Specific Psychological Distress: Eating Disorders and Intuitive Eating

This sub-section focuses specifically on intuitive eating research.

Specific Psychological Distress

Eating Disorders

Eating Disorders (Intuitive Eating)

Hawks, S. R., Merrill, C. G., Gast, J. A., & Hawks, J. F. (2004) 'Validation of the Motivation For Eating Scale', Ecology of Food and Nutrition 43(4): 307-326. [available online]

This study presents initial validation measures for a new eating motivation scale that was designed to assess different reasons for initiating food consumption. Such a scale seems warranted given increasingly popular self-help methods of weight management that are focusing less of diet composition and caloric intake, and more on underlying motivations for eating.

Hawks, S.R., Madanat, H.N., Merrill, R.M., Goudy, M.B., & Miyagawa, T. (2004) 'A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States', Health Promotion International 18(2): 153-162. [available online]

This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged >18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants’ motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise.

Hawks, S. R., Madanat, H. N., & Merrill, R. M. (2004) 'The Intuitive Eating Scale: Development and preliminary validation', American Journal of Health Education 35(2): 90-99: [available online]

This article describes the development and validation of an instrument designed to measure the concept of intuitive eating. To ensure face and content validity for items used in the Likert-type Intuitive Eating Scale (IES) content domain was clearly specified and a panel of experts assessed the validity of each item. Based on responses from 391 university students in the United States, the IES was evaluated for internal consistency and reliability using cross-tabulations, factor analysis, test-retest correlation coefficients, and logistic regression techniques. The factor solution isolated four factors that replicated scale construction, including: intrinsic eating, extrinsic eating, anti-dieting, and self-care with alpha coefficients ranging from .42 to .93. Retesting after four weeks (N = 285) yielded correlation coefficients that ranged between .56 and .87. The presence of theorized relationships between IES scores and certain demographic and lifestyle variables (obesity, presence of an eating disorder, gender, and restrictive dieting) adds support for concurrent validity. IES subscales also correlated significantly with the Cognitive Behavioral Dieting Scale in predicted directions suggesting convergent validity. Findings provide tentative support for the use of the IES in identifying intuitive eating attitudes and behaviors among college populations. Implications for practice, theory, and future research are discussed.

Hawks, S.R., Merrill, R.M., Madanat, H.N., Miyagawa, T., Suwanteerangkul, J., Guarin, C.M., Shaofang, C. (2004) 'Intuitive eating and the nutrition transition in Asia', Asia Pacific Journal of Clinical Nutrition 13(2):194-203: [available online]

Current models of the nutrition transition focus on demographic changes and economic development. A further influence may be the adoption of western-based perceptions of beauty that lead to potentially harmful eating behaviours which contribute to overweight, obesity, and eating disorders. This paper proposes a comprehensive model of the nutrition transition that includes western influences on perceived attractiveness and subsequent eating styles. An exploratory test of this model for Asian countries explores differences in intuitive eating as a function of economic development and the adoption of western standards of beauty. The intuitive eating scale (IES), a measure of food consumption that is primarily characterized by the satisfaction of physical hunger, was used to evaluate agreement with intuitive eating principles in the US and four Asian countries (Japan, Thailand, the Philippines, and China). Although intuitive eating scores in the US and Thailand failed to follow predicted patterns on two of the four IES subscales, scores for the other two IES subscales and the total IES score followed predicted patterns for Asian countries. Intuitive eating appears to be a valid, measurable concept that is correlated with economic development and levels of western influence in Asian countries. The tentative findings of this exploratory study support further evaluation of cultural influences as an important component of the nutrition transition.

Hawks, S.R., Madanat, H.N. (2003) 'Stemming racial and ethnic disparities in the rising tide of obesity', American Journal of Health Education 34(2): 90-96: [available online]

At the national level, obesity and obesity-related illnesses are increasing dramatically. As with many other public health problems, some racial and ethnic populations are disproportionately affected. This article presents current information on the prevalence and consequences of obesity for racial and ethnic groups in the United States and evaluates race/culture-specific causes of obesity for these populations. After analysis of various interventions that attempt to address this problem, a full-spectrum, three-pronged model for eliminating racial and ethnic disparities in obesity is presented and discussed. It is argued that a comprehensive population model, with a balance between downstream, midstream, and upstream interventions is necessary. Examples of culturally appropriate interventions that address the behavioral, social, and environmental determinants of obesity at each of these levels are presented. Using the tools of sound theory, appropriate methods, and cultural sensitivity, health educators are in a unique position to provide leadership to this effort.

Hawks, S.R., Goudy, M.B., & Gast, J.A. (2003) 'Emotional Eating and Spiritual Well-Being: A Possible Connection', American Journal of Health Eduation 34(1): 30-33: [available online]

The purpose of this exploratory study was to evaluate the relationship between emotional eating and spiritual well-being. It was found that among college women lower levels of spiritual well-being correlated with higher levels of emotional eating. In other studies, emotional eating has been found to contribute to higher calorie intake, binge eating, and bulimic eating attitudes. A better understanding of the correlates of emotional eating may lead to health education strategies for preventing or managing overweight, obesity, and eating disorders – which may be some of the major public health issues of the future. Implications for health educators are discussed, and research needs are suggested.

Hawks, S.R., Madanat, H.N., Merrill, R.M., Goudy, M.B., & Miyagawa, T. (2002) 'A cross-cultural comparison of health promoting behaviors among college students', International Electronic Journal of Health Education 5, 84-92. [available online]

The Health-Promoting Lifestyle Profile (HPLP) was used to compare the prevalence of selected behaviors between 594 college students residing in the US, and 629 students residing in Japan. No significant differences were found on subscales for stress management and interpersonal relations. Japanese students, however, scored higher on nutrition and health responsibility subscales, whereas US students scored higher on spiritual growth and exercise subscales. Paradoxically, Japanese students reported higher levels of restrictive dieting and placed greater importance on weight loss, but US students were more likely to be actively trying to lose weight and to have had experience with eating disorders. Differences in social environments were considered in the interpretation of results. Arguments are made for addressing the macro level determinants of health behaviors as part of the design and implementation of population based health education programs.

Bacon, L., Stern, J.S., Van Loan, M.D., Keim, N.L. (2005). 'Size acceptance and intuitive eating improve health for obese, female chronic dieters', Journal of the American Dietetic Association 105(6), 929-36.

OBJECTIVE: Examine a model that encourages health at every size as opposed to weight loss. The health at every size concept supports homeostatic regulation and eating intuitively (ie, in response to internal cues of hunger, satiety, and appetite). DESIGN: Six-month, randomized clinical trial; 2-year follow-up. SUBJECTS: White, obese, female chronic dieters, aged 30 to 45 years (N=78). SETTING: Free-living, general community. INTERVENTIONS: Six months of weekly group intervention (health at every size program or diet program), followed by 6 months of monthly aftercare group support. MAIN OUTCOME MEASURES: Anthropometry (weight, body mass index), metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), and psychology (self-esteem, depression, body image). Attrition, attendance, and participant evaluations of treatment helpfulness were also monitored. STATISTICAL ANALYSIS PERFORMED: Analysis of variance. RESULTS: Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained. CONCLUSIONS: The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.


This page was last reviewed by Dr Greg Mulhauser, Thursday, 14 October 2021.