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Comparing one's appearance to other people's and believing in an ideal body shape can negatively impact an individual. The probability of developing ED in individuals with high body dissatisfaction is higher than in the general population, leading to long-term emotional and metabolic damage. Populational studies on the prevalence of ED in Brazil are scarce in the literature. The research was carried out through the Google Forms website and evaluated risk of eating disorders through the Eating Attitude Test, degree of body dissatisfaction in the sample through the Body Shape Questionnaire and the Internet Addiction Test was used to evaluate time spent on the internet. The results showed that 84.5% of the sample were female and 62.3% of the individuals had eutrophic by the Body Mass Index. About 40.2% of the population studied had abnormal attitudes towards food, indicating a possible risk of developing ED, and 62.5% of the sample did not show body dissatisfaction. Regarding internet use, 10.8% had problematic internet use. The presence of risky eating attitudes was more prevalent in participants dissatisfied with their bodies. In addition, participants with problematic internet use had a higher risk for EDs.

This study examined the relationship between weight stigma and disordered eating behaviors in university students during the COVID-19 pandemic, considering individuals with and without overweight. A national sample of 738 college students completed an online questionnaire at three time points between July 2020 and December 2021, reporting their experiences of weight stigma, perceived increase in weight stigma during the pandemic, internalized weight stigma, and disordered eating behaviors. The findings showed that the trajectories of disordered eating behaviors varied depending on participants' anthropometric status. Among those with overweight, there was a decrease over time in binge eating, food restriction, and purging. Conversely, the non-overweight group experienced a slight increase in binge eating from T2 to T3. Using the Generalized Estimating Equations model, the study revealed that weight stigma predicted disordered eating behaviors in both weight spectrums during the pandemic. Experiences of weight stigma and the perceived increase in weight stigma significantly increased the likelihood of engaging in binge eating, food restriction, and purging among individuals with overweight. Furthermore, the internalization of weight stigma was longitudinally associated with all examined eating behaviors, regardless of anthropometric status. These findings highlight the importance of addressing weight stigma to prevent disordered eating in college students., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Importance: It remains controversial whether adhering to a vegan diet may be associated with a higher prevalence of disordered eating. Also, main food choice motives and their association with disordered eating in this population are still unknown., Objective: To determine the association between disordered eating attitudes and food choice motives of individuals who follow a vegan diet., Design, Setting, and Participants: This is a cross-sectional online survey conducted between September 2021 and January 2023. Individuals of both sexes, aged 18 years or older, following a vegan diet for at least 6 months, currently living in Brazil were recruited through advertisements on social media., Exposure: Adherence to a vegan diet and food choice motives., Main Outcomes and Measures: Disordered eating attitudes and food choice motives., Results: Nine hundred seventy-one participants completed the online survey. Median (IQR) age and BMI of participants was 29 (24-36) years and 22.6 (20.3-24.9), respectively, and 800 participants (82.4%) were female. Most participants (908 respondents [94%]) were categorized with the lowest level of disturbed eating attitudes. "Need and hunger," "liking," "health," "habits," and "natural concerns" were the most important food choice motives in this population, while "affect regulation," "social norms," and "social image" were the less important ones. Adjusted models showed that "liking," "need and hunger," and "health" were associated with lower levels of disordered eating attitudes, while "price," "pleasure," "sociability," "traditional eating," "visual appeal," "social norms," "social image," "weight control," and "affect regulation" were associated with higher levels of disordered eating attitudes., Conclusions and Relevance: In this cross-sectional study, as opposed to previous suggestions, levels of disordered eating were very low among vegans, although certain food choice motives were associated with disordered eating attitudes. Understanding the motivations of adhering to diets that may impose restrictions, which include vegan diets, may help tailor interventions focused on promoting healthy eating and preventing or treating disordered eating.

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants ( N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% ( n = 239) and was consistent with high-income countries, while NCG was 29.8% ( n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries.

The aims for this study were to perform a Portuguese language cross-cultural adaptation of the Teruel Orthorexia Scale (TOS) and to evaluate the scale's psychometric properties, including verifying the frequency of behaviors characteristic of orthorexia nervosa and healthy orthorexia, among a group of Brazilian gym users. First, we adapted the Spanish version of the TOS to the Brazilian Portuguese language following international protocols to guarantee idiomatic, semantic, conceptual, and cultural equivalence. Then participants completed both the new Portuguese version of the TOS and a socioeconomic questionnaire. Among our sample of 226 young Brazilian adults (63.7% men; M age  = 28.8, SD  = 5.1 years), we assessed the bi-factorial model of the TOS through factorial, convergent, and discriminant validity, reliability, and factorial invariance. We calculated the mean scores of the TOS factors and the frequency of behaviors of both orthorexia nervosa and healthy orthorexia. The new Portuguese version was well understood by participants, and the TOS bi-factorial model presented adequate psychometric properties and showed invariance in independent subsamples and in men and women. The mean scores were different between sexes only for orthorexia nervosa, with women obtaining higher values. The frequency of orthorexia nervosa behaviors was 5.3% and of healthy orthorexia was 41.2%. Based on these findings, the Brazilian Portuguese version of the TOS can be a useful tool for investigating orthorexia-like behaviors in future research.

