This is my MHS graduate manuscript titled, “A Narrative Review: The Effects of Intuitive Eating on Body Image, Health Practices, and Life Quality in Females” by Rachel L. Beiler, RD, LDN
Table of Contents
Abstract
Background: Today, the focus of health is achieving weight loss. Weight loss is traditionally achieved by decreasing overall caloric intake from food while simultaneously increasing the number of calories burnt from physical activity. This method is commonly used because individuals often associate a decrease in weight with an increase in health. With this heavy emphasis on weight loss in today’s society, the prevalence of body image dissatisfaction is at an all-time high, especially among females. This can lead to disordered eating habits, poor healthy living practices, and an overall low quality of life. However, research is demonstrating that weight loss is not a long-term or effective way to achieve overall health. Instead of weight loss, research is supporting a focus on determining health based on an individual’s overall feeling of wellbeing, biochemical data, and mental health. This switch emphasizes healthy living practices such as eating a healthful, balanced diet, participating in physical activity, and improving mental health. Research is showing that non-diet approaches to health, such as Intuitive Eating (IE) and Health at Every Size (HAES), are better options than weight loss. These approaches focus on nourishing an individual’s physical and mental health without pursuing restrictive, harmful habits.
Objective: To carry out a narrative review of the effect of Intuitive Eating on body image acceptance, healthy living practices, and overall quality of life in females 13 years and older.
Method: A narrative review will be performed. A search of the literature from 2009 to the present will be done utilizing the Health and Human Sciences Research Guide provided by Western Carolina University in order to identify peer-reviewed articles that discuss the effect of Intuitive Eating on females 13 years and older. Articles will be reviewed using the Evidence Analysis Process created by the Academy of Nutrition and Dietetics. Information received from the reviewed articles will be compiled and reported in the format of a narrative review.
Anticipated Results: The study results are anticipated to show that Intuitive Eating has an overall positive effect on body image acceptance, healthy living practices, and overall quality of life in females 13 years and older.
Anticipated Conclusion: Intuitive Eating helps to improve body image acceptance, healthy living practices, and quality of life in females 13 years and older.
Chapter 1. Introduction
Overview of Dieting Trends
Over recent years, dieting has taken over the health and wellness world (Harrison, 2018). Hundreds of diets have been created by doctors, nurses, nutritionists, dietitians, and other health professionals. These diets promise a healthier body and life through successful weight loss (Harrison, 2018). The popularity of dieting has grown to the point that the majority of people have dieted several times throughout their lifetime. Within the dieting community, it is commonly thought that an individual is not considered healthy unless the individual is on a diet and pursuing weight loss (Harrison, 2017).
Commonly known diets include the Atkins Diet, which has been rebranded as the Ketogenic Diet. This diet emphasizes low-carbohydrate intake while simultaneously increasing fat and protein intake in order to lose body fat (Harrison, 2018). Another popular diet is Paleo, which encourages eating only foods that could theoretically be scavenged or hunted such as meat, berries, seeds, and nuts (Harrison, 2018). Other well-known diets include meal plans such as Weight Watchers, Jenny Craig, or Nutrisystem which involve calorie counting, support groups, and meal delivery services. The list of popular diets is almost never ending and includes diets such as the Alkaline Diet, Whole30, detox diets, juicing, Raw Food Diet, Blood Type Diet, Zone Diet, Macrobiotic Diet, Grape Fruit Diet, gluten free diet, etc (Harrison, 2018).
One thing all diets have in common is a goal of weight loss in order to improve health and enhance physical appearance (Harrison, 2017). However, although diets promise weight loss, current research is showing that no diet or combination of diets has been able to prove that the achieved weight loss is sustainable. Research is showing that, as time passes, diets are incapable of maintaining the achieved weight loss (Harrison, 2017).
Shifting the Focus of Health
After years of the health and wellness industry being dominated by diets, research began to emerge that discussed the dangers of dieting. Research started demonstrating that dieting leads to decreased metabolism, weight re-gain, obsession with food, low self-esteem, eating disorders, and more (Harrison, Zavodni, 2019). In addition to this, research also started demonstrating that health cannot be accurately determined by weight. The Health at Every Size (HAES) movement, founded by health professionals, started to argue and prove that weight is not a determinant of health. HAES demonstrated that health can be achieved at any body weight, thus decreasing the need for diets and weight loss (ASDAH, 2013).
As new research continued to be published and support the omission of diets, certain health professionals started to shift the focus of health from weight loss to overall well-being. This shift emphasized eating a balanced diet, participating in enjoyable physical activity, and basing health on how an individual feels, not how an individual looks (ASDAH, 2013). Health professionals began to leave weight-centered health promotion and instead began to emphasize weight-neutral health promotion. During this shift and research period, two registered dietitians created Intuitive Eating, a non-diet approach to health that emphasizes a healthy relationship with food and an individual’s body. During recent years, Intuitive Eating has gained popularity in the health and wellness world and has begun to revolutionize what health really is (Tribole, Resch, 2012).
Introduction to Intuitive Eating
Created by two registered dietitians, Evelyn Tribole and Elyse Resch, Intuitive Eating (IE) is an evidence-based, mind-body health approach that is comprised of 10 core principles. Intuitive Eating is a personal process of honoring health by listening and responding to the direct messages of one’s body in order to meet one’s physical and psychological needs. Intuitive Eating is not a diet or food plan. The goal of IE is not weight loss; instead the goal is to create a healthy relationship with food, physical activity, and personal body image (Tribole, Resch, 2012).
Operational Definitions
Registered Dietitian (RD): A food and nutrition expert who has completed a bachelor’s degree from a program approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), completed an ACEND accredited dietetic internship program, successfully passed the national RD exam provided by the Commission on Dietetic Registration (CDR), and continues to complete required continuing professional education requirements (AND, 2013).
Intuitive Eating: An evidenced based, mind-body health approach, comprised of 10 principles and created by two dietitians, Evelyn Tribole and Elyse Resch (Tribole, Resch, 2012).
Health at Every Size (HAES): Created by the Association for Size Diversity and Health (ASDAH); an approach to health that affirms a holistic definition of health, which cannot be characterized by the absence of physical or mental illness, limitation or disease, instead health exists on a continuum that varies with time and circumstance for each individual; involves 5 main principles – weight inclusivity, health enhancement, respectful care, eating for well-being, and life-enhancing movement (ASDAH, 2013).
Eating disorder: Serious and sometimes fatal illnesses associated with severe disturbances in people’s eating behaviors and related thoughts and emotions; characterized by preoccupation with food, body weight, and shape; common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder (NIH, 2016).
Body image: How one sees oneself when looking in the mirror or when picturing oneself in one’s mind; encompasses what one believes about one’s own appearance, how one feels about one’s body, and how one senses and controls one’s body (NEDA, 2018).
Health practices: Diet patterns, physical activity levels, and mental health status
Life quality: The standard of health, comfort, and happiness experienced by an individual or group
Problem Statement
The purpose of this research project is to determine the effect of Intuitive Eating on the general health practices, body image satisfaction, and overall life quality of females ages 13 years and older. Research shows that females experience the negative impacts of dieting the most in comparison to males (Harrison, 2017). Through this research, a potential solution could be found that links Intuitive Eating to increased health practices, body image satisfaction, and life quality in the population of interest.
Chapter 2. Literature Review
Overview
Today, the overarching focus of health is to successfully achieve weight loss. This is typically accomplished by decreasing calorie intake from food while increasing calories burnt from physical activity. This is because it is commonly thought that a decrease in weight is synonymous with an increase in health. However, current research is showing that weight loss is not a sustainable or effective way to achieve overall health. Instead, certain health practitioners have proposed the idea of shifting from emphasizing weight loss to focusing on an individual’s overall health based on feeling and biochemical health data (Harrison, 2017). This shift of focus puts an emphasis on healthy living practices such as eating a balanced diet, participating in physical activity, and improving mental health (Harrison, 2017). By doing this, weight is no longer being used as an identifiable factor for health. Due to this progression in the thought behind what health really is, movements such as Intuitive Eating, Health at Every Size (HAES), and the Anti-Diet Movement have been created. These movements focus on nourishing the mental and physical body through food and enjoyable physical activity with no regard to weight (Harrison, 2018). Intuitive Eating abandons the idea of focusing on weight loss through restrictive habits that can result in metabolic damage to the body.
The concept of Intuitive Eating can be used to help individuals heal one’s relationship with food and body. In theory, Intuitive Eating can help improve psychological health by potentially improving self-esteem, body image dissatisfaction, overall quality of life, and restrictive eating habits. It can also, in theory, enhance physical health by potentially improving participation in physical activity, types of foods eaten, relationship with food, restrictive food habits, binge eating, undereating, and disordered eating patterns. However, despite the possible benefits of Intuitive Eating, not all health professionals are in agreeance with the usage of Intuitive Eating. The main drawback of Intuitive Eating is the possibility of it not only leading to the inability to lose weight, but it increasing the chances of weight gain, since food is not restricted (Anglin, Borchardt, 2015). This drawback results in a constant debate between health professionals who follow a weight-neutral approach to health and those who follow a weight-centered approach to health.
Basis for Methodology
The chosen methodology for this study is a comprehensive narrative review. The key words and phrases include: Intuitive Eating, influence of Intuitive Eating, effect of Intuitive Eating, influence of Intuitive Eating on females, effect of Intuitive Eating on females, and results of Intuitive Eating. These terms were used to ensure a broad overview of Intuitive Eating and its influence on individuals. Additional terms that could have also been used during this search process include body image, quality of life, and health practices. However, these terms were not used during the research process in order to keep the search broad and prevent valuable research articles from not being discovered. Once this process was complete, the resources identified were also searched for additional valuable resources.
Intuitive Eating
Intuitive Eating (IE) is a program created by two registered dietitians, Evelyn Tribole and Elyse Resch. (Tribole, Resch, 2012). These dietitians specialize in eating disorders and are passionate about helping people develop a healthy relationship with food and body. Intuitive Eating is an evidence based, mind-body approach to health that uses a non-diet and weight-neutral model. It is important to know that Intuitive Eating is not a diet. Instead, it is a non-restrictive program that helps one connect with the body’s needs and become the expert of self. It was created to be a tool of empowerment to help free people from weight obsession and diet culture. Today, diet culture can be defined as a community that praises the idea of the “ideal body,” which is small and provides an individual with additional value to society. Diet culture encourages food restriction, excessive exercise, and uses weight as the primary indicator of health. The goal of Intuitive Eating is to leave dieting, food restriction, body dissatisfaction, and weight stigma behind to pursue overall health and wellness.
To adopt Intuitive Eating into a daily routine, there are 10 principles to help guide individuals through the process. 1. Reject the Diet Mentality. This means to forget and stand up to the lies diet culture teaches. This involves no longer participating in fad diets, calorie counting, over-exercising, or restrictive behaviors. 2. Honor Your Hunger. This principle focuses on the importance of receiving proper nourishment through consuming an adequate balance of macro- and micro-nutrients. This also involves learning to listen to and act accordingly to physical hunger. 3. Make Peace with Food. This principle reinforces one of the most importance practices in Intuitive Eating, giving oneself unconditional permission to eat. This is important because restricting or depriving oneself of certain foods can lead to an unhealthy relationship with those foods. 4. Challenge the Food Police. The Food Police are the people and an individual’s internal thoughts that monitor rules around food consumption. This principle involves the “re-wiring” of the brain to not label foods as “good” or “bad.” 5. Respect Your Fullness. This principle involves learning how to identify when one’s body feels comfortably full. This is not meant to be a restrictive behavior but it is meant to help one listen to the body and prevent overeating, which can often lead to guilt and compensatory behaviors. 6. Discover the Satisfaction Factor. This principle focuses on eating what the body desires, in an inviting and peaceful environment, to help the body feel satisfied and content, thus, leading to a healthier relationship with food and body. 7. Honor Your Feelings Without Using Food. Intuitive Eating focuses on finding ways to cope with life that do not involve food. By practicing this, food is no longer seen as a tool to drown emotions but as a positive experience used to nourish the body. This also helps one to develop proper coping strategies to stress, sadness, anger, and other emotions. 8. Respect Your Body. Intuitive Eating focuses on the fact that bodies come in all shapes, size, and colors. An individual’s health cannot be determined by external appearance and it is important to learn to respect the body. 9. Exercise – Feel the Difference. The focus of this principle is to develop a healthy relationship with physical activity by participating in enjoyable exercise and moving in ways that feel good to an individual’s body. 10. Honor Your Health. Intuitive Eating focuses on choosing foods both that honor health and the body’s taste buds. An individual should choose foods that make one feel physically and mentally healthy (Tribole, Resch, 2012).
In comparison, as a whole, the principles of Intuitive Eating contrast and challenge traditional strategies of achieving health. Traditional strategies encourage calorie counting, restricting certain foods and/or food groups, fasting for extended periods of time, setting weight loss goals, achieving a certain physique as well as additional strategies. On the other hand, Intuitive Eating focuses on honoring hunger and satiety cues while making peace with food instead of restricting intake. Intuitive Eating focuses on respecting the body instead of striving for weight loss and a particular physique or body type (Tribole, Resch, 2012).
Intuitive Eating and the General Population
Several studies were reviewed that involved collecting data on a population and correlating that data to the degree of Intuitive Eating experienced. These studies involved female participants that varied in age and the use of various measurement tools to determine degree of Intuitive Eating as well as its impact. (Andrew, Clark, 2016, Augustus-Horvath, Tylka, 2011, Schoenefeld, Webb, 2013)
A longitudinal study by Andrew and Clark investigated prospective predictors and health-related outcomes of positive body image in adolescent females (Andrew, Clark, 2016). The participants were a subset of a larger cross-sectional study investigating a model of Intuitive Eating. The participants completed two separate questionnaires that included measures of activity, media consumption, body appreciation, self-objectification, social appearance comparison, perceived body acceptance, health behaviors, and general demographics. Participants were also asked about intuitive eating habits and patterns. The data was then analyzed to determine the link between an individual’s level of intuitive eating and its impact on body appreciation, quality of life, and other topics addressed. The results suggested that enhancing body appreciation might be one way to tackle the development of disordered eating that is highly prevalent amongst adolescent females. The results also showed that public health programs for adolescents that focus on weight may negatively impact body appreciation while more holistic programs, such as Intuitive Eating, that challenge weight stigma, encourage body acceptance, and focus on an overall healthy lifestyle are likely to be more beneficial for both physical and psychological health.
