Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Original Article Imprimir 

Páginas 64 a 71


Risk Behavior Survey for Eating Disorder, Nutritional Status and Sources of Information Used by Adolescents

Encuesta de comportamiento de riesgo para trastornos alimenticios, estado nutricional y fuentes de información utilizadas por adolescentes

Levantamento do comportamento de risco para transtorno alimentar, estado nutricional e fontes de informação utilizadas por adolescentes

Autores: Cinthia Monteiro da Silva1; Ana Manuela Ordoñez2

1. Resident in Family Health by the Federal University of Latin American Integration (UNILA). Graduation in Nutrition by the Union of the Americas University Center (UNIAMÉRICA). Nutritionist by the Federal University of Latin American Integration (UNILA). Foz do Iguaçu, PR, Brazil
2. Master in Child and Adolescent Health by the Federal University of Paraná. Teacher of the Nutrition course by the Union of the Americas University Center (UNIAMÉRICA). Foz do Iguaçu, PR, Brazil

Correspondência:
Cinthia Monteiro da Silva
Faculdade União das Américas, Nutrição
Avenida das Cataratas, nº1118 - Vila Yolanda
Foz do Iguaçu, PR, Brasil. CEP: 85853-000
(cinthiamonteiro19@hotmail.com)

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Keywords: Adolescent; Feeding Behavior; Feeding and Eating Disorders.
Palabra Clave: Adolescente; Comportamiento Alimenticio; Trastornos de la Alimentación y de la Ingestión de Alimentos.
Descritores: Adolescente; Comportamento Alimentar; Transtornos da Alimentação e da Ingestão de Alimentos.

Abstract:
INTRODUCTION: Adolescence is a phase of vulnerability to the development of eating disorders where intense psychological, biological changes and social adaptations occur.
OBJECTIVE: Identify the prevalence of risk behavior for the development of eating disorders in adolescents and its association with sex, nutritional status and sources of nutrition information. Methods: A study was conducted with 191 adolescents of both sexes, ages between 15 and 19 years. Eating Attitudes Test (EAT-26) was used to identify risk behaviors for eating disorders. The nutritional status was evaluated through the Body Mass Index according to World Health Organization standards. Finally, the Questionnaire on Nutrition Information Sources was applied. The research data were analyzed through descriptive statistics.
RESULTS: We found 28% risk of developing an eating disorder in the analyzed sample, with higher risks among female adolescents (37%). Regarding nutritional status, the majority of adolescents evaluated presented eutrophy (75%). The most used information source was internet (87%) followed by television (57%).
CONCLUSION: The study showed a relevant percentage of risk for eating disorder. Thus, due to the impacts generated by the pathology, it is important to take actions aimed at this public for prevention.

Resumen:
INTRODUCCIÓN: La adolescencia es una fase de vulnerabilidad al desarrollo de trastornos alimenticios donde ocurren intensas mudanzas psicológicas, biológicas y adaptaciones sociales.
OBJETIVO: Identificar la prevalencia de comportamiento de riesgo al desarrollo de trastornos alimenticios en adolescentes y su asociación con sexo, estado nutricional y fuentes de información en nutrición.
MÉTODOS: Estudio realizado con 191 adolescentes de ambos sexos, con edad entre 15 y 19 años. Para identificar comportamientos de riesgo para trastorno alimenticio se utilizó el Test de Actitudes Alimenticias (EAT-26). Se evaluó el estado nutricional a través del Índice de Masa Corporal conforme los estándares de la Organización Mundial de Salud. Finalmente, fue aplicado el Cuestionario de Fuentes de Información en Nutrición. Los datos de la pesquisa fueron analizados por medio de estadística descriptiva.
RESULTADOS: Se encontró 28% de riesgo para el desarrollo de trastorno alimenticio en la muestra analizada, con mayor riesgo entre las adolescentes del sexo femenino (37%). En relación al estado nutricional, la mayoría de los adolescentes evaluados presentó eutrofia (75%). La fuente de información más utilizada por los participantes fue internet (87%) seguido de televisión (57%).
CONCLUSIÓN: El estudio mostró un porcentaje relevante de riesgo para trastorno alimenticio. Así, en consecuencia de los impactos generados por la patología, se realizan importantes acciones vueltas a ese público para la prevención.

