Desenvolvimento e eficácia de uma intervenção em comer intuitivo baseada na dissonância cognitiva na imagem corporal e no comportamento alimentar: um ensaio clínico controlado randomizado

Abstract

Intuitive eating (IE) is an approach based on respecting and trusting the body's internal signals to determine when to eat, and the quantity and quality needed. In general, IE is positively correlated with positive body image variables and inversely associated with risk behaviors for eating disorders. However, interventions that promote IE vary in methodology, lack time-based monitoring, and are not based on Cognitive Dissonance theory. Therefore, this study aimed to develop and evaluate the effectiveness of an IE intervention using cognitive dissonance strategies to increase IE, body appreciation, body acceptance by others, internal body orientation, functional motivation for physical exercise, and reduce cognitively restrictive, uncontrolled, and emotional eating in young Brazilian adults. Young female adults, aged 18 and 35, who agreed to participate voluntarily participated in the study. Participants were randomly allocated to one of three groups: Cognitive Dissonance Intervention (CDI), Educational Intervention (EDI), and Passive Control (PC) group. Participants enrolled in the IDC participated in six 60-minute, in-person, interactive intervention sessions with a one-week interval between sessions. The IED received educational materials on each topic addressed throughout the intervention by the IDC. The PC only responded to the data collection. Intention-to-treat analysis was performed using the mixed-model module to assess the effectiveness of the IC intervention, comparing the effects between the three groups and each dependent variable over time (baseline, post-intervention, four, 24-, and 48-week follow-ups). The IDC showed an increase in body appreciation, internal body orientation, health motivation for physical exercise, and a reduction in cognitive restrictive eating after the intervention. At 24-week and 48-week follow-ups, there were increases in all variables and reductions in scores for cognitive restrictive eating, uncontrolled eating, and emotional eating. The only variable that did not show any change was appearancebased motivation for physical exercise. Furthermore, the IDC showed a statistically significant increase compared to both groups (IED; CP) at four, 24, and 48 weeks of followup. Body appreciation and internal body orientation indicated efficacy in the IDC group compared to the CP group in the post-intervention and in the remaining study segments. Body acceptance by others was found to be effective at 24 and 48 weeks of follow-up. Cognitively restrictive, uncontrolled, and emotional eating showed reductions in the IDC group compared to the CP group, especially in the post-intervention period and at four weeks of follow-ups (cognitively restrictive eating) and at 24/48 weeks of follow-ups (all). The results provide substantial evidence for the effectiveness of the intervention in increasing intuitive eating and positive body image constructs and reducing dysfunctional eating behaviors in young Brazilian adults.