Relationship between family functioning and food consumption during a health and social crisis: A COVID-19 study in Chile

The COVID-19 pandemic and government measures have challenged family functioning (FF) and eating behaviors. In non-pandemic scenarios, FF has shown a protective role in diet quality. This study aimed to explore the role of FF in family members' food consumption during the first wave of the COVID-19 pandemic in Chile. We conducted a cross-sectional, non-probabilistic study. Chilean adults (n= 821) answered an online survey based on the Family Adaptability and Cohesion Evaluation Scales (FACES) IV and a scale of food intake perceptions (non-processed and processed food). The survey also included an open space for comments (n= 147). Most participants had a medium or high FF category. Participants with higher FF had a lower risk of decreasing the consumption of non-processed foods (RR= 0.58 for fruits and RR= 0.45 for legumes) and lower risk of increasing processed foods (RR= 0.37 for sugar-sweetened beverages, RR= 0.46 for snacks, and RR= 0.64 for chocolates) when compared to lower FF participants and controlling for per-capita income. Participants commented on changes in FF: some had more conflicts and others were happy to be together during the pandemic. Most participants indicated that they maintained or increased non-processed and processed food consumption compared to the pre-pandemic period. They perceived having the opportunity of eating healthier during the pandemic. However, the stress they suffered produced them to eat unhealthily. Therefore, FF had a protective role in diet quality during the pandemic. Policymakers should consider FF when promoting healthy diets, especially in health crises.

La pandemia por COVID-19 y las medidas gubernamentales han desafiado el funcionamiento familiar (FF) y los hábitos alimentarios. En escenarios no pandémicos, el FF ha demostrado un papel protector en la calidad de la dieta. Este estudio tuvo como objetivo explorar el papel del FF en el consumo de alimentos de los miembros de la familia durante la primera ola de la pandemia de COVID-19 en Chile. Realizamos un estudio transversal, no probabilístico. Adultos chilenos (n= 821) respondieron una encuesta online basada en la Escala de Evaluación de Cohesión y Adaptabilidad Familiar (FACES) IV y una escala de percepción de consumo de alimentos (alimentos no procesados y procesados). La encuesta también incluyó un espacio abierto para comentarios (n= 147). La mayoría de los participantes tenían una categoría de FF medio o FF alto. Los participantes con mayor FF tenían un menor riesgo de disminuir el consumo de alimentos no procesados (RR= 0,58 para frutas y RR= 0,45 para legumbres) y menor riesgo de aumentar los alimentos procesados (RR= 0,37 para bebidas azucaradas, RR= 0,46 para snacks, y RR= 0,64 para chocolates) en comparación con los participantes de FF más bajos y controlando por ingreso per cápita. Los participantes comentaron cambios en sus FF y teniendo más conflictos, aunque algunos estaban felices de estar juntos durante la pandemia. La mayoría de los participantes indicaron que mantuvieron o aumentaron los alimentos procesados y no procesados en comparación con el período pre-pandemia. Ellos percibieron tener la oportunidad de comer más sano. Sin embargo, el estrés que sufrían les producía comer menos saludable. La FF tuvo un papel protector en la calidad de la dieta durante la pandemia. Quienes formulen políticas públicas deben considerar la AF cuando promuevan dietas saludables, especialmente en crisis de salud.

Adaptation and validation of the Perceived Nutrition Environment Measures Survey for the Chilean context (NEMS-P-Ch)

