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Promoting healthy nutrition: a long and winding road

http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975915615994 http://ghp.sagepub.com Great emphasis has been placed on the idea that health promotion should not be exclusively limited to encouraging people to change their habits, but that it should also focus on bringing about structural transformations that do not necessarily depend on the health sector; however, a discrepancy still exists between this type of statement, which is commonly accepted by all, and the specific practices of the people who design and implement health promotion programs. Interventions in the field of nutrition (and particularly those aimed at preventing and reducing obesity) are a good example of this schism between discourse and practice. State-sponsored plans and programs do not always take a multidisciplinary, multisectoral approach. Nor do they always take into account the effects produced on eating patterns by factors such as technological innovations in agriculture; lack of access to high-quality, nutritious food; the move towards open economies; the high concentration of wealth; or the political lobbying exerted by transnational food and agriculture corporations. We are still finding that many initiatives are based on seeing people diagnosed as obese as being responsible for their own state of health. Thus, the emphasis is placed upon bringing about changes in individual determinants, by means of health education activities or by distributing leaflets and advertisements, which warn people of the risks of physical inactivity and the consumption of sugary drinks and energy-dense foods. Such initiatives tend to recommend healthy eating plans, weight control and healthy ways of eating that fail to take into account the fact that how people choose what foods to eat and the very act of eating are much more than just processes for nourishing our bodies. They are situations that involve a range of different factors: identity, gender relations, people’s perceptions about their own bodies and the material conditions in which they live their lives. Thus, as Bourdieu (1) noted some time ago, the way in which people choose foods that they consider ‘suitable’ to eat depends more on the way that the food will be cooked, served, presented and offered; rather than on the composition and nature of the products consumed. When designing and implementing healthy nutrition promotion programs, we must not lose sight of the intrinsic and indissoluble links that exist between three different levels: the subjective, the biological and the social. Biomedicine is governed by a positivist idea that attributes causes to different spheres: biological mechanisms, the functioning of the psyche, events in the surrounding environment and social life (2). From this vantage point, the only possible objectivity available to us relates to the body, which can be observed, measured, weighed, classified and situated on a predetermined scale: ‘underweight’, ‘normal’, ‘overweight’ and ‘obese’. As a result, women and men diagnosed as obese diverge from what is accepted as being normal and desirable. The labeling, discrimination and stigma regarding such people and the reductionist view of biomedicine have been pointed out and analyzed by the fields of health anthropology, feminism and medical sociology; and in particular, by activists and researchers involved in what are known as ‘critical studies on obesity’ or ‘fat studies.’ This is a field which covers a wide range of research topics and problems. A great deal of academic literature has been produced that questions the rigidity of the clinical category of obesity and the appropriateness of the expression ‘obesity epidemic’, in addition to the fear of weight gain and anxiety that result in people who compulsively monitor what and how much they eat, or who engage in strenuous physical activity (3,4,5). 615994PED0010.1177/1757975915615994D. CardaciEditorial research-article2015