The emergence of overweight as a disease entity: Measuring up normality

Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling

Purpose

Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes.

Methods

Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables).

Results

Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives.

Conclusions

Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.

Under the 'weight' of norms: Social representations of overweight and obesity among Brazilian, French and Spanish dietitians and laywomen

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians' perception of patients with obesity and the eating education process.

Not 'putting a name to it': Managing uncertainty in the diagnosis of childhood obesity

Childhood obesity is a challenging diagnosis. Children's body mass index (BMI) is an imprecise diagnostic of health, leading clinicians' interactions with patients and families to focus on the potential of future harm rather than the presence of infirmity or disease. This is complicated by emphasis on certainty in medical care; clinical diagnoses like childhood obesity are intended to help delineate good and bad health among patients. However, healthiness and wellbeing take on many meanings among individual children and families, especially in relation to weight. To better understand different forms of uncertainty and challenges in providing care, this study draws on 28 semi-structured interviews with U.S. health practitioners working with pediatric patients to examine strategies for communicating risk and defining success in the diagnosis and treatment of childhood obesity. Rather than focusing on patients' current BMIs or making the explicit diagnosis of obesity, clinicians turn to more optimistic prognoses emphasizing the gradual development of beliefs and behaviors that promote long-term physical, mental, and social health. This prognostic framework privileges the doctor-patient relationship over medical guidelines and protocols dictated by diagnoses, encouraging greater consideration of non-clinical factors shaping patients' health and weight. Clinicians expand their diagnostic framework and criteria to include information on the totality of patients' present and future lives, allowing for cognitively, emotionally, and socially attuned understanding of health and weight that is not focused on BMI. Critically, clinicians' awareness of the social etiology childhood obesity heightens their sense of futility about addressing it through clinical interventions, demonstrating the need for a diagnostic and treatment model that empowers doctors to look beyond the more proximate, biophysiological determinants of health.

Fat Is All My Fault: Globalized Metathemes of Body Self-blame

Norms valorizing not-fat bodies appear to have spread around the world, combined with a globalizing belief that thinness is the result of individual management of self and hard work. We examine themes of blame and felt responsibility for weight and "fat" in four distinct geographic and cultural locations: peri-urban Georgia, United States; suburban Osaka, Japan; urban Encarnación, Paraguay; and urban Apia, Samoa. Use of a novel metatheme approach that compares and contrasts these four distinct places characterized by different population-level prevalences of obesity and by specific cultural histories relevant to body norms and ideals provides a flexible toolkit for comparative cross-cultural/multi-sited ethnographic research. We show that self-blame, marked by an articulated sense of individual responsibility for weight and a sense of failing in this responsibility, is present in every field site, but to varying degrees and expressed in different ways. [fat, obesity, metatheme, stigma, self-blame].

Body mass index is just a number: Conflating riskiness and unhealthiness in discourse on body size

Despite the ubiquity of the body mass index (BMI) in discourse on health, there is ambiguity in its use as a biomarker of current abnormality versus future risk. This distinction is consequential for knowledge of the relationship between body size and health, as well as for individuals deemed to have abnormal and 'unhealthy' bodies. Consequently, the purposes of this review are threefold. The first is to differentiate this 'biomarker' perspective from extant critiques of BMI as a proxy for health behaviours or as the defining characteristic of obesity as a disease. The second is to highlight the shift towards treating BMI as a measure of attained unhealthiness, rather than a probabilistic indicator of risk. Finally, rather than call for the abolition of BMI, this paper argues that its continued use as 'just a number' is in keeping with the push for weight neutrality in research and practice. The review concludes by demonstrating how the riskiness and unhealthiness of body size is conflated in public health messaging on COVID-19. BMI is a marker of risk, but its use as a surrogate for COVID-19 severity equates body size with health, shaping beliefs about vulnerability and personal responsibility amid an ongoing pandemic.

Talking about overweight and obesity in rural Australian general practice

As many patients' sole point of contact with the health care system, primary health care physicians (general practitioners [GPs] in Australia) are often positioned as key players in responding to rates of overweight and obesity in dominant public discourse. However, research from Western industrialised countries suggests that GPs may not be prepared for, or confident in, having conversations about overweight and obesity with patients. Little attention has been given to this topic in Australia, particularly in the context of rural health. The aim of this study was to understand how GPs in two rural settings in Victoria, Australia talk about overweight and obesity with patients. Working from a multidisciplinary perspective, a qualitative study design was adopted, and semi-structured interviews were conducted with seven GPs and seven GP patients living in two rural communities between January and April, 2016. Data was coded manually and thematic analysis was used to explore the data. The findings of this study support the argument that, in contrast to dominant messages within public health discourses, GPs may not be best placed to act as the primary actors in responding to overweight and obesity as they are constructed in epidemiological terms. In fact, the perspectives of GP study participants suggest that to do so would compromise important dimensions of general medical practice that make it simultaneously a human practice. Instead, more balanced, holistic approaches to discussing and responding to overweight and obesity with patients could be taken up in local, interdisciplinary collaborations between different health professionals and patients, which utilise broader social supports. Focussing on long-term, incremental programs that consider the whole person within their particular socio-cultural environment would be a productive means of working with the complexities of overweight and obesity. However, structural level changes are required to ensure such initiatives are sustainable in rural practice.

