Developing a guide to climate & health justice education: Process and content.

Climate justice and health education can address the disproportionate health impacts of climate change on minoritized communities by providing frameworks to build awareness and instigate action on climate-related health inequities. The Envisioning Environmental Equity Educator's Guide to Climate and Health Justice provides a framework for educators, activists and health professionals to lead lessons on health and climate justice that center the experiences of those Most Affected People and Areas (MAPA) by climate change. Collaborators in Brazil, the Philippines, and Uganda engaged in stakeholder meetings to assess priorities and needs about climate and health with policymakers, doctors, activists, and students. These meetings informed the product: An educator's guide to climate and health justice that explores their dynamics from an anti-racist, anti-colonial approach. The guide serves as a recommended lesson framework fit with concepts, examples, and activities for educators teaching in primary and secondary learning settings. It is an innovative climate and health justice educational resource that draws on principles of anti-colonialism, critical thinking and consciousness, and engaged pedagogy. It offers a strategy for climate justice communication that targets diverse audiences across climate, health and social contexts by promoting educational approaches that center MAPA experiences, fit for diverse audiences.

Oficina educativa para profissionais da Atenção Primária à Saúde como estratégia para promover alimentação complementar saudável no Acre, Amazônia brasileira / Educational workshop for Primary Health Care professionals as a strategy to promote healthy complementary feeding in Acre, Brazilian Amazon

RESUMO A alimentação adequada e saudável é crucial para o desenvolvimento infantil, principalmente nos primeiros mil dias de vida. Sendo a alimentação não saudável um fator de risco modificável para doenças e desnutrição, ações que promovam as orientações do 'Guia alimentar para crianças brasileiras menores de 2 anos' são necessárias. O presente relato compartilha o processo de planejamento, construção, divulgação, oferecimento e avaliação de uma oficina virtual para profissionais da Atenção Primária à Saúde no Acre, Amazônia Ocidental brasileira, com destaque para os desafios encontrados e as lições aprendidas. A oficina contou com 170 inscritos e foi assíncrona para facilitar o acesso dos participantes diante da baixa disponibilidade de tempo e instabilidade do sinal de internet na região. O uso de diferentes ferramentas virtuais favoreceu o diálogo entre os participantes e as coordenadoras da oficina. Participantes relataram preferir vídeos curtos com animações, e os conteúdos considerados mais importantes abordaram avaliação antropométrica, processamento e classificação de alimentos e desafios da alimentação. Ressalta-se a importância das parcerias com secretarias de saúde para o adequado planejamento e divulgação da oficina, e da colaboração de pesquisadoras e profissionais da área para a definição e elaboração de conteúdo relevante.

ABSTRACT Adequate and healthy nutrition is crucial for child development, especially in the first 1,000 days of life. Since unhealthy eating is a modifiable risk factor for diseases and malnutrition, actions that promote the guidelines of the 'Food guide for Brazilian children under 2 years old' are necessary. This report shares the process of planning, building, disseminating, offering, and evaluating a virtual workshop for professionals in Primary Health Care in Acre, Western Brazilian Amazon, highlighting the challenges encountered and lessons learned. The workshop had 170 participants and was asynchronous to facilitate access for participants given the low availability of time and instability of the internet signal in the region. The use of different virtual tools favored dialogue between the participants and the workshop coordinators. Participants reported preferring short videos with animations, and the content considered most important addressed anthropometric assessment, food processing and classification, and food challenges. The importance of partnerships with health departments is highlighted for the adequate planning and dissemination of the workshop, and the collaboration of researchers and professionals in the field for the definition and elaboration of relevant content.

"I Like the One With Minions": The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices.

Objective: This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups. Design: The study design involved free lists and semi-structured focus group interviews. Setting: São Paulo, Brazil. Participants: A total of 69 children were involved in this study. Phenomenon of Interest: Children's perceptions of food labels. Analysis: Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis. Results: Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels. Conclusions and Implications: Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Consumer perceptions of non-caloric sweeteners and the content of caloric and non-caloric sweeteners in ultra-processed products in Brazil.

