrition-related choices [7,8]. Additionally, it has been suggested that intuitive eating interventions may lend themselves well to self-management [47], which may include online information. In a 2016 study investigating Facebook use for health information among college students (n = 351, aged 18-29 years), the participants rated information to be more credible and useful when presented by health professionals, compared with media and peers [49]. ...
Non-dieting approaches, including mindful/intuitive eating, to health improvement are of increasing interest, yet little is known about young adults’ social media exposure to them. Therefore, this study aimed to describe the imagery related to mindful/intuitive eating which is visible to young adult Instagram users. Images categorized under the hashtags ‘mindfuleating’ and ‘intuitiveeating’ were searched in September 2021 using the ‘top posts’ view. Screen captures of 1200 grid-view images per hashtag were used to construct coding frameworks and to determine saturation. Sample sizes for #mindfuleating and #intuitiveeating were 405 and 495 images, respectively. Individual images were coded collaboratively. Almost half of each sample depicted food or drink, of which 50–60% were healthy foods. Approximately 17% were single-person images, of which the majority were young, female adults with healthy weight. Approximately one-third of text suggested credibility through credentials, profession, or evidence. Messaging was similar for both hashtags, encompassing mindful/intuitive eating (~40%), nutrition/eating behaviours (~15%), physical/mental health (~20%), disordered eating (~12%), and body-/self-acceptance (~12%). Differences were observed between hashtags for weight-related concepts (20%/1%) and anti-diet/weight-neutral approaches (10%/35%). The representation on Instagram of mindful and intuitive eating portrays healthy lifestyles without a focus on weight but lacks demographical and body-type diversity. Instagram holds the potential for health professionals to disseminate culturally/demographically inclusive, evidence-based health/nutrition information to youth.
... Research evaluating HAES interventions, which emphasize healthy behaviors, size acceptance, and non-dieting approaches, has demonstrated health benefits regardless of weight loss. Nevertheless, as mentioned in previous sections and corroborated by other literature from the last twenty years (33, 43,44), the longterm effectiveness of these interventions remains in question. Available data and findings from other authors suggest the long-term (>12 months) may not be sustained (45,46). ...
Objective
This study aims to provide rapid and up-to-date evidence on the effectiveness of Health at Every Size (HAES) interventions compared to controls or other conventional approaches in individuals with overweight or obesity, with the goal of developing more effective and body-diverse respectful strategies.
Methods
A review of literature was carried out using the following databases: PubMed, Scopus, Embase, Web of Science, and SciELO. Research articles were selected based on predefined inclusion and exclusion criteria. Extracted data included study characteristics (design, setting, population demographics, sample size, intervention characteristics, study duration, and follow-up period) and health-related outcomes.
Results
The search yielded 324 articles, of which 20 articles met the inclusion and exclusion criteria. The majority of studies focused on lifestyle improvement, particularly in nutrition, body image, and relationships with food, utilizing a HAES approach. Additionally, other studies examined outcomes such as general well-being, body weight, body composition, cardiovascular risk, and changes in physical activity. Long-term results were particularly noted in studies incorporating physical activity interventions.
Conclusion
HAES interventions appear to be a feasible strategy for promoting overall health and wellness, regardless of body size or shape. However, further evaluation is needed to assess the sustainability of these changes and their long-term impact, as current evidence suggest a they may not be maintained over time.
... Depending on this decision, eating behavior outcomes can be reinforced [9]. Recent studies suggest that individuals who decide to eat intuitively tend to have a better relationship with food [10][11][12]. Intuitive eating is defined as being connected to internal hunger, satiety, and appetitive cues, and flexibly using these cues to determine when, what, and how much to eat [12]. ...
The Preference for Intuition and Deliberation in Food Decision-Making Scale (E-PID) was developed to evaluate both intuitive and deliberative food decision-making within a single instrument. However, its psychometric properties have only been assessed among German-speaking participants. The main aim of the present study was to evaluate evidence of validity and reliability of the E-PID among 604 Brazilian adult women. Exploratory (n = 289) and confirmatory factor analyses (n = 315) were conducted to evaluate the factor structure of the E-PID. Convergent validity was assessed correlating the E-PID with measures of eating behaviors (Tree-Factor Eating Questionnaire-18), intuitive eating (Intuitive Eating Scale-2), and a measure of beliefs and attitudes towards food (Food-Life Questionnaire-SF). McDonald’s Omega coefficient (ω) was used to test the internal consistency of the E-PID. Results from an exploratory and confirmatory factor analysis supported a two-factor structure with seven items. We found good internal consistency (McDonald’s ω = 0.77–0.81). Furthermore, the E-PID demonstrated adequate convergent validity with measures of intuitive, restrictive, emotional and uncontrolled eating, and beliefs and attitudes towards food. Results support the use of the E-PID as a measure of intuition and deliberation in food decision-making among Brazilian adult women, expanding the literature on eating decision-making styles.
... The three systematic reviews have some overlap in studies. The systematic reviews suggested that in the short term, weight-neutral interventions improved intuitive eating and resulted in positive changes on dietary quality [49][50][51] but highlighted the need for further well-designed and longterm studies also including men, who were underrepresented in the most of the studies [48,[52][53][54]. While weight loss was not part of the weight-neutral strategy, the meta-analyses showed no between-group differences in weight-related or cardiometabolic outcomes, diet quality, physical activity and most psychosocial and behavioural outcomes, but demonstrated an improvement in the bulimia subscale of the Eating Disorder Inventory in two studies, compared with conventional weight management interventions [47]. ...
Purpose of Review
Despite decades of development and testing of weight-loss interventions, the adult populations worldwide have witnessed a continuous rise in body weight. There is an ongoing debate about how to move forward. Some argue that this rise calls for more intensive and possibly life-long treatments, including the new effective GLP1 weight loss medications, while others have called for a fundamental shift away from weight and on to a broader understanding of health. The two strategies are represented as a weight-centric health strategy and a weight neutral health strategy. This paper debates the benefits and potential harms related to the use of these two strategies.
Recent Findings
While major weight loss may have substantial health benefits, many individuals will need intensive treatment including weight loss medication to achieve it, as generally few are able to sustain a lifestyle induced weight loss in the long term.
Summary
Both the weight loss and the weight-neutral health strategies have advantages and limitations emphasizing the need for further research comparing the two strategies. Currently, not everyone is offered, can afford, will tolerate or even desire treatment with weight loss medication, and weight neutral health strategies may be a desirable alternative intervention offering a more holistic approach to health and addressing psychological and social issues including the burden of experienced and internalized weight stigma. However, this method still needs to be tested for effectiveness with regards to both physical and long-term psychological benefits.
... There is emphasis on understanding that no foods are inherently 'good' or 'bad', and all foods have a place in the diet, whilst also encouraging participants to start to tune in to their hunger and fullness cues. Some of the principles of Intuitive Eating are incorporated into the course, speci cally around rejecting restrictive diets, making peace with food, and gentle nutrition (32) . However, participants are taught about the importance of re-establishing structure in the form of regular eating and aiming for nutritionally balanced meals as a rst step in inner wisdom development. ...
This protocol describes the planned delivery and analysis of the Eating Freely programme to a group of 15 UK based adults living with obesity and emotional eating. The intervention will be delivered online with weekly group meetings facilitated by 2 Eating Freely Practitioners. The intervention uses a combination of second and third wave CBT approaches to help adults overcome emotional eating. The analysis is a mixed methods approach involving a process evaluation. A basic study design and overview has been previously published (https://aspredicted.org/S52_GS2), whilst this protocol provides a more in-depth description the theoretical underpinnings of the programme and how it has been adapted to a UK audience.
... So far, IE has mainly been researched by observational studies, while only few interventional studies have addressed this topic [24]. Overall, the existing research indicates positive effects of IE on (adaptive) dietary practices and psychological health indicators [25][26][27][28]. ...
