This study examined the prevalence of intuitive eating and its associations with psychological and physical health indicators among rural U.S. adults (N = 187). The prevalence of intuitive eating was 13.9%, assessed using the IES-2. Psychological health indicators included anxiety and depressive symptoms (PHQ-4), perceived stress (PSS-10), and self-esteem (RSES); physical health indicators included self-reported BMI and diagnoses of high blood pressure, high cholesterol, and type 2 diabetes. Multivariate and logistic regression analyses showed intuitive eating was positively associated with self-esteem (b = 0.49, p < 0.001) and inversely associated with anxiety (b = −0.40, p < 0.001), depression (b = −0.49, p < 0.001), stress (b = −0.36, p < 0.001), and BMI (b = −1.41, p = 0.049), but not with high blood pressure or cholesterol (ps > 0.05). Findings highlight intuitive eating as an approach for health interventions supporting psychological well-being and weight management in rural populations.
AhernMBrownCDukasS (2011) A national study of the association between food environments and county-level health outcomes. Journal of Rural Health27(4): 367–379.
2.
AuneDGiovannucciEBoffettaP, et al. (2017) Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology46(3): 1029–1056.
3.
AverettSLSikoraAArgysLM (2008) For better or worse: Relationship status and body mass index. Economics and Human Biology6(3): 330–349.
4.
BabbottKMCavadinoABrenton-PetersJ, et al. (2023) Outcomes of intuitive eating interventions: A systematic review and meta-analysis. Eating Disorders31(1): 33–63.
5.
BayramHMGürbüzM (2025) The associations of mindful and intuitive eating with BMI, depression, anxiety and stress across generations: A cross-sectional study. International Journal of Food Sciences and Nutrition1–11. Advance online publication. https://doi.org/10.1080/09637486.2025.2462185
6.
BordersTFWilliamsT (2022) Serious mental illness and mental health treatment utilization among adults residing in non-metropolitan and metropolitan counties. Report for the Rural & Underserved Health Research Center. Report no. 20, Lexington, KY.
7.
BruceLJRicciardelliLA (2016) A systematic review of the psychosocial correlates of intuitive eating among adult women. Appetite96: 454–472.
8.
CamilleriGMMéjeanCBellisleF, et al. (2016) Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study. Obesity24(5): 1154–2116.
9.
CohenSKamarckTMermelsteinR (1983) A global measure of perceived stress. Journal of Health and Social Behavior24(4): 385–396.
10.
CoughlinSSClaryCJohnsonJA, et al. (2019) Continuing challenges in rural health in the United States. Journal of Environment and Health Science5(2): 90–92.
11.
DeanWRSharkeyJR (2011) Rural and urban differences in the associations between characteristics of the community food environment and fruit and vegetable intake. Journal of Nutrition Education and Behavior43(6): 426–433.
12.
FelminghamTIslamFMA (2022) Relationship between sociodemographic factors and depression in Australian population aged 16–85 years. Applied Sciences12(24): 12685.
13.
FerdinandAOBolinJNCallaghanT, et al. (2023) Rural healthy people 2030. Report, Texas A & M University School of Public Health, Texas A & M Health Southwest Rural Health Research Center, TX.
14.
GarcíaMCRossenLMMatthewsK, et al. (2024) Preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties, United States, 2010–2022. MMWR Surveillance Summaries73(2): 1–11.
15.
GeorgeDMalleryP (eds) (2016) IBM SPSS Statistics 23 Step by Step: A Simple Guide and Reference, 14th edn.New York, NY: Routledge.
16.
GiaconeLSobCSiegristM, et al. (2024) Intuitive eating and its influence on self-reported weight and eating behaviors. Eating Behaviors52: e101844.
17.
GöddeJUYuanTYKakinamiL, et al. (2022) Intuitive eating and its association with psychosocial health in adults: A cross-sectional study in a representative Canadian sample. Appetite168: e105782.
18.
HawksSMadanatHHawksJ, et al. (2005) The relationship between intuitive eating and health indicators among college women. American Journal of Health Education36(6): 331–336.
19.
HazzardVMTelkeSESimoneM, et al. (2021) Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: Findings from EAT 2010–2018. Eating and Weight Disorders26(1): 287–294.
20.
HorwathCHagmannDHartmannC (2019) Intuitive eating and food intake in men and women: Results from the Swiss food panel study. Appetite135: 61–71.
21.
HrubyAHuFB (2015) The epidemiology of obesity: A big picture. PharmacoEconomics33(7): 673–689.
22.
Järvelä-ReijonenEKarhunenLSairanenE, et al. (2016) High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age. Appetite103: 249–258.
23.
JohnsonJAIIIJohnsonAM (2015) Urban–rural differences in childhood and adolescent obesity in the United States: A systematic review and meta-analysis. Childhood Obesity11(3): 233–241.
24.
JokelaMLaakasuoM (2023) Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian randomization studies and implications for population mental health. Journal of Psychiatric Research163: 86–92.
25.
KivimäkiMKuosmaEFerrieJE, et al. (2017) Overweight, obesity, and risk of cardiometabolic multimorbidity: Pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health2(6): e277–e285.
26.
KroenkeKSpitzerRLWilliamsJB (2003) The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care41(11): 1284–1292.
27.
KroenkeKSpitzerRLWilliamsJB, et al. (2007) Anxiety disorders in primary care: Prevalence impairment comorbidity and detection. Annals of Internal Medicine146(5): 317–325.
28.
KroenkeKSpitzerRLWilliamsJB, et al. (2009) An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics50(6): 613–621.
29.
LeeSHMooreLVParkS, et al. (2022) Adults meeting fruit and vegetable intake recommendations – United States, 2019. MMWR Morbidity and Mortality Weekly Report71(1): 1–9.
