Elsevier

Appetite

Volume 60, 1 January 2013, Pages 13-19
Appetite

Research report
Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors?

https://doi.org/10.1016/j.appet.2012.09.029Get rights and content

Abstract

Intuitive eating (i.e., reliance on physiologic hunger and satiety cues to guide eating) has been proposed as a healthier, more effective, and more innate alternative to current strategies of weight management. The current study explored intuitive eating among young adults according to socio-demographic characteristics and body mass index (BMI), and examined associations between intuitive and disordered eating behaviors. Data were drawn from Project EAT-III, a population-based study of 2287 young adults (mean age: 25.3 years). More males reported trusting their bodies to tell them how much to eat than did females. Intuitive eating was inversely associated with BMI in both genders. Males and females who reported trusting their body to tell them how much to eat had lower odds of utilizing disordered eating behaviors compared to those that did not have this trust. Females who reported that they stop eating when they are full had lower odds of chronic dieting and binge eating than those who do not stop eating when full. Overall, this study found that intuitive eating practices are inversely associated with a number of harmful outcomes. Clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.

Highlights

► Men are more likely than women to trust their bodies to tell them how much to eat. ► No significant differences in either aspect of intuitive eating were found across socio-demographic characteristic. ► Both aspects of intuitive eating were lower among those with higher BMI status. ► Both aspects of intuitive eating were associated with fewer disordered eating behaviors.

Introduction

The prevalence of overweight and obesity continues to be high; a nationally representative study in the United States found that two in three adults were either overweight or obese (Flegal, Carroll, Ogden, & Curtin, 2010). Thinner aesthetic preferences (Swami and Tovee, 2005, Swami et al., 2010) and physical and emotional health consequences associated with obesity (Wyatt, Winters, & Dubbert, 2006) are among the drivers for weight loss. Dieting is a commonly utilized method of attempted weight loss (Field et al., 2010, McCracken et al., 2007, Wharton et al., 2008). Dieting becomes extremely common by adolescence, during which time 46% of U.S. high school students report dieting behaviors (Centers of Disease Control and Prevention [CDC], 2012). Furthermore, research indicates that dieting behaviors observed in adolescence have a general tendency to continue into adulthood, suggesting that early behaviors set the stage for later behaviors (Neumark-Sztainer, Wall, Larson, Eisenberg, & Loth, 2011). Interestingly, research consistently shows that attempts at dieting are often unsuccessful and do not predict weight loss or maintenance, but instead predict weight gain and overweight status (Field et al., 2007, Field et al., 2010, Neumark-Sztainer et al., 2012, Neumark-Sztainer et al., 2006, Williams et al., 2007). Furthermore, dieters may experience large weight fluctuations (Mann et al., 2007), emotional distress (Hawks et al., 2008, Rubinstein, 2006, Theim, 2007), depression (Cachelin and Regan, 2006, Gillen et al., 2012), and are at risk for the development of eating disorders (Cachelin and Regan, 2006, Hawks et al., 2008, Keel et al., 2007, Neumark-Sztainer et al., 2006). This body of evidence suggests that dieting is not a sustainable strategy for weight loss and does not promote a healthy lifestyle.

In a society where concerns and public attention regarding obesity and its associated physical health problems are at the forefront, methods to improve weight status and associated health problems that also promote healthier emotional status need to be explored. A new body of research suggests that helping people recognize and respond to their internal signs of hunger and satiety may offer a healthier alternative to dieting (Bacon et al., 2005, Smith and Hawks, 2006, Tylka and Wilcox, 2006). Researchers have proposed that humans are naturally equipped to use internal cues to regulate their food consumption for optimal energy balance (Birch & Fisher, 1998; Birch, Johnson, Andersen, Peters, & Schulte, 1991; Fomon, 1993). For example, research has shown that infants as young as 6 weeks old (Fomon, 1993) and young children (Birch and Fisher, 1998, Birch et al., 1991) have the ability to respond to and compensate for the energy density of their diet and to self-regulate their caloric intake based on their physiologic needs.

Research has also demonstrated that the ability to innately regulate energy intake by responding to internal hunger and satiety cues can be disrupted by a change in focus from internal cues to external cues, notably environmental pressures, such as parental control and messages (Birch and Fisher, 1998, Patrick and Nicklas, 2005, Scaglioni et al., 2008). Parental control over when, what, and how much a child eats is negatively associated with that child’s ability to self-regulate their energy intake (Birch and Fisher, 1998, Patrick and Nicklas, 2005, Scaglioni et al., 2008). For example, children who are regularly encouraged to “clean their plate” will begin to associate fullness with the cleanliness of their plate rather their own physical sensation of fullness (Fisher & Birch, 1999). Caregiver messages regarding eating and weight can impact a child’s eating behavior (Birch & Fisher, 2000; Fisher & Birch, 1999). For instance, certain foods become more desirable to children if withheld from them (Birch, Fisher, & Davison, 2003) or less desirable if pushed upon them (Galloway, Fiorito, Fracis, & Birch, 2006). Such restriction and pressure on child eating are inversely associated with eating in accordance with internal hunger and satiety cues later in life (Kroon Van Diest & Tylka, 2010). Notably, the replacement of these internal signals with external cues, or motivators, has been shown to be related to weight gain (Faith et al., 2004, Kroon Van Diest and Tylka, 2010) and several unhealthy eating practices, such as dietary restraint, eating in the absence of hunger, and eating in response to emotions (Birch and Fisher, 2000, Birch et al., 2003, Carper et al., 2000, Faith et al., 2004, Kroon Van Diest and Tylka, 2010, Patrick and Nicklas, 2005, Scaglioni et al., 2008). This body of evidence suggests that the ability to use physical hunger and satiety cues to effectively regulate energy consumption is innate. Yet, when this ability diminishes due to increased focus on external cues, naturally regulated energy consumption is replaced by unhealthy eating practices.

