A redescoberta alimentar: experiências e desafios do emagrecimento em uma enfermaria de cirurgia plástica no Rio de Janeiro / Nutritional rediscovery: Experiences and challenges of weight loss in a plastic surgery ward in Rio de Janeiro / El redescubrimiento alimentario: experiencias y desafíos de la pérdida de peso en una enfermería de cirugía plástica de Río de Janeiro

A posição do Brasil como um dos maiores consumidores de cirurgia plástica no mundo sinaliza a importância da imagem corporal na cultura nacional. O discurso do corpo em forma e saudável, com frequência associado à imagem de celebridades, remete à ideia de um padrão despótico de beleza, sobretudo a feminina, que privilegia a magreza e a juventude. A proliferação de procedimentos estéticos atinge de formas muito diferentes todas as camadas sociais e tem reflexos em outras áreas, como no campo da alimentação. Na linha tênue entre saúde e beleza, são poucos os trabalhos que investigaram questões nutricionais e práticas alimentares na área de cirurgia plástica no país, principalmente com um olhar socioantropológico, capaz de apreender as subjetividades envolvidas no processo. Diante desse contexto, essa tese teve como objetivo compreender a experiência das tentativas de emagrecimento de mulheres que buscam intervenção cirúrgica estética na Santa Casa de Misericórdia do Rio de Janeiro (SCM-RJ) e foram encaminhadas ao Serviço de Nutrição da enfermaria 38 da referida Instituição. Para tal investigação, foram realizadas 16 entrevistas semiestruturadas com mulheres que passaram em algum momento pelo serviço entre 2017 e 2022. Aliás, ainda que o foco da pesquisa seja qualitativo, foi delineado um panorama sociodemográfico das 2.448 pacientes atendidas entre 2003 e 2020 para contextualizar o campo investigado. Através da análise de conteúdo de suas narrativas, busquei capturar valores, ideias e crenças envolvidos na relação dessas mulheres com o corpo e a comida em contraposição à necessidade de mudanças de hábitos imposta pelo desafio do emagrecimento. Isso fez emergir questões muitas vezes invisibilizadas na sociedade e pouco consideradas nas abordagens nutricionais, como: o incômodo corporal feminino diante de uma cultura estética moralizadora que transforma o emagrecimento em sofrimento; o patrulhamento do corpo feminino, chancelado pelo discurso midiático e científico e, muitas vezes, pelos profissionais de saúde; os desafios que as mulheres enfrentam em suas mudanças alimentares assim como o reflexo destas mudanças em suas vidas. Neste processo, as interlocutoras despertaram a atenção para seu corpo e para a comida, construindo o que denominei de redescoberta alimentar. Além disso, surgiram como resultados uma bricolagem de saberes e sabores que evidenciou a capacidade de agência dessas mulheres e a possibilidade da construção de um cuidado que está para além de dietas e cirurgias, ainda que o emagrecimento seja um sofrimento crônico em suas vidas. (AU)

Brazil's position as one of the largest consumers of plastic surgery in the world signals the importance of body image in national culture. The discourse of a fit and healthy body, often associated with celebrity images, points to the idea of a despotic standard of beauty, particularly for women, which emphasizes thinness and youth. The proliferation of aesthetic procedures affects various social strata in different ways and has repercussions in other areas such as the field of nutrition. In the fine line between health and beauty, few studies have investigated nutritional and dietary issues in the field of plastic surgery in Brazil, especially from a socio-anthropological perspective capable of grasping the subjectivities involved in the process. In light of this context, this thesis aimed to understand the experiences of weight loss attempts by women seeking cosmetic surgery referred to the Nutrition Service of Ward 38 of the Santa Casa de Misericordia do Rio de Janeiro (SCM-RJ). For this investigation, 16 semi-structured interviews were conducted, with women who had attended the service at some point between 2017 and 2022. Additionally, although the focus of the research is qualitative, a socio-demographic overview of the 2,448 patients attended to between 2003 and 2020 was outlined, to contextualize the investigated field. Through the content analysis of their narratives, I aimed to capture values, ideas and beliefs involved in these women's relationship with their bodies and food, in contrast to the need for habit changes imposed by the challenge of weight loss. This brought up issues often invisible in society and little considered in nutritional approaches, such as female body discomfort in the face of a moralizing aesthetic culture that turns weight loss into suffering; the patrolling of the female body, endorsed by media and scientific discourse and often by healthcare professionals; the challenges women face in their dietary changes, as well as the reflection of these changes in their lives. In this process, they gave attention to their bodies and food, creating what I termed "nutritional rediscovery". Additionally, a bricolage of knowledge and flavors emerged as a result that highlighted the agency of these women, and the possibility of constructing care beyond diets and surgeries even though weight loss remains a chronic struggle in their lives. (AU)

