A Review of Interventions that Promote Eating by Internal Cues

Published:March 14, 2014DOI:https://doi.org/10.1016/j.jand.2013.12.024

      Abstract

      Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Goodrick G.K.
        • Foreyt J.P.
        Why treatments for obesity don't last.
        J Am Diet Assoc. 1991; 91: 1243-1247
        • Katan M.B.
        Weight-loss diets for the prevention and treatment of obesity.
        N Engl J Med. 2009; 360: 923-925
        • Mann T.
        • Tomiyama A.J.
        • Westling E.
        • Lew A.M.
        • Samuels B.
        • Chatman J.
        Medicare's search for effective obesity treatments: Diets are not the answer.
        Am Psychol. 2007; 62: 220-233
        • Sacks F.M.
        • Bray G.A.
        • Carey V.J.
        • et al.
        Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.
        N Engl J Med. 2009; 360: 859-873
        • Wadden T.A.
        • Sternberg J.A.
        • Letizia K.A.
        • Stunkard A.J.
        • Foster G.D.
        Treatment of obesity by very low calorie diet, behavior therapy, and their combination: A five-year perspective.
        Int J Obes. 1989; 13: 39-46
        • Cachelin F.M.
        • Regan P.C.
        Prevalence and correlates of chronic dieting in a multi-ethnic U.S. community sample.
        Eat Weight Disord. 2006; 11: 91-99
        • Neumark-Sztainer D.
        • Wall M.
        • Guo J.
        • Story M.
        • Haines J.
        • Eisenberg M.
        Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later?.
        J Am Diet Assoc. 2006; 106: 559-568
        • Pietilainen K.H.
        • Saarni S.E.
        • Kaprio J.
        • Rissanen A.
        Does dieting make you fat? A twin study.
        Int J Obes (Lond). 2011;
        • Wadden T.A.
        Treatment of obesity by moderate and severe caloric restriction. Results of clinical research trials.
        Ann Intern Med. 1993; 119: 688-693
        • Stice E.
        • Presnell K.
        • Spangler D.
        Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.
        Health Psychol. 2002; 21: 131-138
        • Stice E.
        • Burger K.
        • Yokum S.
        Caloric deprivation increases responsivity of attention and reward brain regions to intake, anticipated intake, and images of palatable foods.
        Neuroimage. 2013; 67: 322-330
        • Ackard D.M.
        • Croll J.K.
        • Kearney-Cooke A.
        Dieting frequency among college females: Association with disordered eating, body image, and related psychological problems.
        J Psychosom Res. 2002; 52: 129-136
        • Johnson F.
        • Wardle J.
        Dietary restraint, body dissatisfaction, and psychological distress: A prospective analysis.
        J Abnorm Psychol. 2005; 114: 119-125
        • Stice E.
        A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect.
        J Abnorm Psychol. 2001; 110: 124-135
        • Packard P.
        • Krogstrand K.S.
        Half of rural girls aged 8 to 17 years report weight concerns and dietary changes, with both more prevalent with increased age.
        J Am Diet Assoc. 2002; 102: 672-677
        • Bacon L.
        • Aphramor L.
        Weight science: Evaluating the evidence for a paradigm shift.
        Nutr J. 2011; 10: 9
        • Tribole E.
        • Resch E.
        Intuitive Eating: A Revolutionary Program that Works.
        3rd ed. St Martin's Press, New York, NY2012
        • Tylka T.L.
        Development and psychometric evaluation of a measure of intuitive eating.
        J Couns Psychol. 2006; 53: 226-240
        • Tylka T.L.
        • Kroon Van Diest A.M.
        The intuitive eating scale-2: Item refinement and psychometric evaluation with college women and men.
        J Couns Psychol. 2013; 60: 137-153
        • Hawks S.
        • Madanat H.
        • Hawks J.
        • Harris A.
        The relationship between intuitive eating and health indicators among college women.
        Am J Health Educ. 2005; 36: 331-336
        • Denny K.N.
        • Loth K.
        • Eisenberg M.E.
        • Neumark-Sztainer D.