Training interoceptive sensitivity (IS) might be a first step in effectively promoting intuitive eating (IE). A dyadic interoception-based pilot randomized controlled trial was conducted to increase IE among couples aged 50+. The training consisted of three exercises, a Body Scan (BS), a hunger exercise (HU), and a satiety (SA) exercise. This study explored how spouses accepted the (dyadic vs. single) training. In a mixed-methods convergence design, the findings of a survey (n = 68 couples) and focus groups (n = 4) were synthesized. Moderate general acceptance (e.g., regarding feasibility and low burden) and a hierarchical gradient in favor of the BS (e.g., pleasantness and improved sleep quality) emerged. Barriers concerned a perceived lack of the exercises’ usefulness and a limited understanding of the training purpose. A wish for regular feedback and exchange with the study stuff and other participants was expressed. Spousal training involvement was experienced as being rather beneficial. Previously harmonized dietary practices and daily routines appeared as constructive pre-conditions for the joint training. This study highlights the potential and implications of training couples in IS. Future interventions should involve a regular exchange and closer guidance by study staff to promote a better understanding of the processes and goals of IS and IE.
... Therefore, preventive interventions promoting favorable opinions and attitudes towards the body (e.g., cognitive dissonance-based or yoga-based interventions, writing-based functionality interventions; Guest et al., 2019), unconditional permission to eat and eating for physical rather than emotional reasons (i.e., intuitive eating interventions) might be effective in reducing different facets related to ED symptom dimensions, including the desire to be thin, bulimic symptoms, and body dissatisfaction. This can be especially helpful to prevent the onset of ED and related symptoms, as emerged in previous studies showing the effectiveness of psychological interventions focusing on intuitive eating and positive body image in reducing ED symptoms (e.g., Babbott, Cavadino, Brenton-Peters, Consedine, & Roberts, 2023;Guest et al., 2019). ...
... One small-scale study compared an IE nutrition programme to usual nutrition education in 15-17 year old students and found those who received IE information were significantly more likely to demonstrate reduced DE attitudes (Healy et al., 2015). These findings combined with studies of intuitive eating education in adults (Babbott et al., 2023) are promising, though further robust research is necessary to fully understand its effectiveness. For now, educators could incorporate elements of IE into PSHE or nutrition lessons to complement typical nutrition education and act as a potential buffer to DE until the evidence base has been developed. ...
Whilst clinical eating disorders are relatively uncommon in children and young people, a much larger proportion are thought to experience subclinical difficulties with eating, termed ‘disordered eating’. Given that the issue is so widespread and many young people experiencing disordered eating do not meet the criteria for specialist eating disorder services, schools have a responsibility to work systemically to reduce the prevalence of these difficulties. Educators may be able to use some of the risk factors for disordered eating, including body dissatisfaction, parental pressure to lose weight, peer influence and internalisation of food rules, to inform preventative strategies. These strategies may include, but not be limited to, implementing curriculum changes such as teaching about body image and nutrition education in developmentally appropriate ways, as well as considering whole-school policy changes such as specifying weight-related victimisation in the school’s anti-bullying policy and deliberating the school’s involvement in national child weighing schemes. Taken together, schools have the potential to play a critical role in reducing disordered eating in children and young people. Educational psychologists are well-positioned to raise educators’ awareness of disordered eating and support senior leadership teams implement these preventative strategies in an evidence-informed way as well as considering the role disordered eating might play in their own casework.
... While IE and associated measurement tools were initially developed for adults, preliminary research has shown that IE is associated with positive outcomes in adolescents, including a lower incidence of depression, anxiety, binge eating, and harmful weight control behaviours such as fasting, purging, or the use of diuretics and laxatives (Denny et al., 2013). There is a growing body of evidence for the efficacy of both face-to-face and digital health interventions based on the IE framework (Babbott, Cavadino, et al., 2022), indicating improvements in both physical and physiological health outcomes. However, both in terms of interventional efficacy and cross-sectional correlates, the usability of research findings are predicated on the validity of the measurement tools used to evaluate them. ...
... These findings have been replicated across a variety of ages, body mass categories, genders and cultural and ethnic groups (for a review, see Bruce and Ricciardelli, 2016;Linardon et al., 2021). Crucially, recent studies using experimental and prospective designs are yielding promising results with intuitive eating being found to lower symptoms of disordered eating and enhance body image, self-esteem, self-compassion, quality of life and psychological wellbeing (Bush et al., 2014;Humphrey et al., 2015;Carbonneau et al., 2017;Wilson et al., 2020;Babbott et al., 2022). ...
The transition from secondary to tertiary education seems to be a stressful period for many students, since they need to adjust to the new academic environment. This paper is a systematic review of 4.285 articles. The aim of this review was to investigate the factors in the university environment associated with emotion regulation, academic buoyancy and academic adjustment of tertiary students within a self-determination theory framework in combination with the nascent third wave of Positive Psychology. 41 papers met the inclusion criteria, all of which were rated as either good or moderate quality. The bulk of the studies included in the systematic review reported individual factors, i.e. self-efficacy, intrinsic motivation, academic factors, i.e. intention to drop out, learning climate and family and social factors i.e. faculty, peer and parental autonomy support. In accordance with the third wave of Positive Psychology that focuses on how interpersonal and ecological factors create nurturing environments and positive institutions, the systematic review highlighted the factors that institutes should consider in order to help students adjust better to the academic environment.
... These findings have been replicated across a variety of ages, body mass categories, genders and cultural and ethnic groups (for a review, see Bruce and Ricciardelli, 2016;Linardon et al., 2021). Crucially, recent studies using experimental and prospective designs are yielding promising results with intuitive eating being found to lower symptoms of disordered eating and enhance body image, self-esteem, self-compassion, quality of life and psychological wellbeing (Bush et al., 2014;Humphrey et al., 2015;Carbonneau et al., 2017;Wilson et al., 2020;Babbott et al., 2022). ...
... These findings have been replicated across a variety of ages, body mass categories, genders and cultural and ethnic groups (for a review, see Bruce and Ricciardelli, 2016;Linardon et al., 2021). Crucially, recent studies using experimental and prospective designs are yielding promising results with intuitive eating being found to lower symptoms of disordered eating and enhance body image, self-esteem, self-compassion, quality of life and psychological wellbeing (Bush et al., 2014;Humphrey et al., 2015;Carbonneau et al., 2017;Wilson et al., 2020;Babbott et al., 2022). ...
Positive psychology (PP) is the scientific field that focuses on revealing, understanding,
and reinforcing the factors that make individuals and systems flourish. At first, PP research
gave emphasis on individual’s positive experiences and characteristics (Pezirkianidis and
Stalikas, 2020). Later on, the second research wave focused on the dialectic relationship
between the positive and negative aspects of one’s life, proposing that wellbeing can only be
achieved through overcoming suffering (Wong, 2019). Recently, the third wave of research
suggested PP to become more interdisciplinary and multicultural and incorporate systems’
principles (Lomas et al., 2021).
Counseling psychology (CP) and PP share their roots in humanistic psychology. Also, CP
focuses on a positive orientation toward individual development, mental health promotion
and prevention rather than pathology (Malikiosi-Loizos and Ivey, 2012). However, while US
counseling psychologists have incorporated PP principles, European ones hesitate to engage
with strength-based approaches and use PP theories and techniques (Steffen et al., 2015).
At the same time, more and more approaches in CP have emerged focusing on building
positive qualities and making use of the empirically tested positive psychology interventions
(PPIs; Carr et al., 2021). These models focus on the promotion of clients’ wellbeing and,
simultaneously, on symptom alleviation (Jankowski et al., 2020). Counseling practitioners
can offer their skills and knowledge as a fertile ground for the application of such models,
while at the same time they can benefit by integrating new techniques in their counseling
practice (D’raven and Pasha-Zaidi, 2014).
... Further, IE interventions have resulted in decreases in weight-bias internalization and disordered eating and improvements in body image and quality of life, though most interventions have been conducted with White women, limiting the generalizability of findings (18,19) . ...
Objective:
To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood.
Design:
Longitudinal population-based study. Young people reported IE and FI (two items from the U.S. Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item U.S. Household Food Security Module in adolescence.
Setting:
Adolescents (Mage=14.3±2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage=22.1±2 years).