Food industries are reformulating their products to lower total sugar and caloric content. Caloric sugars are often substituted by or combined with non-caloric sweeteners. Our study analyzed information about the presence, number and type, and content of different sweeteners displayed on the ingredient list of 10 key ultra-processed products (UPP), from 3 different categories. It also assessed consumers' opinions, perceptions and understanding of caloric and non-caloric sugars used in UPPs using data from 12 focus group discussions. Results indicate a large diversity in sweeteners, frequent use of a combination of multiple caloric and non-caloric sweeteners, often in the same product, and a lack of disclosure of the amounts of non-caloric sweeteners on the nutrition labels. Qualitative analysis reflected the inconsistency of information on nutrition labels and the challenges in compliance with regulations. Participants were unsure about the different types of sweeteners, examples of artificial sweeteners and their potential health consequences. Presenting clearer additive and nutrition information would facilitate consumer comprehension and support healthy food choices.

Consumer perceptions of non-caloric sweeteners and the content of caloric and non-caloric sweeteners in ultra-processed products in Brazil / Percepções do consumidor sobre adoçantes não calóricos e o conteúdo de adoçantes calóricos e não calóricos em produtos ultraprocessados no Brasil

Abstract Food industries are reformulating their products to lower total sugar and caloric content. Caloric sugars are often substituted by or combined with non-caloric sweeteners. Our study analyzed information about the presence, number and type, and content of different sweeteners displayed on the ingredient list of 10 key ultra-processed products (UPP), from 3 different categories. It also assessed consumers' opinions, perceptions and understanding of caloric and non-caloric sugars used in UPPs using data from 12 focus group discussions. Results indicate a large diversity in sweeteners, frequent use of a combination of multiple caloric and non-caloric sweeteners, often in the same product, and a lack of disclosure of the amounts of non-caloric sweeteners on the nutrition labels. Qualitative analysis reflected the inconsistency of information on nutrition labels and the challenges in compliance with regulations. Participants were unsure about the different types of sweeteners, examples of artificial sweeteners and their potential health consequences. Presenting clearer additive and nutrition information would facilitate consumer comprehension and support healthy food choices.

Resumo Indústrias alimentícias estão reformulando produtos para reduzir a quantidade total de açúcar. Para reduzir a densidade calórica e manter o dulçor de seus produtos, açúcares são combinados com edulcorantes. Esse estudo teve como objetivo analisar as informações sobre a presença, número e tipo, e conteúdo de diferentes edulcorantes exibidos na lista de ingredientes de 10 produtos ultraprocessados, de 3 categorias diferentes. O estudo também avaliou as percepções e entendimento dos consumidores sobre adoçantes calóricos e não calóricos usados em produtos ultraprocessados, através da análise de discussões com 12 grupos focais. Observou-se combinação de açúcares com edulcorantes no mesmo produto e, frequentemente, ausência das quantidades dos edulcorantes nos rótulos nutricionais. Esses produtos voltados a crianças oferecem calorias reduzidas às custas do aumento da variedade e concentração desses edulcorantes. Os participantes mostraram-se confusos sobre os diferentes tipos de adoçantes e edulcorantes e suas possíveis consequências à saúde. Apresentar informações mais claras sobre os ingredientes e nutrição facilitariam a compreensão dos consumidores e os apoiariam em escolhas alimentares saudáveis.

Under the 'weight' of norms: Social representations of overweight and obesity among Brazilian, French and Spanish dietitians and laywomen.

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians' perception of patients with obesity and the eating education process.

Mulheres Comem, Mães Cozinham: uma aproximação da construção da maternidade e das práticas culinárias domésticas na Amazônia Ocidental Brasileira / Women eat, Mothers cook: motherhood and cooking practices in Western Brazilian Amazon

Resumo Este artigo objetiva descrever e discutir as maneiras como a maternidade é praticada e representada nas práticas culinárias domésticas das mulheres na Amazônia ocidental brasileira. Desenvolvemos um estudo qualitativo descritivo, conduzimos entrevistas em profundidade com 16 mulheres que eram mães e que cozinhavam em domicílio. Os dados foram analisados identificando as unidades de significância regulares, expressivas e significativas coletadas por meio das entrevistas. Essas mulheres, quando não tinham filhos, realizavam práticas culinárias atendendo suas demandas pessoais e horários do trabalho extradomiciliar. A partir da gestação, porém mais marcadamente após o parto, as mulheres modificam suas práticas culinárias se apropriando das ideias hegemônicas pré-construídas do que é ser uma mãe, desenvolvendo atividades culinárias mais rotineiras, não discricionárias, focadas no cuidado dos membros da família e com maior investimento de tempo e esforço. Estas mudanças reforçam a concepção de que a relação mãe e criança deve estar orientada para uma maternidade intensiva.

