A systematic review and narrative synthesis of the psychometric properties and biopsychosocial correlates of the English version of the Intuitive Eating Scale-2

Clinical Snapshot

Key Findings

• P Value: Not applicable for systematic review

• Effect Size: Good construct validity demonstrated, but significant underperformance in other psychometric domains

• Primary Outcome: Psychometric properties of IES-2 across diverse populations

• Nnt Or Sensitivity: Three-factor solution excluding 'Unconditional permission to eat' subscale showed promising psychometric performance

• Confidence Interval: Not applicable for narrative synthesis

Clinical Application

IES-2 is widely used but clinicians should be aware of psychometric limitations, particularly with the 'Unconditional permission to eat' subscale Relevant for Australian dietitians, psychologists, and GPs working with eating disorders and weight management under Medicare Better Access scheme and eating disorder treatment pathways Healthcare professionals assessing eating behaviours in diverse clinical populations including eating disorder treatment, weight management, and general practice settings

Abstract

Intuitive eating is an adaptive eating approach characterised by having unconditional permission to eat when you are hungry, eating for physical rather than emotional reasons, relying on internal hunger and satiety cues, and honouring your health and practising gentle nutrition. The Intuitive Eating Scale-2 (IES-2) is currently the most commonly-used intuitive eating measure but, to date, there has not been a systematic review of how it performs psychometrically outside of the student sample in which it was developed. This systematic review aimed to assess the psychometric properties of the IES-2, including its associations with other variables, across all studies that used it as a measure of intuitive eating and reported psychometric data. MEDLINE, PsycINFO, Scopus and Web of Science were searched in April 2022, May 2024 and June 2025, identifying 90 papers from diverse populations including college students, people from the general population/community, and people seeking treatment for eating disorders or weight management. Results were presented and synthesised narratively, and risk of bias was assessed using two domains from the COSMIN Risk of Bias checklist. Findings suggest that the IES-2 has good construct validity but underperforms psychometrically in other areas such as response distribution, subscale inter-correlations and dimensionality, particularly in relation to the 'Unconditional permission to eat' subscale. Alternative factor structures were reported on and a three-factor solution excluding the 'Unconditional permission to eat' subscale was found to have promising results. The review contributes a comprehensive account of the biopsychosocial correlates of the IES-2, as well as identifying that studies relating to weight or eating disorders often report mean scores that tend towards the extremes of the scale. Limitations include the exclusion of non-English translations of the IES-2, and future reviews would benefit from being conducted in other languages. PROSPERO registration: CRD42022299436. Funder: ESRC (ES/P000711/1).

References

1. 1.Linnett, R. J., Robertson, N., & Hubbard, S. J. (2026). A systematic review and narrative synthesis of the psychometric properties and biopsychosocial correlates of the English version of the Intuitive Eating Scale-2. PLoS One. https://doi.org/10.1371/journal.pone.0349590