Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-09-26T14:25:54Z No. of bitstreams: 1 claudiarochafranco.pdf: 1295484 bytes, checksum: e185d6d953ea86e2ada3c92396dbddd3 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-09-26T20:33:58Z (GMT) No. of bitstreams: 1 claudiarochafranco.pdf: 1295484 bytes, checksum: e185d6d953ea86e2ada3c92396dbddd3 (MD5) / Made available in DSpace on 2016-09-26T20:33:58Z (GMT). No. of bitstreams: 1 claudiarochafranco.pdf: 1295484 bytes, checksum: e185d6d953ea86e2ada3c92396dbddd3 (MD5) Previous issue date: 2016-07-08 / A síndrome metabólica é um aglomerado de fatores de risco metabólico e cardiovascular, que apresenta como um dos principais componentes a obesidade abdominal. A obesidade associase frequentemente à compulsão alimentar periódica. O objetivo do presente estudo foi avaliar a presença da compulsão alimentar periódica em mulheres com Síndrome Metabólica e a possível associação com parâmetros sociodemográficos, clínicos e comportamentais. Em estudo transversal, foram selecionados 124 indivíduos com Síndrome Metabólica, distribuídos em dois grupos: Grupo 1 (ausência de compulsão alimentar periódica) e Grupo 2 (presença de compulsão alimentar periódica). A avaliação clínica incluiu medidas de peso e altura, circunferência da cintura e pressão arterial de consultório. Foram também avaliados parâmetros comportamentais, como presença de compulsão alimentar periódica, nível de atividade física, consumo de álcool, imagem corporal, sintomas depressivos e qualidade de vida. A avaliação laboratorial incluiu as dosagens de glicose e insulina em jejum, TSH, perfil lipídico e taxa de filtração glomerular estimada. A média de idade foi 41 ± 10,9 anos, 64% se declararam como não brancas, 60% tinham escolaridade igual ou superior a oito anos de estudo, 56% se declararam casadas ou em união estável e 59% não tinham ocupação formal. A totalidade da amostra apresentava obesidade abdominal, com média da circunferência da cintura de 110 ± 11,0 cm, 70% eram hipertensas, com média de Pressão arterial sistólica de 133 ± 13,0 mmHg e Pressão arterial diastólica de 89 ± 11,0 mmHg. Além disso, 95% eram sedentárias, 7% eram fumantes, 12% faziam uso nocivo do álcool, 98% declararam insatisfação com a imagem corporal e 62% apresentavam depressão. Observou-se presença de compulsão alimentar periódica em 57% das mulheres avaliadas. Houve associação entre compulsão alimentar periódica e idade, com predomínio na faixa etária entre 20 e 39 anos (p = 0,010) e entre compulsão alimentar periódica e pior qualidade de vida (p = 0,039). Quanto aos parâmetros laboratoriais, não foi observado diferença significativa entre os grupos. Em conclusão, a presença de compulsão alimentar periódica foi um achado frequente em indivíduos com Síndrome Metabólica, sendo observada associação da compulsão alimentar periódica com faixa etária mais jovem e com pior qualidade de vida. / Metabolic syndrome is a cluster of metabolic and cardiovascular risk factors in which abdominal obesity is one of the main components. Obesity is frequently associated with binge eating. The aim of this study was to evaluate the occurrence of binge eating in women with metabolic syndrome and its possible association with sociodemographic, clinical, and behavioral parameters. This was a cross-sectional study that included 124 individuals with MS distributed in two groups: Group 1 (without binge eating) and Group 2 (with binge eating). Clinical evaluation included measurement of weight and height, waist circumference, and office blood pressure. We also evaluated behavioral parameters including the occurrence of binge eating, level of physical activity, alcohol consumption, body image, depressive symptoms, and quality of life. Laboratory evaluation included the determination of fasting glucose and insulin, TSH, lipid profile, and estimated glomerular filtration rate. The mean age of the participants was 41 ± 10.9 years. Sixty four percent were self-reported non-Whites, 60% had received education for 8 or more years, 56% reported being married or in a stable relationship, and 59% had no formal occupation. The entire cohort presented abdominal obesity, with an average waist circumference of 110 ± 11.0 cm, and 70% of the individuals were hypertensive. In addition, 95% were sedentary, 7% were smokers, 12% abused alcohol, 98% declared dissatisfaction with body image, and 62% had depression. We observed the occurrence of binge eating in 57% of the women evaluated. There was an association between binge eating and age, which predominated in the age range of 20 to 39 years (p = 0.010) and between binge eating and poor quality of life (p = 0.039). Regarding laboratory parameters, there were no significant differences between the groups. In conclusion, the occurrence of BE was a frequent finding in individuals with MS and was associated with younger age and poorer quality of life.

