Fernanda Scagliusi | Universidade de São Paulo (original) (raw)

Papers by Fernanda Scagliusi

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a t... more 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.

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morall... more 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.

We examined whether weight loss following HAES ®-based interventions associates with changes in c... more 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/m 2) 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 (β = 0.83, p < 0.001), fasting glycemia (β = 0.45, p = 0.036), total cholesterol (β = 1.48, p = 0.024), LDL (β = 1.33, p = 0.012), clustered cardiometabolic risk (β = 0.18, p = 0.006), and quality of life (β = −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.

(2022): "Because I saw my mother cooking": the sociocultural process of learning and teaching dom... more (2022): "Because I saw my mother cooking": the sociocultural process of learning and teaching domestic culinary skills of the Western Brazilian Amazonian women, Food and Foodways,

Purpose-The authors aimed to triangulate food intake data obtained by two qualitative methods (in... more Purpose-The authors aimed to triangulate food intake data obtained by two qualitative methods (in-depth interviews and participant observations) and one quantitative method (food-frequency questionnaire (FFQ)). The purpose of this paper was to analyze the kind of data each method produced and how these different pieces of information are methodologically related to the characteristics and limitations of different methods used and theoretically connected to participants' identities and masculinities. Design/methodology/approach-The analysis was based on data from an ethnographic study; whose participants were 35 men who self-identified as gay bears. The participants' food intake was investigated through participant observations, in-depth interviews and an FFQ. Findings-The qualitative methods indicated an overconsumption of meat and beer and a rejection of fresh foods, especially fruits and vegetables, as diacritical signs of the bears' identity. The FFQ showed a major consumption of minimally processed food, with fruits and vegetables being eaten more than meat. The authors proposed that the participants have compartmentalized their many habitual intakes and assessed one of them, separately, according to the method used (what was being asked and the context of that moment). Additionally, the authors connected these two patterns of habitual intake to the participants' identities and masculinities, questioning the existence of a constant hegemonic masculinity among this group. Originality/value-The triangulation of methods employed in the present study is seldom addressed in the literature. This approximation provided a rich discussion regarding the connections between eating, sexuality, gender and identity, through a novel methodological and theoretical lens.

This article examines constitutive elements of contemporary domestic cooking practices among wome... more This article examines constitutive elements of contemporary domestic cooking practices among women who live in the urban area of Cruzeiro do Sul, Acre, Brazil. We conducted semi-structured interviews with 16 self-identified women and mothers, who cook at home at least once a day. Here, we offer an in-depth analysis of our qualitative data, having coded our interviews with attention to the elements of cooking practices (i.e., understandings, procedures, engagements, materials, competencies, and meanings). Our findings reveal that cooking practices are not only gendered but also play a vital part in the construction and affirmation of these Brazilian women's identity, as indicated by how they negotiate elements of their domestic culinary practices regarding financial availability (materials), time availability (procedures), sociocultural gender norms (competences), and aspirations and personal desires (understandings). Read from a feminist perspective, we conclude that tensions surrounding the performance of femininity occurred when buying food at the supermarket or participating in the practice of "comprar fiado" in small neighborhood markets; preparing menus to meet familial preferences; preparing meals quickly and with little effort; offering the best foods to her children and husband; and showing affection and appreciation to those they feed.

Objective: To assess how mothers classify foods and how their eating practices interact with thes... more 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.

Weight stigma is reportedly globalizing, but there is limited evidence of how concerns around wei... more Weight stigma is reportedly globalizing, but there is limited evidence of how concerns around weight change are impacting those in many places. Additionally, few studies to date have considered how weight stigma operates in the context of interventions that purposefully eschew from a focus on weight itself. We have used qualitative analysis to examine body acceptance and responses to weight stigma among urban Brazilian gorda women participating in two forms of Health at Every Size ® (HAES ®) interventions: an intensive HAES ® program (I-HAES ® , n=26), which directly addressed weight stigma and a traditional, lessintensive HAES ® program (CTRL, n=13). Individual, semi-structured interviews regarding how participants felt about their bodies were conducted post-intervention. Exploratory content analysis followed an inductive approach. The I-HAES ®-group was more prone to accept their bodies, to feel well-being, to do new things, and to give proactive responses to weight stigma, while the CTRL-group internalized and accepted stigma, reported a lack of body acceptance, and indicated they were less able to challenge stigma in their lives. Interdisciplinary, intensive HAES ® interventions appear able to meaningfully tackle responses to weight stigma and promote body acceptance, important in contexts where stigma is a major component of how women experience their weight.

