FINAL REPORT - Understanding Eating Behaviors and ... · styles. Conclusions: GMFR’s definitions of diet mentality, emotional, and dazed and confused styles are clearly defined

UnderstandingEatingBehaviorsandAttitudestoDefineEatingStylesChristineAlbertelli;DanaNotte,MS,RD,CD;AmyNickerson,MS,RDN;Dr.PeterCallas,Ph.D.

UniversityofVermont,BurlingtonVTandGreenMountainatFoxRuninLudlow,VTMasterofScienceinDieteticsEvidenced-BasedResearchProjectFinalPaper

May2017

UnderstandingEatingBehaviorsandAttitudestoDefineEatingStyles|May2017 2

ABSTRACT

Background:GreenMountainatFoxRun(GMFR)isanon-diet,mindfulness-basedwellness

retreatforwomenwhostrugglewitheatingandweight.Partoftheprogramistohelp

participantsdeterminetheir“eatingstyle(s)”,whichinformsappropriatebehavioralstrategies

thatguidethemtowardsamorehealth-supportive,“skillful”eatingstyle.Currently,thereare

nostandardeatingstyledefinitionsnoristhereavalidatedtoolfortheiridentification.The

objectiveofthestudywastoevaluateeatingbehaviorsandattitudesofparticipantstomore

accuratelydefineeatingstylesandprovidenextstepsforcreatingavalidatedassessmenttool.

Methods:AliteraturereviewoneatingtypesandpatternsandGMFR’seatingstyles(skillful,

chaotic,dietmentality,emotional,disconnected/habitual,anddazedandconfused)wereused

todevelopaninitialsurveythatwasemailedto185incomingparticipantsenrolledinGMFR’s

program.Qualitativeandquantitativeanalyseswereusedtoobservetrendsamongeating

stylesandevaluatetheinternalconsistencyandreliabilityofthesurvey,respectively.

Results:Theskillfuleatingstylewasnegativelycorrelatedwiththeotherfivestyles.Acceptable

internalconsistencywasobservedinallGMFR’seatingstylesexcept“chaotic”(Cronbach’s

alpha>0.6).Theexploratoryfactoranalysisrevealedsixdistinctfactors;threeofthose

identifiedfactorscorrespondedwiththedietmentality,emotionalanddazedandconfused

styles.

Conclusions:GMFR’sdefinitionsofdietmentality,emotional,anddazedandconfusedstyles

areclearlydefinedanddemonstratedreliability.Theremainingthreestylesrequireadditional

exploration.Further,largersamplesizesareneededtovalidatetheinitialeatingstylessurvey.


INRODUCTIONANDLITERATUREREVIEW

Thepersistentincreasein“obesity”ratesovermultipledecadesiswelldocumentedand

acknowledgedbymedicalprofessionalsandcommunitymembersacrosstheglobe.Research

hasdemonstratedthatalargerbodysizeisassociatedwithmanyotherchronicdiseases,such

ashighbloodpressure,diabetes,cardiovasculardisease,sleepapneaandcancer.1Eating

patternsandothermodifiableriskfactorscontributetotheprevalenceofthesechronic

diseasesandthusresearcharoundeatingbehaviorshasgrownimmensely.Additionally,

westernizedsocietiesarerespondingwithanintensefocusonweightlosstocombatthe

growing“epidemic,”buttheresearchdoesnotentirelydefendthetraditionalapproachto

weightloss.2Datasupporttheassociationthatdietaryrestraintmayresultinfutureweightgain

anddisorderedeatingbehaviors.2–5Thecomplexityofeatingbehaviorsandassociated

outcomeshascontributedtothegrowinginterestinthisareaofresearch.

Foryears,nutritionandpsychologyresearchershavebeenanalyzingeatingbehaviors,

beliefsandattitudestobetterunderstandcharacteristicsofdifferenttypesofeatingstylesand

dietarypatterns.“Eatingstyles”aregroupsofeatingbehaviors,attitudesandbeliefsthattend

tooccurtogetherintrendsorcategories.Practitionershavecreatedtheirownlistsand

definitionsofeatingstylesandorreferenceexistingonesinpractice.Onepurposeof

identifyingeatingstylesistobetterunderstandpotentialcausesofproblematiceatingbehavior

andinformbehavioralinterventions.Manypractitionershavealsodevelopedquestionnairesto

measuretheseeatingbehaviorsandattitudesinindividualsandpopulationsinanattemptto

providethelinkbetweeneatingbehaviorsandoutcomes(refertoTable1foralistofauthors


andfacilities,definitionsandquestionnaires).Moreover,todaythereareavarietyofeating

theoriesandstylesrecognizedbyresearchersandpractitionersacrossmanydisciplines.

Intheearlyyearsofthisresearch,Strienandcolleaguesdevelopedanassessmenttool

knownastheDutchEatingBehaviorQuestionnaire(DEBQ).6Thistoolwasdesignedtoenhance

understandingofeatingpatternsamongindividualswithalargerbodysize.Usingthreespecific

psychology-basedtheoriesofeatingbehaviorsasthefoundation,threescaleswerecreated:

emotional,externalandrestrainedeating.Emotionaleatingorthepsychosomatictheorywas

describedaseatinginresponsetoemotions,suchasanger,fearoranxiety,lossofappetite,

whensomeindividualsconsumedlargeamountsoffoodintheformofabinge.Theexternal

eatingphenomenoniseatinginresponsetoexternalstimuliregardlessofhungerlevels,suchas

presenceorevensmelloffood.Therestrainedeatingtheoryhassimilarqualitiestothe

traditionalweightlossapproachandischaracterizedbydietingandrestriction,whichatintense

levelscanleadtoexternalandemotionaleating.Althoughdated,thatstudyoutlinesthree

scalesoreatingtheoriesthatremaininmanylistsofeatingstylestodayandpresentstheidea

thatcharacteristicsofeatingstylesmayoverlapsuchasrestrainedeatingtheory.

Manyotherquestionnaireshavebeendevelopedusingcomparableconstructsand

theoriestolinkeatingbehaviorswithassociatedoutcomes,primarilyrelationshipsbetween

eatingbehaviorsandbodysize,andtoidentifyconstructsthatcapturespecificeatingstyles.7

Multiplestudiessupportedthecausalrelationshipbetweendietaryrestraintandovereating

and,thus,itbecameanimportantconstructandbehaviortoexplore.8Williamsonand

colleaguesconductedastudytotestthevalidityofmultiplequestionnairesthatmeasurethe

dietaryrestraintconstruct,definedas“theintentiontorestrictfoodintakeinordertocontrol


bodyweight”.Theirresearchrevealedthatthreeofthefoureatingstylequestionnaires[the

DEBQ,theEatingInventory(EI)/Three-FactorEatingQuestionnaireandtheCurrentDieting

Questionnaire(CDQ)],werevalidindicatorsofcurrentdietingandweightsuppression.

