Fatores associados a diferentes padrões de comportamento alimentar e atitudes alimentares transtornadas em candidatos a cirurgia bariátrica atendidos em um hospital público de referência no Pará, Brasil

Abstract

Introduction: Patients in the preoperative period of bariatric surgery may present inappropriate eating behaviors such as emotional eating, binge eating, pinching/nibbling and/or pasteurization that may impair treatment results. The assessment of eating behavior patterns has often been neglected in traditional programs for the treatment of obesity, which focus on weight reduction without considering psychological issues involving eating behavior, which may increase vulnerability to eating disorders. Objective: To analyze eating behavior, patterns associated with grazing behavior and susceptibility to disturbed eating attitudes in candidates for bariatric surgery treated at a public hospital of reference in the care of people with severe obesity in Pará, Brazil. Methods: This is a cross-sectional, descriptive and analytical study, carried out with male and female candidates for bariatric surgery, followed at the endocrinology clinic of a public hospital in the Amazon. Data regarding grazing behavior and its compulsive and non-compulsive subtypes were collected through the Repetitive Feeding Questionnaire REP(EAT)-Q, in addition to sociodemographic information initiated through self-report and the description of the use of medications administered in the medical records. The presence of dysfunctional eating attitudes was assessed using the Disordered Eating Attitudes Scale (EAAT), which assesses beliefs, feelings, thoughts and behaviors related to eating. To investigate patterns of eating behavior, the Three Food Factors Questionnaire (TFEQ-R21) was used, which assesses the three dimensions of eating behavior: Emotional Eating, Cognitive Restriction and Eating Disorder. The body mass index (BMI) was calculated by measuring weight and height. This research was approved by the Research Ethics Committee for the project. For statistical analysis, SPSS software, version 24.0, was used. Results: This dissertation had its results presented in the format of two articles. Both studies were carried out with 205 participants with a mean age of 37.5 ± 8.6 years, most of whom (93.7%) were women. In the first study, most participants (59.5%) did not use medication to lose weight. About 66.3% had compulsive grazing and 56.6% had non-compulsive grazing. The domain with the highest score was emotional eating, with 73.5±31.5 (p<0.001). Individuals who used weight loss drugs had higher scores in the cognitive restriction domain (p=0.017) and lower scores for compulsive grazing (p=0.021) and non-compulsive grazing (p=0.034). In the multiple linear regression, a correlation was observed between compulsive grazing behavior and emotional eating (β =0.193; CI= 0.002; 0.013; p=0.009) and uncontrolled eating (β = 0.429; CI=0.018; 0.035; p= 0.000), and between non-compulsive grazing behavior and emotional eating (β = 0.303; CI=0.006; 0.20; p=0.000) and uncontrolled eating (β = 0.363; CI= 0.014; 0.34; p =0.000), both regardless of gender and medication use. In the second study, approximately 82.4% of the participants had disturbed eating attitudes (p<0.001). The female gender had a higher score in the domain of eating disorder (p=0.026). In multiple linear regression, it was observed that emotional eating was a predictor of disturbed eating attitudes, regardless of gender (β = 0.273; CI=0.002; 0.010; p=0.002). Conclusion: Candidates for bariatric surgery may be an audience with great susceptibility to eating disorders. It is essential to identify dysfunctional behaviors early as a way to prevent complications due to patterns of disordered eating behavior that were maintained or even recovered after surgery.