Abstract This paper describes and discusses how motherhood is practiced and represented in women's domestic cooking practices in Western Brazilian Amazon. A descriptive and qualitative study was conducted with 16 women cooks using in-depth interviews. Data were analyzed by identifying the regular, expressive and significant units of significance. These women, when childless, cooked to meet their individual needs and out-of-home work schedules. During pregnancy, but specially after birth, women modify their cooking practices, appropriating the preconceived hegemonic ideas on what it means to be a mother, focused on homemaking and greater investment of time and effort. Such changes reinforce the belief that mother-child relations should involve intensive motherhood.

Imbricadas entre as dimensões de acesso e exposição: práticas alimentares de mães na Amazônia ocidental brasileira / Intertwined between the dimensions of access and exposure: eating practices of mothers living in the western Brazilian Amazon

Resumo Este estudo investigou como as condições socioeconômicas de mães que residem na área urbana de Cruzeiro do Sul, Acre, interagem com o acesso a alimentos, tendo como foco as motivações envolvidas nas escolhas dos locais de aquisição de alimentos e dos tipos de alimentos adquiridos. Os métodos de produção de dados empregados foram a entrevista em profundidade e observação participante com 20 mulheres, posteriormente classificadas em diferentes grupos socioeconômicos. A partir de análise de conteúdo identificamos quatro principais fatores considerados pelas participantes para pensar os alimentos e seus locais de aquisição: preço, variedade, praticidade e estratégias. Nossos resultados apontam que disparidades socioeconômicas influenciam o acesso a alimentos por meio da valorização de alguns aspectos em detrimento de outros no processo de escolha alimentar, culminando em distintas motivações e formas de aquisição de alimentos. Logo, em um nível local, o acesso aos locais de compra e a aquisição de alimentos são fortemente influenciados pelas condições socioeconômicas, fazendo com que as práticas alimentares de grupos socioeconômicos díspares se diferenciem de forma polarizada, como a valorização de alimentos regionais e a distinção destes em relação aos alimentos "de fora".

Abstract This study investigated how the socioeconomic status of mothers living in Cruzeiro do Sul, Acre relates to food access, focusing on the interactions between socioeconomic status and motivations in the process of food choice and food acquisition. Thus the methodological approach chosen to collect data were in-depth interviews and participant observation with 20 women, which were later classified into different socioeconomic status groups. Through a content analysis method, we identified four main factors that mothers considered in the food choice and food acquisition processes: Price, Variety, Convenience, and Strategies. Our results emphasize that socioeconomic inequality influences food access through enhancing some aspects above others in the food choice process, ensuing in different motivations and ways to purchase food. Therefore, on a local level, access to food stores and food acquisition is deeply influenced by socioeconomic status, hence the different socioeconomic status groups' eating practices contrasting very much polarized, such phenomenon is seen by the regional food valorization and the distinction of the regional food compared to the "outside" food.

Signs and strategies to deal with food insecurity and consumption of ultra-processed foods among Amazonian mothers.

Although food insecurity configures a public health issue in developing countries going through nutrition transition, there is still lack of evidence on how it is affected by social determinants and its relationship with ultra-processed food (UPF) consumption. Using qualitative methods, we investigated the experience of food (in)security among mothers living in the Brazilian Amazon area, identifying aspects of food insecurity promoting UPF consumption. In-depth interviews were performed with 40 women and inductive content analysis was used. Signs of food insecurity included difficulties in food affordability and irregular access to food. Strategies to deal with lack of food quantity took place during food production (growing foods and raising animals), acquisition (gaining food, shopping incentives and food substitutions) and preparation (creativity in cooking). Not being able to afford staple foods was the main aspect of food insecurity promoting UPF consumption, as fresh foods were substituted by UFP options. Our study contributes to the current literature by presenting explanatory insights about the inconclusive quantitative results on the relationship between food insecurity and UPF consumption. Additionally, it supports the need of policies and interventions focused on promoting sustainable food systems and the regional food culture, which may approach food insecurity through an intersectional perspective.

Mothers' food choices and consumption of ultra-processed foods in the Brazilian Amazon: A grounded theory study.