However,itwasconcludedthatthefourquestionnairesdidnotmeasurethesametheoretical

construct.8Astheresearchgrew,randomizedcontrolledtrials,factoranalysesandothertests

ofvalidityrevealedthatquestionnaires,whichwereintendedtomeasureseeminglysimilar

eatingstyleconstructs,werenotinterchangeableanddidnotexhibitconstructvalidity.The

fundamentalconclusionfromthesestudiesisthatmeasuringeatingstyleconstructsisan

incrediblycomplexprocess.Nonetheless,thesetoolsandquestionnairesarethelinkbetween

understandingtherelationshipbetweeneatingbehaviorandhealthoutcomes.An

understandingofeatingstylesandvalidquestionnairesareneededtobeginprovidingthe

frameworkforstandardizedapproachesatalllevels,frompolicytointerpersonalinterventions.

ThePresentStudy

Asnotedpreviously,theresponsetothe“obesityepidemic”inwesternsocietieshas

beenaweightfocuseddietculturethatwasusedasaframeworkforweightlossinterventions.

Thetraditionalweightlossapproachischaracterizedbyalteredeatingbehaviors,intheformof

dieting,caloriecountingandrestriction,andincreasedexercisetoachieveanidealbodyweight

andshape.2,9However,researchdemonstratesthatthetraditionalapproachhasbeen

unsuccessfulinmaintainingthegoalofweightloss.Forexample,Pietilaninenetal.foundthat

intentionalweightlossattemptswereindependentlycorrelatedwithfutureweightgain.3

Furthermore,datastronglysuggestthatdietaryrestrictionandovervaluationofweightand


bodyshapepredictsbingeeating.4Thisisevidenceshowingthatthetraditionalapproachto

weightlossmayleadtodetrimentaloutcomes.

Individualswithalargebodysizehavebecomesubjecttoanegativeweightbiasin

clinicalandcommunitysettings.10Experiencesofweightbiasorinternalizedweightstigma

increaseanindividual’sriskforimpairedoverallpsychologicalhealth(anxiety,depression,low

self-esteem,bodydissatisfaction)andisassociatedwithdisorderedandunhealthyeating

behaviors,suchasincreasedintakeandlowermotivationforexercise.Moreover,therehas

beenariseinratesofeatingdisordersoverthepasttwodecades.11

Researchexplainingthenegativephysiologicalandpsychologicaleffectsofdieting,

restrictionandintentionalweightlosshasopeneddoorsfornewtreatmentapproaches,such

asthenon-dietapproach.Thenon-dietapproachmaybesuperiortotraditionalweightloss

practicesinachievinglongtermbehaviorchangerelatedtodietaryhabitsandphysicalactivity.2

AsdefinedbyCliffordetal.,thenon-dietapproachencompassesseveraloverlapping

perspectivesofhealthpromotion,includingHealthatEverySize(HAES),theSatterEating

CompetenceModel(ecSatter),IntuitiveEatingandMindfulEatingPractices.TheHAES

paradigmpromotesweightinclusivity,adoptionofhealthpromotingbehaviorsforhealth

ratherthanweight,andencouragespeopletoeatforreasonsincludingbutnotlimitedto

hunger,nutritionalpurposesandpleasure.2,12EcSatter,derivedfromthespectrumofeating

attitudesandbehaviors,isgroundedintheprinciplethatusinginternalcues,hunger,appetite

andsatietytoguidefoodchoiceswillresultinanappropriatebodyweight.Eatingcompetence,

asdefinedbyecSatter,incorporatesfourprinciples:attitudes,foodacceptanceskills,internal

regulationskillsandcontextualskills(ie.planning,acquiringandpreparingfood).2,13


Additionally,theIntuitiveandMindfulEatingPracticeshavemanyfeaturesthatoverlap,yetare

recognizedindividuallybysomepractitioners.IntuitiveEatingisallowingoneselftoeatwhen

hungrywithnorestrictionoffoodchoices,eatingtofuelthebodyforphysicalreasonsand

usinginternalcuestoguidewhenandhowmuchtoeat.2,9,14Comparatively,MindfulEatingis

the“nonjudgmentalawarenessofphysicalandemotionalsensationswhileeating”byusing

one’ssensesandlearningtobeawareofhungerandsatietycuestoguidefoodchoicesand

eatingbehavior.15,16,17

Asaresultoftheongoingfailureoftraditionalweightlossprograms,manypractitioners

andfacilitieshaveadoptedanon-dietapproach.Intheprocess,attemptshavebeenmadeto

definerelevanteatingstyles.Forexample,GreenMountainatFoxRun(GMFR),anon-

traditionalwellnessretreatlocatedinsouthernVermont,hasbeenusingthenon-dietapproach

since1997tohelpwomenwhostrugglewithweight,eatingandbodyimage.18Theirmulti-

prongedprogramconsistsofwellnessassessments;workshopsandeducationalgroups;courses

suchasSelf-care&Compassion,RedefiningHealthyEating,MindfulEating,etc.;fitnessand

recreationalclassesandactivities;culinarydemonstrations;andmuchmore.18Basedonmany

yearsofworkwithwomenwhostrugglewithweightandtheirrelationshipwithfood,the

GMFRpractitionersestablishedalistofeatingstylesanddefinitions(seeAppendixBforGMFR’s

listofeatingstyles).Fromthesedefinitions,a“GuidetoEatingStylesChecklist”wascreated

andisusedinoneoftheprogram’sclasses,“IdentifyingYourEatingStyle”.Theclassaimsto

helpparticipantsdeterminetheireatingstyle.Theidentifiedeatingstyleguidesthestrategies

usedbyaregistereddietitian(RD)tofacilitatebehaviorchangetowardsamorehealth


supportive“skillful”eatingstyle,whichencouragesahealthpromotingrelationshipwithfood,

bodyandmind.

Whileunderstandingeatingbehaviorsandattitudesisimportantforoverallhealthandwell-

being,thereiscurrentlynoreliablemeasurementtool.Thecurrentsetoftoolsattemptto

providealinkbetweeneatingbehaviorsandoutcomesandguidepeopletowardsanon-diet

approachtohealthandeating.Althoughthesetoolsarevaluable,theabsenceofuniversally

acceptable,validateddefinitionsispreventingtheareaofresearchandpracticefromfurther

development.Manyofthetoolsfocusononespecificeatingstyle,whichhelpstorecognize

certaincharacteristicsinanindividual’seatingpattern,suchasabilitytorecognizehungerand

satietycues.Forexample,theIntuitiveEatingScalecreatedbyTylkaonlyintendstomeasure

IntuitiveEatingbehaviorsandattitudes.SimilarlytheMindfulEatingQuestionnairesaimto

measureafewconstructsorfactors,suchasawareness,externalcuesandemotional

response.14,19Thentherearesometoolsthatincorporateavarietyofeatingstyles,orcycles,

suchasthe“AmIHungry?”EatingCycleAssessment.20Thistoolidentifiesfoureatingstylesor

constructs(Instinctive,Overeating,RestrictiveandtheEat-Repent-Repeatcycle);yetother

practitionershaveidentifiedstylesbeyondthese.

Manyoftheeatingstyledefinitionsandquestionnairesusedinpractice,suchasGMFR’s

EatingStylesChecklist,arenotvalidated.Therearenostandarddefinitionsforeatingstylesnor

isthereavalidatedtoolfortheiridentification.Thepracticeofidentifyingeatingstyleshas

madelargestrides,however,theneedforfurtherresearchisuniversallydocumented.

Clear,validatedstandarddefinitionsofeatingstylesareneededsothatprofessionalscan

helpclientsunderstandbeliefsandattitudesthatcontributetotheireatingbehaviors.


