Feelings reported by adolescents after food ingestion: a comparative study

Introduction: Food is closely linked with emotions in a complex relationship. The imaginary and symbolic meaning attributed to food has been little studied and the act of eating needs to be better understood. Objective: To analyze the association of adolescents ́ feelings to selected foods. Methods: Cross-sectional study with 995 adolescents from public and private schools in Teresina, PI, Brazil. It was a Supplementary Project to the Brazilian national survey ERICA (Estudo de Riscos Cardiovasculares em Adolescentes). Adolescents had to choose one of the following feelings to selected food: well-being/satisfaction, malaise, no feeling, aversion. For the option aversion, the participant had to indicate if it was related to smell, color, appearance, or taste. Adolescents ́ feelings to foods were analyzed by type of school, sex, and age range, using Pearson’s chi-square (χ2) or Fisher’s exact tests. Results: There was significant differences regarding the type of school for the feeling to chocolate (p=0.015); vegetables (p=0.003); leafy greens (p=0.005); healthy sandwich/ natural fruit juice (p≤0.001); high fat red meat (p=0.046); fruit/natural fruit juice (p≤0.001). For sex, there was significant difrerences for healthy sandwich/natural fruit juice (p=0.001); beans and rice (p=0.021) and high fat red meat (p=0.005). There was significant differences between age groups for sandwich, chips, soda and ice cream (p=0.018); pasta (p=0.047) and high fat red meat (p=0.021). Well-being predominated in almost all foods and aversion was poorly reported. Conclusion: The results suggest that adolescents’ feelings are not directed to specific foods.


INTRODUCTION
There is evidence that the valuation of certain preferences or aversion for food may compromise the adolescent's nutritional status and lead to exposure of risk situations and negative health outcomes, such as obesity, anxiety, depression and unspecified feelings 1,2 . In Brazil, data from ERICA -Estudo de Riscos Cardiovasculares em Adolescentes point to a prevalence of overweight and obesity of 25.5% in 73,399 adolescents 3 , demonstrating a worrying increase in risk of developing chronic conditions, such as diabetes and cardiovascular diseases at this age 4 .
The expressive growth in the prevalence of overweight and obesity among children and adolescents in the last three decades, between 1980 and 2013, highlights childhood Rodrigues NC, Santos MM, Paz SMRS, Paiva AA, Nogueira TR, Freitas BJSA, Carvalho CMRG ABCS Health Sci. 2020;45:e020014 obesity as an endemic global public health problem 5,6 . Several factors, especially eating behavior, can be decisive for the creation of the obesogenic environment. Therefore, nutritional studies should be aimed at understanding what happens at the emotional level in the act of eating, with regard to the sensations coming from the most diverse foods, and/or the experience lived in each specific and individual behavior 7 .
In this sense, food is strongly connected with emotions, which is proved by the simple fact that imagining a favorite food or of important significance evokes associations that combine images, emotions, senses and memory, in a mixture in which it is almost impossible to separate the different components. It is worth mentioning that the relationship "emotion and eating behavior", in addition to being diversified, is complex, since there is a particularity with regard to the effect of emotion on eating behavior, as well as other particularities, on the effect of the consumed food on the emotional state 8 .
Thus, considering the imaginary and symbolic meaning attributed to food, the objective of this study was to assess the association between adolescents' feelings related to selected foods.  The feeling of malaise was more frequent among public school students for food: vegetables, leafy greens, healthy sandwich and natural fruit juice, beans and rice, fish, chicken, fruit or natural fruit juice and artificial juice. For private school students in relation to this feeling, the highlights were: chocolate (6.9%); sandwich accompanied by french fries, soda and ice cream (14.3%); soda (17.2%) and ice cream (5.6%).

