The body asks and the mind judges: the episode of food craving, its triggers and nutritional treatment

ABSTRACT Food desires are defined as motivations that drive the search for and consumption of food. However, when domains of intensity and urgency are activated, these desires can become intense (i.e. food craving), being then characterized by episodes or cognitive events loaded with affectivity, in which food is associated with obtaining pleasure or relief, which is the only attentional focus. Specificity and urgency mark the differentiation between food desires and cravings. The process of elaboration with vivid images, the retention in working memory, the emergence of a negative affect state (awareness of the lack), and a committed attentional focus to seek food are characterized as stages of an episode of food craving. Individuals with eating disorders have the lowest levels of food craving when it comes to anorexia nervosa and the subsequent increase to bulimia nervosa and binge eating disorder. Some environmental and cultural triggers and internal factors of cognition and emotions play a crucial role in the emergence of food craving episodes. The external factors include positive/negative events, food environment, advertisements, cultural beliefs about food, specific locations, and food itself. The internal factors comprise dietary restriction, food reward, impulsivity/inflexibility, emotions, thoughts and feelings about food, hunger/satiety/appetite, and anxious/depressive symptoms. Treatment involves the association of flexibility, awareness, and questioning strategies about dietary practices based on three principles: unconditional permission to eat, eating more for physical than emotional reasons, and tuning in with the body's signs of hunger and satiety (intuitive eating).

Cognitive restraint directed at carbohydrates in individuals on low-carb diet with binge eating: the role of guilt about food cravings / Restrição cognitiva direcionada aos carboidratos em indivíduos praticantes de dieta low carb com compulsão alimentar: o envolvimento da culpa pelos desejos por comida

ABSTRACT Objective To evaluate whether the carbohydrate-restricted diet leads to higher levels of food cravings in individuals with binge eating. Methods A total of 146 individuals with binge eating participated in the Low-Carb Diet Group (n=48) and Control Group (n=98). The Binge Eating Scale, Hay's questionnaire, Food Cravings Questionnaire - Trait and State, Cognitive restraint subscale and its adapted version for the cognitive restraint toward carbohydrates, were used as measures. Parametric tests were used for comparison between groups (Student's t test), and Pearson's correlation test to verify correlations between variables of interest. Results No differences were found between groups with and without diet concerning the level of binge eating or food craving total score. The differences found were the higher levels of cognitive restraint (p=0.01), cognitive restraint for carbohydrates (p=0.01) and subscales of 'guilt about food craving' (p=0.04) in the Low-Carb Diet Group. Conclusion Individuals with binge eating and a history of low-carb diet have greater cognitive restraint toward carbohydrates and association with altered eating attitudes (guilt about food craving).

RESUMO Objetivo Avaliar se a dieta com restrição de carboidratos acarreta níveis elevados de desejos intenso por comida em indivíduos com compulsão alimentar. Métodos Participaram 146 indivíduos com compulsão alimentar divididos nos Grupos Dieta Low Carb (n=48) e Grupo Controle (n=98). Foram utilizados como medidas: Escala de Compulsão Alimentar Periódica, Questionário de Hay, Questionário de Desejos Intensos por Comida - Traço e Estado, Subescala de restrição cognitiva e sua versão adaptada para a restrição cognitiva direcionada aos carboidratos. Foram utilizados testes paramétricos para comparação entre grupos (teste t de Student) e o teste de correlação de Pearson para verificar correlações entre variáveis de interesse. Resultados Não foram encontradas diferenças entre grupos com e sem prática de dieta em relação ao nível de compulsão alimentar ou ao escore total para desejos intensos por comida. As diferenças encontradas foram os maiores níveis de restrição cognitiva (p=0,01), restrição cognitiva para carboidratos (p=0,01) e subescalas de 'culpa por causa dos desejos' (p=0,04) no Grupo Dieta Low Carb. Conclusão Indivíduos com compulsão alimentar e histórico de dieta com restrição de carboidratos (low carb) possuem maior restrição cognitiva direcionada aos carboidratos e associação com atitudes alimentares alteradas (culpa pelos desejos).

