Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Health Sciences


Nutrition and Food Sciences


Nutrition and Food Sciences

First Advisor

Brietta Oaks


Stress and eating behaviors can influence the health of midlife women, a population at risk for weight gain and redistribution of fat to the abdominal area related to shifts in reproductive hormones and aging. Higher stress is associated with negative health outcomes such as increased abdominal adiposity, depression, and chronic diseases such as cardiovascular disease. Women report higher stress and more emotional and physical side effects from stress than men and are more likely than men to engage in emotional eating in response to stress. Further, the desire to lose weight and the prevalence of body dissatisfaction is high among midlife women and research suggests that this age group demonstrates lower adaptive behaviors such as intuitive eating than younger women. There is a need for research to better understand the impact of stress on eating behaviors to improve health outcomes such as adiposity among midlife women. Intuitive eating (IE) is an adaptive eating behavior that has been consistently associated with a lower body mass index, though its relationship with adiposity, specifically abdominal adiposity, has not been studied. IE is associated with several positive psychosocial outcomes and its guiding principles emphasize the reliance on internal cues of what and when to eat instead of using environmental or external cues, including emotions, to guide food intake. Thus, individuals who use IE may be less vulnerable to using eating to cope with emotions such as stress or depression. However, there is limited evidence of the association between IE and stress, and no studies have explored the relationship between IE and stress using a biomarker such as cortisol. Further, IE has been associated with lower depression in young adults and older women, though the relationship has not been studied in midlife women, who may be at higher risk of depression related to menopausal status. Thus, the objective of this dissertation is to examine the associations between IE, depression, stress, and adiposity in a sample of midlife women.

The three studies in this dissertation were cross-sectional analyses of data from the Women’s Health Improvement Initiative (WHII) study at the University of Rhode Island which enrolled 121 women to explore the role of physical and psychosocial factors in the quality of life of middle-aged women between the ages of 40-64. Participants included in the studies were 114 women with a mean age of 52.4 + 6.2 years, 54% of whom identified as postmenopausal. Participants primarily identified as White (96%), had a high level of education with 86% having graduated college, and 82% had an annual household income greater than $75,000.

The first study used multivariable linear regression analyses to examine the association between IE and total percent body fat and abdominal adiposity. Higher IE was associated with lower total percent body fat and lower abdominal adiposity. Additionally, higher scores on the reliance on hunger and satiety cues and eating for physical rather than emotional reasons subscales of the intuitive eating scale were associated with lower total percent body fat and abdominal adiposity.

The second study used multivariable linear regression analyses to examine associations between perceived stress and IE and between features of diurnal cortisol and IE. Mediation models were tested to examine the indirect effect of IE on the association between perceived stress and adiposity and the indirect effect of IE on the association between cortisol measures and adiposity. Higher perceived stress, higher waking cortisol, and higher cortisol 30 minutes after waking were associated with lower scores on the eating for physical rather than emotional reasons subscale. In mediation analyses, there was a significant indirect effect of waking cortisol on total body fat and abdominal adiposity through eating for physical reasons, such that higher waking cortisol was associated with lower eating for physical rather than emotional reasons which in turn promoted higher total and abdominal adiposity.

The third study used multivariable linear regression to determine associations between IE and depressive symptoms and analyses were further stratified by menopause status due to a significant interaction between menopause status and depressive symptoms. Higher IE and higher scores on the unconditional permission to eat subscale were associated with lower depressive symptoms in all participants. When stratified by menopause status, higher IE and higher unconditional permission to eat were associated with lower depressive symptoms in premenopausal women but not in postmenopausal women.

These findings have implications for promoting IE in the clinical and public health setting, particularly for midlife women who may be vulnerable to stress, depression, and eating to cope with emotions. Results from this study suggest that higher IE is associated with lower total and abdominal adiposity and lower depressive symptoms. Further, having higher IE may mediate the association between higher waking cortisol and greater adiposity. Future studies are needed to understand the temporal relationship and causal pathways between higher IE and positive health outcomes, such as lower adiposity and lower depressive symptoms.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.