I wrote this review of a study a few years ago as part of an application. Then I thought I would publish it, but I didn’t. Here I go again… remembering progress over perfection… I welcome your thoughts on the review.
Intuitive eating is one of the frameworks I use to support my clients in healing their relationship with food. But did you know there is a validated (scientifically proven to work) questionnaire that can determine how intuitive your eating pattern is?
But no measurement tool is perfect. Many nutritionists and dietitians know that this is often the case among ethnic minority populations. A 2019 study in Appetite shared that even validated tools like the Intuitive Eating Scale-2 (IES-2) was not a useful measure of how intuitively a predominantly Black study population ate. And why was that?
Khalsa and the team recognised that in the test group of 204 parents from low-income households, the original 4-section IES-2 did not test well against other measures of body image such as body-image dissatisfaction score and BMI. So they developed a few modified versions of the IES-2 for the study population, with their 6-factor modified Intuitive Eating Scale-2 (mIES-2) being the most feasible indicator of Intuitive Eating. It reorganised questions into 6-subscales, with several labelled negatively, matching perceptions of healthy eating behaviours:Avoiding Forbidden FoodsPermission to EatAvoiding Emotional EatingAvoiding Food-Related Coping StrategiesReliance on Hunger and Satiety CuesBody-Food Congruence
According to this modified questionnaire, the higher your intuitive eating score, the more satisfied you were with your body image. While lower body-image dissatisfaction scores were linked to participants who were less likely to avoid “forbidden foods”. Interestingly, participants who gave themselves permission to eat freely had lower BMI too.
But why did re-rigging the scale work? Intuitive eating is a weight-neutral health approach developed by dietitians Evelyn Tribole and Elyse Resch in 1995. Its 10 Principles help to remove challenges to body awareness like giving oneself permission to eat without any rules or conditions. And while this may appear simple for a middle-class family, socioeconomic factors such as food insecurity influence people’s idea of what permission to eat and food restriction look like. In this study, it was evident that the dynamics of feeding a family on a small budget can present challenges to intuitive eating when measured with the original IES-2 questionnaire.
That’s even without considering cultural differences. A similar study with Hispanic participants mentioned in this research, also noted that the IES-2 scale was unable to accurately show how intuitive these persons ate. Differences in cultural perceptions of food can also influence individuals, as diet culture often promotes a narrow selection of diets and foods as healthy.
So does the IES-2 support Black, Asian and other ethnic minorities? How can we provide more support to these groups?
This study was a good start but missed the opportunity to test for associations between their modified scale and disordered eating, as well as body appreciation. Both of which are critical facets of Intuitive Eating. While it was noteworthy that the population was majorly Black (71%), the small study population was 90% female, so these results may not be fully representative. Studies like this continue to prove why it’s critical to have diversity in Nutrition and Dietetics!
I am keen to see what further research shows, especially qualitative studies within all cultural and socioeconomic groups. In the meantime, I’ll be doing my best to support my clients through their healing journey; obviously using the intuitive eating approach with a good dose of Bajan culture!
Written June 2021. Updated January 2025.
References
Factor structure of the Intuitive Eating Scale-2 among a low-income and racial minority population (Amrik Singh Khalsa, Cathy Odar Stough, Katlyn Garr, Kristen A. Copeland,Roohi Y. Kharofa, Jessica G. Woo., 2019 https://pubmed.ncbi.nlm.nih.gov/31374242/