Participants:
The analytic sample (N=1,372; 53.1% female, 46.9% male) was diverse across race/ethnicity (19.8% Asian, 28.5% Black, 16.6% Latinx, 14.7% Multiracial/Other, and 19.9% White) and SES (58.6% low/lower middle, 16.8% middle, 21.0% upper middle/high).
Results:
In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (p=.02) and emerging adulthood (p<.001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (p=.01). Those who remained food insecure (p=.05) or became food insecure (p=.02) had lower IE in emerging adulthood than those remaining food secure. All effect sizes were small.
Conclusions:
Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.
... These findings have been replicated across a variety of ages, body mass categories, genders and cultural and ethnic groups (for a review, see Bruce and Ricciardelli, 2016;Linardon et al., 2021). Crucially, recent studies using experimental and prospective designs are yielding promising results with intuitive eating being found to lower symptoms of disordered eating and enhance body image, self-esteem, self-compassion, quality of life and psychological wellbeing (Bush et al., 2014;Humphrey et al., 2015;Carbonneau et al., 2017;Wilson et al., 2020;Babbott et al., 2022). ...
Introduction
To date, research on eating behaviors has largely taken a pathological approach. Researchers are increasingly taking a positive approach to explore adaptive eating styles. One such style that has recently received much research attention is intuitive eating. Recent work examining intuitive eating and its relationships with body mass and gender has yielded mixed findings. The current study explored the differential effects of gender and body mass on intuitive eating scores in a sample of Greek-Cypriot adults.
Method
A total of 1,312 adult participants (women n = 655; Mage = 34.49) completed the Intuitive Eating Scale-2 and provided demographic information.
Results
Our analyses revealed that men reported significantly higher intuitive eating scores than women. Body mass was significantly inversely associated with intuitive eating in both men and women. Additionally, a multivariate analysis of variance (MANOVA) indicated significant interaction effects between gender and body mass on intuitive eating. These interaction effects were explored for each of the four subscales of intuitive eating, identifying differential associations for intuitive eating and BMI between men and women.
Discussion
Both gender and body mass are important factors which influence intuitive eating levels in Greek-Cypriot adults. Discussions of how these findings can inform future research, theory and practice are presented.
... Subsequently, existing models associate these processes with the ED etiology and/or target of intervention. For example, the multidimensional model of AN proposes biogenetic and personality factors (e.g., low interoceptive awareness) to predict ED onset (Lyon et al., 1997), while the acceptance model of intuitive eating posits intuitive and/or adaptive eating to prevent and/or reduce ED symptomatology (Augustus-Horvath and Tylka, 2011;Babbott et al., 2022). Furthermore, the AP and its features can be broadly categorized into two domains: social (e.g., communicative/relational difficulties) and nonsocial (e.g., repetitive/restrictive behaviors, intense/obsessive interests; see ). ...
Background
Nutrition students are at greater risk of developing disordered eating attitudes, especially during the COVID‐19 pandemic. Mindfulness‐based interventions (MBIs) have proven to be beneficial in improving mental health outcomes and are also applied to issues related to food through mindful eating. The study aimed to evaluate the effect of a MBI on levels of body dissatisfaction and disordered eating attitudes among nutrition students during the COVID‐19 pandemic.
Methods
This randomised clinical trial performed the ‘Mindfulness‐Based Eating Solution’ (MBES) intervention in nutrition students. Seventy‐eight adult women were randomised into the intervention group ( n = 38) and control group ( n = 40). The intervention group received eleven weekly sessions of MBES and two follow‐up sessions. Body dissatisfaction and appreciation, disordered eating attitudes, intuitive eating and mindfulness were assessed four times (at baseline, post‐intervention, 1‐month follow‐up and 3‐month follow‐up).
Results
The intervention group showed decreased levels of body dissatisfaction (from 86.60 ± 6.13 to 64.13 ± 2.82) and disordered eating attitudes (from 1.46 ± 0.08 to 1.15 ± 0.02), and higher levels of reliance on hunger and satiety cues and mindfulness after the MBES intervention. Body dissatisfaction and levels of reliance on hunger and satiety cues were maintained at follow‐up, whereas the disordered eating attitudes and levels of mindfulness increased in the first and third months, respectively. No significant changes were found in the outcomes evaluated in the control group.
Conclusions
The results suggest the positive effects of a MBI on the nutrition students’ body image perceptions and eating attitudes. Further research is needed to investigate such benefits and understand the related mechanisms in other populations.
Introduction: Interoception, the perception of internal bodily sensations , is increasingly acknowledged as a pivotal construct in the understanding of psychiatric disorders. This is particularly relevant for Eating Disorders (EDs)1-4 where a problematic relationship with one's own body is well-documented5,6 Previous research has explored interocep-tive awareness using the Multidimensional Assessment of Interoceptive Awareness (MAIA)7. In our study, we specifically focus on hospitalized ED patients using the Italian version of the MAIA8. To our knowledge, this is the first study that offers a comprehensive comparison across multiple MAIA studies involving ED patients. Aim of the study: We aim to explore the facets of interoceptive awareness in hospitalized ED patients and offer a unique comparative lens by including four major studies.: Brown et al. (2017), Perry et al. (2021), Monteleone et al. (2021), and Phillipou et al. (2022) [9-12]. Materials and methods: We evaluated 69 inpatients diagnosed with EDs at Maria Luigia Hospital in Monticelli Terme, Parma, using the MAIA at admission. All statistical evaluations were executed using R version 4.2.1. Results: Based on the provided statistical data, our findings indicate significant deficits in multiple MAIA subscales among ED patients. The most pronounced impairments are seen in the Self-Regulation (t = − 12.79, p < 0.001, Cohen's d = − 1.54) and Trusting (t = − 13.32, p < 0.001, Cohen's d = − 1.32) subscales. Additionally, substantial deficits were also found in the Attention Regulation (t = − 9.13, p < 0.001, Cohen's d = − 1.1), Emotional Awareness (t = − 4.45, p < 0.001, Cohen's d = − 0.5), and Body Listening (t = − 7.23, p < 0.001, Cohen's d = − 0.87) subscales. In contrast, the Noticing, Not Distracting, and Not Worrying subscales did not display statistically significant differences. These numerical insights are further contextualized when compared to other studies, offering a nuanced understanding of varying severity levels in ED patients assessed with MAIA.
Children’s eating behaviors are dependent on childhood food experiences, which involve their parental feeding practices, home food environments, and modeling of eating behavior. Intuitive eating (IE) promotes eating based on internal hunger and satiety cues. IE has been associated with improvements in mental and physical health. There has been increasing interest in exploring the association between parent and child IE. The aim of this scoping review was to synthesize current literature reporting on parent and child IE associations. Four databases (MEDLINE, EMBASE, Web of Science and CINAHL) were searched using keywords focusing on IE, parents, and children. Inclusion criteria were reporting on parental and/or child IE, and reporting on parent–child relationships. After screening, 15 studies were retained. From these, 3 main correlations were described. Parental IE was associated with child feeding, child weight concerns, and the home food environment. As well, environmental factors (i.e., family cohesion, food security) were associated with components of child IE. Moreover, IE was directly correlated between parents and children. Overall, this study highlights how child IE behaviors may be shaped by both parental IE and the broader environments that they are raised within. Additional high-quality studies are required to verify these findings.
This study analyzed the attitudes related to eating and determine the prevalence of risk of developing eating disorders (ED) among military students. A secondary objective was to compare prevalence between demographic data and establish the effect of intuitive eating and exercise practice on ED risk. A sample of 256 male military undergraduate and graduate students at the School of Physical Education of the Army answered the Eating Attitudes Test (EAT-26) and Intuitive Eating Scale 2 (IES-2) questionnaires, as well questions regarding age, marital status, the military branch in the Brazilian Army, self-reported body mass and stature, and level of physical activity (Kasari Fit Index). A Kruskal-Wallis test was used to assess factor scores of EAT- 26 and IES-2 total scores among the intensity of self-reported physical activity. A multiple linear regression analysis (forward method) was performed to investigate the extent to which the intuitive eating factors impacted eating disorders risk. Results showed that 4.9% of military students were at risk of developing an ED. Significant difference was found for frequency of exercise practice for EAT total score (U=4375.5, p=0.04, r=0.14) and at UPE (U=3988.5, p=0.005, r=0.19). No significant differences were observed within EAT-26 scores among demographic data. Intuitive eating factors (UPE, BFCC and EPR) showed a significant influence on ED attitudes (F(3, 228)=39.78, p< 0.001; R2adjusted=0.27). In conclusion these findings pointed to a high prevalence of ED risk in military students, and that intuitive eating had a protective impact; however, the practice of exercise does not seem to influence it.
