Ylva Mattsson Sydner

Food That Makes You Different: The Stigma Experienced by Adolescents With Celiac Disease

For adolescents with celiac disease (CD), a gluten-free diet (GFD) is crucial for health, but compliance is problematic and noncompliance is common even among those aware of the risks. To better understand their lives with the disease, Swedish CD adolescents were invited to take part in focus group discussions. Data were analyzed for recurrent stigma-related themes across the groups. Adolescents described an awareness of being different from others that was produced by meal appearance and the poor availability of gluten-free food. The GFD often required discussions and special requests, so eating in public had the effect of making an invisible condition visible, and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided negative consequences of stigma, and other strategies were used to reduce the costs of visibility. The results of the study show that the GFD can produce stigma experiences in adolescence, and that dietary compliance (or lack thereof) can be understood in terms of dealing with GFD concealment and disclosure.

Observed dietary intake in adults with intellectual disability living in the community

Background Knowledge is lacking about dietary habits among people with intellectual disability (ID) living in community residences under new living conditions. Objective To describe the dietary habits of individuals with ID living in community residences, focusing on intake of food, energy and nutrients as well as meal patterns. Design Assisted food records and physical activity records over a 3-day observation period for 32 subjects. Results Great variation was observed in daily energy intake (4.9–14 MJ) dispersed across several meals, with on average 26% of the energy coming from in-between-meal consumption. Main energy sources were milk products, bread, meat products, buns and cakes. The daily intake of fruit and vegetables (320±221 g) as well as dietary fiber (21±9.6 g) was generally low. For four vitamins and two minerals, 19–34% of subjects showed an intake below average requirement (AR). The physical activity level (PAL) was low for all individuals (1.4±0.1). Conclusion A regular meal pattern with a relatively high proportion of energy from in-between-meal eating occasions and a low intake of especially fruits were typical of this group of people with ID. However, the total intake of energy and other food items varied a great deal between individuals. Thus, every adult with ID has to be treated as an individual with specific needs. A need for more knowledge about food in general and particularly how fruit and vegetables could be included in cooking as well as encouraged to be eaten as in-between-meals seems imperative in the new living conditions for adults with ID.

Implementing and sustaining dietary change in the context of social relationships.

BACKGROUND Changing to healthier dietary habits is quite difficult to implement and even more difficult to sustain. As the majority of people have some or all their meals with others, it is likely that their social relationships influence the dietary change process and its sustainability. Thus, the aim of this research was to explore and describe experiences of dietary change and its sustainability in the context of an individuals social relationships. METHODS Semi-structured interviews were conducted individually with fourteen individuals who had previously been participants in a 3-month dietary intervention study using a Mediterranean diet. Thematic analysis was used on verbatim transcripts of the interviews. RESULTS Social relationships were the main barrier to sustainability - in particular social relationships within the household where various coping strategies were needed on an everyday basis. Social relationships outside the household were also difficult to manage as dietary change challenged existing traditions and norms of what to eat. The changer was thereby forced to risk social disapproval or to deviate from the diet. CONCLUSIONS Social relationships within and outside the household complicated the accomplishment of healthy dietary changes. Hence, it is important to acknowledge the social context of the changer when dietary change is to be implemented.

Foodwork among people with intellectual disabilities and dietary implications depending on staff involvement

The food provision for people with intellectual disability (ID) in Sweden is organized within their own households. The aim of this study was to describe how foodwork – planning for meals, shopping for food and cooking – is performed in different social contexts in community settings involving people with ID, staff or both. Dietary intake in the main meals in relation to foodwork practice was also studied. Four different foodwork practices could be distinguished. For some participants only one kind of foodwork practice was found, but for most of them two or more different practices. There was a tendency that food items and dishes chosen and used differed depending on what foodwork practice was performed, which, in turn, affected the nutrient intake. More attention needs to be directed to these everyday matters as a means to increase the quality of support in food for people with ID.

