Internal Hunger Research Articles

Impulsivity and overeating in children in the absence and presence of hunger

Overweight children appear to be more responsive to environmental, hedonic cues and easily overeat in the current obesogenic environment. They are also found to overeat in the absence of hunger, and this overeating seems related to impulsivity: impulsive participants are more prone to external eating. However, some studies showed that impulsive adults are also more prone to hunger cues: impulsive participants overate especially when feeling hungry. This would mean impulsive people are more reactive to both external and internal cues. The overeating was limited to palatable high energy-dense foods: hunger made them fancy a snack. In the current study, we wanted to test the interaction between impulsivity, hunger and consumption of food type in children. Impulsivity was measured in 88 children between the ages of 7 and 9. Next, half of the participants performed a taste test before their own regular lunch and half of the participants immediately after their lunch. During the taste test, low, medium and high energy-dense food items were presented. Results showed that impulsive children ate more high energy-dense foods than low impulsive children, both before and after their lunch. No differences were found on low or medium energy-dense foods. Impulsive children therefore showed normal sensitivity for internal hunger and satiety cues, but abnormal response to high energy-dense foods. This might render them vulnerable to tasty temptation in the environment and to weight gain in their future.

Educator Interactions at Head Start Lunches: A Context for Nutrition Education

Early childhood educators in center‐based care share lunch with preschool children over 150 times in a school year. Unfortunately, research shows that, in terms of nutrition education, lunch is a missed opportunity (Larson et al., 2011). Worse, educator behaviors were often negative in a landmark 2001 study of Head Start (Gable & Lutz, 2001). The current study examined Head Start educators lunchtime interactions with children with the goal of (a) updating the state of mealtimes in the Head Start setting and (b) expanding observations to a greater number of classrooms (n =21) across different centers (n= 7).Lunch observations were conducted by observers who were trained to code phrases by lead and assistant teachers into either 4 positive or 4 negative categories. A broad category related to behavior management was also recorded when firm directives, not appropriate transitions, were used. Interrater reliability of 85% or greater was obtained for all observers.Table 1 presents the mean number of times each target interaction was observed. Lead teachers were more positive than assistant teachers in their comments and generally more vocal. On average, 54% of lead teachers and 61% of assistant teachers' comments were not supportive of a healthy, nurturing food environment.Findings illustrate that a high proportion of interactions at Head Start meals between educator and child are either negative or focused on behavioral control (57% of total comments). Children were commanded to eat 4 times more frequently than they were directed to internal hunger cues. This descriptive, naturalistic, observational study highlights the continued need for improved policy and training for educators acting as role models for at‐risk children. Table 1. Frequency of Educator Interactions by Teacher Role LEAD ASSISTANT TOTAL Positive Language Positive comments about food served (e.g., I am really enjoying the carrots today. Yummy!) 4.64 3.29 7.93 Hunger cues (e.g., Are you full? How does your belly feel?) 1.50 1.00 2.50 Encourage trying in a positive way (e.g., Would you like to try the peas? Peas are good for our bodies.) 4.38 2.25 6.63 Exploring foods (e.g., What does it smell like? How does it feel in your mouth?) 3.39 2.15 5.54 Negative Language Pressure to eat (e.g., Eat your food. Take a bite. Clean your plate.) 6.22 4.17 10.39 Threats to encourage eating (e.g., If you don't eat, you'll be over here by yourself.) 0.45 0.39 0.84 Discourage manipulating food (e.g., Use your manners. Eat, don't play. That's sticky and nasty.) 1.81 2.26 4.07 Hurry to finish eating (e.g., We're waiting on you. Let's hurry so we can go to recess.) 1.10 1.02 2.12 Behavior Language Focus on behavioral control (e.g., Turn around. Sit up straight. Hands in your lap.) 6.89 5.75 12.64

Intuitive eating: an emerging approach to eating behavior.