Background: University students may be a vulnerable group to adopt unhealthy behaviors, including changes in eating behavior. Assessment of factors associated with the prevalence of disordered eating behaviors in this population may facilitate the early identification of their predictors, thus allowing fast interventions., Aim: To analyze the prevalence of disordered eating behaviors (DEB) and associated factors in Brazilian university students., Methods: Cross-sectional study of male and female students aged 16-25 years, enrolled in full-time degree program at a public university in the mid-west of Brazil. Disordered eating behaviors in the last three months (binge eating, purging, and food restriction), through an adapted version of the instrument developed by Hay, was evaluated and the association with demographic and socioeconomic characteristics, including lifestyle, body image, perceived stress, depressive symptoms, and excess weight, was analyzed. A hierarchical analysis model was performed to determine the relative importance of factors on the prevalence of DEB., Results: A total of 1608 university students were evaluated (50.7% male). Prevalence of DEB was 4.4% for binge eating, 2.5% for purging and 9.1% for food restriction, all of which were higher among women (7.0%, 4.4%, and 13.5%) compared with men (1.8%, 0,6%, and 4.9%, respectively). The factors that remained significantly associated with these behaviors were female sex, smoking, consumption of alcoholic beverages, dissatisfaction with body image, excess weight, high perceived stress, and presence of self-reported depressive symptoms., Conclusion: Factors associated with DEB signal that intervention is required to create synergy between individual and population-level interventions in lifestyle behaviors.

The aim of this article is to present the up-to-date diagnostic tools of orthorexia and markers of its prevalence on the basis of the available literature. The authors searched PubMedCentral (PMC) and Google Scholar with the search entry of "orthorexia", "orthorexia nervosa", and "orthorexicbehaviours". We describe the tools of evaluation of orthorexicbehaviour (i.e., orthorexia self-test-BOT, the ORTO-15 questionnaire, Eating Habits Questionnaire-EHQ, Düsseldorf Orthorexia Scale-DOS, Teruel Orthorexia Scale-TOS, Barcelona Orthorexia Scale-BOS, and Orthorexia Nervosa Inventory-ONI), and offer a review of the studies on orthorexia nervosa. We conclude that there are no reliable data regarding the prevalence of orthorexia nervosa. The available studies point to significant differences in the prevalence depending on the value of cut-off points and tools used. The prevalence varies across countries and across populations, ranging from 6.9% in the Italian population to 88.7% in the group of Brazilian students of dieting. Thus, it indicates that some groups seem to be susceptible to the risk of ON more than others. It is a challenge to determine the prevalence of orthorexia, and any obtained results should be treated with caution. Consequently, we claim that the use of the ORTO-15 questionnaire to diagnose orthorexia is questionable due to a high percentage of falsely positive results.

Adolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson's regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.

The Tripartite Influence Model posits that sociocultural influences mediated by internalization and social comparison are predictors of disordered eating and body change behaviours. This study aimed to test the Tripartite Influence Model among Brazilian male university students, which has not been tested yet. 707 undergraduate students of the five Brazilian regions, completed measures of sociocultural influences, internalization, social comparison, body and muscularity dissatisfaction, disordered eating and body change behaviours. Structural equation modelling analyses showed good model-fitting. Parental influence was related to internalization, while peer influence with social comparison. Media influences were related to both internalization and social comparison. Internalization and social comparison are mediating variables that are related to body dissatisfaction and muscularity dissatisfaction. Finally, muscularity dissatisfaction was associated with body change behaviours.

Our aim was to investigate the prevalence of symptoms related to eating disorders, disordered eating and body image perception, and attitudes toward eating in a group of elite male artistic gymnastics. Seventeen athletes took part in this quali-quantitative, cross-sectional study. Presence of eating disorders symptoms, and body image perception and satisfaction were assessed using validated questionnaires. Focus groups were held to discuss their attitudes toward eating and body image perception in more detail. Little to no evidence of symptoms consistent with eating disorders was observed, and this was supported by the qualitative data. However, some concerning practices and attitudes were described. Negative emotional eating cycles appeared prevalent ( e.g. feelings of anger, stress and anxiety creating a desire to eat "junk foods", followed by guilt and regret). Body image perception and attitudes toward body weight's influence on performance varied widely. Some athletes expressed a desire to lose weight and believed that this would positively impact their performance, while others believed weight to be irrelevant and focused on feeling strong and vital. Athletes believed their female counterparts experienced far greater pressure to maintain low body weight and described some very concerning practices. We conclude that e ating disorders and disordered eating did not appear to be prevalent among these elite male artistic gymnastics. However, some concerning attitudes and practices were observed and should be addressed with nutritional support programmes encompassing psychological and behavioural aspects of eating. These programmes should be extended to support staff and significant others, in addition to athletes.