There is an increasing interest in having validated instruments that can classify food environments due to their influence on eating behavior and nutritional status. In Chile, it is not known how people perceive food environments and only a few studies have adapted instruments to the Chilean context, all of which use objective measures. The aim of this study is to present the adaptation and validation of the Perceived Nutrition Environment Measures Survey (NEMS-P-Ch) for Chile using a cross-sectional, non-probability study. First, the NEMS-P was adapted in 3 stages: cultural translation and adaptation, expert judgment (focus groups), and cognitive interviews with a population similar to the target audience. Then, the adapted questionnaire (NEMS-P for Chile, NEMS-P-Ch) was tested on people responsible for buying food in their homes in the Metropolitan Region, Chile, for statistical validation. After 200 people completed the questionnaire a final version of the NEMS-P-Ch was generated with 48 questions and seven sections that measure food environments: home, food supply, restaurants and street. NEMS-P-Ch had acceptable reliability in more than half of the questions analyzed, with Cronbach's alpha values between 0.44 and 0.82. Acceptable values were also obtained for most of the questions when the consistency of the instrument was evaluated after applying it for the second time (n= 167). The NEMS-P-Ch adapted to the Chilean context showed acceptable validity and reliability. Having instruments adapted and validated to the national reality will promote their use and adaptation in other countries of the region and thus deepen the study of food environments in various territories and populations.

El creciente interés por contar con instrumentos validados que clasifiquen los ambientes alimentarios se debe a la influencia que estos tienen en la conducta alimentaria y el estado nutricional. En Chile, se desconoce cómo las personas perciben los ambientes alimentarios y son pocos los estudios que han adaptado instrumentos al contexto chileno, todos utilizando medidas objetivas. En este estudio se presenta la adaptación y validación para Chile de la Encuesta de Medición del Entorno Nutricional Percibido (NEMS-P-Ch). Estudio transversal, no probabilístico. Inicialmente, NEMS-P fue adaptado siguiendo 3 etapas: traducción y adaptación cultural, juicio de expertos (grupos focales) y entrevistas cognitivas con población similar a la audiencia objetivo. Luego, el cuestionario adaptado (NEMS-P-Ch) fue testeado en personas responsables de la compra de alimentos del hogar, Región Metropolitana, Chile, para finalmente validarlo estadísticamente. Tras su aplicación a 200 personas, se generó la última versión de NEMS-PCh, instrumento con 48 preguntas y 7 secciones que mide los ambientes alimentarios: doméstico, de abastecimiento, restauración y vía pública. NEMS-P-Ch mostró una confiabilidad aceptable en más de la mitad de las preguntas analizadas, con valores alfa de Cronbach entre 0,44 y 0,82. También se obtuvieron valores aceptables en la mayoría de las preguntas cuando se evaluó su consistencia al aplicarlo por segunda vez (n= 167). NEMS-P-Ch adaptado al contexto chileno mostró una validez y confiabilidad aceptables. Contar con instrumentos validados a la realidad nacional promoverá su uso, su adaptación en otros países de la región y la profundización del estudio de los ambientes alimentarios en diversos territorios y poblaciones.

Ollas Comunes en Chile. Entendiendo un fenómeno social de organización para enfrentar el hambre durante la pandemia por COVID-19 / Common pots in Chile. Understanding a social phenomenon of organization to face hunger during the COVID-19 pandemic

Fundamentos: La pandemia por COVID-19 ha conducido a una crisis socioeconómica, aumentando lainseguridad alimentaria. Las medidas gubernamentales no han sido suficientes y la comunidad se haorganizado para solucionar sus necesidades alimentarias. En Chile resurgieron las “Ollas Comunes” (OC):organizaciones sociales autogestionadas cuyo propósito es alimentar a miembros de la comunidad ensituación de hambre. El objetivo del estudio es describir los elementos característicos del funcionamiento delas OC en Chile durante la pandemia por COVID-19.Métodos: Estudio descriptivo transversal, que utiliza datos cuantitativos y cualitativos. A través de unformulario online, se recolectó información de 117 OC a nivel nacional.Resultados: En promedio, 9 personas trabajan en las OC, con diferentes tareas. Las OC operabanprincipalmente 3 días a la semana, mayormente en espacios comunitarios en barrios más vulnerables. Los/asvoluntarios/as reconocen que las OC surgen por una necesidad de la comunidad que el gobierno no es capazde atender; las OC promueven la participación social y son una ayuda para la población vulnerable.Conclusiones: Esta investigación podría ayudar a desarrollar políticas públicas que consideren a estasorganizaciones comunitarias y su rol frente a la inseguridad alimentaria, así como aprovechar la capacidad yainstalada por la comunidad. (AU)

