Healthism, rural individualism and self-help: youth mental health in Northwest Tasmania.

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

Healthism online: 'What I eat in a day' vlogs before and during COVID-19 restrictions.

Objective and setting: The COVID-19 pandemic and its restrictions coincide with an increase in body weight and changes in health-related habits worldwide. This study focusses on the way health-related habits are portrayed online in digital food cultures. The study aims to investigate if and how the content of high-profile Dutch 'What I eat in a day' vlogs has changed during the first period of COVID-19 restrictions. We approach changes in digital food culture through the concept of 'healthism' and see vloggers as cultural intermediaries. Design and participants: We collected the most watched vlogs of almost all high-profile Dutch influencers pre-post corona and analyzed these in a mixed method approach by using summative and thematic content analysis. Results: Pre-COVID vlogs highlight an explicit consciousness of energy balance-related behavior, focusing on calorie counting, avoidance of unhealthy food and the use of tracking apps. In vlogs uploaded in 2020, these themes are less present. Instead, intuitive eating and listening to one's body are more central themes within the vlogs. Conclusions: We consider the shift towards intuitive eating as another variant of "wellness diets" rather than a shift away from dieting, furthered by COVID-19 restrictions. The core values of health and self-regulation are upheld within the shift towards intuitive eating. Yet, we nuance the broad claims of healthism in biopolitics and point to relevant cultural changes within foodscapes.

Reconciling healthism and techno-solutionism: An observational study of a digital mental health trial.

In a growing trend in digital psychiatry, algorithmic systems are used to determine correlations between data that is collected using wearable devices and self-reports of mood. They then offer recommendations for behaviour modification for improved mood. The present study consists of observations of the development of one of these systems. Descriptions of the trial emphasise the powerful role of the intrinsically motivated, responsible participant on one hand and the empowering machine learning (ML)-based technology on the other. This conceptualisation is shown to extend the neoliberal paradox of a freedom that, to be maintained, must be continually adjusted through discipline. Because of the paradoxical nature of this formulation, laboratory members disagree about the balance of agency between the objective machine learning system and the empowered participant. The guides who help participants interpret ML outputs and implement system recommendations are ascribed a replaceable role in formal accounts. Observations of this guidance practice make clear not only the important role played by guides but also how their work is relegated to the technological side of the broader formulation of the trial and further how this conceptualisation affects the way they conduct their work.

"Your Diet Defines Who You Are, Especially as a Man": Masculinity in Online Media Focused on Healthy Eating for Men.

In contexts marked by neoliberal ideology and a claimed "crisis" in men's health, men are responsibilized to be/come healthy. Eating has long been a gendered practice in Western cultures, and recent cultural shifts have produced ways of eating that are both masculinized and (claimed) healthy. Online healthy eating advice, which encourages and supports men to eat healthily, is an important information source. However, such information draws on, reproduces, and/or disrupts existing meanings about men and eating. To understand contemporary representations of men and healthy eating, we examined 30 online media articles oriented specifically to this topic. Using reflexive thematic analysis from a social constructionist position, we developed two themes: A lad's looks and lifestyle and Mind over matter: The masculine mindset. These themes together told an overarching story that healthy eating is effectively sold to men by drawing on traditional or hegemonic ideals of masculinity and effectively evoking access to an enhanced masculinity through healthy eating. While these representational practices may sell healthy eating to men, with likely positive health benefits, they also reinforce hegemonic ideals of masculinity which can be problematic from a health perspective.

Shaping the healthy subject in gentrified spaces: Two case studies in Barcelona (Spain).

Several studies have analysed the impact of gentrification on health. However, a more in-depth examination of the constitutive role of health discourses in shaping spaces is required. This article explores the links between the gentrification process and the subjectification of healthy subjects through a critical discourse analysis of 35 walking interviews and a visual semiotic analysis of 140 shopfronts. Health is put forth as a super value to justify market interference in the configuration of urban space and class privilege based on the health products and healthy practices that have undergone a process of elitisation.

Factors influencing women to accept diet and exercise messages on social media during COVID-19 lockdowns: A qualitative application of the health belief model.

