A experiência hiperfágica na obesidade: um estudo fenomenológico nos contextos francês e brasileiro

BLOC, Lucas; RAMALHO, Juniana de Almeida Mota; MOREIRA, Virginia

Lucas BLOC Correspondence to: L. BLOC.E-mail: blocpsi@unifor.com.br.

Universidade de Fortaleza, Programa de Pós-Graduação em Psicologia, Laboratório de Psicopatologia e Clínica Humanista-Fenomenológica. Av. Washington Soares, 1321, Edson Queiroz, 60811-905, Fortaleza, CE, Brasil.

http://orcid.org/0000-0002-8528-131X

Juniana de Almeida Mota RAMALHO

Tribunal de Justiça de São Paulo, Vara da Infância e da Adolescência, Departamento de Psicologia. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-3707-7250

Virginia MOREIRA

Universidade de Fortaleza, Programa de Pós-Graduação em Psicologia, Laboratório de Psicopatologia e Clínica Humanista-Fenomenológica. Av. Washington Soares, 1321, Edson Queiroz, 60811-905, Fortaleza, CE, Brasil.

http://orcid.org/0000-0003-2740-0023

Correspondence to: L. BLOC.E-mail: blocpsi@unifor.com.br.

Contributors

L. BLOC conception, design, analysis, data interpretation and writing of the manuscript, J. A. M. RAMALHO collaborated with the analysis and interpretation of data. V. MOREIRA collaborated with the review and approval of the final version of the article.

Name	Age	Brief description about the eating experience of participants in Paris (France)
Jacques	59	Jacques has had weight problems all his life. He feels unable to stop eating and recognizes that his eating behavior is a repetition of what he experienced with his family in his childhood.
Isabelle	52	Isabelle is married and gained weight after her second pregnancy. The act of eating is a way of compensating for the negative consequences that happened to her.
Karine	59	Karine says she forgets about her weight problems frequently. She admits to having accepted her physical condition but, at the same time, she desires to change her physique. She sometimes believes that she needs to lose control of her act of eating, which is seen as synonymous with freedom for her.
Anne	57	Anne has always had weight problems. She feels fat, but she sees herself as an obese person, because she thinks that obesity corresponds to a pathological dimension. The hyperphagic episodes occur frequently giving her some concern.
Lisa	47	After 25 years of obesity, Lisa considers that her weight gives her a status and it constitutes a kind of protection and strength – a way to face life. On the one hand, she says she gorges herself and on the other, she eats feel relief and to fill a kind of hole she has.
Marion	52	Marion started to gain weight after her first pregnancy. She recognizes that she has let herself go more and more, without paying any attention to herself, especially aesthetically. According to her, eating fills her, but then she feels very bad. She thinks she has an addiction due to her hunger, which constantly occurs.
Pierre	42	Pierre has presented obesity since his childhood. He was born in Portugal, where she lived all his childhood. He thinks he had a bad nutritional education. Nowadays, the malaise with his body is mainly related to consequences of obesity. According to him, his body presents a visible defect and causes a real “mental problem”.
Dominique	44	Dominique feels “substandard”. She lost confidence in herself and does not recognize herself in the image she reflects. She thinks gorging is a solution to cure her malaise and a way of hiding her suffering.
Marine	45	Marine went to the medical service because she gained weight. She finds comfort while eating and has difficulties in having contact with her own body, listening to it and recognizing her physical condition and the needs of her body. For her, it is a strange body with which she can not feel its limits. There is the sensation of an emptiness she tries to fulfill through food. During the binge eating episodes, she says she can eat even if she does not like something very much.
Louise	62	Louise emphasizes that questions of obesity, weight and the act of eating have always been problems for her since childhood. Her bariatric surgery in 2013 changed her eating habits and her body. The binge eating episodes are described as an invasion of her desire to eat followed by feelings of guilt. There is a difficulty to feel her body and a sensation of emptiness she tries to fulfill.

