O que é comportamento de risco para transtornos alimentares em adolescentes?

Altered Brain Reactivity to Food Cues in Undergraduate Students with Disordered Eating Behaviors

PURPOSE

A growing body of evidence has shown that electroencephalography (EEG) is an interesting method of assessing the underlying brain physiology associated with disordered eating. Using EEG, we sought to evaluate brain reactivity to hyper-palatable food cues in undergraduate students with disordered eating behavior (DEB).

METHODS

After assessing the eating behaviors of twenty-six undergraduate students using the Eating Attitudes Test (EAT-26), electroencephalographic signals were recorded while the participants were presented with pictures of hyper-palatable food. The current study used a temporospatial principal component analysis (PCA) approach to identify event-related potential (ERP) responses that differed between DEB and non-DEB individuals.

RESULTS

A temporospatial PCA applied to the ERPs identified a positivity with a maximum amplitude at 347 ms at the occipital-temporal electrodes in response to pictures of hyper-palatable food. This positivity was correlated with the EAT-26 scores. Participants with DEB showed reduced positivities in this component compared with those without DEB.

CONCLUSION

Our findings may reflect greater motivated attention toward hyper-palatable food cues in undergraduate students with DEB. These results are an important step toward obtaining a more refined understanding of specific abnormalities related to reactivity to food cues in this population.

Prevalence and associated factors of eating disorder symptoms in adolescents: a cross-sectional school-based study

PURPOSE

To estimate the prevalence of eating disorder symptoms and associated factors in adolescents between 14 and 17 years old.

METHODS

The data were obtained from a cross-sectional school-based study with 782 adolescents from public schools in Caxias do Sul, in Rio Grande do Sul, Brazil, in 2016. The Eating Attitudes Test (EAT-26) was used to investigate eating disorder symptoms. The chi-square test and Poisson regression with robust variance were performed to estimate the prevalence ratios and associations between the outcome and the variables of interest.

RESULTS

The prevalence of eating disorder symptoms was around 56.9% among adolescents and more prevalent in females. A significant association was found between eating disorders and female gender, mothers who did not study or had an incomplete elementary school, and body image dissatisfaction. To adolescents dissatisfied with being overweight, the prevalence was more than three times higher than that observed among those who did not report such dissatisfaction.

CONCLUSION

The presence of eating disorder symptoms was associated with female gender, maternal education, and body image dissatisfaction. The results show the need to identify early signs and symptoms related to changes in eating behavior and non-acceptance of their bodies in a population especially concerned with their physical appearance.

Association between dating app use and unhealthy weight control behaviors and muscle enhancing behaviors in sexual minority men: a cross-sectional study

BACKGROUND

Body image concerns are prevalent and are viewed as risk factors for engaging in unhealthy weight control behaviors (UWCBs), such as purging, fasting, and the misuse of laxatives and diet pills. Studies have also linked UWCBs to the development of eating disorders. In the United States (U.S.), sexual minority men (e.g., bisexual, gay, and men who have sex with men) are prone to UWCBs often as a result of societal pressures to achieve certain standards of appearance - of which are often perpetuated through various media platforms. A growing number of studies have explored the possible role mobile dating applications ("dating apps") play in contributing to UWCBs. To our knowledge, such studies have not explored this possible relationship between dating apps and UWCBs in sexual minority men (SMM). To fill this gap in the scientific literature, the present study assessed the association between dating app use and UWCBs and muscle enhancing behaviors among a sample of adult SMM in the U.S.

METHOD

549 SMM participated in an anonymous survey from Qualtrics Survey Panels. UWCBs and muscle enhancing behaviors were assessed through items adapted from national surveys. Body image dissatisfaction was assessed using the Male Body Attitudes Scales. Participants also reported their history of dating app use. We performed descriptive statistics, chi-square tests, and student's t-tests. Multivariable logistic regression models assessed the relationship between dating app use and UWCBs and muscle enhancing behaviors.

RESULTS

Dating app users had significantly higher body image dissatisfaction scores than non-users. Dating app users also demonstrated significantly elevated odds of engaging in four UWCBs and muscle enhancing behaviors: laxatives, diet pills, muscle-building supplements, and protein powders.

