Negative and positive affect and disordered eating: The adaptive role of intuitive eating and body image flexibility

The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV)

OBJECTIVE

Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating.

METHODS

Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors.

RESULTS

Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors.

DISCUSSION

Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

Development and preliminary validation of the comprehensive emotional eating scale (CEES)

In emotional eating (EE), affective states influence desire to eat and/or eating behavior. Most research on EE focuses on over-/under-eating in response to negative emotions, the former of which is related to higher weight and binge-spectrum eating disorder (ED) symptoms while the latter has been implicated in low weight and restrictive-only ED. Individuals endorsing both forms of negative EE are more impaired than those reporting unidirectional negative EE. Less is known about the influence of positive emotions on eating, in part due to a lack of self-report measures of positive over- and under-eating as separate constructs. The current study presents the development, including item reduction and initial factorial validity (primary aims) and convergent validity (secondary aims) of the Comprehensive Emotional Eating Scale (CEES), a four-factor measure of positive and negative over- and under-eating. The initial 134-item pool for the CEES was based on a review of extant emotional eating scales and emotion words from the Positive and Negative Affect Schedule. The item pool was reduced and four factors identified using exploratory graphical analysis. The structure of the final set of 40 items was evaluated using confirmatory factor analysis. Convergent validity of the negative over- and under-eating scales was established using measures of body image-focused eating disorder and ARFID symptoms, and exploratory data on the correlates of positive over- and under eating were reported. The CEES showed preliminary evidence of factorial and convergent validity in a US-based convenience sample. It allows for classification on all four quadrants of emotional eating.

Interoceptive sensibility, intuitive eating, binge, and disordered eating behavior among individuals with obesity: A comparative study with the general population

The present study assessed the links between interoceptive sensibility, binge, disordered (emotional, restrained, and external) and intuitive eating among individuals with obesity (n = 57) and normal weight (n = 29). Individuals with obesity presented lower "attention regulation," "body-listening," and "trusting" interoceptive dimensions. When age was controlled, group differences on "trusting" remained significant. Individuals with obesity showed lower intuitive eating, higher emotional, and binge eating compared to controls. Higher "body listening," "eating for physical rather than emotional reasons," and "reliance on hunger and satiety cues" predicted lower binge eating whereas "external eating" predicted higher binge eating among individuals with obesity. Eating for physical reasons and reliance on hunger and satiety had protective mediating roles in the relationship between external and binge eating in both groups. Interoceptive sensibility and intuitive eating should conjointly serve as psychotherapeutic targets for disordered eating, obesity, and weight management.

Reciprocal longitudinal associations between positive body image and wellbeing among early-adult women

This longitudinal study examined the prospective associations between body appreciation and wellbeing (i.e., self-esteem, depression, and emotional wellbeing) as well as body image flexibility and wellbeing among 490 women between 18-35 years of age (M = 28.63; SD = 4.27) residing in the United States. Women were contacted in three waves, each two months apart, and completed measures relating to each construct online. As a prerequisite of longitudinal analyses, this study found evidence of configural, metric, scalar, and strict invariance over time for each relevant measure. Cross-lagged panel modeling evidenced bidirectional associations between body appreciation and self-esteem between all waves and unidirectional associations between body appreciation and subsequent depression (negative) and body appreciation and subsequent emotional wellbeing (positive). Results showed bidirectional associations between body image flexibility, self-esteem, depression, and emotional wellbeing, although these bidirectional associations never occurred during the same interval between waves. This study evidences that higher body appreciation and body image flexibility are prospectively associated with increases in self-esteem, emotional wellbeing and decreases in depression, and also shows scenarios where the inverse associations also hold true. We also describe how this study complements existing cross-sectional research and the need to examine associations among more diverse participant groups.

Validation of the Chinese Version of the Body Image Flexibility and Inflexibility Scale among Chinese College Students

Body image flexibility is a specific type of psychological flexibility relevant to body image. The development of the Body Image Flexibility and Inflexibility Scale (BIFIS) expands the concept and structure of body image flexibility and provides more detailed measurement indicators for theoretical research and clinical practice. However, the tool's applicability to the Chinese population is still unclear. This study aims to test the reliability and validity of the BIFIS among Chinese college students. A total of 1446 Chinese college students were surveyed and completed a series of scales, including the Chinese version of the BIFIS (i.e., C-BIFIS). A total of 99 participants were retested one month later. Confirmatory factor analysis supported the second-order factor structure of the BIFIS. The C-BIFIS showed measurement invariance across genders. The scale also exhibited good internal consistency and test-retest reliability. The higher-order body image flexibility and inflexibility factors were significantly correlated with unidimensional body image flexibility, body satisfaction, body appreciation, intuitive eating, and life satisfaction. Incremental validity tests indicated that two higher-order factors remained unique predictors of intuitive eating and life satisfaction. In conclusion, the Chinese version of the BIFIS has good psychometric properties and could be used to study body image flexibility in Chinese college student populations.