In an effort to treat obesity, health care professionals pursue, by means of dieting and exercise interventions, weight loss as a primary goal of treatment. Although in few cases these interventions induce shortterm moderate weight loss, in the long-term, the efficacy of these treatments is at least questionable. Weight-loss interventions based on restrictive diets may be associated to adverse health and well-being. In this regard, some researchers have considered shifting the focus of obesity treatment into a health-centered paradigm. Among the models derived from this new paradigm, Health at Every Size (HAES) is one of the most referenced. HAES has enhanced intuitive eating as a core component of the paradigm, which refers to the reliance on biological mechanisms to regulate food intake (i.e., internal hunger and satiety cues). Recently, intuitive eating has been winning recognition since it have been associated with numerous indices of physical and psychological well-being, and noteworthy, it have not been related to any adverse effects. The present paper reviews the concept of intuitive eating, as well as the existing evidence that upholds this emerging approach. Also, it discusses the implication of shifting the focus of dietetic interventions into a health-centered paradigm. Narrative Review. Although it is certain there is a need to extend current research on health-centered interventions, this approach may be a more promising and realistic alternative to address overweight and obesity than the conventional weight-loss treatments.

Erratum to: Call for an urgent rethink of the 'health at every size’ concept

Sainsbury and Hay [1] did not cite a source for ‘Healthat Every Size’ in the original article. The following wassourced from the Association for Size Diversity andHealth (ASDH) website, accessed on 23rd March 2014:https://www.sizediversityandhealth.org/content.asp?id=152.“The Health At Every Size® Principles are:1. Weight Inclusivity: Accept and respect the inherentdiversity of body shapes and sizes and reject theidealizing or pathologizing of specific weights.2. Health Enhancement: Support health policies thatimprove and equalize access to information andservices, and personal practices that improve humanwell-being, including attention to individual physical,economic, social, spiritual, emotional, and otherneeds.3. Respectful Care: Acknowledge our biases, and workto end weight discrimination, weight stigma, andweight bias. Provide information and services froman understanding that socio-economic status, race,gender, sexual orientation, age, and other identitiesimpact weight stigma, and support environmentsthat address these inequities.4. Eating for Well-being: Promote flexible,individualized eating based on hunger, satiety,nutritional needs, and pleasure, rather than anyexternally regulated eating plan focused on weightcontrol.5. Life-Enhancing Movement: Support physicalactivities that allow people of all sizes, abilities, andinterests to engage in enjoyable movement, to thedegree that they choose.”While we subscribe to and support most of the above-mentioned principles, in particular the high importanceof ending weight stigma and weight bias, the article waswritten to address issues related to Principles 1 and 4.With regards to Principle 1, and for the reasons out-lined in our commentary, we respectfully disagree that itis possible to be - or to stay - truly healthy with body weightsoutside of certain thresholds.With respect to Principle 4, we believe that externallyregulated eating plans and/or an explicit focus on weightcontrol are necessary in some situations for people to at-tain or maintain a healthy body weight. While we our-selves frequently draw on principles such as eatingaccording to appetite and pleasure in our clinical prac-tice and research, there are situations where intuitiveeating plans per se do not result in loss of excess weight.For instance, such intuitive eating plans - while promotingpsychological health - have shown disappointing resultswith respect to weight loss in clinical trials [2]. We be-lieve it is most likely that intuitive eating plans need tobe combined with some elements of structured, exter-nally regulated dietary programs in order to produce re-liable weight loss. Such elements may include a specificfocus on choosing certain types of foods in preference toothers [3,4], keeping a written record of hunger and sati-ety levels and eating only within externally-prescribedhunger levels [5], or heeding biofeedback on markers ofphysical hunger, such as blood glucose levels [6]. Giventhe challenges of adhering to such requirements, par-ticularly in today’s obesogenic environment, many adults(but not children) may benefit from an explicit focus onweight loss in order to promote adherence.In addition to a lack of robust or reliable weight lossunless combined with aspects of externally regulated eating,ad libitum eating plans are not suitable for people whoprefer to follow more structured weight loss plans, orfor whom internal hunger regulation may be disrupted,perhaps due to the hypothesised hypothalamic changesoutlined in our commentary. Many people with a body massindex in the obese range may indeed benefit from severeand highly externally regulated weight loss strategies suchas very low energy diets [7,8] and bariatric surgery [9,10].

