Association between smoking dependence and intuitive eating in adults in primary care

BackgroundSmoking is associated with appetite regulation and food cravings, yet its relationship with intuitive eating (IE), an internally guided, non-restrictive eating style, remains unclear.AimTo examine associations between smoking status, nicotine dependence, and IE among adults in primary care.MethodsIn a cross-sectional study in Western France (June-July 2023), adults (18-75 y) attending general practices completed a questionnaire on sociodemographics, smoking, physical activity/sedentary time, cannabis use, anthropometrics, and IE (French Intuitive Eating Scale-2, IES-2; total and three subscales). Participants were categorized as non-smokers, smokers with low dependence (Fagerström Test for Nicotine Dependence [FTND] 0-4), or moderate-to-high dependence (FTND 5-10). Associations were tested using ANCOVA, adjusting for sex, BMI, and covariates selected a priori and by statistical criteria.SummaryAmong 466 participants (67.6% women; mean age 42.5 ± 14.1 years; mean BMI 25.5 ± 5.5 kg/m²), 101 (21.7%) were smokers, including 72 with low nicotine dependence and 29 with moderate-to-high dependence. Compared with non-smokers, smokers with low nicotine dependence had higher total IES-2 scores (β = 0.20, 95% CI: 0.03-0.37) and higher Reliance on Hunger and Satiety Cues scores (β = 0.25, 95% CI: 0.05-0.46), whereas smokers with moderate-to-high dependence had higher Unconditional Permission to Eat scores (β = 0.56, 95% CI: 0.22-0.91). No differences were observed for Eating for Physical Rather Than Emotional Reasons. These findings suggest that intuitive eating and its dimensions differ according to nicotine dependence. Longitudinal studies are needed to determine how intuitive eating changes during smoking cessation, whether it predicts post-cessation weight gain, and which mechanisms underlie these associations.