Resumo:
INTRODUÇÃO: A adolescência é uma fase de vulnerabilidade ao desenvolvimento de transtornos alimentares onde ocorrem intensas mudanças psicológicas, biológicas e adaptações sociais.
OBJETIVO: Identificar a prevalência de comportamento de risco ao desenvolvimento de transtornos alimentares em adolescentes e a sua associação com sexo, estado nutricional e fontes de informação em nutrição.
MÉTODOS: Estudo realizado com 191 adolescentes de ambos os sexos, com idade entre 15 e 19 anos. Para identificar comportamentos de risco para transtorno alimentar utilizou-se o Teste de Atitudes Alimentares (EAT-26). Avaliou-se o estado nutricional através do Índice de Massa Corporal conforme os padrões da Organização Mundial da Saúde. Por fim, foi aplicado o Questionário de Fontes de Informação em Nutrição. Os dados da pesquisa foram analisados por meio de estatística descritiva.
RESULTADOS: Encontrou-se 28% de risco para o desenvolvimento de transtorno alimentar na amostra analisada, com maior risco entre as adolescentes do sexo feminino (37%). Em relação ao estado nutricional, a maioria dos adolescentes avaliados apresentou eutrofia (75%). A fonte de informação mais utilizada pelos participantes foi a internet (87%) seguido da televisão (57%).
CONCLUSÃO: O estudo mostrou um percentual relevante de risco para transtorno alimentar. Assim, em decorrência dos impactos gerados pela patologia, se faz importantes ações voltadas a esse público para a prevenção.

INTRODUCTION

According to the World Health Organization, adolescence is the period between the age group of 10 to 19 years1, where individuals leave childhood behaviors and acquire characteristics of adulthood. In this phase, biological and behavioral changes occur, marked by intense growth and physical development, cognitive maturation and the search for social adequacy. Such conditions may favor conflicts related to physical appearance that may affect eating, with increased risk for developing eating disorders2.

Risk behaviors for the development of eating disorders are expressed by excessive food concern, which may result in food restriction and binge eating episodes, characterized mainly by the ingestion of large amounts of food in a short period of time, which occurs mainly after a period of severe food restriction. Purgative attitudes may also be present, such as the use of laxatives, diuretics or other medications, vomiting self-induction and excessive physical exercise, as well as body dissatisfaction and rigid behavior related to eating3. According to Fortes et al.4, approximately 25% of young people in the world exhibit this type of eating behavior.

Eating disorders are disorders of eating behavior of a psychological nature that can lead to biopsychosocial impairments associated with increased morbidity and mortality. Dissatisfaction and distortion of body image and overestimation of weight are precedents for eating disorder and interfere with the interaction of the individual with their weight, body and health. It is observed that when there is dissatisfaction with body image, it is common to adhere to attitudes to suit the desired appearance, at any cost. In general, individuals with eating disorder, prior to the installed pathology, already demonstrate some dysfunctions in eating behavior that signal the risk of developing eating disorders5.

The main organic complications of eating disorders are endocrine disorders such as amenorrhea, increased cortisol levels, decreased testosterone concentration; metabolic disorders such as hypercholesterolemia and hypoglycemia; bone changes such as osteopenia and osteoporosis; hydroelectrolytic changes, with disturbances in serum vitamin and mineral levels; hematological changes, such as anemia and spinal cord hypoplasia; physical changes, such as regression of secondary sexual characteristics, as well as hypotension, cardiac arrhythmia, renal failure, and pulmonary insufficiency. This situation can compromise the process of maturation and development, and the organic impact of eating disorders in adolescence can have consequences that perpetuate in adulthood. Adolescents with eating disorder are more prone to suicide6.

