To examine longitudinal associations of intuitive eating (IE), defined as eating according to internal hunger and satiety cues, with psychological health outcomes and disordered eating behaviors.
Data from a diverse sample of 1491 participants (54.1% female, 19.7% non-Hispanic white) followed from adolescence (baseline; Mage = 14.5 years) into young adulthood (follow-up; Mage = 22.2 years) came from the population-based EAT 2010–2018 (Eating and Activity over Time) study. Logistic regression models predicting psychological health outcomes and disordered eating behaviors at follow-up simultaneously included baseline IE and change in IE from baseline to follow-up as predictors, adjusting for demographic covariates, body mass index, and outcome at baseline.
Greater baseline IE and increases in IE from baseline to follow-up were both associated with lower odds of high depressive symptoms, low self-esteem, high body dissatisfaction, unhealthy weight control behaviors (e.g., fasting, skipping meals), extreme weight control behaviors (e.g., taking diet pills, vomiting), and binge eating at 8-year follow-up. Particularly strong protective associations were observed for binge eating, such that a one-point higher IE score at baseline was associated with 74% lower odds of binge eating at follow-up, and a one-point higher increase in IE score from baseline to follow-up was associated with 71% lower odds of binge eating at follow-up.
These results indicate that IE longitudinally predicts better psychological and behavioral health across a range of outcomes and suggest that IE may be a valuable intervention target for improving psychological health and reducing disordered eating behaviors, particularly binge eating.
Level of evidence
Level III, cohort study.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Stice E, Hayward C, Cameron RP et al (2000) Body-image and eating disturbances predict onset of depression among female adolescents: a longitudinal study. J Abnorm Psychol 109:438–444. https://doi.org/10.1037/0021-843X.109.3.438
Johnson F, Wardle J (2005) Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis. J Abnorm Psychol 114:119–125. https://doi.org/10.1037/0021-843X.114.1.119
Goldschmidt AB, Wall M, Choo T-HJ et al (2015) Shared risk factors for mood-, eating-, and weight-related health outcomes. Health Psychol. https://doi.org/10.1037/hea0000283
Hilbert A, Pike KM, Goldschmidt AB et al (2014) Risk factors across the eating disorders. Psychiatry Res 220:500–506. https://doi.org/10.1016/j.psychres.2014.05.054
Herman CP, Mack D (1975) Restrained and unrestrained eating. J Personal 43:647–660. https://doi.org/10.1111/j.1467-6494.1975.tb00727.x
Heatherton TF, Polivy J (1992) Chronic dieting and eating disorders: A spiral model. In: Crowther JH, Tennenbaum DL, Hobfoll SE, Stephens MAP (eds) Series in applied psychology: social issues and questions. The etiology of bulimia nervosa: the individual and familial context. Hemisphere Publishing Corp, Washington, pp 133–155
Mann T, Tomiyama AJ, Westling E et al (2007) Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol 62:220–233. https://doi.org/10.1037/0003-066X.62.3.220
Ayyad C, Andersen T (2000) Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev 1:113–119
Dansinger ML, Tatsioni A, Wong JB et al (2007) Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med 147:41–50
Neumark-Sztainer D, Wall M, Story M, Standish AR (2012) Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index. J Adolesc Health 50:80–86. https://doi.org/10.1016/j.jadohealth.2011.05.010
Neumark-Sztainer D, Wall M, Guo J et al (2006) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc 106:559–568. https://doi.org/10.1016/j.jada.2006.01.003
Lampuré A, Castetbon K, Hanafi M et al (2017) Relative influence of socioeconomic, psychological and sensory characteristics, physical activity and diet on 5-year weight gain in french adults. Nutrients 9:3–7. https://doi.org/10.3390/nu9111179
Field AE, Aneja P, Austin SB et al (2007) Race and gender differences in the association of dieting and gains in BMI among young adults. Obesity 15:456–464. https://doi.org/10.1038/oby.2007.560
Lowe MR, Annunziato RA, Markowitz JT et al (2006) Multiple types of dieting prospectively predict weight gain during the freshman year of college. Appetite. https://doi.org/10.1016/j.appet.2006.03.160
Van Dyke N, Drinkwater EJ (2014) Relationships between intuitive eating and health indicators: literature review. Public Health Nutr. https://doi.org/10.1017/S1368980013002139
Tribole E, Resch E (1995) Intuitive eating: a recovery book for the chronic dieter. St. Martin’s Press, New York
Bruce LJ, Ricciardelli LA (2016) A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite 96:454–472. https://doi.org/10.1016/j.appet.2015.10.012
Camilleri GM, Méjean C, Bellisle F et al (2016) Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study. Obesity 24:1154–1161. https://doi.org/10.1002/oby.21440
Denny KN, Loth K, Eisenberg ME, Neumark-Sztainer D (2013) Intuitive eating in young adults: who is doing it, and how is it related to disordered eating behaviors? Appetite 60:13–19. https://doi.org/10.1016/j.appet.2012.09.029
Tylka TL, Calogero RM, Daníelsdóttir S (2019) Intuitive eating is connected to self-reported weight stability in community women and men. Eat Disord. https://doi.org/10.1080/10640266.2019.1580126
Tylka TL, Wilcox JA (2006) Are intuitive eating and eating disorder symptomatology opposite poles of the same construct? J Counsel Psychol 53:474–485. https://doi.org/10.1037/0022-022.214.171.1244