Prevalência de comportamentos de risco para transtornos alimentares e uso de dieta "low-carb" em estudantes universitários / Prevalence of eating disorders risk behavior and "low-carb" diet in university students

RESUMO Objetivos Identificar a presença de compulsão alimentar associada ou não a práticas compensatórias em praticantes de dieta low-carb. Métodos Foram utilizadas a Escala de Compulsão Alimentar Periódica (ECAP) e o Questionário de Hay para avaliar a frequência de compulsão alimentar e práticas compensatórias, além de um questionário de frequência do consumo de chocolate, pão e arroz. A intensidade de restrição de carboidratos foi avaliada com escala de 1 a 8 pontos. Os participantes foram divididos nos grupos (i) dieta low-carb e (ii) controle. Foram realizadas comparações entre grupos, além de correlações entre variáveis de interesse no grupo dieta (p < 0,05). Resultados Participaram 853 universitários, sendo 75,97% mulheres com média de 22,04 anos (DP = 3,33) e índice de massa corporal (IMC) com média de 23,56 kg/m2 (DP = 4,38). Do total, 214 fizeram dieta low-carb e 639 não. A prevalência de um alto escore sugestivo de compulsão alimentar sem práticas compensatórias foi de 17,94% (n = 153) e a presença de compulsão alimentar associada com compensação foi de 2,23% (n = 19). No grupo dieta, 35,05% (n = 75) também realizaram jejum intermitente. O grupo dieta atingiu maiores valores para ECAP e IMC e menores para frequência de consumo de arroz e pão francês. Ainda, os escores da ECAP se correlacionaram positivamente com o consumo de chocolate (r = + 0,14 ; p = 0,0377) e valores de IMC (r = + 0,19; p = 0,0042), enquanto a restrição de carboidratos apresentou correlação negativa com o consumo de chocolate (r = - 0,13; p = 0,041), pão francês (r = - 0,20; p = 0,0024) e arroz (r = - 0,36; p = <0,0001). Conclusões Destacam-se a alta prevalência da prática de dieta (25,09%) e os maiores níveis de compulsão alimentar neste grupo, além de menor consumo de arroz e pão francês em relação aos que não fizeram dieta.

ABSTRACT Objectives To identify the presence of binge eating associated or not with compensatory practices in low-carb dieters. Methods Binge Eating Scale (BES) and Hay Questionnaire were used in order to assess the frequency of binge eating and compensatory practices, in addition to a frequency questionnaire for the consumption of chocolate, bread and rice. A scale of 1-8 points assessed the carbohydrate restriction intensity, and participants were divided into groups (i) low-carb diet and (ii) control. Comparisons between groups were part of the analysis, as well as correlations between variables of interest per diet group (p < 0.05). Results Participants were a total of 853 university students, in which 75.97% were women with an average of 22.04 years old (SD = 3.33) and an average BMI of 23.56 kg/m2, (SD = 4.38). From the aforementioned total, 214 had a low-carb diet, and 639 did not. The prevalence of a high score suggestive of binge eating without compensatory practices was 17.94% (n = 153), while the presence of binge eating associated with compensation was 2.23% (n = 19). As for the diet group, 35.05% (n = 75) also performed intermittent fasting. The diet group reached higher values for ECAP and BMI, and lower for frequency of consumption of rice and bread. Furthermore, ECAP scores correlated positively with chocolate consumption (r = + 0.14; p = 0.0377) and BMI values (r = + 0.19; p = 0.0042), whereas carbohydrate restriction showed negative correlation with chocolate consumption (r = - 0.13; p = 0.041); French bread (r = - 0.20; p = 0.0024) and rice (r = - 0.36; p = <0.0001). Conclusions We highlight the high prevalence of diet practice (25.09%), and the higher levels of binge eating in this group, as well as the lower consumption of rice and bread compared to those who did not diet.