A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate ‘health-centric’ eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n=48), mindful eating (n=19), and eating competence (n=11). There were 298 outcomes identified for body composition, size, and physical health (n=116), mental health and wellbeing (n=123), health promoting behaviours (n=51) and other eating behaviour (n=8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and higher body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Findings demonstrate that ’health-centric’ eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. Findings enhance the understanding of eating behaviours that do not centre around weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.