Rethinking Obesity

Critical Perspectives in Crisis Times

Lee F. Monaghan, Emma Rich, Andrea E. Bombak

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781317329985
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Theoretically informed and empirically grounded, Rethinking Obesity invites readers to reconsider the medical and public health framing of population weight (gain) as a massive global problem, epidemic or crisis. Attentive to social values, scientific uncertainty and possible harms, the book furthers critique of the weight-centred health paradigm and world war on obesity. Building upon existing international literature from critical weight studies, fat studies and critical obesity research, the book advances scholarship with reference to body politics and health policy, epidemiology and obesity science, media reporting and weight-related stigma.

The authors resist the common moralised narrative that 'the overweight majority' are lazy, gluttonous, and personally responsible for their actual or potential ills and the solution ultimately necessitates individual lifestyle change. Critique is also extended to seemingly compassionate public health interventions that putatively avoid victim-blaming through an appeal to 'the obesogenic environment', a consequence of modern living. Empirical case studies are grounded in women's repeated and often frustrating experiences of dieting and schoolgirls' encounters with fat pedagogy, which challenges dominant obesity discourse. Recognising that declared public health crises may become layered and cascade through society, this book also includes timely research on the COVID-19 pandemic response amidst concerns about lockdown weight-gain, heightened risk of infection and death among people deemed overweight and obese.

Rethinking Obesity interrogates how social injustice is reproduced not only through cruelty but also through seemingly benevolent representations, pedagogies and policies. Alternative approaches and action, ranging from weight-inclusive health paradigms to broader social change, are also considered when seeking to foster collective hope in crisis times. This is valuable reading for students and researchers in medical sociology, social and population health sciences, physical education, critical weight and fat studies, and the social dimensions of the body.

Part 1 The politics of a ‘public health problem’

1 The global obesity crisis Situating critique in a broader context

DOI: 10.4324/9781315658087-3

The authoritative definition of obesity as a global public health crisis not only raises questions about what kind of problem weight/fat/obesity might be and where responsibility lies but also serves to mobilise actions and proposed interventions. Drawing on critical perspectives of health and other overlapping approaches outlined in our introduction (critical weight studies, fat studies and critical obesity research), this book furthers reflexive, ethically informed discussion on obesity discourse and the WCHP (O’Hara and Taylor, 2018). Building on earlier critical contributions (e.g. Bombak, 2014b; Evans et al., 2008; Gard and Wright, 2005; Kwan and Graves, 2013; Monaghan et al., 2014; Rich et al., 2011; Saguy, 2013), our challenge has been to rethink obesity and ask how this issue is or might be interpreted and approached within research, policy and practice. Ensuing chapters posit that amidst considerable uncertainty, complexity and contestation there remains a pressing need to scrutinise this problem field.

Before examining some of the theoretical traditions that shape the way obesity is constructed and critiqued in research, and how certain framings or narratives dominate the design of contemporary public health strategies and programmes (issues explored respectively in Chapters 2 and 3), this chapter situates our critique in a broader context. Discussion is divided into three main sections. First, we outline dominant representations of ‘the global obesity crisis’ in societies wherein an institutionalised war on fat or ‘excess’ weight tends to be strongest. As we will see, concerns about population weight (gain) have been recurrent in public health circles, government reports, mass media, academic journals and consumer culture. Second, we elaborate upon the ‘signature elements’ of the ‘fat as fatal’ frame (Kwan and Graves, 2013) or what Evans et al. (2008) term ‘obesity discourse’. This section also opens up alternative spaces by outlining overlapping and competing frames or ‘organizational premises’ (Goffman, 1974: 247), including those produced by the fashion and food industries and fat rights movement. Third, we position our critical scholarship within studies of body politics and embodied sociology, clarifying that we are not only interested in discourses and identity but also the materiality of flesh and blood bodies in contexts of power, inequality and pedagogy. This literature supports our goal to reconceptualise the putative obesity crisis and call for a broader rethink of health and society. Chapter 1 ends with a summary and preliminary reflections, including on the influence of neoliberalism within politicised debates.

