Internal Cues Versus External Cues for Eating and Activity
Condition: Eating Behavior; Body Image; Diet Habit; Dietary Habits
Study type: Interventional

Summary: 
      The majority of female undergraduate students experience disordered eating and/or weight
      gain, increasing the risk for two serious public health problems, eating disorders and
      obesity. Traditional nutrition education about weight control delivered during college has
      not been effective and may even exacerbate these problems. Thus, the investigators propose
      that instead of focusing on external information as taught by nutrition education (e.g.
      'calories in, calories out', quantification and cognitive processing of nutrition
      information), at-risk females be trained to become more attuned to their internal hunger and
      fullness signaling to set them on a trajectory for decreased chronic disease risk as they
      age.
    

Detailed description: 
      The proposed study, Internal versus External Cues for Eating and Activity, will collect data
      on within-person changes in psychological (e.g. attunement with bodily signals, eating and
      activity behaviors) and physiological (e.g., body mass index, heart rate, saliva) markers of
      risk for both eating disorders and obesity in female University of Delaware students.
      Outcomes will be assessed at baseline, mid-treatment, end-of-treatment, and one-year
      follow-up. This three-armed randomized, controlled trial will assess the effects of a novel
      internal cues intervention (treatment group; intuitive eating and body positive yoga)
      compared to an active control group consisting of traditional healthy weight sessions,
      following standardized government recommendations for eating and activity, and a no-treatment
      control group completing assessments only. The Internal Cues group will attend one intuitive
      eating session and take three body-positive yoga sessions weekly for ten weeks. The External
      Cues group will attend one healthy weight class and three cardiovascular-based exercise
      sessions each week for ten weeks. The Assessment Only no-treatment control group will only
      attend assessments. The curriculum for the intuitive eating classes (previously piloted and
      revised accordingly) and healthy weight classes (modeled off of classes offered at
      universities and government-available recommendations and educational documents) will be
      taught by two Registered Dietitians who are Certified Intuitive Eating Counselors. The yoga
      classes will be taught by a Registered Yoga Instructor trained in Body Positive Yoga and in a
      curriculum specifically designed for UD students (funded by Dean Matt). During the Internal
      Cues group's intuitive eating classes, participants will, as a group, eat dinner that is
      prepared by ServSafe certified undergraduate dietetics students in the test kitchen in the
      STAR Tower. This dinner will allow the participants to experientially learn the intuitive
      eating principles taught in class. The External Cues group will receive an identical dinner
      during the class period but they will learn how to properly portion their meals to meet their
      caloric needs, in line with traditional education about weight control. Finally, students
      randomized to the External Cues group will receive a UD fitness pass and will be able to
      choose from select cardio-based fitness classes in order to meet public health
      recommendations for physical activity.

      Additionally, the interventionists for both the Internal Cues and External Cues sessions will
      be video recorded to allow content to be tested in a lab study following the intervention.
      The research team worked with IT at STAR campus to position equipment so that the video only
      captures the interventionists (session leaders). Participants will not be recorded. If any
      participant audio is captured, content containing participants' voices will be deleted from
      the file. The purpose of recording is to modify the curriculum for future interventions and
      programs.
    

Intervention name(s): Internal Cues; External Cues
Intervention type(s): Other; Other
Intervention description(s): The intuitive eating curriculum that was pilot tested and adapted has been modified for use for the Internal Cues group with college-aged females for delivery over a 10-week time period.
The classes will be delivered by two Registered Dietitians and Certified Intuitive Eating Counselors from the University of Delaware, Julia Katcher and Maryann Eastep.
During the Internal Cues group's intuitive eating classes, participants will, as a group, eat dinner that is prepared by ServSafe certified undergraduate dietetics students in the test kitchen in the STAR Tower. This dinner will allow the participants to experientially learn the intuitive eating principles taught in class.
The yoga classes will be adapted to all levels of experience, mobility, and body size. Specific breathing techniques and body positive language will be incorporated into a body-positive yoga training done by Ms. Lisa Jones, RYT.; The 10-week traditional healthy weight program for the External Cues group was created by a Graduate Assistant based on MyPlate principles.
The External Cues classes will be delivered by two Registered Dietitians from the University of Delaware, Julia Katcher and Maryann Eastep.
During the External Cues group's healthy eating classes, participants will, as a group, eat dinner that is prepared by ServSafe certified undergraduate dietetics students in the test kitchen in the STAR Tower. This dinner will allow the participants to experientially learn how to properly portion their meals to meet their caloric needs, in line with traditional education about weight control.
Students randomized to the External Cues group will receive a UD fitness pass and will be able to choose from select cardio-based fitness classes in order to meet public health recommendations for physical activity.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This three-armed randomized, controlled trial will assess the effects of a novel internal cues intervention (treatment group; intuitive eating and body positive yoga) compared to an active control group consisting of traditional healthy weight sessions, following standardized government recommendations for eating and activity, and a no-treatment control group completing assessments only.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: intuitive eating; body positive yoga; weight management; cardiovascular fitness; interoceptive awareness; embodiment; internal cues; external cues