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.

Objective: To synthesize the risk of eating disorder (ED) symptoms in Brazilian university students through a systematic review and meta-analysis. Secondary goals were to analyze whether any specific majors were related to higher ED risk and whether any regions of Brazil had higher proportions of college students at risk of ED., Methods: The procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and a search was conducted in three electronic databases (MEDLINE, LILACS, and SciELO)., Results: Thirty-three studies were included in the analysis, of which 14 were included in the meta-analysis. All included studies used self-report questionnaires, the most frequent of which was the Eating Attitudes Test (EAT-26). None of the studies used a structured interview to diagnose ED. A meta-analysis of studies with a cutoff ≥ 20 for the EAT-26 (n=5) found 14.9% (95%CI 12.8-17.2%) positive screenings, while those with a cutoff of t ≥ 21 (n=9) found 13.3% (95%CI 11.3-15.6%) positive screenings. There was a significantly higher proportion of positive screenings among nutrition majors than all other majors combined (26.5 and 20.5%, respectively)., Conclusion: Nutrition students seem to be at higher risk of ED. Further research should investigate whether positive screenings translate to actual ED diagnoses.

Purpose: To estimate the prevalence of disordered eating behaviors and the association with energy and nutrient intake and nutritional status in adolescents., Methods: A school-based cross-sectional study was performed involving a probabilistic sample of 487 teenagers (aged 15-19 years) from public schools in the Metropolitan area of Rio de Janeiro, Brazil. The Eating Attitude Test and the Bulimic Investigatory Test Edinburgh questionnaires were applied to identify abnormal eating patterns and unusual dietary patterns, respectively. Nutritional status was defined by sex- and age-specific body mass index cutoffs. Energy and nutrient intake were assessed by a 3-day food record. The association between variables was assessed by the prevalence ratio and 95% confidence intervals, Pearson's Chi-square test, and linear regression., Results: The prevalence of abnormal eating patterns was 7.4% and that of unusual dietary patterns was 18.9%. Vitamin C intake was higher among girls with abnormal dietary patterns, with a consequent lower frequency of vitamin C deficiency when compared to those with normal dietary patterns. Calcium intake was lower in boys with unusual dietary pattern than in those without this behavior. Excess weight was associated with the presence of unusual dietary pattern in girls (PR: 2.4, 95% CI 1.6-3.5)., Conclusions: The prevalence of disordered eating behaviors was high, mainly in those who were overweight. It was associated with lower calcium intake in boys and with higher Vitamin C intake in girls., Level of Evidence: Level V, descriptive studies.

