Karin Louise Lenz Dunker

Tratamento nutricional dos transtornos alimentares

Patients with eating disorders have disturbed food intake, food pattern, food behavior, and mistaken beliefs about food and nutrition, which can worsen nutritional status. The nutritional treatment aims to revert such alterations and to promote better food habits and relationship with food. The objectives and characteristics of the treatment are different for anorexia nervosa and bulimia nervosa, but usually the approach has two phases: the educational phase, whose major goals are regularization of food habits and increase of nutrition knowledge; and the experimental phase, whose targets are better nutritional rehabilitation and more complex improvements of nutritional behavior. Evidence suggests that nutritional treatment can ameliorate such parameters, but some inadequate food behaviors remain, such as feeling of incompetence while dealing with food. More studies are needed to evaluate the efficacy of the nutritional treatment.

Influência da mídia em universitárias brasileiras de diferentes regiões

A midia tem impacto na satisfacao com a imagem corporal e risco para o desenvolvimento de transtornos alimentares. OBJETIVO: Avaliar a influencia da midia em universitarias e possiveis associacoes com idade, estado nutricional, renda e escolaridade do chefe da familia. METODOS: 2.489 estudantes do sexo feminino das cinco regioes do Brasil responderam a Sociocultural Attitudes Towards Appearance Scale (SATAQ-3). O escore na SATAQ foi comparado entre as regioes por meio de uma analise de variância. Uma analise de covariância foi utilizada para verificar a influencia das variaveis estudadas no escore da SATAQ. Uma regressao logistica foi realizada para verificar a interferencia conjunta das variaveis em relacao a influencia da midia. RESULTADOS: Nao foram encontradas diferencas regionais na SATAQ total (p = 0,164) e subescalas Internalizacao atletica (p = 0,293) e Pressao (p = 0,150); houve diferenca para as subescalas Internalizacao geral (p = 0,010) e Informacao (p = 0,002). Idade, estado nutricional e renda influenciaram o resultado. CONCLUSOES: O escore total na SATAQ foi similar entre as regioes, mas o Sul e o Nordeste apresentaram maiores pontuacoes para subescalas Internalizacao geral e Informacao respectivamente. Estudantes com menos de 25 anos, com excesso de peso e maior renda foram em media mais influenciadas pela midia.

Media influence and body dissatisfaction in Brazilian female undergraduate students

The aim was to evaluate possible associations between media influence (internalization, pressure and information) on body satisfaction in a sample of Brazilian female undergraduate students. Sample consisted of female undergraduate from 37 institutions in Brazil who answered the Sociocultural Attitudes Towards Appearance Questionnaire-SATAQ (n = 2,414) and the Stunkards Silhouettes Scale (n = 2,402). A bivariate correlation among variables was performed, and also a covariance analysis with the SATAQ score and the body satisfaction categories. Linear multiple regression was done to evaluate the influence of variables in body dissatisfaction. Results show 64.4% of students desired to be smaller, 21.8% to be equal and 13.9% to be bigger than their actual figure. The group of students who desired to be smaller had the greatest SATAQ total and all the subscales scores. According with regression analyses, the body dissatisfaction increased 0.22 for each more Body Mass Index point; 0.02 for each more unit in SATAQ Internalization-General subscale; 0.03 for each more unit in SATAQ Pressure subscale. It was concluded that media influence and body dissatisfaction were related; in addition, media Internalization and Pressure predicted body dissatisfaction for this sample. The knowledge provide by these results is important for prevention strategies.

Preventing weight-related problems among adolescent girls: A cluster randomized trial comparing the Brazilian ‘New Moves’ program versus observation

PURPOSE To conduct a cluster randomized controlled trial comparing the Brazilian version of the New Moves program (NMP) versus observation among Brazilian adolescent girls. METHODS Ten schools were randomly allocated to the Brazilian NMP or the observation arm. Study participants included 12-14-year-old girls. Recruitment occurred between February 2014 and March 2015. The NMP included sports, nutritional support, motivational interviews, collective lunch, and parental information materials. Our main outcome was the Body Shape Questionnaire (BSQ). Secondary outcomes included the Rosenberg Self-Esteem Scale and the Unhealthy Weight-Control Behaviors Index, as well as body mass index. Study results were evaluated through generalized estimating equations. RESULTS A total of 270 adolescents participated in the study. At baseline, mean age was 13.4 years, and average BMI was 21.4. The intervention did not result in any statistically significant differences between the NMP and the observation arm, including BSQ (predicted means of 64.33 - IC 95% 59.2-69.47 vs. 62.02 - IC 95% 56.63-67.4), respectively) and our secondary outcomes. Adherence was low during the intervention (32.9%) and maintenance (19.1%) phases of the program. CONCLUSION The New Moves program did not lead to significant changes in our measured outcomes. Future studies should investigate whether changes might occur when comprehensive behavioral programs are sustained over longer periods while also being customized to local population characteristics.

Seletividade alimentar: uma abordagem nutricional

Selective eating is known by food refusal, lack of appetite and interest in food. It is atypical behavior of preschool, but when present in adverse family environments, can perpetuate and remain until adolescence. This paper is a case report of a patient with diagnosis of selective eating that seeks for specialized treatment center for eating disorders at 14 years old. The particularity of this case is the fast and good evolution, possibly due to the desire to treat himself and the support received by the family. The case points out the importance of identifying earlier and correctly cases of selectivity so they will be submitted as soon as possible to professionals specialized in treatment of eating disorders in different developmental stages of childhood and adolescence, resulting in a better prognosis framework.

Prevenção de transtornos alimentares e obesidade: relato de experiência da implementação do programa New Moves

The aim of this study was to reflect upon the adaptation process, difficulties and potentials of the implementation of the New Moves program, designed to prevent obesity and eating disorders in girls of public schools in Sao Paulo (SP). The Brazilian version of the program has the potential to use effective behavioral techniques such as socio-cognitive theory and motivational interviewing, and present a content that addresses factors common to obesity and eating disorders, which can be applied considering the difficulties related to adaptation process and implementation presented in the study.

Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis

Introduction Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures (‘integrated approach’) do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes. Methods and analysis Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I2 ≥75%). Ethics and dissemination Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.

Validity and Reliability of the Brazilian Version of the Weight Control Behaviors Scale

Objective To develop and validate the weight‐control behaviors (WCBs) scale and to evaluate its psychometric properties. Study design We made use of data from a cluster‐randomized trial assessing the effectiveness of the Brazilian New Moves Program. The Brazilian New Moves Program was a multicomponent intervention aimed at preventing weight‐related problems among adolescent girls in public schools in São Paulo, Brazil. Results Healthy and unhealthy WCBs were strongly associated. A 2‐factor solution was the best model to explain the correlation across items, including following constructs: (1) healthy WCB: exercising, eating more fruits and vegetables, drinking less regular soda or sweetened drinks, eating fewer sweets, and paying attention to portion sizes; and (2) unhealthy WCB: skipping meals and the presence of any other, combined unhealthy weight‐control behaviors, including fasting, eating little, going on a diet, vomiting, taking diet pills, using diuretics (water pills), using laxatives, using food substitutes (powder/special drinks), and smoking more cigarettes. The WCB scale was determined to be reliable (internally consistent) and valid, with high scores positively associated with body dissatisfaction and high body mass index values. Individual reliability values were high for factors representing healthy and unhealthy WCBs. Conclusions Our findings support the use of the WCB scale as a screening tool for overall weight control behaviors among female adolescents. This assessment tool should be considered in future observational and experimental prospective studies. Trial registration Brazilian Registry of Clinical Trials: RBR‐6ddpb3.