In recent decades, an increase in consumption of ultra-processed foods (UPF), a type of product frequently associated with diet-related obesity, chronic diseases, decrease of eating traditions and loss of culinary diversity, has been observed in middle-income countries. However, there is lack of information on factors related to choosing UPF. In this study, we aimed to understand the factors promoting UPF choices and consumption among mothers living in an urban context in the Brazilian Amazon, and to present a conceptual model grounded on their experiences that illustrates the dynamics between the observed factors. For this qualitative study, we used a constructive grounded theory approach, with a theoretical sampling of 40 women, to choose mothers with high and low consumption of ultra-processed foods. Data production and the first steps of analysis were performed concomitantly, followed by four steps of coding focused on creating conceptual categories and explaining the interactions between them. Our findings highlighted the importance of context in promoting UPF choice and consumption, particularly the "food environment", physical and virtual, and the "sociocultural environment". These contextual aspects interacted with the two main personal aspects influencing participants' UPF consumption, one concerning practices, "cooking behaviors", and the other concerning preferences, "food tastes". Factors such as economic and time constraints were also important and competed to shape eating practices through interactions with participants' health valorization. Findings are discussed in relation to food choice theories, social roles and the food environment. Implications for public health initiatives include the importance of considering environmental changes, sociocultural and economic influences, the reliance on UPF, and the role of women in the home, when promoting healthy diets.

"Despite being an athlete, I am also a human-being": Male elite gymnasts' reflections on food and body image.

Our aim was to investigate the prevalence of symptoms related to eating disorders, disordered eating and body image perception, and attitudes toward eating in a group of elite male artistic gymnastics. Seventeen athletes took part in this quali-quantitative, cross-sectional study. Presence of eating disorders symptoms, and body image perception and satisfaction were assessed using validated questionnaires. Focus groups were held to discuss their attitudes toward eating and body image perception in more detail. Little to no evidence of symptoms consistent with eating disorders was observed, and this was supported by the qualitative data. However, some concerning practices and attitudes were described. Negative emotional eating cycles appeared prevalent (e.g. feelings of anger, stress and anxiety creating a desire to eat "junk foods", followed by guilt and regret). Body image perception and attitudes toward body weight's influence on performance varied widely. Some athletes expressed a desire to lose weight and believed that this would positively impact their performance, while others believed weight to be irrelevant and focused on feeling strong and vital. Athletes believed their female counterparts experienced far greater pressure to maintain low body weight and described some very concerning practices. We conclude that eating disorders and disordered eating did not appear to be prevalent among these elite male artistic gymnastics. However, some concerning attitudes and practices were observed and should be addressed with nutritional support programmes encompassing psychological and behavioural aspects of eating. These programmes should be extended to support staff and significant others, in addition to athletes.

Dialogues and Tensions in the Eating Habits of Syrian Refugees Living in São Paulo, Brazil.

This study investigates the processes of acculturation, interculturality and interactions in the eating habits of Syrian refugees who had a Syrian food venue in the city of São Paulo, Brazil. We conducted a qualitative study, with an ethnographical design, with ten participants, using semi-structured interviews and participant and non-participant observation. There were changes in the preparation of consumed and served food products. These changes were accompanied by tensions, connected to the acculturation strategies and intercultural relations. Even with these changes, consuming Syrian food allowed our participants to maintain connections with their original country, despite the sudden temporal and spatial separation.

It is over there, next to that fat lady: a qualitative study of fat womens own body perceptions and weight-related discriminations / É lá, perto da moça gorda: estudo qualitativo sobre as percepções de mulheres gordas acerca de seus corpos e discriminações relacionadas ao peso corporal

Abstract We investigated fat women's perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.

Resumo Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental.

Comparison of government recommendations for healthy eating habits in visual representations of food-based dietary guidelines in Latin America.