La posición de Brasil como uno de los mayores consumidores de cirugía plástica del mundo señala la importancia de la imagen corporal en la cultura nacional. El discurso de un cuerpo en forma y saludable, a menudo asociado a la imagen de las celebridades, remite a la idea de un canon despótico de belleza, especialmente de la belleza femenina, que privilegia la delgadez y la juventud. La proliferación de procedimientos estéticos afecta de formas muy distintas a todos los estratos sociales y repercute en otros ámbitos, como en el campo de la alimentación. En la tenue distinción entre salud y belleza, son pocos los trabajos que han investigado cuestiones nutricionales y prácticas dietéticas en el área de la cirugía plástica en el país, principalmente bajo una perspectiva socioantropológica, capaz de aprehender las subjetividades involucradas en el proceso. Frente a ese contexto, esta tesis tuvo como objetivo comprender la experiencia de intentos de pérdida de peso de mujeres que buscan intervención quirúrgica estética en la Santa Casa de Misericórdia do Rio de Janeiro (SCM-RJ) y fueron remitidas al Serviço de Nutrição de la enfermería 38 de esa institución. En la investigación, fueron realizadas 16 entrevistas semiestructuradas a mujeres que pasaron por el servicio en algún momento entre 2017 y 2022. Aunque el enfoque de la investigación sea cualitativo, se esbozó un panorama sociodemográfico de las 2.448 pacientes atendidas entre 2003 y 2020 para contextualizar el campo investigado. A través del análisis de contenido de sus narrativas, busqué capturar valores, ideas y creencias involucrados en la relación de estas mujeres con el cuerpo y la comida frente a la necesidad de cambiar hábitos impuesta por el desafío de la pérdida de peso. Esto dio lugar a cuestiones muchas veces invisibilizadas en la sociedad y poco consideradas en los abordajes nutricionales, como: el malestar corporal femenino ante una cultura estética moralizante que transforma la pérdida de peso en sufrimiento; el patrullaje del cuerpo femenino, avalado por los discursos mediático y el científico y, muchas veces, también por los profesionales de la salud; los desafíos que enfrentan las mujeres en sus cambios dietéticos, así como el reflejo de esos cambios en sus vidas. En ese proceso, las interlocutoras despertaron la atención hacia sus cuerpos y hacia la comida, construyendo lo que llamé redescubrimiento alimentario. Además, surgió como resultado un bricolaje de saberes y sabores, que muestra la capacidad de agencia de esas mujeres y la posibilidad de construir un cuidado que va más allá de dietas y cirugías, aunque la pérdida de peso sea un sufrimiento crónico en sus vidas. (AU)

Epistemologies of Living With and Treating Rare Metabolic Disorders.

Treatment of a child diagnosed with an inherited metabolic disease is a demanding task both for the clinicians and for the parents. The metabolic pediatricians and dietitians have to deal with scarce and dispersed clinical knowledge, while the parents must actively participate in its treatment, the bulk of which consists of a stringent diet and managing the risk of metabolic decompensation or intoxication. In this article, I characterize the medical epistemologies of a particular kind of "metabolic living," discussing differences and similarities between the clinical/expert knowledge of metabolic specialists, and the lay knowledge of parents of affected children.

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing.

BACKGROUND: As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally. METHODS: Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework. RESULTS: 99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs. CONCLUSION: Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.

"Writing nutritionistically": A critical discourse analysis of lay people's digital correspondence with the Swedish Food Agency.