Professionalsalsoneedtocreatepracticalstrategiestohelpindividualsovercomeproblematic

behaviorsaroundeatingandfacilitatelastingchanges.GMFR’slong-termgoalistocreatea

user-friendlyquestionnairethatisbasedonvalidatedterminology.Thequestionnairewill

encompassalleatingstyles,andbeusedtodevelopstandardizedapproachesandstrategiesto

workwithclients.Further,suchatoolwillhelpotherpractitionersandfacilitiesadoptsimilar

effectiveapproachesandinterventions.

ThefirststeptowardsGMFR’slongtermgoalofavalidatedmeasureistoclearlydefine

eatingstylesusedintheirprogram.Thepurposeofthepresentstudywastoevaluateeating

behaviorsandattitudesofparticipantstomoreaccuratelydefineeatingstylesandprovide

insightintonextstepsforcreatingavalidatedassessmenttool.Theaimsoftheprojectwereto

investigatetrendsinbehaviorsandattitudesrelatedtoeating;andtoidentifyanyeating

characteristicsorbehaviorsthataremissingfromthecurrentlistofGMFR’seatingstyles.

Additionally,thestudysoughttocollectpreliminarydataonthereliabilityandvalidationofa

surveytool.Theinformationobtainedfromthepresentstudywillbeusedtodetermineifthe

behaviorsandattitudesattachedtoeacheatingstylecorrespondedcorrectlytotheeatingstyle

inwhichitwaslisted.Theresultsoftheanalysiswillbeusedtoinformarevisionofcurrent

GMFR’sEatingStylesChecklist,whichisusedasthebasisforaclassthatseekstoincrease

participantawarenessoftheirpersonaleatingstyles,andinformbestpracticeforcoaching

theseindividualstoachievemoreMindfulandIntuitiveEatingstyles.


METHODS

LiteratureReviewandQuestionnaireDevelopment

Intheformofadescriptivesurveyresearchdesign,thefirststepofthepresentstudy

wasaliteraturereviewtolearnabouttypesandpatternsofeatingstylesdescribedbyother

professionals.GMFR’soriginallistofeatingstyleswascomparedagainstacollectionof

publisheddefinitionsandcorrespondingquestionnairestoidentifythecommonconstructsand

gapsinbehaviorsandattitudes.Thatinformedthedevelopmentoftheeatingstylessurvey,

whichwastestedtoasamplepopulationofGMFR’sparticipantsinthepresentstudy.

Thestatementsbelowdescribethedefinitionsandquestionnairesgleanedfromthe

literaturethatwereprimarilyconsideredtodescribeeacheatingstyleconstruct.However,all

definitions,scales,questionnaires,modelsandconstructswerereviewedcomprehensivelyfor

similaritiesanddifferencestoinformthecreationofthesurveydevelopedandtestedinthe

presentstudy(seeAppendixCfortheGMFREatingStylesSurvey).Forexample,todevelop

questionsthatcapturetheskillfuleatingstyleconstruct,theinvestigatorconsideredsimilar

constructsdescribedbyTribole(IntuitiveEaterdefinition);Tylka[theIntuitiveEatingScale

(IES)];May(theInstinctiveandMindfulEatingCycles);andecSattermodel.9,13,14,21Similarly,the

dietmentalityconstructwascomparedtoeachofthedietingpersonalitysubtypesdescribedby

Tribole,theCarefulEaterandProfessionalDieter,andtheRestrictiveandEat-Repent-Repeat

CyclesbyMay.9,21Additionally,atotaloffiveconstructsandonequestionnairewereusedto

formthequestionsfortheemotionaleatingstyleconstructintheEatingStylesSurvey[1.

EmotionalUnconscioussubtypebyTribole;2-4.theBingeEating,OvereatingandEat-Repent-

RepeatCyclesbyMay;5.theEmotionalResponseconstructintheMindfulEatingQuestionnaire


(MEQ);andthe6.EmotionalEatingScale(EES)].5,9,19,21–23Lastly,GMFR’schaotic,

disconnected/habitualanddazedandconfusedeatingstyleswerewidelyanalyzedagainstallof

Tribole’ssubtypesoftheUnconsciousEaterpersonality(Emotional,Chaotic,Waste-Not,and

Refuse-Not),manyoftheeatingcyclesbyMay,thehabitualeatingdefinitionbyTylka,the

MEQ,andtheMindfulEatingScale(MES).5,9,14,21,22

Afterthatcomprehensiveanalysis,theinvestigatorsagreedthatGMFR’soriginalsix

eatingstyleswereinclusiveandcapturedtheessenceofawidecontinuumofeatingbehaviors

andattitudes.Next,threeobjectivequestionsforeachconstructweredevelopedandreviewed

bytheauthors,including;skillful,dietmentality,chaotic,emotional,disconnectedorhabitual,

anddazedandconfused.Theobjectivequestions,numbers2-19,weredevelopedusinga5-

pointLikertscale(1-5;when1=stronglydisagree,2=disagree,3=neitheragreenordisagree,

4=agreeand5=stronglyagree).Additionally,threesubjectivequestionsweredevelopedto

elicitfeedbackonanyeatingcharacteristics,behaviorsorattitudesthatmaynothavebeen

capturedorrepresentedintheobjectivequestions(questions1,20-21).

ParticipantsandRecruitment

ThenontraditionalweightmanagementprogramatGMFRtargetswomenintheUnited

Statesaged18+whostrugglewithweight,bodyimageandtheirrelationshipwithfood.

Subjectswererecruitedfromthepopulationofnewandreturningparticipantswhoenrolledin

programatGMFRbetweenNovember7,2016andFebruary15,2017(3-months).Participants

inthestudywerewomenaged19-75yearsold(average=50yearsofage).Uponregistration

foraprogramatGMFR,incomingparticipantsreceivedalinktothesurveyandacorresponding

researchinformationsheetviaemail.Theactofclickingonthesurveylinkwastakenasimplied


consent.Theresearchinformationsheetprovideddetailsaboutthepurpose,proceduresand

potentialrisksversusbenefitsforparticipatingintheresearch,measurestakentoensure

participants’confidentialityandcontactinformationforfollowup(SeeResearchInformation

SheetinAppendixD).Participationinthesurveywasvoluntaryandsubjectswerenotifiedthat

theycouldwithdrawatanytime.ThestudywasapprovedbytheUniversityofVermont’s

InstitutionalReviewBoard(IRB)CommitteeonHumanResearchintheBehavioralandSocial

Sciences(CHRBSS).

TheEatingStyleSurveywasadministeredusingtheelectronicsurveysoftwareprogram,

Salesforce.Overthecourseofthe3-monthdatacollectionperiod,thesurveywasdistributedto

185individualsandcompletedby62women.Uponcompletionofthesurvey,responseswere

sentanonymouslytoadministrativepersonnelatGMFR,compiledintoanelectronicfileand

thenanalyzedbytheinvestigators.

Qualitativeandquantitativeanalyseswereperformedtoachievethestatedgoalsandaims

oftheproject.Thequalitativeanalysisattemptedtoidentifyanygapsinbehaviorsand

attitudesbycompilinggeneralobservationsfromtheresponsestothesubjectivequestions.