30.
LinardonJTylkaTLFuller-TyszkiewiczM (2021) Intuitive eating and its psychological correlates: A meta-analysis. International Journal of Eating Disorders54(7): 1073–1098.
31.
LinBHGuthrieJSmithT (2023) Dietary quality by food source and demographics in the United States, 1977–2018. U.S. Department of Agriculture, Economic Research Service. Available at: https://www.ers.usda.gov/publications/pub-details?pubid=105955 (accessed 13 February 2025).
32.
LöweBKroenkeKGräfeK (2005) Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research58(2): 163–171.
33.
LöweBWahlIRoseM, et al. (2010) A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders122(1–2): 86–95.
34.
LundeenEAParkSPanL, et al. (2018a) Obesity prevalence among adults living in metropolitan and Nonmetropolitan Counties – United States 2016. MMWR Morbidity and Mortality Weekly Report67(23): 653–658.
35.
LundeenEAParkSPanL, et al. (2018b) Daily intake of sugar-sweetened beverages among US adults in 9 states by state and sociodemographic and behavioral characteristics, 2016. Preventing Chronic Disease15: e154.
36.
MaddenCELeongSLGrayA, et al. (2012) Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutrition15(12): 2272–2279.
37.
MalikVSPanAWillettWC, et al. (2013) Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis. American Journal of Clinical Nutrition98(4): 1084–1102.
38.
MasoodBMoorthyM (2023) Causes of obesity: A review. Clinical Medicine23(4): 284–291.
39.
ModicaCADiLilloV (2023) A structural invariance analysis of the acceptance model of intuitive eating across black Hispanic and white young-adult women. Body Image44: 157–169.
40.
MoralesDABarksdaleCLBeckel-MitchenerAC (2020) A call to action to address rural mental health disparities. Journal of Clinical and Translational Science4(5): 463–467.
41.
National Institutes of Health, National Heart, Lung, and Blood Institute (2020) The practical guide: Identification, evaluation, and treatment of overweight and obesity in adults. Report no. 02-2650, Bethesda, MD.
OkobiOEAjayiOOOkobiTJ, et al. (2021) The burden of obesity in the rural adult population of America. Cureus13(6): e15770.
44.
ÖzkanNBiliciS (2021) Are anthropometric measurements an indicator of intuitive and mindful eating?Eating and Weight Disorders26(2): 639–648.
45.
PettroneKCurtinSC (2020) Urban-rural differences in suicide rates, by sex and three leading methods: United States, 2000–2018. NCHS Data Brief No. 373. Hyattsville, MD: National Center for Health Statistics.
46.
QuanSMenecVO’ConnellM, et al. (2022) Prevalence of obesity and elevated body mass index along a progression of rurality: A cross-sectional study – The Canadian Longitudinal Study on Aging. Canadian Journal of Rural Medicine27(4): 148–157.
47.
RajanTMMenonV (2017) Psychiatric disorders and obesity: A review of association studies. Journal of Postgraduate Medicine63(3): 182–190.
48.
RosenbergM (1965) Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
49.
RosenbergM (1989) Society and the Adolescent Self-Image, revised edn. Middletown, CT: Wesleyan University Press.
50.
RosingerAHerrickKGahcheJ, et al. (2017) Sugar-sweetened beverage consumption among U.S. adults, 2011–2014. NCHS Data Brief No. 270. Hyattsville, MD: National Center for Health Statistics.
51.
SareenJAfifiTOMcMillanKA, et al. (2011) Relationship between household income and mental disorders: Findings from a population-based longitudinal study. Archives of General Psychiatry68(4): 419–427.
52.
SarwerDBPolonskyHM (2016) The psychosocial burden of obesity. Endocrinology and Metabolism Clinics of North America45(3): 677–688.
53.
SegalYGunturuS (2024) Psychological issues associated with obesity. In: StatPearls. Treasure Island, FL: StatPearls Publishing. Available at: http://www.ncbi.nlm.nih.gov/books/NBK603747/ (accessed 11 February 2024).
54.
TeasEKimiecikJWardRM, et al. (2022) Intuitive eating and biomarkers related to cardiovascular disease in older adults. Journal of Nutrition Education and Behavior54(5): 412–421.
55.
TempleNJ (2022) The origins of the obesity epidemic in the USA–Lessons for today. Nutrients14(20): 4253.
56.
TriboleEReschE (eds) (2020) Intuitive Eating: A Revolutionary Anti-Diet Approach, 4th edn.New York, NY: St. Martin’s Press Group.
57.
TrivediTLiuJProbstJ, et al. (2015) Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural and Remote Health15(4): 3267.
58.
TylkaTL (2006) Development and psychometric evaluation of a measure of intuitive eating. Journal of Counseling Psychology53(2): 226–240.
59.
TylkaTLKroon Van DiestAM (2013) The intuitive eating scale-2: Item refinement and psychometric evaluation with college women and men. Journal of Counseling Psychology60(1): 137–153.
60.
Van DykeNDrinkwaterEJ (2013) Relationships between intuitive eating and health indicators: Literature review. Public Health Nutrition17(8): 1757–1766.
61.
Van DykeNDrinkwaterEJ (2022) Intuitive eating is positively associated with indicators of physical and mental health among rural Australian adults. Australian Journal of Rural Health30(4): 468–477.
62.
WambogoEAAnsaiNHerrickKA, et al. (2024) Differences in intakes of select nutrients by urbanization level in the United States population 2 years and older, NHANES 2013–2018. Journal of Nutrition154(2): 617–625.
63.
XuHCupplesLAStokesA, et al. (2018) Association of obesity with mortality over 24 years of weight history: Findings from the Framingham Heart Study. JAMA Network Open1(7): e184587.
