Envisioning environmental equity: climate change, health, and racial justice.

Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action.

Racism, xenophobia, and discrimination: mapping pathways to health outcomes.

Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.

Exposure to ultra-processed foods during pregnancy and ultrasound fetal growth parameters.

Periconceptional maternal ultra-processed food (UPF) consumption impairs embryonic growth. Impacts of exposure to UPF on distinct components of fetal growth in late pregnancy are unknown. We investigated the influence of frequency of UPF consumption during pregnancy on fetal head circumference (HC), abdominal circumference (AC) and femur length (FL). This study included 417 live-born singleton pregnancies prospectively followed-up since the antenatal period in the MINA-Brazil Study, with an available ultrasound scan at >24 gestational weeks. Frequency of food groups consumption in the previous month was categorised as no/monthly, weekly or daily. Ultrasound scans were conducted at 27·8 (sd: 1·7) gestational weeks. HC, AC and FL z-scores were calculated for gestational age using the INTERGROWTH-21st Project standards. Simultaneous-quantile regression models were fitted at the 10th, 50th and 90th percentiles of the distribution of each ultrasound parameter according to UPF consumption, with adjustment for potential confounders. Participants were aged on average 24·7 (sd: 6·5) years, 44·8 % were primiparous, and 26·9 % and 24·9 %, respectively, had weekly and daily UPF consumption. Compared with no/monthly intake, daily UPF consumption impaired HC across its distribution, with significant effect sizes varying from -0·24 to -0·40 z-score. Weekly UPF consumption decreased HC at the 90th percentile by -0·39 z-score (95 % CI: -0·78, -0·01) and FL at the 50th percentile by -0·32 z-score (95 % CI: -0·60, -0·04). No association was noted with AC. Frequency of UPF consumption was negatively associated with skeletal components of fetal growth in late pregnancy. Infant body composition may benefit from healthy food practices since pregnancy.

Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach.

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 behavior-change 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. CONCLUSIONS: This study provides the blue-print for the phase-wise development of messages that synthesize the key recommendations of the food-based BDG and communicate the adoption of behaviors and goals that are consistent with it's message. It details methods which could be adapted and replicated for message development in other contexts.

"Macho food": Masculinities, food preferences, eating practices history and commensality among gay bears in São Paulo, Brazil.

This article describes and explore eating practices and food preferences among gay men who call themselves bears in São Paulo, Brazil, and their relation with their life history, masculinities representations, and sexuality. It is a qualitative and quantitative research within an ethnographic perspective. A purposive sample of thirty-five self-declared gay bears. The data were analyzed identifying the regular, expressive and meaningful significance units collected through the interviews. We identified that the self-declared bears in São Paulo, Brazil, build a solid relation between food preferences, eating practices, masculinity, and group belonging. From the bear's perspective, meat, especially bovine, is related to masculinity and extensively understood as a strong common bond within the community, leveraging their sexuality. For these persons, eating meat as well as drinking beer can build the ideal mannish and unfeminine body that is overvalue. Being gay and "eating like a man," as well as exposing a "macho" body while disdaining other body types constructions could represent a strategy to avoid discrimination, shame and humiliation. On the other way, this community does not just linearly imitate heterosexual men although their conducts can reproduce patriarchal representations and meanings through eating practices. These findings could be used to understand the complexity of alimentary practices, particularly food preferences as well as commensalities, among specific communities or membership groups.

Comparing the ways a sample of Brazilian adults classify food with the NOVA food classification: An exploratory insight.

