Social class and body management. A qualitative exploration of differences in perceptions and practices related to health and personal body weight

Weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to synthesize the best available qualitative evidence on the weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity. Additionally, the review aims to deepen our understanding of the common narratives of obesity according to these people.

INTRODUCTION

People living with poor socioeconomic circumstances are at increased risk of obesity, particularly in high-income countries, and their weight management practices (eg, weight-related behaviors) tend to be less healthy. Since prior research on socioeconomic inequalities in obesity is mostly from quantitative studies, the individual views and experiences related to weight management have been largely ignored. Thus, systematic qualitative evidence is needed on the weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity.

INCLUSION CRITERIA

Qualitative studies examining adults (aged 18 to 74 years) living with poor socioeconomic circumstances and obesity, and conducted in high- and upper-middle-income countries will be considered. The phenomenon of interest is these people's weight management practices, views, and experiences.

METHODS

Searches will be conducted in MEDLINE (Ovid), APA PsycINFO (Ovid), CINAHL (EBSCOhost), Scopus, Web of Science, and the Finnish health sciences database, MEDIC, restricted to the English and Finnish languages. Sources of unpublished studies and gray literature will include Google Scholar and ProQuest Dissertations and Theses. Two independent reviewers will screen the papers, assess methodological quality, and extract data following JBI's procedures. The meta-aggregative approach will be used for data synthesis. Confidence in the findings will be assessed using the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42023407938.

"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.

Decomposition of Gender Differences in Body Mass Index in Saudi Arabia using Unconditional Quantile Regression: Analysis of National-Level Survey Data

Understanding gender differences in body mass index (BMI) between males and females has been much debated and received considerable attention. This study aims to decompose gender differentials in the BMI of people of the Kingdom of Saudi Arabia. The study decomposed the BMI gender gap into its associated factors across the entire BMI distribution by using counterfactual regression methods. The main method of analysis was newly developed unconditional quantile regression-based decomposition, which applied Blinder-Oaxaca decomposition using data from the Saudi Health Interview Survey. Gender differentials were found in the BMI, with females showing a higher BMI than males. The aggregate decomposition showed that both the covariate effect and the structural effect were significant at the 25th and 50th quantiles. Detailed decomposition indicated that income level and employment status as well as soda consumption and the consumption of red meat were significantly correlated in explaining gender differentials in BMI across various quantiles, but the magnitude varied by quantile. Our study suggests the government should consider introducing programs that specifically target women to help them reduce BMI. These programs could include organizing sporting events at the workplace and at the national level. Furthermore, the effect of soda consumption could be reduced by levying a tax on beverages, which might reduce the demand for soda due to the increased price.

Obesity and Weight Change in Two United Kingdom Male Prisons

Prisoners' weight and waist circumference were measured 6 and 12 months after imprisonment. Variables known to be associated with differences in lifestyle behaviors and obesity were considered as covariates in the study. A total of 367 prisoners were recruited into the study at baseline, with 116 of these having dropped out of the study from the 6-month to the 12-month follow-up. The obesity prevalence rate increased 50% from baseline (16%) to the 6-month follow-up (24%). Obesity prevalence rates then declined 4-fold from the 6-month (24%) to the 12-month follow-up (6%). While time in prison was associated with an increase in body mass index, this effect was influenced by intrinsic prisoner characteristics, extrinsic factors, and the prison regime.

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.

Vitamin B4 as a salt substitute in bread: A challenging and successful new strategy. Sensory perception and acceptability by French consumers

Numerous scientific studies have shown that overconsumption of salt can be harmful and promotes the development of cardiovascular diseases. For this reason, many international organizations and government agencies aim to reduce overall salt consumption from food. Recent exploratory work has shown that vitamin B4 can play the role of salt substitute. This study aims on the one hand to develop and optimize a bread recipe reduced in salt and enriched with vitamin B4. On the other, it aims to study the acceptability for consumers of this double innovation, combining the addition and withdrawal of a nutrient. The study was conducted with French consumers. The sensory test showed that vitamin B4 tends to increase the perception of salt in salt-reduced bread. The acceptance of reduced-salt and vitamin B4-enriched bread was investigated in three focus-groups, mixing blind tests, information input and spontaneous evocations. Three potential targets have been identified: health-oriented young people, young parents who want to educate children to engage in a healthy lifestyle, and people broadly sensitive to nutritional information. Consumers with a pleasure and taste-oriented profile were more skeptical of the new bread formula because of greater attachment to traditional, salty French bread.

Embodiment of social roles and thinness as a form of capital: A qualitative approach towards understanding female obesity disparities in Chile

Obesity in Chile disproportionately affects women of low socioeconomic status (SES). Research has shown that ideals of body size and differences in perceived social pressure for being slim across socioeconomic strata contribute to the social stratification of body size among women in modern societies. Thinness is most valued by high SES women, following western standards of ideal body size. Aiming to understand the link between ideals of body size and SES, this qualitative study explored how 36 Chilean women construct their bodily ideals according to their social position. A purposive sample of women with different profiles with regard to educational attainment, nutritional status and body size (dis)satisfaction was defined, aiming to cover a diverse spectrum of bodily perceptions. Data were collected through semi-structured interviews and approached through a thematic and narrative analysis. Drawing on Bourdieu's concepts of habitus, field, capital and embodiment of the social context, this study explains how ideals of body size and appearance are strongly linked to class-dependent gender roles and social roles. The existing gender and class inequalities in the Chilean social structure have been literally embodied by these women through a 'gendered class habitus'. Compliance with the thin ideal confers women different degrees of power according to their social position in different fields, such as in marriage and on the labour market, which turns thinness into an embodied form of capital. The societal dynamic behind obesity rates cannot be disregarded when approaching possible solutions. Promoting obesity-related lifestyle modification at an individual level might appear an over-simplistic and individualistic approach to a complex social issue. Context-oriented interventions that take cultural constructions of gender and social class into account might yield better results in the long term, while advocating for a more equitable society and social justice as a public health concern.