Aim: The main aim of this research is to understand the relationship between intuitive eating behaviors and cognitive emotion regulation strategies in individuals between the ages of 40-65. Method: In the study, a socio-demographic data form was used to determine participants' general information, health habits, and eating habits. The Intuitive Eating Scale and Cognitive Emotion Regulation scales were employed to assess individuals' emotion regulation strategies following negative life events. The study was conducted with 149 participants. Results: According to the results of the study, no significant relationship was found between intuitive eating behaviors and cognitive emotion regulation strategies in middle-aged individuals. In addition, there was no statistically significant relationship between Intuitive Eating Scale scores and cognitive emotion regulation strategy scores in terms of gender (p>0.05). The findings also indicated that 21.5% of participants had normal Body Mass Index (BMI) values, while 49.7% were classified as slightly obese, 28.2% as obese, and 0.7% as underweight. Analyzing the impact of intuitive eating behaviors and cognitive emotion regulation strategies on BMI revealed no statistically significant relationship (p>0.05). Conclusion: The research findings demonstrate that intuitive eating behaviors in middle-aged individuals are not directly associated with cognitive emotion regulation strategies. Nevertheless, further detailed examination of the relationship between cognitive emotion regulation strategies and BMI is necessary. These results emphasize the importance of healthy eating habits and suggest the need for tailored educational programs to enhance cognitive emotion regulation skills in middle-aged individuals. Additionally, it is recommended that nutritionists and healthcare professionals provide conscious nutrition and healthy lifestyle education specifically for this age group. Conducting such studies will contribute to a better understanding of factors influencing intuitive eating behaviors in middle-aged individuals and support healthy aging.
Under the conditions of neo‐liberal individual responsibilisation, self‐tracking has become the predominant model of health management. More recently, though, intuition‐based approaches to exercise and eating are also gaining traction. These two approaches are often located in opposition. While self‐tracking uses datafication and calculability to structure health decisions, intuitive approaches encourage abandonment of rules and restrictions around exercise and food in favour of corporeal self‐awareness and attunement to sensation. Although navigating these competing approaches is a common experience for all populations, the tensions between them are felt particularly acutely by people with complex health histories, such as eating disorders (EDs). In this article, we draw on mixed‐methods longitudinal data, analysed using phenomenological analysis, to propose a novel framework ‐ ‘intuitive tracking’—which moves beyond understandings of self‐tracking as the antithesis of intuitive engagement with exercise and health. Drawing on longitudinal interviews and photo elicitation with 19 women who are in recovery from EDs and using weightlifting as a tool to support their recovery, we demonstrate how attentiveness to bodily and emotional cues is successfully combined with an emphasis on monitoring health behaviours to support wellbeing. We conclude that theoretical understandings of self‐tracking can and should make space for intuition‐led decision‐making.
Objective:
Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating.
Methods:
Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors.
Results:
Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors.
Discussion:
Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.
This review of 16 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Seven articles fell into the category of prevention rationale (including screening studies) and relevant reviews, while nine articles addressed correlates of/risk factors (RFs) for various aspects of DE and EDs. One implication of the 16 articles reviewed is that RF research toward construction of selective and indicated prevention programs for an expanding array of diverse at-risk groups needs to address, from a nuanced, intersectional framework, a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses; protective factor research; prevention program development and multi-stage evaluation; and case studies of multi-step activism at the local, state (province, region), and national levels.
Intuitive eating has been found to protect against disordered eating and preserve well-being. Yet, there are methodological (length), conceptual (inconsideration of medical, value-based, and access-related reasons for food consumption), and psychometric (item wording) concerns with its most common measure, the Intuitive Eating Scale-2 (IES-2). To address these concerns, we developed the IES-3 and investigated its psychometric properties with U.S. community adults. Across three online studies, we evaluated the IES-3’s factorial validity using exploratory factor analysis (EFA; Study 1; N=957; Mage=36.30), as well as confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), bifactor-CFA, and bifactor-ESEM (Study 2; N=1152; Mage=40.95), and cross-validated the optimal model (Study 3; N=884; Mage=38.54). We examined measurement invariance across samples and time, differential item functioning (age, body mass index [BMI], gender), composite reliability, and validity. Study 1 revealed a 12-item, 4-factor structure (unconditional permission to eat, eating for physical reasons, reliance on hunger and satiety cues, body-food choice congruence). In Study 2, a bifactor-ESEM model with a global intuitive eating factor and four specific factors best fit the data, which was temporally stable across three weeks. This model also had good fit in Study 3 and, across Studies 2 and 3, and was fully invariant and lacked measurement bias in terms of age, gender, and BMI. Associations between latent IES-3 factors and age, gender, and BMI were invariant across Studies 2 and 3. Composite reliability and validity (relationships with disordered eating, embodiment, body image, well-being, and distress; negligible relationship with impression management) of the retained model were also supported. The 12-item IES-3 demonstrates strong psychometric properties in U.S. community adults. Research is now needed using the IES-3 in other cultural contexts and social identity groups.
Across studies, intuitive eating is associated with many health indicators. The Intuitive Eating Scale-2 (IES-2), the instrument for measuring intuitive eating, had not previously been explored with a sample of sexual minority [Sexual minority refers to individuals who experience consensual sexual identity, attraction, or behavior that is non normative (typically sexual minority individuals are lesbian, gay, bisexual, queer, or non-heterosexual)] individuals despite the disparities in eating behaviors and stress that persist among this population. Further, past work suggests the context of being partnered can be both protective and harmful for eating behaviors, highlighting an important avenue for investigating intuitive eating at the dyad level. This study sought to investigate the factor structure of the IES-2 and to explore the associations between both partner’s mental health, relational quality, and interpersonal eating interactions within a dyadic sample of 228 married male sexual minority couples (88% white, 8.8% Latino or Hispanic, 5.3% African American or Black, and 5.9% in other racial or ethnic groups). The original four-factor solution did not fit the current sample; instead, a new, fifth factor emerged, which was labeled as Eating Not as Coping. Intuitive eating behaviors were dyadically associated with mental and relational health and partners’ health-related interactions with one another. Future use of the IES-2 is informed by present results which may also inform recommendations for practice with and study of health and relationships.