Although food insecurity configures a public health issue in developing countries going through n... more Although food insecurity configures a public health issue in developing countries going through nutrition transition, there is still lack of evidence on how it is affected by social determinants and its relationship with ultra-processed food (UPF) consumption. Using qualitative methods, we investigated the experience of food (in)security among mothers living in the Brazilian Amazon area, identifying aspects of food insecurity promoting UPF consumption. In-depth interviews were performed with 40 women and inductive content analysis was used. Signs of food insecurity included difficulties in food affordability and irregular access to food. Strategies to deal with lack of food quantity took place during food production (growing foods and raising animals), acquisition (gaining food, shopping incentives and food substitutions) and preparation (creativity in cooking). Not being able to afford staple foods was the main aspect of food insecurity promoting UPF consumption, as fresh foods were substituted by UFP options. Our study contributes to the current literature by presenting explanatory insights about the inconclusive quantitative results on the relationship between food insecurity and UPF consumption. Additionally, it supports the need of policies and interventions focused on promoting sustainable food systems and the regional food culture, which may approach food insecurity through an intersectional perspective.

To investigate the association between food consumption stratified by processing level and cardio... more To investigate the association between food consumption stratified by processing level and cardiovascular risk factors in rheumatoid arthritis. In this cross-sectional study, 56 patients (age: 62.5 ± 7.9 years, BMI: 28.4 ± 5.1 kg/m 2) had food consumption evaluated according to the processing level (e.g., unprocessed or minimally processed foods, processed foods, and ultraprocessed foods) and associated with cardiovascular risk factors. The most prevalent food processing level was unprocessed or minimally processed foods (42.6 ± 12.6% of total energy intake [TEI]), followed by processed (24.2 ± 11.9%TEI), ultraprocessed (18.1 ± 11.8%TEI), and culinary ingredients (15.1 ± 6.4%TEI). Adjusted regression models showed that higher consumption of ultra-processed foods was positively associated with Framingham risk score (β = 0.06, CI: 95% 0.001, 0.11, p = 0.045) and glycated hemoglobin (β = 0.04, CI: 95% 0.01, 0.08, p = 0.021). In contrast, higher consumption of unprocessed or minimally processed foods was associated with lower 10-year risk of developing cardiovascular diseases (β = −0.05, CI: 95% − 0.09, −0.003, p = 0.021) and LDL (β = −1.09, CI: 95% − 1.94, −0.24, p = 0.013). Patients with rheumatoid arthritis consuming more ultra-processed foods showed worse metabolic profile, whereas those consuming more unprocessed or minimally processed foods had lower cardiovascular risks. A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis. Key-Points • Higher ultra-processed food consumption was associated with worse metabolic profile and increased cardiovascular risk, whereas higher unprocessed or minimally processed food consumption was associated with lower 10-year risk of developing cardiovascular diseases. • A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis.

In recent decades, an increase in consumption of ultra-processed foods (UPF), a type of product f... more In recent decades, an increase in consumption of ultra-processed foods (UPF), a type of product frequently associated with diet-related obesity, chronic diseases, decrease of eating traditions and loss of culinary diversity, has been observed in middle-income countries. However, there is lack of information on factors related to choosing UPF. In this study, we aimed to understand the factors promoting UPF choices and consumption among mothers living in an urban context in the Brazilian Amazon, and to present a conceptual model grounded on their experiences that illustrates the dynamics between the observed factors. For this qualitative study, we used a constructive grounded theory approach, with a theoretical sampling of 40 women, to choose mothers with high and low consumption of ultra-processed foods. Data production and the first steps of analysis were performed concomitantly, followed by four steps of coding focused on creating conceptual categories and explaining the interactions between them. Our findings highlighted the importance of context in promoting UPF choice and consumption, particularly the "food environment", physical and virtual, and the "sociocultural environment". These contextual aspects interacted with the two main personal aspects influencing participants' UPF consumption, one concerning practices, "cooking behaviors", and the other concerning preferences, "food tastes". Factors such as economic and time constraints were also important and competed to shape eating practices through interactions with participants' health valorization. Findings are discussed in relation to food choice theories, social roles and the food environment. Implications for public health initiatives include the importance of considering environmental changes, sociocultural and economic influences, the reliance on UPF, and the role of women in the home, when promoting healthy diets.

Objective: To identify and monitor food industry use of political practices during the adoption o... more 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.

Background: Dietary Guidelines are an important tool for population health promotion efforts. How... more 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 behaviorchange 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.