Name	Age	Brief description of eating experiences of participants in Fortaleza (Brazil)
Maria	65	Maria had an experience of abandonment by her husband who left her with two children. She associates her attachment to food to the experience of abandonment. For her, the act of eating is a way to release herself from something, “a shelter”. Nevertheless, food became a means of suffering as well.
Joaquim	28	Joaquim has presented obesity since childhood. He decided to start a treatment when he realized he was excluded from job interviews because of his bad mobility related to his excessive weight. He is conscious of his bad eating habits and binge eating episodes. He desires to change his eating habits very gradually, without adopting radical measures.
Claudia	40	Claudia started to suffer with her obesity when she felt disturbed by her appearance and the discriminatory looks from others. She became an anxious person. She tries to fulfill her emptiness and to relax while eating. Even if she feels well during mealtimes, she describes a feeling of guilt followed by excessive food intake and loss of control during the act of eating.
Nicolas	25	Nicolas did not see himself as an obese person before suffering clinical consequences of obesity. He thinks the act of eating is something so natural that he sometimes does not even realize that he is eating. He realized that he was having binge eating episodes only when there was no more food in front of him.
Helena	35	Helena feels bad about the looks from others, full of disregard. She feels a constant fatigue. She has a bad image of herself and suffers depression, which is treated with psychotropic medicines. Despite her reluctant relationship with food and her desire to lose weight, eating is an act which gives her pleasure and relief.
Sara	50	Sara associates her weight problem and excessive food intake with anxiety. When she feels anxious, she can eat “without realizing” and without having any control over food intake. She thinks she is “addicted” to food.
Laura	34	For Laura, food is the “whole” to which all feelings are directed. Concerning her malaise generated by the loss of control in eating, she says: “it’s something stronger, I can’t say no”. For her, she needs to feel a burden in the stomach so that she stops eating.
Monique	31	For Monique, obesity is a new experience. She talks about experiencing feelings of strangeness while her body undergoes its change and weight gain. She does not recognize her own body, but she says she is happy while eating and then feels sad with her physique.
Paula	40	Paula started to gain weight after the birth of her children. She also associates her weight gain with anxiety which started to be part of her life with motherhood. There are moments in which she eats in secret. She says she is: “eating to live”. She says there is an intense “force” that makes her eat as if there was another person inside her.
Rebeca	45	After a late pregnancy, Rebecca experienced major weight gain. She lived only for her son and she didn’t realize the change in her body. When she became conscious about her physique, she realized she lived in a body she didn’t recognize as her own body. Hyperphagic episodes were described as moments of despair. Eating is a kind of compensation and brings her a moment of happiness, but she feels guilty after food intake.

