An Online Intuitive Eating Program for Pregnant Women With Obesity to Support Well-Being

Feasibility and Preliminary Effects of an Online Intuitive Eating Intervention on Gestational Weight Gain and Well-Being in Pregnant Women

The goal of this feasibility randomized controlled trial is to assess the feasibility, acceptability, and demand, as well as preliminary effects of an evidence-based Intuitive Eating (IE) intervention among pregnant women who have obesity. The main questions we aim to answer are:

RQ1: What is the feasibility (acceptability and demand) of implementing an Intuitive Eating Intervention among pregnant and postpartum women? RQ2: How does participation in the Pregnancy Intuitive Eating Intervention (PIE-I) impact key maternal health outcomes (i.e., gestational weight gain, intuitive eating behaviors, dietary quality, body image, and mental health) compared to a wait-list control?

Researchers will compare the Pregnancy Intuitive Eating Intervention (PIE-I) intervention group with the wait-list control to see what impact the PIE-I has on maternal well-being.

Participants randomized to the intervention group will complete the 8 week asynchronous IE intervention and have an opportunity to interview at the end of the study.

Study Overview

• Status: Recruiting
• Conditions: Physical Activity; Pregnancy; Anxiety; Diet Quality; Perceived Stress; INTUITIVE EATING; Prenatal Depression; Excessive Gestational Weight Gain; Body Awareness
• Intervention / Treatment: Other: Intuitive Eating Intervention

Detailed Description

This study is designed as a pilot feasibility trial. We plan to enroll 80 participants (40 per group; 1:1 randomization).

The purpose of this study is to evaluate the feasibility and preliminary effects of an evidence-based Intuitive Eating (IE) intervention, adapted from the Tribole and Resch framework, among pregnant individuals with obesity. Feasibility will be determined based on acceptability and demand scores. Acceptability will be assessed through satisfaction, perceived appropriateness, burden, and intent to continue use. Demand will be defined as retention and adherence to the intervention and participant engagement. Preliminary effects of the IE intervention will be explored in relation to the prevention of excessive gestational weight gain, intuitive eating behaviors, dietary quality, mental health, body image, and perceived stress.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jeni Green, PhD; Phone Number: 619-594-6489; Email: jgreen5@sdsu.edu

Study Locations

• United States
  • California
    • San Diego, California, United States, 92182
      • Recruiting
      • San Diego State University
      • Contact: Jeni Green, PhD; Phone Number: 619-594-6489; Email: jgreen5@sdsu.edu
      • Principal Investigator: Jeni Green, PhD
    • San Diego, California, United States, 92182
      • Recruiting
      • UC San Diego Health
      • Contact: Jeni Green, PhD; Phone Number: 619-594-6489; Email: jgreen5@sdsu.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥18 years
• Pregnant women between 12 weeks and <22 weeks gestation
• Pre-pregnancy BMI 30.0 kg/m² or greater
• Able to read and understand English (for intervention materials and questionnaires)
• Receiving prenatal care at UC San Diego Health (UCSD)
• Reliable access to a device (e.g., smartphone, tablet, or computer) with internet connection

Exclusion Criteria:

• Current or past diagnosis of an eating disorder (e.g., anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID)
• High-risk pregnancy or medical complications that may significantly affect diet, physical activity, or weight gain (e.g., gestational diabetes requiring insulin, preeclampsia, hyperemesis gravidarum)
• Multiple gestation pregnancy (e.g., twins or higher-order multiples)
• Current participation in another nutrition, weight management, or behavioral intervention study
• Severe psychiatric illness (e.g., schizophrenia, bipolar disorder) or current substance use disorder that would interfere with participation
• Inability to provide informed consent or comply with study procedures

