Psychometric Evaluation of the Food Life Questionnaire-Short Form among Brazilian Adult Women.

Measures of beliefs and attitudes toward food have generally been limited to the measurement of more pathological eating attitudes (e.g., disordered eating). The Food Life Questionnaire (FLQ) and its short form (FLQ-SF) were developed to examine attitudes toward a broader range of foods; however, the factor structure of the FLQ-SF was not confirmed in any study with young women. In the present study, we performed a psychometric evaluation of the Brazilian Portuguese translation of the FLQ-SF in a sample of 604 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach. Results supported a four-factor structure (i.e., weight concern, diet-health orientation, belief in a diet-health linkage, and food and pleasure) with 18 items (χ2/df = 2.09; CFI = 0.95; TLI = 0.94; RMSEA = 0.05 (90% CI = 0.04; 0.06; p > 0.05); and SRMR = 0.08). Additionally, we found good internal consistency for all FLQ-SF subscales (McDonald's ω = 0.79-0.89) and convergent validity with measures of feelings, beliefs, and behaviors involved in food attitudes. Collectively, these results support the use of the FLQ-SF in Brazilian women and provide a foundation to expand the literature on beliefs and attitudes toward food in this population.

Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 Instrument.

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach's alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.

Sociocultural drivers of body image and eating disorder risk in rural Nicaraguan women.

OBJECTIVE: Technological and economic globalisation has been suggested as a cause of increasing rates of body dissatisfaction and eating disorders globally, especially as regards the impact of mass media on internalised body ideals. This process is rarely observed in action, however. The current work investigates multiple aspects of body ideals, body image, sociocultural attitudes and eating attitudes in 62 Creole and Mestizo women living in communities at differing stages of technological development on the Caribbean coast of Nicaragua METHOD/RESULTS: In Study 1, women used 3D avatar software to create their own 'ideal' body without the constraints of ready-made stimuli. Analyses of resulting avatars showed that components of the ideal body shape (upper and lower body curvaceousness) but not body size (body mass) were associated with levels of film and television consumption. In Study 2, women completed measures of variables in the sociocultural model of eating disorder risk. As expected, body dissatisfaction mediated the relationship between internalisation of sociocultural body ideals and pathological eating attitudes. In contrast, body appreciation reduced pathological eating attitudes, via reduced body dissatisfaction. Finally, Study 3 measured sociocultural influences, body image and eating attitudes at 2 or 3 timepoints per woman; body dissatisfaction covaried with pathological eating attitudes across time. Ethnicity varied in its effects across studies. DISCUSSION: Together these data show that even at early stages of media acculturation, women may show similar patterns of association between sociocultural internalisation, body dissatisfaction and eating disorder risk as in high income nations. However, they also demonstrate unique aspects of this population's body shape ideals, and the independent protective effect of body appreciation.

Body dissatisfaction and eating disorders are increasing on a global scale. It has been suggested that increasing access to globalised media maybe one factor in rising risk of eating disorders in low- and middle-income countries. We examined 3-dimensional body ideals, body satisfaction, and eating disorder risk in a population with relatively recent access to mass media. We find that although women in these communities maintain higher body weight ideals, and greater body appreciation, than Western women, those women who are internalising globalised cultural messaging about appearance are at greater risk of body dissatisfaction and, in turn, increased risk of eating disorders. This was true both when comparing between women and looking at how individual women's attitudes varied over time. These data show that cultural messaging about appearance has implications for body image and eating disorder risk even in populations which do not have a long history of promoting thin ideals.

Ideales estéticos, imagen corporal, actitudes y conductas alimentarias en hombres con diferente orientación sexual / Aesthetic ideals, body image, eating attitudes and behaviors in men with different sexual orientation