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No. of bitstreams: 1 gilmarajaqueschaves.pdf: 1761470 bytes, checksum: f4673b60f6e22822f7c804429925379d (MD5) Previous issue date: 2010-08-30 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo deste trabalho exploratório foi investigar a prevalência de Compulsão Alimentar Periódica, Síndrome Depressiva, Síndrome Ansiosa e Insatisfação corporal, bem como verificar suas possíveis associações entre si, ao consumo de psicoativos, a outras variáveis sócio-demográficas e comportamentais entre 1.590 universitários do 1º e 7º períodos de todos os cursos de graduação da Universidade Federal de Juiz de Fora. O questionário aplicado na pesquisa foi semiestruturado, autoaplicável, anônimo, sigiloso, contendo variáveis diversas — estudantis, demográficas, sociais, pessoais, relativas à sexualidade, comportamentais ligadas ao uso de psicoativos, estéticas, de tratamento médico, massa corporal, bem como resultados de rastreamento para compulsão alimentar periódica, depressão, ansiedade e insatisfação corporal. Foram efetivadas análises exploratórias, bivariadas e, para caracterizar o peso relativo das variáveis estudadas sobre os desfechos analisados, utilizou-se a regressão logística. Os resultados indicaram que, dentre os estudantes avaliados, foi positivamente identificado pelos instrumentos de rastreamento que: 8,2% apresentavam compulsão alimentar periódica; 3,8%, depressão; 13,9%, ansiedade e 10,1%, insatisfação corporal. Nos modelos de regressão logística desenvolvidos, observou-se que as escalas de compulsão alimentar periódica e de ansiedade associaram-se significantemente à presença de depressão e de insatisfação corporal. As escalas de depressão e de insatisfação corporal associaram-se à presença de compulsão alimentar periódica e de ansiedade. Os universitários com Índice de Massa Corporal elevado tiveram maior probabilidade de apresentar compulsão alimentar periódica e insatisfação corporal e, os que usaram psicoativos sob prescrição médica, de desenvolver compulsão alimentar periódica e depressão. As mulheres foram vulneráveis aos quadros de ansiedade e de insatisfação corporal e, aqueles que mencionaram sentir-se nunca ou raramente felizes, aos de depressão e de ansiedade. Universitários que relataram fazer tratamento para alguma doença crônica e com renda familiar de até 10 salários mínimos apresentaram maiores chances de ter ansiedade e, os possíveis dependentes alcoólicos, de ter depressão. Finalmente, os que mencionaram ser o abdome a parte do corpo de que menos gostavam, que tinham vontade de fazer cirurgia plástica e que cursavam disciplinas da saúde foram suscetíveis à insatisfação corporal. / The objective of this exploratory study was to investigate the prevalence of Binge Eating, Depressive Syndrome, Anxiety Syndrome and Body dissatisfaction as well as to verify their possible associations within these different disorders, with the use of psychoactive drugs and with other socio-demographic and behavioral variables among 1,590 college students attending the 1st and 7th semesters of all undergraduate courses at the Federal University of Juiz de Fora. The questionnaire applied for this research was semi-structured, self-applied, anonymous, confidential, containing several variables — related to student life style, demographic, social, personal, sexuality, related behaviorally to the use of psychoactive drugs, aesthetic, related to medical treatment, body mass/weight, as well as to traced results for Binge Eating, Depressive Syndrome, Anxiety Syndrome and Body image dissatisfaction. Exploratory bivariate analyzes were executed and logistic regression was used to characterize the relative weight of the studied variables over the analyzed outcomes. Among the students evaluated, it was indicated that the following results were positively identified through the tracing instruments utilized: 8.2% presented Binge Eating; 3.8% presented Depression; 13.9% presented Anxiety and 10.1% presented Body dissatisfaction. In the logistic regression models developed it was observed that the levels of Binge Eating and anxiety were associated to the presence of depression and body dissatisfaction. The levels of depression and body dissatisfaction were associated to the presence of Binge Eating and anxiety. The students with elevated body mass indexes were more likely to present Binge Eating and body dissatisfaction and the ones taking psychoactive prescription drugs were more likely to develop Binge Eating and depression. Female students were vulnerable to present anxiety and body dissatisfaction and the students who reported rarely or never feeling happy were prone to present depression and anxiety. College students that reported being under treatment for any chronic diseases and placed in the monthly income bracket of up to 10 minimum wages showed higher likelihood to display anxiety as well as the presence of alcoholism and depression among their children. Finally, the students that reported dissatisfaction with their bodies, particularly with their midsection, the desire to undergo plastic surgery and were taking health related courses were more susceptible to body dissatisfaction.

