Healthy eating through the eyes of adolescents: A qualitative analysis of messages from the Dietary Guidelines for the Brazilian Population

CHAGAS, Carolina Martins dos Santos; BOTELHO, Raquel Braz Assunção; TORAL, Natacha

doi:10.1590/1678-98652018000600007

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • Rev Nutr 31 (6) • Nov-Dec 2018 • https://doi.org/10.1590/1678-98652018000600007 copy

Healthy eating through the eyes of adolescents: A qualitative analysis of messages from the Dietary Guidelines for the Brazilian Population

Alimentação saudável na ótica de adolescentes: uma análise qualitativa das mensagens do Guia Alimentar para a População Brasileira

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the interpretation by adolescents of messages contained in the Dietary Guidelines for the Brazilian Population.

Methods

Qualitative study of adolescents distributed across “conversation circles”. Each group received messages about healthy eating from the Dietary Guidelines and was instructed to develop materials containing their own interpretation thereof, using appealing wording and format. Content analysis was then used to evaluate these materials.

Results

Presentation of the produced materials revealed a focus on placing the participants at the center of the process and highlighting the dynamic and innovative nature of each strategy. Corpus analysis identified three clusters of meaning: (I) Food classification and selection model: The participants showed comprehension of the different formulations of foods and their impacts on health, but using other terms. A reductionist understanding of the composition of a healthy diet was observed; (II) Environment and eating practices: the environment was characterized as conducive or not to healthy eating, and open-air markets were recognized as spaces for healthy choices. Creating recipes was judged a wise choice to be shared; and (III) Diet-related individual and collective wellness: consequences of unhealthy food intake were linked to physical and emotional well-being. Concerns were raised about the use of natural resources and the impact of pesticides on individuals and the environment.

Conclusion

To facilitate understanding of the Dietary Guidelines, the wording of its messages must be adapted, and the discussion about healthy eating and proper diet must be broadened to ascribe greater value to the act of cooking in this population.

Keywords
Adolescent; Food Guide; Healthy Diet; Qualitative Research

Messages	Additional concepts
Step 1 (part 1). Make unprocessed or minimally processed foods the foundation of your diet	Variety

Unprocessed or minimally processed foods, when consumed with variety and largely of vegetable origin, are the foundation of a nutritionally balanced, flavorful, culturally appropriate diet and promote a socially and environmentally sustainable food system.	Concept: no food alone, other than breast milk, gives humans the amount of nutrients their body needs in the proper proportion. Therefore, it is necessary to combine unprocessed foods of vegetable and animal origin (less of the latter). This means: a) A variety of food groups: fruits, nuts, grains, meats, and others; b) Variety within each food group: (1) banana, strawberry, oranges; (2) beans, lentils, chickpeas; (3) rice, potatoes, cassava; (4) meat, fish, eggs.

	Culturally appropriate diet

	Concept: a diet that values the eating culture and traditions of the region. Examples: Rice and pequi in Goiás; cassava meal and acai in the Amazon region; rice and jambu in Pará.

Step 1 (part 2). Make unprocessed or minimally processed foods the foundation of your diet	Socially sustainable food system

Unprocessed or minimally processed foods, when consumed with variety and largely of vegetable origin, are the foundation of a nutritionally balanced, flavorful, culturally appropriate diet and promote a socially and environmentally sustainable food system.	Concept: a food production system that promotes social justice, such as: exploitation-free working condition; farmers free to use fertilizers or refrain from using them; equality in work and income opportunities; fair distribution of profits; fewer middlemen.

	Environmentally sustainable food system

	Concept: a food production system that promotes environmental protection, such as through: use of organic fertilizers; use of non-genetically modified seeds; biological pest and disease control; waste treatment; less distance between growers and consumers; less water and power required for food production.

Step 2. Use oils, fats, salt, and sugar sparingly when seasoning and cooking and preparing foods	Moderation

Oils, fats, salt, and sugar, when used in moderation in culinary preparations that contain unprocessed or minimally processed foods, can diversify one’s diet and make it more flavorful without making it nutritionally unbalanced.	Concept: oils, fats, salt, and sugar are foods rich in nutrients that can be harmful to health because they increase the risk of heart disease, dental caries, obesity, and other diseases. *When reducing the amount of salt, it is important to use natural seasonings that enhance flavor instead, including garlic, onion, pepper, parsley, and chives.

	Culinary preparations

	Concept: culinary preparations are dishes made in home kitchens, cafeterias, or restaurants by mixing unprocessed or minimally processed foods and ingredients (oils, fats, salt, sugar, herbs, vinegar etc.). Examples: rice; beans; fruit juice; stir-fried vegetables; fried eggs; soup; broths; homemade sweets, breads, cakes, and cookies; and homemade pasta (from wheat flour and water alone).

