The Intuitive Eating Scale-2 Adapted for Mexican Pregnant Women: Psychometric Properties and Influence of Sociodemographic Variables

Abstract

A weight-inclusive approach to health involves the promotion of intuitive eating, i.e., the individual’s ability to be aware of their physiological hunger and satiety cues to determine when and how much to eat, while paying attention to how certain foods affect their body. The second version of the Intuitive Eating Scale (IES-2) evaluates four interrelated traits of intuitive eating: Unconditional Permission to Eat (UPE), Eating for Physical rather than emotional Reasons (EPR), Reliance on internal Hunger/Satiety Cues (RHSC), and Body–Food Choice Congruence (BFCC). In this study, our aim was to evaluate the psychometric properties of a Mexican Spanish adaptation of the IES-2 for pregnant women and examine the relationship between intuitive eating traits and maternal sociodemographic characteristics. A sample of 514 pregnant women answered our IES-2 adaptation and a sociodemographic questionnaire. We determined the quality, validity, and reliability of our adaptation through descriptive measures, frequency distributions, intra-class correlations, and extreme answer group comparison for each item, eliminating those with weak technical properties. We then performed an exploratory principal component analysis and a confirmatory factor analysis. Last, we analyzed the association between intuitive eating and maternal sociodemographic and reproductive variables through correlation tests and multivariable linear regressions. Psychometric tests confirmed the validity and reliability of our IES-2 adaptation, which comprised 18 out of the 23 original items. Notably, both the exploratory and confirmatory factor analyses yielded not four but five factors, due to the EPR subscale splitting in two (the “emotional” and “physical” components of EPR). We attribute this novel finding to the emotional manifestations that naturally accompany pregnancy, which may incline pregnant women to base their eating behaviors more on the emotional than the physical component that would otherwise dominate their EPR trait. Further research is also needed about the UPE subscale during pregnancy, due to item removal and subtle changes in meaning. Finally, the influence of sociodemographic variables on the IES-2 score was extremely low, suggesting that other variables, possibly of a psychological nature, may have greater influence on a pregnant woman’s intuitive eating.

The Intuitive Eating Scale-3: Development and psychometric evaluation

“…Second, the IES-2's 4-factor structure with all 23 items sometimes fails to replicate in both non-clinical (e.g., Anastasiades, Maïano, Argyrides, & Swami, 2022;Flores-Quijano et al, 2023;Khalsa et al, 2019;Małachowska & Jeżewska-Zychowicz, 2022;Saunders, Nichols-Lopez, & Frazier, 2018;Swami et al, 2020) and clinical populations (Martin-Wagar & Heppner, 2023). This has typically prompted researchers to discard items, correlate item residuals, and/or propose alternative factor structures to achieve adequate fit (e.g., Małachowska & Jeżewska-Zychowicz, 2022;Swami et al, 2020).…”

“…These studies have varied in the alternative factor structures proposed. For instance, EPR items were split into two factors (avoiding emotional eating [negatively worded items], avoiding food-related coping [positively worded items]) in four studies (Anastasiades et al, 2022;Flores-Quijano et al, 2023;Khalsa et al, 2019;Parsons et al, 2024), UPE items were split into two factors (permission to eat [positively worded items], avoiding forbidden foods [negatively worded items]) in one study (Khalsa et al, 2019) or did not form a distinct factor in three studies (Ramalho, Saint-Maurice, Félix, & Conceição, 2022;Saunders et al, 2018;Swami et al, 2020), and RHSC items were split into two factors (trust in internal cues and reliance on these cues) in one study (Anastasiades et al, 2022). These alternative factor structures are likely due to the positive/negative wording or lack of clarity in the (intended) meaning of some items (e.g., some RHSC items were worded to assess relying on internal cues, whereas other RHSC items were worded to assess trusting internal cues; some UPE items were written to assess approaching foods, whereas others were worded to assess rules placed on foods and then reverse scored).…”