StatisticalAnalysis

QuantitativeanalyseswereperformedusingIBMSPSSStatistics,Version24.Descriptive

datawererecordedasmeansandpercentages.Themeanscoreforeachobjectivequestionon

thesurvey(questions2-19)wasrecordedtoinformtheaverageresponsetoeachquestion

amongthesamplepopulation.Forexample,allresponsestoquestionnumbertwowereused

todeterminehowonaveragethesamplepopulationrespondedtothatquestion.Additionally,

thefrequencyofresponsesforeachitemontheLikertscalewerecomputedaspercentagesfor


eachquestion.Pearson’scorrelationswerealsocomputedtoexaminerelationshipsbetween

theeatingstyleconstructs.

Cronbach’salphawascomputedtoassessthereliabilityandorinternalconsistencyforeach

construct’ssetofquestions(ie.Questions5-7forchaotic).24Morespecifically,ittestswhether

thesetofsurveyquestionsforeachconstructwereconsistentinmeasuringthesameeating

styleconstruct,giventhatareliablemeasurecontainslittletonoamountofmeasurement

error.25Thestrengthoftheconsistencywascomputedasanalphacoefficient,whichranges

from0-1(0=nocorrelation,1=allitemshavehighco-variances).Intheliterature,thereare

variedreportsontheacceptablevaluesofthealphacoefficient,rangingfrom0.60–0.95;the

alphacoefficientscomputedinthepresentstudywereconsideredacceptablevaluesbetween

therangeof0.60–0.90.25,26

Exploratoryfactoranalysiswasusedtoidentifytheunderlyingrelationshipsbetweenthe

variables(characteristics,behaviorsandattitudesofeating)andthusdeterminethemain

constructsofeatingstyles.27Aprinciplecomponentanalysisextractionmethodwasusedto

condensethematrixofcorrelationsandexplainthevariancesofthatmatrix.Additionally,the

correlationmatrixwasrotatedusingtheQuartimaxmethod.Aminimumloadingfactorof0.5

wasusedtodeterminewhichvariableshadstrongcorrelationswiththeunderlyingfactors.

Thepercentageofsurveyresponderswhoidentifywitheacheatingstylewasdetermined.

“Identify”wasdefinedasasumof>12forthequestionsforeachconstruct.Onascaleof3-15,

asumof12oraboveindicateda“high”or“close”identificationwithaneatingstyleconstruct.

Amongtheparticipantswhoidentifiedwithagivenstyle,crosstabulationwasthenusedto

determinethepercentageofsubjectswhoidentifiedwitheachoftheotherstyles.Forexample,


thismethodwasusedtodeterminethepercentageofemotionaleaterswhoalsoidentified

withthedietmentalityconstruct.Lastly,thesubjectiveresponsestoquestion20were

qualitativelycodedforthemesaboutmajorchallengestofoodselection,preparationand

eating.Trendsbetweenthethemesandidentificationwithanyeatingstyleconstructswere

computedusingcrosstabulation.


RESULTS

With185surveyssentouttoincomingparticipantsatGMFR,62surveyswerecompleted

andreturnedforaresponserateof33.5%.Studyparticipantswereallfemalesranginginage

from19-75yearswithanaverageageof50years.Descriptivestatisticsfromtheobjective

surveyresponsesmaybefoundinAppendixE,Table2andTable3.

StatisticalAnalysis

TheCronbach’salphatestrevealedthatallconstructsdemonstratedinternalconsistency,or

reliability,exceptforthe“chaotic”eatingstyle(acceptablevalues0.60-0.90;seeAppendixE,

Table3).Theskillfulconstruct’salphacoefficientwas0.625,chaotic0.456,dietmentality0.668,

emotional0.791,disconnected/habitual0.609anddazedandconfused0.678.Acceptable

valuesindicatedthatthesurveyquestionsforeachconstructwereconsistentinmeasuringthe

sameeatingstyleconstruct.ThesecondpartoftheCronbach’salphatestwastodeterminethe

alphacoefficientsoftheconstructs(indicativeofinternalconsistency)whenaquestionor

“item”wasdeletedfromthesurvey.Therewerethreenoteworthyresultsfromthisportionof

thetest.Fortheemotionalconstruct,thealphacoefficientincreasedto0.868(by0.77)if

question13wasdeleted,andforthedisconnected/habitualeatingstyleconstruct,thealpha

coefficientincreasedto0.691(by0.082)ifquestionfourteenwasdeleted.Similarly,when

questionseventeenwasdeleted,thedazedandconfusedalphacoefficientincreasedto0.758

(by0.08).

Theexploratoryfactoranalysisrevealedsixfactors,orstrongunderlyingrelationships

betweenvariables(eatingstyleconstructs),indicatedbyaninitialeigenvalueof1.0orgreater.

A0.5loadingfactorwasusedtodetermineastrongcorrelationbetweenavariableandan


underlyingfactor.Values0.5andabovearehighlightedinyelloworlightblueinTable4in

AppendixEontherotationcomponentmatrix.Threeoftheidentifiedfactorscorresponded

withthedietmentality(Q8-10),emotionalanddazedandconfused(Q17-19)eatingstyles.

Questions8-10correlatedstronglywiththefourthfactorandisrepresentativeofthediet

mentalityconstruct.Questions11-13correlatedstronglywithfirstfactorontherotation

componentmatrix,whichsuggeststhatthefirstunderlyingfactoristheemotionaleatingstyle.

Additionally,questions17-19correlatedstronglywiththethirdfactor,whichisrepresentative

ofthedazedandconfusedconstruct.Theremainingfactors(2,5and6)didnotcorrespond

withtheotherthreeeatingstyles:skillful,chaoticanddisconnected/habitual.Thesecondfactor

ontherotationcomponentmatrixwasstronglycorrelatedwithquestionstwo,six,fifteenand

sixteen.Factorfivecorrelatedwithtwoofthethreequestionsrelatedtotheskillfulconstruct(2

and3),buthasastrongcorrelationwithquestionsevenfromthechaoticstyle(andnot

questionfourfromtheskillfulconstruct).Thesixthfactorwasstronglycorrelatedwithfour

questions:#5,#7,#14and#17.Lastly,thereweretwoquestionsthatcorrelatedwithmorethan

onefactor,questionsseven(correlatedwithfactorfiveandsix)andseventeen(correlatedwith

factorthreeandsix).

TherelationshipsbetweeneatingstyleconstructsevaluatedbyPearson’scorrelationsare

foundinAppendixE,Table5.Theskillfuleatingstylehasanegativecorrelationwiththeother

fiveeatingstyles,chaotic,dietmentality,emotional,disconnected/habitualanddazedand

confused.Allconstructsweresignificantlycorrelatedwithskillfuleatingstyleata0.01level

exceptfordazedandconfused.Thissuggeststhatasskillfulbehaviorsincrease,theother

variablesorbehaviorsoftheothereatingstylesdecrease.Additionally,thedazedandconfused


eatingstylewasnotsignificantlycorrelatedfourofthefiveothereatingstyles.Dazedand

confusedwassignificantlycorrelatedwiththechaoticeatingstyleatthe0.01levelanddiet

mentalityatthe0.05level,butwasnotsignificantlycorrelatedwiththeskillful,emotionaland

disconnected/habitualstyles.Thus,ifsomeonebecomeslessconfusedbyfood,nutritionand

dietinformation,theywillnotnecessarilybecomemoreskillfuleaters.