Step 3. Limit your intake of processed foods	Processed foods and their negatively affected nutritional composition

The ingredients and methods used making processed foods have a negative effect on their nutritional composition. In small amounts, they can be consumed as ingredients in culinary preparations or as a part of meals containing unprocessed or minimally processed foods.	Concept: although processed foods retain the basic identity and most of the nutrients of the original food (e.g., canned corn), the addition of salt or sugar – usually in very large amounts – turns the end product into a source of nutrients associated with heart disease, obesity, and other diseases.
	Processed foods as ingredients in culinary preparations

	Examples: Homemade jerky and beans; eggplant stuffed with canned sardines; a wheat-flour cake with candied fruit in the batter.

	Processed foods as a part of meals containing unprocessed or minimally processed foods

	Examples: Homemade macaroni with cheese; tomato salad garnished with canned corn.

Step 4 (part 1). Avoid ultra-processed foods	Ultra-processed foods and their unbalanced composition

Because of their ingredients, ultra-processed foods are classified as nutritionally unbalanced. Their composition and presentation lead to excessive intake and replacement of unprocessed or minimally processed foods. The way in which they are made, distributed, commercialized, and consumed have negative effects on culture, social life, and the environment.	Concept: ultra-processed foods are made by large-scale industries. Their manufacturing process involves many stages and many ingredients (salt, sugar, oils, fats, and industrial substances). Some characteristics include: (a) the ingredients of ultra-processed foods are high in fats and/or sugars; (b) they have a high sodium content necessary to extend the product’s shelf life, improve its flavor, or hide unpleasant tastes; (c) use of vegetable oils rich in saturated, hydrogenated, and trans fats is common; (d) they are poor in fiber, vitamins, and minerals. All of these factors can facilitate development of heart disease, diabetes, and several types of cancer.

	Ultra-processed foods and excessive intake

	- Ultra-processed foods “trick” our body’s inner workings so that we take longer to feel full or don’t feel full at all after eating them.
	- They are “hyperpalatable”: with the “aid” of sugars, fats, and salt, ultra-processed foods are engineered specifically to make them extremely tasty and lead to dependence.
	- They promote unmindful eating: ultra-processed foods can be eaten anywhere; in the street, while driving, while walking – and don’t need plates, knives, forks, or tables. This makes it harder for the body to “record” that calories are being consumed.
	- They are supersized: as their ingredients are so cheap, ultra-processed foods are commonly sold in supersized containers at only a slight price premium over “normal” - sized products. This increases the risk of inadvertent overeating.
	- Liquid calories: sodas, juice cocktails, and other ready-to-drink beverages lead to excessive intake because our bodies have a harder time “recording” the calories provided by sugar-sweetened beverages.

Step 4 (part 2). Avoid ultra-processed foods	Ultra-processed foods have a negative effect on culture

Because of their ingredients, ultra-processed foods are classified as nutritionally unbalanced. Their composition and presentation lead to excessive intake and replacement of unprocessed or minimally processed foods. The way in which they are made, distributed, commercialized, and consumed have negative effects on culture, social life, and the environment.	- The branding, packaging, labels, and content of ultra-processed foods tend to be identical worldwide.
	- The best-known brands are promoted by aggressive advertising campaigns, which often include launching hundreds of products to create a false sense of diversity.
	- Under the onslaught of these campaigns, indigenous food cultures tend to be seen as uninteresting, especially by youth.
	- The consequence is a desire to consume more and more so that people feel they are part of a modern, superior culture.

	Ultra-processed foods have a negative effect on social life

	- Ultra-processed foods are engineered and packaged so they can be consumed anytime, anywhere, with no need for any preparation. Their use makes food preparation, eating meals at the family table, and sharing food completely unnecessary.
	- They are often eaten at random times, in front of a television set or computer, while walking or driving, while on the phone, and in other settings of relative isolation.
	- The “social interactions” usually displayed in ads for these products belie this reality.

	Ultra-processed foods have a negative effect on the environment

	- Piles and piles of ultra-processed food containers and packages are discarded, and many are not biodegradable, thus requiring new spaces and technologies for waste management.
	- High demand for sugar, vegetable oils, and other raw materials widely used in manufacturing ultra-processed foods encourages monocultures which are dependent on pesticides, intensive fertilizer use, and massive irrigation, to the detriment of a more diverse agriculture.
	- The manufacturing, distribution, and commercialization flows of ultra-processed foods involve long-haul transport, which means massive power consumption and pollution.
	- Huge amounts of water are used at each of the many stages of manufacturing ultra-processed foods.

