original February 16, 2026 February 16, 2026

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

DOI: 10.20945/2359-4292-2026-0010

ABSTRACT

Objective:

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

Subjects and methods:

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).

Results:

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 (%): 1^st < 24.10% (n = 25); 2^nd between 24.10%–35.40% (n = 26); and the 3^rd > 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).

Conclusion:

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.