Categories	Subcategories	Speeches
1. Being obese: the body, the weight and the gaze of others	1.1. The “burden” and suffering of being obese	“you cannot do what you want to do, you cannot move easily” (Isabelle).
		“it is mainly on the physical plane because, as I said, it unbalances everything, I feel very tired, this is mainly what irritates me, fatigue” (Marion).
		“Obesity seems really pathological […]. Heavy, negative, not having much character because it cannot resist temptations, weak, weak, very negative” (Anne).
		“I still have trouble pronouncing the word obese, because for me being obese actually represents a negative image” (Dominique).
	1.2. Body Experience in Obesity	“I gained weight so fast that it’s a new body, I do not recognize my body when I look at it. I don’t recognize it and I don’t think I accept it […]”the body has grown so much that I won’t necessarily be able to get through there”(Marine).
		“It’s strange, I know I’m fat, but I don’t feel it everyday, especially when I see photos” (Marion).
		“It makes me a statue, it strengthens me [...] I think it’s really a kind of protection” (Lisa).
	1.3. Obesity as “visible defect”: the gaze of others	“We all have a defect somewhere, mine is visible, my defect is seen. Most people have defects that you cannot see [...] my defect is visible” (Pierre).
	1.3. Obesity as “visible defect”: the gaze of others	“It’s something that has weighed on me throughout my entire life, it’s been a daily suffering, the eyes of others, my own view of myself and, above all, the fact of being judged” (Louise).
2. The Sense of Eating in the Hyperphagic Experience of Obesity	2.1. Eating for...	“Sometimes it is necessary to fill, as if there was a great emptiness in me and a need to fill it by eating” (Marine).
		“It fills me, it fills me in a moment and then I do not feel good [...]. It’s just to stuff me, fill me up” (Marion).
		“the act of eating gives rhythm to the day. It is one of the points of passing, it is a social point of passing” (Jacques).
	2.2.“After, we feel guilty”	“After, we feel guilty, we tell ourselves, if you get fat, it’s your fault” (Marine).
		“And then, that guilt that also makes me see everything in a negative way. I say, “That’s it, I’m the worst of the worst, I’ve failed again, I’ve lost everything again, I’m worthless, I’m pitiful” (Louise).
		“Everything goes wrong because I feel guilty, but, at the same time, it is the only antidote I have found, it is the other side of the coin” (Dominique).
	2.3. Eating as an addiction	“Once I lapse, I have to finish. It’s addictive” (Anne).
		“It’s the worst addiction… It’s terrible because we have to eat to live, we don’t have the possibility of leaving it alone” (Lisa).
		“It’s a dependency, without a doubt [...]. You can control yourself for three days and then you can’t any more, there’s a more serious problem behind it” (Pierre).
	3. The experience of loss of control with eating	“I was completely out of control. Before, during, after... I was caught up by an irrepressible will to eat [...] all my thoughts were filled with what I’m going to eat” (Louise).
		“This emotion is stronger, this desire to eat, I have the impression that it is stronger than anything and I have the impression that it is uncontrollable”. She identifies it as an action that is due to her problems and negative thoughts. She is moved, or even hypnotized, by an irresistible urge to eat, like a zombie: “I’m so deep into my thoughts that I walk like a zombie practically [...] I’m so focused on my thoughts that the body does it automatically” (Marine).
		“During the act, in any way, I don’t feel that I can control myself by definition, I am not aware of it” (Jacques).
4. Hunger and Satiety		“I was never hungry. I’ve always eaten before, never been hungry. And I was never satisfied [...] I just felt like it, but hunger, I don’t know what it is. And eating enough, I don’t know what it is”. She continues, “I have always been a mass, a carcass, a mass. At the same time, a carcass and a mass, but never hungry [...] a block with a hole in the middle, an emptiness” (Louise).
		“my problem is the desire to eat, firstly, I’m often not hungry. My desire to eat, if I could spend my life eating, I think I would” (Pierre).
		“I ask myself: is it a craving for food or am I really hungry?” (Marine).
		“I think I had, that I have a problem, because I just do not feel any more, I have difficulty feeling hunger, satisfaction”. He believes that any improvement means going through the process of relearning to eat: “It is necessary that I relearn to eat again, I relearn my sensations, and so on. That’s really my goal” (Jacques).
5. The family and the act of eating		“It’s historic, because in my family, my father and mother had six children and have always loved family gatherings, table meetings, and when we go home they eat a lot [...] I think that we have, that there is a family relationship with food which is a little abnormal. It’s definitely an issue with my family” (Jacques).
		“For me, it’s usually almost a celebratory moment. And even when I was young, eating was the time to meet with the family” [...] “In my home it is also a time to find myself face to face with myself. I come from a family where everyone is very sporty and very skinny. Ultimately, I feel that I no longer belong to my family” (Marine).
		“In the family I’ve always been the ugly duckling, the one who’s not like the others [...] We were all around the table, the table was important to me because it was a way of getting together. When I went to Paris, I found myself alone” (Louise).

