Fernanda Rodrigues de Oliveira Penaforte

Introduction: From a biomedical perspective, metabolic and bariatric surgery can effectively treat obesity. However, traditional strategies (diet and exercise) to prevent weight regain have not been fully effective, as they may help some individuals maintain postoperative weight loss, but approximately 30% of patients still regain weight after surgery. This highlights the need to explore alternative approaches, including mindfulness-based interventions. This study aims to evaluate the feasibility and describe the effects of a mindfulness-based intervention on behavioral and anthropometric outcomes in women with weight regain after metabolic and bariatric surgery. Methods: A pre-post feasibility pilot study was conducted with 10 women who had regained ≥ 15% of the achieved weight loss. The intervention combined Mindfulness-Based Eating Awareness Training with elements of the Mindful Self-Compassion program. Feasibility outcomes included adherence, attendance (overall and among completers), recruitment rate, data completeness, and informal facilitator feedback. Behavioral (binge eating, self-compassion, mindfulness) and anthropometric measures (weight and BMI) were assessed at three time points: baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Results: Feasibility indicators revealed low adherence (60% dropout), low overall attendance (41.7%), high attendance among completers (87.5%), moderate recruitment rate (38.5%), and low data completeness (40.0%). Challenges in engagement were associated with expectations of diet-based approaches. Among completers, improvements were observed in binge eating (22.7 ± 5.4 to 11.3 ± 2.5), “Isolation” (2.6 ± 0.4 vs. 2.3 ± 0.4), “Over-Identification” (3.3 ± 0.5 vs. 2.8 ± 0.2), and “Mindfulness” (3.1 ± 0.3 vs. 3.5 ± 0.4) subscales of the Self-Compassion Scale. From baseline to the 3-month follow-up, we observed improvement in “Mindfulness” (3.1 ± 0.3 vs. 3.9 ± 0.2), “Over-Identification” (3.3 ± 0.5 vs. 2.8 ± 0.3), and “Nonreactivity to Inner Experience” (19.5 ± 1.6 vs. 22.2 ± 2.2). Body weight remained stable throughout the intervention period (82.1 ± 4.0 vs 81.7 ± 4.0) and reduced at 3-month follow-up (79.8 ± 3.7). Conclusion: Although not feasible in its current format, the intervention showed preliminary benefits, indicating the need for protocol refinement and a new feasibility evaluation before moving to larger trials.

Resumo Profissionais de saúde frequentemente reproduzem atitudes gordofóbicas que criam barreiras no cuidado em saúde às pessoas com obesidade, especialmente na Atenção Primária em Saúde (APS). Assim, este estudo teve como objetivo construir e aplicar, em caráter piloto, o programa QualiCuidar, voltado para a promoção de práticas de cuidado livres do estigma do peso na APS. A pesquisa seguiu abordagem quanti-qualitativa, contemplando a elaboração do programa, sua aplicação em duas unidades de saúde e sua avaliação por meio da aplicação das escalas Fat Phobia Scale e Short Version e Beliefs About Obese Persons Scale antes e após a participação; e também por meio de grupos focais ao final do Programa. Concluíram o programa 13 profissionais, majoritariamente Agentes Comunitários de Saúde (ACS) (84,6%). Embora não tenham sido observadas diferenças significativas nos escores das escalas aplicadas, os participantes relataram mudanças na oferta do cuidado às pessoas com obesidade, destacando maior empatia, escuta ativa e acolhimento. Também emergiram reflexões críticas sobre a necessidade de ampliar a participação de outros profissionais e de incorporar a temática na formação permanente em saúde. Conclui-se que o QualiCuidar demonstrou potencial para sensibilizar profissionais da APS, reforçando a importância de capacitações contínuas e multiprofissionais no enfrentamento da gordofobia.

Background: Nutrition students are at greater risk of developing disordered eating attitudes, especially during the COVID‐19 pandemic. Mindfulness‐based interventions (MBIs) have proven to be beneficial in improving mental health outcomes and are also applied to issues related to food through mindful eating. The study aimed to evaluate the effect of a MBI on levels of body dissatisfaction and disordered eating attitudes among nutrition students during the COVID‐19 pandemic.Methods: This randomised clinical trial performed the ‘Mindfulness‐Based Eating Solution’ (MBES) intervention in nutrition students. Seventy‐eight adult women were randomised into the intervention group (n = 38) and control group (n = 40). The intervention group received eleven weekly sessions of MBES and two follow‐up sessions. Body dissatisfaction and appreciation, disordered eating attitudes, intuitive eating and mindfulness were assessed four times (at baseline, post‐intervention, 1‐month follow‐up and 3‐month follow‐up).Results: The intervention group showed decreased levels of body dissatisfaction (from 86.60 ± 6.13 to 64.13 ± 2.82) and disordered eating attitudes (from 1.46 ± 0.08 to 1.15 ± 0.02), and higher levels of reliance on hunger and satiety cues and mindfulness after the MBES intervention. Body dissatisfaction and levels of reliance on hunger and satiety cues were maintained at follow‐up, whereas the disordered eating attitudes and levels of mindfulness increased in the first and third months, respectively. No significant changes were found in the outcomes evaluated in the control group.Conclusions: The results suggest the positive effects of a MBI on the nutrition students’ body image perceptions and eating attitudes. Further research is needed to investigate such benefits and understand the related mechanisms in other populations.