Background: The COVID-19 pandemic has led to a socioeconomic crisis, increasing food insecurity.Government measures have not been enough, and the community has organized itself to solve its foodneeds. In Chile, the "Ollas Comunes" (OC) have re-emerged: self-managed social organizations whose purposeis to feed community members in a situation of hunger. The study aims to describe the characteristicelements of the operation of the OC in Chile during the COVID-19 pandemic.Methods: This is a cross-sectional and descriptive study, which uses quantitative and qualitative data.Through an online form, information was collected from 117 OC nationwide.Results: On average, nine people work in the OC, with different tasks. The OC operated mainly three days aweek in community spaces and in the more vulnerable neighborhoods. The volunteers recognized that the OCarose from a community need that the government could not attend to; the OC promoted social participationand helped the vulnerable population.Conclusions: This research could help develop public policies that consider these community organizationsand their role in food insecurity and take advantage of the community capacity. (AU)

Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta / Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. Aim: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. Conclusions: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Derecho a la alimentación: ¿Qué dicen las constituciones de América y el Caribe?

RESUMEN Introducción: Numerosos países de América y el Caribe cuentan con el derecho constitucional a la Alimentación. Chile no cuenta con este derecho constitucionalizado. Objetivo: Describir comparativamente cómo se encuentra explícito el derecho a la alimentación (DA) en la Constitución de los países de América y el Caribe, generando insumos para aquellos países que no cuentan con este derecho explícito, como en Chile. Fuentes de datos: Esta búsqueda se realizó en las plataformas: Seguridad Alimentaria y Nutricional (SAN-CELAC), Derecho a la Alimentación en el Mundo (FAO) y Constitute Project que presenta las constituciones del mundo. Método de revisión: Se realizó una revisión todas las constituciones disponibles de los países independientes de América y el Caribe y de países con territorios dependientes y departamentos de ultramar en la Región. Posteriormente, en aquellos países que presentan el DA de forma explícita en su texto constitucional, se realizó una revisión sobre las características generales del texto constitucional y de los conceptos asociados a la definición del DA, sugeridos por la FAO. La revisión se llevó a cabo entre los meses de junio y septiembre de 2020. Resultados: Del total de los países revisados (n= 42), solo el 40,5% presentó el DA explícito en su texto constitucional. La seguridad alimentaria es el concepto que aparece con mayor frecuencia. Conclusión: La mayor parte de las constituciones acompañan el DA con características de seguridad alimentaria, disponibilidad y accesibilidad, e incluyen alguna forma de judicialización, conceptos que deberían ser incorporadas la nueva Carta Magna de Chile.

ABSTRACT Introduction: Many American and Caribbean countries consider the right to food as constitutional right. Chile does not have this explicit right in the Constitution. Objective: To describe comparatively how the right to food is explicit in the constitutions of American and Caribbean countries, generating inputs for those countries that do not have this constitutional right, such as the case of Chile. Data sources: This research was carried out on platforms: Food and Nutritional Security (SAN-CELAC), Right to Food in the World (FAO) and Constitute Project which presents constitutions of the world. Revision method: A revision was made of all available constitutions of American and independent Caribbean countries, dependent territories and overseas departments in the Region. Subsequently, in those countries which explicitly consider the right to food in constitutional texts, a review of general characteristics and right to food-associated concepts, suggested by FAO, was carried out. The review was carried out between June and September 2020. Results: Of the total of countries reviewed (n= 42), 40.5% presented the right to food in constitutional text. The most frequently associated concept was food security. Conclusion: Most of the revised constitutions accompany the right to food with food safety, availability and accessibility characteristics, and include kinds of judicialization, concepts that should be incorporated into the new Magna Carta of Chile.

Exploring parents' perspectives on feeding their young children: a qualitative study using photo-elicitation in Chile.