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intuitive Eating Intervention Group; The (PIE-I) will be based on the IE Book & Workbook published by RDNs Evelyn Tribole & Elyse Resch. Each week, participants will be asked to watch 20 minute online modules and complete 1-2 workbook pages (workbook provided for free). Optional weekly office hours will be held by Certified Intuitive Eating Counselors. Participants in the PIE-I will complete two online surveys - one at baseline (upon enrollment) and one after 8 weeks (the same surveys and time schedules as the intervention group). Each completed survey will earn participants an e-gift card as compensation for their time. Participants will also have an opportunity to complete a virtual interview at the end of the 8-week study.	Other: Intuitive Eating Intervention; The (PIE-I) will be based on the IE Book & Workbook published by RDNs Evelyn Tribole & Elyse Resch. Each week, participants will be asked to watch 20 minute online modules and complete 1-2 workbook pages. Optional office hours will be held by Certified Intuitive Eating Counselors. The online modules are as follows: Week 1: Orientation of IE framework, overview of 10 Intuitive Eating Principles, and Principle 1-Reject Diet Culture Week 2: Principle 2-Honor Your Hunger & Principle 3-Make Peace with Food Week 3: Principle 4-Discover the Satisfaction Factor Week 4: Principle 5-Feel Your Fullness Week 5: Principle 6-Challenge the Food Police Week 6: Principle 7-Cope with Your Emotions with Kindness Week 7: Principle 8-Respect Your Body& Principle 9 -Movement: Feel the Difference Week 8: Principle 10-Honor Your Health with Gentle Nutrition, wrap-up and conclusion of modules
No Intervention: Usual Care Group (Waitlist Control); Participants assigned to the Wait-List Control Group will continue their usual daily habits and routines during the 8-week study period. They will not receive access to the Intuitive Eating modules or workbook materials until the completion of their participation. During the 8-week study period, control participants will complete two online surveys - one at baseline (upon enrollment) and one after 8 weeks (the same surveys and time schedules as the intervention group). Each completed survey will earn participants an e-gift card as compensation for their time. Control participants may contact the study team via the study email at any time with questions or concerns.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intervention Acceptability as Assessed by the Post-Intervention Satisfaction Survey at 8 Weeks	Intervention acceptability will be assessed using a post-intervention satisfaction survey administered at 8 weeks. Participants will rate satisfaction with the intervention, intention to continue using intuitive eating principles, and perceived appropriateness of the intervention content for pregnancy on a 1-5 scale. The feasibility benchmark will be met if ≥70% of participants provide a rating of ≥4 for each indicator.	8 weeks
Burden of the Intervention at 8 Weeks	Perceived intervention burden will be assessed using a post-intervention survey on a 1-5 scale, with higher scores indicating greater perceived burden. The feasibility benchmark will be a mean burden rating of ≤2.5.	8 Weeks
Participant Retention Through the 8-Week Intervention	Retention will be calculated as the proportion of enrolled participants who complete the intervention and 8-week post-intervention assessment. The feasibility benchmark is ≥80% retention (≥64 of 80 enrolled participants).	Baseline through 8 weeks
Participant Adherence to the Intervention During the 8-Week Intervention	Intervention adherence will be assessed using Moodle analytics. Participants will be considered adherent if they complete at least 6 of the 8 intervention modules. The feasibility benchmark will be met if ≥70% of participants meet this adherence criterion.	Baseline through 8 weeks
Participant Engagement with the Intervention During the 8-Week Intervention	Participant engagement will be assessed using Moodle and Zoom analytics. Platform interactions will include logins, module views, and attendance at weekly Zoom office hours. The feasibility benchmark will be a median of ≥1 platform interaction per participant per week during the 8-week intervention.	Baseline through 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Intuitive Eating Scale-3 (IES-3) Score at 8 Weeks	Intuitive eating will be assessed using the Intuitive Eating Scale-3 (IES-3). The IES-3 assesses individuals' tendency to eat in response to physiological hunger and satiety cues rather than external or emotional cues. Higher scores indicate greater levels of intuitive eating. Change in IES-3 score from baseline to the 8-week post-intervention assessment will be compared between the intervention and wait-list control groups.	Baseline and 8 weeks
Change from Baseline Health Eating Index (HEI) Score at 8-weeks	Diet quality will be assessed using the Healthy Eating Index (HEI), calculated from dietary intake data collected using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool. The HEI assesses alignment with the Dietary Guidelines for Americans, with total scores ranging from 0 to 100. Higher scores indicate greater adherence to dietary recommendations and better overall diet quality.	Baseline and 8 weeks
Proportion of Participants Exceeding Recommended Gestational Weight Gain Guidelines	Gestational weight gain will be evaluated relative to recommended ranges based on pre-pregnancy body mass index (BMI) using Institute of Medicine (IOM) gestational weight gain guidelines. Excessive gestational weight gain (EGWG) will be defined as total gestational weight gain exceeding the recommended range for the participant's pre-pregnancy BMI category. The proportion of participants with EGWG will be compared between the intervention and wait-list control groups.	From baseline through delivery
Change from Baseline in Perceived Stress Scale (PSS) Score at 8 Weeks	Perceived stress will be assessed using the Perceived Stress Scale (PSS-10), which measures the degree to which situations in one's life are perceived as stressful. The PSS-10 produces a total score ranging from 0 to 40. Higher scores indicate greater perceived stress. Change in PSS score from baseline to the 8-week post-intervention assessment will be compared between the intervention and wait-list control groups.	Baseline and 8 weeks
Change from Baseline in Edinburgh Postnatal Depression Scale, United States Version (EPDS-US) Score at 8 Weeks	Depressive symptoms will be assessed using the Edinburgh Postnatal Depression Scale, United States version (EPDS-US). The EPDS is a self-report measure designed to assess symptoms of depression during the perinatal period. The 10-item scale produces a total score ranging from 0 to 30, with higher scores indicating greater depressive symptom severity. Change in EPDS-US score from baseline to the 8-week post-intervention assessment will be compared between the intervention and wait-list control groups.	Baseline and 8 weeks
Change from Baseline in Generalized Anxiety Disorder-7 (GAD-7) Score at 8 Weeks	Anxiety symptoms will be assessed using the 7-item Generalized Anxiety Disorder scale (GAD-7). Each item is scored from 0 to 3, resulting in a total score ranging from 0 to 21. Higher scores indicate greater anxiety symptom severity. Change in GAD-7 score from baseline to the 8-week post-intervention assessment will be compared between the intervention and wait-list control groups.	Baseline and 8 weeks
Change from Baseline in Body Appreciation Scale-2 (BAS-2) Score at 8 Weeks	Body appreciation will be assessed using the Body Appreciation Scale-2 (BAS-2), a 10-item measure assessing acceptance of, favorable opinions toward, and respect for one's body. Items are rated on a 5-point scale, and an overall score is calculated by averaging item responses, resulting in scores ranging from 1-5. Higher scores indicate greater body appreciation. Change in BAS-2 score from baseline to the 8-week post-intervention assessment will be compared between the intervention and wait-list control groups.	Baseline and 8 weeks

