New clinical research links ultra-processed food consumption with disordered eating patterns and poorer diet quality in adults with obesity, highlighting potential targets for improved nutritional intervention.
Study: Higher consumption of ultra-processed foods is associated with disordered eating symptoms and low-quality diet in adults with obesity. Image Credit: Inna Tarnavska / Shutterstock
In a recent cross-sectional study published in the Archives of Endocrinology and Metabolism, researchers examined ultra-processed food (UPF) intake and its association with eating behavior in adults with obesity in São Paulo, Brazil.
Nutritional Transition and Ultra-Processed Food Consumption
Nutritional transition is increasingly observed in developing countries due to demographic, economic, cultural, and social shifts. This transition is marked by reductions in malnutrition and infectious diseases but a parallel rise in noncommunicable diseases, including obesity. These changes are largely driven by higher consumption of fat- and sugar-rich, industrially processed foods.
High intake of ultra-processed foods (UPFs) has been linked to increased prevalence of obesity, overweight, type 2 diabetes, metabolic syndrome, cardiovascular and cerebrovascular disease, anxiety, depression, and all-cause mortality. Emerging evidence suggests UPFs may alter eating behavior by affecting neurobiological and endocrine pathways involved in appetite regulation, potentially promoting compulsive overeating.
Eating disorders and disordered eating patterns can occur in individuals with obesity and may negatively influence the effectiveness of weight management interventions. Understanding how UPF consumption relates to eating behavior is therefore clinically relevant.
Study Design and Participant Characteristics
The study recruited adults aged 18-59 years with obesity, defined as body mass index (BMI) ≥ 30 kg/m², from a clinical obesity treatment service and via social media in São Paulo. Exclusion criteria included pregnancy, diagnosed eating disorders, cardiac or renal disease, obesity secondary to genetic disorders, use of antiepileptic drugs or corticosteroids, smoking, alcohol abuse, and ongoing pharmacological weight loss treatment.
Dietary intake was assessed using the mean of three non-consecutive 24-hour dietary recalls conducted with the multiple-pass method, including one weekend day. Foods were categorized using the NOVA classification system to determine the degree of industrial processing. Diet quality was evaluated using the Diet Quality Index associated with the Digital Food Guide.
Eating behavior was assessed through validated self-administered online questionnaires.
- BITE, measuring bulimia and binge eating symptoms and severity
- TFEQ-21, assessing cognitive restraint, emotional eating, and uncontrolled eating
- DEBQ, evaluating external, emotional, and restrained eating
Associations between UPF intake and eating behavior were analyzed using generalized linear models.
Prevalence of Unusual Eating Behaviors
A total of 77 adults participated, 78% of whom were female. The mean age was 36 years, and the mean BMI was 39.14 kg/m², consistent with class II obesity on average.
Participants were divided into tertiles based on the proportion of calories derived from UPFs.
- First tertile: < 24.1% of calories from UPFs
- Second tertile: 24.1%-35.4%
- Third tertile: > 35.4%
Only about one-quarter of participants demonstrated normal eating behavior. Approximately 52% exhibited unusual eating behavior, and 23.4% reported binge eating. Across all tertiles, symptoms consistent with unusual eating were observed. The highest UPF tertile had significantly higher BITE symptom subscale scores compared with the lowest tertile, although severity scores did not significantly differ across groups.
Overall, 40.3% of participants had clinically significant symptoms, and 13% presented severe symptoms.
Eating Style Patterns and UPF Intake
Regarding eating styles, 37.8% of participants had elevated external eating scores, 36.5% had elevated emotional eating scores, and 25.7% had elevated restrained eating scores. On the TFEQ-21, 52% demonstrated higher emotional eating, 29.3% showed increased cognitive restraint, and 18.7% exhibited higher uncontrolled eating.
UPF intake was positively associated with binge eating and bulimia symptoms measured by BITE, emotional eating, external eating, and uncontrolled eating. These findings suggest that higher consumption of ultra-processed foods is associated with eating behaviors characterized by reduced self-regulation and heightened responsiveness to emotional and environmental cues.
Diet Quality and Macronutrient Intake
Diet quality was classified as intermediate across the overall sample and within the first and second UPF tertiles. Individuals in the highest UPF tertile had significantly lower diet quality scores than those in the lower tertiles.
The first tertile consumed more unprocessed or minimally processed foods, while the third tertile consumed a greater proportion of UPFs. The first and second tertiles reported higher intake of processed culinary ingredients compared with the third tertile.
Mean macronutrient distribution was 20% protein, 48% carbohydrates, and 32% lipids. The third tertile had significantly lower protein intake than the other tertiles, whereas carbohydrate and lipid intake did not significantly differ across groups. Median total caloric intake was 1,661 kcal, with higher caloric intake observed in the third tertile compared with the second.
Higher UPF intake was associated with poorer diet quality and reduced protein intake, which may influence satiety and appetite regulation.
Clinical Implications and Study Limitations
The study found that more than half of adults with obesity demonstrated unusual eating behaviors. Higher UPF intake was associated with binge eating, bulimia-related symptoms, emotional eating, external eating, and uncontrolled eating. Greater UPF consumption also correlated with lower diet quality and reduced protein intake.
These findings suggest that obesity treatment strategies should incorporate assessment of diet quality and eating behavior dimensions that may predispose individuals to unhealthy food choices. Addressing behavioral drivers alongside dietary composition may improve weight management outcomes.
Because this was a cross-sectional study conducted in a clinical sample from a single urban center, causal relationships cannot be established. Self-reported dietary recalls and questionnaires may introduce recall and social desirability bias. The small sample size and predominantly female composition may further limit generalizability.
Overall, the results highlight the need to consider ultra-processed food consumption within a broader behavioral and nutritional framework for obesity management, while acknowledging the observational nature of the findings.
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