METHODS
For high fat red meat the feeling was similar for students from both types of school.
The absence of feeling had a greater proportion for students of public schools, especially chocolate (51.3%). Analyzing the students' feelings about food aversion, it was noticed that the highest proportion was for vegetables; leafy greens and fish (Table 1). The results showed a significant association between different types of feelings reported by the adolescents, and the intake of healthy sandwich and natural fruit juice; beans and rice and high fat red meat (p<0.05). The feeling of well-being predominated in the male gender and that of malaise was little mentioned by the adolescents. However, the consumption of sandwiches in addition to chips, soda and ice cream; high fat red meat; artificial juice and soda were the foods that girls reported most malaise.
A higher proportion of feelings of malaise was observed for high fat red meat, with emphasis on females (17.8%). Regarding aversion, fish was the type of meat that had the highest proportion for boys and girls, with girls reporting a higher proportion of this feeling for red meat (12.8%), chicken (5.6%) and fish (20.6%).
The feeling of malaise associated with the consumption of high fat red meat stood out among women (17.8%), and the aversion related to fish consumption prevailed for boys and girls ( Table 2).
Analyzing the age group (    Food aversion was also rarely mentioned by students; and leafy greens, healthy sandwiches, high fat red meat, fish and artificial juice were the most mentioned. For several researchers, the relationship between food intake and the feeling of aversion can be seen in the different tastes for food. Although it is recognized that there is an in- Food aversions result, therefore, from the interaction of several factors, including individual preferences, socioeconomic conditions, cultural, moral, social or health issues 20 . Certainly, eating habits are not determined only by biological need, it also appears in a complex symbolic system that involves reality in its various meanings -social, historical, sexual, economic, religious and aesthetic -linked to culture and power 21 .
Research of an additional project to ERICA, carried out by Santos et al. 22 observed that the proportion of teenagers who reported aversion to fast food was lower than those who declared aversion to fruits or juices and that the number of teenagers with aversion to vegetables was high.
Analyzing the feelings regarding the gender of the teenagers, it was observed a statistically significant association only for the healthy sandwich and natural fruit juice; beans and rice and high fat red meat (Table 2). However, the proportions expressed by teeagers with regard to the feeling of well-being were higher in males, especially for high fat red meat and healthy sandwiches. While for feelings of malaise, the girls pointed out only greasy red meat in a greater proportion. It is emphasized that several factors can be associated with the feeling of malaise, socio-cultural norms, economic status, eating habits, lifestyle and the influence of the media can lead to negative feelings in the recognition of the consumption of unhealthy foods 23,24 .
Still regarding the girls' feelings, there was a greater proportion of aversion to high fat red meat, healthy sandwiches and beans and rice, with statistically significant differences. It is known that food preferences develop from genetically determined predispositions, which are later modified by experience 23 .
Indeed, social influence is greater than physiological factors such as hunger and satiety and may even affect food consumption individually. These practices play an important role in determining a range of eating experiences, including feelings and associated food intake, which can influence both the physical aspect and mental health 25 .
For Ogden 26 , eating habits are more focused on the eating pleasure than on the nutritional value of the food, that is, people eat for pleasure and not for what the food represents in its nutritional and functional aspects, valuing more sensorial aspects and gastronomic pleasures. In addition, it is essential to evaluate eating behavior according to the socio-cultural context, that is, the rules that guide social, family and personal life, as the act of eating can be characterized as "the product of the interface between the individual and his social world, which manifests itself through the themes of communication, conflict and control" 26 .
In the present study, it was observed that students had a high proportion of well-being for ice cream, with emphasis on students from the private school. This relationship seems to be linked to the fact that adolescents prefer not to struggle to eat, so they look for ready-made or frozen foods, which, in their majority, have high levels of fat, salt and sugar 27,28 .
Another important aspect to be considered refers to the desire for certain specific foods, which can be a way to improve the emotional state, providing the sensation of pleasure and indefinable well-being. The fact is that teenagers prefer food that is nutritionally unbalanced, densely caloric, rich in saturated fat, cholesterol, sugars, and sodium, which has a negative impact on health 29 . Cultural and environmental factors, like the food choices of family and friends, in addition to where these foods are consumed (home, school, work) are some reasons that explain this preference 17 .
It is recommended, therefore, that adolescents should adopt a varied diet, including all food groups, as recommended by the Brazilian' s Population Food Guide for the prioritizing the consumption of cereals, legumes, fruits, vegetables, legumes, milk and dairy products. In addition, the document also reinforces that a healthy diet is one that feeds the body, mind and spirit, going far beyond simply sustaining life 14 .
Despite the recommendations of the Food Guide, the study by Leme et al. 30 demonstrated that adolescents prefer industrialized and easily accessible foods, therefore, it should be encouraged to conduct research with students on the acceptance and preferences of foods in the sense to value healthy eating at school. Simply improving accessibility to healthy foods may be insufficient to improve eating behavior; therefore, complementary strategies to address individual and socioenvironmental influences may also be necessary 23 .
It is known that assessing people's feelings about food consumption is a challenge given the complexity of factors that interfere in this relationship. The option for the development of this research in the school environment is to believe that the feelings involved in food intake are potentialities that allow a deeper understanding of eating habits and behaviors. Thus, the present investigation can bring contributions that promote positive impacts on the health and quality of school meals.
Despite the limitations, the present study presented a considerable sample size and a randomized selection process of participants, featuring a representative sample of students aged 12 to 17 years in Teresina, in addition to trained interviewers, which minimized the effects of possible methodological biases.
Among the limitations, some deserve to be considered. The fact that the questionnaire contained only objective questions did not allow for more precise answers about the different feelings after food intake, considering the subjectively of the theme. In addition, the sociodemographic differences between public (municipal and state) and private schools may have influenced the understanding of the question "What do you feel when you eat ... ", regarding the level of understanding, ability and motivation to answer.
Another point that deserves to be highlighted arises from the fact that the study is descriptive and in the evaluation of the results, only measures of relative and absolute frequencies were used, not allowing for more in-depth interpretations on the theme.
Other aspects of adolescents' food intake may be important in evaluating future studies to better understand feelings. In this logic, the experiences related to human nutrition show that the act of eating has a complex relationship with the social, cultural, socio-environmental, personal and behavioral aspects, in addition to the interactions between them in the world. Therefore, it is necessary to transcend the biological, limited and reductionist approach focused only on objective aspects and which does not incorporate subjectivities in the links mediated by food 31,32 .
Thus, in the view of all the issues raised, the results of the present study should be interpreted with caution, as the act of eating is complex, involves factors of a physiological, psychological, cultural and social nature, and has an expressive symbolic value for the acceptance or rejection of the food. Most adolescents expressed the feeling of well-being associated with the consumption of certain foods, however, vegetables, leafy greens, fish and artificial juice were the most related to food aversion.
There was a significant association between adolescents from public and private schools with the different types of feelings related to chocolate; vegetables or greens; leafy greens; healthy sandwich and natural fruit juice; high fat red meat; fruit or natural fruit juice.
The data related to the results of this study brought important information about the theme that can help to better understand the relationship between feelings and the act of consuming food, however, a specific context was analyzed about the feelings expressed by adolescents induced by different foods. Thus, the results presented indicate future trends or directions that should appear in other research in the area in order to deepen and better understand the emotional behavior related to the different contextual factors in which the food is consumed. In addition, the aversion to healthy foods should be a concern of public policies, which should be looked at more carefully when it comes to the (re)definition of strategies and actions for the adolescents' diet.