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AN ABSTRACT OF THE THESIS OF Lisa Grabinsky for the degree of Master of Arts in Applied Anthropology presented on May 20, 2020. Title: Current Use of Dietary Guidelines in Private CliniCal Nutrition PraCtiCe and its ImpaCts on the Dietary Patterns of OffiCe Workers in MexiCo City. AbstraCt approved: ______________________________________________________ Emily Yates-Doerr For the last 30 years, the population of MexiCo has grappled with overweight, obesity, and associated ChroniC diseases, such as type-2 diabetes and hypertension. To standardize Care among healthcare providers and dietitians, an offiCial nutritional guideline was published in the early 2000s, whiCh included a non-modifiable food-based dietary guideline in the shape of a plate Called El Plato del Bien Comer (“The Plate of Well Eating”). In the present work I examine El Plato’s Current use among young MexiCan dietitians in their private Consultation with offiCe workers to Consider the impaCt that it is having on dietary patterns in MexiCo City. I draw on partiCipant observation in regular private nutrition Consultations, in depth interviews with five offiCe-worker patients, and a focus group of four MexiCan dietitians using photo-eliCitation, as well as in depth interviews with two nutrition experts who helped to develop guidelines. I illustrate the diversity in Consultation styles and health education tools among the dietitians who have been mandated to use El Plato. I also desCribe the divergence in patient’s “CorreCt” eating praCtiCes, whiCh varied greatly between the weekdays and weekends. The thesis highlights the debate El Plato stirred among partiCipant dietitians and Concludes with a suggestion with how MexiCan offiCials might redesign El Plato’s dietary guidelines today. ©Copyright by Lisa Grabinsky May 20, 2020 All Rights Reserved Current Use of Dietary Guidelines in Private CliniCal Nutrition PraCtiCe and its ImpaCts on the Dietary Patterns of OffiCe Workers in MexiCo City by Lisa Grabinsky A THESIS submitted to Oregon State University in partial fulfillment of the requirements for the degree of Master of Arts Presented May 20, 2020 Commencement June 2020 Master of Arts thesis of Lisa Grabinsky presented on May 20, 2020 APPROVED: Major Professor, representing Applied Anthropology DireCtor of the SChool of Language, Culture, and Society Dean of the Graduate SChool I understand that my thesis will beCome part of the permanent colleCtion of Oregon State University libraries. My signature below authorizes release of my thesis to any reader upon request. Lisa Grabinsky, Author ACKNOWLEDGEMENTS First and foremost, I want to thank my family for their love and support now and always: my parents Memo and BeCky, my sister JaCkie, and my nephew Alex. Also, I would like to thank my extended family, espeCially Jaime, Alan, Jonathan, Yvonne, Salo, Gina, Shai, Igal, Daniel, Mariana, León, and Chivis. To my friends from home, who always have my baCk, and who I’ve missed terribly: Sofi, Lore, Gaby, Marianita, Maribel, Regina, Fer, Marga, Diana, Aline, Astrid, Shuki, Andrea, Ximena, MariCela, and Christie. To every friend that during these two years has made Corvallis feel like a seCond home, espeCially Argenis, Laura, Savanna, Katie and Jansen, Zhuo, Kaitlyn, Melissa, Paula and Camila, Ana, Mariana, Cynthia, Chandra, Loren and Belinda, NiCk, Paddy, VeróniCa, Froggi, and Andie. To my professors and mentors, whose teaChings have broadened my vision of the world and whose adviCe translates beyond university walls: José Monroy, AliCia Parra, Ana CeCila Fernández Gaxiola, Guillermo Alfaro, Karime Haua, Sarah Bak-Geller, Daniel López- Cevallos, Jonathan Garcia, Drew Gerkey, Stephanie GrutzmaCher, Mark Edwards, Shaozeng Zhang, Melissa Cheyney, Kenneth Maes, Vasiliki Touhouliotis, and Lisa PriCe. SpeCial thanks to my major advisors —Emily Yates-Doerr and Joan Gross—, who took me under their wing, have supported me beyond my aCademiC work, and opened up doors for me not only to their own homes but also to a world of possibilities, plaCes, and like- minded people. I want to thank the MexiCo-US Commission (COMEXUS) and the Fulbright-García Robles SCholarship program for financing my graduate studies at Oregon State University, along with this whole journey of life and aCademiC sucCesses. Last but not least, a big ‘thank you’ to all 15 study partiCipants. Not a single word of this document would have been possible without your partiCipation. TABLE OF CONTENTS Page INTRODUCTION ............................................................................................................................................. 1 LITERATURE REVIEW ....................................................................................................................................... 3 Health Education Tools ............................................................................................................................. 3 Food Based Dietary Guidelines (FBDGs) ................................................................................................. 4 Obesity in Mexico ....................................................................................................................................... 5 El Plato del Bien Comer ............................................................................................................................ 5 Dietary Patterns in Mexico City ................................................................................................................ 8 METHODS ........................................................................................................................................................ 9 Population and sampling ......................................................................................................................... 11 Data collection methods ........................................................................................................................... 14 Data analysis methods ............................................................................................................................. 16 ETHICAL CONSIDERATIONS ........................................................................................................................... 18 CHAPTER 1. OFFICE WORKER CULTURE IN MEXICO CITY ......................................................... 19 THE “GODÍNEZ” LIFESTYLE REALITY ............................................................................................................ 23 Navigating Mexico City and its office spaces .......................................................................................... 23 Eating at the office ................................................................................................................................... 27 Eating at home ......................................................................................................................................... 32 WEEKENDS VS. WEEKDAYS ........................................................................................................................... 37 OFFICE WORKERS AND NUTRITION ............................................................................................................... 40 Nutrition talk ............................................................................................................................................ 40 Nutrition treatment history ....................................................................................................................... 40 Prohibitions and somatization of diet ...................................................................................................... 44 CONCLUSION ................................................................................................................................................. 45 TABLE OF CONTENTS (CONTINUED) Page CHAPTER 2: CULTURES OF NUTRITION COUNSELLING IN MEXICO CITY ............................. 48 CONSULTATION OFFICES AND ACCESSIBILITY ............................................................................................... 50 Reception desk and waiting room ............................................................................................................ 52 Consultation room(s) and dietitians ........................................................................................................ 55 PHASES OF A CONSULTATION ......................................................................................................................... 57 1. Establishing rapport ....................................................................................................................... 57 2. Weighing the patient ....................................................................................................................... 59 3. Nutrition education ......................................................................................................................... 61 4. Meal plan ........................................................................................................................................ 63 CONCLUSION ................................................................................................................................................. 65 CHAPTER 3: NUTRITIONAL THEORY VS. REAL-LIFE PRACTICE ................................................ 67 INDIVIDUAL DIETARY PATTERNS AND MEXICAN FOOD CULTURE ...............................................................

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