Resumen Aun cuando existe amplia información disponible sobre imagen corporal y trastornos alimentarios, se sabe poco sobre estos tópicos en minorías sexuales, y especialmente en Latinoamérica. Por tanto, el propósito de este estudio fue comparar la satisfacción corporal, la interiorización de ideales estéticos (delgadez y musculatura), así como las actitudes y las conductas alimentarias entre varones con diferente orientación sexual. Participaron 217 varones (94 heterosexuales, 30 bisexuales y 93 gais), de 14 a 41 años de edad (M = 22.0, DE = 4.59). Los hombres bisexuales y gais reportaron mayor malestar con la imagen corporal, interiorización del ideal de delgadez y motivación por adelgazar, en comparación con los varones heterosexuales. Los bisexuales informaron mayor preocupación por la comida que los heterosexuales y los gais, pero estos últimos presentaron mayor restricción alimentaria. Los resultados apoyan la hipótesis de que en la insatisfacción corporal de los hombres de minorías sexuales predomina el deseo de adelgazar, resultado de una mayor interiorización del ideal corporal de delgadez. Por el contrario, los resultados relativos a la muscularidad no registraron una tendencia clara en función de la orientación sexual, de lo que destaca la necesidad de profundizar en su análisis, priorizando el empleo de instrumentos de evaluación más específicos sobre la motivación de incrementar musculatura.

Abstract Although there is a lot of information available about body image and eating disorders, little is known about the issue in sexual minority groups, especially in our culture and context. Therefore, the purpose of this study was to compare the body satisfaction, the internalization of aesthetic ideals (thin and muscular), the attitudes and eating behaviors in a sample of Mexican men with different sexual orientation. A total of 217 men (94 heterosexuals, 30 bisexuals and 93 gays), with an age range from 14 to 41 (M = 22.0, SD = 4.59) participated in the study. Bisexual men and gay men, compared to heterosexual men, reported greater body image discomfort, influence of thin shape and more motivation to lose weight. Bisexual men reported more concern about food than heterosexual men and gay men, but gay men had greater food restriction. These results support the hypothesis that body dissatisfaction in men of sexual minority groups is not oriented towards the development of the musculature, since they have internalized a thinner ideal body. On the contrary, the results related to muscularity did not register a clear tendency based on sexual orientation, which highlights the need to deepen its analysis, prioritizing the use of more specific evaluation instruments on the motivation to increase muscle.

[Diagnostic validity and usefulness of the Eating Attitudes Test-26 for the assessment of eating disorders risk in a Colombian male population]. / Validez y utilidad diagnóstica de la escala Eating Attitudes Test-26 para la evaluación del riesgo de trastornos de la conducta alimentaria en población masculina de Medellín, Colombia.

OBJECTIVE: To establish the diagnostic validity and usefulness of Eating Attitudes Test-26 (EAT-26) for the risk assessment of eating disorders in a male population. DESCRIPTION: Observational validation study questionnaire. SETTING: Performed in Medellin city at a community care level of mixed (public and private) psychiatric clinics. SUBJECTS: The study included 21 male subjects aged ≥14 with DSM-IV-TR diagnostic criteria for anorexia nervosa, bulimia nervosa, and Eating Disorder Not Otherwise Specified (EDNOS), and 93 controls without ED. MAIN OUTCOME MEASUREMENTS: A convenience sample was used for the cases and a simple, randomised one for controls. A reference standard (structured psychiatrist interview confirming the fulfilment of ED case inclusion criteria) was compared with the EAT-26 questionnaire. Reliability, cultural, semantics, and factorial validation were performed, and the best cut-off score was established with the ROC curve. RESULTS: Four domains remain in the instrument: dieting-bulimia and food pre-occupation, dieting, oral control-dieting, and oral control-bulimia. The Cronbach's alpha was 0.89, and a score of ≥20 is the best cut-off (sensitivity=100% and specificity=97.8%). The positive predictive value was 91.3% and the negative predictive value was 100.0%. CONCLUSIONS: EAT-26 questionnaire is an ideal multidimensional instrument for Eating Disorder screening in risk populations, with excellent reliability, sensitivity and specificity values. EAT-26 could be a useful tool to be considered when strategies for early detection of Eating Disorders are implemented in the male population.

Body checking and eating cognitions in Brazilian outpatients with eating disorders and non psychiatric controls.