Effect of sensory-based intervention on the increased use of food-related descriptive terms among restrained eaters

The goals of this pilot randomized controlled trial were to investigate and determine whether sensory-based intervention influenced the number and type of terms (descriptive and hedonic) used by restrained women to describe a certain food, and whether changes in the number of descriptive terms were associated with changes in intuitive eating. We collected data at baseline (T=1), at the end of the intervention period (T=2), and at 12weeks post-intervention (T=3) using the descriptive form and Intuitive Eating Scale (IES). At T=1, 50 women were randomly assigned to an intervention group (sensory-based intervention) or a control group (waiting list). To determine the effect of intervention over time on the number of descriptive and hedonic terms, we conducted statistical analyses using mixed models. To determine associations between Intuitive Eating Scale subscales and the number of descriptive terms, we also calculated Spearman correlation coefficients. We noted a significant group-by-time interaction for descriptive terms associated with all senses (p<0.04), except for a sight-related trend (p=0.06). In comparison with T=1, intervention group women at T=2 and T=3 showed a significant increase in descriptive terms associated with smell (p=0.0002 and p=0.03, respectively), taste (p=0.001 and p=0.01, respectively) and hearing (p=0.04 and p=0.0003, respectively). Among intervention group women, we noted a positive correlation between changes (T=3 vs. T=2) in the number of descriptive terms used and changes in reliance on internal hunger and satiety cues (r=0.48; p=0.04), as well as between changes (T=3 vs. T=1) in the number of descriptive terms used and changes in unconditional permission to eat (r=0.45; p=0.05). Overall, these data show that sensory-based intervention may help restrained women become more objective and enjoyably connected to food and their own bodies, which may promote a more intuitive approach to eating.

Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index

Intuitive eating is relevant for adaptive eating, body weight and well-being and impairments are associated with dieting and eating disorders. It is assumed to depend on the ability to recognize one’s signs of hunger and fullness and to eat accordingly. This suggests a link to the individual ability to perceive and processes bodily signals (interoceptive sensitivity, IS) which has been shown to be associated with emotion processing and behavior regulation. This study was designed to clarify the relationships between IS as measured by a heartbeat perception task, intuitive eating and body mass index (BMI) in N=111 healthy young women. Intuitive eating was assessed by the Intuitive Eating Scale (IES) with three facets, reliance on internal hunger and satiety cues (RIH), eating for physical rather than emotional reasons (EPR), and unconditional permission to eat when hungry (UPE). IS was not only positively related to total IES score and RIH and EPR, and negatively predicted BMI, but also proved to fully mediate the negative relationship between RIH, as well as EPR and BMI. Additionally, the subjective appraisal of one’s interoceptive signals independently predicted EPR and BMI. IS represents a promising mechanism in research on eating behavior and body weight.

Reduced Taste Sensitivity in Congenital Blindness

Sight is undoubtedly not only important for food identification and selection but also for the modulation of gustatory sensitivity. We can, therefore, assume that taste sensitivity and eating habits are affected by visual deprivation from birth. We measured taste detection and identification thresholds of the 5 basic tastants in 13 congenitally blind and 13 sighted control subjects. Participants also answered several eating habits questionnaires, including the Food Neophobia Scale, the Food Variety Seeking Tendency Scale, the Intuitive Eating Scale, and the Body Awareness Questionnaire. Our behavioral results showed that compared with the normal sighted, blind subjects have increased thresholds for taste detection and taste identification. This finding is at odds with the superior performance of congenitally blind subjects in several tactile, auditory and olfactory tasks. Our psychometric data further indicate that blind subjects more strongly rely on internal hunger and satiety cues, instead of external contextual or emotional cues, to decide when and what to eat. We suggest that the lower taste sensitivity observed in congenitally blind individuals is due to various blindness-related obstacles when shopping for food, cooking and eating out, all of which contribute to underexpose the gustatory system to a larger variety of taste stimuli.

