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1.2. Eating together, a recommendation of the National Nutrition and Health Plan
ОглавлениеSince 2001, France has had a real public policy targeting food, through the Plan National Nutrition Santé (PNNS, French National Nutrition and Health Plan). This initiative, launched by Prime Minister François Fillon in December 2000, had as its general objective “to improve the health status of the population by acting on the major determinant represented by nutrition” (Hercberg 2006). The PNNS materials include food guides, poster campaigns, press articles, support documents and television campaigns. Most of the communication tools are aimed at the general public, but some of the productions are intended for health professionals. The PNNS is intended to be applied in all areas of food consumption, with interventions in schools, health systems, the workplace, neighborhoods and cities, as well as in collective catering. The overall goal of the PNNS is to “contribute to the creation of an overall nutritional environment, facilitating positive choice for the health of consumers” (Chauliac 2011). As a public policy, the PNNS is equipped with evaluation systems to assess the effects of its actions. Thus, it “integrates the regular evaluation of its quantified objectives and, as much as possible, of the actions or measures it implements (effectiveness indicators or process evaluation)”. Its objectives can be summarized in four main points:
– reduce obesity and excess weight among the population;
– increase physical activity and decrease sedentary behavior at all ages;
– improve dietary practices and nutritional intakes, particularly in at-risk populations;
– reduce the prevalence of nutritional diseases.
An assessment of the achievement of these objectives was carried out in 2006–2007 via the Étude Nationale Nutrition Santé (Castetbon et al. 2011), supplemented by the Étude Individuelle Nationale des Consommations Alimentaires (INCA2, National Individual Food Consumption Study (Afssa 2009)), the Baromètre santé-nutrition (Health and Nutrition Barometer) and regional studies (HCSP 2010). These assessments revealed that the objectives had only partially been achieved and that the program needed to be strengthened to continue to promote the desired behaviors (e.g. only a very slight increase in the purchase of fruits and vegetables had been observed) (Hercberg 2006). From this observation, the PNNS2 (2006–2010) emerged.
At the end of the PNNS2, the evaluation report noted that the expected results had not been obtained (particularly in terms of obesity screening (IGAS 2010)). This report recommends, among other things, revising the feasibility of certain objectives, correcting the formulation of certain principles that are sometimes the source of a binary vision of nutrition (“good” vs. “bad” products) and systematically citing the programs with which the PNNS is linked for better coherence between the public policy programs (Menninger et al. 2010). The PNNS is also criticized for not taking sufficient account of local specificities or social groups, which risks stigmatizing certain sectors of the population (Poulain 2006). For example, the PNNS3 includes a special section on overseas territories and emphasizes the importance of social, economic and cultural determinants of diet. This version explicitly emphasizes that it aims to banish “any stigmatization of people based on a particular dietary behavior or nutritional status” from the PNNS (Ministère du travail, de l’emploi et de la santé 2010). The PNNS3 also ensures overall coherence with other national food programs (such as the Programme National pour l’Alimentation (French National Food Program) resulting from the law on the modernization of agriculture and fishing, as well as the Obesity Plan, of which the PNNS is a component (Chauliac 2011)).
From its first version, the ambition of the PNNS was to “take into account the biological, symbolic and social dimensions of the food act” (Chauliac 2011). Thus, “eating well”, a concept that is more encompassing than “nutritionally healthy eating”, takes into account the social dimensions of eating and includes eating together in its program. However, eating together is not explicitly addressed in the evaluation. It is mentioned in the general parts of the reports, such as the preface, the foundations or the objectives of the program, but is not the subject of any explicit recommendations in the same way as there are consumption guidelines for fruit and vegetables, dairy products, etc. Despite this, on the Manger Bouger website, a section asks the question “Why is it important to get together for regular meals?”1. Eating together is therefore a more comprehensive practice of balanced nutrition, and is more in line with a balanced lifestyle. Indeed, eating together is beneficial for several reasons:
– promoting the structuring of meals (starter–main course–dessert), which itself promotes nutritional diversity;
– avoiding skipping meals;
– taking the time to eat (favorable to better digestion and a better perception of the signs of satiation);
– cooking fresh products (healthier than processed products, which are generally saltier, more fatty and less natural).
In France, despite the fact that the conviviality of meals remains central among the discourse of the French population (Mathe et al. 2014), eating together is less and less in line with the evolution of lifestyles, affected in particular by demographic changes (e.g. composition of households, activities of their members) or changes in food supply (e.g. prepared and individualized dishes). The INCA2 study published in 2009, based on data collected in 2006 and 2007, highlights a trend towards a destructuring of eating patterns among the youngest members of society (15–35 years), which has been increasing since 1999.
Similarly, it is clear that the time spent in front of screens and the solicitations of smartphones at all hours of the day and night can interfere with maintaining time to eat together, parasiting the interpersonal relationships essential to conviviality. The INCA3 study (Anses 2017) emphasizes that the time spent daily in front of screens (excluding work time) is constantly increasing, with an average increase over the last 7 years of 20 minutes in children and 1 hour and 20 minutes in adults. As a result, eating together is not self-evident, and more support is needed.
In conclusion, eating together is at the heart of the PNNS’s concerns but is not the subject of accompanying measures, and current lifestyles make it difficult to maintain this practice which contributes to a healthy lifestyle. Faced with this observation, a study of the different practices of eating together and a reflection on the conditions of implementation of these practices are necessary.