Observación y análisis "en vivo" de comidas familiares de pacientes con trastorno alimentario / Observation and analysis "in vivo" of family meals of patients with eating disorders

Resumen Involucrar a la familia en el tratamiento de los trastornos del comportamiento alimentario (TCA) es una recomendación clave de las guías de práctica clínica para adolescentes. El objetivo de este estudio fue analizar los patrones de interacción y roles familiares, sus estilos de respuesta emocional y las características del menú traído a una sesión de comida terapéutica familiar (CTF). Participaron las familias de 13 pacientes con TCA, de entre 12 y 29 años de edad, asistentes a un programa ambulatorio intensivo. Dos terapeutas llenaron de manera independiente una matriz de observación de la sesión de CTF e hicieron anotaciones de campo; además fueron utilizadas estrategias de triangulación de datos, considerando diferentes fuentes (contenidos de las sesiones individuales y grupales) y técnicas (observación en vivo y entrevista familiar). El análisis realizado reveló, independientemente del tipo de TCA o de la edad de las pacientes, la predominancia de comportamientos evitativos en las familias; en menor medida, y principalmente en los padres, los patrones agresivos, retadores o de amenaza también estuvieron presentes. No obstante, resultó evidente la discordancia entre el comportamiento observado en la CTF vs. el reportado por las pacientes y sus terapeutas. En general, estuvieron ampliamente presentes patrones comportamentales que pueden contribuir al mantenimiento de la enfermedad.

Abstract Inclusion of the family members in eating disorders (ED) treatment is a key recommendation of clinical practice guidelines for adolescents. The aim of this study was to observe and analyze roles, interaction patterns, and emotional response styles of family and patients, as well as the features of a menu brought to a family meal session (FMS). A total of 13 patient's families from the intensive outpatient program for ED participated, patients aged among 12-29 years. Two therapists filled out a family meal observation matrix and took field notes. To improve validity, data triangulation strategies were used, including different sources of information (individual and group sessions contents) and triangulation of techniques (observation in vivo of FMS and a subsequent session with participants was carried out). The analysis of thematic contents revealed that regardless the type of ED and age of the patient the presence of avoidant behaviors in relatives and to a lesser extent, and especially in parents, aggressive, challenging or threatening patterns. However, the discrepancy between the behavior observed in the FMS and the one reported by the patients and their therapists was evident. In general, was observed that behavioral patterns may contribute to the maintenance of the disease.

Hábitos alimentarios y funcionalidad familiar en familias de la región metropolitana: un estudio descriptivo / Eating habits and family functionality in families in the metropolitan region: A descriptive study

Existen múltiples estudios acerca del funcionamiento familiar en la población chilena y sobre sus prácticas alimenticias, relacionándose ambas con morbilidades psicológicas o psiquiátricas. A pesar de esto, no logramos encontrar estudios que relacionen específicamente los hábitos alimenticios con el comportamiento a la hora de comer y el funcionamiento familiar en Chile. Definir los hábitos alimentarios no resulta sencillo, ya que existe una diversidad de conceptos, sin embargo, la mayoría converge en que se tratan de manifestaciones recurrentes de comportamiento individuales y colectivas respecto al qué, cuándo, dónde, cómo, con qué, para qué se come y quién consume los alimentos (1). El presente estudio es un estudio descriptivo tipo corte transversal, cuyo objetivo es explorar la relación entre el funcionamiento familiar y el hábito de comer en familia en padres y madres que acuden al policlínico de pediatría. El estudio se aplicó en 5 centros de salud de diferentes comunas de la región Metropolitana: Centro de Salud de San Bernardo (San Bernardo), Policlínico el Salto (Recoleta), Patronato Nacional de la Infancia (Estación central), CESFAM Juan Pablo II (La Reina) y CESFAM Aníbal Ariztía (Las Condes). Todos corresponden a campos clínicos universitarios de la Universidad de Los Andes en el área de pediatría. Todos centros caracterizados por recibir pacientes en su mayoría chilenos, de un nivel socioeconómico medio-bajo (2). Se consideraron como criterios de inclusión el ser padres y/o madres de pacientes que se atendían en los consultorios antes mencionados, mayores de 18 años y que firmaran el consentimiento informado. Los datos fueron obtenidos mediante la auto-aplicación de dos cuestionarios, uno de ellos, de fabricación propia, describe la práctica alimenticia de la familia, el otro, correspondiente al cuestionario APGAR familiar, validado en Chile, fue usado para medir el funcionamiento familiar según la percepción de los padres y/o madres. De un total de 53 encuestas realizadas, 90.6% presentó un APGAR de familia funcional, un 7.5% un APGAR con disfunción familiar moderada y un 1.88% con un APGAR de disfunción familiar severa. El análisis estadístico muestra que este nivel de funcionamiento se explica en un 53% por tres de las variables estudiadas; Comunicación y ambiente a la hora de comer, y si los padres viven juntos o no. Será necesario confirmar estos hallazgos en futuras investigaciones que cuenten con poblaciones de estudio más extensas y variadas en su morfología familiar, para extrapolar estos datos a nivel regional. Palabras clave: APGAR, funcionamiento familiar, comer en familia, hábito alimenticio, trastornos alimenticios