CONCLUSIONS

This is one of the first studies to assess dating app use and its association with UWCBs and muscle enhancing behaviors in SMM. Increased surveillance and detection for such behaviors among SMM, particularly those using dating apps, are needed.

Effect of a Nutritional Behavioral Intervention on Intuitive Eating in Overweight Women With Chronic Kidney Disease

OBJECTIVES

This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent women with chronic kidney disease and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group.

DESIGN AND METHODS

This is a prospective noncontrolled clinical trial of a behavioral multisession group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale 2, translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey questionnaire was applied to assess health-related quality of life.

RESULTS

Of the 33 patients who began participation in the study, 23 patients (median [interquartile range]: age = 62.0 years [58.0-68.0]; 52.2% with diabetes; body mass index = 32.6 kg/m² [30.2-39.3]; estimated glomerular filtration rate = 28.0 mL/min/1.73 m² [22.0-31.0]) completed the intervention. Except for the IE subscale Body-Food Choice Congruence, the IE total score and all its subscales (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) improved after the intervention. In a cross-sectional analysis, more intuitive eaters were older and had better scores for health-related quality of life.

CONCLUSIONS

The nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of chronic kidney disease patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.

Cross-cultural adaptation of the Eating Beliefs Questionnaire into Brazilian Portuguese

OBJECTIVE

The aim of this study was the cross-cultural adaptation of the Eating Belief Questionnaire (EBQ)-an instrument that assesses positive, negative, and permissive eating beliefs in relation to binge eating episodes-in its shorted version of 18 questions, into Brazilian Portuguese, for female teenagers.

METHODS

Conceptual, semantic, cultural and operational equivalence of the items were evaluated. The semantic and cultural equivalence involved 12 bilingual people and 12 experts in eating behavior. Operational equivalence consisted of applying the transcultural adapted version of the EBQ-18 to 20 girls with a mean age of 17.55 (SD=1.00) years. Item's clarity and understanding were assessed by the Content Validity Coefficient.

RESULTS

Questions 5, 6, 11, 14, 15, 16, 17 and 18, with adequate classification percentage for all equivalences, were not altered. The other items were adapted according to the committee's suggestions and by consensus among researchers. The adapted version of the EBQ-18 in Brazilian Portuguese displayed good content validity coefficient for clarity (CVC=0.975) and comprehension (CVC=0.971); except for item 3, all items had values between 0.88 and 1.00.

CONCLUSION

The Brazilian Portuguese version of the EBQ-18 had a good understanding by the adolescent public when it comes to investigate the role of dietary beliefs in the maintenance of binge eating episodes. Future studies with adolescents are recommended, jointly assessing risk for and presence of eating disorders in significant clinical and non-clinical samples, as well as its psychometrics properties.

Adaptação transcultural do Eating Beliefs Questionnaire para português do Brasil

RESUMO Objetivo: Conduzir adaptação transcultural, para o português brasileiro, da versão reduzida de 18 questões do Eating Belief Questionnaire (EBQ) ao público de meninas adolescentes. O instrumento avalia crenças positivas, negativas e permissivas do comer com relação a episódios de compulsão. Métodos: Realizou-se avaliação das equivalências conceitual, semântica, cultural e operacional dos itens. A equivalência semântica e cultural envolveu 12 bilíngues e 12 especialistas em comportamento alimentar. A equivalência operacional consistiu na aplicação da versão transcultural adaptada do EBQ-18 em 20 meninas, com média de idade de 17,55 anos (DP=1,00). O grau de clareza e compreensão das questões foi avaliado pelo coeficiente de validade de conteúdo. Resultados: Na avaliação semântica e cultural, 8 itens tiveram classificação adequada para todas as equivalências e não sofreram alterações; 10 itens foram alterados de forma mínima, conforme sugestões dos especialistas e mediante consenso entre pesquisadoras; e apenas o item 3 sofreu adaptação após resultados da equivalência operacional. O modelo adaptado para o português apresentou bom coeficiente de validade de conteúdo para clareza (CVC=0,975) e compreensão (CVC=0,971); com exceção do item 3, todos os itens foram avaliados com valores entre 0,88 e 1,00. Conclusão: A versão em português do EBQ-18 apresentou-se com boa compreensão do público adolescente para investigação do papel de crenças alimentares na manutenção de episódios de compulsão. Recomendam-se trabalhos futuros avaliando conjuntamente risco e presença de transtornos alimentares em amostras significativas clínicas e não clínicas, bem como suas propriedades psicométricas.