In view of this, adolescence is the most vulnerable phase to the development of eating disorders due to excessive concern with physical appearance and exacerbated susceptibility to environmental influences and information about body, health and diet to which these individuals are exposed. This picture reinforces the relevance of studies on eating behaviors in adolescents4.

The weakness in the volume of information available demonstrates the importance of the quality of food and nutrition in promoting health and proper and healthy eating. Therefore, the level of exposure of the adolescent population to sources of nutrition information of dubious reliability is of concern. Many media messages are inaccurate, unstable and distorted, reinforcing beauty ideals, propagating fad diets and creating food insecurity, thus, contributing to the adoption of risky eating behaviors that may evolve into an eating disorder7.

Thus, the objective of the present study was to identify the occurrence of risk behavior for the development of eating disorder and its association with gender, nutritional status and food and nutrition information sources in adolescents.


METHODS

It is an observational, exploratory and sectional research. The approach to data was quantitative and descriptive. The survey was conducted with 191 adolescents of both sexes, aged 15-19 years, enrolled in a public high school during the month of August 2017. The sampling was done by convenience and is not probabilistic, and was performed among the 487 high school students enrolled in the morning and evening shifts.

For data collection, were invited to participate in the research all students enrolled in high school classes present on the days intended for the explanation of the research. Only individuals aged between 15 and 19 years old, duly enrolled, who presented the signed informed consent form were included. For individuals under 18 years old the IC was signed by the responsible. All underage individuals had to sign the Informed Consent Form - TALE, agreeing to participate in the research. This research was approved by the Research Ethics Committee of the State University of Western Paraná - UNIOESTE, under opinion number 2.162.785.

To assess the presence of risk behavior for eating disorder, the Eating Attitude Test - EAT-26 was used. The test consists of 26 self-completion questions and was developed by Garner and Garfinkel in 1979 and validated for Portuguese by Bighetti and Ribeiro8.

The questions are divided into three scales. The first scale refers to diet and concerns the dysfunctional denial of food and the exaggerated concern with body shape. The second scale is related to bulimia and food concern and verifies the occurrence of binge eating episodes followed by purgative behaviors to avoid weight gain. The last scale is the oral control scale, which demonstrates self-control over food and identifies environmental factors that relate to food intake8.

The answer options are Likert scale, with six alternatives and a score ranging from 0 to 3. Alternatives are never, almost never, and rarely are 0 points, sometimes 1 point, often 2 points and always at 3 points. In question 25 this order is reversed. At the end, the score of each question is added and if it is equal to or higher than 21 points, it indicates the presence of risk behavior for eating disorder8.

The survey of the most commonly used sources of information was carried out through the Ferraz (2002)9 Simplified Information Sources Questionnaire, which consists of a single question in which the sources used to obtain information on related subjects should be highlighted to food and nutrition. The questionnaire consists of eight options and there is no limit to alternatives to be marked. The options are: TV, internet, doctor / nutritionist, food packaging, books, magazines and newspapers, friends and family or others, and when the latter was marked, it was necessary to specify the source9.

Anthropometric evaluation was performed by measuring weight and body height and Body Mass Index - BMI was obtained according to the Quetelet formula (BMI = body mass (kg)/height (m2)). The classification of nutritional status was performed using the WHO AnthroPlus percentile verification software, which was later classified according to the cutoff points proposed by the World Health Organization - WHO10. The research results were expressed in percentile, and represented in tables and graphs, where the Microsoft Excel spreadsheet was used.

Descriptive statistical analysis of the data was performed through frequency, mean, minimum values, maximum values and standard deviation. Tests were performed for analytical statistics (correlation and chi-square), with no association between the study variables.


RESULTADOS RESULTS

Nineteen adolescents participated in the research, of which 60% (n = 115) were female and 40% (n = 76) male. The average age was 16.71 ± 1.15 years (15 - 19), and the majority (31%) was concentrated in the range of 16 to 16.9 years.