Step 5. Eat regularly and mindfully, in appropriate settings, and, if possible, not alone	Settings that do not encourage unlimited eating

Try to have your meals at the same time every day, and avoid “snacking” between meals. Eat slowly and enjoy what you’re eating; don’t engage in another activity. Try to eat in a clean, comfortable, quiet place which does not encourage you to eat unlimited amounts of food. Avoid eating alone if possible; eat with relatives, friends, coworkers, or classmates. Having someone keep you company during meals facilitates regular, mindful eating, goes well with conducive environments, and helps you enjoy what you are eating more. You should also share in the household chores that precede and follow meals.	People tend to eat more than they need when faced with large quantities of food. A good way of avoiding overeating is to help yourself only once or, at least, wait a while before going back for seconds. A second serving often exceeds our actual needs.

	Household chores that precede and follow meals

	Examples: Making shopping lists; organizing the pantry; setting the menu; peeling, chopping, and dicing; doing the dishes and utensils. All of these chores provide opportunities for interactions with your loved ones.
	^* Even if you don’t have many opportunities to exercise your culinary skills, value the act of cooking and encourage the people around you – particularly the youngest – to cook.

Step 6. Shop at markets that offer a varied range of unprocessed or minimally processed foods	Seasonal, locally grown foods

Try to shop at greengrocers, street markets, farmer’s markets, and other places that sell a varied range of unprocessed or minimally processed foods. Prefer seasonal, locally grown produce. Buy organic and ecologically farmed foods whenever you can, preferably from farmers themselves.	Concept: Fruits and vegetables are sold practically year-round throughout the country. However, locally or regionally grown produce that is in season is cheaper, better, and tastier.

	Organic and ecologically farmed foods
	Concept: These are foods of vegetable or animal origin that were grown through the sustainable use of natural resources, are free of contaminants, protect biodiversity, contribute to the fair distribution of fertile land, help create jobs, and simultaneously respect and perfect traditional wisdom and foodways.

Step 7. Develop, exercise, and share culinary skills	Culinary skills

If you have culinary skills, try to develop them and share them, particularly with children and young people, with no regard for gender. If you lack culinary skills, try to acquire them – that goes for men and women. To do so, talk to people who know how to cook. Ask your family, friends, coworkers, and schoolmates for recipes. Read cookbooks. Go online. Take classes, perhaps... but get cooking!	Fresh foods usually need to be selected, pre-prepared, seasoned, cooked, combined with other foods, and presented in the form of a dish before they can be eaten. This takes culinary skills! These skills are developed in every society and perfected and passed down over generations. People who have culinary skills make culinary preparations which taste, smell, feel, and look better. This is essential in determining whether people will enjoy their meals more or less.

Step 8. Manage time well to give eating the space it deserves	Meal-related household chores

Plan ahead for grocery shopping, keep your pantry organized, and make meal plans or menus for the whole week in advance. Share responsibility for all meal-related household chores with the other members of your family. Make food preparation, and the act of eating itself, special times for being together and enjoying things. Reassess your use of time and identify which activities could be rearranged to make room for mindful eating.	Examples: Making shopping lists; organizing the pantry; setting the menu; peeling, chopping, and dicing; doing the dishes and utensils. All of these chores provide opportunities for interactions with your loved ones.

Step 9. When eating out, prefer establishments that serve meals cooked to order	Pay-what-you-weigh (or pay-per-pound) restaurants

When eating out every day, try to patronize establishments that serve fairly priced meals, cooked to order. Pay-what-you-weigh restaurants can be a good choice, as well as cafeterias that serve home-style cooking at school or at work. Avoid fast-food chains.	Concept: Buffet-style restaurants that charge by weight offer a wide, varied range of freshly prepared foods and are usually your best bet when eating out every day.

	Fast-food chains

	Concept: Fast-food restaurants are particularly inappropriate places to eat. In addition to offering few or no unprocessed or minimally processed food options, they are often noisy, uncomfortable places which lead patrons to eat too fast and too much.

The Golden Rule: Always prefer unprocessed or minimally processed foods and culinary preparations over ultra-processed foods.	- Choose water, milk, and fruit over soda, dairy beverages, and cookies.
	- Never choose ready-made food (e.g., instant “soup”, instant “noodles”, TV dinners and frozen meals, luncheon and deli meats) over meals cooked to order (e.g., soups, broths, salads, sauces, rice and beans).
	-.Choose homemade desserts over industrialized sweets.

Sub-categories	Context units
When referring to foods in natura	[...] plants or animals, they don’t go through any other process (G8).
	Natural ones are those obtained directly from plants and animals, and they are healthier (G10).
	Eat fresh food to feel good (G2).

When referring to minimally processed foods	[...] these are foods that have gone through a little processing, which is artificial, before they arrive at our homes (G12).
When referring to minimally processed foods	I recommend you eat more carrots, broccoli, and some healthier foods, like salad, and even some semi-industrialized foods (G14).