Abstract: There are multiple studies on family functioning in the Chilean population and on their dietary practices, both have been related to psychological or psychiatric morbidities. Despite this, we could not find studies that specifically relate eating habits to eating behaviors and family functioning in Chile. Defining eating habits is not easy, since there is a diversity of concepts, however, most converge in that they are recurrent manifestations of individual and collective behavior with respect to what, when, where, how, with what, and for what purpose we eat and who consumes the food (1). The present study is a descriptive cross-sectional study, whose objective is to explore the relationship between family functioning and the habit of eating as a family in parents who attend the pediatric polyclinic. The study was performed in 5 health centers in different communes of the Metropolitan Region: San Bernardo Health Center (San Bernardo), El Salto Polyclinic (Recoleta), National Children's Trust (Central Station), CESFAM Juan Pablo II (La Reina) and CESFAM Aníbal Ariztía (Las Condes). All correspond to pediatric university clinical campuses of the Universidad de Los Andes. All centers are characterized as receiving mostly Chilean patients, of a medium-low socioeconomic level (2). Inclusion criteria were: fathers and/or mothers of patients who attended the clinics, who were older than 18 years and who signed the informed consent. The data were obtained through the self-administration of two questionnaires, one of them of our own manufacture, describes the family's nutritional practice, the other, corresponding to the family APGAR questionnaire, validated in Chile, was used to measure family functioning according to the perception of fathers and/or mothers. Of a total of 53 surveys conducted, 90.6% presented an APGAR of functional family, 7.5% an APGAR with moderate family dysfunction and 1.88% with an APGAR of severe family dysfunction. The statistical analysis shows that this level of functioning is explained in 53% by three of the studied variables: communication and atmosphere at mealtime, and whether the parents live together or not. It will be necessary to confirm these findings in future investigations that have more extensive and varied study populations in their family morphology to extrapolate these data at a regional level.Key words: APGAR, family functionality, family meal, feeding behavior, eating disorders

The Perceptions and Attitudes of Elementary School Children Towards Family Meals

The objective of this study was to determine the overall conditions related to family meals-including perceptions, attitudes, and behaviors-among elementary school children. The data were collected from 464 male and female students attending elementary schools in Seoul and Gyeonggi-do in December 2006 to February 2007, using self-administered questionnaires. The results were as follows: 77.7% of the students regarded family meals as meals eaten with all family members living together in a household. With regard to the frequency of family meals, 40.9% of the students reported that they ate with their family 'more than once per day'. 74.7% of the students reported that they enjoyed family meals because mealtime is a time to talk with other family members. When the degree of satisfaction with life was evaluated using a Likert scale (strongly satisfied-5 points, strongly unsatisfied-1 point), the results showed a significantly higher level of satisfaction with their daily lives, health, nutritious conditions, and family care. Students had more positive psychological feelings as the frequency of family meals increases. Likewise, the groups who frequently ate family meals scored higher in positive attitudes and behaviors toward family meals, thereby implying that the consumption of family meals is associated with the promotion of familial relationships, psychological stability, and positive thinking in children. These findings indicate that attention should be directed toward increasing the frequency of family meals and creating a positive family meal environment.

The Perceptions and Attitudes of Elementary School Children Towards Family Meals

The objective of this study was to determine the overall conditions related to family meals-including perceptions, attitudes, and behaviors-among elementary school children. The data were collected from 464 male and female students attending elementary schools in Seoul and Gyeonggi-do in December 2006 to February 2007, using self-administered questionnaires. The results were as follows: 77.7% of the students regarded family meals as meals eaten with all family members living together in a household. With regard to the frequency of family meals, 40.9% of the students reported that they ate with their family 'more than once per day'. 74.7% of the students reported that they enjoyed family meals because mealtime is a time to talk with other family members. When the degree of satisfaction with life was evaluated using a Likert scale (strongly satisfied-5 points, strongly unsatisfied-1 point), the results showed a significantly higher level of satisfaction with their daily lives, health, nutritious conditions, and family care. Students had more positive psychological feelings as the frequency of family meals increases. Likewise, the groups who frequently ate family meals scored higher in positive attitudes and behaviors toward family meals, thereby implying that the consumption of family meals is associated with the promotion of familial relationships, psychological stability, and positive thinking in children. These findings indicate that attention should be directed toward increasing the frequency of family meals and creating a positive family meal environment.