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Introdução:O estigma relacionado ao peso corporal, presente entre profissionais e estudantes da área da saúde, prejudica a saúde e o cuidado de pessoas com sobrepeso e obesidade, e deve ser combatido. Objetivo:Este artigo visa relatar os resultados obtidos por meio da aplicação de um curso educativo sobre estigma relacionado ao peso corporal e o cuidado em saúde. Métodos:A aplicação ocorreu com 11 profissionais de saúde e teve desenho misto. No componente quantitativo, foi realizada análise estatística dos resultados iniciais e finais obtidos por meio da Escala de Atitudes Antiobesidade (AFAT), com realização de teste t pareado (nível de significância de p ≤ 0,05). No componente qualitativo, foi realizada análise de conteúdo temática de uma atividade final dissertativa sobre ideias que ficaram marcadas a partir do curso. Feedbacksestruturados a respeito da qualidade do material foram preenchidos. Resultados:As análises estatísticas não identificaram alterações entre os valores iniciais e finais da AFAT (p >0,05), com escore geral médio inicial de 0,418 e final de 0,419. Cinco temas emergiram da análise de conteúdo, os quais demonstram aprendizagem quanto à multifatorialidade da obesidade; reconhecimento de implicações interseccionais; compreensão dos impactos do estigma no cuidado em saúde; estímulo ao pensamento crítico; e considerações sobre o curso, no geral, bem avaliado de forma consistente. Conclusão:O instrumento quantitativo não indicou mudança; contudo, as análises qualitativas demonstram que o curso promoveu compreensão ampliada sobre os temas discutidos, bem como a reflexão e a autocrítica das/os profissionais.

Introduction:Weight stigma, present among health professionals and students, harms the health and healthcare of people with overweight and obesity and must be combated. Objective:This article aims to report the results obtained through a test application of an educational course on weight stigma and healthcare. Methods:The test was carried out with 11 healthcare professionals and had a mixed design. In the quantitative component, statistical analysis was carried out on the initial and final results obtained using theAntifat Attitudes Scale (AFAT), with a paired t test (significance level of p ≤ 0.05). In the qualitative component, a thematic content analysis was carried out with data produced in a final dissertation activity about ideas that were highlighted from thecourse. Structured feedback regarding the quality of the material was completed. Results:Statistical analyzes did not identify changes between initial and final AFAT values (p >0.05), with an initial overall average score of 0.418 and final of 0.419. Five themes emerged from the content analysis, which demonstrate learning regarding the multifactorial nature of obesity; recognition of intersectional implications; understanding of impacts of stigma on health care; stimulation of critical thinking; and considerations about the course, overall, consistently well evaluated. Conclusion: The quantitative instrument did not indicate change, however, qualitative analysis indicated that the course promoted expanded understanding of the topics discussed, as well as reflection and self-criticism by professionals.

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Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.

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O estigma relacionado ao peso corporal, definido como a desvalorização de indivíduos devido ao volume de seu corpo mais elevado, ocasiona prejuízos à saúde e está presente entre estudantes e profissionais da saúde. Abordar tal estigma em espaços de formação desses profissionais é crucial para combatê-lo. Este artigo relata a experiência de construção do curso educativo "Narrativas de peso: o estigma relacionado ao peso corporal e o cuidado em saúde", voltado para estudantes e profissionais da área da Saúde. Foram priorizadas a diversidade de materiais, a abrangência de perspectivas, a acessibilidade da linguagem e a presença de pessoas gordas. Considera-se que o processo de construção do curso possui elementos que podem orientar a elaboração de outros materiais e intervenções potentes e contextualizadas para o público-alvo.(AU)

El estigma relacionado al peso corporal se define como la desvalorización de individuos debido a su peso corporal más elevado, lleva a perjuicios para la salud y está presente entre estudiantes y profesionales de la salud. Abordar este estigma en espacios de formación de estos profesionales es crucial para combatirlo. Este artículo relata la experiencia de construcción del curso educativo "Narraciones de Peso: el estigma relacional al peso corporal y el cuidado de la salud", dirigido a estudiantes y profesionales del área de la salud. Se priorizaron la diversidad de materiales, el alcance de perspectiva, la accesibilidad del lenguaje y la presencia de personas gordas. Se considera que el proceso de construcción del curso cuenta con elementos que pueden orientar la elaboración de otros materiales e intervenciones potentes y contextualizadas para el público-objetivo.(AU)