Regarding the anthropometric assessment, the mean BMI was 22.47±4.02 kg/m2 (15.79 - 40.09). Regarding the classification of nutritional status by BMI, 75% (n = 143) of the evaluated adolescents had eutrophy. Among female participants, 74% (n=85) were eutrophic, 17% (n=19) overweight, 8% (n=9) obesity, 2% (n=2) thinness and none had severe obesity. Of the male participants, 76% (n=58) were eutrophic, 13% (n = 10) overweight, 8% (n = 6) obesity, 1% (n = 1) thinness and 1 (1%) severe obesity. The classification of the nutritional status of the evaluated individuals is described in table 1.




The average EAT-26 score was 15.40 ± 9.77 points (0-50). Among the research participants, 28% (n=53) had a positive result for risk behavior (cutoff above 21 points) and 72% (n=138) did not show a result above 21 points.

Among female participants, 37% (n=43) were identified with risk behavior for eating disorder. Among males, 13% (n=10) expressed this behavior. Among the interviewed adolescents at risk for eating disorder, 16% (n=30) were aged between 16 and 17.9 years. The prevalence of risk behavior according to sex is shown in table 2.




Regarding the sources of information on food and nutrition used by the studied population, it was observed that 87% (n=166) reported using the internet as their main source of information, followed by TV 57% (n = 109), friends and family with 48.5% (n = 93), according to table 3.




DISCUSSION

Evidence shows that adolescence is a period of vulnerability to the development of food-related conflicts, since at this stage nutritional needs are high and there is a high susceptibility to the influence of environmental factors. The search for identity is also an important factor characteristic of this age group and may contribute to body dissatisfaction, the main risk factor for the development of eating disorder4,6,11.

The prevalence of normal nutritional status in adolescents can be explained by the high nutritional demand characteristic of this phase due to the complexity of the development and maturation process. During this period, although the diet usually presents an irregular pattern and the presence of dysfunctional behaviors, the BMI normality of these individuals is maintained, according to Pinho et al.12.

It is observed that females appear to be more vulnerable to the development of dysfunctional eating behaviors, which may be justified by the constant effort to control body weight, especially among adolescents4,11,13. This may explain the fact that most studies investigating eating disorder-related behaviors focus exclusively on the female audience.

Data from the National School Health Survey conducted in 2015 showed that female adolescents attribute an overvaluation to their physical appearance, which leads them to cultivate intense body dissatisfaction and increases their propensity to present image disorders. In males, concerns about physical appearance permeate the yearning for a muscular body. The highest proportions of adolescents who had attitudes towards weight loss were found in females14.

The occurrence of risk behavior for eating disorder in this study is considered worrying, as pointed out by Cubrelati et al.13, indicating that percentages greater than 20% deserve attention and reflect the need for intervention.

According to Fortes et al.15, in recent years the frequency of risk behaviors for eating disorder in male individuals has increased, in a proportion of 1 case per 10 in the female public, which has stimulated further studies on etiology and risk detection instruments for the male public. The EAT-26 questionnaire was validated for use in females, however, with the increase of cases in males, it was necessary to study its application for these individuals. Like the studies by Fortes et al.15, which evaluated the psychometric qualities of EAT-26 for male adolescents. The authors concluded that the instrument has good applicability for this audience with proven internal consistency and reproducibility.

Fortes et al.4 built an etiological model of risk behaviors for eating disorders and suggest that the media content to which adolescents are exposed has a direct relationship with these behaviors. In addition, the incorporation of thinness ideals and dubious and subliminal messages into the diet, body appearance and diet media are associated with triggering inappropriate eating behaviors.

These notes reinforce the findings of the present study with worrying evidence regarding the sources of food information most used by the public. It is noteworthy that there are few researches that investigated the sources of information used for this purpose, being the few population researches, and with a wide age group.