A similar study by August Horvath and Tylka involved women of varying ages (emerging adulthood, early adulthood, and middle adulthood). The participants completed various surveys that assessed support systems, body acceptance, perception of body shape/size, overall life satisfaction, and level of intuitive eating. The degree of intuitive eating was compared to the participants’ body image satisfaction, overall quality of life, and other topics addressed. The results indicated that an increase in perceived social support was associated with body acceptance of others as well as an increase in body appreciation and intuitive eating when others approved of their bodies.The authors concluded that the higher the degree of intuitive eating, the more likely a participant was to have a positive body image as well as an increased level of life satisfaction.
A third study by Scheonegeld and Webb involved female undergraduate students that completed various online surveys including the Self-compassion Scale (SCS), the Distress Tolerance Scale (DTS), the Body Image Acceptance and Action Questionnaire (BI-AAQ), the Intuitive Eating Scale (IES), and the Rosenberg Self-Esteem Scale (RSES). The results of the surveys indicated that participants that scored high on self-compassion reported higher levels of intuitive eating, distress tolerance, and body image flexibility. The results also showed that participants that reported higher levels of intuitive eating tended to report high levels of body image acceptance. These results strongly suggest that practicing the principles of Intuitive Eating can lead to increased body image satisfaction and improved self-esteem/self-love.
In summary, these research studies demonstrated that Intuitive Eating can increase the likelihood of a participants experiencing a positive body image as well as increased self-love and acceptance. In addition to this, the studies demonstrated that Intuitive Eating can positively influence an individual’s overall healthy lifestyle and can result in an increased life quality.
Intuitive Eating Integrated or Combined with Health Programs
Several studies were reviewed that involved the integration or combination of Intuitive Eating and existing health programs. These studies involved predominantly female participants that completed health programs or health interventions that were combined with Intuitive Eating practices (Bush, Rossy, 2014, Cole, Horcek, 2010, Loughran, Harfel, 2018, Cadena-Schlam, Lopez- Guimera, 2015).
An experimental study by Bush and Rossy determined the difference between two groups of females. The intervention group participated in the Eat for Life class (combination of Intuitive Eating and mindfulness approaches) while the control group did not. The results showed that the intervention group reported higher levels of body appreciation and lower levels of problematic eating behaviors in comparison to the control group. The results demonstrated that the intervention group experienced an overall increase in life satisfaction and body acceptance while practicing the principles of Intuitive Eating.
A similar experimental study by Cole and Horcek involved the intervention group participating in the My Body Knows When Intuitive Eating program while the control group did not. After the completion of the My Body Knows When program, the results showed that the intervention group displayed signs of rejecting the “diet-mentality”, improved self-worth, and reduction in emotional eating. The intervention group showed signs of increased body acceptance and improvements in overall healthy eating practices.
An additional experimental study by Loughran and Harfel observed the effect of an Intuitive Eating text-message intervention on college students. The study involved ten text messages (2 texts/week) regarding Intuitive Eating reminders. The results showed a positive correlation between Intuitive Eating and self-efficacy, new found food independence, increase in desire for healthy behaviors, and decreased levels of perceived stress. The results suggested that those who were reminded to practice the Intuitive Eating principles experienced an overall improvement in body image satisfaction and healthy living practices.
In addition to these experimental studies, a review study conducted by Cadena-Schlam and Lopez- Guimera selected eight different research articles that aimed to explore the effectiveness of interventions based on Intuitive Eating and the Health at Every Size (HAES) principles. The results of the review showed that using Intuitive Eating alone or in conjunction with another program, such as HAES, may be a more promising and realistic method to addressing overweight and obesity than conventional weight-loss treatments. It demonstrated that Intuitive Eating can help meet an individual’s health goals and does not negatively affect the integrity and welfare of the patient. It found that Intuitive Eating protects people of all sizes from unhealthy weight-focused behaviors that may diminish an individual’s overall health and well-being.
In summary, these studies demonstrated that wholistic approaches to health, such as Intuitive Eating can positively influence body image and increase body acceptance. In addition to this, Intuitive Eating can help decrease problematic eating habits and reduce the level of emotional eating. These studies demonstrated that Intuitive Eating can meet health goals and improve the welfare of participants by healing participant’s relationship with food as well as their outlook on weight-focused behaviors.
Intuitive Eating in Specialized Fields of Study
Two specialized Intuitive Eating studies were discovered during the literature search. These studies focus on two groups of females that are at an increased likelihood of disturbed body image and disordered eating habits (Plateau, Petrie, Papathomas, 2017, Richards, Crowton, Berrett, 2017).
One study by Platueau, Petrie, and Papathomas involved retired collegiate female athletes. This is a specialized study because female athletes are known to have an increased likelihood of disordered eating patterns and body image dissatisfaction. The participants completed various surveys that inquired about their level of intuitive eating and the results of incorporating Intuitive Eating into daily life. The participants also answered questions regarding how their health habits changed after retirement from their sport. The study showed that most of the participants reported that their frequency and/or quantity of eating changed after retirement. (Plateau, Petrie, Papathomas, 2017).
Many of the participants resonated with questions regarding Intuitive Eating principles including permission to eat, recognizing internal hunger and satiety signals, and eating to meet physical and nutritional needs. This was because many of the athletes experienced constraints around food intake while competing. These constraints included avoidance of “unhealthy” foods, limited caloric intake, rigid eating schedules, loss of hunger and satiety cues, and negative emotions around food. The results of the surveys showed that Intuitive Eating principles can help retired female athletes resume a “normal” pattern of eating and reduce disordered eating practices. The results also found that Intuitive Eating can be effectively used to improve the participant’s body acceptance and general healthy living practices. However, it was noted additional research is needed to understand the process of helping retired female athletes develop a healthier approach to eating.(Plateau, Petrie, Papathomas, 2017).
The second specialized study by Richards, Crowton, and Berrett, involved women at an inpatient-residential care facility for females with eating disorders such as anorexia nervosa, bulimia nervosa, binge eating, eating disorder-not other specified, and additional comorbid diagnoses. (Richards, Crowton, Berrett, 2017). The participants received education on the ten Intuitive Eating principles and registered dietitians met with the patients individually each week in order to discuss Intuitive Eating. Via observation of the patients during admission in the inpatient-residential care facility, the results showed that the participants developed healthier attitudes towards food/eating and learned to apply the principles to make healthier choices. The results also showed a reduction in depression, anxiety, and conflicts with body image. The authors inferred that Intuitive Eating can be an effective intervention when working with eating disorder patients (Richards, Crowton, Berrett, 2017).
In summary, these specialized studies show that Intuitive Eating can have an overall positive impact on individuals at increased risk of negative body image and disordered eating practices. These studies demonstrated that Intuitive Eating can help individuals develop a healthy approach to eating and make peace with food as a whole. In addition to this, these studies demonstrated that Intuitive Eating can positively influence body image and acceptance, even in individuals that have developed eating disorders.
Research Focus
The focus of this research is to identify robust, peer reviewed studies that discuss the relationship between Intuitive Eating and its impact on a female’s body image satisfaction, health habits, and quality of life. The goal of this narrative review is to answer a proposed research question: What is the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older?
Chapter 3. Methodology
Research Design
A comprehensive narrative review will be conducted to review the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life among females 13 years of age and older. The review will be done according to the Evidence Analysis Process created by the Academy of Nutrition and Dietetics (AND). There are few studies that evaluate and summarize the current research available on the topic of Intuitive Eating. Completing a narrative review will help form a broad perspective of the topic of interest and will provide a comprehensive and critical analysis of the current knowledge of this topic.
Data
Setting:
The literature reviewed for this study will include articles in English. The research will not be limited to specific settings since Intuitive Eating can occur in every aspect and setting of life. In the end, observing the impact of Intuitive Eating on females 13 years and older within various life settings will allow an understanding of the relationship between Intuitive Eating, body image, health practices, and quality of life to be developed.
Population:
Information regarding this population will be collected through the Health and Human Sciences Research Guide provided by Western Carolina University’s Hunter Library. This database includes but is not limited to Cumulative Index to Nursing and Allied health (CINAHL), Cochrane Library, Medline, Psyctests, Psycinfo, and Socindex.
Sample:
The population of interest is females ages 13 and older. This is because the prevalence of body image dissatisfaction, which can lead to disordered eating patterns, poor healthy living practices, and an overall low quality of life, is the highest among females. It is more common for females to be unsatisfied with their exterior appearance than it is for males. This dissatisfaction often leads to compensatory behaviors that influence diet patterns and mental health status (Eating Disorder Hope Organization, 2020). It is crucial to investigate females of all ages because this problem occurs during various stages in life or throughout an individual’s entire lifespan. In order to provide a summary of how females are influenced throughout life, the age criteria will be greater than or equal to 13 years of age. Choosing to look at research starting at 13 years old is important because that age signifies the becoming of a teenager, which is a critical time for physical and mental development within women.
Search phrases used to define the sample include Intuitive Eating, influence of Intuitive Eating, effect of Intuitive Eating on females, influence of Intuitive Eating on females, and results of Intuitive Eating.
Inclusion and Exclusion Criteria:
Studies will be screened using the following inclusion and exclusion criteria. All retained studies must meet inclusion criteria.
Inclusion:
- Published between January 2009 – Present
- English language or articles published in English
- Randomized control trials, meta-analyses, narrative review and other forms of literature reviews, cohort study, cross-over study, descriptive study, cross-sectional study, longitudinal study
- Full-text articles
- Peer reviewed articles
- Gender specific data separate for ease of analysis of female participants
- All races/ethnicities
- Participant age range: >13
- Contains at least 1 of 3 dependent variables (body image satisfaction, healthy living practices, and quality of life)
- Size of study groups >30 participants
- Study dropout rate <20%
Exclusion:
- Published before January 2009
- Published in a language other than English
- One-shot case studies, before-after study, cost benefit analysis, diagnostic/validity/reliability study, intention to treat analysis, magnitude of effect, non-controlled trial, non-randomized controlled trial, phenomena, time series, trial, trend study
- Articles that are not full-text
- Articles that are not peer reviewed
- Articles researching the correlation between IE and weight loss
- Gender data aggregate only
- No race/ethnicity exclusions
- Participants age range: <13
- Does not contain at least 1 of 3 dependent variables (body image satisfaction, healthy living practices, and quality of life)
- Size of study groups <30 participants
- Study dropout rate >20%
Variables
Independent Variable(s):
The independent variable for this study includes the presence of/participation in Intuitive Eating. A nominal variable categorized as “yes” or “no.”
Dependent Variables:
The dependent variables for this study include the level of body image satisfaction, healthy living practices such as diet patterns as well as physical activity habits, and overall quality of life of the participants. Variables will be measured based on the information provided by studies that are reviewed.
Demographic Variables:
The demographic variable for this study includes females 13 years and older. Level of measurement will be years and the study participants will be categorized by age.
Instrumentation
Data Collection Instruments:
A comprehensive Excel spreadsheet will be used to organize, summarize, and characterize studies selected, how obtained and the disposition of those articles. A detailed flow chart will be used to graphically display the research and data collection process.
Administrators:
The study administrator will be Rachel Beiler, author, with assistance from a graduate faculty mentor.
Procedures:
In order to evaluate the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life among females 13 years and older, a series of steps will be taken. The review process will follow the guidance of the Evidence Analysis Process created by the Academy of Nutrition and Dietetics (AND), which is described in detail below. First, literature will be collected by using the Health and Human Sciences Research Guide provided by Western Carolina University’s Hunter Library. This database includes but is not limited to Cumulative Index to Nursing and Allied health (CINAHL), Cochrane Library, Medline, Psyctests, Pstcinfo, and Socindex. Examples of key words and phrases used will include: (“Intuitive Eating” or “IE”) and (“influence of Intuitive Eating” or “results of Intuitive Eating”) and (“effect of Intuitive Eating on females” or “influence of Intuitive Eating on females)
Second, the articles collected will be screened initially using the inclusion and exclusion criteria. All studies must meet the criteria. Studies that satisfy the criteria, will be reviewed for additional resources identified from the study references. This process will continue until a reasonable saturation level is reached. Studies that do not satisfy the criteria, will be organized in an Excel spreadsheet in combination with the reasons those studies were excluded (See Table 5 in Appendix B). These discarded articles may be used to provide background information regarding Intuitive Eating, as needed.
Third, articles that meet the inclusion criteria will be categorized using an Excel spreadsheet. A summary of pertinent information discovered through the included articles will also be organized using an Excel spreadsheet. In addition to this, a flowchart will be created that identifies how and what articles made it through the inclusion/exclusion process.
Errors and Limitations
Due to the nature of narrative reviews, there is an increased chance of bias as well as the exclusion of certain literature, since the methods used to obtain literature cannot ensure that all literature is considered. In addition to this, upon searching the current literature, it appears that limited data is available on this subject.
Potential Bias
No potential bias has been identified among the research articles reviewed thus far. The study administrator, Rachel Beiler, has chosen to set any personal biases aside during the proposal and research periods.
Analysis of Findings
The retained studies will be read thoroughly and reviewed. Various information from the studies will be recorded in a comprehensive Excel spreadsheet. The Evidence Analysis Process created by the Academy of Nutrition and Dietetics (AND) will be used to review and rate each study as well as grade the overall evidence provided. This process is done by completing a Quality Criteria Checklist (QCC) for each retained study reviewed, which indicates the rating of the study as positive, neutral, or negative. After each study has been reviewed using the Quality Criteria Checklist, the strength of the evidence provided by all included studies will be graded as Grade I: Good, Grade II: Fair, Grade III: Limited, Grade IV: Expert Opinion Only, or Grade V: Not Assignable. Once all studies have been thoroughly examined and the Evidence Analysis Process is complete, the information collected will be summarized in the format of a narrative review. See Appendix C for more information regarding the Evidence Analysis Process.