Weight stigma is defined as the devaluation of people due to their higher body weight, causing harmful effects to health and is present among healthcare undergraduate students and professionals. Addressing weight stigma in training spaces is crucial to fight against it. This article reports the experience about the construction of the educational course "Narratives of Weight: weight stigma and health care", aimed at healthcare undergraduate students and professionals. Priority was given to the diversity of materials, range of perspectives, language accessibility and the presence of fat people. It is considered that the course's building process has elements that can guide the development of other powerful and contextualized materials and interventions for the target audience.(AU)

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Resumo Este ensaio, que traz contribuições póstumas da primeira autora, parte da compreensão da interseccionalidade como ferramenta teórica-metodológica e oferenda analítica que evidencia como sistemas múltiplos de subordinação e discriminação, suas consequências e dinâmicas estruturais, se relacionam entre dois ou mais eixos de opressão social. Propomos uma aproximação epistemológica entre esta compreensão e o campo da Alimentação e Nutrição, que contribua para pensar um cuidado alimentar e nutricional interseccional e uma práxis integral. Corroborando a metáfora da intersecção (e da encruzilhada), afirmamos que vários eixos de poder - raça, gênero, sexualidade, etnia, idade, classe, tamanho corporal, (dis)capacidades, entre outros - conformam as avenidas que estruturam o terreno do cuidado em saúde, inclusive o alimentar e nutricional. Entre tais avenidas e encruzilhadas, traçamos uma proposição inicial de Nutrição Clínica Ampliada e Implicada. Entre as implicações propostas, destacamos a reflexividade e a ação nas relações de poder e opressão, situando o(a) nutricionista como agente político, implicado com práxis emancipatórias, participativas e referenciadas socialmente. A interseccionalidade se traveste aqui como estratégia para o trabalho de justiça social, incluindo nesta a alimentação e a nutrição. Tratamos de relações em construção, constituindo práticas reflexivas, de composição de sentidos no ato do trabalho vivo alimentar e nutricional.

Abstract This essay, which brings posthumous contributions from the first author, starts from the understanding of intersectionality as a theoretical-methodological tool and analytical offering that shows how multiple systems of subordination and discrimination, their consequences and structural dynamics, relate between two or more axes of social oppression. We propose an epistemological approximation between this understanding and the field of Eating and Nutrition, which contributes to thinking an intersectional eating and nutritional care and an integral praxis. Corroborating the intersection (and crossroads) metaphor, we state that several axes of power - race, gender, sexuality, ethnicity, age, class, body size, (dis)abilities, among others - shape the avenues that structure the field of health care, including eating and nutritional care. Among such avenues and crossroads, we outline an initial proposal of an Extended and Implicated Clinical Nutrition. Among the proposed implications, we highlight reflexivity and action in power and oppression relations, placing the nutritionist as a political agent, involved with emancipatory, participatory, and socially referenced praxis. Intersectionality, therefore, is treated here as a strategy for social justice work, including eating and nutrition. We deal with relationships under construction, constituting reflective practices, the composition of meanings in the act of living eating and nutrition work.

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Introdução: A insegurança alimentar e nutricional da população em situação de rua perpassa a negação de direitos básicos, como moradia, e abrange a incerteza do que, quando, onde e como se alimentar. Assim, dar voz às vulnerabilidades e reivindicações dessa população é essencial. Objetivo: Descrever e discutir as principais questões que permearam a temática da alimentação e da comida nas matérias do jornal O Trecheiro, focado nas realidades sociais da população em situação de rua no Brasil, durante um período da pandemia de Covid-19 (março de 2020 a fevereiro de 2021). Métodos: Tratou-se de pesquisa qualitativa genérica com produção de dados a partir de análise documental; adotou-se o método de análise de conteúdo para categorizar o corpus documental e discutir os temas construídos a partir dos dados. Resultados: A "alimentação enquanto direito" surgiu como parte dos saberes e lutas da pessoa em situação de rua. Os temas e subtemas construídos abrangeram alimentação enquanto um direito não assegurado, vinculando-se à não garantia de outras necessidades (terra e trabalho); às saídas para a garantia do alimento e de outros insumos (solidariedade, luta popular); e aos sentidos e significados que a alimentação e os rituais em torno dela possuem para a pessoa em situação de rua. Conclusão: Pensar sobre o cuidado e a alimentação dessa população exige um olhar integral e multifatorial que considere a complexidade do grupo estudado, assim como os diversos aspectos que atravessam as vivências desses indivíduos, como questões estruturais, sociopolíticas e experiências individuais discutidas neste artigo.