The Tripartite Influence Model posits that parents, peers and media influences mediated by internalization and appearance social comparison are predictors of body dissatisfaction, a key risk factor for eating disorders. However, the Tripartite Influence Model has not been tested in Brazil where the people are known to have high levels of body image and appearance concerns. This study aimed to test an adapted Tripartite Influence Model of body dissatisfaction and disordered eating behaviors among Brazilian women. A sample of 741 undergraduate students (M age  = 23.55 years, SD = 4.09) completed measures of sociocultural influences, internalization of body ideal, social appearance comparison, body dissatisfaction, muscularity dissatisfaction, disordered eating and body change behaviors. Structural equation modeling analyses indicated that the proposed etiological model for Brazilian women has good fit indexes (χ 2 (2064) = 6793.232; p = 0.0001; χ 2 /gl = 3.29; CFI = 0.82; PCFI = 0.79; RMSEA = 0.056 [IC90% = 0.053-0.057]). Parent and media influences were related with both internalization and social comparison, while peer influence with social comparison. A full mediation model was found, with both internalization and social comparison contributing to body dissatisfaction. Finally, body dissatisfaction was associated with disordered eating behaviors. The findings inform the importance of considering cultural aspects that influence body image and eating behaviors, and highlight the validity of the proposed etiological model for Brazilian women, that can be used for research and clinical purposes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The objective of this study was to develop a socio-sports model of disordered eating (DE) in Brazilian male athletes. Three hundred and twenty one athletes over 12 years of age from 18 different sports modalities were investigated. The Eating Attitudes Test (EAT-26) was applied to evaluate DE. The Body Shape Questionnaire (BSQ) was used to evaluate athlete dissatisfaction with body fat levels. The Muscularity Concern subscale of the Drive for Muscularity Scale (DMS) was used to evaluate athlete dissatisfaction with muscularity levels. To investigate the influence of sociocultural factors on body image, the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) was applied. Body fat was estimated by skinfold measurement. Demographic data were collected (competitive level and training regimen). Structural equation modelling was conducted to analyse the relationships between research variables and the factors that mediate them. The results indicated that the sociocultural factors and body fat dissatisfaction adhered to socio-sports model of DE (X(2) = 18.50, p = .001, RMSEA = .069, GFI = .97, AGFI = .91, TLI = .93). The BSQ accurately predicted the relationship between SATAQ-3 and EAT-26 (R(2) = .08, p = 0.001) scores. A direct relationship between the SATAQ-3 and EAT-26 (R(2) = .07, p = 0.01) and BSQ (R(2) = .10, p = 0.001) scores was identified. No relationship was found between structural equation model and Muscularity Concern (R(2) = .02, p = 0.14), competitive level (R(2) = .01, p = 0.19), training regimen (R(2) = .03, p = 0.11) or body fat (R(2) = .02, p = 0.14). The results suggest that sociocultural factors and body fat dissatisfaction follow the socio-sports model of DE in Brazilian male athletes., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To identify disordered eating behaviors and body image dissatisfaction, as well as their relationship to body fat (BF), among male athletes in high risk sports for eating disorders., Methods: One hundred and fifty-six male athletes were divided into the following categories: weight-class sports, sports where leanness improves performance, and sports with aesthetic ideals. BF was assessed and three questionnaires were used: the Eating Attitudes Test; the Bulimic Investigatory Test, Edinburgh; the Body Shape Questionnaire., Results: Disordered eating behaviors and body image dissatisfaction were found in 43 (27.6%) and 23 athletes (14.7%), respectively, and an association was detected between the two variables (p < 0.001). Athletes with and without disordered eating behaviors did not differ in %BF (11.0 ± 5.2% and 9.8 ± 4.0%, respectively; p = 0.106). However, athletes with body image dissatisfaction had higher %BF than those who were satisfied (12.6 ± 5.9% and 9.7 ± 3.9%, respectively; p = 0.034). There were no differences in BF, frequency of disordered eating behaviors, and body image dissatisfaction between sports categories., Conclusion: Nearly one-quarter of athletes showed disordered eating behaviors, which was associated with body image dissatisfaction. Athletes with higher %BF were more likely to be dissatisfied with body image. There was no difference in eating behavior and body image between athletes from different sports categories.

The aim of this study was to estimate the prevalence of disordered eating and possible health consequences in adolescent female tennis players. This cross-sectional controlled study investigated the pubertal development (Tanner stages); body composition (dual energy X-ray absorptiometry-DXA); dietary intake (food record); presence of disordered eating (EAT-26, BITE and BSQ); menstrual status (questionnaire) and bone mineral density (DXA). The Female Athlete Triad (FAT) was divided into two severity stages. The study included 45 adolescents (24 athletes and 21 controls) at some pubertal developmental stage. The athletes exhibited better body composition profiles. We found that 91.7%, 33.3% and 25% of athletes and 71.4%, 9.5% and 33.3% of controls met criteria for disordered eating and/or low energy availability, menstrual irregularities and low bone mass, respectively. A greater percentage of athletes than controls presented with 1 and 2 FAT components (stage I), and 4.2% presented with the full syndrome. In conclusion, tennis players appear to present with more severe disorders than controls and should be monitored to avoid damage to their performance and health., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This study aimed to investigate the socioeconomic and nutritional factors associated with disordered eating among Brazilian female college students (n = 2,489). Prevalence ratios of risk factors were calculated using Poisson regression models with robust variance based on responses to selected questions from the Eating Attitude Test and Disordered Eating Attitude Scale. It was found that 40.7% of students were dieting, 35.6% were using diet or compensatory methods, 23.9% skipping meals, 12.6% not eating or just drinking liquids, and 3.3%, vomiting to lose weight. A positive association was found between not eating or just drinking liquids and skipping meals and nutritional status after adjustment for age and region. A positive association was found between compensatory methods and dieting and education level of the head of the family. Disordered eating behaviors were frequent, and not eating and skipping meals were more prevalent among overweight/obese students; compensatory methods and dieting were less prevalent among students from families whose head had up to only four years of education. Prevention strategies and food education are necessary in order to decrease the prevalence of these behaviors.

This article seeks to estimate the prevalence of eating disorders among workers living in urban areas of Feira de Santana, Bahia. It involves an epidemiologic, descriptive and exploratory cross-sectional study of 1,273 randomly selected workers. Socio-demographic and work characteristics, lifestyle, psychosocial aspects at work and eating behavior were investigated. Females were predominant (60.2%), the youngest 51.7% were up to 35 years old, married (53.1%), Afro-Brazilian descent (55.2%), with high school education (51.5%) and with low incomes (81.2%). The prevalence of Binge Eating Disorder and Bulimia Nervosa were, respectively, 4.3% and 1%. The prevalence of these disorders was higher among workers who indulged in excessive alcohol consumption, were dissatisfied with their personal appearance and weight, reported violence in childhood and had financial problems or related worries. Also included were those involved in house care services and commerce, who had informal work arrangements or were in highly demanding work environments. Besides investigating the relation between eating disorders and work, data was provided about these disorders in a population-based study. It is hoped that this study may encourage investments in health policies for these disorders.