Chapter 4. Results
The Evidence Analysis Process – A Five Step Process
The Evidence Analysis Process was created by the Academy of Nutrition and Dietetics (AND). The process is used to review literature regarding a topic of interest. During the process, scientific articles are reviewed according to a search plan defined by the researcher. Next, the articles are graded for quality of research and the information provided in the included articles is summarized. Last, the current research regarding the topic and research question of interest is given a grade to dictate the overall quality of the articles as well as the conclusions that were drawn. Further information regarding the Evidence Analysis Process can be found in Appendix C.
Step 1 – Formulate the PICO Question
To begin, a PICO question was formed according to the Evidence Analysis Process guidelines. PICO stands for: Population (patient or problem), Intervention (cause, treatment, or prognostic factor), Comparison intervention (if necessary), and Outcomes. For this narrative review, the population was decided to be females ages 13 years and older; the intervention was practicing Intuitive Eating; the comparison was not practicing Intuitive Eating; and the outcomes were body image satisfaction, healthy living practices, and quality of life. This results in a PICO question: What is the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 years and older? It is important to note that the comparison (the C in PICO) is not included in the PICO question in order to fulfill the graduate level research question requirements. The PICO question was approved by the MHS program director. See Table 1 in Appendix B for the completed table used by AND to create the PICO question.
Step 2 – Gather & Classify Research (Develop Search Plan)
The search plan developed according to the Evidence Analysis Process was used to determine the search terms/phrases, inclusion criteria, exclusion criteria, and electronic databases. This information was discussed in details in Chapter 3. By using the search terms and inclusion/exclusion criteria, a total of 50 research articles were collected. Of the articles collected, 16 articles met the inclusion criteria and 34 did not meet the inclusion criteria. Of the 16 articles included, 13 were primary research and 3 were secondary research. The list of excluded articles and reasons for exclusion can be found in Appendix B. The main reasons articles were excluded were irrelevancy to research topic, lack of discussion of IE, participants <13 years old, articles not written in English, and results not sorted according to sex. The entire search plan, in the format provided by AND, can be found in Table 2 in Appendix B.
Step 3 – Appraise Each Article Using the Quality Criteria Checklists (QCC)
A QCC was completed for each included article (16 total articles). For each article included, the QCC reviewed the research purpose, inclusion criteria, exclusion criteria, recruitment methods, study protocol, statistical analysis, data collection, description of data sample, summary of results, and the authors’ conclusions. In addition to this information, each QCC has relevance and validity questions that must be assessed for each included article. An example of a relevancy question is: “Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group?” An example of a validity question is: “Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were intervening factors described?” Once all of the relevancy and validity questions had been answered with a “yes,” “no,” “unclear”, or “N/A,” each article was given a rating of negative, neutral or positive. An article would receive a negative grade if most of the answers to the validity questions were “no.” An article would receive a neutral grade if the answers to the specific validity questions were “no”. An article would receive a positive grade if most of the answers to the validity questions were “yes”. It is important to point out that primary and secondary research articles have different QCCs that vary slightly.
After completing a QCC for all 16 of the included articles, 11 articles received a positive rating and 5 articles received a neutral rating. An example of a completed QCC can be found in Table 3 in Appendix B.
Step 4 – Summarize the Evidence
Once all of the included articles were reviewed using a QCC, each article was summarized using the Evidence Analysis Overview Table provided by AND. For each article, the table included author, year, study design, class, rating, study type, study purpose, intervention, and outcomes. The completed table can be found in Table 4 in Appendix B.
Step 5 – Conclusion Statement & Grade
After the PICO question was developed, the search plan was completed, the articles were reviewed using the QCCs and the articles were thoroughly summarized in the Evidence Analysis Overview Table, a conclusion statement was written and a grade was assigned to the research available on the topic of interest. The conclusion statement is: Intuitive Eating, as an intervention, and intuitive eating as a health habit have both shown to have highly positive effects on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older. Intuitive Eating can be successfully used to support body image acceptance; promote healthy living practices such as an increase in fruit, vegetable, and whole-grain intake as well as a decrease in foods high in fat and sugar; IE can also help alleviate disordered eating habits such as binge eating; and IE has seen to improve quality of life by decreasing the prevalence or severity of depression and allowing intuitive eaters to live a less stressful life in regards to food and body. The conclusion grade determined is: Grade Level I – Good/Strong.
The completed Conclusion Statement and Grade table provided by AND can be found in Table 6 in Appendix B.
Chapter 5. Discussion
The results of the Evidence Analysis Process demonstrated that there is more than an adequate amount of high quality research available that supports the use of Intuitive Eating for health promotion.
Effects of IE on Body Image Satisfaction
The research demonstrated that IE can have a positive impact on body image satisfaction in females 13 years and older. After undergoing a 10-week IE intervention, participants who noted an increase in their level of intuitive eating also noted an increase in body appreciation and acceptance (Bush, Rossy, Mintz, Schopp, 2015). Eating intuitively and mindfully was found to positively influence a participant’s body appreciation (Bush, Rossy, Mintz, Schopp, 2015). Integrating the principles of Intuitive Eating was found to decrease the internalization of the thinness ideal, pressure to lose weight, body shame, and body dissatisfaction (Cadena-Schlam, Lopez-Guimera, 2015). It was also found that intuitive eaters are more likely have higher levels of body appreciation, self-esteem, and overall feeling of satisfaction with themselves and their bodies (Cadena-Schlam, Lopez-Guimera, 2015). An additional 10-week IE intervention found that practicing Intuitive Eating helped participants improve self-worth and reduce negative self-talk (Cole, Horacek, 2010). The reviewed research also found that high scores on the Intuitive Eating Scale (IES) were correlated with high scores of body awareness, body responsiveness, and body satisfaction (Dittman, Freedman, 2009). Overall, the research suggested that intuitive eaters may be inherently more appreciative of their bodies and have an overall higher level of body image satisfaction than non-intuitive eaters.
Effects of IE on Healthy Living Practices
Due to the IE principle regarding unconditional permission, health professionals have exhibited concern that IE may result in excessive eating, high calorie intake and an unbalanced diet. However, the research is suggesting that intuitive eaters tend to consume less high sugar and high fat foods than restrictive eaters (Cadena-Schlam, Lopez-Guimera, 2015). IE has been associated with a more varied and nutritious diet in addition to the adoption of healthy eating patterns (Cadena-Schlam, Lopez-Guimera, 2015). Also, IE has been associated with a decrease in problematic eating behaviors such as binge-eating and emotional eating (Plateau, Papathomas, 2017). One study found that IE can help even the most extreme problematic eating behaviors that are found in patients with clinically diagnosed eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorder not otherwise specified (Richards, Crowton, Berrett, Smith, Passmore, 2017).
In addition to healthy eating practices, it was also found that IE can have a positive influence on levels of physical activity. One study found that intuitive eaters were more likely to identify with higher levels of physical activity than non-intuitive eaters. Not only this, but intuitive eaters were more likely to engage in physical activity for health issues instead of external aesthetic reasons (thinness ideals) than non-intuitive eaters. This was found to be most likely due to the fact intuitive eaters are more appreciative of their bodies and have less of a desire to change extrinsic factors than non-intuitive eaters (Dittmann, Freedmann, 2009).
Although IE is a holistic approach to health that claims a weight neutral point-of-view, research has shown that IE can also be used by health practitioners who desire patients to lose weight for health purposes. IE has been associated with a lower BMI and it has been seen that intuitive eaters are less likely to engage in weight gain behaviors (Cadena-Schlam, Lopez-Guimera, 2015). One article that studied postpartum women found that women who practiced IE were found to have a greater postpartum BMI decrease and overall weight decrease (Leahy, Berlin, Banks, Bachman, 2017). Another article reviewed the link between IE and weight loss after bariatric surgery. The study demonstrated that the higher degree of IE practiced, the greater relative BMI loss after bariatric surgery. It was found that a 1-point increase in the IES score was associated with a relative BMI loss of ~2.6% (Nogue, Molinari, Avignon, Sultan, 2019). Another study found that practicing IE was correlated with a lower BMI and that IE is a great tool for weight management, even when compared to traditional weight loss methods (Pember, 2015).
In addition to lower BMIs, a study found that IE is significantly correlated with lower levels of blood triglycerides, lower levels of total cholesterol and LDL cholesterol, higher levels of HDL cholesterol, and decreased blood pressure. Due to these factors, IE was found to be significantly correlated to a decreased risk of developing cardiovascular disease (Cadena-Schlam, Lopez-Guimera, 2015).
Effects of IE on Overall Quality of Life
According to the reviewed research, IE can have a highly positive impact on a person’s psychological well-being (Augustus-Horvath, Tylka, 2011). It was seen that IE is related to improved psychological measures and lower levels of depression (Pember, 2015). IE was also seen to be positively associated with positive effect, proactive coping, optimism and social problem solving (Cadena-Schlam, Lopez-Guimera, 2015). According to a study by Richards et al, IE had a positive influence on participants’ relationships, social role, spiritual symptoms, and attitudes. During this review, it was also found that IE can have a positive influence on people with diagnosed eating disorders as well as people exhibiting eating disorder symptoms. In a study by Bush et al, it was found that participants, in regards to disordered eating and eating disorders, in an IE intervention were 3.65 more likely to be asymptomatic than symptomatic as well as 3.65 more likely to be symptomatic than eating disordered than participants from the control group.
In summary, Intuitive Eating is a promising intervention for females 13 years or older when it comes to body image satisfaction, healthy living practices, and overall quality of life. Further primary research is needed to test the validity of IE for health promotion, specifically long-term, randomized control trials with several follow-up periods are needed. Additionally, further research is needed regarding how to integrate IE into health care settings as well as how to introduce IE into the Nutrition Care Process (NCP) used by registered dietitians.
References
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Anglin JC, Borchardt N, Ramos E, Mhoon K. Diet quality of adults using intuitive eating for weight loss – pilot study. Nutr Health. 2013 Jul-Oct;22(3-4):255-64. doi: 10.1177/0260106015601943.
Association for Size Diversity and Health (ASDAH). (2013). The Health at Every Size Approach. Association for Size Diversity and Health Website.https://www.sizediversityandhealth.org/index.asp
Augustus-Horvath CL, Tylka TL. The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood. Journal of Counseling Psychology. 2011;58(1):110-125. doi:10.1037/a0022129.
Bégin, C., Carbonneau, E., Gagnon-Girouard, M.-P., Mongeau, L., Paquette, M.-C., Turcotte, M., & Provencher, V. (2019). Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec. American Journal of Health Promotion, 33(2), 248–258.
Bush HE, Rossy L, Mintz LB, Schopp L. Eat for Life: A Work Site Feasibility Study of a Novel Mindfulness-Based Intuitive Eating Intervention. American Journal of Health Promotion. 2014;28(6):380-388. https://search-ebscohost-com.proxy195.nclive.org/login.aspx?direct=true&db=s3h&AN=96935834&site=ehost-live. Accessed August 23, 2019.
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Camilleri, G. M., Méjean, C., Bellisle, F., Andreeva, V. A., Kesse-Guyot, E., Hercberg, S., & Péneau, S. (2017). Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population-Based NutriNet-Santé Study. Journal of Nutrition, 147(1), 61–69.
Cole RE, Horacek T. Effectiveness of the “My Body Knows When” intuitive-eating pilot program. American Journal of Health Behavior. 2010;34(3):286-297. https://search-ebscohost-com.proxy195.nclive.org/login.aspx?direct=true&db=rzh&AN=105106378&site=ehost-live. Accessed August 28, 2019.
Dittmann KA, & Freedman MR. (2009). Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. Eating Disorders, 17(4), 273–292. https://doi-org.proxy195.nclive.org/10.1080/10640260902991111
Eating Disorder Hope Organization. (2020) Weight & Body Image Disorders: Causes, Symptoms, & Signs. Eating Disorder Hope Website. https://www.eatingdisorderhope.com/information/body-image.
Gast, J., Nielson, A. C., Hunt, A., & Leiker, J. J. (2015). Intuitive Eating: Associations With Physical Activity Motivation and BMI. American Journal of Health Promotion, 29(3), e91–e99.
Harrison, C. (2017, August 31). The Truth About Intentional Weight Loss. Christy Harrison Website. https://christyharrison.com/blog/the-truth-about-intentional-weight-loss.
Harrison, C. (2018, December 18). Why I’m an Anti-Diet Dietitian – and What That Really Means. Christy Harrison Website. https://christyharrison.com/blog/what-does-anti-diet-really-mean.
Harrison, C. Zavodni, K. (2019, January 28). Food Psych #183 How the Wellness Diet Harms Your Health with Katherine Zavodni.Christy Harrison Website. https://christyharrison.com/foodpsych/6/how-the-wellness-diet-harms-your-health-with-katherine-zavodni.
Leahy, K., Berlin, K., Banks, G., & Bachman, J. (2017). The Relationship Between Intuitive Eating and Postpartum Weight Loss. Maternal & Child Health Journal, 21(8), 1591–1597. https://doi-org.proxy195.nclive.org/10.1007/s10995-017-2281- 4
Loughran TJ, Harfel T, Vollmer R, Schumacher J. Effective of Intuitive Eating Intervention Through Text Messaging Among College Students. College Student Journal. 2018;52(2):232-244. https://search-ebscohost- com.proxy195.nclive.org/login.aspx?direct=true&db=s3h&AN=130165003&site=ehost-live. Accessed August 23, 2019.
Nogué, M., Nogué, E., Molinari, N., Macioce, V., Avignon, A., & Sultan, A. (2019). Intuitive eating is associated with weight loss after bariatric surgery in women. American Journal of Clinical Nutrition, 110(1), 10–15. https://doiorg.proxy195.nclive.org/10.1093/ajcn/nqz046
Pember, S. E. (2015). Intuitive Eating Interventions for Both Disordered Eating and Weight Management. Health Education Monograph Series, 32(1), 10–14.