        Intuitive eating in young adults. who is doing it, and how is it related to disordered eating behaviors?.
        Appetite. 2012;
        • Tylka T.L.
        • Wilcox J.A.
        Are intuitive eating and eating disorder symptomatology opposite poles of the same construct?.
        J Couns Psychol. 2006; 53: 474-485
        • Bacon L.
        • Stern J.S.
        • Van Loan M.D.
        • Keim N.L.
        Size acceptance and intuitive eating improve health for obese, female chronic dieters.
        J Am Diet Assoc. 2005; 105: 929-936
        • Gagnon-Girouard M.P.
        • Begin C.
        • Provencher V.
        • et al.
        Psychological impact of a “health-at-every-size” intervention on weight-preoccupied Overweight/Obese women.
        J Obes. 2010; 2010: 928097
        • Leblanc V.
        • Provencher V.
        • Begin C.
        • Corneau L.
        • Tremblay A.
        • Lemieux S.
        Impact of a health-at-every-size intervention on changes in dietary intakes and eating patterns in premenopausal overweight women: Results of a randomized trial.
        Clin Nutr. 2012; 31: 481-488
        • Provencher V.
        • Begin C.
        • Tremblay A.
        • Mongeau L.
        • Boivin S.
        • Lemieux S.
        Short-term effects of a “health-at-every-size” approach on eating behaviors and appetite ratings.
        Obesity (Silver Spring). 2007; 15: 957-966
        • Bacon L.
        • Keim N.L.
        • Van Loan M.D.
        • et al.
        Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors.
        Int J Obes Relat Metab Disord. 2002; 26: 854-865
        • Katzer L.
        • Bradshaw A.J.
        • Horwath C.C.
        • Gray A.R.
        • O'Brien S.
        • Joyce J.
        Evaluation of a “nondieting” stress reduction program for overweight women: A randomized trial.
        Am J Health Promot. 2008; 22: 264-274
        • Carrier K.M.
        • Steinhardt M.A.
        • Bowman S.
        Rethinking traditional weight management programs: A 3-year follow-up evaluation of a new approach.
        J Psychol. 1994; 128: 517-535
        • Steinhardt M.A.
        • Bezner J.R.
        • Adams T.B.
        Outcomes of a traditional weight control program and a nondiet alternative: A one-year comparison.
        J Psychol. 1999; 133: 495-513
        • Ciampolini M.
        • Lovell-Smith D.
        • Sifone M.
        Sustained self-regulation of energy intake. loss of weight in overweight subjects. maintenance of weight in normal-weight subjects.
        Nutr Metab (Lond). 2010; 7: 4
        • Dalen J.
        • Smith B.W.
        • Shelley B.M.
        • Sloan A.L.
        • Leahigh L.
        • Begay D.
        Pilot study: Mindful eating and living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity.
        Complement Ther Med. 2010; 18: 260-264
        • Timmerman G.M.
        • Brown A.
        The effect of a mindful restaurant eating intervention on weight management in women.
        J Nutr Educ Behav. 2012; 44: 22-28
        • Polivy J.
        • Herman C.P.
        Breaking the Diet Habit: The Natural Weight Alternative.
        Basic Books, New York, NY1985
        • Satter E.
        Eating competence: Definition and evidence for the Satter Eating Competence Model.
        J Nutr Educ Behav. 2007; 39: S142-S153
        • Savoye M.
        • Berry D.
        • Dziura J.
        • et al.
        Anthropometric and psychosocial changes in obese adolescents enrolled in a weight management program.
        J Am Diet Assoc. 2005; 105: 364-370
        • Allen H.N.
        • Craighead L.W.
        Appetite monitoring in the treatment of binge eating disorder.
        Behav Ther. 1999; 30: 253-272
        • Kristeller J.L.
        • Hallett C.B.
        An exploratory study of a meditation-based intervention for binge eating disorder.
        J Health Psychol. 1999; 4: 357-363
        • Kristeller J.L.
        • Wolever R.Q.
        Mindfulness-based eating awareness training for treating binge eating disorder: The conceptual foundation.
        Eat Disord. 2011; 19: 49-61