Syfte: Studien syftar till att få en djupare förståelse i hur användarens tittarvanor påverkas av Netflix design och teknik, och huruvida dessa uppmuntrar användaren till Binge Watching. Teori: Studien använder sig främst av Sidneyeve Matrix (2014) teori och forskning om det tekniska fenomenet Binge Watching från artikeln “The Netflix Effect: Teens, Binge Watching and on Demand Media Trends” samt Jonas Löwgrens (2002) teori om kvalitet på användning från artikeln “The use qualities of digital designs, draft 1.0”. Även Gunnar Nygren och Ingela Wadbrings (2013) forskning om den tekniska utvecklingen från publikationen “På väg mot medievärlden 2020” används i undersökningen. Metod: Studien utgår från en kvalitativ forskningsmetod baserad på enskilda djupgående intervjuer. Resultat: Resultatanalysen indikerar att Netflix teknik och funktioner har en stor påverkan på användaren och dess tittarvanor. Informanterna upplever att de utan dessa funktioner inte hade använt tjänsten i lika stor utsträckning och att en lojalitet och känslomässig hängivenhet upprättats efter Netflix många taktiker att förbättra den personliga användarupplevelsen. De tekniska funktionerna har även resulterat i att samtliga informanter kontinuerligt Binge Watchar och inte sällan ser fler avsnitt av en serie än från början tänkt. / Purpose: The study aims to gain a deeper understanding of how the users viewing habits are influenced by Netflix design and technology, and whether they encourage the user to Binge Watching. Theory: The study mainly uses the theory and research by Sidneyeve Matrix (2014) on the technical phenomenon Binge Watching from the article “The Netflix Effect: Teens, Binge Watching and on Demand Media Trends” and the theory about the use qualities by Jonas Löwgren (2002) from the article “The use qualities of digital designs, draft 1.0”. The research on technological developments by Gunnar Nygren and Ingela Wadbring (2013) from the publication “På väg mot medievärlden 2020” is also used in this study. Method: The study is based on a qualitative research method based on individual in-depth interviews. Results: The result analysis indicates that Netflix technologies and features have a transparent impact on users and their viewing habits. The informants felt that they without these features would not have used the service to the same extent and that loyalty and emotional commitment was established due to the many tactics Netflix used to improve the personal user experience. The technical features have also resulted in an increased Binge Watching for all of the informants who also often view more episodes of a series than originally thought. It also became clear that it was the technology, features and wider range that made Netflix the most preferred VoD service among the informants.

Magister Artium (Social Work) - MA(SW) / Heavy alcohol drinking is a serious health concern in many African countries such as Namibia and South Africa. The heavy use of alcohol is mainly due to avoid coping with the realities of life. There is however, a paucity of research on heavy alcohol use amongst women, particularly in Oshana region of Namibia, where problem drinking is threatening the well-being of women and society. This study explored the psycho-social determinants of women who are heavy alcohol users in the Oshana region. The study design was explorative and descriptive within a qualitative approach. The social constructionist theory underpinned this study. Four participants were randomly selected from the Developmental Social Services caseload which led the researcher to snowball the other four participants for a total of eight participants in the study. Data was collected by means of semi-structured face-to-face interview with the aid of an interview guide. Interviews were transcribed verbatim and field notes were taken. Thematic analysis was used to analyse and interpret the data. The participants identified with coping with realities among women heavy drinking. They reported psychological and social factors affected the well- being of women drinking. These factors included poverty, unemployment, family pressure or influence, availability and accessibility of alcohol, expression, stress, low self-esteem, fear of loneliness and many others. Based on these results, some of the suggestions put forward by all the participants and the researcher concluded the study with a recommendation that an awareness can be created by service providers such as social workers working with women who are heavy drinkers to establish and improve alcohol programmes in Oshana Region and Namibia as a whole.