This study investigates how engagement with social media leads women to adopt diet and exercise practices. We base our analysis on qualitative research, including surveys and in-depth interviews, with thirty (30) Australian women aged 18-35 years between April and August 2021. Our findings reveal how healthism discourse on social media, namely Facebook, Instagram and TikTok, underpin the adoption of diet and exercise practices by enhancing experiences of digital intimacy, repeat messages and personal testimonials from other women, and supporting new routines during COVID-19 lockdowns. This article contributes to health marketing literature by providing critical knowledge about women's experiences that prompt and shape complex ideologies of health that are often masked through diet and exercise practices on social media.

Love and lifestyle: how 'relational healthism' structures couples' talk of engagement with lifestyle advice associated with a new diagnosis of coronary heart disease.

OBJECTIVES: Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD. DESIGN: A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change. RESULTS: Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change. CONCLUSION: In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice.

El deporte en edad escolar como dispositivo biopolítico de gubernamentalidad neoliberal: un estudio de caso / O esporte em idade escolar como dispositivo biopolítico da governamentalidade neoliberal: um estudo de caso / Sport at school age as a biopolitical dispositive of neoliberal governmentality: a case study

Resumen El objetivo de este trabajo fue analizar los discursos en torno a los programas deportivos con carácter educativo para la población en edad escolar en Chile como un ejemplo de dispositivo biopolítico de orientación hacia la gubernamentalidad neoliberal, a partir de dos fuentes de información: un corpus documental como soporte discursivo institucional y entrevistas a profesionales implicados en los programas. El análisis se realizó en dos fases: 1) Análisis categorial de primer orden del contenido del corpus y las entrevistas, y 2) análisis de segundo orden con base en los objetivos del presente trabajo. Los resultados son discutidos siguiendo dos grandes líneas: los programas deportivos escolares como dispositivos biopolíticos, y como instrumentos que promueven la gubernamentalidad neoliberal. Concluimos que es necesario examinar el deporte desde una perspectiva crítica que trascienda la visión ideológicamente neutra que predomina y nos permita indagar en su papel en la imposición de estilos de vida normativos, en línea con el orden social neoliberal hegemónico. Finalizamos aportando algunas implicaciones pedagógicas y perspectivas futuras de investigación.

Resumo O objetivo deste trabalho foi analisar os discursos em torno de programas esportivos de caráter educativo para a população em idade escolar no Chile como exemplo de dispositivo biopolítico orientado para a governamentalidade neoliberal, a partir de duas fontes de informação: um corpus documental como apoio de discurso institucional e entrevistas com profissionais envolvidos nos programas. A análise foi realizada em duas fases: 1) análise categorial de primeira ordem do conteúdo do corpus e das entrevistas e 2) análise de segunda ordem com base nos objetivos deste estudo. Os resultados são discutidos seguindo duas linhas principais: os programas esportivos escolares como dispositivos biopolíticos e como instrumentos promotores da governamentalidade neoliberal. Concluímos que é necessário examinar o desporto numa perspetiva crítica que transcenda a visão ideologicamente neutra prevalecente e permita investigar o seu papel na imposição de estilos de vida normativos, em consonância com a ordem social neoliberal hegemônica. Terminamos com algumas implicações pedagógicas e perspectivas de investigação futura.

Abstract The aim of this work was to analyze the discourses around sports programs with an educational nature for the school-age population in Chile as an example of a biopolitical device oriented towards neoliberal governmentality, based on two sources of information: a documentary corpus as institutional discursive support and interviews with professionals involved in the programs. The analysis was carried out in two phases: 1) first- order categorical analysis of the content of the corpus and the interviews, 2) second-order analysis based on the objectives of this study. The results are discussed following two lines: school sports programs as biopolitical dispositive, and as instruments that promote neoliberal governmentality. We conclude that it is necessary to examine sport from a critical perspective that transcends the ideologically neutral vision that dominates and allows us to investigateits role in the imposition of normative life styles, in line with the social order hegemonic neoliberal. Weend by providing some pedagogical implications and future research perspectives.

A post-phenomenological analysis of using menstruation tracking apps for the management of premenstrual syndrome.

