The social construction of competence: Conceptions of science and expertise among proponents of the low-carbohydrate high-fat diet in Finland

Dealing with dissent from the medical ranks: Public health authorities and COVID-19 communication

During a public health crisis like the COVID-19 pandemic, the public health authorities will typically be criticized for their efforts. When such criticism comes from the ranks of medical personnel, the challenge becomes more pronounced for the authorities, as it suggests a public negotiation of who has sufficient expertise to handle the pandemic. Hence, the authorities are faced with the challenge of defending their competence and advice, while at the same time adhering to a bureaucratic/scientific ethos that imposes communicative boundaries. This explorative study analyzes the response strategies used by the Norwegian public health authorities in this regard. A main finding is that the authorities shunned aggressive language and mostly relied on a strategy pointing to well-established values such as proportionality (between the measures and the gravitas of the epidemiological situation) and relevance (the measures should meet the challenge in question).

A Framework for Online Public Health Debates: Some Design Elements for Visual Analytics Systems

Nowadays, many people are deeply concerned about their physical well-being; as a result, they invest much time and effort investigating health-related topics. In response to this, many online websites and social media profiles have been created, resulting in a plethora of information on such topics. In a given topic, oftentimes, much of the information is conflicting, resulting in online camps that have different positions and arguments. We refer to the collection of all such positionings and entrenched camps on a topic such as an online public health debate. The information people encounter regarding such debates can ultimately influence how they make decisions, what they believe, and how they act. Therefore, there is a need for public health stakeholders (i.e., people with a vested interest in public health issues) to be able to make sense of online debates quickly and accurately. In this paper, we present a framework-based approach for investigating online public health debates—a preliminary work that can be expanded upon. We first introduce the concept of online debate entities (ODEs), which is a generalization for those who participate in online debates (e.g., websites and Twitter profiles). We then present the framework ODIN (Online Debate entIty aNalyzer), in which we identify, define, and justify ODE attributes that we consider important for making sense of online debates. Next, we provide an overview of four online public health debates (vaccines, statins, cannabis, and dieting plans) using ODIN. Finally, we showcase four prototype visual analytics systems whose design elements are informed by the ODIN framework.

"Writing nutritionistically": A critical discourse analysis of lay people's digital correspondence with the Swedish Food Agency

This article analyzes lay people’s use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the lexical items and grammar people use when constructing “food” in scientific terms. The findings show how message writers place nutrients at the discursive center. Message writers’ grammatical constructions instrumentalize food and eating. This is reinforced by the message writers’ frequent use of terms that indicate preciseness, such as numbers and amounts. Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation—as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.

Reconfiguring health knowledges? Contemporary modes of self-care as 'everyday fringe medicine'

The contestation of expertise is perhaps nowhere more pronounced than in the field of health and well-being, on which this article focuses. A multitude of practices and communities that stand in contentious relationships with established forms of medical expertise and promote personalised modes of self-care have proliferated across Euro-American societies. Drawing on multi-sited ethnography in three domains - body-mind-spirit therapies, vaccine hesitancy and consumer-grade digital self-tracking - we map such practices through the concept of 'everyday fringe medicine'. The concept of everyday fringe medicine enables us to bring together various critical health and well-being practices and to unravel the complex modes of contestation and appreciation of the medical establishment that are articulated within them. We find three critiques of the medical establishment - critiques of medical knowledge production, professional practices and the knowledge base - which make visible the complexities related to public understandings of science within everyday fringe medicine.

Public Expressions of Trust and Distrust in Governmental Dietary Advice in Sweden

We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and "alternative" evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency's advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.