OBJECTIVE: Compare inadequate eating behaviors and their relationship to body checking in three groups: patients with anorexia nervosa (AN), patients with bulimia nervosa (BN) and a control group (C). METHODS: Eighty three outpatients with eating disorders (ED) and 40 controls completed eating attitudes and body checking questionnaires. RESULTS: The overall relationship between the eating attitude and body checking was statistically significant in all three groups. The worse the eating attitude, the greater the body checking behavior. However, when we look at each group individually, the relationship was only statistically significant in the AN group (r=.354, p=0.020). DISCUSSION: The lower the desired weight and the worse the eating attitude, the more people check themselves, although in the presence of an ED the relationship between body checking and food restrictions is greater. In patients displaying the AN subgroup, body checking is also related to continued dietary control.

Riesgo de padecer trastornos de la conducta alimentaria en estudiantes de licenciatura en nutrición en cinco universidades de Argentina / Risks of developing eating disorders on undergraduate nutrition students in five universities of Argentina

Objetivos: Esta investigación desarrollada durante los meses de agosto, septiembre y octubre de 2013- tuvo como objetivo identicar el riesgo de padecer trastornos de la conducta alimentaria en estudiantes cursantes de 1º a 5º año de la carrera de Licenciatura en Nutrición en cinco universidades de Argentina. Materiales y métodos: el diseño del estudio es descriptivo y de corte transversal. El instrumento que se utilizó para recolectar los datos es el Test de Actitudes Alimenticias-26. Resultados y conclusiones: la investigación muestra que los estudiantes presentaron un 13,3% de riesgo de padecer trastornos de la conducta alimentaria, encontrándose que, según la universidad a la que asisten, existe mayor o menor riesgo de presentar trastornos de la conducta alimentaria (TCA). En relación al estado nutricional de los alumnos se observó que aquellos que mostraron sobrepeso y obesidad presentaron mayor riesgo de padecer TCA. El estudio reflejó la gran preocupación de los estudiantes en relación con los alimentos que ingieren y la posibilidad de aumentar su peso corporal. Al detectarse que pueden existir casos de alumnos de la Carrera de Nutrición con algún tipo de TCA, se recomiendan medidas preventivas en relación a este tema y al correcto tratamiento y/o derivación en los casos diagnosticados.

Objetives: The purpose of this study is to identify the risk of developing eating disorders in students from 1st to 5th year of the degree in Nutrition from ¬ve universities in Argentina. It was developed during the months of August, September and October 2013. Materials and methods: the study design is descriptive and cross-sectional, and the measure used to collect the data is the Eating Attitudes Test-26 (EAT-26). Results and conclusions: this research shows that students have 13,3% risk of developing eating disorders. It was found that depending on the University attended by students, there is a greater or lesser risk of eating disorders. It was observed that those who are overweight and obese are at increased risk for these diseases regarding nutritional status of students. It is notorious the concern among students about food and weight gain. This shows that there might be cases of Nutrition students with some sort of eating disorders. That is why we recommend taking preventive measures in relation to this issue and the correct treatment or referral in diagnosed cases.

Factores relacionados con las prácticas maternas de control alimentario en preescolares / Related Factors to Maternal Intake Control Practices in Preschoolers

Las prácticas de crianza durante los primeros años de vida son cruciales para el desarrollo de las preferencias alimentarias, la autorregulación de la ingesta y el establecimiento de hábitos de consumo. El papel de las madres es fundamental en el monitoreo de la alimentación de sus hijos, y sus prácticas pueden estar influenciadas por diversos factores. En este estudio se evaluó la relación entre las actitudes de las madres hacia la alimentación, la importancia otorgada al peso propio y al de sus hijos y el control alimentario que ejercen sobre ellos. Participaron 82 madres de preescolares. Se les aplicó el Child Feeding Questionnaire, el Cuestionario de control alimentario ejercido sobre los hijos, y el Cuestionario de Emociones y Creencias hacia la Alimentación y el Peso. Los resultados señalan que la preocupación por el peso propio y de los hijos, las actitudes hacia la alimentación y la importancia otorgada al control del peso, se relaciona con el control alimentario sobre los hijos. Esto podría generar contenidos de pensamiento y comportamientos que pudieran constituirse como factores de riesgo o protección en el desarrollo de hábitos de alimentación.

