615994

research-article2015
PED0010.1177/1757975915615994D. CardaciEditorial

Editorial

Promoting healthy nutrition: a long and winding road

Dora Cardaci1,2

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).

1. Metropolitan Autonomous University, Xochimilco Campus, Mexico.

2. Associate Spanish language editor, Global Health Promotion.

Correspondence to: Dora Cardaci, Universidad Autónoma Metropolitana Xochimilco, México. Email: dcardaci@
correo.xoc.uam.mx
Global Health Promotion 1757-9759; Vol 22(4): 3­ –4; 615994 Copyright © The Author(s) 2015, Reprints and permissions:
http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975915615994 http://ghp.sagepub.com
4 Editorial
Some studies speak of the risk of pathologizing
those social groups which, according to biomedical
discourse, have a greater risk of obesity (populations
living in poverty, children of obese mothers, etc.).
Others criticize the causal model underlying research
studies in which macro-level determinants are
minimized and a uni-causal, direct link is established
between weight that exceeds ‘normal’ standards and
a greater propensity towards illness (6,7,8). Still other
studies go beyond merely deconstructing hegemonic
knowledge and practices, to present interesting
theoretical and methodological ideas; however, this
series of initiatives and research studies has not yet
been sufficiently disseminated nor analyzed among
those of us working in health promotion.
Very often, we assume that health promotion has
broadened its horizons to include theoretical
approaches and analytical models from many
different disciplines; however, this broadening
process has not taken place in a uniform, continuous
way, nor has it been free of obstacles. The persistence
of health promotion programs that are based on
approaches that exclude or undervalue crucial
macro-social determinants of health suggests that
the road still ahead of us is long and winding.
IUHPE – Global Health Promotion Vol. 22, No. 4 2015
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