A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.

Intuitive eating and its influence on self-reported weight and eating behaviors

Intuitive eating (IE) is an adaptive eating behavior that involves paying attention to the body's physiological signals, including eating when hungry and stopping when feeling full. A growing body of literature has examined the effect of IE on the development of maladaptive eating behaviors and body weight, even though IE is not centered around the latter. However, longitudinal observation studies among the general population are still rare. Therefore, this study aimed to longitudinally examine the links between IE and changes in body weight, maladaptive eating behaviors (reward, external, restrained eating), and overeating frequency over time. For this purpose, we used data from the first (2017) and the fourth waves (2020) of the Swiss Food Panel 2.0 survey, which included 1821 randomly selected Swiss participants. The same participants completed a self-administered questionnaire annually, measuring their self-reported eating behaviors and weight status. IE was measured with the Intuitive Eating Scale-2. Results showed that women with high IE scores were more likely to maintain their body weights (within ±2 kg) and less likely to gain weight (>2 kg) than women with low IE scores. No such effects were found for men. Furthermore, IE was linked to a reduction in maladaptive eating behaviors and overeating frequency over time in both genders. Results suggest that IE may counteract maladaptive eating behaviors, which can promote weight stability over time. Therefore, the encouragement of IE patterns seems to be a promising strategy to address problematic eating behaviors and the challenges associated with controlling food intake and prevention of overeating.

Longitudinal association between self-compassion and intuitive eating: Testing emotion regulation and body image flexibility as mediating variables

OBJECTIVES

Growing evidence suggests that intuitive eating is associated with numerous positive mental health and well-being constructs. Understanding factors that predict intuitive eating is necessary for identifying practical targets to enhance this style of eating, yet research identifying such predictors is scarce. Self-compassion is one variable that could enhance intuitive eating because it involves the practice of healthy emotion regulation skills that may disrupt the tendency to turn to food to cope during distressing situations. The present study tested for a longitudinal association between self-compassion and intuitive eating. We also tested whether this association was mediated by indices of emotion regulation (i.e., global emotion regulation skill scores and body image flexibility).

METHOD

Adult women (n = 3039) were invited to completed study measures at baseline (T1), 4-month follow-up (T2), and 8-month follow-up (T3). Path analyses were computed to test hypothesized indirect effects.

RESULTS

A direct path from T1 self-compassion to T3 intuitive eating emerged, such that higher self-compassion levels predicted increased intuitive eating over time. However, this association was not mediated by T2 emotion regulation skills nor body image flexibility.

CONCLUSION

Findings suggest that self-compassion may facilitate an intuitive eating style, which does not appear to be explained by certain emotion regulation skills.

Effectiveness of a text-messaging intervention on intuitive eating: a randomised controlled trial

Intuitive eating (IE) is a concept based on mind-body integration of instinct, emotion and rational thought, to improve eating behaviours, physical and mental health. Several attempts were developed to teach IE principles including text-messaging interventions given that they are easy to implement and low cost.

OBJECTIVE

The present study aimed to assess the effectiveness of a 5-week text message-based IE intervention on IE, while correcting for perceived stress (PS) and self-compassion (SC).

DESIGN

A randomised controlled trial.

SETTING

Online, in Lebanon.

PARTICIPANTS

Adults (n 195) were randomised into one of three groups: the active IE group receiving IE-related messages with a practice exercise, the passive IE group receiving only IE-related messages and the control group receiving general health-related tips. Ten messages were delivered over 5 weeks. Two follow-ups were made: directly post-intervention and 7 weeks later. Baseline data and follow-ups included demographics, nutrition-related variables and measures of IE, SC and PS.

RESULTS

Results indicated improvements in IE scores in the two intervention groups (P = 0·05), with the passive IE group showing the most improvement. Also, a significant improvement in SC (Λ = 0·88, F (2, 63) = 4·40, P = 0·01) and reduction in PS (Λ = 0·86, F (2, 63) = 5·21, P = 0·008) were observed in the active IE group.

CONCLUSION

Text-messaging interventions might be efficient in enhancing IE. Results shed light on the need for further large-scale interventions that use visual aids and provide practical guidance to teach IE, while further characterising the relation between IE, SC and stress.