Visual representations of food-based dietary guidelines (FBDG) express diverse dietary and sociocultural norms, especially as they relate to healthy eating habits. This article investigates government recommendations for healthy eating habits expressed in the visual representation of Latin American FBDGs. Drawing on 15 images published between 1991 and 2017, we conducted an anthropological visual analysis guided by the methodology proposed by James Collier and Malcolm Collier: unstructured analyses, open viewing analyses, structured analyses and microanalyses. Here, we explore government recommendations based on visual representation shapes, food classification systems, lifestyle recommendations and embedded sociocultural elements. Our main findings relate to how dietary and sociocultural norms are used to promote eating practices considered healthy. Dietary norms focus on variety, proportionality, and moderation, as expressed in terms of food classification and food standards considered healthy. Sociocultural norms are referenced by the use of cultural symbols as strategies to promote traditional foods, cooking practices, commensality, water consumption and physical activity. Ultimately, we argue that FBDG visual representations contain embedded messages that counsel individuals to plan, buy, prepare and consume food with family; to consume foods considered healthy; to pay full attention to their meals, without distractions, such as television and cell phones; and to celebrate traditional, local and/or native foods and culinary preparations.

Food categorizations among low-income women living in three different urban contexts: The pile sorting method.

Transformations in eating practices are reflected in the multiplicity of competing food-related discourses. These discourses contribute to different food categorizations among individuals. Scientists have long argued that food categorizations may help understanding cultural systems of health beliefs. However, not enough work has been conducted to improve the understanding of the dimensions of food categorizations and their interface with food choices, tastes, and culturally defined food systems. This study aims at describing and interpreting how low-income women living in three urban settings in Santos, Brazil, classify and give meaning to foods. We used the pile sorting method to investigate categorizations created by 90 women, following 6 steps: (1) creating units of analysis, (2) sorting the units of analysis into piles, (3) running multidimensional scaling analysis, (4) running cluster analyses on the multidimensional scaling coordinates, (5) labelling the clusters, and (6) analyzing consensus among the participants. The final solution to food categorizations comprised six clusters, namely: home meals, convenience foods, special meals, fish, breads and cereals, and hot dogs. Additionally, we observed four rationales for food categorization: frequency of consumption, degree of healthfulness, personal taste, and meals in which the food was usually part of. These categories highlight the importance of considering personal taste and the type of meal that the food is culturally consumed in, to propose meaningful interventions and appropriate education tools, towards promoting healthy eating practices, especially among vulnerable populations.

Opinião dos consumidores sobre rótulos de advertência em embalagens de alimentos: um estudo qualitativo no Brasil / Consumers' opinions on warning labels on food packages: A qualitative study in Brazil

This study aimed to assess consumers' uses of and opinions on the current Brazilian food label and their reaction to the introduction of a front-of-package warning label. We conducted 12 focus groups among a diverse sample of adult consumers, to broadly assess: (1) uses of and perceptions about the current food label, and (2) opinions about implementing a front-of-package warning label to guide food purchases. Data was analyzed with a triangulation of researchers using an exploratory content analysis, which allowed codes to emerge from the data. The frequency of codes across focus groups was compared by gender and socioeconomic status to explore differences by these sociodemographic factors. Codes were divided into six main themes: (1) "Reasons for using food labels"; (2) "Barriers to using food labels"; (3) "Requirements for a new label"; (4) "Perceived influence on consumption behaviors"; (5) "Perceived influence on child behaviors"; and (6) "Perceptions of the food manufacturers using of warning labels". Participants used food labels to check nutrient content and ingredient information but the format of these labels and the technicality of the content displayed often made the information inaccessible, particularly for those with low socioeconomic status. Most participants were supportive of the display of front-of-package warning labels on products and considered them useful to inform purchases. Women believed that they and their children would reduce the consumption of foods with front-ofpackage warning labels, while men reported more polarity in their intentions. For men and their children, front-of-package warning labels would result in either stopping food intake entirely or continued consumption without changes to the amount. The study results highlight the potential of front-of-package warning labels to support healthier behaviors in both consumers and their children.

Comparison of government recommendations for healthy eating habits in visual representations of food-based dietary guidelines in Latin America / Comparação das recomendações governamentais para hábitos alimentares saudáveis expressos em representações visuais de guias alimentares baseadas em alimentos na América Latina / Comparación de recomendaciones gubernamentales sobre alimentación saludable, expresadas en representaciones visuales de guías alimentarias de Latinoamérica