The ongoing world war on obesity

We began this book by referring to dire claims about obesity, expressed by England’s Chief Medical Officer and other authoritative sources in a global context (e.g. WHO, 2016, 2018). According to these actors, obesity is in the same league as terrorism, climate change and pandemics of infectious disease (Borland, 2015; Brody, 2020; Swinburn et al., 2019). Defining obesity as a threat and calling for government action – bolstered in ‘the COVID society’ (Lupton, 2020) via a ‘paradigm of preparedness’ (David and Le Dévédec, 2019; see also Chapter 8) – are hardly original. Rather, these are recycled concerns that have been expressed by leading public health officials and their allies for decades. For example, US Surgeon General C. Everett Koop popularised the expression ‘war on obesity’ in 1997, citing an alleged annual death toll of 300,000 Americans (Mayer, 2004: 999). His call was preceded by a study in the Journal of the American Medical Association, reporting a large increase in the prevalence of overweight (Kuczmarski et al., 1994) alongside an editorial featuring the term ‘epidemic’ (Saguy, 2013: 107–8). As Saguy explains, the media then helped to ‘spread’ the idea that an ‘obesity epidemic’ was afoot. Whilst the 1990s could be viewed as the beginning of a distinct obesity ‘epidemic psychology’ (Strong, 1990), which has amplified weight-related stigma and moralising action, there are antecedents. For instance, in 1952 the Director of the National Institutes of Health claimed obesity was ‘the number one nutritional problem in the United States’ (cited by Gaesser, 2002: 44). Similar concerns were expressed in Canada, related, in part, to national anxieties generated during the Cold War (McPhail, 2017).

Calls to tackle ‘excess’ weight/fatness/obesity persist in national and international contexts (e.g. DHSC, 2019, 2020; OECD, 2017; WHO, 2021), despite mounting critique (Chapter 2). Definitions of population weight (gain) as a ‘big’ problem requiring urgent solutions appear irresistible when obesity is conflated with overweight, alongside downward revisions of BMI thresholds that render most people ‘too heavy’ (Oliver, 2006). Calls to combat weight/fatness ‘feed off’ normative cultural values about self-control, care, responsibility and body malleability. Of course, the world war on obesity – or ‘globesity’ (WHO, 2021) as it has been called – is not uniform in its embodied effects and affects. This is because ‘health discourses flow across territories and national boundaries’ thus entering different ‘socio-political systems’ with varying degrees of inequality and ‘status differentials’ (Evans and Davies, 2020: 739). Nonetheless, the aforementioned healthist values are shared across many neoliberal nations, meaning the imperatives of obesity discourse, whilst unpredictable, often resonate. Thille (2019: 892), in an article on anti-fat stigma in primary healthcare, writes: ‘In the US, Canada, Australia, New Zealand, and Britain, people commonly assert weight and body composition are highly malleable and under individual control through eating and exercise practices’. Such tenets underpin public health pedagogies that target ‘risk behaviours’ and presumed ignorance via technologies such as the BMI, tape measure (Dukelow, 2017; Lupton, 2014, 2018) and social media (OECD, 2017), with the normatively healthy body symbolising ‘morally worthy’ citizenship (LeBesco, 2011: 154). Embedded in globally circulating pedagogic systems of symbolic and economic control, which invite obsessive comparison and competition in policy fields (Evans and Davies, 2020; Chapter 3), such citizens are ideally self-disciplined and motivated to resist an ‘obesogenic environment’ wherein ‘toxic’ overconsumption and sedentary living are deemed endemic (Schorb, 2013: 5; Chapter 2).

Gard (2011) professed a decade ago that the end of the obesity epidemic was nigh due to a levelling of rates in the West and increasing life expectancy. Yet, events scuttled that bold prediction. Thereafter life expectancy declined or stalled in high-income nations (Marmot et al., 2020a), attributable to suicide, drug overdose (Ho and Hendi, 2018), austerity policies and social vulnerability (especially for women and the elderly) (Annandale, 2022). Moreover, many enterprising actors continued or reinvigorated the war on obesity. These actors are variously described as ‘“anti-obesity proponents” (Saguy & Riley, 2005), “obesity alliances” (Strategies to Overcome and Prevent [STOP] Obesity Alliance), “obesity crusaders” (Basham & Luik, 2008), or “obesity alarmists” (Gard, 2011)’ (O’Hara and Taylor, 2018: 2). Drawing from classic and contemporary social theory, including interactionist writings on ‘the moral entrepreneur’ (Becker, 1963) and Foucauldian-inspired scholarship on the new public health (Petersen and Lupton, 1996), Monaghan et al. (2010) refer to these actors as ‘obesity epidemic entrepreneurs’. They include: scientists, journalists, policymakers, drug companies, charities, celebrities, clinicians, weight-loss consultants and dieters. Interests and practices include: establishing rationalised benchmarks (e.g. the BMI), dramatising the epidemic, campaigning for legislation, launching taskforces, writing reports, devising policy, ‘educating’ the public, profiteering and displaying moral worth. Drawing from Monaghan et al.’s typology of obesity epidemic entrepreneurs, O’Hara and Taylor (2018: 4) describe these as ‘promulgators of the WCHP’ and a crucial element of its context.