Psychometric properties of an Arabic translation of the Inflexible Eating Questionnaire (IEQ) in a non-clinical sample of adults

BACKGROUND

The Inflexible Eating Questionnaire (IEQ) is an 11-item instrument designed to evaluate the behavioural and psychological components of inflexible eating. However, the psychometric properties of the instrument have been infrequently examined, and no previous work has examined its utility in the context of the Middle East.

METHODS

A total of 826 Lebanese citizens and residents completed a novel Arabic translation of the IEQ, as well as previously validated measures of body appreciation, functionality appreciation, and disordered eating.

RESULTS

The unidimensional factor structure of the IEQ was upheld through both exploratory and confirmatory factor analyses, with all 11 items retained. We obtained evidence of scalar invariance across gender and found that there were no significant differences in observed IEQ scores between men and women. IEQ scores were also found to have adequate composite reliability and adequate patterns of concurrent validity.

CONCLUSION

The present findings provide support for the psychometric properties of the Arabic version of the IEQ in examining inflexible eating in Arabic-speaking adults in Lebanon. Inflexible or rigid dietary restraint reflects an all-or-none approach that encompasses feeling compelled to obey a set of self-imposed dieting rules (e.g., avoiding high-calorie food, calorie counting, fasting to lose weight and/or skipping meals), having a sense of self-control and feeling empowered when adhering to these rules, and not respecting or following internal/external cues of hunger, satiety, and appetite. Therefore, the inflexible eating construct is composed of two dimensions, the first one is behavioural (i.e., obeying restrictive dietary rules) and the second one is psychological (i.e., the belief that following these rules is a consistent must). Until recently, the measures designed to assess inflexible eating focused on the behavioral dimension, while omitting to account for the psychological processes underlying the construct. To bridge this gap, the Inflexible Eating Questionnaire (IEQ), an 11-item self-report measure, was developed to assess both the behavioural and psychological components of dietary restraint. To date, the IEQ is not yet validated in Arabic. Through the present study, we aimed to examine the psychometric properties of an Arabic translation of the IEQ, which would in turn facilitate improved research and clinical practices related to dietary restraint in Arabic-speaking nations. Overall, findings provided support for the good psychometric qualities of the Arabic version of the IEQ, which suggests its utility for detecting inflexible eating in Arabic-speaking adults.

Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index

Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m² (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.

A survey of eating styles in eight countries: Examining restrained, emotional, intuitive eating and their correlates

INTRODUCTION

Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample.

METHOD

Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey.

RESULTS

Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries.

CONCLUSION

Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.

The powerful effect of body image inflexibility on the explanation of eating psychopathology severity

PURPOSE

Feelings of shame and social comparison focused on physical appearance have been identified as important risk factors for the engagement in disordered eating behaviours. Further, recent studies have emphasized the role of body-image psychological (in)flexibility in the association between several risk factors and eating psychopathology. The current study intended to explore, in two different path models, the effects of external shame, physical appearance-related social comparison, and body image inflexibility on the explanation of eating psychopathology severity.

METHODS

This study follows a cross-sectional design and was conducted in a sample of 776 emerging-adult women, aged between 18 and 28, who completed an online battery of self-report measures. Path analyses were conducted using a structural equation modeling.

RESULTS

Model 1's results showed that external shame and unfavourable social comparison based on physical appearance directly accounts for 26% of the variance in disordered eating. In turn, when body image inflexibility is introduced as a mediator in the relationship presented in Model 1, variance in disordered eating increases to 60% (Model 2). These results suggest that both external shame and unfavourable physical appearance-related social comparison have an impact on disordered eating behaviours. However, when body image inflexibility is introduced, the mentioned relationships change and reveal that psychological inflexibility is a significant mediator of these associations.

CONCLUSION

These findings seem to demonstrate that body image inflexibility is a key process for the engagement in disordered eating, so the promotion of psychological flexibility focused on one's body is crucial for the prevention and treatment of disordered eating behaviours and attitudes.

LEVEL OF EVIDENCE

Level IV: Cross-sectional study.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

PURPOSE

Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction.

METHODS

Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups.

RESULTS

The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60).

CONCLUSION

Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem.

LEVEL OF EVIDENCE

Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

Distinguishing between healthy and pathological orthorexia: a cluster analytic study

PURPOSE

This study represents a first attempt to explore the typology of female adults from a large non-clinical sample based on healthy orthorexia (HO) and pathological orthorexia (orthorexia nervosa, ON).