Plateau CR, Petrie TA, Papathomas A. Learning to eat again: Intuitive eating practices among retired female collegiate athletes. Eating Disorders. 2017;25(1):92-98. doi:10.1080/10640266.2016.1219185.
Reel, J. J., Lee, J. J., & Bellows, A. (2016). Integrating exercise and mindfulness for an emerging conceptual framework: The intuitive approach to prevention and health promotion (IAPHP). Eating Disorders, 24(1), 90–97. https://doiorg.proxy195.nclive.org/10.1080/10640266.2015.1118951
Richards PS, Crowton S, Berrett ME, Smith MH, Passmore K. Can patients with eating disorders learn to eat intuitively? A 2-year pilot study. Eating Disorders. 2017;25(2):99-113. doi:10.1080/10640266.2017.1279907.
Schnepper, R., Richard, A., Wilhelm, F. H., & Blechert, J. (2019). A combined mindfulness–prolonged chewing intervention reduces body weight, food craving, and emotional eating. Journal of Consulting and Clinical Psychology, 87(1), 106– 111. https://doi-org.proxy195.nclive.org/10.1037/ccp0000361
Schoenefeld SJ, Webb JB. Self-compassion and intuitive eating in college women: Examining the contributions of distress tolerance and body image acceptance and action. Eating Behaviors. 2013;14(4):493-496. doi:10.1016/j.eatbeh.2013.09.001.
Tribole E, Resch E. (2012). About Us: Meet the Original Intuitive Eating Pros. The Original Intuitive Eating Pros Website. https://www.intuitiveeating.org/about-us/. Accessed August 30, 2019.
Tribole E, Resch E. (2012). 10 Principles of Intuitive Eating. The Original Intuitive Eating Pros Website. https://www.intuitiveeating.org/10-principles-of-intuitive-eating/. Accessed August 30, 2019.
Appendix A. Approvals
CITI Training Certificate
Appendix B. Measurement Instruments
Table 1 – Completed Evidence Analysis Process PICO Question Table
The PICO Format
Specify question for evidence analysis using “PICO”
Specify Population, Intervention, Comparison, and desired Outcome.
| Population (Patient or Problem) | Intervention (cause, treatment or prognostic factor) | Comparison Intervention* (if necessary) | Outcomes | |
| Tips | Describe group (of patients). Balance precision with brevity. | What intervention are you considering? Be specific. | What is the main alternative to compare with the intervention? Be specific. | What could this intervention really affect? Be specific. |
| Identify your possible content | Females ages 13 and older | Practicing Intuitive Eating (IE) | Not practicing Intuitive Eating (IE) | Body image satisfaction Healthy living practices Quality of life |
Question for Evidence Analysis:
What is the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older?
*Comparison is not included in the question in order to fulfill graduate level research question requirements. Question approved by MHS program director.
Table 2 – Completed Evidence Analysis Search Plan and Results
Search Plan and Results Template
| Question: | What is the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older? |
| Date of Literature Review: | June, 2020 |
| Search Terms | Intuitive Eating, influence of Intuitive Eating, effect of Intuitive Eating, influence of Intuitive Eating on females, effect of Intuitive Eating on females, and results of Intuitive Eating |
| Inclusion Criteria: | • Age: 13 years and older • Setting: All • Health Status: All • Nutrition-Related Problem or Condition: All • Study Design: Randomized control trials, meta-analyses, narrative review and other forms of literature reviews, cohort study, cross-over study, descriptive study, cross-sectional study, longitudinal study • Size of Study Groups: >30 participants • Study Drop-Out Rate: <20% • Year Range: January 2009 – Present • Authorship: N/A • Language: English language or articles published in English • Additional Criteria: Full text articles; peer reviewed articles; gender specific data separate for ease of analysis of female participants; all races/ethnicities; contains at least 1 of 3 dependent variables (body image satisfaction, healthy living practices, and quality of life) |
| Exclusion Criteria: | • Age: <13 years old • Setting: None • Health Status: None • Nutrition-Related Problems or Condition: None • Study Design: One-shot case studies, before-after study, cost benefit analysis, diagnostic/validity/reliability study, intention to treat analysis, magnitude of effect, non-controlled trial, non-randomized controlled trial, phenomena, time series, trial, trend study • Size of Study Groups: <30 participants • Study Drop-Out Rate: >20% • Year Range: Published before January 2009 • Authorship: N/A • Additional Criteria: Articles that are not full-text; articles that are not peer-reviewed; gender data aggregate only; no race/ethnicity exclusions; does not contain at least 1 of 3 dependent variables (body image satisfaction, healthy living practices, and quality of life) • Language: Not in English |
| Search Terms: Search Vocabulary | Intuitive Eating, influence of Intuitive Eating, effect of Intuitive Eating, influence of Intuitive Eating on females, effect of Intuitive Eating on females, and results of Intuitive Eating |
| Electronic Databases: | • Database: Health and Human Sciences Research Guide provided by Western Carolina University’s Hunter Library. This database includes but is not limited to Cumulative Index to Nursing and Allied health (CINAHL), Cochrane Library, Medline, Psyctests, Pstcinfo, and Socindex |
| • Hits: 50 hits | |
| Inclusion List: | 1. Effectiveness of Intuitive Eating Intervention Through Text Messaging Among College StudentsEating-Related and Psychological Outcomes of HAES Intervention in Health and Social Services Centers Across the Province of Quebec 2. Intuitive eating is associated with weight loss after bariatric surgery in women. 3. The Relationship Between Intuitive Eating and Postpartum Weight Loss 4. Learning to Eat Again – Intuitive Eating Practices Among Retired Female Collegiate Athletes 5. Eat for Life: A Work Site Feasibility Study of a Novel Mindfulness-Based Intuitive Eating InterventionIntuitive Eating – 6. Associations with Physical Activity Motivation and BMI 7. Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population-Based 8. NutriNet-Sante StudyIntegrating Exercise and Mindfulness for an Emerging Conceptual Framework – The Intuitive Approach to Prevention and Health Promotion 9. Effectiveness of My Body Knows When Intuitive Eating Pilot Program 10. Intuitive Eating Interventions for Both Disordered Eating and Weight Management. 11. The Acceptance Model of Intuitive Eating: A Comparison of Women in Emerging Adulthood, Early Adulthood, and Middle Adulthood 12. Intuitive eating: an emerging approach to eating behavior. 13. A combined mindfulness–prolonged chewing intervention reduces body weight, food craving, and emotional eating 14. Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. 15. Can patients with eating disorders learn to eat intuitively? A 2-year pilot study. 16. Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga |
| List of Articles Included from Handsearch or Other Means | N/A |
| List of Excluded Articles with Reason: | 1. Intuitive Eating Scale: An Examination among Early Adolescents -Exclusion criteria: <13 years old 2. KONCEPCJE WYJAŚNIAJĄCE ZNACZENIE ŚWIADOMOŚCI ODCZUĆ CIELESNYCH W PROFILAKTYCE I TERAPII OTYŁOŚCI. -Exclusion criteria: articles not in English 3. On (Not) Knowing Where Your Food Comes From: Meat, Mothering and Ethical Eating -Irrelevant to research question; does not discuss IE 4. Reduced Taste Sensitivity in Congenital Blindness. -Irrelevant to research question; does not discuss IE 5. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. -Exclusion criteria: <13 years old 6. Coaching to improve mealtime parenting in treating pediatric obesity. -Exclusion criteria: <13 years old 7. Full of Ourselves PLUS’: Lessons learned when implementing an eating disorder and obesity prevention program. -Exclusion critera: <13 years old 8. The role of body mass index, weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models. -Exclusion criteria: <13 years old Pilot 9. Investigation of 2 Nondiet Approaches to Improve Weight and Health -Exclusion criteria: gender data aggregate only 10. The calorie counter-intuitive effect of restaurant menu calorie labelling. -Irrelevant to research question; does not discuss IE 11. Pilot Investigation of 2 Nondiet Approaches to Improve Weight and Health (Duplicate) -Exclusion criteria: gender data aggregate only 12. Illusory Changes in Body Size Modulate Body Satisfaction in a Way That Is Related to Non-Clinical Eating Disorder Psychopathology. -Irrelevant to research question; does not discuss IE 13. Experiences and Perspectives of Polycystic Kidney Disease Patients following a Diet of Reduced Osmoles, Protein, and Acid Precursors Supplemented with Water: A Qualitative Study. -Irrelevant to research question; does not discuss IE 14. 社区骨质疏松患者饮食行为及健康管理策略. -Exclusion criteria: articles not in English 15. The relationship between emotions and food consumption (macronutrient) in a foodservice college setting – a preliminary study. -Irrelevant to research question; does not discuss IE 16. Gut feelings: the emerging biology of gut-brain communication. -Irrelevant to research question; does not discuss IE 17. Mindfulness Based Approaches to Obesity and Weight Loss Maintenance. -Discusses mindful eating not IE 18. Managing European cormorant-fisheries conflicts: problems, practicalities and policy. -Irrelevant to research question; does not discuss IE 19. Theory-based explanation as intervention. -Irrelevant to research question; does not discuss IE 20. Cancer Risk Factor Knowledge Among Young Adults. -Irrelevant to research question; does not discuss IE 21. Dis)connected: An examination of interoception in individuals with suicidality. -Irrelevant to research question; does not discuss IE 22. When commonsense does not make sense. -Irrelevant to research question; does not discuss IE 23. The challenge of monitoring elusive large carnivores: An accurate and cost-effective tool to identify and sex pumas (Puma concolor) from footprints. -Irrelevant to research question; does not discuss IE 24. DISAGREEMENT ABOUT TASTE AND ALETHIC SUBEROGATION. -Irrelevant to research question; does not discuss IE 25. Key to the Genera of Nearctic Syrphidae. -Irrelevant to research question; does not discuss IE 26. Marine mammal culling programs: review of effects on predator and prey populations. -Irrelevant to research question; does not discuss IE 27. Teaching Young Children a Theory of Nutrition: Conceptual Change and the Potential for Increased Vegetable Consumption. -Exclusion criteria: <13 years old Irrelevant to research question; does not discuss IE 28. Phylogenetic analysis reveals positive correlations between adaptations to diverse hosts in a group of pathogen-like herbivores. -Irrelevant to research question; does not discuss IE 29. Disordered eating and psychological distress among adults. -Does not discuss IE as an intervention; does not measure IE 30. Intuitive Eating – A Novel Eating Style? Evidence from a Spanish Sample -Does not discuss IE as an intervention 31. Understanding disordered eating at midlife and late life. -Irrelevant to research topic; does not discuss IE 32. The Intuitive Eating Scale-2: Item Refinement and Psychometric Evaluation with College Women and Men -Does not discuss IE as an intervention 33. Women’s experiences of changes in eating during pregnancy: A qualitative study in Dunedin, New Zealand -Irrelevant to research topic; does not discuss IE 34. Normal Weight Status in Military Service Members was Associated with Intuitive Eating Characteristic Exclusion criteria: -Does not properly split data according to sex |
| Summary of Articles Identified to Review | Number of Included Primary Research Articles Identified from all sources: 13 Number of Included Review Articles Identified from all sources: 3 Total number of included articles: 16 Total number of articles considered but excluded: 34 Total number of articles considered: 50 |
Table 3 – Example of Completed QCC
Academy of Nutrition and Dietetics
Evidence Analysis Library® Worksheet Template and
Quality Criteria Checklist: Primary Research
| Citation | Richards, P. S., Crowton, S., Berrett, M. E., Smith, M. H., & Passmore, K. (2017). Can patients with eating disorders learn to eat intuitively? A 2-year pilot study. Eating Disorders, 25(2), 99–113. https://doi- org.proxy195.nclive.org/10.1080/10640266.2017.1279907 | |||||
| Study Design | 2 year pilot study | |||||
| Class | Class B | |||||
| Quality Rating | + (Positive) – (Negative) x (Neutral) | |||||
| Research Purpose | To evaluate whether it is possible to teach intuitive eating principles to inpatients with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDON). | |||||
| Inclusion Criteria | Adult women with an eating disorder who were admitted to the in-patient treatment unit at the Center for Change during 2008-2009 | |||||
| Exclusion Criteria | Adult women without an eating disorder who were not admitted to the in-patient treatment unit at the Center for Change during 2008-2009 | |||||
| Description of Study Protocol | Recruitment: Patient admitted for in-patient treatment at the Center for Change Design: 2 year pilot study Blinding used (if applicable): N/A Intervention (if applicable): CFC’s dietary program includes a stepwise structured program that progresses from more dietary structure and intervention to less structure and intervention as patient exhibit readiness for management of dietary choices. Consultations occur every week to determine a patient’s readiness to implement this stepwise approach. Patients begin to learn about the 10 principles of Intuitive Eating soon after being admitted for treatment, but they do not receive permission to begin practicing Intuitive Eating until they exhibit a clear readiness to do so. All patient in the study initially participated in a menu where they were expected to eat 100% of their plated portions. Eventually, they transitioned to family style dining where they were able to choose menu items within guidelines and were expected to eat 100%. Only after a period of time where patients were able to demonstrate ability to plate and eat appropriately, accurately assess hunger-fullness, and resist eating disorder urges were they advanced to Intuitive Eating. Once they received approval to begin Intuitive Eating, patients were allowed to choose menu items in accordance with Intuitive Eating principles. Patients received education on the 10 Intuitive Eating principles. RDs met individually each week with the patients and discussed the Intuitive Eating principles. Weekly nutrition classes were also held where the principles were discussed and reviewed. Patients were also given opportunities to practice the principles in weekly cooking classes and during schedule meal outings. Statistical Analysis: T-tests, repeated measures analysis of variance, Cohen’s d, and Pearson correlations. | |||||
| Data Collection Summary | Timing of Measurements: 8-week program; assessments were conducted at the beginning of inpatient enrollment, transfer from inpatient to residential, and transfer from residential to discharge. Dependent Variables: eating disorder symptoms, depression, anxiety, social conflict, body image, spiritual well-being, ability to eat intuitively Independent Variables: Intuitive Eating lessons Control Variables: N/A | |||||
| Description of Actual Data Sample | Initial: 120 (0 Males 120 Females) Attrition (final N): 120 Age: M = 21.2 years old; range = 13 to 55 years old Ethnicity: 90% Caucasian; 1% African American, Asian, Hispanic Other relevant demographics: 39% AN, 30% BN, 31 EDNOS Anthropometrics: N/A Location: Center for Change | |||||
| Summary of Results | Key Findings: Collectively, patients’ scores on the outcome measures all improved significantly between the time of admission and the time of discharge. Changes on 3 of the scales (EAT, BSQ, OQ) were large and clinically significant. At the time of discharge, patients reported clinically significant improvements in eating disorder, psychological, relationship, social role, and spiritual symptoms and attitudes. Patients Intuitive Eating scorers increase significantly between the time they were admitted to the time they were discharged. Dietitians perceived that the patients’ eating behaviors become healthier during the course of treatment on all five of the behavioral dimensions they assessed (eating flexibility, comfortable eating, appropriate eating, using food to cope, obsessing about food). Other Findings: All patients with EDs were able to enhance their Intuitive Eating skills. | |||||