Item Response Theory-based validation of a short form of the Disordered Eating Attitude Scale (DEAS-s) to a Brazilian sample

This study aimed to validate a short version of the Disordered Eating Attitude Scale (DEAS-s). To this end, 2,902 adult individuals answered the original DEAS and informed age, weight, and height. Data were analyzed using the full-information factor analysis and Item Response Theory (IRT) analysis. Exclusion criteria retained items with adequate values of commonality and factor loadings. Estimation of IRT parameters, the Item Characteristic Curve (ICC), and test information guided the selection of the best quality items. The final model adjustment was evaluated using Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMSR), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). The eating attitudes on each level of DEAS-s were described. The analyses were performed on R software and Microsoft Excel version 2013. As results, six items were excluded because of the low communalities and factor loadings, and one more was excluded because of an overlapping on the ICC. The remaining 17 items explained 0.53 of the total variance and had an adequate goodness-of-fit (RMSEA = 0.05; SRMSR = 0.05; CFI = 0.98; TLI = 0.98). The information test is more accurate between the scores 0 and +3. Scores higher or equal to 1.5 identified individuals with disordered eating attitudes. Women, older individuals, and those with a higher body mass index presented more disordered eating; thus, the one-dimensional and short version of DEAS showed a suitable adjustment and may contribute to properly evaluate disordered eating in diverse populations.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil

OBJECTIVE

To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction.

METHODS

Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes.

RESULTS

The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively.

CONCLUSION

A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

Prevalência de comportamentos de risco para transtornos alimentares e uso de dieta “low-carb” em estudantes universitários

RESUMO Objetivos Identificar a presença de compulsão alimentar associada ou não a práticas compensatórias em praticantes de dieta low-carb. Métodos Foram utilizadas a Escala de Compulsão Alimentar Periódica (ECAP) e o Questionário de Hay para avaliar a frequência de compulsão alimentar e práticas compensatórias, além de um questionário de frequência do consumo de chocolate, pão e arroz. A intensidade de restrição de carboidratos foi avaliada com escala de 1 a 8 pontos. Os participantes foram divididos nos grupos (i) dieta low-carb e (ii) controle. Foram realizadas comparações entre grupos, além de correlações entre variáveis de interesse no grupo dieta (p < 0,05). Resultados Participaram 853 universitários, sendo 75,97% mulheres com média de 22,04 anos (DP = 3,33) e índice de massa corporal (IMC) com média de 23,56 kg/m2 (DP = 4,38). Do total, 214 fizeram dieta low-carb e 639 não. A prevalência de um alto escore sugestivo de compulsão alimentar sem práticas compensatórias foi de 17,94% (n = 153) e a presença de compulsão alimentar associada com compensação foi de 2,23% (n = 19). No grupo dieta, 35,05% (n = 75) também realizaram jejum intermitente. O grupo dieta atingiu maiores valores para ECAP e IMC e menores para frequência de consumo de arroz e pão francês. Ainda, os escores da ECAP se correlacionaram positivamente com o consumo de chocolate (r = + 0,14 ; p = 0,0377) e valores de IMC (r = + 0,19; p = 0,0042), enquanto a restrição de carboidratos apresentou correlação negativa com o consumo de chocolate (r = - 0,13; p = 0,041), pão francês (r = - 0,20; p = 0,0024) e arroz (r = - 0,36; p = <0,0001). Conclusões Destacam-se a alta prevalência da prática de dieta (25,09%) e os maiores níveis de compulsão alimentar neste grupo, além de menor consumo de arroz e pão francês em relação aos que não fizeram dieta.

Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015

INTRODUCTION

This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents.