Individual motivations for eating have been classified into three groups (Hawks, Madanat, Merrill, Goudy, & Miyagawa, 2003), including physical (eating due to internal cues, such as a growling stomach), emotional (eating due to depression, boredom, or other emotional states), or environmental (eating triggered by something in the immediate surrounding, such as food odor). Intuitive eating is a style of eating that focuses on eating motivated by physical reasons, with an individual relying on their connection with and understanding of physical hunger and satiety cues, rather than on emotional or environmental motivators (Avalos and Tylka, 2006, Tribole and Resch, 1995, Tylka, 2006). It has been proposed that unconditional permission to eat whatever food is desired based on these cues, regardless of nutrient or caloric content, may decrease excessive preoccupation with food (Avalos and Tylka, 2006, Tribole and Resch, 1995, Tylka, 2006). Although research has been limited, intuitive eating has shown some promise in promoting healthy dietary practices and improving physical and emotional health outcomes (Avalos and Tylka, 2006, Bacon and Aphramor, 2011, Bacon et al., 2005, Hawks et al., 2005, Smith and Hawks, 2006, Tylka, 2006, Tylka and Wilcox, 2006). Intuitive eating is associated with several markers of improved physical health, including lower body mass index (BMI), cholesterol, and blood pressure, indicating lower cardiovascular risk (Augustus-Horvath and Tylka, 2011, Bacon and Aphramor, 2011, Bacon et al., 2005, Hawks et al., 2005, Madden et al., 2012, Smith and Hawks, 2006, Tylka, 2006). Furthermore, research has suggested that intuitive eating is associated with a number of measures of better psychological health. For example, intuitive eaters have been found to show greater unconditional self-regard and body satisfaction (or appreciation) and lower levels of depression and disordered eating behaviors (Bacon and Aphramor, 2011, Bacon et al., 2005, Polivy and Herman, 1992, Smith and Hawks, 2006, Tylka, 2006, Tylka and Wilcox, 2006).

While existing research on intuitive eating is promising, studies have been conducted primarily in small samples (Bacon et al., 2005, Hawks et al., 2005, Polivy and Herman, 1992, Smith and Hawks, 2006, Tylka and Wilcox, 2006), in females (Augustus-Horvath and Tylka, 2011, Avalos and Tylka, 2006, Bacon et al., 2005, Hawks et al., 2005, Madden et al., 2012, Polivy and Herman, 1992, Tylka, 2006, Tylka and Wilcox, 2006), and in limited populations within single universities (Avalos and Tylka, 2006, Hawks et al., 2005, Smith and Hawks, 2006, Tylka, 2006, Tylka and Wilcox, 2006) and weight loss programs (Bacon et al., 2005, Polivy and Herman, 1992). It is of interest to learn more about the extent to which the general population utilizes intuitive eating principles and their associations with dieting and disordered eating behaviors. The present study expands the current literature by: (1) describing two aspects of intuitive eating according to socio-demographic characteristics and BMI within a large community-based, racially and socioeconomically diverse sample of young adult women and men; and (2) examining associations of the same two aspects of intuitive eating with chronic dieting, unhealthy and extreme weight control behaviors, and binge eating within this population.

Section snippets

Sample and study design

Data for this observational, cross-sectional analysis were drawn from Project EAT-III (Eating and Activity in Teens and Young Adults), the third wave of Project EAT, a Minnesota population-based study designed to examine weight-related issues among adolescents and young adults. Project EAT involves data collection over time, but does not include an intervention component. The University of Minnesota’s Institutional Review Board Human Subjects Committee approved all study protocols.

In Project

Intuitive eating by socio-demographic characteristics and weight status

Among young adult men, 74.8% indicated that they trusted their body to tell them how much to eat, and 79.1% reported that they stopped eating when full. Among young adult women, 64.8% indicated that they trusted their body to tell them how much to eat, and 76.4% reported that they stopped eating when full. More men than women reported trusting their body to tell them how much to eat (p < .01), but there was no difference between genders in their report of stopping eating when full (p = .12). There

Discussion

The objectives of the current study were to describe two aspects of intuitive eating according to socio-demographic characteristics and BMI, and to examine associations between these aspects of intuitive eating and disordered eating behaviors, including chronic dieting, binge eating, and unhealthy and extreme weight control behaviors, in a population-based sample of young adults. Overall, young adults reported a high prevalence of both trusting their body to tell them how much to eat and of

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    Acknowledgements: Data collection for this study is financially supported by a grant for Project EAT [Grant No. R01HL084064 (PI: Neumark-Sztainer)] from the National Heart, Lung, and Blood Institute. Additionally, financial support for the first author was provided by a grant for Faculty Development in Primary Care [Grant No. D55HP04186 (PI: Borowsky)] from the Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services (Public Health Service Act, Title VII, Section 747).

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