OBJECTIVE: Childhood obesity is considered one of the most important public health problems around the world. Chile is currently one of the Latin American countries with a high prevalence of childhood obesity. Given that parents' food parenting practices shape their children's lifelong eating habits, addressing those practices is key to curbing later problems of obesity. However, studies of the influences on Chilean parents' food parenting practices are scarce. Hence, this study explores factors that influence food parenting practices of preschool-aged children in Chile. DESIGN: Qualitative research, using interviews with the photo-elicitation technique. SETTING: Metropolitan Region, Chile. PARTICIPANTS: Twenty-five parents from families recruited from public childcare centres. RESULTS: Through a thematic analysis with an inductive approach, we identified five themes that influence food parenting practices: (1) parents' previous experiences and how they determine their current goals and beliefs; (2) responses to the child's characteristics; (3) the influences of other family members, especially grandparents; (4) parents' nutritional knowledge; and (5) living contexts, especially limited budgets and lack of time. CONCLUSIONS: The study reveals multilevel influences, which converge at the family level, on food parenting practices. A family-centrerd approach that addresses the mentioned influences is necessary to improve the management of the childhood obesity problem in Chile.

[Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal]. / Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta.

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. AIM: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. CONCLUSIONS: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Women's perceptions about changes in food-related behaviours at home during COVID-19 pandemic in Chile.

OBJECTIVE: To explore women's perceptions of changes in specific food habits at home, specifically the food budget and shopping, and food preparation, during the COVID-19 period. DESIGN: Non-probabilistic, exploratory study. Participants completed an online self-administered questionnaire. Perceptions of food habit changes were measured on a five-point Likert scale (strongly disagree to strongly agree). Data analysis was conducted in STATA v16.0. SETTING: Chile. PARTICIPANTS: Adult women between 25 and 65 years old (n 2047). RESULTS: Of the participants, 72 % were responsible for cooking, 69 % for buying food and 85 % for child care. Difficulties in organising and doing food budget works were observed in groups with a lower educational level, lower income and single mothers with children. Younger participants, dependent workers, women from biparental families with children and those in mandatory quarantine perceived more changes in their food shopping and budget management tasks. Participants more educated, with higher income and non-mandatory quarantine perceived to cook and eat healthier. Older participants perceived minor changes in their food preparation tasks at home; in contrast, more educated women and women from biparental families with children perceived more changes. If women were in charge of the kids or grocery shopping, more food environment changes were noticed. CONCLUSIONS: Women perceived changes in their food environments. Some of these changes are perceived worse in the more vulnerable population. COVID-19 presents a challenge for the food system and gender perspectives. This information should be considered in the design of food-related interventions.

Participación social en la atención primaria en salud: tensiones y contradicciones / Social participation in primary health care: Tensions and contradictions

OBJETIVO: Explorar las perspectivas de tomadores de decisiones y miembros de la comunidad en atención primaria en salud (APS) en torno a la conceptualización de la participación social (PS). DISEÑO: Estudio transversal de carácter exploratorio con metodología cualitativas. Emplazamiento: Centros de Salud de la Región Metropolitana (RM), Santiago, Chile. PARTICIPANTES: Ocho informantes del nivel directivo (grupo 1), 13 del nivel de ejecución en APS (grupo 2) y 28 miembros de la comunidad y cuatro agentes comunitarios de salud (grupo 3). MÉTODO: Se realizaron entrevistas y grupos de discusión, que fueron grabados y transcritos. La organización y análisis se realizó con Atlas.ti 8.1. Las narrativas fueron sistematizadas mediante un análisis temático. Se codificó la totalidad de los documentos a través de reuniones periódicas para revisar los códigos existentes y para discutir la inclusión de nuevos códigos. RESULTADOS: El grupo 1 remite concepciones más teóricas acerca de la PS. El grupo 2 expresa dimensiones más concretas y operativas. El grupo 3 indica que la PS se encarna en experiencias particulares, vividas cercanamente por quienes las relatan. Los grupos 1 y 3 poseen más de una noción de la participación social en salud. CONCLUSIONES: Predomina transversalmente una concepción institucional de la participación, arraigada desde la década de 1990. En el nivel de la comunidad, las narrativas adquieren la forma de prácticas colectivas vividas en torno al mejoramiento de la calidad de vida comunitaria mediadas por el nivel de ejecución

OBJECTIVE: To explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS). DESIGN: An exploratory cross-sectional study with qualitative methodology. LOCATION: Health Centers of the Metropolitan Region (RM), Santiago, Chile. PARTICIPANTS: Eight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3). METHOD: Interviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes. RESULTS: Group 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health. CONCLUSIONS: An institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution

[Social participation in primary health care: Tensions and contradictions]. / Participación social en la atención primaria en salud: tensiones y contradicciones.