The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014

OBJECTIVES

Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction.

METHODS

We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period.

RESULTS

The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial.

CONCLUSIONS

Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.

Knowledge brokering: (mis)aligning population knowledge with care of fat bodies

OBJECTIVE

Two prominent Canadian knowledge brokers aim to influence how primary care clinicians address obesity, through the dissemination of texts: the Canadian Task Force on Preventive Health Care (guideline) and the Canadian Obesity Network (5As). While written for the same clinician and adult patient population, the recommendations differ. This analysis highlights active decisions that produced the difference.

METHODS

Frame analysis of the guideline and 5As texts.

RESULTS

The brokers both frame obesity as a chronic and pathological threat to health, at least to a point. The guideline texts frame obesity primarily as a sign of a behavioural problem, discrediting or ignoring many complicating sources of knowledge. In contrast, the 5As frames obesity as complex through diversifying the knowledge foundation embedded in the texts (e.g., including fat-related stigmatisation; health status differences among those classified as obese). Both de-emphasize social and environmental determinants of weight and health.

CONCLUSION

Frames of problems used by brokers are not neutral, nor are decisions about how knowledge is excluded and included. Knowledge brokering, no matter how scientific and systematic, is limited by its frame. Recognizing the limits of each frame supports reflexivity in knowledge brokering and interventions taken to enhance health.

The shame of fat shaming in public health: moving past racism to embrace indigenous solutions

OBJECTIVES

The aim of this article is to explore perceptions of weight and racism towards Māori, as an indigenous group, and the association between the two. We then propose indigenous solutions as pathways out of fat shaming.

STUDY DESIGN

This is a conceptual article supported by a review of literature in the fields of weight stigma, racism and indigenous (Māori) health.

METHODS

This article is taken from the perspective of three researchers involved in Māori health research, studies on institutional and societal racism and critical research on weight stigma and the weight loss industry. Indigenous peoples in developed nations are more likely to be overweight, obese and disproportionately affected by the comorbidities and physical disorders associated with weight when compared with their counterparts. Beyond the physical ailments are a variety of psychological, emotional and social issues, which are associated with being 'fat' and/or overweight and/or from subsequent stigmatisation.

RESULTS

Long before this world's populations reached the current alarming level of obesity, indigenous peoples in colonised countries were stigmatised because of the colour of their skin, their beliefs and their culture. Stigma is nothing new to indigenous peoples, and so when Māori, or any other indigenous groups are told they are fat and less productive (or moral) because of 'fatness', there is no surprise because they have been told the same thing (albeit for a different reason) for generations. Considering the relatively high proportion of indigenous people in New Zealand, North America and beyond who do not fit the 'recommended weight range', the justification for racist sentiment is seemingly strengthened.

CONCLUSIONS

A weight loss-centred approach to health has not improved the health of indigenous people. Initiatives that draw on, or are underpinned by local, traditional knowledge are more relevant for indigenous peoples and could lead to better health outcomes for these groups.

The Weight of Things: Understanding African American Women's Perceptions of Health, Body Image, and Attractiveness

Negative attitudes toward being overweight or obese are widespread, and these notions perpetuate into conceptions about one's health. Clinically, being overweight is associated with health problems such as diabetes, hypertension, heart disease, and many other illnesses. African American women, who are generally larger in body size, are a particular target for health interventions. However, these women have resisted the "obesity" label, arguing that dominant measures of health are White norms and oppressive. Through the use of in-depth interviews, this study investigates how African American women understand and experience healthfulness, body image, and barriers to each. Findings show that African American women are ambivalent in their acceptance of dominant markers of health and expressed an almost universal disdain for the thin ideal as a marker of "good" health and a positive body image. Moreover, participants articulated a suspicion of formal medical measurements of obesity.

The concept of medicalisation reassessed

Medicalisation has been an important concept in sociological discussions of medicine since its adoption by medical sociologists in the early 1970s. Yet it has been criticised by some sociologists, in part because it seems too negative about medicine, and modified or replaced by others with concepts deemed more relevant like biomedicalisation and pharmaceuticalisation. My aim in this paper is to reassess the concept and consider whether it still has value in exploring significant aspects of the role of medicine in present-day society. I start with an archaeology of the concept's development and the different ways it has been used. This covers some familiar ground but is essential to the main task: examining criticisms of the concept and assessing its value. I conclude that the concept continues to have a crucial and productive place in sociological analyses of medicine and that the process of medicalisation is still a key feature of late-modern social life and culture.