Parenting practices during the first years of life are crucial for the development of food preferences, self-regulation of intake and for establishing habits. The role of mothers is essential in the monitoring of their children's feeding, and their practices may be influenced by several factors. In this study the relationship between mothers' attitudes towards eating, the importance given to their own weight and that of their children, and intake control exerted over them was evaluated. 82 mothers of preschoolers participated. They were administered the Child Feeding Questionnaire, the Intake Control Exercised on the Children Questionnaire, and the Questionnaire of Emotions and Beliefs to Eating and Weight. Results indicate that concerns about the own weight and the children's, the attitudes towards eating and the importance given to weight control, are related to the control exerted on children's intake. This could generate thoughts and behaviors that could be constituted as risk or protective factors in the development of eating habits.

Body image dissatisfaction, nutritional status, and eating attitudes in adolescents / Insatisfação corporal, estado nutricional e atitudes alimentares em adolescentes

The study investigated the relationship between body image dissatisfaction, nutritional status, and eating attitudes in adolescents from a small town of the interior of São Paulo State. A total of 278 adolescents (106 boys and 172 girls) aged between 15 and 18 years had completed measures of body image dissatisfaction through the Figure Rating Scale and eating attitudes by the Eating Attitudes Test (EAT- 26) and had their weight and height measured. Girls related more dissatisfaction and abnormal eating behavior than boys and, in both genders the abnormal eating attitudes tend to increase with increasing dissatisfaction. Moreover, dissatisfaction was higher between those individuals classified as overweight and obesity. These results demonstrated that body image dissatisfaction and inappropriate eating behaviors afflict boys and girls even from small cities in developing countries, highlighting the need to undertake epidemiological studies to early recognition of populations at risk of developing eating disorders.

O estudo investigou a relação entre insatisfação com a imagem corporal, estado nutricional e atitudes alimentares em adolescentes de uma pequena cidade do interior do Estado de São Paulo. Um total de 278 adolescentes (106 meninos e 172 meninas) entre 15 e 18 anos tiveram respondidas medidas de insatisfação com a imagem corporal, por meio de uma Escala de Figuras de Silhuetas, e de atitudes alimentares, pelo Eating Attitudes Test (EAT-26), além de terem seu peso e altura aferidos. Meninas relataram maiores índices de insatisfação e atitudes alimentares inadequadas quando comparadas aos meninos e, em ambos os sexos, os comportamentos alimentares inadequados tendem a aumentar conforme aumenta a insatisfação com a imagem. Além disso, a insatisfação foi maior entre os adolescentes com sobrepeso e obesidade. Estes resultados demonstram que a insatisfação com a imagem corporal e os comportamentos alimentares inadequados afetam adolescentes até mesmo de pequenas cidades de países em desenvolvimento, demonstrando a necessidade de mais estudos epidemiológicos para o reconhecimento precoce de populações em risco de desenvolver transtornos alimentares.

Checagem corporal, atitude alimentar inadequada e insatisfação com a imagem corporal de jovens universitários / Body-checking, inappropriate eating attitudes and body image dissatisfaction among young students

OBJETIVO: O objetivo do estudo foi avaliar a checagem corporal, a atitude alimentar inadequada e a insatisfação corporal em universitários de ambos os sexos. MÉTODOS: Participaram 587 indivíduos (311 homens). Foram avaliados os comportamentos de checagem (mulheres - Body Checking Questionnaire; homens - Male Body Checking Questionnaire), as atitudes alimentares inadequadas (Eating Attitudes Test-26) e a insatisfação corporal (Body Shape Questionnaire). Massa corporal e estatura foram autorreferidas para o cálculo do índice de massa corporal (IMC). Foi realizada estatística descritiva, inferencial e teste qui-quadrado (teste exato de Fisher) utilizando o software Statistic 8.0 e adotado nível de significância de 5%. RESULTADOS: A checagem corporal está associada às atitudes alimentares inadequadas e à insatisfação corporal, independentemente do sexo do indivíduo. Foram encontradas diferenças entre o sexo feminino e masculino para as variáveis avaliadas, sendo maior a frequência entre as mulheres. CONCLUSÃO: Concluiu-se que a checagem corporal é um comportamento presente e de alta frequência em universitários com risco para o transtorno alimentar e também naqueles insatisfeitos com sua imagem corporal.