Background: The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessive-compulsive disorder (OCD) have been previously addressed in primarily relatively small samples., Methods: We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories., Results: The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking., Conclusions: Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders., (© 2012 Wiley Periodicals, Inc.)

Objective: To assess the impact of binge eating behavior (BE) during pregnancy on birth outcomes among 697 Brazilian women who attended primary care., Method: Pregnant women answered a questionnaire on sociodemographic data, obstetric history, and The Eating Disorder Examination Questionnaire (EDE-Q). Perinatal outcomes were obtained from birth records. Birth weight, prematurity, caesarean delivery, being small or large for gestational age were compared among women reporting BE (N = 119) and those without BE (N = 578). Poisson regression was used to estimate the association between BE during pregnancy and birth outcomes., Results: BE during pregnancy was not significantly associated with the birth outcomes analyzed. Gestational weight gain was significantly higher among those who reported BE., Discussion: Binge eating behavior during pregnancy may not influence birth outcomes as binge eating disorder does but affects gestational weight gain. Women reporting binge eating during pregnancy should undergo a diagnostic assessment for eating disorders., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Patients with obsessive-compulsive disorder (OCD) frequently show poor social adjustment, which has been associated with OCD severity. Little is known about the effects that age at symptom onset, specific OCD symptoms, and psychiatric comorbidities have on social adjustment. The objective of this study was to investigate the clinical correlates of social functioning in OCD patients., Methods: Cross-sectional study involving 815 adults with a primary DSM-IV diagnosis of OCD participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were assessed with the Social Adjustment Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Clinical correlates of social adjustment were assessed with generalized linear models with gamma distribution., Results: Poor overall social functioning was associated with greater OCD severity (p = 0.02); hoarding symptoms (p = 0.004); sexual/religious obsessions (p = 0.005); current major depressive disorder (p = 0.004); current post-traumatic stress disorder (p = 0.002); and current eating disorders (p = 0.02). Poor social adjustment was also associated with impaired quality of life., Conclusions: Patients with OCD have poor social functioning in domains related to personal relationships and professional performance. Hoarding symptoms and sexual/religious obsessions seem to have the strongest negative effects on social functioning. Early age at OCD symptom onset seems to be associated with professional and academic underachievement and impairment within the family unit, whereas current psychiatric comorbidity worsen overall social functioning. In comparison with quality of life, social adjustment measures seem to provide a more comprehensive overview of the OCD-related burden., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To evaluate whether an interdisciplinary intervention program on lifestyle results in better quality of life (QoL) and lower frequencies of depression and binge eating disorder (BED) in individuals at risk for type 2 diabetes mellitus., Methods: A total of 177 individuals (32.2% men, age 55.4 ± 12.5 years) at risk for diabetes were allocated to a 9-month traditional (TI) or intensive interdisciplinary intervention (II) on dietary habits and physical activity including psychoeducative groups. They were submitted to questionnaires and clinical and laboratory examinations. Predictors of non-adherence were analyzed by logistic regression., Results: Only individuals submitted to II had blood pressure and plasma glucose levels reduced. Frequencies of depression reduced in both interventions but of BED only in II (28.0-4.0%, P < 0.001). Increments in the scores of SF-36 domains (physical functioning: 11.1 ± 14.0 vs. 5.3 ± 13.0, role-emotional: 20.4 ± 40.2 vs. 6.2 ± 43.8, P = 0.05) were greater in the II than in TI, respectively. Changes in SF-36 correlated with decreases in anthropometry, blood pressure and glucose levels, depression and BED scores. Male gender was independently associated with non-adherence to the II., Conclusions: In addition to metabolic benefits, an interdisciplinary approach may induce desirable extrametabolic effects, favoring the control of psychiatric disorders and improving the QoL of individuals at risk for diabetes.

Background: Under the restrictive component, patients undergoing gastric bypass may have food intolerance with or without complications., Methods: This study used quantitative, analytical, observational methodology with patients submitted to Roux-en-Y gastric bypass without the placement of a ring at Hospital Universitário do Rio Grande do Norte in the city of Natal, Brazil between July 2005 and August 2010. Out of 176 patients monitored after surgery by the interdisciplinary team, 47 took part in the study. Two questionnaires were applied to participants: one elaborated by Suter et al. and previously validated for assessment of food tolerance and another to characterize schooling and socioeconomic status. Evaluation of food tolerance considered patient satisfaction with eating, most accepted food types, and frequency of vomiting and/or regurgitation. After application of the first questionnaire, a score was generated, characterizing food intolerance., Results: Of the 47 patients evaluated, 85.1% classified their degree of food satisfaction as good or excellent. Red meat was the most cited as being difficult to ingest (38.3%), representing a significant impact on overall tolerance level (P < 0.001); 48.9% of participants exhibited rare episodes of vomiting, which resulted in a mean food tolerance score of 23.02 (2.87 ± SD). Moreover, socioeconomic status showed a significant correlation with tolerance level (P = 0.032)., Conclusions: The degree of food tolerance observed in the study sample was better than that obtained in other investigations using similar methodology. The questionnaire proved to be useful in evaluating food quality and comparing postoperative results. Socioeconomic status was correlated with food tolerance level.