The aim of this study is to have an exploratory insight on how a sample of Brazilian adults classify food, attempting to identify the main factors involved in this process, and to compare these classifications to the NOVA food classification of the 2014 Brazilian dietary guidelines. An exploratory and qualitative approach was conducted with a selected sample of teachers, administrative technicians, and students (N = 24) from the Federal University of Grande Dourados, Brazil. First, using the pile sort method, participants were asked to freely classify 24 pictures of food (sourced from examples of the four food groups specified in NOVA) into food groups meaningful to them. Next, in semi-structured interviews, participants were asked to describe the food groups they created. The food groups created by participants were analyzed using non-metric multidimensional scaling followed by hierarchical cluster analysis, and the interviews were analyzed using content analysis. Participants had a mean age of 30 (±9.4) years. A total of 128 food groups were created by 24 participants (an average of five food groups per person); and a total of 55 non-mutually exclusive groups names were used by them to describe these food groups. Sixteen themes emerged from the content analysis. The most recurrent themes were food groups, nutrients, foods I consume, foods I do not consume, and food processing. Contrasting themes such as real food and junk foods, meals and ready-made foods, healthy foods and unhealthy foods were also noted. Six clusters emerged from the cluster analysis, each related to one or more themes. Overall, a striking similarity was observed between the ways the individuals classified food and the NOVA food classification.

Representations of Syrian food by Syrian refugees in the city of São Paulo, Brazil: An ethnographic study.

The civil war in Syria began in 2011 and there is currently no prospect of resolution. This has led to an intensive forced migration. Due to the agile Brazilian policy of issuing visas, the Syrians became the largest group of refugees living in Brazil. Although migration might have a significant effect on eating practices, there are no studies analyzing eating practices, including the sociocultural representations of these practices to Syrian refugees. Thus, we aimed to analyze the representations of what is Syrian food for Syrian refugees who have Syrian food-based enterprises in the city of São Paulo. We conducted a qualitative study, with ethnographic design, using semi-structured interviews and participant and non-participant observation. The ten participants were of Syrian nationality; have taken refuge in Brazil since 2011 and had some type of enterprise with Syrian food in the city of São Paulo. We obtained seven themes that encompassed the native and meaningful category of Syrian food: 1) variety; 2) the hand that makes the food had to be Syrian; 3) ingredients; 4) the food presentation; 5) social preference for omnivorism; 6) labor and; 7) connection with the nuclear and extended family. In Brazil, as refugees, the Syrian food made them 'feel at home' and seemed to become a point of reference and a bridge, allowing them to continue perceiving and recognizing themselves as Syrians.

Eating practices among low-income overweight /obese Brazilian mothers: a Bourdieusian approach.

We investigated the eating practices of socially vulnerable overweight and obese Brazilian mothers, exploring the relationships between eating practices, capitals, fields and excess-weight. We conducted a qualitative study involving in-depth interviews of 21 women living in three vulnerable urban regions. Content analyses were performed and codes were used to locate actors in relation to each other in terms of 'capitals' and 'fields', forming a typology based on Bourdieu's theory with five groups. Socioeconomic conditions during childhood and liking to cook were the main characteristics related to each group's distinct eating practices. While socioeconomic conditions during childhood were related to region of origin and food tastes, liking to cook worked as a type of cultural capital, called culinary capital, which produced pleasure and status. For each pattern of eating practices, different factors seemed to contribute to participants' excess weight, including liked foods, enjoying cooking, and financial constraints. One group combined a highly vulnerable economic situation and health problems, shedding light onto a habitus that demands special attention from public health studies and interventions. This study illustrates the complexity of practices within a seemingly homogeneous group and reinforces that health studies should not assume homogeneity within a group of overweight/obese low-income women.

Strategies used by overweight and obese low-income mothers to feed their families in urban Brazil.