Introduction: The food and nutritional insecurity of the homeless population goes beyond the denial of basic rights, such as housing, and encompasses the uncertainty of what, when, where and how to eat. It is therefore essential to give voice to the vulnerabilities and demands of this population. Objective: To describe and discuss the main issues that permeated the theme of food and eating in articles in the newspaper O Trecheiro, focused on the social realities of the homeless population in Brazil, during a period of the Covid-19 pandemic (March 2020 to February 2021). Methods: This was a generic qualitative research with data production from documentary analysis; the content analysis method was adopted to categorize the documentary corpus and discuss the themes constructed from the data. Results: "Food as a right" emerged as part of the knowledge and struggles of homeless people. The themes and sub-themes that emerged included food as a right that is not guaranteed, linked to the failure to guarantee other needs (land and work); ways of guaranteeing food and other inputs (solidarity, popular struggle); and the senses and meanings that food and the rituals surrounding it have for homeless people. Conclusion: Thinking about the care and feeding of this population requires a comprehensive and multifactorial approach that takes into account the complexity of the group studied, as well as the various aspects that permeate the experiences of these individuals, such as structural and socio-political issues and the individual experiences discussed in this article.

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ABSTRACT The second edition of the Dietary Guidelines for the Brazilian Population (DGBP) advises "eating regularly and carefully", "eating in appropriate environments," and "eating in company". Individuals may interpret these guidelines differently. We analyzed social representations of these recommendations to ascertain how such representations relate to the official DGBP advice. This cross-sectional, exploratory study was conducted with a selected sample of teachers, administrative technicians, and students (N= 24) from the Federal University of Grande Dourados, Brazil. We carried out an exploratory content analysis of the responses to semi-structured interviews on the topic. We identified seven themes that encompassed the social representations of "eating regularly and carefully": 1) paying attention to what you eat; 2) having several meals; 3) eating slowly; 4) having time to eat; 5) eating without distractions; 6) eating adequate amounts; and 7) ensuring a nutritional balance. Four themes emerged from the analysis of the social representations of "eating in appropriate environments": 1) a pleasant environment; 2) at the table; 3) without interferences; and 4) a clean environment. The following themes encompassed the social representations of "eating in company": 1) eating in company is good; 2) I prefer to eat alone; and 3) eating in company is inconsequential. Although participant representations align with DGBP recommendations in the three orientations, in general, they extend beyond them. Professionals and government organizations in Brazil or abroad could take into consideration these results in order to optimize this tool's potential for research and policy in nutrition and public health.

RESUMEN La segunda edición de la Guía Alimentaria para la Población Brasileña (DGBP) aconseja "comer con regularidad y atención", "comer en ambientes adecuados" y "comer en compañía". Las personas pueden interpretar estas pautas de manera diferente. Analizamos las representaciones sociales de estas recomendaciones para determinar cómo se relacionan con la postura oficial de la DGBP. Este estudio transversal y exploratorio se realizó con una muestra seleccionada de profesores, técnicos administrativos y estudiantes (N= 24) de la Universidad Federal de Grande Dourados, Brasil. Realizamos un análisis exploratorio de contenido de las respuestas a entrevistas semiestructuradas sobre el tema. Identificamos siete temas que abarcan las representaciones sociales de "comer con regularidad y atención": 1) prestar atención a lo que come; 2) tener varias comidas; 3) comer despacio; 4) tener tiempo para comer; 5) comer sin distracciones; 6) comer cantidades adecuadas; y 7) asegurar un equilibrio nutricional. Cuatro temas surgieron del análisis de las representaciones sociales de "comer en ambientes adecuados": 1) ambiente agradable; 2) en la mesa; 3) sin interferencias; y 4) medio ambiente limpio. Los siguientes temas engloban las representaciones sociales de "comer en compañía": 1) comer en compañía es bueno; 2) prefiero comer solo; y 3) comer en compañía es intrascendente. Aunque las representaciones de los participantes se alinean con las recomendaciones de la DGBP en las tres orientaciones, en general, se extienden más allá de ellas. Investigadores y organizaciones gubernamentales en Brasil y en el extranjero podrían tener en cuenta estos resultados para optimizar el potencial de esta herramienta para la investigación y las políticas en nutrición y salud pública.

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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.