| Author Conclusion | The study provided preliminary evidence that Intuitive Eating behaviors and attitudes can be taught and learned in an inpatient and residential eating disorder | |||||
| treatment program. The IE principles can be effectively taught in a highly structured treatment setting. | ||||||
| Reviewer Comments | Great layout, good statistical analysis, great illustration and explanation of findings, good section of further study ideas. | |||||
| Funding Source | Center for Change | |||||
| Symbols Used | Explanation | |||||
| + | Positive – Indicates that the report has clearly addressed issues of inclusion/exclusion, bias, generalizability, and data collection and analysis | |||||
| — | Negative – Indicates that these issues have not been adequately addressed. | |||||
| x | Neutral – indicates that the report is neither exceptionally strong nor exceptionally week | |||||
| Relevance Questions | ||||||
| 1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (NA for some Epi studies) | 1 | Yes | ||||
| 2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | 2 | Yes | ||||
| 3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dietetics practice? | 3 | Yes | ||||
| 4. Is the intervention or procedure feasible? (NA for some epidemiological studies) | 4 | Yes | ||||
| If the answers to all of the above relevance questions are “Yes,” the report is eligible for designation with a plus (+) on the Evidence Quality Worksheet, depending on answers to the following validity questions. | ||||||
| Validity Questions | ||||||
| Was the research question clearly stated? Was the specific intervention(s) or procedure (independent variable(s)) identified? Was the outcome(s) (dependent variable(s)) clearly indicated? Were the target population and setting specified? | 1 | Yes | ||||
| 1.1 | Yes | |||||
| 1.2 | Yes | |||||
| 1.3 | Yes | |||||
| Was the selection of study subjects/patients free from bias? Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Were criteria applied equally to all study groups? Were health, demographics, and other characteristics of subjects described? Were the subjects/patients a representative sample of the relevant population? | 2 | Yes | ||||
| 2.1 | Yes | |||||
| 2.2 | Yes | |||||
| 2.3 | Yes | |||||
| 2.4 | Yes | |||||
| Were study groups comparable? Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | 3 | Yes | ||||
| 3.1 | Yes | |||||
| 3.2 | Yes | |||||
| 3.3. Were concurrent controls used? (Concurrent preferred over historical controls.) 3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? 3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some crosssectional studies.) 3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., “gold standard”)? | 3.3 | N/A | ||||
| 3.4 | Yes | |||||
| 3.5 | N/A | |||||
| 3.6 | N/A | |||||
| 4. | Was method of handling withdrawals described? 4.1. Were follow up methods described and the same for all groups? 4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) 4.3. Were all enrolled subjects/patients (in the original sample) accounted for? 4.4. Were reasons for withdrawals similar across groups 4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? | 4 | Yes | |||
| 4.1 | N/A | |||||
| 4.2 | Yes | |||||
| 4.3 | Yes | |||||
| 4.4 | Yes | |||||
| 4.5 | Yes | |||||
| 5. | Was blinding used to prevent introduction of bias? 5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? 5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) 5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? 5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? 5.5. In diagnostic study, were test results blinded to patient history and other test results? | 5 | No | |||
| 5.1 | No | |||||
| 5.2 | No | |||||
| 5.3 | No | |||||
| 5.4 | N/A | |||||
| 5.5 | N/A | |||||
| 6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were intervening factors described? 6.1. In RCT or other intervention trial, were protocols described for all regimens studied? 6.2. In observational study, were interventions, study settings, and clinicians/provider described? 6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? 6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? 6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? 6.6. Were extra or unplanned treatments described? 6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? 6.8. In diagnostic study, were details of test administration and replication sufficient? | 6 | Yes | |||
| 6.1 | N/A | |||||
| 6.2 | N/A | |||||
| 6.3 | Yes | |||||
| 6.4 | Yes | |||||
| 6.5 | Yes | |||||
| 6.6 | Yes | |||||
| 6.7 | Yes | |||||
| 6.8 | N/A | |||||
| 7. | Were outcomes clearly defined and the measurements valid and reliable? 7.1. Were primary and secondary endpoints described and relevant to the question? 7.2. Were nutrition measures appropriate to question and outcomes of concern? 7.3. Was the period of follow-up long enough for important outcome(s) to occur? | 7 | Yes | |||
| 7.1 | Yes | |||||
| 7.2 | Yes | |||||
| 7.3 | Yes | |||||
| 7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? 7.5. Was the measurement of effect at an appropriate level of precision? 7.6. Were other factors accounted for (measured) that could affect outcomes? 7.7. Were the measurements conducted consistently across groups? | 7.4 | Yes | ||||
| 7.5 | Yes | |||||
| 7.6 | Yes | |||||
| 7.7 | Yes | |||||
| Was the statistical analysis appropriate for the study design and type of outcome indicators? Were statistical analyses adequately described the results reported appropriately? Were correct statistical tests used and assumptions of test not violated? Were statistics reported with levels of significance and/or confidence intervals? Was “intent to treat” analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Was clinical significance as well as statistical significance reported? If negative findings, was a power calculation reported to address type 2 error? | 8 | Yes | ||||
| 8.1 | Yes | |||||
| 8.2 | Yes | |||||
| 8.3 | Yes | |||||
| 8.4 | Yes | |||||
| 8.5 | Yes | |||||
| 8.6 | Yes | |||||
| 8.7 | N/A | |||||
| Are conclusions supported by results with biases and limitations taken into consideration? Is there a discussion of findings? Are biases and study limitations identified and discussed? | 9 | Yes | ||||
| 9.1 | Yes | |||||
| 9.2 | Yes | |||||
| Is bias due to study’s funding or sponsorship unlikely? Were sources of funding and investigators’ affiliations described? Was there no apparent conflict of interest? | 10 | Yes | ||||
| 10.1 | Yes | |||||
| 10.2 | Yes | |||||
| MINUS/NEGATIVE (-) If most (six or more) of the answers to the above validity questions are “No,” the report should be designated with a minus (-) symbol on the Evidence Worksheet. | ||||||
| NEUTRAL () If the answers to validity criteria questions 2, 3, 6, and 7 do not indicate that the study is exceptionally strong, the report should be designated with a neutral () symbol on the Evidence Worksheet. | ||||||
| PLUS/POSITIVE (+) If most of the answers to the above validity questions are “Yes” (including criteria 2, 3, 6, 7 and at least one additional “Yes”), the report should be designated with a plus symbol (+) on the Evidence Worksheet. | ||||||
Table 4 – Completed Evidence Analysis Overview Table
| Evidence Analysis Overview Table | ||||
| Author, Year Study Design Class Rating | Study Type/Purpose | Study Population(s) | Intervention | Outcomes |
| Augustus-Horvath, C. L., & Tylka, T. L. 2011 Correlational & Cross Sectional Study Positive | Primary Research To examine the ability of the body acceptance model of intuitive eating to be applied to women at various stages of life including emerging adulthood, early adulthood, and middle adult women and that BMI can be meaningfully integrated into its structure. | Woman 18-65 years old | After providing consent, the women participants were invited to take several surveys online. These surveys included the Social Provisions Scale, the Body Acceptance by Others Scale, the Body Surveillance subscale of the Objectified Body Consciousness Scale, the Body Appreciation Scale, and the Intuitive Eating Scale. Participants were also asked questions regarding age and other demographics. | Resistance to adopt an observer’s perspective of the body was uniquely associated with body appreciation and intuitive eating; women were more likely to appreciate their bodies and eat according to their hunger and satiety cues when they did not focus on how their body appeared to others. Body appreciation was uniquely and positively related to intuitive eating. BMI directly predicted intutive eating for early adult and middle adult women but not emerging adult women. The fact that body acceptance by others accounted for the relationship between BMI and body appreciation highlights the necessity of promoting body acceptance within media and interpersonal interaactions. Intuitive Eating appears to be positively associated with emerging adult’s psychological well-being but the extent to which intuitive eating is a reflection of early, middle, and late adults psychological and physiological functioning and not simply a reflection of how young women process calories is not understood. On the basis of the present study’s findings, IE seems to be associated positively with two adaptive variables – body appreciation and resistance to adopt an observer’s perspecive of the body – to a similar degree as emerging adult women. |
| Bégin, C., Carbonneau, E., Gagnon-Girouard, M.-P., Mongeau, L., Paquette, M.-C., Turcotte, M., & Provencher, V 2019 Quasi-experimental design Positive | Primary research To report the outcomes of a HAES intervention (which emphasizes IE principles) in a real-world setting on eating behaviors (restraint, intuitive eating, disinhibition, hunger cues, and obsessive-compulsive eating), psychological factors (body esteem, self-esteem, and depression) and BMI. | Weight preoccupied adult women who were seeking help for weight issues at local HSSC in the province of Quebec. | All participants were evaluated at the baseline, postintervention, and 1 year after the intervention. The questionnaires used in the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale, the Intuitive Eating Scale (IES), the Eating Obsessions and Compulsions Scale, the Body Esteem Scale, the Rosenberg Self-Esteem Scale, the Beck Depression Inventory, and the Hamilton Psychiatric Rating Scale for Depression. Participants were split into an intervention group and a waitlist group (control group). The waitlist group did not receive any interventions but still evaluated by the questionnaires at the 3 different stages. The intervention group experienced the program which was conducted in small groups of 10 to 15 women for 14 weekly sessions (13 3 hour evening sessions and 1 six hour intensive day). A RD and a social worker or psychologist provided the intervention. A weekly food diary and group discussions were used to facilitate the recognition of internal cues of hunger and satiety and the identification of external influences on eating behaviors and food intake. At the end of the intervention, the women were asked how they want to pursue their health from that point on and in the long-term. | Key Findings: Intervention group showed a significant increase in flexible restraint, intuitive eating, appearance-related, weight-related and self esteem. Intervention group showed a significant decrease in obsessive-compulsive eating and eating obsession. Changes in intuitive eating and appearance-related body esteem are associated. All improvements observed at short term, except for flexible restraint, were also maintained in the long term. At the 1 year mark, the women from the intervention group were still showing more positive outcomes than the comparison group and maintained more of the positive changes long term. Other Findings: The HAES intervention generated a significant reduction is disinhibition and suspectibility to hunger and that these behaviors were significantly lower in the HAES group. The HAES intervention induced a shift away from emotional and external eating to more intuitive eating behaviors. IE was shown to improve diet quality and reduce short-term BMI, suggesting that IE behaviors can promote a better relationship with food. |
| Bush, H. E., Rossy, L., Mintz, L. B., & Schopp, L. 2015 Prospective Cohort Study Positive | Primary research To examine the efficacy of a novel intervention (Intuitive Eating combined with mindful eating) for problematic eating behaviors and body dissatisfication | Status as an employee or partner/spouse of an employee at a local university. | There were two groups: 1) Intervention group, which underwent the 10 week program. 2) Waitlist group (control group), which only answered the pre- and post-intervention questionnaires, without receiving the intervention. Prior to the program, the intervention group were administered the pre-intervention questionnaires during orientation. The Eat for Life intervention was conducted as a group class, which met weekly (for 10 weeks) for 1-1.5 hours. Class members received Intuitive Eating, Breaking Free from Emotional Eating, the Eat for Life curriculum and a CD of recorded mindfulness meditations. Each of the classes consisted of a formal mindfulness practice, a group discussion about the prior weeks homework, and a lecure about the weekly theme and principle of intuitive eating. Participants were given weekly homework assignments. On the last day of the 10-week program, postquestionnaires were administered. The questionnaires included the Intuitive Eating Scale (IES), the Body Appreciation Scale (BAS), the Five-Facet Mindfulness Questionnaire (FFMQ), the Questionnaire for Eating Disorder Diagnosis (Q-EDD), and an author constructed questionnaire aimed to assess demographics, dieting history, physical activity, and weight | Key Findings: The One-way ANCOVAs revealed a significant difference between the intervention group and the waitlist group. There was a significant difference between groups on body appreciation scores. At post 10 weeks, average scores on body appreciation, intuitive eating, and mindfulness were significantly higher in the intervention group than the waitlist comparison group. There was a significant difference between the levels of intuitive eating pre- and postintervention, 3 of the 4 IE subscales were significantly increased. Participants in the interveniton were 3.65 times more likely too be asymptomatic than symptomatic (and 3.65 times more likely to be symptomatic than eating disordered) than those in the waitlist control group. Other Findings: The mindfulness approaches had a positive influence on body appreciation and level of intuitive eating. |
| Cadena-Schlam, L., & López-Guimerà, G. 2015 Narrative Review / Consensus Report Neutral | Secondary research To examine the concept of intuitive eating, as well as the existing evidence that upholds this emerging approach. Also, to discuss the implication of shifting the focus of dietetic intervention into a health-centered paradigm | Inclusion criteria not provided | Review / summary of literature regarding topic of interest. | IE is inversely related to, although distinct from, ED symptomatology, but it is also positively related to several parameters of physical and psychological well-being. IE components are inversely related to various risk factors of ED including the internalization of the thin ideal, pressure to lose weight, body dissatisfaction, body surveillance, body shame, lack of interoceptive awareness, emotional eating, and negative effect. Intuitive eaters are 40% less likely to indulge in extreme weight control behaviors and less likely to experience chronic binge eating and dieting. Research has associated IE with higher levels of body appreciation, self-esteem, and feelings of satisfaction. These research findings suggest that intuitive eaters are more likely to be satisfied with their own body and feel less pressure to achieve thinness ideals. Eating for physical rather than emotional hunger and relying on hunger and satiety, have been positively associated with certain adaptative psychological feastures such as positive affect, proactive coping, optimism, and social problem solving. Other Findings: IE is significantly correlated with lower levels of blood TG, lower levels of TC and LDL cholesterol, higher level of HDL, decreased BP and therefore, diminished risk for cardiovascular disease. IE has also been associated with a lower BMI in numerous cross sectional studies. It appears that intuitive eaters may be less likely to engage in behaviors that may lead to weight gain than those who follow external rules. Overall, there is concern about whether or not intuitive eating (particularly the principle regarding unconditional permission to eat) could result in an excessive and unbalanced diet. However, research has shown that intuitive eaters do not tend to consume more high-fat/sugar foods than restrictive eaters. In fact, IE has been associated with a more varied and nutritious diet as well as the adoption of healthy eating habits. Training in IE has a relatively longterm lasting effect on improving physical and psychological wellness in comparison with conventional weight loss interventions. IE not only reduces the risk of developing disordered eating by encouraging adaptative strategies but also reduces the onset of chronic diet related disease by improving physical and psychological outcomes. |