Abstrak Idealnya perilaku makan dalam keseharian individu dapat memberikan dampak sehat secara fisik maupun psikososial. Namun, terkadang individu berperilaku makan semata-mata dilakukan karena ketidaknyamanan kondisi psikologis dan sosial, ataupun sebaliknya, perilaku makan yang berdampak pada kondisi fisik dan psikososial yang kurang sehat. Perilaku makan intuitif menjadi salah satu alternatif perilaku makan yang lebih adaptif karena lebih mengandalkan sinyal fisiologis rasa lapar dan rasa kenyang, untuk makan maupun menghentikan aktivitas makan. Agar individu dapat intuitif dalam berperilaku makan dibutuhkan faktor-faktor tertentu. Faktor yang dipertimbangkan dalam perilaku makan remaja adalah ketidakpuasan terhadap tubuh dan indeks massa tubuh. Penelitian ini bertujuan untuk mengetahui peran ketidakpuasan terhadap tubuh dan indeks massa tubuh terhadap perilaku makan intuitif pada remaja. Alat ukur yang digunakan adalah Skala Perilaku Makan Intuitif, Skala Ketidakpuasan terhadap Tubuh, pada remaja sebanyak 135 orang. Reliabilitas Skala Perilaku Makan Intuitif adalah 0,625, dan reliabilitas dimensi kognitif, afektif, serta perilaku pada Skala Ketidakpuasan terhadap Tubuh berkisar antara 0,689-0,835. Hasil uji regresi berganda menunjukkan model prediksi ketidakpuasan terhadap tubuh F(4,130)=5,205, p<0,05, yang mengindikasikan bahwa ketidakpuasan terhadap tubuh dan indeks massa tubuh secara bersama-sama berperan terhadap perilaku makan intuitif, meskipun kemudian ditemukan bahwa hanya dimensi perilaku dari ketidakpuasan terhadap tubuh (beta=-0,391, p<0,05) yang secara signifikan memprediksi perilaku makan intuitif jika dibandingkan dengan prediktor lainnya dalam penelitian ini. Berdasarkan hasil tersebut, patut dipertimbangkan faktor ketidakpuasan terhadap tubuh yang lebih rendah guna membantu perilaku makan remaja yang lebih intuitif sehingga diperolehnya kondisi fisik dan psikososial yang lebih sejahtera. Kata kunci: indeks massa tubuh, ketidakpuasan terhadap tubuh, perilaku makan intuitif, remaja Abstract Ideally, eating behavior should be beneficial for individuals’ physical and psychosocial well-being. However, individuals sometimes exhibit eating behavior that is motivated by psychological and social discomforts, or vice versa, where eating behavior causes unhealthy conditions. In this study, intuitive eating behavior could be one of the alternatives for a more adaptive way of eating because it relies on the physiological cues of hunger and satiety for the individuals to eat or stop eating. There are some known factors for individuals to eat intuitively, such as body dissatisfaction and body mass index. This study aims to investigate the role of body dissatisfaction and body mass index in adolescents’ intuitive eating behavior. There were two instruments employed in this study, namely the Intuitive Eating Behavior Scale and Body Dissatisfaction Scale, which were administered to 135 participants. Reliability for the Intuitive Eating Behavior Scale was 0.625, while the cognitive, affective, and behavioral dimensions of Body Dissatisfaction Scale were ranging from 0.689-0.835. The multiple regression analysis showed a predictive model of body dissatisfaction [F(4,130)=5.205, p<0.05], which indicates that body dissatisfaction and body mass index simultaneously affect intuitive eating behavior, although it was later found that only the behavior dimension of body dissatisfaction (beta=-0,391, p<0,05) that could significantly predict intuitive eating behavior compared to the other predictors in this study. Therefore, it is recommended that the behavioral aspect of body dissatisfaction should be considered as an important factor in adolescents’ intuitive eating behavior in order to achieve a better physical and psychosocial well-being. Keywords: body mass index, body dissatisfaction, intuitive eating behavior, adolescents
Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE’s prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach.
Public significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.
Objectives:
Growing evidence suggests that intuitive eating is associated with numerous positive mental health and well-being constructs. Understanding factors that predict intuitive eating is necessary for identifying practical targets to enhance this style of eating, yet research identifying such predictors is scarce. Self-compassion is one variable that could enhance intuitive eating because it involves the practice of healthy emotion regulation skills that may disrupt the tendency to turn to food to cope during distressing situations. The present study tested for a longitudinal association between self-compassion and intuitive eating. We also tested whether this association was mediated by indices of emotion regulation (i.e., global emotion regulation skill scores and body image flexibility).
Method:
Adult women (n = 3039) were invited to completed study measures at baseline (T1), 4-month follow-up (T2), and 8-month follow-up (T3). Path analyses were computed to test hypothesized indirect effects.
Results:
A direct path from T1 self-compassion to T3 intuitive eating emerged, such that higher self-compassion levels predicted increased intuitive eating over time. However, this association was not mediated by T2 emotion regulation skills nor body image flexibility.
Conclusion:
Findings suggest that self-compassion may facilitate an intuitive eating style, which does not appear to be explained by certain emotion regulation skills.
The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualised as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793) using exploratory structural equation modelling (ESEM) and bifactor analysis (B-ESEM) indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.
PurposeIntuitive Eating (IE) is an approach to eating designed to facilitate a positive relationship with food. Its use in clinical settings and in the community is rapidly growing in popularity. The Intuitive Eating Scale 2 (IES-2) is a widely used measure that indexes intuitive eating motivations and behaviour, however evidence of its validity in populations with clinical eating disorders remains scarce. The objective of the proposed study was thus to evaluate the factor structure of the IES-2 in a large sample of individuals seeking treatment for eating disorders in private practice.Methods
Data collected from 569 women and men aged 12–68 years seeking treatment for an eating disorder in one of eight specialist private outpatient eating disorder clinics were examined using confirmatory factor analysis (CFA). Relationships between IES-2 scores and measures of psychopathology were also examined.ResultsResults were relatively consistent with the purported four-factor structure of the IES-2. The measure displayed strong construct validity and good internal consistency. Scores on the IES-2 were inversely associated with scores of depression, anxiety, and disordered eating, providing evidence for divergent validity of the measure. Clinical norms are provided for anorexia nervosa (AN) spectrum disorders and bulimia nervosa (BN) spectrum disorders, as well as for the clinical sample as a whole.Conclusion
Findings suggest that the IES-2 may be an appropriate measure for evaluating behaviours relating to IE in community outpatient eating disorder settings, and provide further evidence for the association between IE and positive health outcomes.Level of evidenceIII, evidence obtained from well-designed cohort or case–control analytic studies.
Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another.
Objectives: This systematic review aimed to explore a key gap in the current literature, that being, identifying whether HRV and interoception predict emotional regulation outcomes and strategies.
Methods: The process of article retrieval and selection followed the PRISMA guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the PICO framework, whilst the CHARMS framework was used to help formulate the research question, and critically assess for bias.
Results: Two hundred and thirty-seven studies were identified after initial database searches. Of these, eight studies were included in the final selection. Six studies explored the associations between HRV and ER, whilst three investigated the associations between interoception and ER (one study included both). Results show that greater HRV and interoception are associated with better ER. Specifically, high parasympathetic activity largely predicted the use of adaptive ER strategies such as reappraisal, and better acceptance of emotions. High interoception, instead, was predictive of effective downregulation of negative emotions and handling of social uncertainty, there was no association with any specific ER strategy.
Conclusions: Awareness of one's own bodily feelings and vagal activation seem to be of central importance for the effective regulation of emotional responses. However, one limitation is the small sample of studies found, thus more studies in this area are needed in the future.
Qualitative studies examining women’s experiences of learning to eat more intuitively are scarce. We aimed to explore the experience of learning intuitive eating among mid-age women (n = 11) who participated in a web-based intuitive eating programme. Motivation to learn intuitive eating, perceptions of the experience of attempting to eat more intuitively, and facilitators and barriers to intuitive eating were explored using inductive thematic analysis. Findings suggest that women were able to learn to eat more intuitively; however, they encountered social and environmental barriers, and the ‘unconditional permission to eat’ aspect of intuitive eating was experienced as the most challenging.
Purpose
To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting.
Design
Quasi-experimental design evaluating eating behaviors and psychological factors.
Setting
The HAES intervention is offered in Health and Social Services Centers in Québec (Canada).
Participants
For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m²) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m²) from a comparison group.
Intervention
The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating.
Measures
Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up.
Analysis
Group, time, and interaction effects analyzed with mixed models.
Results
Significant group by time interactions were found for flexible restraint (P = .0400), disinhibition (P < .0001), susceptibility to hunger (P < .0001), intuitive eating (P < .0001), obsessive–compulsive eating (P < .0001), body-esteem (P < .0001), depression (P = .0057), and self-esteem (P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term.
Conclusion
The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.