Doctor of Philosophy / Department of Psychology / Laura A. Brannon / Binge drinking is a serious health problem among American college students (Wechsler, Lee, Kuo, & Lee, 2000a). One technique that may reduce binge drinking is compliance. Cialdini (2001) defined compliance as taking an action because it has been requested and described sequential request tactics, including the commitment/consistency-based foot-in-the-door (FITD) tactic, and the reciprocity-based door-in-the-face (DITF) tactic. Cialdini claimed that these tactics yield automatic compliance. The present research investigated Cialdini’s automaticity assumption within the context of reducing binge drinking, by including a neutral or weak message along with the compliance request (consistent with Brannon & Brock, 2001). The main hypothesis was that compliance is not automatic, as demonstrated by differential compliance consistent with message strength. Parallel experiments investigated compliance with requests to reduce one’s drinking behavior (Experiment 1, N=129) or communicate about responsible drinking (Experiment 2, N=122). Participants were randomly assigned to one of six conditions in each experiment. Consistent with the purpose of each experiment, participants indicated whether they would comply with initial requests consistent with FITD and DITF methodology, or were not asked to comply with an initial request (control); read either a neutral or weak message about the importance of moderate alcohol consumption; then responded to the target request (dependent variable) by reporting the likelihood that they would not drink excessively for one week (Experiment 1) or would discuss responsible drinking with someone (Experiment 2). Participants in both experiments completed demographic and alcohol consumption information and a social desirability measure (Strahan & Gerbasi, 1972). Data were submitted to 2(Strength) × 3(Appeal) × 2(Gender) ANCOVAs (drinks per occasion and social desirability were covariates). Experiment 1 revealed a significant Strength × Appeal interaction, with the DITF and FITD appeals eliciting lower compliance rates than the control appeal when accompanied by a weak persuasive message, thereby refuting Cialdini’s automaticity assumption. A significant main effect for appeal in Experiment 2 (DITF yielded lower compliance than FITD or control appeal) did not support Cialdini’s (2001) claim. Correlates of drinking behavior among college students are discussed, as are implications of the present research for compliance theory and reducing binge drinking on American college campuses.

Doctor of Philosophy / Department of Psychology / Laura A. Brannon / Two studies address the serious problem of college student binge drinking. Both studies identify factors that improve the effectiveness of public service announcements (PSAs) encouraging responsible drinking presented through a website simulation. Study 1 tested four levels of Message Personalization (i.e., extent to which the PSA targets important aspects of the individual's personality) by comparing the effectiveness of messages matched to the person's Big Five personality traits, their actual self-schema, their ideal self-schema, or a non-personalized control message. Matching to actual self-schema has been found to be effective in past research. However, it was expected that the more thoroughly personalized the message, the more effective it would be. Results revealed that in no instance was the most thoroughly personalized condition (Big Five matched) or the alternate way of matching to schema (ideal self-schema) more effective than the actual self-schema matching. When designing PSAs, there appears to be a threshold of personalization. Research related to testing PSAs discouraging binge drinking should continue to pursue self-schema matching rather than the more complicated Big Five matching. Study 2 tested Person Matching (i.e., whether the PSA matches the person's self-schema type or not) and two types of Context Matching (i.e., whether the PSA matches the Topic or Values of the message context) to determine their relative influence on the effectiveness of the PSA. It was expected that PSAs matched to any of these factors would be more effective than messages not matched, and that Person Matching would be more influential on the PSAs effectiveness than the two types of context matching. Person Matching reduced intentions to drink while staying in/home, but Topic Matching reduced intentions to drink when going out, suggesting that different factors are important for PSAs targeting drinking behavior in different locations. The interaction of Topic Matching and Values Matching indicate that the PSA should not match the message context too closely. Again, there appears to be a matching threshold; increasing the number of factors the message matches does not increase message effectiveness, possibly because it makes the message too redundant with the webpage content.