METHODS

This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control.

RESULTS

7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat.

CONCLUSION

Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.

Relação entre imagem corporal, atitudes para transtornos alimentares e estado nutricional em universitárias da área da saúde

RESUMO Objetivo Avaliar a relação entre a insatisfação da imagem corporal, atitudes para transtornos alimentares e o estado nutricional em universitárias da área da saúde. Métodos Estudo descritivo, transversal e quantitativo com 225 universitárias matriculadas em oito cursos da área da saúde. Para obtenção dos dados, utilizaram-se três instrumentos autoaplicáveis: o Body Shape Questionnaire (BSQ), o Eating Attitudes Test (EAT-26) e um questionário construído pelas pesquisadoras contendo os dados autorreferidos de altura, peso atual e peso desejado, curso e idade. O estado nutricional foi estabelecido segundo o cálculo do índice de massa corporal. Para análise dos dados, aplicou-se o teste qui-quadrado de Pearson, adotando-se o nível de significância de 5%. Resultados A média de idade foi de 22,65 anos e a de IMC, de 23,05 kg/m2, estando a maioria das universitárias em eutrofia (69,8%). Quanto ao peso desejado, 74,7% gostariam de pesar menos; dessas, 64,9% eram eutróficas. Conforme o BSQ, 51,1% das universitárias tiveram algum grau de insatisfação corporal, e a prevalência de atitudes indicativas de transtornos alimentares, de acordo com o EAT-26, foi de 21,8%. Houve associação estatisticamente significativa entre: IMC e BSQ (p < 0,001); IMC e EAT-26 (p < 0,005); BSQ e EAT-26 (p < 0,001). Ao relacionar a insatisfação da imagem corporal e atitudes de risco para transtornos alimentares, percebeu-se que 87,75% das universitárias com EAT positivo também apresentaram algum grau de insatisfação corporal. Conclusão Evidenciou-se a existência de relação entre a insatisfação com a imagem corporal, atitudes de risco para transtornos alimentares e estado nutricional de universitárias da área da saúde.

Temporal changes in the prevalence of disordered eating behaviors among adolescents living in the metropolitan area of Rio de Janeiro, Brazil

To investigate temporal changes in the prevalence of disordered eating behaviors among adolescents, and their association with socio demographic factors and overweight. Using probability sampling, two population-based cross-sectional surveys were conducted: one in 2005 (n=511) and the other in 2010 (n=314). The frequency of disordered eating behaviors (binge eating, strict dieting or fasting and compensatory behaviors) was investigated using a self-administered questionnaire. The presence of binge eating increased by 18.4% in the 5 years between the two surveys. In 2005, girls were 1.95 times more likely to engage in strict dieting or fasting than boys, and this difference increased to 7.02 times in 2010. Overweight adolescents were 2.29 times more likely to undertake strict dieting than non-overweight adolescents in 2005 and 3.65 times more likely to do so in 2010. No significant associations were found for compensatory behaviors. A pronounced increase in the prevalence of binge eating was observed, and girls and overweight adolescents were more likely to engage in strict dieting or fasting.

Relação entre o estado de humor e os comportamentos alimentares de risco para os transtornos alimentares em adolescentes

RESUMO Objetivo Analisar a relação entre o estado de humor e os comportamentos alimentares de risco para os transtornos alimentares (TA) em adolescentes do sexo feminino. Métodos Participaram 397 adolescentes com idade entre 12 e 17 anos. Utilizaram-se as subescalas do Eating Attitudes Test (EAT-26) para avaliar os comportamentos alimentares de risco para os TA. Utilizou-se a Escala de Humor de Brunel (BRUMS) para avaliar o estado humor negativo (ansiedade, tensão, depressão, confusão mental, raiva e fadiga). Conduziram-se a Regressão Logística Binária e a Análise Multivariada de Covariância para analisar os dados. Resultados Evidenciou-se associação estatisticamente significativa entre o estado de humor negativo e os comportamentos alimentares de risco para os TA (X2 = 25,71; Wald = 31,92; p = 0,001). Identificou-se diferença de escore na subescala Dieta entre as adolescentes com alto e baixo estado de humor negativo [F (1, 396) = 13,40; p = 0,04], fato que não foi encontrado para as subescalas Bulimia e Preocupação com Alimentos [F (1, 396) = 1,69; p = 0,09] e Autocontrole Oral [F (1, 396) = 0,95; p = 0,17]. Conclusão Os comportamentos alimentares de risco para os TA estiveram relacionados ao estado de humor negativo.