This article analyzes lay people's use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the lexical items and grammar people use when constructing "food" in scientific terms. The findings show how message writers place nutrients at the discursive center. Message writers' grammatical constructions instrumentalize food and eating. This is reinforced by the message writers' frequent use of terms that indicate preciseness, such as numbers and amounts. Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation-as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.

"Can naughty be healthy?": Healthism and its discontents in news coverage of orthorexia nervosa.

Orthorexia nervosa was first proposed as a diagnosis in 1997, referring to a pathological obsession with healthy food. While not formally accepted by the medical establishment, since its inception, it drew the attention of news outlets around the world. This paper examines almost two decades of news coverage about orthorexia to understand how writers have made sense of the proposed diagnosis. Based on an inductive thematic analysis of 492 articles, I find news stories have overwhelmingly framed orthorexia as a medical problem but relied on narratives that mix moral and medical beliefs to explain what is problematic about it, depicting it as absurd, obnoxious, paradoxical, and dangerous. I also examine how shifting explanations of orthorexia's causes differentially allocate responsibility, presenting it as a matter of personal choice when associating it with diets, while presenting orthorexics as victims in technology-focused explanations. I compare orthorexia coverage with discourses about obesity and eating disorders to show how the label simultaneously draws from and contests preceding health discourse. While narratives about orthorexia demonstrate the pervasiveness of medicalization, I suggest they can also be read as a backlash against healthism, relying on metaphors of mental health, illness, and risk to speak to healthism in its own language.

Particular Alimentations for Nutrition, Health and Pleasure.

People around the world select their foods and meals according to particular choices based on physiological disorders and diseases, traditions, lifestyles, beliefs, etc. In this chapter, two of these particular alimentations are reviewed: those of the gourmet and the frail elderly. They take place in an environment where food is usually synonymous of body health disregarding its effects on social, cultural and psychological aspects, including emotions. Based on an extensive literature review, it is proposed that the paradigm changes from food equals health to food means well-being, the latter encompassing physical and physiological aspects as well as psychological, emotional and social aspects at the individual and societal levels. The growing food and nutrition requirements of an aging population are reviewed and special nutritious and enjoyable products available for this group are discussed.

Nutritionism and the construction of 'poor choices' in families facing food insecurity.

The dominant research approach to both food insecurity and charitable meal provision is nutritionistic, deficit-orientated and ignores wider socio-economic issues. This reinforces existing power dynamics and overlooks the agency of people living food-insecure lives. We critique this dominant approach and draw on the everyday experiences of families facing food insecurity to ground an alternative approach that emphasises food as a social determinant of health.

What Should We Eat? Biopolitics, Ethics, and Nutritional Scientism.

Public health advocates, government agencies, and commercial organizations increasingly use nutritional science to guide food choice and diet as a way of promoting health, preventing disease, or marketing products. We argue that in many instances such references to nutritional science can be characterized as nutritional scientism. We examine three manifestations of nutritional scientism: (1) the simplification of complex science to increase the persuasiveness of dietary guidance, (2) superficial and honorific references to science in order to justify cultural or ideological views about food and health, and (3) the presumption that nutrition is the primary value of food. This paper examines these forms of nutritional scientism in the context of biopolitics to address bioethical concerns related to the misuse of scientific evidence to make claims regarding the effect of diet on health. We argue that nutritional scientism has ethical implications (i) for individual responsibility and freedom, (ii) concerning iatrogenic harm, and (iii) for well-being.

Nutrient-centrism and perceived risk of chronic disease.

This experiment explored consequences of two common lay theories about the diet-disease link: nutrient-centrism, the belief that nutrients (e.g. potassium) are crucial to staving off disease, and whole-food centrism, the belief that whole foods (e.g. bananas), containing these nutrients in their natural context, are most beneficial. Depicting an individual's diet in terms of nutrients rather than whole foods containing these nutrients reduced the perceived likelihood that the individual would experience leading diet-related diseases (e.g. heart disease, diabetes). Although nutrition experts increasingly emphasize the health benefits of natural whole foods, people nevertheless appear to privilege nutrients when estimating disease risks.