When referring to processed foods	[...] manufactured by the industry with the addition of salt, sugar, and oil, they’re not as healthy (G10).
When referring to processed foods	Processed foods are industrialized foods (G1).

When referring to ultra-processed foods	[...] they go through many manufacturing steps, they are less healthy foods (G10). This type of industrialized food [Bfrozen lasagna">frozen lasagna] you eat, a lot of times it’s not very healthy for your body (G14).
	I can’t believe it, did you buy industrialized stuff [Bchocolate and packaged snacks">chocolate and packaged snacks] again? (G15).
	If I keep eating this stuff (soda and sandwich cookies) for the rest of my life, I’ll end up dying in the hospital (G22).
	Ultra-processed foods are like mega-industrialized foods (G1).

Composition of a healthy diet and healthy eating practices	[...] I’m just going to finish seasoning this super salad that has everything that’s green, red, blue, purple, yellow and everything you’re entitled to... with a little salt and pepper, really natural. So, you won’t feel sick again [...] (G14).
	You’ve got to eat corn, papaya, apple, banana (G12).
	You’ve got to eat this (fruit), this is what you should choose. It’s got to be this (G15).
	Leave it off, leave those potato chips; leave it off, that Nutella^®; leave it off, that sausage [...] (G28).

Sub-categories	Context units
Environment and healthy eating practices	Have an apple too, with your sister (G2).
	[...] it’s good to eat at certain times, regular times, in good company, so you’ll eat more carefully and slowly, which is very important; and in places that won’t make you eat more than you want to (G23).
	We must try to avoid frying, [Beat">eat] more baked [goods]... an example, instead of fried chicken, have roast chicken. And instead of salt, we can use natural seasonings, such as parsley, onion, garlic (G27).
	[...] Mrs. Maria started going to an open market near her home, buying healthier foods, and eating a more balanced diet (G30).

Unhealthy spaces	[...] you can have [ultra-processed foods] anytime, anywhere, for example, if you’re driving, you can pick up a snack and eat in your car (G29).
	[Ultra-processed foods] can be consumed anywhere, it’s faster, people usually pick them up because it’s easier, even though they aren’t healthy. [...] they also end up taking away a custom that was great about Brazilian culture, which was for the whole family to gather and eat together. They end up pushing the family apart (G32).
	Taste much better [...] but won’t do me any good (G28).

The act of cooking	Rice, when [...] it’s fresh... everyone eats a bunch (G7).
	We wrote an enigmatic letter to show that cooking is better [...]. Cook, it’s better! Choose healthy foods (G9).
	If you know how to cook, use this gift to help (G7).
	Yeah, our topic says that if you have cooking skills, cook for everyone, young people and teenagers, don’t keep it to yourself. Share it! (G9).
	Having a friend over for lunch... one of them was cooking for the other (G14).

Sub-categories	Context units
Physical wellness	Little food, little food, which made me so fat [...] (G7).
	How about you buy some natural juice which is good for your health [...]. And fatty foods, frozen foods, they’re very bad for your health. They can cause high blood pressure (G6).
	As he ate it [frozen lasagna], he started to feel sick, so his friend decided to take him to the hospital. [...] What are you feeling? It hurts right here [stomach], I feel really bad (G14).
	[Ultra-processed foods] usually increase your odds of having heart problems, health problems, because they’re harmful (G31).

Emotional wellness	If your life’s not healthy, you become a sad person [...]. However, if you are a healthy person, you can be super fashionable, have a super bright life and do exercise. So, you should always be healthy and be a cheerful, happy person [...] (G16).
Emotional wellness	Processed foods aren’t natural, let’s not eat them so we don’t feel sick; let’s eat natural and raise our spirits up high (G20).

Environmental and social sustainability	The packaging [of ultra-processed foods] isn’t biodegradable, it contaminates the environment, pollutes it, and takes time to decompose (G29).
	Natural foods [...] they’re made all-natural, they don’t have pesticides or anything like that, which can hurt the environment as well as ourselves. [BOn the benefits of in natura foods">On the benefits of in natura foods] socially it’s [...] when we’re taking care of the people who are producing our food (G13).
	Mrs. Maria [Bwho bought food at the market">who bought food at the market] helped Mr. John, who was very poor and selling his produce. Ever since, little Julie has had a balanced diet and Mr. John is now able to make a profit, buy medicine and things for his house (G30).

Pontifícia Universidade Católica de Campinas Núcleo de Editoração SBI - Campus II , Av. John Boyd Dunlop, s/n. - Prédio de Odontologia, 13059-900 Campinas - SP Brasil, Tel./Fax: +55 19 3343-6875 - Campinas - SP - Brazil
E-mail: sbi.submissionrn@puc-campinas.edu.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondência para/Correspondence to: CMS CHAGAS. E-mail: <carolina.nutricionista@gmail.com>.