There is evidence that functions related to attachment may play an important role in the etiology and maintenance of eating disorders, particularly anorexia and bulimia nervosa (Kuipers & Bekker, 2012; Tasca & Balfour, 2014). However, there is little research available on attachment functioning in those with binge-eating disorder (BED). This dissertation consists of three studies that examine the role of attachment states of mind and attachment dimensions in understanding BED and co-morbid overweight, and to examine mechanisms related to group treatment response for those with BED. The first study assessed attachment state of mind classifications (i.e., attachment categories) to understand better: 1) the psychopathology and maintenance of BED and co-morbid overweight, and 2) the treatment response of women with BED who receive Group Psychodynamic Interpersonal Psychotherapy (GPIP; Tasca, Mikail, & Hewitt, 2005). Overweight women with BED (subsequently referred to as women with BED), overweight women without BED, and normal weight women without BED completed the Adult Attachment Interview (AAI; Main, Goldwyn, & Hesse, 2002). Those with BED completed the AAI pre- and six months post- GPIP and those without BED completed the AAI at one-time point. Women with BED have significantly higher rates of insecure (preoccupied) and unresolved/disorganized attachment states of mind compared to normal weight women without BED. Women with BED had similar rates of insecure and unresolved/disorganized attachment states of mind as overweight women without BED. With respect to treatment completers, changes in attachment states of mind were not statistically significant. However, follow-up analyses indicated clinically meaningful changes which are discussed in the study. The second study used attachment dimensions of coherence of mind and reflective functioning (measured using the AAI) to add to our understanding of the psychopathology and maintenance of BED and co-morbid overweight. Higher Reflective Functioning scores differentiated normal weight women from both women with BED and overweight women without BED, and the latter two groups did not differ from each other. Coherence of Mind scores did not differentiate the groups. The third study used attachment dimensions of coherence of mind and reflective functioning to understand better group psychotherapy response for those with BED who received GPIP. Greater reflective functioning at pre-treatment was associated with a decline in binge eating frequency at 12 months post-treatment. Pre-treatment levels of coherence of mind was not related to group treatment outcomes. Reflective Functioning scores significantly improved from pre- to six months post-treatment. Further, more than 39% of participants demonstrated clinically reliable improvement and almost 32% experienced clinically reliable recovery with respect to reflective functioning. These results were moderated by pre-treatment self-reported attachment anxiety. That is, those with lower attachment anxiety showed significant improvement in reflective functioning, whereas those with higher attachment anxiety did not show this improvement. A third of participants experienced clinically significant improvement in coherence of mind, but this change was not statistically significant. Overall, attachment dimensions and attachment state of mind classification contribute to our understanding of the etiology and maintenance of BED and co-morbid overweight, as well as to our understanding of the group treatment response of those with BED. Addressing attachment insecurity and low reflective functioning in those with BED may improve treatment outcomes.

Background: Binge drinking (BD) is common in Peru, but may not be routinely detected by standard assessments of hazardous drinking. Objectives: We describe prevalence and risk behaviors of men who have sex with men (MSM) and transgender women (TW) in Peru who met criteria for BD as compared with those who met criteria for hazardous drinking. Methods: In a cross-sectional sample of MSM and TW from Lima (2012-2014), we calculated prevalence of BD (consuming ≥6 alcoholic drinks per occasion by AUDIT-3 criteria), conducted bivariate analyses of associations of BD with demographic and behavioral characteristics, and compared prevalence and behaviors of BD to those of hazardous drinkers (identified by AUDIT-10 criteria). Results: Of 1,520 MSM (n = 1,384) and TW (n = 137) with median age 27 years, 74.4% of MSM and 86.9% of TW met criteria for BD. Among MSM, BD was associated with a greater likelihood of using alcohol (41.6% vs. 13.8%; p <.01) or drugs (7.8% vs. 2.8%; p <.01) prior to a recent sexual contact. Among TW, BD was associated with greater frequency of alcohol use (44.9% vs. 11.1%; p <.01) or unprotected anal intercourse (58.8% vs. 33.3%; p =.04) during ≥1 of their three most recent sexual contacts. There was a higher prevalence of BD (75.5%) than hazardous drinking (53.2%) in our sample, with binge drinkers exhibiting similar sexual risk behaviors to hazardous drinkers. Conclusions: Binge drinking is common among MSM and TW in Lima, associated with risky sexual behavior, and may not be adequately captured by AUDIT-10 criteria. / Revisión por pares