OBJECTIVE: To explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS). DESIGN: An exploratory cross-sectional study with qualitative methodology. LOCATION: Health Centers of the Metropolitan Region (RM), Santiago, Chile. PARTICIPANTS: Eight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3). METHOD: Interviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes. RESULTS: Group 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health. CONCLUSIONS: An institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution.

¿Es efectiva la entrevista motivacional individual en la malnutrición por exceso? Una revisión sistemática de la literatura / Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review

Objetivo: Analizar la efectividad de la entrevista motivacional (EM) individual en el tratamiento ambulatorio de la malnutrición por exceso. Diseño: Revisión sistemática de literatura con protocolo registrado en PROSPERO con N.° CDR42017058814. Fuentes de datos: EBSCO-CINAHL, Pubmed, Scielo, PsycINFO de 2010 a 2017. Selección de estudios: Se incluyeron estudios con participantes adultos con sobrepeso u obesidad, pertenecientes a estudios aleatorizados controlados y caso-control con EM individual y presencial, con resultados primarios, secundarios o intermedios, incluyendo cambios de composición corporal (peso o IMC). Se incluyeron estudios en inglés o español, con texto disponible y publicados en revistas con revisión de pares. Extracción de datos: Las variables principales fueron antropométricas, conductuales, psicosociales u otras variables de efecto de la EM, además de aquellas variables descriptivas de la intervención. Resultados: Once artículos fueron incluidos en esta revisión. Existe una gran variabilidad entre los estudios respecto a población, tipo de intervención y tiempo de seguimiento. En la mayoría se expresó algún efecto en la reducción de peso corporal, con un máximo de 7 kg en el grupo que recibió la intervención. Se aprecian variaciones en variables mediadoras psicosociales y metabólicas en los estudios. Conclusiones: Las intervenciones individuales de EM tienen un efecto modesto sobre la variación del peso corporal, pero podrían tener buenos resultados en variables conductuales, psicosociales y otras. Más estudios son necesarios para dilucidar la mejor forma de aplicación de EM para tener efectividad en distintas variables. Es aquí donde la atención primaria de salud presenta ventajas para generar investigación en esta estrategia

Objective: To analyze the effectiveness of individual motivational interviewing (MI) in the ambulatory treatment of the overweight and obese. Design: The protocol of this systematic review is registered in PROSPERO N° CDR42017058814. Databases: EBSCO-CINAHL, Pubmed, Scielo, PsycoINFO from 2010 to 2017. Study selection: We included studies with overweight and obese adult participants, randomized trial and case control studies, with MI being applied individually and face to face, with primary or secondary results in changes in body composition (weight or BMI), published in English or Spanish, with available text and in peer-reviewed journals. Data extraction: We obtained anthropometric, behavioral, psychosocial, and other variables as effects of MI. In addition, we collected descriptive variables of the interventions. Results: Eleven articles were included in this revision. There is a great variability between the studies in terms of population, kind of intervention, and time of follow-up. In most of them, some effect was observed in reducing bodyweight, reaching a maximum of 7 kg in the group that received the MI. There are positive variations in psychosocial and metabolic variables in the studies. Conclusions: Individual MI interventions have a modest effect on the variation of bodyweight, and could have a positive impact on behavioral, psychosocial, and other variables. More studies are needed to elucidate the best form of MI application with regard to effectiveness on different variables. The primary healthcare system is in an advantageous position for generating fruitful research on this motivational strategy

Weight Matters-Factors Influencing Eating Behaviors of Vulnerable Women.