| Camilleri, G. M., Méjean, C., Bellisle, F., Andreeva, V. A., Kesse-Guyot, E., Hercberg, S., & Péneau, S. 2017 Cross-sectional study Positive | Primary Research To examine the relationship between IE and food intake in a large sample from the general adult population | Participants were volunteers enrolled in a different study (NutriNet Sante study), which was an ongoing cohort launched in France in May 2009 with a follow up of 10 years | Participants completed a baseline set of self-administered, web based questionnaires assessing dietary intakes, physical activity, anthropometrics, lifestyle, socioeconomic conditions, and health status. As part of the follow-up, participants completed the same set of questionnaires every year. IE was assessed by using the French version of the Intuitive Eating Scale (IES). At inclusion and 1 time per year and thereafter, participants were asked to complete 3 nonconsecutive 24 hour dietary records, randomly assigned over a 2 week period (2 weekdays and 1 weekend day). Participants were invited to complete an optional questionnaire on meal time patterns and snacking habits. At inclusion and each year thereafter, participants provided data on sociodemographics and lifestyle characteristics including sex, age, and more. Physical activity was assessed using the International Physical Activity Questionnaire. | Physical reasons and cues scores were inversely and linearly associated with energy intake in women. The permission score was positively and linearly associated with energy intake in women. Women with higher physical reasons scores had lower intakes of dairy products and meat, fish and eggs, and were more often consumers of fruit. Participants with higher permission scores had lower intakes of fruit and vegetables as well as whole grain products. To a lesser extent, women with higher permission scores had higher consumption of sweet and fatty products, whereas the percentages of consumers of fast food, pizza, and appetizers increased across quartiles of permission scores. |
| Cole RE, & Horacek T. 2010 Randomized prospective study Neutral | Primary research To evaluate the effectiveness of the “My Body Knows When” intuitive eating (IE) program tailored to assist Fort Drum military spouses in rejecting the diet mentality | Military spouses from Fort Drum; 18 years or older and no specific dietary restrictions. | Participants completed a baseline pretest, end of study posttest and a 6 month follow up data collection. This included a survey packet that assessed quality of life issues, medical history, eating and physical activity attitudes / behaviors (dieting mentality), self-efficacy, self image, and social support; anthropometric assessment including BMI, height, weightt, and arm circumference; and dietary intakes in order to calculate a Healty Eating Index (HEI) score for each participant. The intervention group attended the “My Body Knows When” program offered one hour each week for 10 weeks. The IE principles were broken down into 10 weekly sessions. Each session involved education on each IE principle, group discussions, and/or activities associated with the previous week’s progress and current topic and homework assignment for the next week. | The 10 week program appeared to be affective at making attitude / behavior changes in rejecting the dieting mentality, as well as reducing emotional eating and improving self worth although behavior regression was identified. Participants were able to improve their ability to listen to physical hunger/fullness signals while decreasing caloric consumption for nonphysical reasons and breaking the connection between emotion and food. The results suggest that IE is positively related to increased body signal awareness (physical eating), improved emotional well-being (with reduced emotional eating), improved self-worth with reduced negative self-talk and less preoccupation with food choice although no association was found with BMI. |
| Dittmann KA, & Freedman MR. 2009 Descriptive Study Positive | Primary research To determine levels of body awareness (BA), body responsiveness (BR), intuitive eating (IE), and overall body satisfaction (BS) as indicators of healthy body image and eating attitudes in a group of women who practice yoga. | Women 18 years and older who regularly practiced yoga (defined by attending a class or practicing at home at least once a week). | Volunteers were recruited from yoga studios and fitness centers in a West Coast metropolitan area. Study 1: Likert-type and multiple choice questionnaires were used as well as qualitative commentary was collected to examine body awareness, intuitive eating, spiritual beliefs, and motivations of women practicing yoga. Study 2: After completing the 1st survey, participants were asked to participate in a 15 minute recorded phone interview to examine how yoga practice impacts their body satisfaction, eating attitudes and perceived changes in spirituality since beginning yoga practice. | Participants had high scores of body awareness, body responsiveness, intuitive eating, body satisfaction, and spiritual readiness. Several modest to moderate correlations among these variables, the stronger being positive association between intuitive eating and body satisfaction as well as body responsiveness and body satisfaction. A higher level of body responsiveness was moderately associated with a greater body awareness and intuitive eating. A lower BMI was associated with higher scores in body responsiveness, intuitive eating, and body satisfaction but not body awareness. Intuitive eating was more highly correlated to body responsiveness than body awareness. Body responsiveness, but not body awareness, mediated the relationship between self objectification and disordered eating. Intuitive eating was found to be negatively correlated with disordered eating attitudes. Other Findings: As a group, women yoga practitioners had high scores on measures of body awareness, body responsiveness, intuitive eating, and body satisfaction. Women in this study attriubuted improvement in body image, body satisfaction, and eating attitudes, in part, to yoga paractice and associated spirituality. |
| Gast, J., Nielson, A. C., Hunt, A., & Leiker, J. J. 2015 Cross-sectional study Positive | Primary research To determine whether university women who demonstrated internal motivation related to eating behavior may also be internally motivated to participate in regular physical activity (PA) and have a lower BMI when controlling for age | Female undergraduate students at a large public university in the western United States | Participants were given the option to complete specific questionnaires in class or at home and return them at the following scheduled class time. The two standardized measures were the Intuitive Eating Scale (IES) and the Behavioral Regulation in Exercise Questionnaire (BREQ). Results were collected and statistically analyzed. | Key Findings: 34.5% of participants were considered low intuitive eaters, 29% were considered medium intuitive eaters, 36.5% were considered high intuitive eaters. There was a significant negative correlation between external regulation and the antidieting subscale. Negative correlations were statistically significant between introjected regulation and extrinsic eating, antidieting, and self care subscales. A significant positive correlation was found between identified regulation and self care subscale. Positive significant correlations were also found between intrinsic regulation and the antidieting and self care subscales. Correlation analysis revealed that individuals who were internally motivated to engage in physical activity were also less likely to engage in restrictive eating behaviors and more likely to practice self care. The IES total score was inversely related to external regulation and introjected regulation in the continuous models, which indicates that being an intuitive eater made one less likely to be motvated to engage in physical activity because of external factors. Intuitive eaters were more likely to identify with the highest level of physical activity motivation. Other Findings: Intuitive eaters may be inherently more appreciative of their bodies and the pleasure that they get from being physical active than non intuitive eaters. This might be because non intuitive eaters focus more on completing their physical activity rather than enjoying it for the experience, thus hindering their intrinsic motivation. The study found that intuitive eaters are less likely to be motivated to be physically active for reasons of guilt or shame. BMI decreased as IES score increased, moderately significant. |
| Leahy, K., Berlin, K., Banks, G., & Bachman, J. 2017 Cross-sectional study Positive | Primary research To examine the relationship between IE and postpartum weight loss | Women ages 18- 36 years old, 12- 18 months postpartum. English speaking. Could not be pregnant at the time of completing the questionnaires. | Participants were asked to complete a series of questionnaires. The first part asked questions regarding demographics, anthropometrics, and infant feeding history. Questions regarding breastfeeding were obtained from a National Immunization Survey. Participants also completed the Intuitive Eating Scale (IES). | Key Findings: Following a more IE style of eating was associated with greater postpartum BMI and weight decreases. The association remained even when controlling for potential confounding variables such as breastfeeding durations, exercise, pre-pregnancy BMI, and pregnancy BMI changes. Following an IE approach to eating may be beneficial not only for weight loss but also for improvements in mental health within a vulernable population. |
| LOUGHRAN, T. J., HARFEL, T., VOLLMER, R., & SCHUMACHER, J. 2018 Experimental study Positive | Primary research To examine the effects of an intuitive eating (IE) text messaging intervention on the IE habits, perceived stress, and perceived self-efficacy of college students in comparison to an electronically emailed handout with the same information | 1) A current university student 2) between 18 to 24 years of age 3) possess a personal smartphone with the ability to receive standard text messages 4) live within a 15 minute walk to campus | Participants completed a pre-intervention survey online which assessed IE practice (IES), perceived stress (Perceived Stress Scale, and self-efficacy (General Self-Efficacy Scale and Eating Habits Confidencce Survey). Participants were randomly divided into a control and interveniton group. The intervention group received 5 weeks of intervention with weekly IE texts, and the control received the same IE informaiton in one emailed handout. Following the intervention, all participants completed the post-intervention survey with the same measures. | Key Findings: There was a significant increase in total IES scores, the IES subscale Reliance on Hunger and Satiety Cue scores significantly increased in the intervention group. The study found that an IE texting intervention significantly increase total intuitive eating habits within a college student population. The results suggest that the implementation of IE texting programs on college campuses can increase student healthy eating habits, which may reduce obesity and promote healthy lifestyles. |
| Nogué, M., Nogué, E., Molinari, N., Macioce, V., Avignon, A., & Sultan, A. 2019 Cross-sectional study Positive | Primary research To evaluate the link between IE and weight loss after bariatric surgery | Limited to participants who claim to be women and had undergone bariatric surgery | After completing the initially recruitment questionnaire and successfully qualifying for the study, participants completed various self administered questionnaires. These included a questionnaire regarding certain anthropometrics and the French validated version of the Intuitive Eating Scale (IES). Results were collected and statistically analyzed. . | Key Findings: The study showed that the more IE behavior, particularly eating for physical more than emotional reasons, was related to a greater relative BMI loss after bariatric surgery. It was found that a 1-point increase in the IES score was associated with a relative BMI loss of ~2.6% after adjusting for elapsed time since surgery and type of surgery. Other Findings: Behavioral eating should perhaps be taken into consideration to improve the long term bariatric surgery effect on weight loss. |
| Pember, S. E. 2015 Narrative Review / Consensus Report Neutral | Secondary research To investigate the potential for adaptive and IE approaches to successfully treat or prevent obesity and disordered eating in women | Inclusion criteria not provided | Review / summary of literature regarding topic of interest. | Key Findings: As traditional methods for treating both obesity and disordered eating fail to meet with consistent success, questions have been raised among health researchers as to whether the cognitive-behavioral approach towards changing maladaptive eating should be replaced with a positive, adaptative approach. Although dieting has become normalized in the culture of the American female, dieting rarely works in the long term treatment of obesity. Dieting as a form of weight control has been found to be inversely related to IE scores. These findings support the potential use of an Intuitive Eating program as a combined treatment for obesity and eating disordered women needing to break away from the restrictive diet mentality. The Academy of Nutrition and Dietetics recently asserted the need for a total diet approach to public health nutrition messages, marketing, and education as a counter to the dichotomous thinking and nutrient focused information that may lead to overwhelming confusion in the general population and more harmfully, a guilt ridden good or bad food mentality. Other Findings: IE has been mildly correlated with a diversity of diet, considered an indicator of positive nutrition supporting the notion that eating according to physical hunger cues in a non-dieting manner does not appear to compromise the overall nutritional quality of food intake. Although IE has correlated with lower BMIs, it has not been an effective strategy for actually losing weight when compared to traditional weight loss interventions. However, there is extensive research supporting its use as a weight management technique. IE is also related to improved psychological measures, such as higher self-esteem, improved body image, and lower levels of depression. |
| Plateau CR, Petrie TA, Papathomas A 2017 Cross-sectional study Positive | Primary research To collect and analyze information about current eating practices and coping strategies among retired female athletes | Female athletes that had participated in a 6-year follow-up to a specific NCAA funded study. Athletes retired from collegiate sports for 2-3 years or more. | Athletes were contacted via email, phone or social media to solicit their participation in a larger NCAA grant funded study on the physical and psychological health and well being of retired female collegiate athletes. | Key Findings: The majority of the sample reported that the frequency and/or quantity of their post-retiremenet eating behaviors had changed. The alleviation of constraints upon retiring was associated with reduced anxiety and greater freedom in eating. A few athletes did not feel as liberated as the majority and reported an increase in concerns about food’s impact on their weight and shape. Many of the athletes reported that the changes did not occur automatically and that there was a process of bodily retraining and recalibration that was challenging and required an extended period for adjustment. A small number of athletes states the retraining helped them to move away from disordered eating practices such as binge eating. Other Findings: After retirement, many of the athletes found that food was no longer to be feared or avoided, but rather enjoyed and appreciated. The findings of this study did not suggest an increase in disordered eating practices among retired collegiate athletes, unlike the results from previous studies. |