Introducción: La ansiedad puede causar sentimientos de profunda preocupación y se ha asociado con inadecuada alimentación y uno de los grupos afectados son los universitarios, quienes presentan cambios en la calidad de la alimentación y suelen tener atracones, sobre todo en quienes cursan los primeros años de la carrera de medicina. Por esta razón, el objetivo de este estudio fue la asociación entre el estado de ansiedad y el grado de Binge eating en estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas (UPC). Metodología: Estudio analítico de corte transversal en estudiantes mayores de 18 años de la carrera de Medicina de la UPC. Se invitó a 126 estudiantes en quienes se aplicó el cuestionario de Ansiedad de Beck (BAI) y de acuerdo con el puntaje obtenido se clasificó el nivel de ansiedad como: muy baja (menor de 22 puntos, ansiedad moderada (22 a 35 puntos), ansiedad alta (36 o más puntos). Para evaluar Binge eating se aplicó un cuestionario que mide la Binge Eating Scale (BES) y de acuerdo con los resultados se clasificó como: inexistencia de Binge eating (0 a 17 puntos), presencia moderada (18 a 26 puntos) y presencia severa (27 o más puntos). Resultados: Se observó un aumento en la prevalencia de Binge eating en participantes con niveles más elevados de ansiedad. Conclusiones: Se evidenció una asociación significativa entre el estado de ansiedad y el grado de Binge eating. Se observó mayor prevalencia de Binge eating en mujeres. / Introduction: Anxiety can generate feelings of deep concern and has been associated with inadequate nutrition and one of the affected groups is university students, who present changes in the quality of food and tend to binge, especially in those who are in the first years of the medical career. The objective of this study is to identify the association between the state of anxiety and the degree of Binge Eating in medical students from the Universidad Peruana de Ciencias Aplicadas (UPC). Methodology: Cross-sectional analytical study in students over 18 years of age of the Medicine career of the UPC. 126 students were invited to applied the Beck anxiety questionnaire (BAI) and according to the score obtained, the level of anxiety was classified as: very low (less than 22 points, moderate anxiety (22 to 35 points), high anxiety (36 or more points) To evaluate Binge Eating, a questionnaire that measures the Binge Eating Scale (BES) was used and according to the results it was classified as: nonexistence of Binge Eating (0 to 17 points), moderate presence (18 to 26 points). points) and severe presence (27 or more points). Results: An increase in the prevalence of Binge Eating was observed in participants with higher levels of anxiety. Conclusions: Although there was evidence of an association between the state of anxiety and the degree of Binge eating, the presence of variables such as symptoms of depression, measured with PHQ-2, showed a greater relationship with it. / Trabajo de investigación

Bakgrund: Ett av symtomen för hetsätningsstörning är att inte ha kontroll över den mängd mat som äts. Individen får i sig mer mat än vad kroppen behöver under en kort period, vilket över tid kan leda till komplikationer för hälsan såsom fetma, diabetes och kardiovaskulära sjukdomar. Stöd från sjuksköterskan, familj och närstående kan leda till en bättre återhämtningsprocess för individen samt att individen lättare kan nå sina mål. Syfte: Syftet var att belysa kvinnors upplevelse av hetsätningsstörning. Metod: Studien genomfördes som en litteraturstudie med en induktiv ansats där nio vetenskapliga artiklar granskats med hjälp av en innehållsanalys. Resultat: I resultatet framkom tre kategorier: hetsätning som en hanteringsmekanism för stress, negativa känslor associerade med hetsätning och känslan av att inte kunna sluta äta. Konklusion: Kvinnorna upplever att de hanterar stress och ångest bättre när de hetsäter, men hetsätningen orsakar viktuppgång, vilket i sin tur leder till mer ångest. Ångesten utlöses bland annat av att inte kunna leva upp till samhällets bild av den perfekta kroppen. Att ständigt hetsäta leder till matvanor som gör att individen inte kan begränsa sitt matintag.