Recent findings converge to the idea that the central function of eating disorders (ED) can be understood as an attempt to control unwanted or dysregulated emotions. The restriction of food intake can be seen as the predominant and general dysregulated behavior with the aim to reduce emotional experience in women with ED. The aim of the present study was to test the hypothesis that emotional and interoceptive awareness as indexed by the Level of Emotional Awareness Scale (LEAS) and Body Perception Questionnaire (BPQ) will be in negative correlation with food restriction (Restriction Scale) and emotional eating (General Food Craving Questionnaire Trait). Our study was performed on women with ED (N = 73) and healthy controls (N = 207). The findings revealed that, in comparison with the controls, girls from the ED group were less able to discriminate their emotional states and were less aware of their body processes and autonomic nervous system reactivity. Contrary to our hypothesis, a three-stage hierarchical multiple regression analysis showed a significant effect of interoceptive sensitivity and emotional awareness on the restriction. Emotional and interoceptive awareness in women with ED explains the 25.2% variance of restriction in comparison with 8.8% in controls. It seems that the predominant use of restriction in the ED group could be explained by a limited repertoire of emotion regulation strategies or the persistent use of one emotion regulation strategy, such as restriction, while the controls had more options how to regulate their affect. Further studies are needed to explore the relations between these variables and the underlying causal mechanisms.
Holistic approaches which include a religious element are a promising intervention
within obesity, but have not been explored in the UK. Objective: To conduct a feasibility study
of a three-month, Christian-based intuitive-eating programme in a church. Methods: A total of
18 adults participated. Ethical approval was granted by Coventry University Ethics Committee.
Participant and facilitator experience was investigated qualitatively. Results showed participants
accepted the programme and engaged well with its spiritual component. Lay facilitators managed
to adequately run the programme, although some difficulties identified training needs. Clinical,
psychological and spiritual measures were analysed using intention to treat; baseline observation
carried forward to input missing data. Mental well-being, anxiety, depression, quality of life,
pain/discomfort uncontrolled-eating, emotional-eating, cognitive-restrained-eating, intuitive-eating
and Body Mass Index (BMI) improved significantly post-intervention. There were improvements in
spiritual well-being, and reductions in energy, fat and saturated fat intake. Between the end of the
intervention and a six-month follow-up, there were no statistically significant changes. However, the
extent that weight and BMI returned to baseline levels meant that the reduction from baseline was no
longer significant or clinically important. Mean changes in other variables, including uncontrolled
eating, emotional eating, mental well-being and anxiety remained statistically improved from baseline.
At six-month follow-up, improvements in intuitive eating were fully sustained at this time point and
total fat, saturated fat and sugar intake had reduced further even though these values did not reach
statistical significance. Conclusion: It is feasible to recruit to, deliver and evaluate Taste & See in a UK
church, with lay volunteers. Clinical outcomes were positive, but a larger, controlled study is needed.
Quantitative evidence is beginning to document the successful outcomes achieved from
holistic interventions that include a spiritual element as an approach to self-manage obesity in
the community. However, qualitative research, which helps us understand the reasons behind
their success, is scarce. Our aim was to explore participants’ acceptance of and engagement with
the Taste & See programme. Semi-structured interviews were carried out after participants had
completed the Taste & See programme. Interviews were transcribed and analysed using deductive
thematic analysis. Themes showing that ‘God and food issues had been kept separate’ at the start of
the programme and that participants then ‘Began to use faith as a resource’ were identified. Also,
while ‘Eating freely was a challenge’ initially, participants later found ‘empowerment and enjoyment
in freedom’. ‘Addressing more than just a weight problem’ was valued highly and there were benefits
and difficulties that arose from ‘Coping with other group members’. The rich level of evaluation
provided through this study identifies that the participants found the programme a novel experience.
The intervention was acceptable and participants engaged well with the programme content.
Background
Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making.
We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature.
Results
Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan.
As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users.
Conclusions
Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
Background
Middle-aged women are at risk of weight gain and associated comorbidities. Deliberate restriction of food intake (dieting) produces short-term weight loss but is largely unsuccessful for long-term weight management. Two promising approaches for the prevention of weight gain are intuitive eating (ie, eating in accordance with hunger and satiety signals) and the development of greater psychological flexibility (ie, the aim of acceptance and commitment therapy [ACT]).
Objectives
This pilot study investigated the usage, acceptability, and feasibility of “Mind, Body, Food,” a Web-based weight gain prevention intervention prototype that teaches intuitive eating and psychological flexibility skills.
Methods
Participants were 40 overweight women (mean age 44.8 [standard deviation, SD, 3.06] years, mean body mass index [BMI] 32.9 [SD 6.01] kg/m², mean Intuitive Eating Scale [IES-1] total score 53.4 [SD 7.46], classified as below average) who were recruited from the general population in Dunedin, New Zealand. Module completion and study site metrics were assessed using Google Analytics. Use of an online self-monitoring tool was determined by entries saved to a secure online database. Intervention acceptability was assessed postintervention. BMI, intuitive eating, binge eating, psychological flexibility, and general mental and physical health were assessed pre- and postintervention and 3-months postintervention.
Results
Of the 40 women enrolled in the study, 12 (30%) completed all 12 modules (median 7.5 [interquartile range, IQR, 2-12] modules) and 4 (10%) used the self-monitoring tool for all 14 weeks of the intervention period (median 3 [IQR 1-9] weeks). Among 26 women who completed postintervention assessments, most women rated “Mind, Body, Food” as useful (20/26, 77%), easy to use (17/25, 68%) and liked the intervention (22/25, 88%). From pre- to postintervention, there were statistically significant within-group increases in intuitive eating (IES-2 total score P<.001; all IES-2 subscale scores: P ≤.01), psychological flexibility (P=.01), and general mental health (P<.001) as well as significant decreases in binge eating (P=.01). At the 3-month follow-up, IES-2 improvements were maintained, and there were further improvements in binge eating (P<.001) and general mental health (P=.03), and a marginal yet nonsignificant tendency for further improvement in psychological flexibility (P=.06). There were no significant within-group changes in BMI from pre- to postintervention and postintervention to 3-month follow-up (P=.46 and P=.93, respectively).
Conclusions
The “Mind, Body, Food” prototype Web-based intervention is appealing to middle-aged women and may be a useful tool to help women learn intuitive eating and ACT skills, reduce binge eating, and maintain weight over 3 months. Further work to improve the user experience and engagement is required before testing the online intervention in a randomized controlled trial.
Obesity treatment remains a high global priority. Evidence suggests holistic approaches, which include a religious element, are promising. Most research is from the USA, but recent evidence suggests a need within the UK population. The aim of this study is to explore the feasibility of running and evaluating a Christian-based, healthy, intuitive-eating programme, in a UK church. This is the protocol of a mixed-methods single-group feasibility study of a ten-week programme. The programme focuses on breaking the “diet and weight regain” cycle using principles from intuitive eating uniquely combined with biblical principles of love, freedom, responsibility, forgiveness, and spiritual need. We will recruit at least ten adult participants who are obese, overweight, or of a healthy weight with problematic eating behaviours. Participants can be from any faith or none. Robust measures of physical, psychological and spiritual outcomes will be used. Results are not yet available. Findings will be used to design a cluster-randomised controlled trial to test efficacy through many churches. If weight reduces by a small amount, there will be substantial benefits to public health. With a strong association between obesity and mental-ill health, a holistic intervention is particularly important. Using churches addresses religious and spiritual health, and uses existing social structures and a voluntary workforce that are sustainable and cost-effective.
: Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols--PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols.
This paper describes version 0.8-2 of R package meta which has been published in February 2007.
Most R commands presented in the paper are still working today with the current version of meta.
The command
summary(m1, byvar = Fleiss93$year < 1980, bylab = "year<1980")
has been replaced by
summary(update(m1, byvar = year < 1980, bylab = "year<1980")).
Furthermore, the R function plot.meta() has been replaced by forest.meta().
Purpose
– There is a growing need for school-based nutritional educational programs that promote healthy eating attitudes without increasing an unhealthy focus on restrictive eating or promoting a poor body image. Research suggests that intuitive eating (IE) approaches, which encourage individuals to focus on internal body signals as a guide for eating, have had a positive impact on eating-related psychological outcomes in adults. The purpose of this paper is to investigate the effects an IE education program on the eating attitudes of high school students.
Design/methodology/approach
– In a quasi-experimental study, 48 high school students (30 females) in a Midwest town in the USA received instruction on IE or a comparison program over seven days during health classes. Repeated measures analyses of covariance were conducted to examine changes in eating attitudes in sexes across conditions.