ParticipantIdentificationwithEatingStyles

Thepercentofsubjectswhoidentifiedwitheacheatingstylewascomputedtodescribe

thesamplepopulation;31%ofsubjectsidentifiedwiththeemotionaleatingstyle,21%with

disconnected/habitual,18%withdietmentality,18%withchaotic,8%withdazedand

confused,and4%withskillful(seeAppendixE,Figure1).

Crosstabulationwasusedtodeterminetrendsamongidentificationwithmultipleeating

styles.Whenparticipantsidentifiedwithtwoeatingstyles,themostcommontrendwas

identificationwiththeemotionalanddisconnected/habitualstyles(90%ofemotionaleaters

alsoidentifiedwithdisconnected/habitual).Thesecondandthirdmostcommontrendswere

identificationwithdazedandconfusedandemotional(72.7%ofthedazedandconfusedeaters

alsoidentifiedwithemotional);anddazedandconfusedandchaoticstyles(72.7%ofthedazed

andconfusedeatersalsoidentifiedwithchaotic).

Additionaltrendswereobservedamongtheeatingstyles.Forchaotic,53.3%ofthe

disconnected/habitualeaters;52.0%ofdietmentalityeaters;and40.9%ofemotionaleaters

alsoidentifiedwithchaotic.Trendsamongthedietmentalityareasfollows:54.5%ofdazedand

confused,50%ofdisconnected/habitual,and45.5%oftheemotionaleatersalsoidentifiedwith


dietmentality.Lastly,54.5%ofthedazedandconfusedeatersalsoidentifiedwiththe

disconnectedeatingstyle.

MajorChallengestoFoodSelection,PreparationandEating

Whenanalyzingthesubjectiveresponsestoquestion20,challengestofoodselection,

preparationandoreatingdescribedbythesubjectswerecodedintotrends.Of49responsesto

question20,thetopthreechallengeswere“mealplanning”(n=15;30.6%),“time”(n=9;18.4%),

“cravings”(n=8;10.8%)andother(n=17;35%).Mealplanningchallengesincludeddifficulties

shoppingandpreparingfood,andfeelingoverwhelmedbytheprocessofmealplanning.For

example,onesubjectreportedthat“havingtopreparefoodformultiplepeople(husband,2

kids,me)makesitdifficulttoeatwhatIwantorwhenIwant”(mealplanningcategory).The

timechallengeswererelatedtobusyschedulesandreportsofnotenoughtimeinthedayto

planandprepareadequatefood.Experiencesmentionedinthecravingscategoryincluded

feelingsofintensecravings,lossofcontroloverfoodchoices,orhighlypalatableortrigger

foods.Forexample,“whenIaminthemiddleofacraving,allmyreasoningquicklyfliesoutthe

window.Allofit.Andthere'snoretrievingit.BeforeIknowit,I'meatingravenously.”

The“other”categoryincludedavarietyofchallengesdescribedlessfrequentlyby

subjects.Forexample,afewsubjectsdescribedchallengestofoodselection,preparationor

eatingthatincludedhealthoramedicalcondition,suchasmenopause.Othersdescribedwhat

maybecategorizedas“habitualeating”,where“Ihavetheknowledgeofwhatishealthytofix

butIhavegottenintoahabitoffixingthesametypesofmealsformyhusbandthatIthinkhe

expectsnow.IhavecookedhealthyforhiminthepastwhenI'vebeenonahealthiereating

kickandIdon'trememberhimcomplainingbutsomehowI'vegottenintoarutoflookingand


shoppingformore"comfort"mealsthattendtobemorefattening.Igetstuckonbadeating

habits.”Otherchallengesincludedpreoccupationwithfood,foodpreferences(ie.pickyeater),

cost,needforconveniencefood,accesstohealthyfoods,navigatingrestaurants,externalcues

toeating(presenceoffoodaroundthehouse)andlackofcookingskills.

Theresearchattemptedtoidentifytrendsbetweenchallengesandeatingstylesusing

crosstabulationmethods.Thedazedandconfusedeatingstylewashighlycorrelatedwiththe

“mealplanning”challenges(62.5%ofdazedandconfusedeatermentionedmealplanning).

Amongthechaoticeaters,55%mentionedmealplanningasachallenge.Thetimebarrierwas

highlycorrelatedwiththedisconnected/habitualanddazedandconfusedeatingstyles,

reportedby25%ofthethesetypesofeaters.Lastly,thesubjectswhoidentifiedwiththe

disconnected/habitualeatingstyleweremorelikelytoexperience“cravings”comparedtoany

othereatingstyle(20.8%ofdisconnected/habitualeatermentionedcravings).Similarly,19.4%

oftheemotionaleatersalsomentionedcravings.

GapsinEatingBehaviorsandAttitudes

Generalobservationsweregatheredfromthesubjectiveresponsestoidentifyany

eatingbehaviorsandattitudesnotcapturedbytheinitialsurvey.Multiplesubjectsmentioned

ordescribedanoteworthypreoccupationwithfood.Forexample,“Ijustwanttostopobsessing

aboutitandleadanormallife.”Otherbehaviorsreportedinthesubjectiveresponsesincluded

eatinginsecrecyandeatingoutofboredom.Lastly,multiplesubjectsmentionedeatingata

fasterpacerelatedtoconcernthattherewouldnotbeenoughforasecondserving,“justas

whenIwasakidwithseveralsiblings,whenIamsharingwithmyhusband,Iameatingfastto

getmyshare.”


DISCUSSION

Thisstudypresentedthedevelopmentofaninitialeatingstylesurveyderivedfrom

yearsofexperienceworkingwithwomenwhostrugglewitheatingandweightandpooled

itemsfromexistingquestionnairesregardingeatingbehaviorsandattitudes.Theresults

providedinsightintoGMFR’sparticipanteatingbehaviorsandattitudes,andabaseline

overviewofthereliability,validityandcomprehensivenessofthesurveytool.Bysurveyingthe

participantsusingquantitativeandqualitativequestions,trendsbetweeneatingstylesandgaps

inbehaviorsandattitudesnotinitiallycapturedbythesurveywereidentified.Tothe

researchers’knowledge,thesurveydevelopedinthisstudyisthefirstassessmenttoolcreated

thatincorporatesacomprehensivelistofeatingbehaviorsandattitudes,andaimstohelp

peopleidentifytheirindividualeatingstyle.Althoughtheidentifiedeatingstyleconstructsand

correspondingsurveyareatanearlystageofdevelopment,theresultsprovideinsightintonext

stepsforcreatingavalidatedeatingstylesassessmenttool.

Theobservednegativerelationshipbetweentheskillfuleatingstyleandtheremainingfive

styleswasexpected.GivenGMFR’saimtoguideindividualstowardsa“skillful”eatingstyle,itis

reassuringtoknowthatwhensomeonebecomesamoreskillfuleater,problematiceating

behaviorsinthedietmentality,emotional,chaotic,anddisconnected/habitualcategoriesare

likelyminimized.Thisisconsistentwithotherliteraturethatconfirmsintuitiveeatingis

negativelyrelatedtoeatingdisordersymptomatology,andmindfulnessisassociatedwith

decreasedemotionalandexternaleating.14,28Thedazedandconfusedstylewasnot

significantlycorrelatedwiththeskillful,dietmentality,emotionalordisconnected/habitual

styles.Thissuggeststhatspecifictargetedinterventionstrategiesmayberequiredtoimprove


understandingoffoodandnutritioninformation,orincreaseconfidenceinplanningand

preparingmeals;thesecharacteristicswillnotbeimprovedsimplybyincreasingskillful

behaviorsorattitudes.