        • Hepworth N.S.
        A mindful eating group as an adjunct to individual treatment for eating disorders: A pilot study.
        Eat Disord. 2011; 19: 6-16
        • Albers S.
        Using mindful eating to treat food restriction: A case study.
        Eat Disord. 2011; 19: 97-107
        • Bannert B.
        • Schobersberger W.
        • Tran U.
        • Remmel A.
        The effectiveness of a nondiet multidisciplinary weight reduction program for severe overweight patients with psychological comorbidities.
        J Obes. 2011; 2011: 641351
        • Goodrick G.K.
        • Poston 2nd, W.S.
        • Kimball K.T.
        • Reeves R.S.
        • Foreyt J.P.
        Nondieting versus dieting treatment for overweight binge-eating women.
        J Consult Clin Psychol. 1998; 66: 363-368
        • Munsch S.
        • Biedert E.
        • Keller U.
        Evaluation of a lifestyle change programme for the treatment of obesity in general practice.
        Swiss Med Wkly. 2003; 133: 148-154
        • Nauta H.
        • Hospers H.
        • Jansen A.
        One-year follow-up effects of two obesity treatments on psychological well-being and weight.
        Br J of Health Psychol. 2001; 6: 271-284
        • Rapoport L.
        • Clark M.
        • Wardle J.
        Evaluation of a modified cognitive-behavioural programme for weight management.
        Int J Obes Relat Metab Disord. 2000; 24: 1726-1737
        • Miller W.C.
        Cardiovascular risk reduction in a self-taught self-administered weight loss program called the nondiet diet.
        Med Exercise Nutr Health. 1993; 2: 218-223
        • Tapper K.
        • Shaw C.
        • Ilsley J.
        • Hill A.J.
        • Bond F.W.
        • Moore L.
        Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women.
        Appetite. 2009; 52: 396-404
        • Lowe M.R.
        • Foster G.D.
        • Kerzhnerman I.
        • Swain R.M.
        • Wadden T.A.
        Restrictive dieting vs. “undieting” effects on eating regulation in obese clinic attenders.
        Addict Behav. 2001; 26: 253-266
        • Carroll S.
        • Borkoles E.
        • Polman R.
        Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome.
        Appl Physiol Nutr Metab. 2007; 32: 125-142
        • Ciliska D.
        Evaluation of two nondieting interventions for obese women.
        West J Nurs Res. 1998; 20: 119-135
        • Cole R.E.
        • Horacek T.
        Effectiveness of the “my body knows when” intuitive-eating pilot program.
        Am J Health Behav. 2010; 34: 286-297
        • Tanco S.
        • Linden W.
        • Earle T.
        Well-being and morbid obesity in women: A controlled therapy evaluation.
        Int J Eat Disord. 1998; 23: 325-339
        • Higgins L.C.
        • Gray W.
        Changing the body image concern and eating behaviour of chronic dieters: The effects of a psychoeducational intervention.
        Psychol Health. 1998; 13: 1045-1060
        • Jackson E.G.
        Eating order: A 13-week trust model class for dieting casualties.
        J Nutr Educ Behav. 2008; 40: 43-48
        • Mellin L.
        • Croughan-Minihane M.
        • Dickey L.
        The solution method: 2-year trends in weight, blood pressure, exercise, depression, and functioning of adults trained in development skills.
        J Am Diet Assoc. 1997; 97: 1133-1138
        • Polivy J.
        • Herman C.P.
        Undieting: A program to help people stop dieting.
        Int J Eat Disord. 1992; 11: 261-268
        • Omichinski L.
        • Harrison K.R.
        Reduction of dieting attitudes and practices after participation in a non-diet lifestyle program.
        J Can Diet Assoc. 1995; 56: 81-85
        • Roughan P.F.
        • Seddon E.F.
        • Vernon-Roberts J.
        Long-term effects of a psychologically based group programme for women preoccupied with body weight and eating behaviour.
        Int J Obes. 1990; 14: 135-147
        • Smith B.W.
        • Shelley B.M.
        • Leahigh L.
        • Vanleit B.
        A preliminary study of the effects of a modified mindfulness intervention on binge eating.