Perceived hunger mediates the relationship between attachment anxiety and emotional eating

Eating is an inherently emotional activity and the attachment system is an emotion regulation system. Individuals with attachment insecurity have less interoceptive awareness and difficulty regulating emotion. Insecurely attached individuals may eat emotionally because they misinterpret internal hunger cues, (i.e. think they are hungry when they are experiencing some other internal, attachment-related state). The current study found a positive association between attachment anxiety and emotional eating. This relationship was mediated by perceived hunger.

Desire for Very Low Weight May Be Associated with Unexplainable Obesity Stress and Depression in Female Adolescents without Being Overweight

Objective: To explore relationships between factors that affect food intake and weight status of active-duty service members. Design, Setting and Participants: A cross-sectional design in which service members from Joint Base Lewis McChord, Washington completed a demographic/behavior survey and 2 validated surveys, Intuitive Eating Scale (IES) and Motivation for Eating Scale (MFES). Height and weight of each participant were measured, body mass index (BMI) was calculated, and participants were grouped by BMI as normal weight or overweight. Outcome Measures and Analysis: The primary outcome was the correlation between IES/MFES scores and BMI. Secondaryoutcomes, fromthedemographic/behavior survey, evaluated whether other factors (sleep, medication, dietary behaviors, weight loss efforts, etc) influenced IES/ MFES scores. Results: A total of 88 service members completed surveys (normal weight n 1⁄4 51, overweight n 1⁄4 37; 84% men; mean age 28.3 7.61 years; mean BMI 27.5 4.45 kg/m). There was a significant negative inverse relationship between BMI group and both IES total score (r 1⁄4 0.214; P 1⁄4 .013) and a subscale of the IES (r 1⁄4 0.263; P 1⁄4 .046). Significant secondary outcomes, compared with those of the weight status group, included individuals currently dieting (r1⁄4 0.504; P< .001), trying to lose weight (r1⁄4 0.445; P< .001), receivingmedications (r1⁄4 0.211; P 1⁄4 .048), who skip meals (r 1⁄4 0.240; P 1⁄4 .03), who gained weight (r 1⁄4 0.343; P 1⁄4 .001), and who experienced no weight change (r 1⁄4 0.410; P < .001). Conclusions and Implications: The predominance of men in the study was representative of military demographics. Relying on internal hunger and satiety cues decreased the likelihood of being overweight. Compensation of eating habits via frequency of physical activity was not present between groups. Weight management counseling should emphasize recognition rationale behind eating patterns and promote reliance on physiological cues. Funding: None.

Testing the Acceptance Model of Intuitive Eating With College Women Athletes

Intuitive eating is an adaptive eating style that involves eating for physical rather than emotional reasons, reliance on internal hunger and satiety cues, and lack of restriction in eating. In our study, the authors tested the acceptance model of intuitive eating with 160 college women athletes from Division I and Division II schools, using path analysis and controlling for body mass index. Similar to a previous study with general college women, the model provided an excellent fit to the data. These results support the hypothesis that perceived acceptance from others indirectly contributes to intuitive eating through college women athletes’ attitudes toward their bodies. For college women athletes, body acceptance by coaches, trainers, and teammates predicted athletes’ own body appreciation, which in turn, predicted their eating style. These findings suggest ways for coaches and counselors to help women athletes enhance their body appreciation and improve their eating. These results also indicate the need for researchers to further explore women athletes’ eating styles and attitudes toward their bodies.

Correlation between Ventromedial Prefrontal Cortex Activation to Food Aromas and Cue-driven Eating: An fMRI Study.