| Reel, J. J., Lee, J. J., & Bellows, A. 2016 Narrative Review / Consensus Report Neutral | Secondary Research To examine the need for health prevention programs, such as the Intuitive Approach to Prevention and Health Promotion (IAPHP) that address the spectrum of disordered eating and exercise behaviors | Inclusion criteria not provided | Review / summary of literature regarding topic of interest | Body image, which predicts increased risk for eating disorders and obesity, has been intricately linked to one’s relationship with food and exercise. Like disordered eating, dysfunctional exercise patterns represent a spectrum of behaviors from a lack of physical activity to excessive compulsive exercise behaviors. Current prevention approaches tend to be segregated by disease outcomes without regard for eating and exercise behaviors. Eating disorder prevention programs could also benefit from devoting more time toward promoting a healthy relationship with exercise. Moving toward a positive relationship with food and exercise is necessary to achieve optimal health and balance. Therefore, IE and exercise teaching components should be infused into eating disorder prevention programs. Although IE has been considered an “advanced” concept in clinical settings and takes months or even years to fully learn, this model represents the philosophy with food that preventon programs should espouse. An IE eating philosophy of listening to the body and applying unconditional permission should also be applied to exercise. Having a dysfunctional mindset surrounding exercise that mirrors other types of addictions is common among eating disordered clients. Dysfunctional exercise is estimated to be present in more than 3% of the general population, 25 to 65% of athletes across competitive levels of sports and 33% to 100% of eating disorder clients. |
| Richards, P. S., Crowton, S., Berrett, M. E., Smith, M. H., & Passmore, K. 2017 2 year pilot study Positive | Primary research To evaluate whether it is possible to teach intuitive eating principles to inpatients with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). | Adult women with an eating disorder who were admitted to the in-patient treatment unit at the Center for Change during 2008-2009 | CFC’s dietary program includes a stepwise structured program that progresses from more dietary structure and intervention to less structure and intervention as patients exhibit readiness for management of dietary choices. Consultations occur every week to determine a patient’s readiness to implement this stepwise approach. Patients begin to learn about the 10 principles of Intuitive Eating soon after being admitted for treatment, but they do not receive permission to begin practicing intuitive eating until they exhibit a clear readiness to do so. All patients in the study intitially participated in a menu where they were expected to eat 100% of their plated portions. Eventually, they transitioned to family style dining where they were able to choose menu items within guidelines and were expected to eat 100%. Only after a period of time, where patients were able to demonstrate ability to plate and eat appropriately, accurately assess hunger-fullness, and resist eating disorder urges were they advanced to intuitive eating. Once they received approval to begin intuitive eating, patients were allowed to choose menu items in accordance with intuitive eating principles. Patients received education on the 10 intuitive eating principles. RDs met individually each week with the patients and discussed the intuitive eating principles. Weekly nutrition classes were also held where the principles were discussed and reviewed. Patients were also given opporunities to practice the principles in weekly cooking classes and during schedule meal outings. | Key Findings: Collectively, patients’ scores on the outcome measures all improved significantly between the time of admission and the time of discharge. Changes on 3 of the scales (EAT, BSQ, OQ) were large and clinically significant. At the time of discharge, patients reported clinically significant improvements in eating disorder, psychological, relationship, social role, and spiritual symptoms and attitudes. Patients intuitive eating scores increased significantly between the time they were admitted, to the time they were discharged. Dietitians perceived that the patients’ eating behaviors became healthier during the course of treatment on all five of the behavioral dimensions they assessed (eating flexibilty, comfortable eating, appropriate eating, using food to cope, obsessing about food). Other Findings: All patients with EDs were able to enhance their intuitive eating skills. |
| Schnepper, R., Richard, A., Wilhelm, F. H., & Blechert, J. 2019 RCT Positive | Primary research To determine the effectiveness of mindfulness interventions on long term weight loss and participants eating habits | Individuals motivated to lose weight and/or improve eating habits | Baseline: demographic characteristicsc and questionnaire scores on craving and emotional, eternal, and intuitive eating were assessed. Group Session 1 (week 1): covered information on mindful eating and included a body scan; 10-20 minute PCh session, various health foods were eaten while participants were instructed to eat with their eyes closed and to swallow only completely liquified foods. Participants received written materials and a MbT diary for all main meals at home and were instructed to regularly practice MbT and eating exercises at home. Individual Session 1 (week 3): included a 20 minute body scan and psychoeducation on stress and emotional eating; problematic eating behaviors (such as overeating) were discussed; solutions for problems with practicing MbT and PCh in daily life were discussed; mindfullness exercises were practiced; reminder text messages were sent in the following weeks. Group Session 2 (week 8): session started with PCh; participants shared experiences and satisfaction with the completed program; completed posttest. Each group filled out a follow-up questionnaire 4 weeks after the interventions. | Key Findings: IG: BMI significantly decreased, cravings significantly decreased, emotional eating significantly decreased, level of intuitive eating significantly increased. WG: No significant changes were found. Other Findings: Intervention decreased BMI, which was maintained at the 4-week follow up; reduced emotional eating; reduced food cravings; and increased level of intuitive eating; |
Table 5 – Excluded Articles & Reasons for Exclusion
| Reel, J. J., Ashcraft, C., Lacy, R., Bucciere, R. A., Soohoo, S., Richards, D., & Mihalopoulos, N. (2010). “Full of Ourselves PLUS”: Lessons learned when implementing an eating disorder and obesity prevention program. Journal of Sport Psychology in Action, 1(3), 109–117. https://doiorg.proxy195.nclive.org/10.1080/21520704.2010.534545 | Participants <13 years old |
| Wynne, C., Comiskey, C., & McGilloway, S. (2016). The role of body mass index, weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models. Psychology & Health, 31(2), 147–165. https://doiorg.proxy195.nclive.org/10.1080/08870446.2015.1082560 | Participants <13 years old |
| Webber, K. H., Mellin, L., Mayes, L., Mitrovic, I., & Saulnier, M. (2017). Pilot Investigation of 2 Nondiet Approaches to Improve Weight and Health. Alternative Therapies in Health & Medicine, 23(7), 122–126. | Gender data aggregate only |
| DUPLICATE: Webber, K. H., Mellin, L., Mayes, L., Mitrovic, I., & Saulnier, M. (2017). Pilot Investigation of 2 Nondiet Approaches to Improve Weight and Health. Alternative Therapies in Health & Medicine, 23(7), 122–126. | Gender data aggregate only; duplicate |
| McGeown, L. (2019). The calorie counter-intuitive effect of restaurant menu calorie labelling. Canadian Journal of Public Health, 110(6), 816–820. https://doi-org.proxy195.nclive.org/10.17269/s41997-019-001837 | Irrelevant to research question; does not discuss IE |
| Preston, C., & Ehrsson, H. H. (2014). Illusory Changes in Body Size Modulate Body Satisfaction in a Way That Is Related to Non-Clinical Eating Disorder Psychopathology. PLoS ONE, 9(1), 1–9. https://doiorg.proxy195.nclive.org/10.1371/journal.pone.0085773 | Irrelevant to research question; does not discuss IE |
| Taylor, J. M., Ptomey, L., Hamilton-Reeves, J. M., Sullivan, D. K., Creed, C., Carlson, S. E., Wesson, D. E., Grantham, J. J., & Gibson, C. A. (2016). Experiences and Perspectives of Polycystic Kidney Disease Patients following a Diet of Reduced Osmoles, Protein, and Acid Precursors Supplemented with Water: A Qualitative Study. PLoS ONE, 11(8), 1–13. https://doi-org.proxy195.nclive.org/10.1371/journal.pone.0161043 | Irrelevant to research question; does not discuss IE |
| 毕娜, 丁红, 苏天娇, & 杨雪. (2017). 社区骨质疏松患者饮食行为及健康管理策略. Chinese Journal of Osteoporosis / Zhongguo Guzhi Shusong Zazhi, 23(4), 452–472. https://doiorg.proxy195.nclive.org/10.3969/j.issn.1006-7108.2017.04.007 | Article is not written in English |
| Hartwell, H. J., Edwards, J. S. A., & Brown, L. (2013). The relationship between emotions and food consumption (macronutrient) in a foodservice college setting – a preliminary study. International Journal of Food Sciences & Nutrition, 64(3), 261–268. https://doiorg.proxy195.nclive.org/10.3109/09637486.2012.734288 | Irrelevant to research question; does not discuss IE |
| Mayer, E. A. (2011). Gut feelings: the emerging biology of gut-brain communication. Nature Reviews Neuroscience, 12(8), 453–466. https://doiorg.proxy195.nclive.org/10.1038/nrn3071 | Irrelevant to research question; does not discuss IE |
| Caldwell, K. L., Baime, M. J., & Wolever, R. Q. (2012). Mindfulness Based Approaches to Obesity and Weight Loss Maintenance. Journal of Mental Health Counseling, 34(3), 269–282. https://doiorg.proxy195.nclive.org/10.17744/mehc.34.3.t016616717774643 | Only discusses mindful eating, not IE |
| Marzano, M., Carss, D. N., & Cheyne, I. (2013). Managing European cormorant-fisheries conflicts: problems, practicalities and policy. Fisheries Management & Ecology, 20(5), 401–413. https://doiorg.proxy195.nclive.org/10.1111/fme.12025 | Irrelevant to research question; does not discuss IE |
| Weisman, K., & Markman, E. (2017). Theory-based explanation as intervention. Psychonomic Bulletin & Review, 24(5), 1555–1562. https://doi-org.proxy195.nclive.org/10.3758/s13423-016-1207-2 | Irrelevant to research question; does not discuss IE |
| Merten, J., Parker, A., Williams, A., King, J., Largo-Wight, E., Osmani, M., Merten, J. W., & King, J. L. (2017). Cancer Risk Factor Knowledge Among Young Adults. Journal of Cancer Education, 32(4), 865–870. https://doiorg.proxy195.nclive.org/10.1007/s13187-016-1093-3 | Irrelevant to research question; does not discuss IE |
| Forrest, L. N., Smith, A. R., White, R. D., & Joiner, T. E. (2015). (Dis)connected: An examination of interoception in individuals with suicidality. Journal of Abnormal Psychology, 124(3), 754–763. https://doiorg.proxy195.nclive.org/10.1037/abn0000074.supp (Supplemental) | Irrelevant to research question; does not discuss IE |
| DhurDhurandhar, N. V. (2012). When commonsense does not make sense. International Journal of Obesity, 36(10), 1332–1333. https://doiorg.proxy195.nclive.org/10.1038/ijo.2012.100 | Irrelevant to research question; does not discuss IE |
| Alibhai, S., Jewell, Z., & Evans, J. (2017). The challenge of monitoring elusive large carnivores: An accurate and cost-effective tool to identify and sex pumas (Puma concolor) from footprints. PLoS ONE, 12(3), 1–22. https://doi-org.proxy195.nclive.org/10.1371/journal.pone.0172065 | Irrelevant to research question; does not discuss IE |
| FERRARI, F. (2016). Disagreement about Taste and Alethic Suberogation. Philosophical Quarterly, 66(264), 516–535. https://doiorg.proxy195.nclive.org/10.1093/pq/pqv116 | Irrelevant to research question; does not discuss IE |
| Miranda, G. F. G., Young, A. D., Locke, M. M., Marshall, S. A., Skevington, J. H., & Thompson, F. C. (2013). Key to the Genera of Nearctic Syrphidae. Canadian Journal of Arthropod Identification, 23, 1–351. https://doi-org.proxy195.nclive.org/10.3752/cjai.2013.23 | Irrelevant to research question; does not discuss IE |
| Bowen, W. D., & Lidgard, D. (2013). Marine mammal culling programs: review of effects on predator and prey populations. Mammal Review, 43(3), 207–220. https://doi-org.proxy195.nclive.org/10.1111/j.1365- 2907.2012.00217.x | Irrelevant to research question; does not discuss IE |
| Gripshover, S. J., & Markman, E. M. (2013). Teaching Young Children a Theory of Nutrition: Conceptual Change and the Potential for Increased Vegetable Consumption. Psychological Science (0956-7976), 24(8), 1541–1553. https://doiorg.proxy195.nclive.org/10.1177/0956797612474827 | Irrelevant to research question; does not discuss IE |
| Peterson, D. A., Hardy, N. B., Morse, G. E., Stocks, I. C., Okusu, A., & Normark, B. B. (2015). Phylogenetic analysis reveals positive correlations between adaptations to diverse hosts in a group of pathogen-like herbivores. Evolution, 69(10), n/a-N.PAG. https://doiorg.proxy195.nclive.org/10.1111/evo.12772 | Irrelevant to research question; does not discuss IE |
| Patrick, J. H., Stahl, S. T., & Sundaram, M. (2011). Disordered eating and psychological distress among adults. The International Journal of Aging & Human Development, 73(3), 209–226. https://doiorg.proxy195.nclive.org/10.2190/AG.73.3.b | Does not discuss IE as an intervention; does not measure IE F29 |
| Barrada, J. R., Cativiela, B., van Strien, T., & Cebolla, A. (2020). Intuitive eating: A novel eating style? Evidence from a Spanish sample. European Journal of Psychological Assessment, 36(1), 19–31. https://doiorg.proxy195.nclive.org/10.1027/1015-5759/a000482 (Supplemental) | Does not discuss IE as an interventio |
| Patrick, J. H., & Stahl, S. T. (2009). Understanding disordered eating at midlife and late life. Journal of General Psychology, 136(1), 5–20. https://doi-org.proxy195.nclive.org/10.3200/GENP.136.1.5-20 | Irrelevant to research question; does not discuss IE |
| Tylka, T. L., & Kroon Van Diest, A. M. (2013). The Intuitive Eating Scale2: Item Refinement and Psychometric Evaluation with College Women and Men. Journal of Counseling Psychology, 60(1), 137–153. | Does not discuss IE as an intervention; does not measure IE |
| Paterson, H., Hay-Smith, E. J. C., & Treharne, G. J. (2016). Women’s experiences of changes in eating during pregnancy: A qualitative study in Dunedin, New Zealand. New Zealand College of Midwives Journal, 52, 5–11. https://doi-org.proxy195.nclive.org/10.12784/nzcomjnl52.2016.1.511 | Irrelevant to research question; does not discuss IE |
| Cole, R. E., Clark, H. L., Heileson, J., DeMay, J., & Smith, M. A. (2016). Normal Weight Status in Military Service Members Was Associated With Intuitive Eating Characteristic. Military Medicine, 181(6), 589–595. https://doi-org.proxy195.nclive.org/10.7205/MILMED-D-15-00250 | Gender data aggregate only |
Table 6 – Completed Conclusion Statement & Grade
Conclusion Statement and Grade
| Purpose of the Evidence Appraisal Process What is the effect of Intuitive Eating on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older? |
| Conclusion Statement: Intuitive Eating, as an intervention, and intuitive eating as a health habit have both shown to have highly positive effects on body image satisfaction, healthy living practices, and overall quality of life in females ages 13 and older. Intuitive Eating can be successfully used to support body image acceptance; promote healthy living practices such as an increase in fruit, vegetable, and whole grain intake as well as a decrease in foods high in fat and sugar; IE can also help alleviate disordered eating habit such as binge eating; and IE has seen to improve quality of life by decreasing the prevalence or severity of depression and allowing intuitive eaters to live a less stressful life in regards to food and body. |
| Conclusion Grade: Grade levels: I – good/strong |
Appendix C. Presentation Graphics
Flow Chart of Research Process
Evidence Analysis Process Information
.