Objective This study aimed to evaluate how weight stigma is addressed in national and international clinical guidelines for the treatment of obesity. Methods A systematic review with qualitative synthesis was conducted, analyzing recommendations from clinical guidelines published between 2000 and 2022. Both national and international documents were included, with the goal of identifying the presence, emphasis, and treatment given to the topic of weight stigma. The search yielded 713 publications, of which only 26 met the inclusion criteria established for this study. Results The findings revealed that most of the analyzed guidelines do not meaningfully address weight stigma in their recommendations. Despite the importance of this issue for improving the quality of care for individuals with obesity, it remains underexplored, highlighting persistent gaps in the ethical and humanized approach to treatment. Conclusion The results underscore the urgent need to incorporate the discussion of weight stigma into clinical guidelines for obesity. Such incorporation is essential to foster an epistemological shift in how obesity is understood and managed in clinical contexts. This transformation requires coordinated efforts at multiple levels – individual, community, and systemic – and entails a reconfiguration of societal relations with fat bodies, as well as a redefinition of the very notion of healthcare.

Background Weight stigma is a complex construct formed by various components. This study aimed to compile these components and classify them into the multilevel intervention levels of stigma (structural, interpersonal, and intrapersonal).Methods A non-systematic literature review was conducted to identify the most commonly used definitions of weight stigma components. Subsequently, a proposal was made to classify these components into different intervention levels as proposed (Structural, Interpersonal, Intrapersonal). The components were categorized based on their definitions and specificities at each level. A panel of experts evaluated the proposal, and the degree of agreement was assessed using Fleiss' Kappa coefficient (₭). Values of ₭ between 0.40 and 0.60 indicated moderate agreement; between 0.61 and 0.75, good agreement; and above 0.75, excellent agreement.Results Ten terms were identified and classified in the different levels of stigma, except “Weight stigma” and “Weight bias”. At the structural level were included "fatphobia" and "weight-based stereotypes"; at the interpersonal level, "weight discrimination" and "explicit weight bias"; and at the intrapersonal level, "implicit weight bias", "lipophobia," "fat stigma", and "internalized weight bias". Agreement among the experts' responses for the structural and interpersonal levels was 100% (₭ = 1.0). For the components allocated at the intrapersonal level, there were some disagreements in the classification of the “Fat stigma” component (₭ = 0.4), and “Lipophobia” and “Implicit weight bias” were considered inappropriate by one specialist (₭ = 0.6).Conclusion The proposed classification of weight stigma components across multi-level interventions is novel and deemed appropriate by the experts. In future studies, this classification can help assess associations between weight stigma components across inter- and intra-levels and guide interventions across different levels for more effective outcomes in combating weight stigma.

Introdução: O período pandêmico provocou inúmeras alterações, sendo a alimentação um dos contextos afetados. Objetivo: Compreender os novos arranjos e significados das práticas alimentares vivenciados durante a primeira onda da pandemia pela Covid-19 por profissionais da educação superior. Métodos: Trata-se de uma pesquisa qualitativa e de caráter exploratório. Foram entrevistados, individualmente e de forma remota, dez profissionais do setor da educação superior de duas universidades federais do interior de Minas Gerais. As entrevistas foram analisadas por meio da Análise Temática de Bardin em conjunto com a Análise de Similitude via IRAMUTEQ. Resultados: As entrevistas permitiram a identificação de três eixos temáticos: (1) “Manejos da comida e do corpo: prazer, culpa e medo do ganho de peso”, explorando os embates que se intensificaram no que tange ao corpo e às escolhas alimentares; (2) “Re-arranjos sociais, comensalidade e práticas alimentares”; e (3) “O exercício do cozinhar no confinamento: polissemias, temporalidades e gênero”, discorrendo sobre o dinamismo da alimentação ao vivenciar alterações na composição domiciliar, rotina e obrigações de trabalho. Discussão: Foi possível identificar relações entre o distanciamento social, o confinamento domiciliar e as práticas alimentares individuais e coletivas. Em razão dos diferentes rearranjos sociais, estruturados pelos participantes para lidar com as restrições impostas pela pandemia, comportamentos dicotômicos emergiram, refletindo conflitos frente aos ajustes nas práticas alimentares. A relação nutriente-alimento (nutricionismo) esteve muito presente nas narrativas, influenciando pensamentos e comportamentos sobre o corpo e o bem-estar. Conclusão: Conclui-se que o contexto pandêmico gerou alterações em relação aos arranjos, representações e significados do comer e da alimentação.

Os objetivos deste estudo foram relatar a experiência da utilização de oficinas culinárias como estratégia didático-pedagógica na disciplina de educação nutricional, e analisar as percepções dos estudantes quanto à interdisciplinaridade e aplicabilidade na atuação profissional, pela análise de conteúdo temática. Este é um relato de experiência da utilização de oficinas culinárias durante a disciplina de Educação Nutricional no curso de nutrição de uma universidade pública. Foram quantificados os tipos de receitas selecionadas e seus respectivos princípios dietéticos e/ou dietoterápicos. Identificamos que 80% das receitas selecionadas priorizavam o conteúdo de nutrientes dos ingredientes como princípio dietético/dietoterápico e somente 20% consideraram aspectos sensoriais e culturais. Na análise qualitativa, foram identificados três eixos temáticos: (1) O olhar do estudante sobre a oficina culinária; (2) O aprendizado da oficina culinária para sua prática profissional; (3) A racionalização da alimentação. A oficina foi considerada uma experiência inovadora e enriquecedora para a formação acadêmica, principalmente pela interdisciplinaridade. Conclui-se que o uso de oficinas culinárias como estratégia didático-pedagógica interdisciplinar nos cursos de Nutrição pode trazer benefícios na formação dos futuros nutricionistas.