Tylka TL, Kroon Van Diest AM (2013) The Intuitive Eating Scale-2: item refinement and psychometric evaluation with college women and men. J Counsel Psychol 60:137–153. https://doi.org/10.1037/a0030893
Cole RE, Horacek T (2010) Effectiveness of the “My Body Knows When” intuitive-eating pilot program. Am J Health Behav 34:286–297. https://doi.org/10.5993/AJHB.34.3.4
Tylka TL (2006) Development and psychometric evaluation of a measure of intuitive eating. J Counsel Psychol 53:226–240. https://doi.org/10.1037/0022-0126.96.36.199
Tylka TL, Calogero RM, Daníelsdóttir S (2015) Is intuitive eating the same as flexible dietary control? Their links to each other and well-being could provide an answer. Appetite 95:166–175. https://doi.org/10.1016/j.appet.2015.07.004
Iannantuono AC, Tylka TL (2012) Interpersonal and intrapersonal links to body appreciation in college women: an exploratory model. Body Image 9:227–235. https://doi.org/10.1016/j.bodyim.2012.01.004
Dittmann K, Freedman M, Beddoe A, Waldrop J (2009) Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. Eat Disord 17:273–292. https://doi.org/10.1080/10640260902991111
Bacon L, Stern JS, Van Loan MD, Keim NL (2005) Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc 105:929–936. https://doi.org/10.1016/j.jada.2005.03.011
Gagnon-Girouard M-P, Bégin C, Provencher V et al (2010) Psychological impact of a “Health-at-Every-Size” intervention on weight-preoccupied overweight/obese women. J Obes. https://doi.org/10.1155/2010/928097
Mensinger JL, Calogero RM, Stranges S, Tylka TL (2016) A weight-neutral versus weight-loss approach for health promotion in women with high BMI: a randomized-controlled trial. Appetite 105:364–374. https://doi.org/10.1016/j.appet.2016.06.006
Neumark-Sztainer D, Wall MM, Larson N et al (2012) Secular trends in weight status and weight-related attitudes and behaviors in adolescents from 1999 to 2010. Prev Med 54:77–81. https://doi.org/10.1016/j.ypmed.2011.10.003
Neumark-Sztainer D, Wall M, Fulkerson JA, Larson N (2013) Changes in the frequency of family meals from 1999 to 2010 in the homes of adolescents: trends by sociodemographic characteristics. J Adolesc Health 52:201–206. https://doi.org/10.1016/J.JADOHEALTH.2012.06.004
Seaman SR, White IR (2013) Review of inverse probability weighting for dealing with missing data. Stat Methods Med Res 22:278–295. https://doi.org/10.1177/0962280210395740
Little RJA (1986) Survey nonresponse adjustments for estimates of means. Int Stat Rev 54:139. https://doi.org/10.2307/1403140
Neumark-Sztainer D, Story M, Perry C, Casey MA (1999) Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc 99:929–937. https://doi.org/10.1016/S0002-8223(99)00222-9
Sallis JF, Owen N, Fisher EB (2008) Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K (eds) Health behavior and health education: theory, research, and practice, vol 4. Josey-Bass, San Francisco, pp 465–485
Ackard DM, Neumark-Sztainer D, Story M, Perry C (2006) Parent–child connectedness and behavioral and emotional health among adolescents. Am J Prev Med 30:59–66. https://doi.org/10.1016/j.amepre.2005.09.013
Crow S, Eisenberg ME, Story M, Neumark-Sztainer D (2006) Psychosocial and behavioral correlates of dieting among overweight and non-overweight adolescents. J Adolesc Health 38:569–574. https://doi.org/10.1016/j.jadohealth.2005.05.019
Kandel DB, Davies M (1982) Epidemiology of depressive mood in adolescents. Arch Gen Psychiatry 39:1205–1212. https://doi.org/10.1001/archpsyc.1982.04290100065011
Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton (NJ)
Pingitore R, Spring B, Garfield D (1997) Gender differences in body satisfaction. Obes Res 5:402–409. https://doi.org/10.1002/j.1550-8528.1997.tb00662.x
Neumark-Sztainer D, Croll J, Story M et al (2002) Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys-findings from Project EAT. J Psychosom Res 53:963–974. https://doi.org/10.1016/S0022-3999(02)00486-5
Yanovski SZ (1993) Questionnaire on eating and weight patterns-revised (QEWP-R). Obes Res 1:319–324
Neumark-Sztainer D, Hannan PJ, Story M et al (2003) Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc 103:317–322. https://doi.org/10.1053/jada.2003.50048
Gibson RS (2005) Principles of nutritional assessment, 2nd edn. Oxford University Press, New York
Linardon J, Mitchell S (2017) Rigid dietary control, flexible dietary control, and intuitive eating: evidence for their differential relationship to disordered eating and body image concerns. Eat Behav 26:16–22. https://doi.org/10.1016/j.eatbeh.2017.01.008
Schmitt N (1996) Uses and abuses of coefficient alpha. Psychol Assess 8:350–353. https://doi.org/10.1037/1040-35188.8.131.520
This research was supported by the National Heart, Lung, and Blood Institute (Grant numbers R01HL084064 and R35HL139853, PI: Dianne Neumark-Sztainer) and the National Institute of Mental Health (grant number T32MH082761, PI: Scott Crow). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institute of Mental Health, or the National Institutes of Health.
This research was supported by the National Heart, Lung, and Blood Institute (Grant numbers R01HL084064 and R35HL139853, PI: Dianne Neumark-Sztainer) and the National Institute of Mental Health (Grant number T32MH082761, PI: Scott Crow).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Minnesota Institutional Review Board and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Hazzard, V.M., Telke, S.E., Simone, M. et al. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010–2018. Eat Weight Disord 26, 287–294 (2021). https://doi.org/10.1007/s40519-020-00852-4
- Appetite regulation
- Body image
- Feeding and eating disorders