Theresultsdemonstratedthatthedietmentality,emotionalanddazedandconfusedeating

stylesarethemostreliableandclearlydefinedconstructs.Thereisoverlapbetweenthese

factorsandotherassessmenttoolsthatincludemultipleconstructs.Similarly,the“AmI

Hungry?”assessmenttoolandtheDEBQincorporateconstructsorscalesthathaveparallels

withthedietmentality,suchastherestrictiveeatingcycleandtherestraintscale.6,20The

emotionaleatingstyleoverlapswiththeemotionaleatingscaleontheDEBQ.Theoverlapwith

the“AmIHungry?”cyclesandtheemotionalstyleislessstraightforwardgiventhecomplex

structureofeatingcycles.TheDEBQandthe“AmIHungry?”questionnairesdonotoverlap

withthedazedandconfusedeatingstyle,however,itissimilartothecontextualskills

describedbytheecSattermodel(“skillsandresourcestoprocureadequateamountsof

rewardingfood”).13Theresultsandthiscomparisonstronglysuggestthatthedietmentality,

emotionalanddazedandconfusedstylesaredistinctconstructsandshouldremainas

individualeatingstylesinthesurvey.

Asexpected,additionaleatingstylecharacteristicsemergedthatwerenotincludedonthe

initialsurvey.Eatingoutofboredomwasmentionedafrequentlybyparticipantsinrelationto

thequestion,“onceIstarteating,Ioftenfinditdifficulttostop”,whichwasdevelopedunder

theemotionaleatingconstruct.Emotionaleatingisacomplexconstructsinceitconsidersa

varietyofemotionsandexternalstimulithatinfluenceeating,suchasstress,anger,loneliness,

boredom,etc.Thereisquestionwhethereatinginresponsetoboredomcategorizesasa


componentofemotionalorexternaleating.23Koballetal.’sresearchsuggeststhatboredomis

animportantandindependentdimension,orsubscale,ofemotionaleating.Therefore,adding

“eatingoutofboredom”totheeatingstyleassessmenttoolmustbecarefullyconsidered.

Lastly,futureresearchinvestigatinghowtobestcategorizeboredomwouldfurtherinformthe

developmentofausefulassessmenttool.

Limitations

Thereareseverallimitationstothisstudythatmayhaveimpactedtheoutcomesandability

todrawconclusions.First,withonly62responses,repeatmeasuresofthestatisticalanalyses

areneeded.Morespecifically,researchersusuallyrecommendasamplesizeof100participants

ormoretomakeconclusionsfromanexploratoryfactoranalysis.27However,inthisstudythe

exploratoryfactoranalysiswasintentionallypreliminaryandprovidedapreviewofthe

underlyingfactors.Additionally,thesamplepopulationlimitsthegeneralizabilityoftheresults

becauseGMFRparticipantsarenotonlyauniquepopulationoffemaleswhostrugglewith

eatingandweight,theyarealsoanaffluentpopulation.Asapilotstudy,thepurposeofthe

researchwastoprovideinsightabouteatingstylesandwaystocategorizeeatingcharacteristics

andbehaviors.Identificationandvalidationofeatingstylesmaybeusefulforother

practitionersworkingwithclientswhoexperiencedisorderedeatingandissueswithbody

image.Therefore,incorporatingotherpopulationswhodonothavethesamefinancial

resourcesisnecessarybeforetheassessmenttoolcouldbevalidatedforusewithother

populationsandpractices.

Thesurveymethodwasadequateforprovidingpreliminaryinformationaboutobservable

trendsamongeatingstylesandinvestigatinggapsinthedefinitions.However,thesamplesize


andthesurveymethodlimitedtheabilitytodrawconcreteconclusionsabouttrendsamong

eatingstylesandwherenewcharacteristicsshouldbecategorized.Forexample,theresultsare

notclearenoughtomakeconclusionsaboutwhichbarriersshouldbelistedundereacheating

stylebecausethereweresofewresponsesineachcategory.Organizedfocusedgroupsarethe

nextlogicalstepstotrulyevaluatetheeatingbehaviorsandattitudesofparticipants.

Lastly,afewoftheresultswerebasedontheinferencethataparticipant“identified”with

aneatingstyle,indicatedbyasumof12orgreater,onascaleof3-15.Thisrequiresa

considerableamountofevidenceandassessmenttoensurethatthecutoffpointvalidly

capturesareasonablepointofidentifyingwiththateatingstyle,whichwasnotdoneto

determinethisindicator.Insuchearlystagesofresearch,thecutoffpointof12orgreateris

reasonablebecauseitreflectsanindividualwhoprimarilyansweredagreeorstronglyagreeto

thethreequestionsregardingthateatingstyle.However,furtherresearchinvestigatingan

appropriatescaleandcutoffpointfordeterminingidentificationwithaneatingstyleisneeded.

CONCLUSION

Overall,thepresentstudyaccomplishedthedevelopmentofaninitialsurvey,provided

insightonGMFR’sparticipants’eatingbehaviorsandattitudes,abaselineassessmentoftrends

amongeatingstyles,andanevaluationofthesurvey’sreliability.Mostimportantly,asskillful

eatingbehaviorsandattitudesincrease,thenotherproblematiceatingbehaviorsarelikelyto

decrease,exceptfordazedandconfusedcharacteristics.Althoughtheresultsidentified

additionalcharacteristicstoincludeontheassessmenttool,furtherresearchisneededto

gatherinsightonbehaviorsandattitudesthatalignwiththesixeatingstyles.Specifically,the

chaoticeatingstyleappearstobetheweakestconstructandtheemotional,


disconnected/habitualanddazedandconfusedstylesneedtoberevisitedtoimproveinternal

consistency.ThestudyprovidedGMFRwithastartingplaceonthemostcommonbarrierstheir

populationfaces.Lastly,theresultswillinformGMFR’snextstepstowardscreatingavalidated

eatingstylesassessmenttoolandstandardizedbehavioralstrategiestoguideindividualsto

becomemore“skillful”eaters.


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AppendixA.

Table1.Overviewofeatingstyledefinitionsandassessmenttools.CreatorofDefinitions TypesorCategoriesofEating“Styles”GreenMountainatFoxRun(GMFR)29

EatingStyles Skillful,Chaotic,DietMentality,Emotional,DisconnectedorHabitual,Dazed&ConfusedMeasure:EatingStylesChecklist

MichelleMay,MD21 EatingCycles Instinctive,Overeating,Mindful,Restrictive,Binge,Eat-Repent-RepeatMeasure:“AmIHungry?”