Appendix D. Classified, Annotated Bibliography
Intuitive Eating Studies:
Andrew R, Tiggemann M, Clark L. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology. 2016;52(3):463-474. doi:10.1037/dev0000095.
The purpose of this longitudinal study was to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. The participants, which were a subset of a larger cross-sectional study investigating a model of Intuitive Eating, included 298 girls from five schools in metropolitan South Australia. The research methodology included completing a questionnaire at Time 1 and then again approximately 1 year later, at Time 2. The questionnaire included measures of activity, media consumption, body appreciation, self-objectification, social appearance comparison, perceived body acceptance, health behaviors (such as level of intuitive eating), and general demographics. The results suggested that enhancing body appreciation might be one way to tackle the development of disordered eating that is highly prevalent amongst adolescent females. The results also showed that public health programs for adolescents that focus on weight may negatively impact body appreciation while more holistic programs, such as Intuitive Eating, that challenge weight stigma, encourage body acceptance, and focus on an overall healthy lifestyle are likely to be more beneficial for both physical and psychological health. This study fits into this research topic because it provides needed information on the female population, intuitive eating, body image acceptance, and healthy habits. Also, the data from this study is useful because it provides information on a specific female age range, adolescent females, which helps further characterize the target population.
Augustus-Horvath CL, Tylka TL. The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood. Journal of Counseling Psychology. 2011;58(1):110-125. doi:10.1037/a0022129.
This experimental study involved a total of 801 women separated into three different groups: emerging adulthood group (18-25 years old, n=318), an early adulthood group (26-39 years old, n=238) and a middle adulthood group (40-65 years old, n=245). Participants completed various surveys that assessed support systems, body acceptance, level of intuitive eating, personal view of other women’s bodies, perception of body shape/size, overall life satisfaction, and other topics. The results indicated an increase in perceived social support was associated with body acceptance of others as well as an increase in body appreciation and intuitive eating when other’s approved of their bodies. It was also found that BMI negatively impacted a woman’s appreciation of her own body. This study fits into this research topic because it provides useful information on the target population of females >13 years old, specifically, it provides data on females experiencing various stages in life. It also provides meaningful data on the correlation between intuitive eating and body acceptance as well as the participant’s overall health choices.
Bush HE, Rossy L, Mintz LB, Schopp L. Eat for Life: A Work Site Feasibility Study of a Novel Mindfulness-Based Intuitive Eating Intervention. American Journal of Health Promotion. 2014;28(6):380-388. https://search-ebscohost-com.proxy195.nclive.org/login.aspx?direct=true&db=s3h&AN=96935834&site=ehost-live. Accessed August 23, 2019.
This experimental study involved 124 total (after exclusion) female participants divided into an intervention group (n=53) and a control group (n=71). The intervention group underwent a 10-week Eat for Life class (combination of Intuitive Eating and mindfulness approaches) while the control group was placed on the program waitlist. The purpose of this study was to determine the difference between the two groups when it comes to body appreciation, problematic eating behaviors, intuitive eating, and mindfulness. The results showed that the women in the 10-week Eat for Life program reported higher levels of body appreciation and lower levels of problematic eating behaviors in comparison to the waitlist group. This study fits into this research topic because it provides information on intuitive eating, body appreciation, and problematic eating behaviors. This information will help me explore the effects of Intuitive Eating. Also, the participants had an average age of 45 years old and were all female, thus, providing further data on the target population.
Cadena-Schlam L, López-Guimerà G. Intuitive eating: an emerging approach to eating behavior. Nutricion Hospitalaria. 2015;31(3):995-1002. doi:10.3305/nh.2015.31.3.7980.
The purpose of this narrative review was to evaluate Intuitive Eating and its implication for health-centered interventions. This narrative review evaluated 8 research studies aimed to explore the efficacy of interventions based on Intuitive Eating and the Health at Every Size (HAES) principles. The results showed that Intuitive eating may be a more promising and realistic method to addressing overweight and obesity than conventional weight-loss treatments. It demonstrated that Intuitive Eating helps meet individual’s health goals and does not negatively affect the integrity and welfare of the patient. It found that Intuitive Eating guards people of all sizes from unhealthy weight-control behaviors that may diminish overall health and well-being. This study fits with this research topic because it explores and provides data on Intuitive Eating and how it impacts overall health. It also provides information on the target population of women. However, it does include studies that had male participants, which is not the target population. Also, the study only reviewed 8 research article and did not discuss the methodology used.
Cole RE, Horacek T. Effectiveness of the “My Body Knows When” intuitive-eating pilot program. American Journal of Health Behavior. 2010;34(3):286-297. https://search-ebscohost-com.proxy195.nclive.org/login.aspx?direct=true&db=rzh&AN=105106378&site=ehost-live. Accessed August 28, 2019.
This randomized prospective study involved 61 female participants divided in an intervention group (n=38) and a control group (n=23). The intervention group participated in the 10-week My Body Knows When Intuitive Eating program while the control group did not. The purpose of this study was to evaluate the effectiveness of the My Body Knows When Intuitive Eating program when it comes to rejecting the diet mentality. The results of the study showed that the intervention group displayed signs of rejecting the diet-mentality, improved self-worth, and reduction in emotional eating. This study fits into this research topic because it provides information on the target population and how Intuitive Eating affected the participant’s body image satisfaction and overall eating behaviors.
Loughran TJ, Harfel T, Vollmer R, Schumacher J. Effective of Intuitive Eating Intervention Through Text Messaging Among College Students. College Student Journal. 2018;52(2):232-244. https://search-ebscohost- com.proxy195.nclive.org/login.aspx?direct=true&db=s3h&AN=130165003&site=ehost-live.
Accessed August 23, 2019.
The goal of this study was to determine the effects of Intuitive Eating on eating habits, stress, and self-efficacy of college students. This experimental study involved 300 participants randomly divided into a control group (n=150) and an intervention group (n=150). The control group received a general healthy eating behaviors email while the intervention group participated in a 5 week long program that consisted of 10 text messages (2 texts/week) regarding Intuitive Eating reminders. The results showed a positive correlation between intuitive eating and self-efficacy, new found food independence, increase in desire for healthy behaviors, and decreased levels of perceived stress. This study fits into this research because it provides information regarding the effects of Intuitive Eating on self-efficacy and healthy behaviors. Of the participants that fully completed the study (n=146), the ages ranged from 18 to 24 (70% were 18 years old) as well as the participants were 85% female, which provides information on the target population of females > 13 years old. However, this means that 15% of the participants were male, which are not included in the target population.
Schoenefeld SJ, Webb JB. Self-compassion and intuitive eating in college women: Examining the contributions of distress tolerance and body image acceptance and action. Eating Behaviors. 2013;14(4):493-496. doi:10.1016/j.eatbeh.2013.09.001.
This study included 322 female undergraduate students with ages ranging from 18 to 24 years old. The purpose of this study was to determine the correlation between Intuitive Eating and self-compassion, distress, and body image acceptance. The participants completed various online surveys including the Self-compassion Scale (SCS), the Distress Tolerance Scale (DTS), the Body Image Acceptance and Action Questionnaire (BI-AAQ), the Intuitive Eating Scale (IES), and the Rosenberg Self-Esteem Scale (RSES). The results showed that participants that scored higher on self-compassion reported higher levels of intuitive eating, distress tolerance, and body image flexibility. The results also showed that participants that reported higher levels of intuitive eating tended to report higher levels of body image acceptance.This study fits into this research topic because it provides data on the correlation between intuitive eating and body image acceptance. It also provides meaningful data on the target population of interest.
Specialized Intuitive Eating Studies:
Plateau CR, Petrie TA, Papathomas A. Learning to eat again: Intuitive eating practices among retired female collegiate athletes. Eating Disorders. 2017;25(1):92-98. doi:10.1080/10640266.2016.1219185.
This study involved 218 retired collegiate female athletes (gymnasts, n=144; swimmers/divers, n= 74). The purpose of this study was to collect information about retired female athletes regarding current practice of Intuitive Eating principles and the principles’ influence. The participants were contacted via email, phone, or social media to participate in a large NCAA grant funded study on physical health, psychological health, and overall well-being of retired female collegiate athletes. In one section of this larger study, the participants were asked various questions about their eating habits. The resulted showed that the majority of the participants (69%, n=149) reported that their frequency and/or quantity of eating changed after retirement. Many of the participants resonated with the questions regarding Intuitive Eating principles including permission to eat, recognizing internal hunger and satiety signals, and eating to meet physical and nutritional needs. This was because many of the athletes experienced constraints around food intake while competing including avoidance of “unhealthy” foods, limited caloric intake, rigid eating schedules, loss of hunger and satiety cues, and negative emotions around food. The results showed that Intuitive Eating principles can help retired female athletes resume a “normal” pattern of eating and reduce disordered eating practices. However, additional research is needed to understand the process of helping retired female athletes develop a healthier approach to eating. With all of this said, this article fits into this research topic because it provides data on intuitive eating practices, females, health choices, and eating behaviors. It also provides data on a specialized population where disordered eating is commonly found. This study will provide further guidance when determining the effects of Intuitive Eating on overall health choices, body image satisfaction, and quality of life.
Richards PS, Crowton S, Berrett ME, Smith MH, Passmore K. Can patients with eating disorders learn to eat intuitively? A 2-year pilot study. Eating Disorders. 2017;25(2):99-113. doi:10.1080/10640266.2017.1279907.
This 2-year pilot study involved 120 participants and was conducted at an inpatient-residential care facility for women with anorexia nervosa, bulimia nervosa, binge eating, eating disorder-not other specified, and additional comorbid diagnoses. The purpose of this study was to determine if teaching eating disorder patients the concepts of Intuitive Eating would improve the patients’ outcomes. The participants received education on the 10 main Intuitive Eating principles and registered dietitians met with the patients individually each week to discuss the principles. The results showed that the participants developed healthier attitudes towards food/eating and learned to apply the principles to make healthier choices. The results also showed a reduction in depression, anxiety, and conflicts with body image. This study fits into this research topic because the participants’ ages ranged from 13 to 55 years old, thus providing information on the target population. It also provides information regarding the effects of Intuitive Eating on overall healthy behaviors and conflicts with body image. Lastly, this study provides information on how Intuitive Eating can positively influence one of the most vulnerable populations that struggles the most with disordered eating and body image issues.
Appendix E. Personal Statement
When it comes to my academic background, I first received my Associate in Science (A.S.) degree in August 2015 from Blue Ridge Community College in Flat Rock, NC. From there, I transferred to Western Carolina University (WCU) in Cullowhee, NC where I obtained my Bachelor of Science (B.S) in Nutrition and Dietetics in May 2018. During my time at WCU, I participated in several nutrition related opportunities. These included the Student Association of Nutrition and Dietetics (SAND), a student organization with the mission of sharing nutrition knowledge; Growing Minds @ WCU, a program dedicated to teaching school age children about local foods and nutrition; and the Community Table of Sylva, a local soup kitchen that provides meals to the community. Upon completion of my undergraduate degree, I continued into the Western Carolina University Dietetic Internship program. During this program, I accrued over 1200 hours of supervised practice in the three main areas of dietetics: clinical nutrition, community nutrition, and foodservice management. After successfully completing the Dietetic Internship program in May of 2019, I became eligible to take the Registered Dietitian exam and passed the exam in August, officially becoming a Registered Dietitian.
Initially, my passions as a student in the Nutrition and Dietetics undergraduate program revolved around weight loss, exercise, and healthy meals. However, upon completion of the internship program, my passions in the field of nutrition drastically changed. I found myself abandoning the weight loss techniques I learned in college and focusing more on a patient’s overall health rather than their BMI. This lead to my current passion of using a non-diet approach to achieve overall health and wellness. A non-diet approach focuses on nonrestrictive behaviors with food and learning how to love your body regardless of its shape or size. In short, it involves listening to your body’s cues when it comes to hunger and fullness, finding room for all foods to fit into your diet, and participating in physical activity that is enjoyable. In the end, the goal of these techniques is to have a healthy body on the inside and to be at peace with what is on the outside.
With this said, I want to focus my research on the effects that movements, such as Health at Every Size (HAES) and Intuitive Eating, have on females in our society. The Heath at Every Size and Intuitive Eating movements both focus on caring for physical and mental health. Instead of focusing on weight loss and BMI to improve health, these movements focus on fueling the body with the proper nutrients, participating in physical activity that is enjoyable, and taking care of mental health.
By researching this topic, I hope to find that the non-diet approach to health has an abundant amount research to back the fact that it is more efficient in achieving overall health than dieting and weight loss are. If I were to discover this, I think it could change the way people view health, the way dietitians view health, and the way people view dietitians. This discovery would hopefully lead to an increase in the use of the non-diet approach when it comes to pursuing a healthy lifestyle.
Thanks for reading! If you’re interested in reading about similar topics, check out my blogs on Intuitive Eating, Health at Every Size (HAES), body positivity, and diet culture.
Sincerely,
Rachel Beiler, MHS, RD, LDN
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