Women from low socioeconomic backgrounds are more affected by obesity than men. The influence of weight as a determinant of women's eating behaviors has seldom been studied, especially in Latin America. In this study, we analyzed the food choices of vulnerable women according to their weight status. We conducted photo-elicitation interviews with 31 women from low-income neighborhoods in Santiago, Chile. Weight and height were measured and participants were divided into normal weight (n = 9), overweight (n = 15), and obese groups (n = 7) according to World Health Organization (WHO) body mass index (BMI) categories (p < 0.001). Quantitative and qualitative approaches were used for the analysis. Women in overweight and obese groups described more about their families, temporality, financial issues, and food perception. When weight groups were analyzed separately, more factors explaining eating behaviors were found (mental and physical health, body dissatisfaction, gender role, and obstacles for eating healthy) in the obese group. Results suggest that women with obesity or overweight based their diets on more internal and external factors than did normal weight women. This study contributes to our understanding of why changing behaviors can be difficult in women with obesity. Health care providers should consider these factors in the implementation of programs to address the need for a healthy diet for overweight and obese women.

[Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review]. / ¿Es efectiva la entrevista motivacional individual en la malnutrición por exceso? Una revisión sistemática de la literatura.

OBJECTIVE: To analyze the effectiveness of individual motivational interviewing (MI) in the ambulatory treatment of the overweight and obese. DESIGN: The protocol of this systematic review is registered in PROSPERO N° CDR42017058814. DATABASES: EBSCO-CINAHL, Pubmed, Scielo, PsycoINFO from 2010 to 2017. STUDY SELECTION: We included studies with overweight and obese adult participants, randomized trial and case control studies, with MI being applied individually and face to face, with primary or secondary results in changes in body composition (weight or BMI), published in English or Spanish, with available text and in peer-reviewed journals. DATA EXTRACTION: We obtained anthropometric, behavioral, psychosocial, and other variables as effects of MI. In addition, we collected descriptive variables of the interventions. RESULTS: Eleven articles were included in this revision. There is a great variability between the studies in terms of population, kind of intervention, and time of follow-up. In most of them, some effect was observed in reducing bodyweight, reaching a maximum of 7kg in the group that received the MI. There are positive variations in psychosocial and metabolic variables in the studies. CONCLUSIONS: Individual MI interventions have a modest effect on the variation of bodyweight, and could have a positive impact on behavioral, psychosocial, and other variables. More studies are needed to elucidate the best form of MI application with regard to effectiveness on different variables. The primary healthcare system is in an advantageous position for generating fruitful research on this motivational strategy.

["We eat in this way because ". Understanding eating behaviors of Chilean women of low socioeconomic status]. / "Comemos así porque ". Entendiendo las conductas alimentarias de mujeres chilenas de bajos recursos.

BACKGROUND: The prevalence of obesity is higher in women than in men, especially in those of lower socioeconomic status. It is established that this group tends to have a less healthy diet. AIM: To explore the eating behaviors of low-income Chilean women. MATERIAL AND METHODS: Semi-structured interviews with photo-elicitation were conducted with 31 Chilean women aged 36 ± 6 years, who lived with a partner and had at least one sibling under 12 years of age. The interviews were transcribed and an inductive analysis of the participants' discourses was made. RESULTS: Seven themes were described in relation to their influence on three eating behaviors (food purchase, preparation and intake): Family, preferences, temporality, financial issues, special occasions, perceptions about food, and availability of food. The family exerted a strong influence on the behaviors and had an impact on the other themes encountered. CONCLUSIONS: Eating behaviors were influenced by several factors, both at the personal and environment levels. These factors interacted with each other to produce different forms of behavior modulation. It is therefore problematic to promote healthy eating behaviors while not considering all the influences on this behavior.

