Intuitive eating and food Intake: A nationwide study of New Zealand middle-aged women

Abstract

Background: Intuitive eating (IE) is a non-dieting approach that is characterised by eating desired foods, in accordance with hunger and satiety cues, and in the absence of emotional distress or triggers. IE has been associated with lower body mass index and enhanced psychological wellbeing indices, although few studies have reported on the relationship between IE and food intake.

Objectives: To examine the relationship between the four IE subscales: “unconditional permission to eat” (UPE), “eating for physical rather than emotional reasons” (EPE), “reliance on hunger and satiety cues” (RHS), and “body-food choice congruence” (B-FCC), with reported food intake among New Zealand middle-aged women. Secondly, to assess whether reported weight control practices (either “trying to lose weight”, “trying to maintain weight”, or “not attempting weight control at all”) drives the direction between the four IE subscales and reported food intake.

Design: A five-year longitudinal, observational study of 1601 randomly selected New Zealand women aged 40-50 years at baseline, whereby secondary analysis of cross-sectional data from the baseline (2009), three-year (2013), and five-year (2014) surveys was conducted. Three IE subscales (UPE, EPE, and RHS) were measured using Tylka’s Intuitive Eating Scale-1, and the B-FCC subscale measured using the Intuitive Eating Scale-2 (at five-years only). Food intake was assessed using an 8-item questionnaire at both baseline and five-years (measuring the intake of 13 foods), and a 7-item questionnaire at three-years (measuring the intake of 26 foods). Linear regression with robust standard errors was used to determine the mean IE subscale score differences with dichotomised foods (grouped into those women who did and did not consume a certain number of servings, at specified frequencies). Additionally, linear regression with robust standard errors assessed the trend between IE subscale scores and women’s intake of foods. To assess potential mediation, within each IE subscale stratified analyses were run for each weight control practice with food group intake.

Results: Higher EPE, RHS and B-FCC subscale scores were associated with higher reported intakes of healthier foods (such as vegetables or vegetable variety), and were associated with lower reported intakes of less healthy foods (such as chocolate coated biscuits) (P<0.05). In contrast, higher UPE subscale scores were associated with lower reported intakes of healthier foods (such as fruits) and higher reported intakes of less healthy foods (such as potato chips) (P <0.05). Trend estimates and mean subscale score differences were small for UPE, EPE and RHS, but were larger for the B-FCC subscale, with the largest subscale score difference presented in those women consuming ≥5 vegetables per day (0.40; 95% CI, 0.29, 0.51; P<0.001). Varying weight control practices among women drove no consistent trend with healthier or unhealthier foods in each of the four IE subscales.

Conclusion: Overall, the EPE, RHS and B-FCC subscales were associated with healthier food practices, whereas the UPE subscale was associated with unhealthier food practices. These associations were not strongly driven by one particular weight control practice. These findings suggest the importance of assessing the varying IE dimensions with food intake, rather than total IE.