Visual representations of food-based dietary guidelines (FBDG) express diverse dietary and sociocultural norms, especially as they relate to healthy eating habits. This article investigates government recommendations for healthy eating habits expressed in the visual representation of Latin American FBDGs. Drawing on 15 images published between 1991 and 2017, we conducted an anthropological visual analysis guided by the methodology proposed by James Collier and Malcolm Collier: unstructured analyses, open viewing analyses, structured analyses and microanalyses. Here, we explore government recommendations based on visual representation shapes, food classification systems, lifestyle recommendations and embedded sociocultural elements. Our main findings relate to how dietary and sociocultural norms are used to promote eating practices considered healthy. Dietary norms focus on variety, proportionality, and moderation, as expressed in terms of food classification and food standards considered healthy. Sociocultural norms are referenced by the use of cultural symbols as strategies to promote traditional foods, cooking practices, commensality, water consumption and physical activity. Ultimately, we argue that FBDG visual representations contain embedded messages that counsel individuals to plan, buy, prepare and consume food with family; to consume foods considered healthy; to pay full attention to their meals, without distractions, such as television and cell phones; and to celebrate traditional, local and/or native foods and culinary preparations.

As representações visuais dos guias alimentares baseados em alimentos (GABAs) expressam normas dietéticas e socioculturais relacionadas aos hábitos alimentares saudáveis. Este artigo investiga as recomendações governamentais de hábitos alimentares saudáveis expressos nas representações visuais de GABAs latino-americanos. Estudamos 15 imagens publicadas entre 1991 e 2017. Realizamos uma análise visual antropológica guiada pela metodologia proposta por James Collier e Malcolm Collier: análise aberta e não estruturada; análise estruturada; e microanálise. Exploramos as recomendações governamentais a partir das formas das representações visuais, sistema de classificação de alimentos, recomendações de estilo de vida e elementos socioculturais. Nossos principais resultados estão relacionados as normas dietéticas e socioculturais usadas para promover hábitos alimentares considerados saudáveis. As normas dietéticas se concentram na variedade, proporcionalidade e moderação expressos nos conceitos de grupos e padrões alimentares saudáveis. As normas socioculturais estão relacionadas ao uso de símbolos culturais como estratégias para promover alimentos tradicionais, prática culinária doméstica, comensalidade, consumo de água e atividade física. Concluímos que as representações visuais dos GABAs contribuem com mensagens que aconselham os indivíduos a planejar, comprar, preparar e consumir alimentos com a família; aderir a padrões alimentares considerados saudáveis; realizar refeições com total atenção e sem distração de televisão e celulares; e celebrar comidas ou preparações culinárias tradicionais, locais e/ou nativas.

Las representaciones visuales de las guías alimentarias basadas en alimentos (GABAs) expresan normas dietéticas y socioculturales, relacionadas con hábitos alimentarios saludables. Este artículo investiga las recomendaciones gubernamentales de hábitos alimentarios saludables, expresadas en representaciones visuales de GABAs latinoamericanas. Estudiamos 15 imágenes publicadas entre 1991 y 2017. Realizamos un análisis visual antropológico, guiado por la metodología propuesta por James Collier y Malcolm Collier: análisis abierto y no estructurado; análisis estructurado; y microanálisis. Investigamos las recomendaciones gubernamentales a partir de las formas de representaciones visuales, sistema de clasificación de alimentos, recomendaciones de estilo de vida y elementos socioculturales. Nuestros principales resultados están relacionados con las normas dietéticas y socioculturales usadas para promover hábitos alimentarios considerados saludables. Las normas dietéticas se concentran en: variedad, proporcionalidad y moderación, expresadas en conceptos de grupos y patrones alimentarios saludables. Las normas socioculturales están relacionadas con el uso de símbolos culturales como: estrategias para promover alimentos tradicionales, práctica culinaria doméstica, comensalidad, consumo de agua y actividad física. Concluimos que las representaciones visuales de las GABAs aportan mensajes que aconsejan a los individuos planear, comprar, preparar y consumir alimentos con la familia; adherirse a patrones alimentarios considerados saludables; realizar comidas con total atención y sin distracción de televisión y celulares; y celebrar comidas o platos culinarios tradicionales, locales y/o autóctonos.

A Youth-Leader Program in Baltimore City Recreation Centers: Lessons Learned and Applications.