OBJECTIVE: To describe and compare strategies adopted by overweight and obese low-income mothers living in different vulnerable contexts to deal with food constraints and feed their families. DESIGN: Qualitative in-depth interviews. Data were analyzed with exploratory content analysis and the number of segments per theme was used to compare neighborhoods. SETTING: Three low-income neighborhoods in Santos, Brazil. PARTICIPANTS: A purposive sample of 21 overweight or obese mothers. RESULTS: We identified three main types of strategies, namely, food acquisition, cooking, and eating. Food acquisition included social support and food-sourcing strategies. Social support strategies ranged from macro (governmental programs) to micro (family) levels. Food-sourcing strategies involved price research and use of credit to buy foods. Cooking approaches included optimizing food (e.g., adding water to beans), avoiding wastefulness, and substitutions (e.g., using water instead of milk when making cakes). Eating themes ranged from lack of quantity to lack of quality. Strategies to deal with the lack of food were affected by family dynamics, such as prioritizing provision of fruits to children. Food choices (e.g., low consumption of fruits and high consumption of fatty meats) derived from strategies may help promote overweight and obesity. Furthermore, for participants, financial constraints were perceived as barriers to following nutritionists' recommendations and weight loss. CONCLUSIONS: This study highlights the barriers that low-income women face in adopting a healthy diet and sheds light on the importance of the symbolic value of food, even in the context of food insecurity. Finally, it suggests that environmental aspects could increase the accessibility to fruits and vegetables. These findings could be used to inform the planning and implementation of interventions.

The design and rationale of an interdisciplinary, non-prescriptive, and Health at Every Size®-based clinical trial: The "Health and Wellness in Obesity" study.

BACKGROUND: This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS: This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS: The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).

Development and Implementation: B'More Healthy Communities for Kid's Store and Wholesaler Intervention.

Higher rates of obesity and obesity-related chronic disease are prevalent in communities where there is limited access to affordable, healthy food. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment including food wholesalers and corner stores to improve the surrounding community's access to healthy food. The objective of this article is to describe the development and implementation of BHCK's corner store and wholesaler interventions through formal process evaluation. Researchers evaluated each level of the intervention to assess reach, dose delivered, and fidelity. Corner store and wholesaler reach, dose delivered, and fidelity were measured by number of interactions, promotional materials distributed, and maintenance of study materials, respectively. Overall, the corner store implementation showed moderate reach, dose delivered, and high fidelity. The wholesaler intervention was implemented with high reach, dose, and fidelity. The program held 355 corner store interactive sessions and had 9,347 community member interactions, 21% of which were with children between the ages of 10 and 14 years. There was a 15% increase in corner store promoted food stocking during Wave 1 and a 17% increase during Wave 2. These findings demonstrate a successfully implemented food retailer intervention in a low-income urban setting.

Eating at the table, on the couch and in bed: An exploration of different locus of commensality in the discourses of Brazilian working mothers.

BACKGROUND: Commensality is a remarkable human act, and tends to be more present among families. Nevertheless, it is possible that eating at the table is being taking for granted when one refers to family meals. Thus, this paper aims to analyze working mothers' discourses about family meals eaten at the table, on the couch and in the bed/bedroom. METHODS: The participants were thirty mothers working in public universities of the Brazilian region called Baixada Santista. A qualitative study was conducted, using semi-structured interviews. In the transcripts the words "table", "couch", "bed", "bedroom" were located and the excerpts containing them were extracted and analyzed according to a classical and exploratory content analysis. RESULTS: The table is a significant component of meals that unite the family. While for some the meal at the table is an enjoyable moment, it is a stiff moment for others. Indeed, manners and the notion of hierarchy appeared only for the table. Regarding the couch, it seems that the family chose to eat there, because it is a more casual and relaxed setting. Eating in the bed was related to precarity, intimacy and casualness. In the three settings, watching television was a common practice, replacing or being added to talking. CONCLUSIONS: Commensality is such an important practice that appears in different settings and even in precarity contexts. The table emerged as the maximal cornerstone of commensality. However, when it was not present, new arrangements were made. Especially the couch seems to be a new commensal space, less formal and rigid, but able to allow some collective conviviality. Eating in the bed was a less common practice. Finally, the significant role that television assumed in meals is highlighted.

Eating practices and habitus in mothers. A Brazilian population-based survey.

A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered 'nutritionally proper' to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus.

Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study.