OBJECTIVE: The aim of this study was to evaluate the body-checking, inappropriate eating attitudes and body dissatisfaction in undergraduate students from both sexes. METHODS: Five hundred eighty-seven undergraduate students (311 men) were surveyed. The body-checking behaviours (women - Body Checking Questionnaire; men - Male Body Checking Questionnaire), inappropriate eating attitudes (Eating Attitudes Test-26) and body dissatisfaction (Body Shape Questionnaire) were evaluated. Body mass and height were self-referred to calculate the body mass index (BMI). Descriptive, inferential and qui-square test (Fisher exact test) statistics were performed using the Statistic 8.0 software and adopting significant level of 5%. RESULTS: Body-checking behaviours are associated with inappropriate eating attitudes and body dissatisfaction in both sexes. Women and men showed differences between the variables evaluated, being higher in women. CONCLUSION: Body-checking is a present and high frequency behaviour in undergraduate students with risk for eating disorders and also with those dissatisfied with their body image.

Comparison of eating attitudes among university students from the five Brazilian regions / Comparação das Atitudes Alimentares entre universitárias das cinco regiões brasileiras

Eating attitudes can be defined as beliefs, thoughts, feelings, behavior and relationship with food. They can influence people's food choices and health status. The scope of this paper is to compare eating attitudes of university students from different regions of Brazil and investigate possible associations and correlations with nutritional status, age, individual income and parental education. 2489 female university students in the area of health answered the Eating Attitude Scale - evaluated by total score and 5 sub-scores. The eating attitudes were compared by means of an analysis of covariance. A logistic regression was conducted to evaluate which variables were associated to the scale score. The Northeast presented more restrictive and compensatory practices and the North and Northeast presented less positive feelings about food and worse ideas about normal eating. The score on the scale did not present strong correlation with any of the variables studied, but nutritional status and age were associated with the total score. The profile of university students was similar among regions with the worst response in the North and Northeast regions. It is believed that these data could help to elucidate dietary patterns and nutritional differences among groups.

Atitudes alimentares são crenças, pensamentos, sentimentos, comportamentos e relacionamento com os alimentos e influenciam as escolhas alimentares e a saúde dos indivíduos. Objetivo: comparar atitudes alimentares de universitárias brasileiras das cinco regiões do país e avaliar associações e correlações com o estado nutricional, curso, idade, renda e escolaridade do chefe da família. Métodos: 2489 universitárias do sexo feminino de cursos da área da saúde responderam à Escala de Atitudes Alimentares - analisada em escore total e suas 5 subescalas. As respostas foram comparadas por região através da análise de covariância. Uma regressão logística foi realizada para avaliar quais variáveis estavam associadas à pontuação da escala. Resultados: a região Nordeste apresentou mais práticas restritivas e compensatórias e as regiões Norte e Nordeste menos sentimentos positivos em relação à alimentação e os piores conceitos sobre alimentação normal. Os escores não apresentaram forte correlação com as variáveis estudadas; mas o estado nutricional e a idade tiveram associação com a pontuação total. Conclusão: As atitudes alimentares de universitárias foram similares entre as regiões, com pior resposta na região Norte e Nordeste. Estes resultados podem ajudar a elucidar padrões dietéticos e diferenças nutricionais entre regiões do país.

Comportamento de risco para transtorno alimentar em universitárias brasileiras / Eating disorders risk behavior in Brazilian female university students

CONTEXTO: Comportamentos de risco para transtornos alimentares envolvem atitudes e práticas inadequadas para com o alimento e o peso e podem ser avaliados com base em instrumentos validados. OBJETIVOS: Avaliar comportamento de risco para transtornos alimentares em universitárias brasileiras das cinco regiões do país. MÉTODOS: 2.483 universitárias responderam ao Teste de Atitudes Alimentares (EAT-26) nas cinco regiões. A pontuação no teste foi comparada entre as regiões por meio do teste qui-quadrado. Possíveis associações ou correlações com curso de graduação, idade, estado nutricional, renda individual e escolaridade do chefe da família foram avaliadas pelos coeficientes de Pearson e Spearman. Uma análise de covariância comparou o escore do EAT entre as regiões. RESULTADOS: A frequência de comportamento de risco para transtornos alimentares variou de 23,7 por cento a 30,1 por cento nas cinco regiões e não houve diferença na pontuação média do EAT e na proporção de escores positivos para comportamento de risco entre as regiões. Não houve forte correlação do escore do EAT com nenhuma das variáveis. CONCLUSÃO: Universitárias brasileiras apresentam alta frequência de comportamentos de risco para TA em todas as regiões do país. Medidas de prevenção devem ser planejadas para a população jovem feminina do Brasil.