Peer-led interventions may be an effective means of addressing the childhood obesity epidemic; however, few studies have looked at the long-term sustainability of such programs. As part of a multilevel obesity prevention intervention, B'More Healthy Communities for Kids, 16 Baltimore college students were trained as youth-leaders (YLs) to deliver a skill-based nutrition curriculum to low-income African American children (10-14 years old). In April 2015, formative research was used to inform sustainability of the YL program in recreation centers. In-depth interviews were conducted with recreation center directors ( n = 4) and the YLs ( n = 16). Two focus groups were conducted with YLs ( n = 7) and community youth-advocates ( n = 10). Barriers to this program included difficulties with transportation, time constraints, and recruiting youth. Lessons learned indicated that improving trainings and incentives to youth were identified as essential strategies to foster continuity of the youth-led program and capacity building. High school students living close to the centers were identified as potential candidates to lead the program. Based on our findings, the initial intervention will be expanded into a sustainable model for implementation, using a train-the-trainer approach to empower community youth to be change agents of the food environment and role models.

Adaptação transcultural para o português dos Questionários de Desejos Intensos por Comida - Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T) / Cross-cultural adaptation of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T) into Portuguese

Resumo Este estudo objetivou apresentar a adaptação transcultural dos Questionários de Desejos Intensos por Comida - Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T) para o Português. Fez-se a tradução e a retradução dos instrumentos, a avaliação da equivalência conceitual, operacional e de itens por especialistas da área e a avaliação dos instrumentos por uma amostra de universitários, por meio da avaliação do grau de compreensão e análise da consistência interna dos instrumentos pelo coeficiente Alpha de Cronbach. Ademais, fez-se a avaliação da equivalência semântica pelo coeficiente de correlação intraclasse entre os escores obtidos por bilíngues em cada questão das versões em inglês e português. Os instrumentos foram considerados de fácil compreensão (para os especialistas foi de 95,4% e 97%, para o QDIC-T e QDIC-E, respectivamente, e, para os universitários, 81,8% os consideraram de fácil compreensão), e demonstraram valores de consistência interna satisfatórios (QDIC-T: variaram de 0,6 a 0,8; QDIC-E: variaram de 0,5 a 0,8). A partir do processo de adaptação transcultural, os resultados satisfatórios possibilitam a recomendação da versão brasileira dos QDICs.

Abstract This study aimed to present the cross-cultural adaptation of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T) into Portuguese. Tools were translated and back-translated, field experts evaluated the conceptual, operational and item-based equivalence and a sample of students assessed tools, evaluating the level of understanding and analyzing internal consistency through Cronbach's coefficient. In addition, the semantic equivalence was assessed though the intraclass correlation coefficient between the bilingual scores in each question of both versions (English and Portuguese). Tools were considered easy to understand (experts scored 95.4% and 97% for the FCQ-T and FCQ-S, respectively, and 81.8% of students considered them easy to understand), and showed satisfactory internal consistency values (FCQ-T ranged from 0.6 to 0.8 and FCQ-S ranged from 0.5 to 0.8). From the cross-cultural adaptation process, the satisfactory results enable the recommendation of the Brazilian version of FCQs.

Family meals and eating practices among mothers in Santos, Brazil: A population-based study.

This study investigates family meals among mothers and explores associations between eating with family and sociodemographic characteristics, body mass index, and eating practices. A population-based cross-sectional study, using complex cluster-sampling, was conducted in the city of Santos, Brazil with 439 mothers. Frequency of family meals was assessed by asking if mothers did or did not usually have a) breakfast, b) lunch, and c) dinner with family. Linear regression analyses were conducted for the number of meals eaten with family per day and each of the potential explanatory variables, adjusting for the mother's age. Poisson regression with robust variance was used to analyze each factor associated with eating with family as classified categorically: a) sharing meals with family, b) not eating any meals with family. Only 16.4% (n = 72) of participants did not eat any meals with family. From the 83.6% (n = 367) of mothers that had at least one family meal per day, 69.70% (n = 306) ate dinner with their families. Mothers aged ≥40 years reported significantly fewer meals eaten with family compared to mothers aged 30-39 years (ß: -0.26, p = 0.04). Having family meals was 54% more prevalent among mothers with ≥12 years of education (PR for no meals eaten with family: 0.54, 95% CI: 0.30; 0.96, p = 0.03), when compared to mothers with less than nine years of education. Eating no meals with family was 85% more prevalent among mothers who reported that eating was one of the biggest pleasures in their lives (PR: 1.85, 95% CI: 1.21; 2.82, p = 0.004). We suggest the need for further research investigating the effects of family meals on mothers' health through nutritional and phenomenological approaches.