Collaborators and Investigators

• Sponsor: San Diego State University
• Collaborators: University of California, San Diego

Publications and helpful links

General Publications

• Blau LE, Hormes JM. Preventing Excess Gestational Weight Gain and Obesity in Pregnancy: the Potential of Targeting Psychological Mechanisms. Curr Obes Rep. 2020 Dec;9(4):522-529. doi: 10.1007/s13679-020-00415-9. Epub 2020 Nov 4.
• Meyer M, Carter J, Woodworth E, Miller B, Vanderkruik R, Lopez N, Papini N. Postpartum Body Image and Eating Behaviors: Receptivity to Nondiet Approaches in a Qualitative Study of Perinatal Women. J Nutr Educ Behav. 2026 Jul 17:S1499-4046(26)00149-1. doi: 10.1016/j.jneb.2026.05.018. Online ahead of print.
• Mehta UJ, Siega-Riz AM, Herring AH. Effect of body image on pregnancy weight gain. Matern Child Health J. 2011 Apr;15(3):324-32. doi: 10.1007/s10995-010-0578-7.
• Samura T, Steer J, Michelis LD, Carroll L, Holland E, Perkins R. Factors Associated With Excessive Gestational Weight Gain: Review of Current Literature. Glob Adv Health Med. 2016 Jan;5(1):87-93. doi: 10.7453/gahmj.2015.094. Epub 2016 Jan 1.
• Green J, Larkey L, Leiferman JA, Buman M, Oh C, Huberty J. Prenatal yoga and excessive gestational weight gain: A review of evidence and potential mechanisms. Complement Ther Clin Pract. 2022 Feb;46:101551. doi: 10.1016/j.ctcp.2022.101551. Epub 2022 Feb 9.
• Rezende F, Oliveira BMPM, Poinhos R. Assessment of Intuitive Eating and Mindful Eating among Higher Education Students: A Systematic Review. Healthcare (Basel). 2024 Feb 29;12(5):572. doi: 10.3390/healthcare12050572.

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: August 25, 2026
• First Submitted That Met QC Criteria: August 25, 2026
• First Posted (Actual): August 28, 2026

Study Record Updates

• Last Update Posted (Actual): August 28, 2026
• Last Update Submitted That Met QC Criteria: August 25, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Obesity; Pregnancy; Maternal Health; Body Image; Gestational Weight Gain; Intuitive Eating; Body Appreciation; Excessive Gestational Weight Gain
• Additional Relevant MeSH Terms: Mental Disorders; Nutrition Disorders; Overnutrition; Body Weight; Body Weight Changes; Overweight; Weight Gain; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Gestational Weight Gain; Obesity; Anxiety Disorders; Motor Activity
• Other Study ID Numbers: IRB-25-0479

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to share individual participant-level data. Study results will be reported and disseminated in aggregate form only, with identifying information removed to protect participant confidentiality.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No