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We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30-39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (ß = 0.83, p <0.001), fasting glycemia (ß = 0.45, p = 0.036), total cholesterol (ß = 1.48, p = 0.024), LDL (ß = 1.33, p = 0.012), clustered cardiometabolic risk (ß = 0.18, p = 0.006), and quality of life (ß = -1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

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RESUMO O objetivo do artigo é analisar as características dos processos de trabalho na Estratégia Saúde da Família direcionados às pessoas com sobrepeso e obesidade no município de São Paulo. Ancorado no referencial teórico da saúde coletiva sobre processo de trabalho, foi desenvolvido um estudo exploratório com abordagem qualitativa. Foram realizadas onze entrevistas com profissionais de uma unidade básica de saúde, na zona leste da cidade de São Paulo, entre os meses de julho e agosto de 2019. A partir da análise temática, o artigo apresenta os resultados e a discussão em três categorias analíticas: objeto de trabalho, instrumentos de trabalho e organização do trabalho. O cuidado às pessoas com sobrepeso e obesidade é mediado pelo baixo investimento em qualificação dos profissionais de saúde sobre o tema, pela falta de materiais técnicos de suporte ao trabalho e pelo modelo de gestão pautado pela produtividade e cobrança de resultados quantitativos. Conclui-se que os profissionais de saúde apresentam pouco domínio sobre seu processo de trabalho, cuja finalidade acaba sendo a mudança de comportamento e a perda de peso corporal, em vez de considerar as necessidades de saúde dos usuários e profissionais, produzindo, por vezes, insatisfação e desgaste com o trabalho.

ABSTRACT The goal of the article is to analyze the characteristics of the work processes in the Family Health Strategy directed to people with overweight and obesity in the city of São Paulo. Based on the theoretical framework of collective health about work processes, an exploratory study with a qualitative approach was developed. Eleven interviews were conducted with professionals from a basic health unit, in the east of the city of São Paulo, between July and August 2019. Starting with the thematic analysis, the article presents the results and discussion in three analytical categories: work object, work instruments and work organization. The care for people with overweight and obesity is mediated by the low investment in training health professionals on the subject, the lack of technical materials to support the work and the management model based on productivity and demand for quantitative results. It is concluded that health professionals have little control over their work process, whose purpose ends up being the change of behavior and the loss of body weight, instead of considering the health needs of users and professionals, sometimes producing dissatisfaction and weariness with work.

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In the past, food industry actors tried to delay and weaken public health efforts to promote adequate and healthy diets in Brazil. This study aimed to identify the political strategies used by food industry actors in Brazil. We undertook a document analysis of publicly available information and interviews with eighteen key informants in public health nutrition. Data collection and analysis were carried between October 2018 and January 2019. In Brazil, food industry actors interacted with health organizations, communities, and the media. They disseminated information on nutrition and physical activity by scientific events and schools. The food industry also had allies within the government and lobbied high ranking officials. Finally, food industry actors intimidated some public health professionals, including by threats of litigation, which had the effect of silencing them. These strategies were facilitated by the use of arguments, such as the crucial role that the food industry plays in the economy and its support to the United Nations Sustainable Development Goals. Personal responsibility, moderation, and education were cited as solutions to the obesity epidemic, and there was little discussion on the broader issue of inadequate and unhealthy diets. Food industry actors in Brazil used a diverse range of political strategies, which have the potential of negatively influencing public policy, research, and practice in the country. Learning about these strategies is an essential first step, and in response, it is crucial to develop robust mechanisms to address undue influence from corporations.

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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.

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OBJECTIVE: To assess how mothers classify foods and how their eating practices interact with these classifications, with special attention to meanings and uses given to ultra-processed foods. DESIGN: Qualitative research with in-depth interviews and pile sorts. SETTING: Urban Brazilian Amazon. PARTICIPANTS: A sample of 34 mothers were selected through theoretical sampling. ANALYSIS: Content analysis for in-depth interviews and multidimensional scaling and cluster analysis for pile sorts. PHENOMENON OF INTEREST: Food classification. RESULTS: Classifications were based on context (ie, a time or a situation in which the food is eaten) and foods' healthiness. Five food groupings based on mothers' classifications were defined: (1) main meal foods, (2) fruits and fruit juices, (3) convenient foods, (4) leisure foods, and (5) canned sardines. Ultra-processed foods were classified differently from non-ultra-processed foods and considered unhealthy, consumed on special occasions or when there was no time or desire to cook. CONCLUSIONS AND IMPLICATIONS: Results highlight the potential of incorporating context-based categories and personal experiences to guide nutrition interventions and the potential of pile sorts to tailor messages to target populations.