Objectives: Menstruation tracking digital applications (MTA) are a popular technology, yet there is a lacuna of research on how women use this technology for the management of PMS. Theoretical frameworks for understanding users' experiences are also underdeveloped in this nascent field. The objectives of the study were therefore twofold, to propose a theoretical framework for understanding women's use of MTA and apply it to the analysis of users' experiences in the management of PMS. Method: A novel theoretical framework was proposed, informed by post-phenomenology, postfeminist healthism, feminist new materialism and digital health technologies as public pedagogy. This framework focuses analytic attention on affective relationships between subjectivity, bodily sensations, digital technology, and discourse. It was used to structure the analysis of five in-depth timeline interviews with women in Aotearoa New Zealand who experienced benefits from using MTA to manage PMS symptoms. Results: Three pedagogical relationships were identified: a pedagogy of empowerment, where users learnt to control, predict and manage their PMS symptoms in line with healthism; a pedagogy of appreciation, where users learnt to understand their menstruating bodies as amazing, a valued part of them, and awe-inspiring that radically overturned past internalised stigma; and an 'untrustworthy teacher' who eroded this affirmative learning through inaccuracy, positioning users in dis-preferred categories, or being 'creepy'. Conclusions: MTA offers huge possibilities for challenging menstrual stigma that need to be nurtured, developed, and protected; and there are benefits for analysing MTA within wider scholarship on postfeminist healthism.

Diagnosis as Subculture: Subversions of Health and Medical Knowledges in the Orthorexia Recovery Community on Instagram.

Diagnoses are powerful tools that fulfill various practical and symbolic functions. In this paper, I examine how a contested diagnosis called orthorexia nervosa has been taken up by users on Instagram, where tens of thousands of posts engage with the topic, many of them from individuals who identify with the condition. I put scholarship on medicalization and diagnosis in conversation with literature on subcultures to foreground the subversive work that is enabled through this diagnosis. Drawing on more than 350 hours of online ethnographic fieldwork and 34 in-depth interviews, I examine how participants construct a shared identity, draw on common language and norms, and undertake collective practices, as they negotiate dominant understandings of health. I show how they draw on the legitimacy endowed by the diagnostic label to validate and make sense of experiences of suffering but also to counter dominant health-seeking discourses, practices, and aesthetics in an online space where these are highly visible and valued. I also discuss some ways Instagram as a digital platform shapes its uptake by this community in meaningful ways. On the one hand, participants draw heavily on the language and framing of medicine to make sense of their fraught experiences with food and their bodies, effectively advocating for the medicalization of their own suffering while also creating a sense of community and shared identity. However, on the other hand, they actively use the diagnosis and the recovery process enabled through it to effectively resignify dominant beliefs, values, and practices that are experienced as injurious, including some that are particularly prevalent on Instagram.

'I wanted to share with you some of my healthy habits': YouTubers' staging of health-related practices.

Professional YouTubers have become highly popular in producing video content through self-mediation. Objective. The present article aimed to study ways in which lifestyle YouTubers construct health practices in their videos within the YouTube media culture. Design. We conducted a narrative and visual analysis across a selection of 15 videos. Results. Results showed that YouTubers' practices and recommendations for a better life were structured around three themes: Eating to live well; Exercising to live well; Resting to live well and, a fourth cross-cutting theme on Practices aimed at self-development to achieve health and happiness. YouTubers were mainly female presenting, as well as middle/upper-class and white appearing. An overall optimistic tone characterised their health stories, as they delivered personal experiences of success on becoming healthy, happy, and better persons, while encouraging viewers to act similarly. Our findings suggested that YouTubers actively contribute to construct unprecedented definitions of health, enhanced by the social media culture and broader societal logics of healthism and postfeminism. Conclusion. Our study constitutes an original contribution to critical health psychology by examining some of the paradoxes raised by social media influencers like YouTubers regarding health and wellbeing.

"That's just healthy eating in my opinion" - Balancing understandings of health and 'orthorexic' dietary and exercise practices.