"Comemos así porque… ". Entendiendo las conductas alimentarias de mujeres chilenas de bajos recursos / "We eat in this way because… ". Understanding eating behaviors of Chilean women of low socioeconomic status

Background: The prevalence of obesity is higher in women than in men, especially in those of lower socioeconomic status. It is established that this group tends to have a less healthy diet. Aim: To explore the eating behaviors of low-income Chilean women. Material and Methods: Semi-structured interviews with photo-elicitation were conducted with 31 Chilean women aged 36 ± 6 years, who lived with a partner and had at least one sibling under 12 years of age. The interviews were transcribed and an inductive analysis of the participants' discourses was made. Results: Seven themes were described in relation to their influence on three eating behaviors (food purchase, preparation and intake): Family, preferences, temporality, financial issues, special occasions, perceptions about food, and availability of food. The family exerted a strong influence on the behaviors and had an impact on the other themes encountered. Conclusions: Eating behaviors were influenced by several factors, both at the personal and environment levels. These factors interacted with each other to produce different forms of behavior modulation. It is therefore problematic to promote healthy eating behaviors while not considering all the influences on this behavior.

Propuesta de un modelo conceptual para el estudio de los ambientes alimentarios en Chile

[RESUMEN]. Objetivo. Describir una propuesta de modelo conceptual para sistematizar los factores que condicionan los ambientes alimentarios y la forma en que estos se expresan en la conducta alimentaria de la población chilena. Métodos. Estudio realizado en Chile que incluyó cuatro etapas secuenciales e iterativas: revisión de la literatura, apertura de discusión del modelo preliminar, generación de un segundo modelo y nueva discusión con expertos y elaboración de modelo conceptual definitivo. Resultados. Se elaboró un modelo conceptual que incluye cinco ambientes alimentarios interrelacionados, aunque con características distintivas: ambiente doméstico, ambiente vía pública, ambiente institucional y organizacional, ambiente de restauración y ambiente de abastecimiento. Se sitúan al sistema alimentario y a la cultura como las variables más amplias del modelo. Los determinantes sociales de los ambientes alimentarios y alimentación constituyen los factores estructurales e intermedios de estos ambientes. En una relación más directa con los ambientes, se hallan la industria alimentaria y las políticas en alimentación y nutrición. Por último, se incluye al individuo y la cohesión social como parte del modelo, ya que son los individuos o los grupos quienes transitan dentro de los ambientes alimentarios. Conclusiones. Este modelo representa un conjunto de definiciones, conceptos y relaciones que tienen una interacción compleja y multidireccional, por lo que el modelo contribuye a comprender de forma integral el fenómeno de cómo son condicionados los ambientes alimentarios sobre la conducta alimentaria.

[ABSTRACT]. Objective. Describe a proposal for a conceptual model to systematize the factors affecting food environments and the ways in which these factors are expressed in food behaviors in the Chilean population. Methods. Study conducted in Chile, with four sequential and iterative stages: literature review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. Results. A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment. The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments. The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Conclusions. This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

[RESUMO]. Objetivo. Propor um modelo conceitual para sistematizar os fatores que condicionam os ambientes alimentares e como eles são expressos no comportamento alimentar da população chilena. Métodos. Estudo realizado no Chile que compreendeu quatro etapas sequenciais e iterativas: revisão da literatura, abertura de discussão do modelo preliminar, geração de um segundo modelo e nova discussão com especialistas e elaboração do modelo conceitual definitivo. Resultados. Foi elaborado um modelo conceitual que engloba cinco ambientes alimentares inter-relacionados, apesar de terem características distintas: ambiente doméstico, ambiente público, ambiente institucional e organizacional, ambiente de restauração e ambiente de abastecimento. O sistema alimentar e fatores culturais são as variáveis mais amplas do modelo. Os determinantes sociais dos ambientes alimentares e da alimentação constituem fatores estruturais e intermediários destes ambientes. A indústria alimentícia e políticas de alimentação e nutrição têm uma relação mais direta com os ambientes. Por último, são incluídos no modelo os indivíduos e a coesão social, visto que são os próprios indivíduos ou grupos de indivíduos que circulam dentro dos ambientes alimentares. Conclusões. Este modelo representa um conjunto de definições, conceitos e relações com interações complexas e multidirecionais. Ele contribui para compreender como um todo o fenômeno de como os ambientes alimentares estão condicionados ao comportamento alimentar.

