Intuitive Eating Practices among African-American Women Living with Type 2 Diabetes: A Qualitative Study

Published:April 01, 2014DOI:


      Intuitive eating programs that improve self-efficacy and dietary habits could enhance glycemic control in African-American women with type 2 diabetes. The goal of our study was to investigate how current eating practices and beliefs of African-American women living with diabetes aligned with intuitive eating concepts. African-American women with type 2 diabetes referred for diabetes education class during 2009-2012 were recruited for a qualitative study using focus groups for data collection. Verbatim group transcriptions were analyzed by two independent reviewers for themes using a combined inductive-deductive approach. Participants (n=35) had an average age 52±9 years, mean body mass index 39±7, and mean time with a type 2 diabetes diagnosis of 10±10 years. Participants' self-reported dietary practices were poorly aligned with intuitive eating concepts. The women reported a lack of self-control with food and regularly eating in the absence of hunger, yet stated that the determinant factor for when to stop eating was to recognize a feeling of fullness. Participants reported knowing they were full when they felt physically uncomfortable or actually became sick. Women frequently cited the belief that individuals with diabetes have to follow a different diet than that recommended for the general public. Many women also discussed diabetes-related stigma from family/friends, and often did not tell others about their diabetes diagnosis. These findings demonstrate that intuitive eating techniques are not currently applied by the women in this sample. Future studies should assess the influence of intuitive eating interventions on dietary habits among low-income African-American women with type 2 diabetes.


      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 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


        • Cowie C.C.
        • Rust K.F.
        • Ford E.S.
        • et al.
        Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006.
        Diabetes Care. 2009; 32: 287-294
        • Sargrad K.R.
        • Homko C.
        • Mozzoli M.
        • Boden G.
        Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus.
        J Am Diet Assoc. 2005; 105: 573-580
        • Sumlin L.L.
        • Garcia A.A.
        Effects of food-related interventions for African American women with type 2 diabetes.
        Diabetes Educ. 2012; 38: 236-249
        • McNabb W.L.
        • Quinn M.T.
        • Rosing L.
        Weight loss program for inner-city black women with non-insulin-dependent diabetes mellitus: PATHWAYS.
        J Am Diet Assoc. 1993; 93: 75-77
        • Flegal K.M.
        • Carroll M.D.
        • Kit B.K.
        • Ogden C.L.
        Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.
        JAMA. 2012; 307: 491-497
        • Gavin 3rd, J.R.
        • Fox K.M.
        • Grandy S.
        Race/Ethnicity and gender differences in health intentions and behaviors regarding exercise and diet for adults with type 2 diabetes: A cross-sectional analysis.
        BMC Public Health. 2011; 11: 533
        • Tyler D.O.
        • Allan J.D.
        • Alcozer F.R.
        Weight loss methods used by African American and Euro-American women.
        Res Nurs Health. 1997; 20: 413-423
        • Huffman F.G.
        • De La Cera M.
        • Vaccaro J.A.
        • et al.
        Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes.
        J Nutr Metab. 2011; : 1-8
        • 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
        • Cole R.E.
        • Horacek T.
        Effectiveness of the “My Body Knows When” intuitive-eating pilot program.
        Am J Health Behav. 2010; 34: 286-297
        • Tribole E.R.
        • E
        Intuitive Eating: A Revolutionary Program that Works.
        St Martin's Press, New York, NY2003
        • Mathieu J.
        What should you know about mindful and intuitive eating?.
        J Am Diet Assoc. 2009; 109: 1982-1987
        • 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
        • 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
        • Miller C.K.
        • Kristeller J.L.
        • Headings A.
        • Nagaraja H.
        • Miser W.F.
        Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study.
        J Am Diet Assoc. 2012; 112: 1835-1842
        • Graneheim U.H.
        • Lundman B.
        Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness.
        Nurse Educ Today. 2004; 24: 105-112
        • Miles M.B.H.
        • M.A
        Qualitative Data Analysis: An Expanded Sourcebook.
        2nd ed. SAGE Publications, Inc, Thousand Oaks, CA1994
        • Cohen D.J.
        • Crabtree B.F.
        Evaluative criteria for qualitative research in health care: Controversies and recommendations.
        Ann Fam Med. 2008; 6: 331-339
        • Pope C.
        • Mays N.
        Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research.
        BMJ. 1995; 311: 42-45
        • Brewer E.A.
        • Kolotkin R.L.
        • Baird D.D.
        The relationship between eating behaviors and obesity in African American and Caucasian women.
        Eat Behav. 2003; 4: 159-171
        • Bhattacharya G.
        Self-management of type 2 diabetes among African Americans in the Arkansas Delta: A strengths perspective in social-cultural context.
        J Health Care Poor Underserved. 2012; 23: 161-178
        • Bhattacharya G.
        Psychosocial impacts of type 2 diabetes self-management in a rural African American population.
        J Immigr Minor Health. 2012; 14: 1071-1081
        • Kumanyika S.
        • Wilson J.F.
        • Guilford-Davenport M.
        Weight-related attitudes and behaviors of black women.
        J Am Diet Assoc. 1993; 93: 416-422
        • Myers H.F.
        • Kagawa-Singer M.
        • Kumanyika S.K.
        • Lex B.W.
        • Markides K.S.
        Behavioral risk factors related to chronic diseases in ethnic minorities.
        Health Psychol. 1995; 14: 613-621
        • Epstein D.E.
        • Sherwood A.
        • Smith P.J.
        • et al.
        Determinants and consequences of adherence to the Dietary Approaches to Stop Hypertension Diet in African American and white adults with high blood pressure: Results from the ENCORE Trial.
        J Am Diet Assoc. 2012; 112: 1763-1773
        • Chlebowy D.O.
        • Hood S.
        • LaJoie A.S.
        Facilitators and barriers to self-management of type 2 diabetes among urban African American adults: Focus group findings.
        Diabetes Educ. 2010; 36: 897-905
        • Hunt C.W.
        • Wilder B.
        • Steele M.M.
        • Grant J.S.
        • Pryor E.R.
        • Moneyham L.
        Relationships among self-efficacy, social support, social problem solving, and self-management in a rural sample living with type 2 diabetes mellitus.
        Res Theory Nurs Pract. 2012; 26: 126-141
        • Egede L.E.
        Beliefs and attitudes of African Americans with type 2 diabetes toward depression.
        Diabetes Educ. 2002; 28: 258-268
        • Vyavaharkar M.
        • Moneyham L.
        • Murdaugh C.
        • Tavakoli A.
        Factors associated with quality of life among rural women with HIV disease.
        AIDS Behav. 2012; 16: 295-303


      A. L. Willig is an assistant professor, Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham.


      B. S. Richardson is a medical student, Department of Medicine, University of Alabama at Birmingham.


      A. Agne is a research coordinator, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham.


      A. Cherrington is an assistant professor, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham.