Research Brief| Volume 47, ISSUE 4, P354-360.e1, July 2015

Health at Every Size College Course Reduces Dieting Behaviors and Improves Intuitive Eating, Body Esteem, and Anti-Fat Attitudes

Published:March 11, 2015DOI:



      To investigate the effects of a Health at Every Size general education course on intuitive eating, body esteem (BES), cognitive behavioral dieting scores, and anti-fat attitudes of college students.


      Quasi-experimental design with 149 students in intervention (45), comparison (66), or control (46) groups. Analysis of variance and post hoc Tukey adjusted tests were used.


      Mean scores for total general education course on intuitive eating (P < .001), unconditional permission to eat (P < .001), reliance on hunger (P < .001), cognitive behavioral dieting scores (P < .001), BES appearance (P = .006), BES weight (P < .001), and anti-fat attitudes (P < .001) significantly improved from pre to post in the intervention group compared with control and comparison groups.

      Conclusion and Implications

      Students in the Health at Every Size class improved intuitive eating, body esteem, and anti-fat attitudes and reduced dieting behaviors compared with students in the control and comparison groups.

      Key Words

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        • Dereene J.
        • Beresin E.V.
        Body image, media, and eating disorders.
        Acad Psychiatry. 2006; 30: 257-261
        • Polivy J.
        • Herman P.
        Distress and eating: why do dieters overeat?.
        Int J Eat Disord. 1999; 26: 153-164
        • Killen J.D.
        • Taylor C.B.
        • Hammer L.D.
        • et al.
        An attempt to modify unhealthful eating attitudes and weight regulation practices of young adolescent girls.
        Int J Eat Disord. 1993; 13: 369-384
        • Pietilainen K.H.
        • Saarni S.E.
        • Kaprio J.
        • Rissanen A.
        Does dieting make you fat? A twin study.
        Int J Obes. 2012; 36: 456-464
        • Neumark-Sztaine D.
        • Wall M.
        • Story M.
        • Standish A.R.
        Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index.
        J Adolesc Health. 2012; 50: 80-86
        • Goldschmidt A.B.
        • Wall M.
        • Loth K.A.
        • Le Grange D.
        • Neumark-Sztainer D.
        Which dieters are at risk for the onset of binge eating? A prospective study of adolescents and young adults.
        J Adoles Health. 2012; 51: 86-92
        • Gillen M.M.
        • Markey C.N.
        • Markey P.M.
        An examination of dieting behaviors among adults: links with depression.
        Eat Behav. 2012; 12: 88-93
        • Bacon L.
        • Keim N.
        • Van Loan M.
        • et al.
        Evaluating a “non-diet” wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors.
        Int J Obes. 2002; 26: 854-865
        • Bacon L.
        • Stern J.
        • Van Loan M.
        • Leim N.
        Size acceptance and intuitive eating improve health for obese, female chronic dieters.
        J Am Diet Assoc. 2005; 105: 929-936
        • Dansinger M.L.
        • Tatsioni A.
        • Wong J.B.
        • Chung M.
        • Balk E.M.
        Meta-analysis: the effect of dietary counseling for weight loss.
        Ann Intern Med. 2007; 147: 41-50
        • Mann T.
        • Tomiyama A.
        • Westling E.
        • Lew A.
        • Samuels B.
        • Chatman J.
        Medicare’s search for effective obesity treatments: diets are not the answer.
        Am Psychol. 2007; 62: 220-233
        • Stice E.
        • Cameron R.P.
        • Killen J.D.
        • Hayward C.
        • Taylor C.B.
        Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents.
        J Consult Clin Psychol. 1999; 67: 967-974
        • Field A.E.
        • Manson J.E.
        • Taylor C.B.
        • Willett W.C.
        • Colditz G.A.
        Association of weight change, weight control practices and weight cycling among women in the Nurses’ Health Study II.
        Int J Obes. 2004; 28: 1134-1142
        • Ackard D.M.
        • Croll J.K.
        • Kearney-Cook A.
        Dieting frequency among college females: association with disordered eating, body image, and related psychological problems.
        J Psychosom Res. 2002; 52: 129-136
        • Racette S.B.
        • Deusinger S.S.
        • Strube M.J.
        • Highstein G.R.
        • Deusnger R.H.
        Weight changes, exercise, and dietary patterns during freshman and sophomore years of college.
        J Am Coll Health. 2005; 53: 245-251
        • Kiess W.
        • Reich A.
        • Muller G.
        • et al.
        Clinical aspects of obesity in childhood and adolescence—diagnosis, treatment and prevention.
        Int J Obes Relat Metab Disord. 2001; 25: S75-S79
        • Bacon L.
        • Aphramor L.
        Weight science: evaluating the evidence for a paradigm shift.
        Nutr J. 2011; 10: 9
        • Schaefer J.T.
        • Magnuson A.B.
        A review of interventions that promote eating by internal cues.
        J Am Diet Assoc. 2014; 114: 734-760
        • Hawks S.R.
        • Madanat H.
        • Smith T.
        • De La Cruz N.
        Classroom approach for managing dietary restraint, negative eating styles, and body image concerns among college women.
        J Am Coll Health. 2014; 56: 359-366
        • Bandura A.
        Social Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice-Hall, Englewood Cliffs, NJ1986
        • Heker E.B.
        • Gardner C.D.
        • Robinson T.
        Effects of a college course about food and society on students’ eating behaviors.
        Am J Prev Med. 2010; 38: 543-547
        • Emrich T.E.
        • Mazier P.
        Impact of nutrition education on university students’ fat consumption.
        Can J Diet Prac Res. 2009; 70: 187-192
        • Tylka T.L.
        The Intuitive Eating Scale-2: item refinement and psychometric evaluation with college women and men.
        J Couns Psychol. 2013; 60: 137-153
        • Martz D.M.
        • Sturgis E.T.
        • Gustafson S.B.
        Development and preliminary validation of the Cognitive Behavioral Dieting Scale.
        Int J Eat Disord. 1996; 19: 297-309
        • Mendelson B.K.
        • Mendelson M.J.
        • White D.R.
        Body-Esteem Scale for adolescents and adults.
        J Pers Assess. 2001; 76: 90-106
        • Crandall C.S.
        Prejudice against fat people: ideology and self-interest.
        J Pers Soc Psychol. 2007; 57: 359-363
        • Keys A.
        • Fidanza F.
        • Karvonen M.J.
        • Kimura N.
        • Taylor H.L.
        Indices of relative weight and obesity.
        J Chronic Dis. 1972; 25: 329-343
        • Satter E.
        Eating competence: definition and evidence for the Satter eating competence model.
        J Nutr Educ Behav. 2007; 39: S142-S153
        • Keeler K.
        • Clifford D.
        • August B.
        • Kowalski P.
        • Neyman Morris M.
        Examination of a peer-led, non-diet nutrition and exercise adherence pilot program on a 5 college campus: FitU.
        Calif J Health Prom. 2013; 11: 84-96
        • O’Brien K.S.
        • Puhl R.M.
        • Latner J.D.
        • Mir A.S.
        • Hunter J.A.
        Reducing anti-fat prejudice in pre-service health students: a randomized trial.
        Obesity (Silver Spring). 2010; 18: 2138-2144
        • O’Brien K.S.
        • Hunter J.A.
        • Banks M.
        Implicit anti-fat bias in physical educators: physical attributes, ideology, and socialization.
        Int J Obes. 2007; 31: 308-314