Reforming foodservice in elderly care: National actions and local outcomes

AIM The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions. METHODS A survey using a web-based questionnaire about elderly care foodservice targeting all Swedish municipalities (n = 290) was conducted in 2006 and 2013/2014. The questionnaire included the topics: organisation of foodservice, its practice in elderly care and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%). RESULTS The response rate from municipalities was 80% in 2006 and 56% in 2013/2014; 45% participated in both surveys. The results showed increased use of local food policies (P = 0.03) and meal choice (P < 0.001), while access to clinical/community dietitians declined (P = 0.01) between the surveys. In home-help services, daily delivered cook-serve meals declined (P < 0.001) and chilled meals delivered three times a week increased (P = 0.002) between the surveys. City municipalities used private foodservice organisations the most (P < 0.001), and reported reduced use of cook-serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook-serve system (94%) were firmly established. Urban municipalities were placed between the other groups. CONCLUSIONS National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.

Teaching and learning cooking skills in Home Economics : what do teachers for students with mild intellectual disabilities consider important to learn?

Purpose - The purpose of this paper is to explore which elements of cooking skills Home Economics (HE) teachers in schools for students withmild intellectual disability (ID) consider important for ...

Organization, responsibility and practice of food provision in home-help service: An exploratory study among professionals

Purpose – In the home help service, food provision is one common welfare service that involves different professionals at different levels within a social organisation. The purpose of this paper is to examine how different professionals involved in this sector view and describe their work and responsibilities. Design/methodology/approach – A qualitative study was designed based on interviews with 17 professionals representing different positions in the organisation, and an inductive thematic analysis was carried out. Findings – The various professionals’ views of food provision mainly focus on the meal box and other meals seem to receive much less attention. The professionals also illuminated their respective roles within the food provision organisation by means of boundaries and split responsibilities, and expressed a view of food provision as an issue for outsourcing. The restricted manner in which food provision was viewed and described illuminates a risk of food insecurity for dependent people in home...

Dependence and Individualism: The Influence of Modern Ideologies on Older People’s Food Security

Individualism has become a dominant part of modern thinking which means that each and everyone should be responsible for their own lives. This could be exemplified by taking care of health and body by responsible food choice. People are encouraged to be as independent as possible no matter what age a person is. This entails that nobody wants to be dependent of other people which is expressed in many studies among young as well as old people. To become dependent is considered a failure, and perhaps especially among those who are independent. However, because so many more old people live longer, and are diagnosed with for example dementia, become frail or enter widowhood, means many more will need support in later life. The area of food could be seen as particularly problematic since food, eating and meals in everyday life requires a continuous support. However, the studies (by our research group) showed that there is a dilemma in the dichotomy between encouraging independency and managing food in everyday life when need of support. Older free living women struggling to be independent were at risk of being undernourished because they lack the strength to shop for food or cook daily meals. On the other hand, community food services for older people are based on collective solutions, overlooking the needs of the individual. The outcomes of both examples may have implications on people’s food security, which involves not only the availability of affordable and nutritious food but also culturally acceptable food. In this chapter, we aim to discuss food security by analyzing loss of what we call physiological appetite, but moreover the loss of social appetite, from a societal context.

Social aspects of eating events among people with intellectual disability in community living

Abstract Background In Sweden, a process involving the deinstitutionalisation of services and the establishment of community-based settings for people with intellectual disability has meant changes in meal arrangements. In the present study, we focus on the social arrangements of meals in community-based settings. Method Participant observations were used to study the meals as social events for 32 participants, 9 of whom lived in supported living and 23 in group homes. Results Breakfast and dinner were often eaten alone, while lunch at the daily activity centre and the food eaten between meals (snacks) were mostly shared with other people. Meals for participants in supported living were seldom social, and meals for participants in the group homes often hierarchical. Conclusion The participants were often limited in choosing their company at meals, which typically consisted of other people with intellectual disability and staff. If they made such choices, they were dependent upon staff support to realise them.

From nutrients to wellbeing identifying discourses of food in relation to health in syllabi

Abstract Food and health have long had dominant position within the subject of Home Economics (HE) in Sweden. However, what constitutes a proper diet, and how it is associated with a healthy lifestyle changes over time. In this article, a discourse analytic approach combined with a didactic perspective are used as the theoretical frame. The aim is to explore how food in relation to health has been constructed within the syllabus of HE. Six HE syllabi from 1962 to 2011 were analysed. From the results three different discourses were identified and named after their main areas of focus: (i) the medical discourse, (ii) the consumer discourse and (iii) the human ecological discourse. Each discourse represents a different way of constructing food in relation to health, and different representations have dominated over the past fifty years. The construction of food in relation to health is thereby seen in its historical and cultural context according to what this knowledge content includes or excludes.