        J Evidence-Based Complementary Alternative Med. 2006; 11: 133-143
        • Provencher V.
        • Begin C.
        • Tremblay A.
        • et al.
        Health-at-every-size and eating behaviors: 1-year follow-up results of a size acceptance intervention.
        J Am Diet Assoc. 2009; 109: 1854-1861
        • Smith T.S.
        • Hawks S.R.
        Intuitive eating, diet composition, and the meaning of food in healthy weight promotion.
        Am J Health Educ. 2006; 37: 130-136
        • Mercurio A.
        • Rima B.
        Watching my weight: Self-weighing, body surveillance, and body dissatisfaction.
        Sex Roles. 2011; 65: 47-55
        • Hawley G.
        • Horwath C.
        • Gray A.
        • et al.
        Sustainability of health and lifestyle improvements following a non-dieting randomised trial in overweight women.
        Prev Med. 2008; 47: 593-599
        • Walker S.N.
        • Sechrist K.R.
        • Pender N.J.
        The Health-Promoting Lifestyle Profile: Development and psychometric characteristics.
        Nurs Res. 1987; 36: 76-81
        • Greaves C.J.
        • Sheppard K.E.
        • Abraham C.
        • et al.
        Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions.
        BMC Public Health. 2011; 11: 119
        • Sharma M.
        Behavioural interventions for preventing and treating obesity in adults.
        Obes Rev. 2007; 8: 441-449
        • Green L.
        • Kreuter M.
        Health Promotion Planning: An Educational and Environmental Approach.
        2nd ed. Mayfield Publishing Company, Mountain View, CA1991
        • Felix-Redondo F.J.
        • Grau M.
        • Baena-Diez J.M.
        • et al.
        Prevalence of obesity and associated cardiovascular risk: The DARIOS study.
        BMC Public Health. 2013; 13: 542
        • Harriger J.A.
        • Thompson J.K.
        Psychological consequences of obesity: Weight bias and body image in overweight and obese youth.
        Int Rev Psychiatry. 2012; 24: 247-253
        • Dalle Grave R.
        • Calugi S.
        • Molinari E.
        • et al.
        Weight loss expectations in obese patients and treatment attrition: An observational multicenter study.
        Obes Res. 2005; 13: 1961-1969
        • Avalos L.C.
        • Tylka T.L.
        Exploring a model of intuitive eating with college women.
        J Couns Psychol. 2006; 53: 486-497
        • Augustus-Horvath C.L.
        • Tylka T.L.
        The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood.
        J Couns Psychol. 2011; 58: 110-125
        • Framson C.
        • Kristal A.R.
        • Schenk J.M.
        • Littman A.J.
        • Zeliadt S.
        • Benitez D.
        Development and validation of the mindful eating questionnaire.
        J Am Diet Assoc. 2009; 109: 1439-1444
        • Brown K.W.
        • Ryan R.M.
        The benefits of being present: Mindfulness and its role in psychological well-being.
        J Pers Soc Psychol. 2003; 84: 822-848
        • Grossman P.
        • Niemann L.
        • Schmidt S.
        • Walach H.
        Mindfulness-based stress reduction and health benefits: A meta-analysis.
        J Psychosom Res. 2004; 57: 35-43
        • Dittmann K.A.
        • Freedman M.R.
        Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga.
        Eat Disord. 2009; 17: 273-292
        • Hawks S.R.
        • Merrill R.M.
        • Madanat H.
        The intuitive eating scale: Development and preliminary validation.
        Am J Health Educ. 2004; 35: 90-99
        • Gast J.
        • Madanat H.
        • Nielson A.C.
        Are men more intuitive when it comes to eating and physical activity?.
        Am J Mens Health. 2012; 6: 164-171

      Biography

      J. T. Schaefer is a doctoral candidate, Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH.

      Biography

      A. B. Magnuson is health promotion director and an adjunct faculty member, Department of Nutrition, Food, and Exercise Sciences, College of Human Sciences, Florida State University, Tallahassee.