These enterprising types, or continually refashioned modes of entrepreneurship, have been busily reproducing the obesity epidemic as a national and/or global problem. For instance, the WOF launched World Obesity Day in 2015, with subsequent events dedicated to calling on governments to invest in treatment, end childhood obesity and weight stigma. The WOF is the rebranded name for the International Association for the Study of Obesity, criticised in the British Medical Journal given its ties to the pharmaceutical industry and for proposing to expand potentially harmful definitions of childhood obesity (Moynihan, 2006a, 2006b). The WOF, in asserting its credentials or ‘symbolic capital’ (Saguy, 2013), reportedly ‘represents professional members of the scientific, medical and research communities from over 50 regional and national obesity associations’ (WOF, 2019). In 2016, its president, Professor Ian Caterson, called for strategic action because: ‘The obesity epidemic has reached virtually every country in the world, and overweight and obesity levels are continuing to rise in most places’ (cited by Boseley, 2016a). Such concerns were subsequently crystallised with ‘the first unified World Obesity Day’ on the 4 March 2020, signalling a more integrated approach from an expansive coalition of organisations from around the world. The campaign website, dedicated to ‘the root causes of obesity’, stated: ‘Obesity is a global crisis that affects 650 million people worldwide’ and ‘by working together on a unified day, the power and reach of our activities can be multiplied’ (World Obesity Day, 2020; for a related report pertaining to 200 countries, see Lobstein and Brinsden, 2020). The WOF is also part of The Lancet Commission on Obesity (Swinburn et al., 2019), which, as noted earlier, frames the putative problem as a ‘global syndemic’ entwined with climate change and undernutrition.

The UK’s Obesity Health Alliance has also been advancing a public health crisis narrative at the national level. Established in 2015, this ‘coalition of 45 leading health charities and medical royal colleges’ (Bauld et al., 2021) campaigns for ministers to take tough action to fight obesity and counter alleged ‘government inertia’ (on the UK policy context, see also Boswell, 2016). The Alliance’s latest report, Turning the Tide: A 10-Year Healthy Weight Strategy (2021), claims to offer ‘a far more nuanced’ approach to ‘the complexities’ of weight by invoking issues such as the obesogenic environment and the problem of COVID-19 ‘for those living with obesity’ (p. 8). Alliance members have also proven to be active independent producers of the obesity crisis narrative in recent years. For example, the Academy of Medical Royal Colleges’ (2013) widely publicised report declared fatness is ‘a problem of epidemic proportions’ that ‘must now be tackled urgently’ (p. 7). Fiscal concerns and unfavourable comparisons with Europe apparently bolstered their claims, reported by news media under headlines such as ‘Obesity crisis risks making Britain “fat man of Europe”’ (Dixon, 2013). Such declarations have political effects, with the UK Government subsequently revising its policy response, especially for childhood obesity (DHSC, 2019; Chapters 3 and 5) and, thereafter, for children and adults (DHSC, 2020). Responding to obesity and COVID-19, the latter report enacts earlier policy concerns and proposed solutions that drift towards lifestyles (Popay et al., 2010; Chapters 3 and 8), belying assurances that ‘less emphasis’ is currently being placed on ‘individual responsibility’ for obesity (Obesity Health Alliance, 2021: 8).

Other governments have similarly renewed their anti-obesity offensive in recent years. The Irish Government is a case in point, evidenced in Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025 (DOH, 2016). That document extends concerns expressed in an earlier report, which claimed ‘body weight is now the most prevalent childhood disease’ [sic] (The Report of the National Taskforce on Obesity, 2005: 6). The Irish Government’s subsequent plan attracted a flurry of media attention. National newspapers featured headlines such as: ‘government launches 10-year war on obesity’ (Hallissey, 2016), ‘new strategy aims to tackle Irish obesity levels’ (Cullen, 2016) and ‘revealed: new plan to stop Ireland becoming the fattest country in Europe’ (O’Regan, 2016). The state television and radio broadcaster, RTÉ, joined this cacophony. Quoting the Minister for Health, the RTÉ website reported that ‘obesity is a ticking time bomb which has already to some extent exploded as 60% of adults and 1-in-4 children in Ireland are either overweight or obese’. The Minister of State at the Department of Health is also quoted, announcing that ‘Ireland is “becoming the fattest nation in Europe” and the new strategy aims to get people to a healthy weight “as a norm”’ (RTÉ, 2016; also Quinlan, 2018). Furthermore, there appeared to be public ...

Table of contents

• Cover Page
• Half Title page
• Series Page
• Title Page
• Copyright Page
• Contents
• List of tables
• List of abbreviations
• Series editors’ preface
• Acknowledgements
• Introduction
• Part 1 The politics of a ‘public health problem’
• Part 2 Researching Matters of Fat
• Part 3 Critically exploring alternatives, fostering collective hope
• Epilogue: Resist TINA, recognise TARA
• References
• Index