Disordered eating, body dissatisfaction, perfectionism, and mood state in female adolescents

Objective The aim of this study was to investigate the relationship between body dissatisfaction, perfectionism, mood, and disordered eating in female adolescents. Methods Three hundred and seventy one adolescents aged between 12 and 16 years of age participated in this research. The Body Shape Questionnaire, Multidimensional Perfectionism Scale, Brunel Mood Scale, and the Eating Attitudes Test - 26 were used to assess, respectively, body dissatisfaction, perfectionism, mood state, and disordered eating. Stepwise multiple linear regression was used to determine the relationship between the independent variables and the Eating Attitudes Test subscale scores. Multivariate analysis of covariance was used to compare the Eating Attitudes Test subscale scores according to body dissatisfaction, perfectionism, and mood state classifications. Results The findings showed that body dissatisfaction (p=0.001), perfectionism (p=0.04), and mood state (p=0.05) were associated with disordered eating in the female adolescents evaluated. Despite the statistically significant results obtained for all independent variables, it is worth mentioning that body dissatisfaction was the main determinant of disordered eating in the multiple regression model. Conclusion It can be concluded that body dissatisfaction explains the variance in disordered eating; however, it is also important to note that perfectionism and mood state are also associated to the disordered eating in female adolescents, although to a lesser extent.

Autoestima, insatisfação corporal e internalização do ideal de magreza influenciam os comportamentos de risco para transtornos alimentares?

OBJETIVO: O objetivo do presente estudo foi verificar a influência da autoestima, da insatisfação corporal e da internalização do ideal de magreza nos comportamentos de risco para transtornos alimentares de adolescentes do sexo feminino. MÉTODOS: Participaram do estudo 471 jovens. Utilizou-se a Escala de Autoestima de Rosemberg, o Body Shape Questionnaire e o Sociocultural Attitudes Towards Appearance Questionnaire-3 para avaliar autoestima, insatisfação corporal e internalização do ideal de magreza, respectivamente. As subescalas do Eating Attitudes Test foram utilizadas para avaliar os comportamentos de risco para transtornos alimentares. RESULTADOS: Os resultados indicaram influência dos escores do Body Shape Questionnaire (p<0,05) e da Sociocultural Attitudes Towards Appearance Questionnaire-3 (p<0,05) em todas as subescalas do Eating Attitudes Test. Em contrapartida, os achados não demonstraram influência da Escala de Autoestima de Rosemberg nos escores das subescalas do Eating Attitudes Test (p>0,05). CONCLUSÃO: Concluiu-se que a insatisfação corporal e a internalização do ideal de magreza influenciam os comportamentos de risco para transtornos alimentares em adolescentes do sexo feminino, fato que não foi evidenciado para a autoestima.

Risk behaviors for eating disorders and depressive symptoms: a study of female adolescents in Juiz de Fora, Minas Gerais State, Brazil

The objective of this study was to analyze the relationship between depressive symptoms and eating disorders in female adolescents. The sample included 371 girls ranging from 12 to 16 years of age in Juiz de Fora, Minas Gerais State, Brazil. The study used the Eating Attitudes Test (EAT-26) and Major Depression Inventory (MDI) to evaluate eating disorders and depressive symptoms, respectively. The linear regression model showed that 18% of the EAT-26 scores were influenced by MDI (F(1, 370) = 14.18; p = 0.001). Moreover, the findings indicated a statistically significant association between depressive symptoms and eating disorders (χ2 = 14.71; Wald = 12.90; p = 0.001). The authors concluded that depressive symptoms were related to eating disorders in female adolescents. Thus, girls with some level of depression showed a greater tendency to adopt disordered eating as a daily habit.