METHODS

1245 female adults (Mage = 38.04, SD = 9.73) completed a set of questionnaires assessing orthorexic behaviors, intuitive eating, self-esteem, perceived social support as well as eating disorders, depressive and anxiety symptoms.

RESULTS

Cluster analysis based on HO and ON scores yielded 4 distinct groups: "Healthy orthorexia cluster" (HO), "Orthorexia Nervosa cluster" (ON), "Low Orthorexia cluster" (LO) and "In-between Orthorexia cluster" (IBO). The HO and ON clusters represented individuals with, respectively, healthy and pathological interest in healthy diet. The LO cluster represented those with no particular interest in healthy eating and the IBO cluster showed that ON and HO behaviors can be associated in some individuals. Among all clusters, the ON cluster displayed highest levels of ED, anxiety and depressive symptoms. Inversely, the HO cluster displayed highest levels of intuitive eating, self-esteem and perceived social support.

CONCLUSION

Altogether, findings from this study support the bidimensional structure of orthorexic eating behavior and further suggest that ON and HO behaviors can be associated in some individuals. Our findings further provide evidence for the assumption that ON and HO could be seen, respectively, as maladaptive and protective eating behaviors.

LEVEL OF EVIDENCE

V, descriptive study.

Making the leap from healthy to disordered eating: the role of intuitive and inflexible eating attitudes in orthorexic behaviours among women

PURPOSE

Orthorexia Nervosa (ON) has been a research focus in recent years. Despite the lack of consensus on its definition and classification as a psychiatric disorder, research has shown that ON is linked to certain behaviours (orthorexic behaviours, e.g.: obsessive thinking and compulsive behavior, guilt and self-punishment, restriction), associated with disordered eating. However, very little is known about this relationship. The aim of this study was to explore the eating-related processes inherent to the relationship between orthorexic behaviours and disordered eating, and understand if it is through the adoption of a more inflexible and less intuitive eating approach, that an interest in healthy eating develops into a pathological one, while controlling the effect of age and BMI. Additionally, this relationship was explored for two different groups: Omnivores and Non-omnivores.

METHODS

Four hundred fifty-one women (281 Omnivores and 170 Non-omnivores) from the Portuguese population participated in this study, by answering a set of self-report measures.

RESULTS

Non-omnivores presented significant higher levels of orthorexic behaviours and inflexible eating. In both groups, orthorexic behaviours and disordered eating were linked positively to inflexible eating and negatively to intuitive eating. A path model analyses showed that the preferred eating approach mediated the relationship between orthorexic behaviours and disordered eating, explaining 51% of the variance of disordered eating. A multigroup analysis confirmed the model invariance between Omnivores and Non-omnivores.

CONCLUSIONS

Our findings contribute to the better understanding of the relationship between orthorexic behaviours and disordered eating and its eating-related processes. Future research regarding the clinical intervention and prevention of ON in women should focus on encouraging a more intuitive eating approach.

LEVEL OF EVIDENCE

IV, cross-sectional study.

Intuitive eating and its psychological correlates: A meta-analysis

OBJECTIVE

Intuitive eating is an adaptive style of eating that has generated significant research attention. Theoretically, intuitive eating is a core construct that features prominently in the Acceptance Model of Intuitive Eating, a framework that explains how positive environmental influences can foster intuitive eating practices via body appreciation. Empirically, intuitive eating has been connected to a broad range of adaptive mental health indices. At present, a quantitative synthesis of intuitive eating and its correlates has yet to be conducted. This was the objective of the current meta-analysis.

METHOD

Ninety-seven studies (89% cross-sectional) were included. Random effects meta-analyses were conducted on 23 psychological correlates, divided into three clusters: eating behavior and body image disturbances, positive body image and other adaptive factors, and general psychopathology. Meta-analytic path analyses were also computed to test the validity of the Acceptance Model.

RESULTS

Intuitive eating was inversely associated with multiple indices of eating pathology, body image disturbances, and psychopathology (rs = -.23 to -.58). Intuitive eating was positively associated with numerous positive psychological constructs, such as positive body image, self-esteem, and wellbeing (rs = .20 to .58). Men reported higher levels of intuitive eating than women (d = 0.39), with differences being largest in Caucasian samples. Meta-analytic path analyses strongly supported the hypothesized pathways specified in the Acceptance Model of Intuitive Eating.

CONCLUSIONS

There is a strong evidence base for intuitive eating's connection to numerous adaptive psychological constructs. Attention should now shift toward prospective and experimental designs so that the temporal nature of these relationships can be identified.

Body image flexibility and its correlates: A meta-analysis

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.