Background: Bipolar Disorder (BD) is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation., Methods/design: ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients) is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates., Discussion: The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED). The Bipolar Spectrum (BS) remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis.

This study sought to estimate the prevalence of eating disorders (ED) and identify risk factors among female adolescents in Fortaleza, Ceará, Brazil. It was conducted a sectional study with 652 high school students (14-20 years) using the Bulimic Investigatory Test of Edinburgh (BITE). A logistic regression model was applied. Approximately one quarter of participants showed risk eating pattern and control weight practices, among 1.2% signs of an installed ED were found. Fear of weight gain was reported by 62% of adolescents, independently if studying at public or private schools (p>0.05), but the use of risk practices was higher among private schools students (p<0.05). Not having a religion (OR: 2.2, 95%CI: 1.1-4.2) and studying in private school (OR: 1.7, 95%CI: 1.2-2.5) were associated with an increased risk of ED. The ED emerge as a public health problem even in the poor areas of Brazil and the desire for a thin body was not differentiated between different social strata, although the risk practices are significantly higher among respondents from private schools. Subjective and cultural aspects are presented not only as risk factors, but also as protectors.

The objective of the study was to estimate abnormal eating attitudes influenced by associated factors among female students of the Universidade Federal de Santa Catarina, Florian6polis, southern Brazil. Abnormal eating attitudes were investigated using the eating attitudes test (EAT-26), according to the presence (EAT+) and absence (EAT-) of symptoms in a sample of 220 students. The body-image was assessed by the body-shape questionnaire (BSQ-34). Body mass index, body-fat percentage, waist-circumference, food intake (24-hour food recall), and socioeconomic characteristics (monthly household income, monthly per-capita income, and parental schooling) were also investigated. Statistical associations were tested by multivariate Poisson regression analysis. The prevalence of EAT+ and dissatisfaction with the body-image were 8.3% [confidence interval (CI) 95% 4.6-12.0] and 20.0% (CI 95% 14.7-25.3) respectively. Dissatisfaction with the body-image maintained its independent association with abnormal eating attitudes, indicating symptoms of anorexia nervosa. The results of this work highlight the importance of the planning of nutrition-education programmes in universities, aiming at assisting in the choices of food that comprise a healthful diet in a period of life of so many changes and decisions.

Objective: To examine the prevalence of oral alterations related to eating disorders and associated factors., Method: A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination., Results: Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders., Discussion: Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Objective: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care., Method: The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed., Results: Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5-20.0], followed by excessive shape (5.6%; 95% CI 4-8) and weight concerns (5.5%; 95% CI 4-8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2-4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3-2.4), and prepregnancy BMI < 19.8 kg/m(2) (PR = 1.6; 95% CI 1.1-2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01-1.11)., Discussion: Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety.

Objective: Female athlete triad (FAT) is a syndrome characterized by the simultaneous presence of disordered eating, amenorrhea, and osteopenia or osteoporosis. The aim of this study was to assess the prevalence of FAT in adolescent elite women swimmers., Methods: The sample was composed of 78 athletes in the age range of 11-19 y from Rio de Janeiro (Brazil). The presence of disordered eating was assessed through three questionnaires (Eating Attitudes Test, Bulimic Investigatory Test Edinburgh, and Body Shape Questionnaire); the presence of menstrual dysfunctions, through a validated questionnaire; and bone dysfunctions, through assessment of bone mineral density by applying the method of dual-energy X-ray absorptiometry. The t test was used to compare means. The chi-square test was used to evaluate the association among categorical variables (P < 0.05). Pearson's coefficients of simple linear correlation between the variables of lean body mass and body mineral density at the spine (L1-L4) and overall in the body were calculated. Kaplan-Meier survival curves to estimate mean menarche age were obtained. All analyses were conducted in SPSS 13.0., Results: The athletes' mean age at menarche was 12.38 +/- 0.2 y. It was verified that 44.9%, 19.2%, and 15.4% of the athletes met the criteria for disordered eating, menstrual irregularity, and low bone mass, respectively. Among participants, 47.4% (37 of 78) met one criterion of FAT, 15.4% (12 of 78) met two criteria, and 1.3% (1 of 78) met all three criteria, corresponding with the development of the syndrome. Only 35.9% (28 of 78) of the athletes did not present positive results for any of the criteria assessed., Conclusion: The prevalence of FAT was low. However, a significant number of athletes presented a partial status of FAT, especially of disordered eating. The present study suggests the need to monitor the causes of these disorders to create preventive actions that will reverse or avoid the development of the syndrome, thus preserving the athletes' health.