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OBJECTIVE: To identify and monitor food industry use of political practices during the adoption of nutrition warning labels (WL) in Colombia. DESIGN: Document analysis of publicly available information triangulated with interviews. SETTING: Colombia. PARTICIPANTS: Eighteen key informants from the government (n 2), academia (n 1), civil society (n 12), the media (n 2) and a former food industry employee (n 1). RESULTS: In Colombia, the food industry used experts and groups funded by large transnationals to promote its preferred front-of-pack nutrition labelling (FOPL) and discredit the proposed warning models. The industry criticised the proposed WL, discussing the negative impacts they would have on trade, the excessive costs required to implement them and the fact that consumers were responsible for making the right choices about what to eat. Food industry actors also interacted with the government and former members of large trade associations now in decision-making positions in the public sector. The Codex Alimentarius was also a platform through which the industry got access to decision-making and could influence the FOPL policy. CONCLUSIONS: In Colombia, the food industry used a broad range of political strategies that could have negatively influenced the FOPL policy process. Despite this influence, the mandatory use of WL was announced in February 2020. There is an urgent need to condemn such political practices as they still could prevent the implementation of other internationally recommended measures to improve population health in the country and abroad, nutrition WL being only of them.

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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.

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In the past, food industry actors tried to delay and weaken public health efforts to promote adequate and healthy diets in Brazil. This study aimed to identify the political strategies used by food industry actors in Brazil. We undertook a document analysis of publicly available information and interviews with eighteen key informants in public health nutrition. Data collection and analysis were carried between October 2018 and January 2019. In Brazil, food industry actors interacted with health organizations, communities, and the media. They disseminated information on nutrition and physical activity by scientific events and schools. The food industry also had allies within the government and lobbied high ranking officials. Finally, food industry actors intimidated some public health professionals, including by threats of litigation, which had the effect of silencing them. These strategies were facilitated by the use of arguments, such as the crucial role that the food industry plays in the economy and its support to the United Nations Sustainable Development Goals. Personal responsibility, moderation, and education were cited as solutions to the obesity epidemic, and there was little discussion on the broader issue of inadequate and unhealthy diets. Food industry actors in Brazil used a diverse range of political strategies, which have the potential of negatively influencing public policy, research, and practice in the country. Learning about these strategies is an essential first step, and in response, it is crucial to develop robust mechanisms to address undue influence from corporations.

En el pasado, agentes de la industria alimentaria intentaron retrasar y debilitar los esfuerzos de la salud pública para promover dietas adecuadas y saludables en Brasil. El objetivo de este estudio fue identificar las estrategias políticas usadas por los agentes de la industria alimentaria en Brasil. Realizamos un análisis documental de la información disponible públicamente y entrevistas con 18 informantes clave en nutrición dentro de la salud pública. La recolección de datos y análisis se llevaron a cabo entre octubre de 2018 y enero de 2019. En Brasil, los agentes de la industria alimentaria interactuaron con organizaciones de salud, comunidades y medios. Ellos diseminaron información sobre nutrición y actividad física mediante eventos científicos y en las escuelas. La industria alimentaria tenía también aliados dentro del gobierno y funcionarios de alto rango que hacía lobby a su favor. Finalmente, los agentes de esta industria intimidaron a algunos profesionales públicos de salud, incluso con amenazas de litigios, que tuvieron el efecto de silenciarlos. Estas estrategias se facilitaron mediante el uso de argumentos tales como el papel crucial que desempeñaba la industria alimentaria en la economía y en su apoyo para los Objetivos de Desarrollo Sostenible de la Organización de las Naciones Unidas. Se citaron la responsabilidad personal, moderación, y educación como soluciones para la epidemia de obesidad, y hubo una pequeña discusión sobre un tema tan amplio como el de las dietas inadecuadas e insanas. Los agentes de la industria alimentaria en Brasil usaron un repertorio diverso de estrategias políticas, que tienen el potencial de influenciar negativamente políticas públicas, investigaciones, así como prácticas en el país. Como primer paso es esencial aprender de estas estrategias, y en respuesta, es crucial desarrollar mecanismos robustos para abordar la influencia indebida de las corporaciones alimentarias.

No passado, os agentes da indústria alimentícia tentaram atrasar e enfraquecer os esforços de saúde pública para promoção de dietas adequadas e saudáveis no Brasil. O presente estudo tem como objetivo identificar as estratégias políticas utilizadas pelos agentes da indústria alimentícia no Brasil. Realizamos uma análise documental das informações disponíveis ao público, bem como entrevistas com 18 informantes-chave em saúde pública e nutrição. A coleta e análise de dados foi realizada entre outubro de 2018 e janeiro de 2019. No Brasil, os agentes da indústria alimentícia interagiram com organizações de saúde, comunidades e com a mídia. Difundiram informações sobre nutrição e atividade física em eventos científicos e escolas. A indústria alimentícia também apresentava aliados dentro do governo e fazia lobby junto a altos funcionários. Por fim, os agentes da indústria alimentícia intimidaram alguns profissionais da saúde pública, inclusive com ameaças de litígio, o que teve o efeito de silenciá-los. Essas estratégias foram facilitadas por argumentos como o papel crucial desempenhado pela indústria de alimentos na economia e seu apoio aos Objetivos de Desenvolvimento Sustentável da Organização das Nações Unidas. Responsabilidade pessoal, moderação e educação foram citadas como soluções para a epidemia de obesidade, e houve pouca discussão sobre a problemática mais ampla de dietas inadequadas e insalutares. Os agentes da indústria alimentícia no Brasil utilizaram uma gama diversificada de estratégias políticas com o potencial de influenciar negativamente as políticas públicas, mas também a pesquisa e a prática no país. Conhecer essas estratégias é um primeiro passo essencial e, em resposta, é crucial desenvolver mecanismos robustos para lidar com a influência indevida das corporações.