Categories	Subcategories	Speeches
1. Being obese: malaise, suffering and (re)knowing the body	1.1. The malaise of being obese: the gaze of society and physical limitations	“Society is very hard on anyone who doesn’t reach its standards, so the fat one is always the reference. Oh, he’s the third person after the fat man. Do you see that fat man there?”. She believes that everyone is looking at her: “To me, if I go out on the street, everyone is commenting: fatty” (Rebeca).
		“It’s very difficult, I wanted to sleep three days and wake up thin. For me, I would be the happiest woman”. Obesity is often seen by others as a simple phenomenon. Paula points to this simplification of obesity by others: “it is good for society to see, to look at fat people as though it is not a problem. Oh, she’s fat because she wants to be” (Paula).
		Claudia expresses her difficulty with the mirror and how she feels discriminated: “I don’t even like looking in the mirror sometimes, I try to see myself without looking. Because it is a terrible thing to be mistreated. So, today, at the University, I feel a little discriminated against” (Claudia).
		“I saw that really I was being excluded because of my weight” (Joaquim)
		“Everything we’re doing soon tires us out, doesn’t it? The body doesn’t react” (Helena).
		“What was bothering me, is not so much aesthetics but discomfort. So, I gained 30kg within a period of a year or so” (Laura).
	1.2. Being myself again: estrangement and (non)acceptance of the body	“I do not recognize myself, it’s not me. My picture is on my page… I didn’t realize I was getting fat... When I saw myself, and I saw myself at that size, it was like my head on another body, that day was shocking to me... I do not accept being fat, I do not accept buying clothes for myself” (Rebeca).
		“I wanted to at least accept myself. My family doesn’t know that I’m so angry with myself” (Paula).
		“When I started to have difficulty sleeping, I had difficulty breathing, I started to feel hypertensive, I noticed that any movement I made was slower, I felt pain in my joints, it was then that I realized that I was really obese”. For Nicolas, there is a long journey to “really accept yourself, until you seek help, know that it is a disorder” (Nicolas).
2. The act of hyperphagic eating in obesity	2.1. Anxiety and the hyperphagic experience	“I eat more from anxiety than from hunger. Properly from hunger, ah, am I starving? No, I eat because of anxiety, not because I’m hungry. To really fill something” (Claudia).
		“I think it’s due to anxiety. Some stop eating, in my case I eat a lot… I think anxiety, nervousness makes me eat more. I’m very anxious. The chest tightens, the heart accelerates” (Helena).
		“Anxiety causes me to eat without realizing it, without even really realizing it... The more I eat, the more I want to eat” (Sara).
		“When I have concerns, some anxiety, I am nervous, I can’t control myself” (Laura).
	2.2. “Everything is in food”: roles in the act of eating	“Everything I seek, I find in food. If I am nervous, I have some problems, I try to eat. If I feel weak, I try to eat, if I’m happy, I’ll eat too, everything is in food” (Laura).
	2.2. “Everything is in food”: roles in the act of eating	“Food is way of “getting rid of something, only I don’t know what it was”, but it also signals suffering: “I started to eat, to eat, to eat, to close off the world from myself, from there the suffering started” (Maria).
		“Eating for me is a refuge. If I’m sad I eat, if I’m scared I eat, if I’m alone I eat, I take out everything in food”. It is “a refuge, it is an escape. As if only there could I satisfy my desires” (Claudia).
		“The solution is food” (Monique).
		“From a certain time to now, I see it as the most important thing. I’m eating to live” (Paula).
	2.3. “I cannot let myself be dominated by a plate of food”: excess and loss of control	“It’s like I have no control. As much as I didn’t want it, I didn’t have the need, I have no control to say no, I can’t”. She is aware of what she does or even what she should not do, but she cannot control herself: “I am aware that I shouldn’t do it, but I am to blame that I can’t control myself, because I know it’s not good, I’m aware that it’s not good, but I blame myself” (Claudia).
		“I ate compulsively, I had no control ... It was every moment, I couldn’t wait to eat. It’s not even in large quantities, but several times a day, small portions” (Nicolas).
		“I feel bad, right? Uneasy, because then, I wonder, how can a small dish control an adult, right? It’s something stronger, I can’t say no, I don’t want to” (Laura).
		“I do not eat because I want to, it’s such a force that it feels like it’s somebody else. Sometimes I’m eating, ah, I’m only going to eat half, then I see that I’ve eaten everything” (Paula).
		“Before comes the mad will, the desire, I need, I want, eat, eat, it will not hurt you, eat, until I get up and get it. I eat a piece, I see some chocolate, a small square of 100g, I eat desperately in what seems like two seconds and want to eat another, then that’s it, then I want to eat another. At the time you put it in your mouth the feeling is wonderful, that feeling of ecstasy, eat, eat, it’s good, that’s delicious. Go on eating, Go on eating. When I looked, there was only the wrapper left. How could I have eaten a kilo of chocolate and not even felt it? Here comes the blame, damn I ate a kilo of chocolate, damn, how could I do this to myself?” (Rebeca).

[1] Correspondence to: L. BLOC.E-mail: blocpsi@unifor.com.br.

Categories and subcategories from clinical interviews in Paris (France)
Categories		Subcategories
1. Being obese: the body, the weight and the gaze of others		1.1. The “burden” and suffering of being obese 1.2. Body Experience in Obesity 1.3. Obesity as “visible defect”: the gaze of others
2. The Sense of Eating in the Hyperphagic Experience of Obesity		2.1. Eating for... 2.2.“After, we feel guilty” 2.3. Eating as an addiction
3. The experience of loss of control with eating 4. Hunger and Satiety 5. The family and the act of eating
Categories and subcategories from clinical interviews in Fortaleza (Brazil)
Categories		Subcategories
1. Being obese: malaise, suffering and (re)knowing the body		1.1. The malaise of being obese: the gaze of society and physical limitations
1. Being obese: malaise, suffering and (re)knowing the body		1.2. “Being myself again”: estrangement and (non)acceptance of the body
2. The act of hyperphagic eating in obesity		2.1. Anxiety and the hyperphagic experience
		2.2. “Everything is in food”: roles in the act of eating
		2.3. “I cannot let myself be dominated by a plate of food”: excess and loss of control

Brasil

Brasil

A experiência hiperfágica na obesidade: um estudo fenomenológico nos contextos francês e brasileiro

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