# Higher consumption of ultra-processed foods is associated with disordered eating symptoms and low-quality diet in adults with obesity

## TL;DR

Eating more ultra-processed foods is linked to disordered eating and poor diet quality in adults with obesity.

## Contribution

This study shows a novel association between ultra-processed food consumption and disordered eating behaviors in individuals with obesity.

## Key findings

- Higher ultra-processed food intake correlates with symptoms of binge eating and bulimia.
- Consumption of ultra-processed foods is linked to lower diet quality scores.
- Emotional and uncontrolled eating behaviors increase with ultra-processed food intake.

## Abstract

This study aims to evaluate ultra-processed food consumption and eating
behavior in adults with obesity.

A cross-sectional study with 77 volunteers from São Paulo, Brazil.
Food consumption was assessed using three 24-hour dietary recalls,
classified by using the NOVA classification system, and the Diet Quality
Index was also evaluated. Eating behavior and symptoms of binge eating and
bulimia were assessed using the Bulimic Investigatory Test Edinburgh (BITE),
the Dutch Eating Behaviour Questionnaire (DEBQ), and the Three Factor Eating
Questionnaire (TFEQ-21).

The average BMI of the sample was 39.14 kg/m² ± 5.57, and the median
caloric intake was 1661 kcal (756.07–4774.40), with a macronutrient
distribution of 48% carbohydrates, 32% fat, and 20% protein. Volunteers were
divided into tertiles of calories ingested from ultra-processed foods (%):
1st < 24.10% (n = 25); 2nd between
24.10%–35.40% (n = 26); and the 3rd > 35.40% (n = 26). The
sample showed intermediate diet quality (43.08 ± 10.17), while the
3rd tertile presented a low-quality diet (37 ± 10), differing from
other groups (p = 0.001; p = 0.003). All groups showed intermediate BITE
scores (19,6 ± 9,8), an indicator of unusual eating behavior. The
third tertile had a higher symptom score than the first tertile (p = 0.008).
In the association analysis, the consumption of ultra-processed foods was
positively associated with the presence of binge eating and bulimia symptoms
(p = 0.018), emotional (p = 0.001) and external eating (p = 0.001) as
assessed by the DEBQ, and emotional (p = 0.008) and uncontrolled eating (p =
0.006) as assessed by the TFEQ-21. In contrast, diet quality was negatively
associated with the consumption of ultra-processed foods (p < 0.001).

Our findings suggest that higher consumption of ultra-processed foods by
volunteers with obesity may be associated with higher scores for unusual
eating behavior, symptoms of binge eating, and bulimia, in addition to
augmented emotional, external and uncontrolled eating, and lower diet
quality scores.