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Introdução - O estigma relacionado ao peso corporal é a discriminação moral que as pessoas com sobrepeso e obesidade vivenciam por causa das mensagens sociais negativas associadas aos seus corpos, como preguiça, gula, descontrole, falta de força de vontade, de motivação, de disciplina, de competência, de inteligência e de compromisso, entre outras. A literatura científica, especialmente do Norte Global, apontou que este estigma é crescente e altamente presente entre profissionais de saúde. Todavia, pesquisas nesse campo podem avançar em termos teóricos e em aplicações práticas, investigando tal fenômeno para além do Norte Global e propondo meios para a diminuição da estigmatização no cuidado em saúde. Objetivos - 1) Revisar sistematicamente o estigma sentido relacionado ao peso corporal ("felt weight stigma") por pessoas com sobrepeso e obesidade na América Latina, África e Ásia; 2) Revisar os protocolos de oficinas educativas do estudo "Apoio e análise para a implementação das ações na atenção básica da linha de cuidado para sobrepeso e obesidade nos municípios do Grande ABC paulista", para eliminar a presença de atitudes potencialmente estigmatizantes nos mesmos e acrescentar práticas e informações que possam contribuir para a diminuição do estigma relacionado ao peso corporal por parte dos/as profissionais de saúde. Percursos metodológicos - Para atender o primeiro objetivo, realizamos uma revisão sistemática da literatura seguindo diretrizes consolidadas, com etapas de busca, seleção dos estudos, extração dos dados e avaliação da qualidade. Os estudos foram incluídos se investigaram o estigma sentido relacionado ao peso corporal de crianças, adolescentes, adultos e idosos com sobrepeso ou obesidade, e que viviam na América Latina, África ou Ásia. Para atender o segundo objetivo, construímos uma lista de características dos serviços de saúde e práticas de profissionais de saúde da atenção básica que diminuem a estigmatização de pessoas com obesidade e a mesma foi avaliada por especialistas e pessoas leigas com obesidade, por meio do método Delphi. Tendo esta lista como nosso referencial, os protocolos foram revistos, com exclusão de excertos potencialmente estigmatizantes e inclusão de trechos que pudessem reduzir o estigma relacionado ao peso corporal. Resultados - Quarenta estudos foram incluídos na revisão sistemática. Eles se focaram em três eixos: sentindo-se estigmatizado/a; consequências do estigma sentido; apoio às pessoas que vivenciam o estigma sentido, sendo que o último não foi encontrado em estudos africanos. A experiência de estigma sentido pareceu ser comum, e sofrida, entre as três regiões. Atendendo ao segundo objetivo, a lista supracitada compreendeu vinte e cinco itens e foi finalizada com duas rodadas do método Delphi. Foram feitas sessenta e nove revisões nos protocolos visando antecipar situações futuras de estigmatização e preveni-las; e inserindo trechos para combater a estigmatização na prática profissional. Conclusões: Constatamos a existência do estigma sentido, em relação ao peso corporal, em diferentes populações que viviam na América Latina, África e Ásia, lugares com muitas diferenças e que normalmente não são foco de pesquisas desta área. Construímos também um caminho metodológico para diminuir o potencial estigmatizante que poderá ser utilizado por diversos protocolos voltados para o cuidado da pessoa com sobrepeso e obesidade.