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/m2) 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 (ß = 0.83, p <0.001), fasting glycemia (ß = 0.45, p = 0.036), total cholesterol (ß = 1.48, p = 0.024), LDL (ß = 1.33, p = 0.012), clustered cardiometabolic risk (ß = 0.18, p = 0.006), and quality of life (ß = -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.

Food Classifications by Brazilian Amazon Mothers: Interactions With Eating Practices.

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.

Choosing a front-of-package warning label for Brazil: A randomized, controlled comparison of three different label designs.

INTRODUCTION: Warning labels (WLs) are the newest paradigm of nutrient-based, front-of-package labels (FOP) that have been consistently shown to be more effective at informing consumer purchases than other FOP labels. Their effectiveness may be attributed to their design and the consistency in the information they communicate. The present study assessed designs effects of WLs in improving understanding and perceptions among 2419 Brazilian adults. METHODS: Participants were randomly assigned to one of four study arms in an online, randomized, controlled experiment: (1) the Triangular WL 'A lot of /Muito' (Muito); (2) Triangular WL 'High in/Alto em' (Alto); (3) the Chilean WL 'High in/Alto em' (Chile); and (4) a control condition (no WL). Participants responded to a series of questions, while viewing images of 9 products, that assessed their understanding of the nutrient content of the product, its healthfulness, and their intentions to purchase. All aggregate differences in responses between study arms were estimated using oneway-ANOVAs. RESULTS: WLs were superior to the list of ingredients and the nutrition facts panel in improving participant understanding and perceptions of the nutrient profile of products, particularly in helping identify nutrients in excess. Alto was significantly better than the control at identifying which of the two products contained an excess of nutrients and at improving consumer understanding of nutrient content across different indicators. Alto, followed by Muito, was also better at communicating that fewer WLs signified a healthier product. The Muito WL was significantly more visible to participants than the Chile WL. There were no differences between study arms in shifting consumer purchase intentions. CONCLUSIONS: In this study, WLs were an important addition to the current nutrition label. The triangular symbol, the white background and the signal word, 'High in/ Alto em' showed consistently better results than the signal word 'A lot of/ Muito' and the octagonal symbol. These design elements serve to make WLs more visible to consumers, capturing their attention and informing their food evaluations, and may have greater potential to influence appropriate for a Brazilian audience.

Consumers' opinions on warning labels on food packages: A qualitative study in Brazil.

This study aimed to assess consumers' uses of and opinions on the current Brazilian food label and their reaction to the introduction of a front-of-package warning label. We conducted 12 focus groups among a diverse sample of adult consumers, to broadly assess: (1) uses of and perceptions about the current food label, and (2) opinions about implementing a front-of-package warning label to guide food purchases. Data was analyzed with a triangulation of researchers using an exploratory content analysis, which allowed codes to emerge from the data. The frequency of codes across focus groups was compared by gender and socioeconomic status to explore differences by these sociodemographic factors. Codes were divided into six main themes: (1) "Reasons for using food labels"; (2) "Barriers to using food labels"; (3) "Requirements for a new label"; (4) "Perceived influence on consumption behaviors"; (5) "Perceived influence on child behaviors"; and (6) "Perceptions of the food manufacturers using of warning labels". Participants used food labels to check nutrient content and ingredient information but the format of these labels and the technicality of the content displayed often made the information inaccessible, particularly for those with low socioeconomic status. Most participants were supportive of the display of front-of-package warning labels on products and considered them useful to inform purchases. Women believed that they and their children would reduce the consumption of foods with front-of-package warning labels, while men reported more polarity in their intentions. For men and their children, front-of-package warning labels would result in either stopping food intake entirely or continued consumption without changes to the amount. The study results highlight the potential of front-of-package warning labels to support healthier behaviors in both consumers and their children.

Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach.

INTRODUCTION: Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. OBJECTIVE: We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DESIGN: The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. PARTICIPANTS: Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. RESULTS: Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. CONCLUSION: HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.