Negotiating Diet in Networks: A Cross-European Study of the Experiences of Managing Type 2 Diabetes

Food and diet are central aspects of diabetes self-management but the relevance of social networks for the way people are supported in their management of type 2 diabetes is often under-acknowledged. In this article, we aimed to explore the coalescences between these two phenomena among people with type 2 diabetes to increase knowledge of interactions within social network related to daily diet. The article is based on 125 qualitative interviews with individuals with type 2 diabetes from five European countries. Based on assumptions that people with chronic illnesses reshape relationships through negotiation, we analyzed negotiations of food at different levels of network. The respondents' reflections indicate that there are complex negotiations that influence self-management and food, including support, knowledge, and relationships within families; attention and openness in social situations; and the premises and norms of society.

Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more "good" work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a "good" work day may be useful for intervention research in other sectors.

Low-income women's conceptualizations of food craving and food addiction

Food craving and food addiction have been proposed as targets for obesity focused interventions. However, individuals' conceptualizations of these constructs are not well understood and no studies have employed a qualitative approach. Therefore, we sought to understand how women conceptualize food craving and food addiction. Low-income women with preschool-aged children (2-5years old) participated in either a semi-structured individual interview or focus group in which they were asked about their conceptualization of eating behaviors among adults and children. All responses were audio-recorded and transcribed. Themes were identified using the constant comparative method of qualitative analysis. Identified themes revealed that the women perceived food craving to be common, less severe and to a degree more humorous than food addiction. It was not felt that food cravings were something to be guarded against or resisted. Food addiction was described in a very "matter of fact" manner and was believed to be identifiable through its behavioral features including a compulsive need to have certain foods all the time. A more detailed understanding of how the general population perceives food craving and food addiction may enable more refined measurement of these constructs with questionnaire measures in the future. In addition, interventions may be designed to use the language most consistent with participants' conceptualizations of these constructs.

Nutritional advice from George Orwell. Exploring the social mechanisms behind the overconsumption of unhealthy foods by people with low socio-economic status

Despite a general consensus and recognition of the importance of the "social gradient" on nutritional standards and ultimately people's health, (Budrys, 2003; Marmot & Wilkinson, 1999; Marmot et al., 1991; Ross & Wu, 1995), the body of literature identifying and describing the actual underlying social mechanisms which could explain this association is small, fragmented and not contained within one single discipline of thought - the effects of this conundrum seem easier to describe than to explain. The aim of this article is therefore to explore and identify social mechanisms, which could help explain why people with low socio-economic status consume a disproportionate amount of unhealthy foods and therefore also observe poorer diets. It is therefore in many ways an exploration into the nature of (relative) poverty. The point of departure for this exploration and identification is historical descriptions (in the form of excerpts) from George Orwell's (1937) book "The Road to Wigan Pier" on the living conditions of the British working classes. These descriptions will be aligned with results from contemporary research into nutritional behaviour. Strong similarities are identified between George Orwell's historical descriptions of the working-class's unhealthy diet and the findings from contemporary research into nutritional behaviour of people with a low socio-economic status. Certain social mechanisms influencing nutritional choices are readily identifiable across disciplines, and even partly reproduced in different historical, social and spatial contexts, with stronger negative (nutritional) consequences for people with low socio-economic status. The disregard of social mechanisms, and therefore implicitly issues of class, could indicate a general "de-socialization" of nutritional advice also in its dispersal through various health-promotion initiatives and campaigns, which raises serious questions about the usefulness of much nutritional advice, already tentatively questioned by some nutritionist (Burr et al., 2007) as well as "food" sociologist (Smith & Holm, 2010).

Meaning of the terms "overweight" and "obese" among low-income women

OBJECTIVE

To determine how low-income, US women understand the meanings of the terms "overweight" and "obese."

METHODS

Low-income women (n = 145; 72% white, 12% black, and 8% Hispanic; 59% obese and 21% overweight) each participated in an individual semi-structured interview during which they were asked to explain what the terms "overweight" and "obese" mean to them. Responses were transcribed and the constant comparative method was used to identify themes.

RESULTS

Three themes emerged: (1) The terms are offensive and describe people who are unmotivated and depressed and do not care about themselves; (2) obese is an extreme weight (eg, 500 lb and being immobile); (3) being overweight is a matter of opinion; if a woman is "comfortable in her own skin" and "feels healthy," she is not overweight.

CONCLUSIONS AND IMPLICATIONS

Health education focused on obesity should consider that vulnerable populations might consider the terms "overweight" and "obese" offensive and stigmatizing.