Giving up sugar and the inequalities of abstinence

Sugar is increasingly supplanting fat as public enemy number one in public health campaigns, and calls for significant reductions in consumption have provided fertile ground for the proliferation of popular texts and services advocating sugar abstention. This article explores three modes of popular sugar abstention (evangelical, experimental and charitable). These vary in chronology, philosophy and the intensity of abstention, but all serve as sites of identity production and self-entrepreneurship for those able to advocate for, and engage with, them. The article argues that these abstention narratives are not only premised on the exercise of social privilege, but that they also necessarily reproduce and sediment those social hierarchies. This is achieved through a combination of nutritionism and healthism, dislocating sugar and its consumption from the vast social, economic and environmental inequalities within which both the consumption of sugar, and the act of giving it up, is made meaningful. (A virtual abstract of this paper can be found at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Newspaper debates on milk fats and vegetable oils in Finland, 1978-2013: An analysis of conflicts over risks, expertise, evidence and pleasure

The study analysed public debates on the association of milk fats, vegetable oils and cardiovascular diseases (CVDs) between 1978 and 2013 in Finland, a country with a decades-long history of public health initiatives targeting fat consumption. The main agendas, conflicts and participants were analysed. The data were collected from the newspaper Helsingin Sanomat and consisted of 52 threads and 250 texts. We identified four themes around which there were repeated, often overlapping conflicts: the health risks of saturated fats, expertise of the risks of fat consumption, the adequate evidence of the risks of fat consumption, and framing the fat question. During the research period, the main arguments of the effects of consumption of fats have remained the same. References to epidemiological and intervention studies and framing of the fat question as a public health issue, have been ongoing, as has the definition of what constitutes genuine expertise. Yet, we also found discontinuities. In the early 2000s new emphases began to emerge: personal experiences were increasingly presented as evidence of the effects of dietary choices on human health, and the question of fat consumption was framed either as one of enjoyment or of a consumers' right to choose rather than only being a public health question. Moreover, new professional groups such as chefs and creative professionals now joined the discussion.

Online weight-loss services and a calculative practice of slimming

This study examines the slimming practice produced by Internet-based weight-loss services and their use. Drawing on theories of practice, the study analyses the script of use that is constructed by the services, and the meanings, materialities and competences that are enacted in their use. Based on 20 semi-structured interviews with women who were users of two Finnish online weight-loss services, the study concludes that the services transform food into quantitative depictions of calories and nutrition. They configure slimmers as calculative agents and slimming as a practice based on incessant recording and monitoring. For online slimmers, the services acted in the double role of a control device with a focus on calorie restriction, and a learning device used to develop a skill of healthy eating. In the latter role, online slimming was hoped to result in an internalisation of a lifestyle change that would make calculation and constant monitoring unnecessary and the services redundant for their users. The results suggest that for its practitioners, online slimming is temporary rather than long-standing, but it may and is expected to act as a mediary in establishing other practices related to healthy lifestyles.

Food choices, perceptions of healthiness, and eating motives of self-identified followers of a low-carbohydrate diet

Background

Low-carbohydrate (LC) diets have gained substantial media coverage in many Western countries. Little is, however, known about the characteristics of their followers.

Objective

The article analyses how those who report following an LC diet differ from the rest of the population in their background, food choices, weight reduction status, as well as food-related perceptions and motives. The data are a part of the Health Behaviour and Health among the Finnish Adult Population survey collected in spring 2012 (n=2,601), covering 15- to 64-year-old Finns.

Results

Seven per cent of the respondents identified themselves as followers of the LC diet. Gender and education were not associated with following an LC diet. The youngest respondents were the least likely to follow such a diet. The LC diet group preferred butter but also vegetables more commonly than the other respondents and were less likely to use vegetable bread spreads. The followers of the LC diet and the other respondents agreed about the healthiness of whole grain, vegetable oils, vegetables, and fruits and berries, and of the harmfulness of white wheat. Compared to the other respondents, the LC diet group was less likely to regard eating vegetable/low-fat products as important, more likely to regard eating healthy carbohydrates, and the health and weight-managing aspects of foods, as important and placed less value on sociability and pleasures connected to food. The results showed varying food choices among the followers of the LC diet: some even reported that they were not avoiding carbohydrates, sugars, and white wheat in their diet.

Conclusions

Planners of nutrition policies should follow-up on new diets as they emerge and explore the food choices and motives of their followers and how these diets affect the food choices of the whole population.