Introduction - Weight stigma is the moral discrimination that people with overweight and obesity experience because of the negative social messages associated with their bodies, such as laziness, gluttony, lack of control, of willpower, of motivation, of discipline, of competence, of intelligence and of commitment, among others. The scientific literature, especially from the Global North, pointed out that this stigma is growing and highly present among health professionals. However, research in this field could advance in theoretical terms and in practical applications, investigating this phenomenon beyond the Global North and proposing ways to reduce stigmatization in health care. Objectives - 1) To systematically review the felt weight stigma by people with overweight and obesity in Latin America, Africa and Asia; 2) To review the protocols of educational workshops in the study "Support and analysis for the implementation of actions in the basic care line for overweight and obesity in the cities of the Greater ABC Paulista", to eliminate the presence of potentially stigmatizing attitudes in them and to add practices and information that could contribute to the reduction of weight stigma on the part of health professionals. Methodological paths - To meet the first objective, we carried out a systematic literature review following consolidated guidelines, with stages of search, study selection, data extraction and quality assessment. Studies were included if they investigated the felt weight stigma of children, adolescents, adults and elderly with overweight and obesity, living in Latin America, Africa or Asia. To meet the second aim, we built a list of characteristics of health services and practices of health professionals in primary care that reduce the stigmatization of people with obesity and it was evaluated by experts and lay people with obesity, through the Delphi method. Using this list as our reference, the protocols were revised, excluding potentially stigmatizing excerpts and including excerpts that could reduce the stigma related to body weight. Results - Forty studies were included in the systematic review. They focused on three axes: feeling stigmatized; consequences of felt stigma; support for people who experience felt stigma, with the latter not being found in African studies. The experience of felt stigma appeared to be common, and painful, across the three regions. Meeting the second objective, the aforementioned list comprised twenty-five items and was completed with two rounds of the Delphi method. Sixty-nine revisions were made to the protocols in order to anticipate future stigmatization situations and prevent them; and inserting excerpts to combat stigmatization in professional practice. Conclusions - We found the existence of felt weight stigma, in different populations living in Latin America, Africa and Asia, places with many differences and which are not normally the focus of research in this area. We also built a methodological path to reduce the stigmatizing potential that could be used by various protocols that aim the health care of people with overweight and obesity.

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ABSTRACT The NOVA classification categorizes foods according to the extent of industrial processing. NOVA has been used in dietary guidelines of some countries including Brazil and Uruguay. This article aimed to investigate knowledge and perceptions of a sample of Brazilian adults regarding NOVA. A qualitative study was conducted in Dourados city, Mato Grosso do Sul, Brazil. First, participants (N= 24) were asked to classify a series of 24 pictures of foods and beverages using NOVA, which define the four major food groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. Next, participants were asked to explain their classification through semi-structured interviews. Data from the classification activity were analyzed using non-metric multidimensional scaling and interviews using exploratory content analysis and summative content analysis. Participants seemed to understand NOVA in terms of food processing, food production, and additives used. They easily identified unprocessed or minimally processed foods and ultra-processed foods; processed culinary ingredients and processed foods were harder to identify. Professionals, researchers and government organisations in Brazil or abroad could consider the results of this study in order to optimize this tool's potential for research and policy in nutrition and public health.

RESUMEN La clasificación NOVA ordena los alimentos según su grado de procesamiento industrial. NOVA ha sido utilizado en las guías alimentarias de algunos países incluyendo Brasil. Investigamos el conocimiento y las percepciones de un muestreo de adultos brasileños con respecto a NOVA. Se realizó una investigación cualitativa en la ciudad de Dourados, Mato Grosso do Sul, Brasil. Los participantes (N= 24) clasificaran 24 imágenes de alimentos y bebidas en los cuatro grupos de NOVA: alimentos sin procesar o mínimamente procesados; ingredientes culinarios procesados; alimentos procesados; y alimentos ultraprocesados. Luego, se les pidió que explicaran su clasificación a través de entrevistas semiestructuradas. Los datos de esa actividad se analizaron mediante escala multidimensional no métrica y las entrevistas mediante análisis de contenido exploratorio y análisis de contenido sumativo. Los participantes entienden la NOVA en términos de procesamiento y producción de alimentos, y uso de aditivos. Ellos identificaron fácilmente los alimentos sin procesar o mínimamente procesados y los alimentos ultraprocessados pero no los alimentos de los otros grupos. Investigadores y organizaciones gubernamentales en Brasil y en el extranjero podrían tener en cuenta estos resultados para optimizar el potencial de esta herramienta para la investigación y las políticas en nutrición y salud pública.