Findings
– Students who received the IE program made significantly greater gains in overall positive eating attitudes on the Intuitive Eating Scale than students in the comparison program ( p =0.045), as well as on the Unconditional Permission to Eat subscale ( p =0.02). There were no significant effects of sex on any of the analyses.
Research limitations/implications
– Because of the relatively small sample size and short duration of the program, the results should be generalized with caution.
Practical implications
– The results suggest that IE instruction may encourage the development of healthy eating attitudes in high school students, and health teachers may wish to consider including IE instruction in the health curriculum.
Originality/value
– This is the first study to examine the effectiveness of an IE program in a K-12 population, with instruction provided in the context of the school. The results are promising and suggest that this may be a fruitful area for future research in nutrition education.
Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols-PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols.
© BMJ Publishing Group Ltd 2014.
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.
Purpose
To examine the efficacy of a novel intervention for problematic eating behaviors and body dissatisfaction.
Design
Participants enrolled in the intervention or waitlist comparison group were assessed at pre and post 10 weeks.
Setting
Midwestern university.
Subjects
One hundred twenty-four female employees or partners/spouses.
Intervention
Eat for Life is a 10-week group intervention integrating mindfulness and intuitive eating skills.
Measures
Self-report questionnaires included the Intuitive Eating Scale, Body Appreciation Scale, Five-Facet Mindfulness Questionnaire, Questionnaire for Eating Disorder Diagnoses, and an author-constructed supplemental and demographic questionnaire.
Analysis
Analyses of covariance and ordinal regression measured group differences. Structural equation modeling examined mediation effects.
Results
Significant differences between groups were observed for body appreciation (F1,121 = 40.17, p=.000, partial eta squared=.25), intuitive eating (F1,121=67.44, p=.000, partial eta squared = .36), and mindfulness (F1,121 = 30.50, p = .000, partial eta squared = .20), with mean scores significantly higher in the intervention group than waitlist comparison group after 10 weeks. The intervention group was 3.65 times more likely to be asymptomatic for disordered eating than the comparison group. Mindfulness served as a partial mediator.
Conclusion
The study provides support for an intervention combining intuitive eating and mindfulness for treatment of problematic eating behaviors and body dissatisfaction, with limitations including self-selection and lack of active control group.
In this article, the authors outline methods for using fixed and random effects power analysis in the context of meta-analysis. Like statistical power analysis for primary studies, power analysis for meta-analysis can be done either prospectively or retrospectively and requires assumptions about parameters that are unknown. The authors provide some suggestions for thinking about these parameters, in particular for the random effects variance component. The authors also show how the typically uninformative retrospective power analysis can be made more informative. The authors then discuss the value of confidence intervals, show how they could be used in addition to or instead of retrospective power analysis, and also demonstrate that confidence intervals can convey information more effectively in some situations than power analyses alone. Finally, the authors take up the question ‘‘How many studies do you need to do a meta-analysis?’’ and show that, given the need for a conclusion, the answer is ‘‘two studies,’’ because all other synthesis techniques are less transparent and/or are less likely to be valid. For systematic reviewers who choose not to conduct a quantitative synthesis, the authors provide suggestions for both highlighting the current limitations in the research base and for displaying the characteristics and results of studies that were found to meet inclusion criteria.
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).
Intuitive eating is characterized by eating based on physiological hunger and satiety cues rather than situational and emotional cues and is associated with psychological well-being. This study reports on the development and initial psychometric evaluation of the Intuitive Eating Scale (IES) with data collected in 4 studies from 1,260 college women. Exploratory factor analysis uncovered 3 factors: unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on internal hunger/satiety cues; confirmatory factor analysis suggested that this 3-factor model adequately fit the data after 4 items with factor loadings below .45 were deleted. IES scores were internally consistent and stable over a 3-week period. Supporting its construct validity, IES scores were (a) negatively related to eating disorder symptomatology, body dissatisfaction, poor interoceptive awareness, pressure for thinness, internalization of the thin ideal, and body mass; (b) positively related to several indexes of well-being; and (c) unrelated to impression management. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The metafor package provides functions for conducting meta-analyses in R. The package includes functions for fitting the meta-analytic fixed- and random-effects models and allows for the inclusion of moderators variables (study-level covariates) in these models. Meta-regression analyses with continuous and categorical moderators can be conducted in this way. Functions for the Mantel-Haenszel and Peto's one-step method for meta-analyses of 2 x 2 table data are also available. Finally, the package provides various plot functions (for example, for forest, funnel, and radial plots) and functions for assessing the model fit, for obtaining case diagnostics, and for tests of publication bias.
To consider methods and related evidence for evaluating bias in non-randomised intervention studies.
Systematic reviews and methodological papers were identified from a search of electronic databases; handsearches of key medical journals and contact with experts working in the field. New empirical studies were conducted using data from two large randomised clinical trials.
Three systematic reviews and new empirical investigations were conducted. The reviews considered, in regard to non-randomised studies, (1) the existing evidence of bias, (2) the content of quality assessment tools, (3) the ways that study quality has been assessed and addressed. (4) The empirical investigations were conducted generating non-randomised studies from two large, multicentre randomised controlled trials (RCTs) and selectively resampling trial participants according to allocated treatment, centre and period.
In the systematic reviews, eight studies compared results of randomised and non-randomised studies across multiple interventions using meta-epidemiological techniques. A total of 194 tools were identified that could be or had been used to assess non-randomised studies. Sixty tools covered at least five of six pre-specified internal validity domains. Fourteen tools covered three of four core items of particular importance for non-randomised studies. Six tools were thought suitable for use in systematic reviews. Of 511 systematic reviews that included non-randomised studies, only 169 (33%) assessed study quality. Sixty-nine reviews investigated the impact of quality on study results in a quantitative manner. The new empirical studies estimated the bias associated with non-random allocation and found that the bias could lead to consistent over- or underestimations of treatment effects, also the bias increased variation in results for both historical and concurrent controls, owing to haphazard differences in case-mix between groups. The biases were large enough to lead studies falsely to conclude significant findings of benefit or harm. Four strategies for case-mix adjustment were evaluated: none adequately adjusted for bias in historically and concurrently controlled studies. Logistic regression on average increased bias. Propensity score methods performed better, but were not satisfactory in most situations. Detailed investigation revealed that adequate adjustment can only be achieved in the unrealistic situation when selection depends on a single factor.
Results of non-randomised studies sometimes, but not always, differ from results of randomised studies of the same intervention. Non-randomised studies may still give seriously misleading results when treated and control groups appear similar in key prognostic factors. Standard methods of case-mix adjustment do not guarantee removal of bias. Residual confounding may be high even when good prognostic data are available, and in some situations adjusted results may appear more biased than unadjusted results. Although many quality assessment tools exist and have been used for appraising non-randomised studies, most omit key quality domains. Healthcare policies based upon non-randomised studies or systematic reviews of non-randomised studies may need re-evaluation if the uncertainty in the true evidence base was not fully appreciated when policies were made. The inability of case-mix adjustment methods to compensate for selection bias and our inability to identify non-randomised studies that are free of selection bias indicate that non-randomised studies should only be undertaken when RCTs are infeasible or unethical. Recommendations for further research include: applying the resampling methodology in other clinical areas to ascertain whether the biases described are typical; developing or refining existing quality assessment tools for non-randomised studies; investigating how quality assessments of non-randomised studies can be incorporated into reviews and the implications of individual quality features for interpretation of a review's results; examination of the reasons for the apparent failure of case-mix adjustment methods; and further evaluation of the role of the propensity score.
Examine a model that encourages health at every size as opposed to weight loss. The health at every size concept supports homeostatic regulation and eating intuitively (ie, in response to internal cues of hunger, satiety, and appetite).
Six-month, randomized clinical trial; 2-year follow-up.
White, obese, female chronic dieters, aged 30 to 45 years (N=78).
Free-living, general community.
Six months of weekly group intervention (health at every size program or diet program), followed by 6 months of monthly aftercare group support.
Anthropometry (weight, body mass index), metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), and psychology (self-esteem, depression, body image). Attrition, attendance, and participant evaluations of treatment helpfulness were also monitored.
Analysis of variance.
Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained.
The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.