In a survey conducted in 2010 by FIESP (Federation of Industries of the State of São Paulo) and IBOPE (Brazilian Institute of Public Opinion and Statistics), with individuals from 16 to 60 years old of both sexes, the sources of information were evaluated. about food and food products. The findings revealed that the main source used by 40% of individuals was television, followed by a doctor or nutritionist with 20% and the internet with 19%. These findings are available in a document titled Brazil Food Trends 202016.

The population survey conducted by Pollard et al.7 in Western Australia between 1995 and 2012 with individuals aged 18 to 64 years sought to evaluate the internet as a source of nutritional information. The result of this study revealed that the use of the internet as a source of nutritional information grew from 9.1% in 2004 to 33.7% in 2012. Younger women were more likely to use the internet as a source of information and the higher search related to weight control. It was found that the information to which the research subjects were exposed was inaccurate and that accurate and reliable information was provided by medical, governmental and university websites. However, they appeared on the second and third pages of the site's searches, as they were less likely to be accessed.

The research also suggests that internet users do not discriminate on the quality of food and nutrition information, by not checking the source and date of content and using commercial websites to search for health information. Such notes may justify the negative impact of excessive and indiscriminate use of the Internet as a source of nutrition information, reinforcing beauty standards and inducing inappropriate behaviors to reach it, especially among the female audience7.

The instrument used to verify the main sources of nutrition information used by the public of this research was simplified from the study by Ferraz9, conducted in 2001, involving individuals aged 16 years and over. An interesting finding corroborating with research conducted in Australia is that at the beginning of the last decade, the main source of information found were books, magazines and newspapers, followed by television, and friends and family in third place. This shows the implications of the growing use of the internet as a source of health information.

Alvarenga et al.17 clarify that suggestions that ensure fast results, extremisms when considering a single food good or bad, guidelines based on only one study or studies that do not consider individual and population divergences are indications of a lack of credibility in food and nutrition information.

Mendonça et al.18 point out that, in Brazil, there are no defined criteria for analyzing the quality of information on health-related issues in the media. The purpose of this analysis is to ensure that the population can rely on the available information and that it is possible to understand the risks related to the adoption of certain practices. The authors suggest that there is a certification process on websites that provide health information.

In some European countries, such as Switzerland and Spain, we work with quality labels on health internet sites, evaluated by various criteria to check the credibility and intangibility of the content. In these countries, we also work with population orientation campaigns, enabling them to develop critical sense. An example of this is the availability of checklist templates to verify the quality of information. This process is relevant considering the current coverage of information conveyed on the Internet.

The school, as an educational environment, has a strong influence on the health of adolescents. In their study with public school students, Leite et al.19 found that 40.5% of participants did not recognize moments aimed at addressing health-related topics in the school environment. Among the participants who responded positively to the existence of these moments, only 2.3% reported having addressed the issue of eating disorders.

In view of the already addressed vulnerability of adolescent individuals, it is essential that the issues of eating disorders, body image and eating are constantly addressed at school, in order to promote health awareness in this period of life and prevent the development of disorders food. As well as detecting positive signs early, providing better prognosis and less impact of these dysfunctions in adulthood. Therefore, it is necessary to work together between health professionals, educators and family members19.


CONCLUSION

This research found worrying results regarding the risk behavior for eating disorders among the studied adolescent public, proving the vulnerability of this phase to dysfunctional eating behaviors.

There was no association of risk behavior with BMI, gender or sources of information used. However, the high use of the internet as a source of information in nutrition stands out as an important factor influencing the development of eating disorders, and the lack of reliability of this information and the spread of beauty standards may favor the adoption of pathological habits for body weight control. Given the relevance of this issue, it is essential that actions to prevent eating disorders aimed at adolescents are developed.


REFERENCES

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2. Pereira TS, Pereira RC, Pereira MC. A influência de intervenções educativas no conhecimento sobre alimentação e nutrição de adolescentes de uma escola pública. Rev. Ciênc. Saúde Coletiva. 2017;22 (2): 427-435.

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