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BACKGROUND: In Colombia, public health policies to improve food environments, including front-of-pack nutrition labelling and marketing restrictions for unhealthy products, are currently under development. Opposition to these policies by the food industry is currently delaying and weakening these efforts. This opposition is commonly known as 'corporate political activity' (CPA) and includes instrumental (action-based) strategies and discursive (argument-based) strategies. Our aim was to identify the CPA of the food industry in Colombia. METHODS: We conducted a document analysis of information available in the public domain published between January-July 2019. We triangulated this data with interviews with 17 key informants. We used a deductive approach to data analysis, based on an existing framework for the CPA of the food industry. RESULTS: We identified 275 occurrences of CPA through our analysis of publicly available information. There were 197 examples of instrumental strategies and 138 examples of discursive strategies (these categories are not mutually exclusive, 60 examples belong to both categories). Interview participants also shared information about the CPA in the country. The industry used its discursive strategies to portray the industry in a 'better light', demonstrating its efforts in improving food environments and its role in the economic development of the country. The food industry was involved in several community programmes, including through public private initiatives. The industry also captured the media and tried to influence the science on nutrition and non-communicable diseases. Food industry actors were highly prominent in the policy sphere, through their lobbying, close relationships with high ranking officials and their support for self-regulation in the country. CONCLUSIONS: The proximity between the industry, government and the media is particularly evident and remains largely unquestioned in Colombia. The influence of vulnerable populations in communities and feeling of insecurity by public health advocates is also worrisome. In Colombia, the CPA of the food industry has the potential to weaken and delay efforts to develop and implement public health policies that could improve the healthiness of food environments. It is urgent that mechanisms to prevent and manage the influence of the food industry are developed in the country.

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BACKGROUND: In the business literature, the term "corporate political activity" (CPA) refers to the political strategies undertaken by corporations to protect or expend their markets, by influencing, directly or indirectly, the policy process. There is evidence that food industry actors use such political practices, which poses a significant threat to public health. Our study objective was to identify the political practices of the food industry in Chile. RESULTS: In Chile, food industry actors supported community initiatives, particularly those targeted at children and those focused on environmental sustainability. Food industry actors also funded research through prizes, scholarships, and by supporting scientific events. Food industry actors lobbied against the development and implementation of a front-of-pack nutrition labelling policy, including with support from the Ministries of Economy, Agriculture and Foreign Affairs. Food industry actors, for example, claimed that there would be unintended negative consequences for society and the economy, and that the policy would breach trade agreements. The same arguments were used against a proposed tax increase on sugar-sweetened beverages. Food industry actors stressed their crucial role in the Chilean economy and claimed to be part of the solution in the prevention and control of obesity, with a particular focus on their efforts to reformulate food products, and their support of physical activity initiatives. Interviewees noted that the political influence of the food industry is often facilitated by the neo-liberal and market-driven economy of Chile. Nevertheless, this system was questioned through social protests that started in the country during data collection. CONCLUSIONS: In Chile, food industry actors used numerous action- and argument-based CPA practices which may influence public health policy, research, and practice. Despite strong influence from the food industry, Chile adopted a front-of-pack nutrition labelling policy. While the country has some measures in place to manage the interactions between government officials or public health professionals, and the industry, there is still a need to develop robust mechanisms to address undue influence from corporations.

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BACKGROUND: Dietary Guidelines are an important tool for population health promotion efforts. However, current surveillance data suggest that only a small minority of the population meet the 2014 Brazilian Dietary Guidelines (BDG) recommendations. Translating recommendations into practice may not be immediately clear and behavior-change messages guiding the behaviors that need to be changed and identifying substitute practices to meet a specific recommendation, are required. This study details the methods undertaken to develop and refine messages supporting the adoption of healthy dietary choices and behaviors in adults, as outlined in the BDG. METHODS: A sequential, five-step, mixed-methods approach, determined a priori, was followed for designing and refining messages. These included: (1) content extraction; (2) audience analysis; (3) input from an expert review panel; (4) message development and message refinement; and a (5) test of content validity. RESULTS: The content extraction process led to the identification of 63 excerpts from the BDG, organized into themes. The audience analysis highlighted barriers to healthy eating that included lack of time (to eat, to cook), difficulty in accessing healthy food, the convenience and the ubiquitous marketing of ultra-processed foods. Twenty of the 63 DG excerpts reviewed by the expert panel were identified as being a priority for message development and total of 111 messages were developed. Messages were short, structured to be one-sided, conveyed the most important information at the beginning (anticlimactic), used simple language and were explicit in the information they relayed. They were positive and gain-framed and used an empathetic, solution- or substitution-based tone and were presented in the active voice. The messages focused on goals and skill development, behavior regulation, incentivized positive practices as time and/or cost saving. Content validity testing helped further messages and reduced the number of messages from 111 to 40. CONCLUSIONS: This study provides the blue-print for the phase-wise development of messages that synthesize the key recommendations of the food-based BDG and communicate the adoption of behaviors and goals that are consistent with it's message. It details methods which could be adapted and replicated for message development in other contexts.

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