HEALTH & WELLBEING statistical association between eating for physical rather than emotional reasons and HBa1c. In general, those with T1DM had a lower overall IE score than a control group. This may be expected, as those with T1DM may have been required to override their natural hunger/fullness in order to manage their blood glucose levels. The researchers highlight the potential to use this research to screen for emotional eating behaviours in those with T1DM in order to improve HBa1c outcomes. In Type 2 diabetes (T2DM), IE has been linked with enhanced glycaemic control in AfricanAmerican women with T2DM.14 This research also highlighted some confusion around dietary interventions in T2DM and the effects of stigma in healthcare. EATING DISORDERS
As chronic dieting and disordered eating can affect the ability to acknowledge innate hunger and fullness cues, there has been much interest in the application of IE in the treatment of eating disorders (ED). IE has been shown to be linked for positive outcomes for ED patients, including anorexia nervosa and bulimia nervosa.15 A mixed-sex study has also shown that although IE is again inversely associated with BMI in both reported sexes, it is also inversely associated with binge eating and other disordered eating behaviours: ‘Males and females who reported trusting their body to tell them how much to eat had lower odds of utilising disordered eating behaviours compared with those who did not have this trust.’16 There is also some promising evidence that IE interventions may be useful in preventing the development of disordered eating, though, again, it may be difficult to apply these results to a wider population. OTHER OUTCOMES FROM IE
Those who participate in IE studies report better psychological wellbeing, self-esteem, body appreciation and, in general, attrition rates are lower than with traditional dietary interventions.17,18 Women who show higher levels of IE have also been shown to be less likely to display disordered eating patterns and have better body image,19 although the majority of these studies have been cross-sectional and carried out at universities in 38
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the United States. Further prospective studies in a wider population are needed. LIMITATIONS
The efficacy of IE public health interventions is unclear, largely due to the difficulties of applying and assessing the principles in public health settings. There is also only limited application of the principles in those with low incomes and reduced food choices, as food scarcity and the need to eat for survival overrides the likelihood or need to eat intuitively. This does present limitations to the application of IE when compared with other interventions, though some aspects of IE may potentially be applied in some circumstances, ie, addressing food rules and body acceptance. Guidance when following the principles of IE is recommended for those with any medical condition, or with a history of disordered eating. SUMMARY
There is mounting evidence that being a more intuitive eater is associated with a host of holistic benefits, including improved psychological outcomes, reductions in binge eating and disordered eating, self-compassion and body acceptance. There is some evidence to support the use of IE in improving HbA1c in those with diabetes (T1DM and T2DM) - though further research is needed. Although IE is not intended to be a primary outcome measure for an ED intervention, it may be a useful tool in developing long-term behaviour changes around food and activity that could attenuate further weight gain and bring health benefits independent of any weight changes. Further research is needed into the effectiveness of IE as an intervention or assessment tool in a number of chronic conditions where eating is limited and rates of disordered eating may be high, such as with coeliac disease and inflammatory bowel disease. Overall, IE appears not to be harmful for those who undertake it, though supervision and guidance is advised for those with any medical condition, or for those with a history of or potential susceptibility to disordered eating. The approach doesn’t seek to replace traditional clinical thinking, but, instead, focuses on improving potentially disordered relationships with food.