[Proposal for a conceptual model for the study of food environments in ChileProposta de um modelo conceitual para o estudo de ambientes alimentares no Chile]. / Propuesta de un modelo conceptual para el estudio de los ambientes alimentarios en Chile.

OBJECTIVE: Describe a proposal for a conceptual model to systematize the factors affecting food environments and the ways in which these factors are expressed in food behaviors in the Chilean population. METHODS: Study conducted in Chile, with four sequential and iterative stages: literature review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. RESULTS: A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment. The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments. The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Conclusions. This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

OBJETIVO: Propor um modelo conceitual para sistematizar os fatores que condicionam os ambientes alimentares e como eles são expressos no comportamento alimentar da população chilena. MÉTODOS: Estudo realizado no Chile que compreendeu quatro etapas sequenciais e iterativas: revisão da literatura, abertura de discussão do modelo preliminar, geração de um segundo modelo e nova discussão com especialistas e elaboração do modelo conceitual definitivo. RESULTADOS: Foi elaborado um modelo conceitual que engloba cinco ambientes alimentares inter-relacionados, apesar de terem características distintas: ambiente doméstico, ambiente público, ambiente institucional e organizacional, ambiente de restauração e ambiente de abastecimento. O sistema alimentar e fatores culturais são as variáveis mais amplas do modelo. Os determinantes sociais dos ambientes alimentares e da alimentação constituem fatores estruturais e intermediários destes ambientes. A indústria alimentícia e políticas de alimentação e nutrição têm uma relação mais direta com os ambientes. Por último, são incluídos no modelo os indivíduos e a coesão social, visto que são os próprios indivíduos ou grupos de indivíduos que circulam dentro dos ambientes alimentares. CONCLUSÕES: Este modelo representa um conjunto de definições, conceitos e relações com interações complexas e multidirecionais. Ele contribui para compreender como um todo o fenômeno de como os ambientes alimentares estão condicionados ao comportamento alimentar.

Facilitadores y obstaculizadores de la estrategia global contra la obesidad “EGO escuelas” en Chile / Facilitators and barriers of the global strategy against obesity “ego-schools” in Chile

Fundamento: “EGO-Escuela” es una estrategia de prevención de la obesidad en escolares de primer año básico que se implementó en Chile en el 2006. El objetivo fue analizar los facilitadores y obstaculizadores de la implementación de la estrategia en tres regiones de Chile. Métodos: Se realizaron grupos focales con directores, profesores y encargados de salud de las escuelas y entrevistas a las encargadas regionales. Este proceso contempló la convocatoria, recolección y trascripción de datos y análisis de la información. Resultados: Entre los facilitadores, los participantes percibieron la estrategia como un cambio real en estilo de vida, percepción positiva del aumento de horas de educación física y la disposición a participar de los directores y encargados de salud. Entre los obstaculizadores, destacó la imposibilidad de insertar un modelo de hábitos para el cuidado de la salud, debido a la competencia con un mercado paralelo de alimentos no saludables que se expenden en el entorno y en la escuela; la falta de continuidad de las actividades desarrolladas y el contexto socioeconómico de las familias. Conclusión: Es necesario que las autoridades consideren los resultados de este estudio para reformular esta estrategia (AU)

Background: “EGO School” is a strategy to prevent obesity among schoolchildren in first grade which was implemented in Chile in 2006. Objective: To analyze the facilitators and barriers of the implementation of the strategy “EGO School” in three regions in Chile. Methods: Focus groups were conducted with principals, teachers and health promoters of schools. Interviews with the regional authorities were also done. This process included calling, data collection, transcription, and analysis of the information. Results: As facilitators are concerned, participants perceived the strategy as a real change in lifestyle. They perceived the increase in hours of physical education as positive. They also perceived as positive the willingness to participate of health promoters and principals. In relation with barriers, participants highlighted the difficulty of inserting a habit model for health care, due to the competition with parallel market unhealthy foods which are sold into the school and its environment. They also complaint about the difficulty to continue with the activities of the strategy. Another problem was the socioeconomic context of families. Conclusions: Authorities need to consider the results of this study to rethink this strategy (AU)