| Traditional culturalist: centered on traditions, culture, and territoriality |
Principles of diversity, territoriality, culture, and social traditions. Based on the idea that different “models” of healthy eating exist. Healthy eating characterized by a profile of food consumption based on food combinations defined by local traditions, crops’ seasonality, and cultural and territorial context. The criterion for eating is based on “pragmatic” and “symbolic” motives in daily life, including cultural ones. Food risk refers primarily to biological contamination and food shortage. |
Adequate eating and diet should be appropriate according to sociocultural aspects and referenced on food culture. These elements should be considered in policies 27. Policies should value such elements as food diversity and social and cultural aspects; availability of foods from family, organic, and agroecological farming and social and biological diversity 58. This perspective is oriented by the idea that there is no single definition of eating, since location and culture define eating parameters 1. The PNAN promotes actions such as reclaiming regional food and farming practices and motivation for local consumption of low-cost foods with high nutritional value 6. |
| Biological nutritional: centered on nutritional (nutrients) and biological rationality (biological body) |
Based on the principle of the best combination of nutrients as a function of biological needs and the definition of standardized human nutritional needs and referenced on the concepts of calories and nutrients. Healthy eating defined as a food consumption profile capable of guaranteeing adequate amounts of all necessary nutrients for growth and maintenance of the body’s biological functions. Reduces the body to its biological and mechanical aspects. Guidelines on recommendations and requirements focus mainly on nutrient supply for full functioning of the body in each life phase and prevention of deficiency diseases (malnutrition due to insufficient energy and/or macronutrients [e.g.: protein]; and micronutrient deficiencies [anemia, vitamin A deficiency, etc.]). |
The emergence of the term healthy eating is associated with the nutritional reductionism that marked the establishment of nutrition science 1,3. Central elements are nutrients, calories, and biological and physiological aspects. This perspective is oriented by the idea that eating is based on rules that express a “normal” standard and a single ideal parameter for eating 4. The biological nutritional perspective drives actions such as industrial technologies and mechanisms in processing seeds and foods, aimed at increasing their nutrient content, yield, and durability. The commercial private sector takes this perspective and contends that processed foods contribute to a wide variety of nutrients for diet, and that a good diet depends on the nutrient value of the foods and beverages consumed, not whether they have been processed or not 4,42. Other actions promoted in this context include regulation of food labels, marketing practices, and food engineering 6. This area also promotes concepts of nutritional orientation and “traditional” nutrition education based on the “myth of ignorance” and actions focused on the change of individual eating behaviors based on idealized dietary patterns 4. |
| Biological and medicalizing nutritional: eating and certain foods and nutrients are considered risk or protective factors for NCDs |
Principle of the best combination of nutrients as a function of biological needs aimed at prevention of NCDs. Standardization of the concept of “healthy diet” based on the idea that healthy eating is universal and characterized by the food consumption profile based on foods with low levels of calories, fats, and other nutrients as a way of preventing NCDs. Epidemiological rationality - prevention-based health promotion watershed based on risk factor logic and prevention of NCDs that leads to an association between healthy eating and restriction in the consumption of foods high in certain nutrients (salt, sugar, fats etc.). Biomedical rationality - based on the body’s biological functioning, leading to an association between healthy eating and stimulus for consumption of certain foods high in specific nutrients to prevent diseases in general. The basis for “healthy” is a diet with strong presence of “functional” foods, fortified foods, and complements based on fiber and micronutrients. The idea of healthy and unhealthy foods based on nutritional principles. The approach combines with the focus on nutrients and foods. Food is medicalized, and healthy diet is one that aims to achieve an ideal of the body and beauty 4. |
The idea that there are healthy and unhealthy foods, as well as eating as a risk factor promoting actions to encourage consumption of fruits, vegetables, and greens and traditional diet (based on “natural” or minimally processed foods) in addition to discouragement of consumption of foods high in fats, sugars, and salt and ultra-processed foods 11,12,14,29,48,49,53. These policy proposals thus alternate between the medicalizing biological nutritional approach and the multidimensional approach by mixing ideas from both. This perspective also promotes a traditional idea of nutrition education focused on actions for changes in individual food behaviors. It features the use of such tools as the food pyramid, the prescription of “light” and “diet” foods with low amounts of calories, fats, and other nutrients, functional foods, fortified foods, and complements based on fiber and micronutrients, and food supplementation associated with a perspective of food’s medicalization 4. Actions such as nutritional labeling increasingly become the object of disputes. The commercial private sector defends the traffic light front-of-package labeling model as the information tool for consumers and contends that classifying individual foods as good/healthy versus bad/unhealthy is reductionist and without a scientific basis 20. It also defends voluntary agreements for reducing components of ultra-processed foods that are associated with unhealthy eating 46. This perspective can promote actions such as regulation of food advertising and practices by the commercial private sector (including industrialization and marketing of pharmaceutical and diet products) as government attributions provided by the policies 6. The perspective promotes industrial mechanisms aimed at processing seeds and foods to increase their nutrient contents, yield, and durability 42, as well as food processing technology 1. |