There is a fine line between eating and exercising "for one's health" and adopting obsessive dietary practices. Not currently recognised in the DSM-5, Orthorexia Nervosa is a proposed eating disorder characterized by an unhealthy obsession with eating healthy foods. In this study, we explored people's self-identified experiences of highly significant dietary and exercise practices, which whilst considered to be healthful may paradoxically have become problematic or resulted in dysfunction. Fifteen participants took part in semi-structured interviews. We used reflexive thematic analysis through a post structuralist theoretical lens to analyze the data, and developed three key themes: (1) feeling good and looking good; (2) relationality: the role of connections, community and social responses; (3) disordered or healthy. Daily health practices were understood as positive acts of self-care which were motivated by a range of embodied experiences and entangled within social relationships. Each theme also highlighted how sociocultural influences such as healthism and post-feminist discourses impacted upon participants food choices, exercise engagement and appearance goals-often producing contradictory understandings of what was considered to be (un)healthy. Overall, findings indicate that achieving 'a healthy balance' may be easier said than done and points to the need for nuanced analyses of the tensions that exist within first-person accounts of engaging with "health" in both "healthful" and potentially problematic ways.

Orthorexia nervosa: replication and validation of the ORTO questionnaires translated into Greek in a survey of 848 Greek individuals.

PURPOSE: The present study aimed to validate the ORTO-15 questionnaire for orthorexia nervosa (ON), translated by our group into the Greek language, and replicate the findings of the recently proposed 6-item ORTO-R. METHODS: The tool was translated into the Greek language (ORTO-15-GR) using the forward-backward-forward method. A total of 848 adults participated in the validation study by filling in the questionnaires and providing general characteristics (age, gender, educational level, body weight, and height). The internal consistency of the tool was assessed by the omega (ω) coefficient, and confirmatory factor analyses (CFA) examined its factorial structure. Using the original six items of the ORTO-15 tool, a separate CFA model examined the factorial structure of the proposed ORTO-R tool. Furthermore, regression models tested the association of ORTO-R with study variables. RESULTS: For ORTO-15-GR, the omega coefficient was 0.70 and for the ORTO-R 0.65. For the latter, the CFA revealed acceptable goodness-of-fit (standardized factor loadings from 0.36 to 0.64); however, all ORTO-15 models were characterized by a poor fit. In addition, there was a negative association between ORTO-R score and female gender, body mass index (BMI), and having a nutrition-related health problem. CONCLUSION: The replication of ORTO-R indicates that it is a reliable tool in the field of ON. Therefore, the use of a 6-item questionnaire for ON assessment appears promising in research and clinical settings.

Límites éticos a la promoción de la salud en el lugar de trabajo en el marco del concepto de empresa saludable / Thical limits to the promotion of health in the workplace within the framework of the “healthy organization” concept

En el contexto de cambios generales en la sociedad en relación con la salud, la empresa saludable se proclama y acepta como algo necesario y legítimo. Este fenómeno se expande globalmente sin apenas cuestionamiento, promocionado por organismos internacionales y grandes empresas. Con presencia global y creciente en políticas y prácticas organizacionales y profesionales, parece ganar aún más fuerza tras la pandemia. Frente a la expansión del fenómeno y por incidir directamente sobre la salud de las personas, es ineludible un análisis del mismo más allá de su imagen positiva generalizada. En este artículo se identifican algunos peligros relevantes del fomento de la cultura de salud en el trabajo, desde una perspectiva ética, y entre ellos, no solo el carácter no beneficiente de algunas prácticas no contrastadas científicamente, sino, también, su propia condición maleficiente. En este trabajo se plantean, pues, los límites éticos para este fenómeno expansivo y se defiende que el principio fundamental para operar en este ámbito de relaciones asimétricas entre empleado y empleador es de no maleficencia y no tanto el de autonomía

In the context of general changes in our societies in relation to health, the healthy organization is proclaimed and accepted as something necessary and legitimate. This phenomenon is expanding globally without being really questioned and promoted by international organizations and large companies. With a global and growing presence in organizational and professional policies and practices, it appears to be gaining even more strength in the aftermath of the pandemic. Faced with the expansion of the pheno- menon and because it directly affects people’s health, an analysis of it beyond its general positive image is unavoidable. This article identifies some relevant dangers of promoting a culture of health at work, from an ethical perspective, and among them, not only the non-beneficial nature of some practices not scien-tifically proven, but also their own malignant condition. In this paper, therefore, the ethical limits for this expansive phenomenon are proposed and the fundamental principle to operate in this area of asymmetric relations between mployee and employer is not autonomy but non-maleficence.

Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus.

Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. Τypical eating disorders (EDs) and USFEDs are common among patients with diabetes mellitus (DM), which complicates metabolic control and disease outcomes. The present systematic review summarizes the evidence on the prevalence of ON symptomatology among patients with DM. PubMed, Web of Science, Scopus, and grey literature were searched, and relevant observational studies were screened using the Rayyan software. The quality of the studies was assessed using the appraisal tool for cross-sectional studies (AXIS) and the Newcastle-Ottawa scale (NOS). Out of 4642 studies, 6 fulfilled the predefined criteria and were included in the qualitative synthesis. Most studies relied on the ORTO-15 or its adaptations to identify ON among patients with DM. No apparent sex or age differences exist regarding the prevalence of ON symptoms. None of the studies compared the prevalence of ON in patients with type 1 and type 2 DM. Most of the research was of average to good methodological quality. In conclusion, patients with DM often exhibit ON tendencies, although research is still limited regarding the etiology or mechanistic drivers behind ON and the characteristics of patients with a dual ON-DM diagnosis.

From Medicine to Health: The Proliferation and Diversification of Cultural Authority.

In his account of the medical profession's ascent, Paul Starr drew a distinction between the social authority of physicians and the cultural authority of medicine-between doctors' capacity to direct others' behavior and the ability of medical institutions and discourses to shape meanings of illness, health, wellness, and treatment. Subsequently, scholars have reflected on the social-structural transformations challenging physicians' social authority but neglected shifts in cultural authority. Focusing on the United States, we find a proliferation and diversification of cultural authority, reflecting a partial movement from the domain of medicine into new terrains of health. This shift is apparent in the resurgence of alternative healing, the advent of new forms of self-care and self-monitoring, the rise of health social movements, and the spread of health information online. We advance a research agenda to understand how the mechanisms and dynamics of cultural authority shape contests to speak in the name of health.

'The Lay Gaze'-Rural Norwegian men's assessment of others' health based on pictures.

In this article, we explore lay men's understanding of the relationship between other's bodily appearance and health-'the Lay Gaze'. We applied the theoretical concepts of biopower, medical gaze, bodyism and healthism-the ideology where one feature is that a slim body is equivalent to a healthy body-and interviewed 18 adult and elderly men in rural Norway, representing a heterogeneous group regarding age, ethnicity and education. To explore the interviewees' subjective perception or 'gaze', the interviewees were presented with eight pictures of different people. Our main findings were, first, that the sample of a relatively heterogeneous group of adult and elderly lay men in rural Norway talk similarly about body appearance and health and follow the healthism discourse with an embedded association between body appearance and health assessment. Second, we found some variation regarding how interviewees define other standards for the elderly and black people.

Emotions and emotion work before, during and after HIV disclosure among Black gay and bisexual men living with HIV.

In the United States, Black gay and bisexual men account for a quarter of HIV infections and face intersecting social and structural stigmas along the axes of race, sexuality and class. For those diagnosed with HIV, these inequities shape their lived experiences which include HIV disclosure. Public health has privileged HIV status disclosure as the appropriate moral and responsible choice to protect sex partners, reduce stigma and obtain social support. Though little is known about the emotional aspects of HIV disclosure for Black gay and bisexual men, or how they are shaped by social and structural contexts. Using the frameworks of healthism and emotion work, I explore HIV disclosure among a sample of 30 Black gay and bisexual men living with HIV in the Deep South. Drawing on in-depth, qualitative interviews, I identify the emotion work that men engaged in to manage their own emotions and protect the emotions of others before, during and after disclosure or nondisclosure. These findings challenge public health research that has explored disclosure as discrete measurable events by illustrating how HIV disclosure is embedded in ongoing social and structural relations and provide insights that can guide new approaches focused on structural inequities that constitute HIV disclosure.

Nurturing the Female Body: Notions of Wellbeing in Womb Yoga.

Alternative therapies which aim to enhance women's wellbeing have been accused of contributing to healthist and postfeminist agendas which rest upon a neoliberal logic. I critically engage with this issue here through an ethnographic study of womb yoga, a women's alternative therapy developed in the UK. I argue that while being commercial and emphasizing personal responsibility, womb yoga largely works against the current neoliberal optimization ideal. Womb yoga practitioners dismiss goal-oriented self-management and discipline, and avoid a simple reproduction of gender stereotypes by deflecting care away from other-directedness and opening the interpretation of femininity to the imaginative and experiential realms.