BACKGROUND: Risk behavior for eating disorders enrolled inadequate practices and attitudes with food and weight control and could be evaluated with valid instruments. OBJECTIVES: To evaluate risk behaviors for eating disorders among Brazilian female university students from different regions. METHODS: 2.483 college students filled out the Eating Attitudes Test (EAT-26) at five regions in Brazil. The test score was compared among regions by chi-square test and possible associations or correlations with major, age, nutritional status, individual income and parental education evaluated by Pearson and Spearman coefficients. A covariance analysis compared the EAT scores among regions. RESULTS: The frequency of positive eating disorder behavior ranges from 23.7 percent to 30.1 percent among five regions. There was no difference in EAT scores among regions, and there was not strong correlation between EAT scores and the variables studied. DISCUSSION: Brazilian female university students have high frequency of risk behaviors for eating disorders in all regions of the country. Prevention strategies must be developed for the young female population of Brazil.

Changing attitudes, beliefs and feeling towards food in bulimic patients / Modificação das atitudes, crenças e sentimentos para com os alimentos em pacientes com bulimia nervosa

Eating attitudes are defined as beliefs, thoughts, feelings and behaviors towards food. Bulimia nervosa (BN) is an eating disorder, in which the eating attitudes are seriously disturbed. Studies that evaluated nutritional aspects of BN focus mainly on food intake, dietary restriction and binge eating, while the follow-up studies evaluate mainly clinical symptoms. The objective of this study was to evaluate eating attitudes of patients with BN, during and after cognitive-behavioral intervention. Thirty nine (39) BN female patients received cognitive behavioral treatment with a multidisciplinary team and had eating attitudes assessed by a questionnaire developed for this research. Frequencies of the attitudes assessed were compared at baseline, after 12 weeks and 24 weeks of treatment. After treatment, patients had less distorted beliefs about food, less guilty after eating “forbidden” foods and they felt more tranquil while eating outside home. Other negative behaviors, as dietary restriction, the desire of not eat, being angry when feeling hungry and using the food to relive stress, persisted. Eating attitudes of patients with BN are hard to be changed in a short-term. More attention to this disease’s component and new approaches to treatment are needed in order to have a better recovery.

Atitudes alimentares são definidas como crenças, pensamentos, sentimentos e comportamentos para com os alimentos. Bulimia Nervosa (BN) é um transtorno alimentar no qual as atitudes alimentares estão seriamente perturbadas. Os estudos que avaliam aspectos nutricionais centram sua atenção principalmente na ingestão alimentar, restrição alimentar e compulsão alimentar, e os estudos de seguimento avaliam essencialmente os sintomas clínicos. O objetivo deste estudo foi avaliar as atitudes alimentares de pacientes com BN durante e depois de uma intervenção cognitivo comportamental. Trinta e nove (39) pacientes do sexo feminino receberam tratamento cognitivo comportamental com equipe multidisciplinar e tiveram suas atitudes alimentares avaliadas por um instrumento desenvolvido para esta investigação. A freqüência de diferentes atitudes foi comparada antes, depois de 12 semanas e 24 semanas de tratamento. Depois do tratamento as pacientes apresentaram menos crenças distorcidas sobre alimentação, menos culpa depois de ingerir alimentos “proibidos” e demonstraram mais tranqüilidade para comer fora de casa. Outras atitudes negativas, como restrição alimentar, o desejo de não comer, a raiva de sentir fome e usar o alimento para aliviar questões emocionais persistiram. Conclui-se que as atitudes alimentares de pacientes con BN são difíceis de serem modificadas em curto prazo. Maior atenção a este componente do distúrbio e novas formas de tratamento são necessárias para obter uma recuperação mais completa.