Because of the prevalence and devastating consequences of age-related macular degeneration (AMD), a systematic review devoted to low-vision rehabilitation and AMD seems timely and appropriate.
Several electronic databases were searched for studies from 1980 to 2006 involving individuals with low vision or visual impairment and rehabilitation interventions. Studies were assessed for quality and level of evidence.
The findings indicate that standard low-vision rehabilitation programs, conventional in-clinic assessments, and optical devices are effective ways of managing and living with vision loss. Areas of unmet need include determining which types of orientation and mobility programs and devices are most effective and developing methods of matching assistive technologies with the individual's visual and environmental requirements.
Additional randomized controlled trials with similar intervention comparisons and outcome measures are needed to form stronger conclusions for the most effective low-vision rehabilitation interventions for individuals with AMD.
Although disordered eating is prevalent in college women, most will not receive treatment, and existing approaches have limitations. Thus, novel and accessible approaches are warranted. However, few behavioral health interventions progress beyond initial implementation, underscoring the importance of feasibility and acceptability data to guide intervention development and refinement. Stakeholder perspectives can enrich these data, as they can highlight potential mechanisms to investigate in larger randomized-controlled trials (RCTs). The current study examined participant and leader feedback from an 8-week pilot intuitive eating (IE) intervention for college women with disordered eating delivered through group and guided self-help (GSH) modalities. Participants (N = 71) and leaders (N = 8) completed anonymous weekly surveys and exit questionnaires. Overall, the intervention was acceptable and feasible for both participants and leaders. Unique benefits of each modality, such as validation and support in group, and individualization and convenience in GSH, contributed to participant satisfaction and efficacy. Moreover, potential mechanisms of intervention effects, such as interoceptive awareness and self-compassion, were cited in both conditions, and should be explored in a future, fully-powered RCT. Areas for potential refinement include extending the intervention, assessing a hybrid treatment, online delivery, and careful design of a control condition to isolate the intervention’s mechanisms of change.
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.
Interoception, the sense of the body’s internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain–body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders.
Objective
College women engage in high rates of disordered eating behaviors (DEBs), and most do not receive treatment. Campuses lack resources to meet this need, thus accessible and affordable treatment options are important. Intuitive eating (IE) is gaining mainstream interest, but intervention research is scarce, with no known clinical trials in college women. This uncontrolled pilot trial examined the feasibility, acceptability, and preliminary efficacy of an eight‐week IE intervention delivered through two potentially accessible and affordable modalities: group and guided self‐help (GSH).
Method
Racially and ethnically diverse college women (N = 71; <50% White) were recruited from a large public Mid‐Atlantic university and randomized to group (n = 40) or GSH (n = 31). Assessments occurred at 0 (pre‐test), 8 (post‐test), and 16 weeks (follow‐up). Group participants attended eight weekly 1.5‐hour sessions. GSH participants engaged in self‐study and had eight weekly 20‐minute phone calls.
Results
Both conditions demonstrated feasibility, with superior retention and attendance in GSH. Over 90% of those attending at least one session in either condition were retained through follow‐up. Both conditions were highly acceptable, and produced medium to large reductions in DEBs, body dissatisfaction, and weight‐bias internalization, and improvements in body appreciation, IE, and satisfaction with life from pre‐ to post‐test, which were maintained at follow‐up.
Discussion
Results of this pilot are encouraging and support the development of a larger randomized controlled trial. Avenues for refinement include strategies to improve feasibility of the group condition, and conducting longer‐term follow‐up to examine maintenance of effects and the intervention's eating disorder prevention potential.
Introduction
The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode.
Materials and Methods
Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power).
Results
Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m². There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (−0.4 ± 0.6 kg/m²; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; −0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; −0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects.
Conclusions
The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).
Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 & 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.
Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.
This is the first experimental study to test the effectiveness of an intuitive eating intervention designed to increase adaptive eating practices and reduce eating disorder risk factors. Participants were 72 non-clinical, female college students from a large Midwestern university who were randomly assigned to either the experimental intervention or the control group (survey completion only). Participants were assessed prior to the intervention, post-intervention, and again at 1-week and 2-week follow-up periods on intuitive eating practices, dieting, body image effects, and disordered eating attitudes. Eating self-efficacy and emotional awareness were also examined as potential moderators of the intuitive eating intervention. Survey data was analyzed using a mixed ANOVA model to test the intervention and moderation effects across time. As hypothesized, after the intervention, the experimental group demonstrated significantly greater adherence to intuitive eating practices and significantly less dieting attitudes and practices relative to the control group. However, the groups did not significantly differ on the body image effects and disordered eating attitudes outcomes. In addition, emotional awareness was supported as a significant moderator of the intuitive eating, dieting, and disordered eating attitudes outcomes. Although different than the hypothesized effects, these results imply that participants with higher and lower emotional awareness both showed benefits from the intuitive eating intervention. Similarly, eating self-efficacy was supported as a significant moderator of the intuitive eating and body image effects variables, even after controlling for general self-efficacy. Overall these results present empirical evidence that the intuitive eating model can be a promising approach to disordered eating prevention in a variety of service delivery modalities.
Intuitive eating (i.e., reliance on physiologic hunger and satiety cues to guide eating) has been proposed as a healthier, more effective, and more innate alternative to current strategies of weight management. The current study explored intuitive eating among young adults according to socio-demographic characteristics and body mass index (BMI), and examined associations between intuitive and disordered eating behaviors. Data were drawn from Project EAT-III, a population-based study of 2287 young adults (mean age: 25.3years). More males reported trusting their bodies to tell them how much to eat than did females. Intuitive eating was inversely associated with BMI in both genders. Males and females who reported trusting their body to tell them how much to eat had lower odds of utilizing disordered eating behaviors compared to those that did not have this trust. Females who reported that they stop eating when they are full had lower odds of chronic dieting and binge eating than those who do not stop eating when full. Overall, this study found that intuitive eating practices are inversely associated with a number of harmful outcomes. Clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.
Confidence intervals (CIs) are widely used in reporting statistical analyses of research data, and are usually considered to be more informative than P values from significance tests.1 2 Some published articles, however, report estimated effects and P values, but do not give CIs (a practice BMJ now strongly discourages). Here we show how to obtain the confidence interval when only the observed effect and the P value were reported.
The method is outlined in the box below in which we have distinguished two cases.
#### Steps to obtain the confidence interval (CI) for an estimate of effect from the P value and the estimate ( Est )
##### (a) CI for a difference
##### (b) CI for a ratio
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.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
To test the feasibility of creating a valid and reliable checklist with the following features: appropriate for assessing both randomised and non-randomised studies; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting, internal validity (bias and confounding) and power, but also for external validity.
A pilot version was first developed, based on epidemiological principles, reviews, and existing checklists for randomised studies. Face and content validity were assessed by three experienced reviewers and reliability was determined using two raters assessing 10 randomised and 10 non-randomised studies. Using different raters, the checklist was revised and tested for internal consistency (Kuder-Richardson 20), test-retest and inter-rater reliability (Spearman correlation coefficient and sign rank test; kappa statistics), criterion validity, and respondent burden.
The performance of the checklist improved considerably after revision of a pilot version. The Quality Index had high internal consistency (KR-20: 0.89) as did the subscales apart from external validity (KR-20: 0.54). Test-retest (r 0.88) and inter-rater (r 0.75) reliability of the Quality Index were good. Reliability of the subscales varied from good (bias) to poor (external validity). The Quality Index correlated highly with an existing, established instrument for assessing randomised studies (r 0.90). There was little difference between its performance with non-randomised and with randomised studies. Raters took about 20 minutes to assess each paper (range 10 to 45 minutes).
This study has shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies. It has also shown that it is possible to produce a checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses. Further work is required to improve the checklist and the training of raters in the assessment of external validity.
- Loughran T.
Evaluating an Intuitive Eating program for binge eating disorder: A benchmarking study (Doctoral Dissertation
- D Smitham
Smitham, D. (2009). Evaluating an Intuitive Eating program for binge eating disorder:
A benchmarking study (Doctoral Dissertation, University of Notre Dame). https://
curate.nd.edu/show/05741r6896v