We investigated the prevalence, by gender, age and nutritional status, of eating disorder (ED) risk behavior, using a simplified self-report questionnaire in a probabilistic sample of 561, 12-19-year-old students from public schools in the metropolitan area of Rio de Janeiro, Brazil. Sex- and age-specific body mass index cut-offs were used to assess nutritional status. The prevalence of overweight/obesity was 16.2% and of being underweight was 2.5%; 37.3% of the adolescents studied presented symptoms of binge eating (BE) and 24.7% would go on a strict diet at least once a week, both cases more frequent in females (40.8% vs. 25.3%; 31.2% vs. 10.5%, respectively). Older students were shown to be more susceptible to binge eating and younger students more susceptible to strict dieting. Overweight adolescents were shown to be more susceptible to strict dieting than normal-weight adolescents, regardless of sex and age. The prevalence of binge eating and strict dieting was high in low-income Brazilian adolescents and females are at greater risk of developing eating disorders than males. The greater prevalence of strict dieting in younger students shows they are at nutritional risk.

Purpose: This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset., Methods: Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis., Results: Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse-control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse-control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample., Conclusions: Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value.

Background/aims: Ghrelin and leptin play important roles in the physiopathology of eating disorders, starting generally in infancy and adolescence. The aim of this study was to evaluate the effects of multidisciplinary short-term therapy on ghrelin and leptin concentrations, bulimia nervosa symptoms, binge eating disorder symptoms, body composition, and visceral and subcutaneous fat in obese adolescents., Methods: Twenty obese adolescents with simple obesity (BMI >95th percentile, 36.93 +/- 4.14, CDC) were submitted to multidisciplinary (nutrition, psychology, exercise and clinical) therapy. Plasma ghrelin and leptin concentrations were measured by radioimmunoassay. Bulimic and binge eating behaviors were measured by the Bulimic Investigation Test Edinburgh and the Binge Eating Scale, respectively. Visceral and subcutaneous fat were measured by ultrasonography and body composition by plethysmography., Results: Significant reductions were observed in body weight (101.04 +/- 11.18 to 94.79 +/- 10.94 kg), BMI (36.93 +/- 4.14 to 34.27 +/- 4.78), fat% (41.96 +/- 6.28 to 39.14 +/- 7.62%), visceral fat (4.34 +/- 1.53 to 3.41 +/- 1.12 cm), leptin concentration (20.12 +/- 6.47 to 16.68 +/- 8.08 ng/ml), prevalence of bulimia nervosa (100 to 67%) and binge eating disorder symptoms (40 to 17%)., Conclusion: Short-term multidisciplinary therapy was effective in improving body composition, visceral fat, leptinemia and eating disorders in obese adolescents., (Copyright 2008 S. Karger AG, Basel.)

Background: feeding/eating disorders are frequent in pediatric patients and, in some cases, can be associated to an upper digestive motility disorder. Gastro-esophageal reflux is, nowadays, considered a risk factor for the development of feeding/eating disorders., Aim: to verify the occurrence of feeding/eating disorders in patients with Gastro-Esophageal Reflux Disease (GERD) determined by the 24-H esophageal pH monitoring evaluation., Method: an analytical observational cross-sectional study of the stomathognatic system and feeding/eating behavior in healthy children and in children with GERD., Results: 25 children (ages 45,68 +/- 34,22 months; mean +/- SD) with the diagnosis of GERD determined by the 24-H esophageal pH monitoring evaluation and 40 children (ages 60,65 + 36,07 months; mean + SD) randomized from their school group. The criteria for the pH monitoring were: vomiting, regurgitation, wheezing and recurrent pneumonia. There was no significant difference in age mean between groups. Children with GERD presented an significantly higher frequency (p<0.05) of feeding/eating problems (F/EP) and of oral motor-sensory disturbances (sucking, chewing and swallowing). Behavioral F/EP was present in 44% of the cases and oral motor-sensory F/EP in 80%. About 64% of the children had a history of feeding/eating complaints, 36% presented an extended feeding/eating time, 68% presented problems in the development of the oral feeding patterns and 60% presented alterations in the nasal breathing pattern., Conclusion: children with GERD presented a higher prevalence of behavioral and stomathognatic feeding/eating problems when compared to healthy children.