Food aromas are signals associated with both food's availability and pleasure. Previous research from this laboratory has shown that food aromas under fasting conditions evoke robust activation of medial prefrontal brain regions thought to reflect reward value (Bragulat, et al. 2010). In the current study, eighteen women (eleven normal-weight and seven obese) underwent a two-day imaging study (one after being fed, one while fasting). All were imaged on a 3T Siemens Trio-Tim scanner while sniffing two food (F; pasta and beef) odors, one non-food (NF; Douglas fir) odor, and an odorless control (CO). Prior to imaging, participants rated hunger and perceived odor qualities, and completed the Dutch Eating Behavior Questionnaire (DEBQ) to assess "Externality" (the extent to which eating is driven by external food cues). Across all participants, both food and non-food odors (compared to CO) elicited large blood oxygenation level dependent (BOLD) responses in olfactory and reward-related areas, including the medial prefrontal and anterior cingulate cortex, bilateral orbitofrontal cortex, and bilateral piriform cortex, amygdala, and hippocampus. However, food odors produced greater activation of medial prefrontal cortex, left lateral orbitofrontal cortex and inferior insula than non-food odors. Moreover, there was a significant correlation between the [F > CO] BOLD response in ventromedial prefrontal cortex and "Externality" sub-scale scores of the DEBQ, but only under the fed condition; no such correlation was present with the [NF > CO] response. This suggests that in those with high Externality, ventromedial prefrontal cortex may inappropriately valuate external food cues in the absence of internal hunger.

Self-Regulation and the Management of Childhood Obesity

Failure in self-regulation has been proposed as a moderator in the development of overweight and obesity, primarily through its effects on deregulated eating behavior. As a result, it might cause regulatory problems in the energy balance, as well as rapid weight gain from early childhood through adolescence. Self-control is the exertion of control over the self by the self. Self-control occurs when a person (or other organism) attempts to change the way he or she would otherwise think, feel, or behave. Thus, self-control may be view as part of self-regulation. Parents and health care providers face the challenge of helping children practice regulation and develop coping skills alongside the ability to take care of their own well-being. This paper attempts to bridge the gap between self-control theories and interventions for the management of childhood obesity. The dietary restriction approach will be compared with the trust paradigm, which emphasizes children’s internal hunger, satiety cues and a division of responsibilities between parents and children.

“Are you done?” Child Care Providers' Verbal Communication at Mealtimes That Reinforce or Hinder Children's Internal Cues of Hunger and Satiation

Objective To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. Methods Video observation transcripts of Head Start staff (n = 29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. Results Adults' verbal communication with children at mealtimes emphasized non-internal cues: (1) cueing children to amounts without referencing children's internal cues; (2) meal termination time; (3) asking children if they wanted more without referencing their internal cues; (4) asking children if they were done without referencing their internal cues; (5) telling children to take, try, eat, or finish food; (6) praising children for eating; and (7) telling children about food being good for you. Adults demonstrated an overriding effort to get children to eat. Conclusions and Implications Training needs to be developed that gives specifics on verbally cueing young children to their internal hunger and satiation cues.

Possiamo parlare di danno sociale delle intolleranze alimentari? La celiachia nei racconti di vita quotidiana (con una proposta interpretativa)

- The definition of Intuitive Eating as a psychological construct was developed in opposition to dieting movements that proposed controlled meal plans, avoidance of taboo foods and restricted intake of fat grams and calories. An eating behavior more consistent with one's internal physiological hunger and satiety cues was thus suggested in order to achieve both an adequate body weight and psychophysical well-being. Tylka (2006) developed the Intuitive Eating Scale (IES), a questionnaire that assesses three main facets of intuitive eating: unconditional permission to eat when hungry and what food is desired, eating for physical rather than emotional reasons, and reliance on internal hunger and satiety cues to determine when and how much to eat. This paper describes the development and validation of the Italian version of the IES. A paper-and-pencil battery that included a socio-demographical questionnaire, the IES and other measures of eating behaviour and attitudes toward food was administered to 206 participants and internal consistency, unidimensionality, factor structure and construct and criterion validity of the scale were investigated. Results showed that psychometric properties of the Italian version of the IES are adequate for the use in a non-clinical context. Future studies should investigate the temporal stability and the discriminant power of IES scores in clinical samples.Key-words: intuitive eating, orthorexia, eating disorders, eating behavior, psichometrics.Parole-chiave: intuitive eating, ortoressia, disturbi alimentari, comportamento alimentare, psicometric.

Eating behaviour and obesity

Eating behaviour and obesity

Are intuitive eating and eating disorder symptomatology opposite poles of the same construct?