EvelynTribole,MS,RD9

EatingPersonalities&Styles

IntuitiveEaterCarefulEater,ProfessionalDieter,UnconsciousEater(Chaotic,Refuse-Not,Waste-Not,EmotionalMeasure:None

EllynSatter,MS,RD,LCSW,BCD13

EatingCompetenceModel

EatingAttitudes,FoodAcceptanceSkills,InternalRegulationSkillsandContextualSkillsMeasure:EatingCompetenceQuestionnaire


AppendixB.GreenMountainatFoxRunEatingStylesDefinitions29SkillfulIngeneral,askillfuleaterlistenstoandtrustsherbody,totellherwhat,when,andhowmuchtoeat.Fooddecisionsarenotdictatedbyexternalcontrolsbutdrivenbyindividualneedsandpreferencesinagivenmoment.Sheusesfoodtofuelandnourishherbodyanddoesnotfeelguiltyaboutherchoices,evenifsheischoosingtoeataparticularfoodpurelyforpleasure.Sheenjoysherfood,savoringeachbite,andselectsfromawidevarietyoffoods.ChaoticDietlacksroutineandstructure.Eatingtimesmaybesporadicandinconsistent.Individualisoftenlessattunedtohungercues,notrespondinguntiltheyfeelveryhungry,whichleadstoconsumptionoflessnutritionallybalancedandmoreconvenience/highly-processedfoods.Italsooftenleadstoeatingbeyondthepointofcomfortablesatisfactionbeforerecognizingfeelingsoffullness.Apersonwhoeatschaoticallyoftenreportslackoftimeasabarriertohealth-supportiveeating.Foodselectionandpreparationtakesabackseattootherperceivedhigherpriorities.Asaresult,theindividualofteneatswhilemultitaskingand/orinarushedmanner.Dietmayalsolackvarietyduetotimeconstraintsandlowprioritizationoffoodselection.DietMentalityCharacterizedbyrigidrules-focusedeatingbehaviors.Individualsoften,butdonotalways,havealonghistoryoffollowingspecificdietprograms(WeightWatchers,Atkins,SouthBeach,Nutrisystem,etc.).Ifnotfollowingaspecificdiet,theyhaveinternalizedthedietmessagesthataresopervasiveinoursociety–viewingfoodasgoodandbad;viewingexerciseasawaytoearn,orpaypenancefor,certainfooddecisions;hyper-focusedoncontrollingportionsizesandcalorieintake;andverystrictaboutwhat,when,andhowmuchtheywilleat.Theyfeelshameandguiltovereatingcertainfoodsanddon’ttrustthemselvestomakedecisionsaboutwhat,when,andhowmuchtoeat,oftenrelyingonexternalcontrols.EmotionalFoodisbeingusedasamajorcopingmechanismand,insomecases,istheonlycopingmechanismformanagingchallengingemotions.Thedecisiontoeat,aswellasthetypeandamountoffood,isinfluencedbymoodandemotionsratherthanphysicalhungerandsatietycuesandnutrientneeds.Individualsmightfeeloutofcontrolandasiftheyareunabletostopeatingoncetheybegin.


Disconnected/HabitualThisisbestdescribedaseatingonautopilot.Individualsarelessawareduringthefoodselectionoreatingprocess,notrespondingtophysiologicalneedsbutratherenvironmentalcuesandtriggers.Theytendtochoosethesamefoodsoverandoveragain,becausetheyarenotattunedtotheirbodies’needsorevenpersonalpreferences.Theymayevenbegintoeatcertainfoodswithoutgivingmuchthoughttowhetherornottheyevenwanttobeeating.Theyareoftendistractedwhileeatingandarelessabletorecognizecuesoffullness;asaresulttheygenerallyrelyonexternalfactorstodictatetheendpointintheeatingoccasion(e.g.,whenthebagisempty,theplateisclean).Dazed&ConfusedIndividualsfeelcompletelyoverwhelmedbytheamountofnutritioninformationtheyreadandhearandarecompletelyconfusedabouthowtoeathealthfully.Additionally,theymayfeeluncomfortableinthekitchenhavinglimitedcookingskillsandareunawareofhowtocreategood-tasting,health-supportivemeals.Theymaynotknowwheretobeginwhenitcomestomealplanning,shopping,andpreparingmeals,andalthoughtheymayhaveadesiretopreparemoremealsthemselves,theyfeeloverwhelmedbytheprocess.Alternatively,theymayhavelittledesiretopreparetheirownmealsandareunsurehowtogoaboutprocuringhealth-supportivemealspreparedoutsideofthehome.


AppendixC.Eating Styles Survey

Please answer the following questions to the best of your ability. You may skip any question you prefer to not answer and still remain in the study.

1. Whatwouldyouliketochangeaboutyoureatingbehaviorsand/orthoughtsaboutfood? For questions 2 – 19, please select the response that best describes your behaviors or attitudes. When prompted, please provide more details about your experiences. 1=strongly disagree | 2=disagree | 3=neither agree nor disagree | 4=agree | 5=strongly agree

2. Iusuallytrustmybodytotellmewhat,whenandhowmuchtoeat.1 2 3 4 5

3. Usually,IsavormyfoodwhenIeat.1 2 3 4 5

4. Iamusuallyflexiblewithfoodchoices(forexample,myfoodchoicesarenotdictatedbyasetof

rules;Ifeelcomfortableeatingavarietyofdifferentfoodsbasedonthecircumstancesormyfoodpreferencesinthemoment,etc.).1 2 3 4 5

5. IamoftenveryhungrywhenIstarteatingandthenoftenuncomfortablyfullwhenIstop.

1 2 3 4 5

6. Myeatingroutineusuallylacksstructure,andissporadicandunpredictable.1 2 3 4 5

7. Iusuallyeatveryquickly.1 2 3 4 5Ifyourated3,4,or5,pleasedescribethefactorsthataffectthespeedatwhichyoueat.

8. Icategorizemostfoodsasbeing“good”or“bad”basedontheircaloriecontentand/ornutritionalvalue.1 2 3 4 5

9. Ioftenfeelguiltyorshamefulaftereatingcertainfoods.

1 2 3 4 5

10. Iusuallyfeeltheneedtocontrolmyfoodintakebycountingcalories,controllingportionsizes,and/orfollowingstrictdietplans.1 2 3 4 5

11. IofteneatwhenI’mfeelingunpleasantoruncomfortableemotions.

1 2 3 4 5


12. Foodoftenprovidesmecomfortanddistractionfromwhatisgoingoninmylife.

1 2 3 4 5

13. OnceIstarteating,Ioftenfinditdifficulttostop.1 2 3 4 5Ifyourated3,4,or5,pleasedescribewhenthisismostlikelytohappenandwhatmaytriggerthis.

14. Iofteneatwhiledistractedorengagedinotheractivities.1 2 3 4 5

15. IofteneatoutofhabitwithoutgivingmuchthoughttowhatorhowmuchIameating.1 2 3 4 5

16. IusuallyrelyonexternalcuestodecidewhenIwillstopeating(forexample,thepackageis

empty,myplateisclean,thefoodisgone,myTVshowisover,etc.).1 2 3 4 5

17. Ioftenfeeloverwhelmedbytheamountoffood,nutrition,anddietinformationIhear.

1 2 3 4 5

18. Ioftendon’tknowwhatfoodtoeatthatwillsupportmyhealth.1 2 3 4 5

19. Ioftenlackconfidenceinmyabilitytoplanandpreparemealsthatarenourishingandenjoyable.1 2 3 4 5

20. Pleasedescribeanyothermajorchallengeswhenitcomestofoodselection,preparation,

and/oreatingthatwerenotcapturedinthissurvey?