Objective: To investigate whether abnormal eating behaviors in young women could predict eating disorders after 4 years., Method: 56 women were identified as presenting abnormal eating behaviors in a cross-sectional study (Eating Attitudes Test-26 and Edinburgh Bulimic Investigation Test). They were matched for age and neighborhood to two controls (n = 112). Four years later, they were re-assessed with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI 2.1)., Results: Women with abnormal eating behaviors at baseline showed a high probability of presenting abnormal eating behaviors but it was not associated with eating disorders 4 years later. They were also at higher risk for obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobia., Discussion: Abnormal eating behaviors were related to the maintenance of the disturbed behavior over the years, and were associated with increased probability for psychiatric diagnoses.

A representative sample of 7-14-year-old young people in southeast Brazil (N=1251) was assessed using standardized parent and youth interviews, thereby identifying an 'at-risk' group of young people who met one or more DSM-IV criteria for anorexia and/or bulimia nervosa. These young people were compared with an age and gender matched comparison group for body mass index (BMI) and socio-economic status (SES). The prevalence of young people at risk for eating disorders was 1.4% (higher in females and rising with age). 'At-risk' individuals did not differ from controls in BMI but were of higher SES. In Brazil, the link between symptoms of eating disorders and higher SES is not just a referral artefact but is evident in a representative community sample. This might reflect a stronger preference for thinness among more westernized social groups.

Background: A few studies have shown high rates of eating disorders and psychiatric morbidity in patients with type 2 diabetes mellitus., Objective: Disturbed eating behavior and psychiatric comorbidity in a sample of T2DM patients., Methods: Seventy type 2 diabetes mellitus patients between 40 and 65 years of age (mean, 52.9 +/- 6.8) from a diabetes outpatient clinic were sequentially evaluated. The Structured Clinical Interview for DSM-IV, Binge Eating Scale and Beck Depression Inventory were used to assess eating disorders and other psychiatric comorbidity. In addition to the descriptive analysis of the data, we compared groups divided based on the presence of obesity (evaluated by the body mass index) or an eating disorder., Results: Twenty percent of the sample displayed an eating disorder. Binge eating disorder was the predominant eating disorder diagnosis (10%). Overall, the group of obese patients with type 2 diabetes mellitus presented rates of psychiatric comorbidity comparable to those seen in their nonobese counterparts. However, the presence of an eating disorder was associated with a significant increase in the frequency of anxiety disorders (57.1% x 28.6%; p = 0.044)., Conclusions: In our study sample, the occurrence of eating disorders was increased compared to rates observed in the general population, with the predominance of binge eating disorder. The presence of an eating disorder in type 2 diabetes mellitus patients was associated with higher rates of anxiety disorders.

Unlabelled: Although comorbidity between attention-deficit/hyperactivity disorder (ADHD) and eating disorders (ED) is relevant for clinical treatment, it is seldom investigated., Methods: 86 DSM-IV attention deficity hyperactivity disorder patients out of 107 self-referred adults in a specialized center for attention deficity hyperactivity disorder were interviewed using SCID-R to evaluate the lifetime prevalence of ED and other comorbid conditions., Results: Nine attention deficity hyperactivity disorder patients had comorbid eating disorders; binge eating disorder (BED) was the most common diagnosis. The group with eating disorders presented a higher prevalence of other comorbid disorders (p=0.02). No significant differences were found on gender, age at assessment, schooling level and type of attention deficity hyperactivity disorder between groups., Conclusion: Attention deficity hyperactivity disorder clinical samples may have a high prevalence of BED comorbidity. Patients with attention deficity hyperactivity disorder and eating disorders may have a different comorbid profile.

Objective: The aim of this epidemiological investigation was to study the prevalence of abnormal eating behaviours in a community sample of young women from Porto Alegre, RS, Brazil., Methods: The research team visited 1524 randomly selected households in Porto Alegre and invited all of the women aged 12-29 years to participate in the study: 513 women subsequently completed a socio-economic and demographic questionnaire, the Bulimic Investigatory Test (BITE) and the Eating Attitudes Test (EAT-26)., Results: Clinically significant disturbed eating behaviour was revealed in the 16.5% of women who had EAT scores above the cut-off point of 21; 2.9% also had BITE symptom scores of > or = 20. The participants were categorised into three groups on the basis of a new variable combining both instruments: those with abnormal eating behaviours (10.9%), those with unusual eating patterns (23.8%), and those with normal eating behaviours (60.2%). Abnormal eating behaviours were significantly more prevalent in the 16-19 year age range (p = 0.007) and were also more prevalent among overweight/obese women (p = 0.009). Laxative use was reported by 8.5% of the women, followed by fasting (3.1%), use of diuretics (2.8%) and vomiting (1.4%)., Conclusions: Abnormal eating behaviours are fairly common among young women in Brazil. In comparison with other population studies, this survey showed a similar use of laxatives, less self-induced vomiting and a greater use of diet pills (probably because they are less strictly controlled in Brazil). Educational programmes aimed at preventing abnormal eating behaviours and developing healthy weight control practices among children and young adolescents should become public health priorities.