Two studies explored whether intuitive eating (i.e., eating based on physiological hunger and satiety cues rather than situational and emotional cues) is a distinct construct from low levels of eating disorder (ED) symptomatology among college women. Previous research has demonstrated that high levels of ED symptomatology are related to lower levels of well-being. Therefore, if intuitive eating is a distinct construct, then it should be associated with indices of well-being above and beyond the variance accounted for by ED symptomatology. Findings revealed that two intuitive eating components (i.e., eating for physical rather than emotional reasons and reliance on internal hunger and satiety cues) made unique contributions to each well-being measure, whereas the remaining intuitive eating component (i.e., unconditional permission to eat) overlapped substantially with low levels of ED symptomatology.

Development and psychometric evaluation of a measure of intuitive eating.

Intuitive eating is characterized by eating based on physiological hunger and satiety cues rather than situational and emotional cues and is associated with psychological well-being. This study reports on the development and initial psychometric evaluation of the Intuitive Eating Scale (IBS) with data collected in 4 studies from 1,260 college women. Exploratory factor analysis uncovered 3 factors: unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on internal hunger/ satiety cues; confirmatory factor analysis suggested that this 3-factor model adequately fit the data after 4 items with factor loadings below .45 were deleted. IES scores were internally consistent and stable over a 3-week period. Supporting its construct validity, IES scores were (a) negatively related to eating disorder symptomatology, body dissatisfaction, poor interoceptive awareness, pressure for thinness, internalization of the thin ideal, and body mass; (b) positively related to several indexes of well-being; and (c) unrelated to impression management.

The Relationship between Intuitive Eating and Health Indicators among College Women

Epidemic levels of obesity represent a growing public health problem associated with a variety of negative health outcomes. Population level interventions that aim to moderate obesigenic environments have been proposed but remain largely unimplemented. Standard individual level interventions that focus on dietary restraint have been ineffective and in some cases harmful. Intuitive eating, an anti-dieting strategy that relies on recognizing and responding to internal hunger and satiation cues, has been proposed as an alternative approach to healthy weight management at the individual level—but it remains largely untested. This study evaluated the relationship between intuitive eating and various health indicators among female college students. As measured by the Intuitive Eating Scale (IES), it was found that intuitive eating was significantly correlated with lower body mass index (r = -.576), lower triglyceride levels (r = -.408), higher levels of high density lipoproteins (.437), and improved cardiovascular risk (r = .425). Findings provide tentative support for intuitive eating as a positive approach to healthy weight management at the individual level. Implications and future research needs are discussed.

Parents Are Key Players in the Prevention and Treatment of Weight-related Problems

There is growing agreement among experts that an obesogenic environment, which encourage excess food intake and idealizes thinness, plays a crucial role in the epidemic of childhood obesity and eating disorders. Because parents provide a child's contextual environment, they should be considered key players in interventions aimed at preventing or treating weight-related problems. Parenting style and feeding style are crucial factors in fostering healthy lifestyle and awareness of internal hunger and satiety cues and de-emphasizing thinness. Effective interventions for prevention and treatment of weight-related problems should be approached from a health-centered rather than a weight-centered perspective, with the parents as central agents of change. This paper reviews the environmental risk factors and parents' role in the prevention and treatment of children's weight-related problems.

Fighting Strategies in Crayfish Orconectes rusticus (Decapoda, Cambaridae) Differ with Hunger State and the Presence of Food Cues

Crayfish, bearing dangerous weapons in the form of chelae, resolve intraspecific conflicts using stereotyped behaviors and structured, escalated encounters. According to predictions of game theory models, any decision to resort to unrestrained combat without prior careful behavioral assessment of the opponent’s fighting abilities carries great risks. The present study examines the significance of internal hunger states and the presence of chemical food cues in this decision process using a 2 × 2 factorial design. Hungry crayfish escalated more rapidly, and thus took greater risks, during agonistic encounters, while the presence of a food source reduced the rate at which fights increased in intensity. However, there were no significant differences in fighting behavior as a result of the interaction between these two variables. We then address the complex trade‐offs that individuals face in fighting with respect to increased risks of injury, appetitive states, and opportunities for resource access.