21. Isthereanythingelseyouwouldliketoshareaboutyoureatingbehaviorsorexperiences?


AppendixD.Research Information Sheet

Title of Study: Understanding Eating Behaviors and Attitudes to Define Eating Styles

Principal Investigator (PI): Christine Albertelli

Faculty Sponsor: Amy Nickerson, MS, RDN, CD

Funder: University of Vermont, Department of Nutrition and Food Sciences & Green Mountain at Fox Run

Introduction You are being invited to take part in this research study because you are an incoming participant at Green Mountain at Fox Run (GMFR). This study is being conducted by Christine Albertelli, a candidate in the Master of Science in Dietetics Program at the University of Vermont.

Purpose This study is being conducted to gather information about and discern patterns within individual eating behaviors and attitudes to better define different types of eating styles.

Study Procedures If you take part in the study, you will be asked to complete an anonymous, online survey. The survey will consist of several open-ended and Likert-scale based questions regarding your current eating behaviors and attitudes. You may skip any question you prefer not to answer and still remain in the study. The survey must be completed in one sitting and will take between 15-20 minutes to complete, depending on the detail of your responses.

Benefits As a participant in this research study, there may not be any direct benefit for you, other than gaining insight into your current eating behaviors and attitudes prior to your arrival at Green Mountain at Fox Run; however, information from this study may benefit other people now or in the future by helping to better inform programming and curriculum development at Green Mountain at Fox Run. This study may also contribute to the field at large by providing information that will help practitioners assess eating styles in clients and thus, better inform intervention approaches.

Risks We will take measures to fully protect the information we collect from you during this study. We will not collect any information that will identify you to protect your confidentiality and avoid any potential risk for an accidental breach of confidentiality.


Costs There will be no costs to you for participation in this research study.

Compensation You will not be paid for taking part in this study.

Confidentiality All information collected about you during the course of this study will be stored without any identifiers (anonymous). No one will be able to match you to your answers.

Survey responses will be kept in a secure electronic data file, on password protected computers, managed by Green Mountain at Fox Run. Anonymous survey responses will be compiled and provided to the PI via an electronic data file to be analyzed. Voluntary Participation/Withdrawal Taking part in this study is voluntary. You are free to not answer any questions or withdraw at any time. You may choose not to take part in this study, or if you decide to take part, you can change your mind later and withdraw from the study.

Questions If you have any questions about this study now or in the future, you may contact me Christine Albertelli at the following phone number (314) 610-5597 or Dana Notte, Nutrition Lead at Green Mountain at Fox Run, at (802) 228-8885 ext. 255. If you have questions or concerns about your rights as a research participant, you may contact the Director of the Research Protections Office at (802) 656-5040.

Participation Your participation is voluntary, and you may refuse to participate without penalty or discrimination at any time. Please print this information sheet for your records before continuing.


AppendixE.Results.

DescriptiveStatistics

Table2.Meanresponsestoobjectivequestions. Mean Std.Deviation NQ2 2.14 .973 59Q3 2.69 1.021 59Q4 3.56 1.303 59Q1 3.29 1.260 59Q2 3.41 1.315 59Q3 3.86 1.196 59Q8 3.78 1.233 59Q9 4.08 1.134 59Q10 2.92 1.343 59Q11 4.39 .983 59Q12 4.27 1.048 59Q13 3.78 1.340 59Q14 3.76 1.208 59Q15 3.61 1.017 59Q16 3.97 1.144 59Q17 3.42 1.499 59Q18 2.14 1.306 59Q19 2.80 1.448 59

Table3.FrequenciesofresponsesontheLikertscaleforeachquestion.

1 2 3 4 5Q2 Count 19 22 15 6 0

RowValidN% 30.6% 35.5% 24.2% 9.7% 0.0%Q3 Count 6 20 27 4 5

















RowValidN% 26.7% 21.7% 16.7% 18.3% 16.7%

KEY:Percentages 30-40% >41-50% >51-60%


Table3.Internalconsistencyofeatingstyleconstructs.Construct Cronbach’salpha(a) Questions Cronbach’sAlphaifitemdeletedSkillful 0.625* Q2 0.595

Q3 0.386Q4 0.594

Chaotic 0.456 Q5 0.250

Q6 0.457Q7 0.362

DietMentality 0.668* Q8 0.519

Q9 0.626Q10 0.566

Emotional 0.791* Q11 0.620Q12 0.681Q13 0.868**

Disconnected/Habitual

0.609* Q14 0.691**

Q15 0.433

Q16 0.390Dazed&Confused

0.678* Q17 0.758**Q18 0.455Q19 0.522

*Acceptablevaluesindicativeofinternalconsistency/reliability=0.60-0.90.**Internalconsistencyincreaseswhenthequestionisdeletedfromtheconstruct. Table 4. Identification of underlying factors among eating behaviors and attitudes (factor analysis: rotated component matrix). Component (Factors)

1 2 3 4 5 6 Q2 -.126 -.629 -.244 -.168 .393 -.244 Q3 -.307 -.175 -.128 .101 .777 -.034 Q4 .051 .128 .081 -.441 .751 -.045 Q5 .130 .269 .435 .375 .217 .502 Q6 -.014 .772 .051 .000 .114 .104 Q7 .065 .223 .014 .169 -.545 .523 Q8 .316 .181 .084 .659 -.029 .032 Q9 .309 .238 .178 .565 -.191 -.231 Q10 -.003 .153 .140 .801 -.106 .318 Q11 .815 .254 .048 .294 -.082 .155 Q12 .910 -.004 .010 .036 -.015 .190 Q13 .616 .455 .016 .151 -.207 -.119 Q14 .185 .272 -.081 .069 -.220 .724 Q15 .219 .722 -.164 .202 -.032 .058 Q16 .413 .542 .166 .312 -.187 .067 Q17 .153 -.049 .552 .034 .070 .513 Q18 -.003 .045 .911 .095 .014 -.051 Q19 .014 .030 .811 .118 -.130 -.006 Extraction Method: Principal Component Analysis. Rotation Method: Quartimax. KEY: Factor loading: >0.5 (yellow or blue highlights; see written report for further explanation).


Table5.RelationshipsbetweeneatingstylesevaluatedbyPearson’sCorrelations. Chaotic DietMentality Emotional Disconnected/

HabitualDazed&Confused

Skillful -.369** -.459** -.366** -.437** -.188

Chaotic .485** .369** .588** .337**

DietMentality .455** .468** .305*

Emotional .594** .122Disconnected/Habitual

.140

*Correlationissignificantatthe0.05level(2-tailed).**Correlationissignificantatthe0.01level(2-tailed).

[CATEGORY NAME]

[PERCENTAGE]

(n=6) [CATEGORY

NAME] [PERCENTAG

E] (n=26)

[CATEGORYNAME]

[PERCENTAGE](n=25)

[CATEGORY NAME]

[PERCENTAGE] (n=44)

[CATEGORYNAME]

[PERCENTAGE](n=30)

[CATEGORYNAME]

[PERCENTAGE](n=11)

FIGURE1.PERCENTOFSUBJECTSWHO"IDENTIFIED"WITHEACHEATINGSTYLE