| Multidimensional: encompasses, to some degree, the nutritional and biological dimensions and sociocultural elements of food practices |
Principles of food culture, ways of preparing foods, commensality, and foods’ health and nutritional quality. Expanded approach to food practices that considers not only food consumption in terms of the amounts and types of foods consumed, but the ways they are prepared and consumed, commensality, and analysis of the set of social, cultural and economic aspects that condition eating. Comprehensive focus that encompasses nutrients, foods, meals, food, and the idea that foods that are considered healthy or unhealthy is not based only on nutritional composition, but on other elements such as environmental impact and food culture. |
This perspective highlights the concept of healthy and sustainable eating 64 that can be found in the PNAN 2011 27, the Dietary Guidelines for the Brazilian Population32, and the Dietary Guidelines for Brazilian Children Under Two Years of Age36, since these documents incorporate, in the discussion of healthy eating, elements pertaining to the environment, culture, commensality, and food practices. The guidelines thus move between the multidimensional approach and the systems approach by mixing ideas present in both. A recent technical document by Food and Agriculture Organization of the United Nations and World Health Organization 64 also reinforces this multidimensionality produced by the sustainability agenda, and from the global perspective, the processes of proposing Voluntary Guidelines for Food and Nutrition Systems65,70confirm this tendency promoted since the 2nd International Conference on Nutrition 71. It also features actions in “critical” nutrition education and the concept of food and nutrition education 57. The commercial private sector also draws on certain elements from this perspective by considering, for example, that the obesity epidemic has multifactorial causes and requires considering food culture factors and sedentary living. It indicates lifestyle reeducation as the central pedagogical action, without problematizing its products’ effects on this scenario 23,43. These policies reveal actions that are consistent with this perspective, such as reclaiming the diversity of cultural practices related to eating, regional foods, and culturally situated ways of preparing foods 6. This perspective also backs policies intended to mobilize actions focused on health promotion and adequate and healthy diet through positive actions in the reconfiguration of environments, territories, and cities, aimed primarily at stimulating healthy practices and guaranteeing the adoption of these practices, besides transforming obesogenic environments 13. International documents addressed to the prevention of obesity and NCDs 11,12,49,53acknowledge the need for multisectoral efforts to improve populations’ eating and actions focused on individuals and contexts. |
| Systemic: concept of adequate and healthy eating (based on an integrated analysis of the multiple dimensions of eating) |
Principles of food systems: flows that connect the production, marketing, and consumption of foods that lead to an integrated analysis of these processes. In a two-way process, the ways foods are produced affect marketing and consumption practices. Systems shaped by mechanisms of the flows’ coordination and feedback. Principles of social and environmental sustainability. Food and nutrition security, from the analytical point of view, assumes an interdisciplinary perspective, and in the political sphere, an intersectoral and socially participant dynamic in the formulation and implementation of actions 3. Principle of adequacy according to the concept of the human right to adequate food that assumes “adequate” diet not limited to a minimum package of specific nutrients but encompassing social, economic, cultural, climate, and technical conditions in addition to the sustainability perspective. Food sovereignty. |
This perspective features the concept of food and nutrition education 57, consistent with the concept of food and nutrition security, which is based on the elements of the systems approach. These elements can also be found in the final report by the Working Group of the CONSEA, which presents a definition of adequate and healthy eating 30 and in the “Real Food Manifesto” and the movement in dialogue with organized civil society in food and nutrition security towards broader participation by Brazilian society. The Manifesto translates into daily images and situations the meaning of healthy eating and presents the essential measures for it to be accessible and affordable for everyone. The different meanings and dimensions of healthy eating are presented with their determinants and the conditions for collaborative actions, principally addressed to reducing inequalities in Brazil for healthy eating to be a reality 56. This perspective highlights actions in the regulation of food systems in the broadest scope, including regulation of pesticides, food advertising, and practices by the commercial private sector, aimed at a transition to fair, sustainable, and healthy food systems, considering that adequate and healthy eating results in socially and environmentally sustainable food systems and strengthens them 28,32,36,55,58. The National Policy on Food and Nutrition Security 28 and the 1st72 and 2nd55 National Plans on Food and Nutrition Security provide for intersectoral actions and promotion of family and organic farming as well as agroecology as paths for transformation of food systems toward the guarantee of adequate and healthy eating and the human right to adequate food. Likewise, the National Pact for the Promotion of Healthy Eating 58 provides for linkage and synergies in a set of actions that include strengthening of sustainable food systems, reduction of critical nutrients in processed and ultra-processed foods, regulation of food environments, and marketing strategies and actions in food and nutrition education. |
Reflections on ideas and disputes in the context of the promotion of healthy eating