Treating the binge or the (fat) body? Representations of fatness in a gold standard psychological treatment manual for binge eating disorder

This article reports the results of a Foucauldian-informed discourse analysis exploring representations of fatness embedded within an empirically based psychological treatment manual for binge eating disorder, a condition characterized by overvaluation of weight and shape. Analyses indicate that the manual prioritizes weight loss with relatively less emphasis placed on treating the diagnostic symptoms and underlying mechanisms of binge eating disorder. We raise critical concerns about these observations and link our findings to mainstream psychology's adoption of the medical framing of fatness as obesity within the "gold standard" approach to intervention. We recommend that psychology as a discipline abandons the weight loss imperative associated with binge eating disorder and fat bodies. We recommend that practitioners locate the problem of fat shame in society as opposed to the individual person's body and provide individuals with tools to identify and resist fat stigma and oppression, rather than provide them with tools to reshape their bodies.

[An overview of the variations surrounding the concept of medicalization between 1950 and 2010]

This article examines the pertinence of the concept of medicalization for socio-cultural analysis. The study is based on the criticism which emerged in the international literature between 2000 and 2010. The criticism stressed the excessive generality of the expression that encompasses different situations and thereby loses its analytical precision. The main meanings of the term medicalization are examined, namely 1) the major strategies of hygienization of the population; 2) the transformation of behavior considered deviant into disorders; 3) control strategies and the medical imperative; 4) the participation of non-medical actors. Based on the different meanings of the notion of medicalization, the transient nature of the concept needs to be stressed, i.e. the need to specify the different meanings attributed to the notion depending on the different contexts in which it is used. If this is not done, the concept will lose its theoretical accuracy and will possibly no longer be useful for social analysis.

Governing obesity policies from England, France, Germany and Scotland

Defining a phenomenon as a political problem could be considered a crucial part of any political process. Body weight, when categorised as obesity, has been defined as a political problem since the beginning of the 21st century and has entered the political agenda in many countries. In this article, I present a study of four plans from four Western European countries: England, France, Germany and Scotland, identifying how obesity is defined as a political issue. The questions addressed are: How is the development in the obesity prevalence explained and who is considered responsible for the development? What are the suggested remedies and who is considered responsible for acting? All plans state that obesity is a political issue because it causes health problems; in fact, weight is almost equated to health. The English and Scottish plans present a bio-political argument, characterising obesity as a serious threat to the countries' economies. So does the German plan, but not with the same emphasis. The plans portray people with obesity as being economically harmful to their fellow citizens. The French plan expresses another concern by focussing on the discrimination and stigmatization of obese people. All plans define the physical and food environment as a crucial factor in the obesity development, but only the Scottish Government is prepared to use statutory means towards industry and other actors to achieve change. The policies convey an unresolved dilemma: To govern or not to govern? The Governments want individuals to choose for themselves, yet they try to govern the populations to choose as the Governments find appropriate. The plans have a legitimising function, showing that the Governments take the issue seriously. Accordingly, in this case, the actual problematisations seem to be less crucial.

A discursive look at large bodies--implications for discursive approaches in nursing and health research

This article illuminates discursive constructions of large bodies in contemporary society and discusses what discursive approaches might add to health care. Today, the World Health Organization describes a current "epidemic of obesity" and classifies large bodies as a medical condition. Texts on the obesity epidemic often draw upon alarming perspectives that involve associations of threat and catastrophe. The concern we see for body size in contemporary discourse is not new. Understandings of body size in Western societies are highly cultural and normative and could be different. The way we approach large bodies affects health care practice as well as subjects' self-perceptions.

Obesity, health at every size, and public health policy

Obesity is associated with chronic diseases that may negatively affect individuals' health and the sustainability of the health care system. Despite increasing emphasis on obesity as a major health care issue, little progress has been made in its treatment or prevention. Individual approaches to obesity treatment, largely composed of weight-loss dieting, have not proven effective. Little direct evidence supports the notion of reforms to the "obesogenic environment." Both these individualistic and environmental approaches to obesity have important limitations and ethical implications. The low levels of success associated with these approaches may necessitate a new non-weight-centric public health strategy. Evidence is accumulating that a weight-neutral, nutrition- and physical activity-based, Health at Every Size (HAES) approach may be a promising chronic disease-prevention strategy.

Creating the 'dis-ease' of high cholesterol: a sociology of diagnosis reception analysis

Using a sociology of diagnosis approach, this paper discusses the implication of high cholesterol being promoted as a disease rather than a risk factor for cardiovascular diseases. Drawing on data collected during the spring/summer of 2012 from 49 in-depth interviews with women over the age of forty concerned with high cholesterol in Ontario, Canada, I explore participants' understanding of the issue of high cholesterol as a disease. More specifically, I examine where blame and responsibility for high cholesterol are placed and if they vary by women's class background. My findings reveal that all the participants believed in and internalized the diagnosis of high cholesterol. However, the disease is blamed on 'lifestyle choices', and individual responsibilities, while women's awareness of the social determinants of health varies by class. I argue the sense of urgency surrounding high cholesterol is worrisome and the sole focus on lifestyle choice as both the cause and solution to high cholesterol is problematic for three reasons: it assumes that individual responsibility is adequate; it minimizes the socioeconomic constraints women face on a daily basis; and it reinforces the idea that individuals can be blamed for their health problems.

"Your body is your business card": Bodily capital and health authority in the fitness industry

Although scholars have noted the connection between appearance and assumptions of health, the degree to which these assumptions matter for establishing authority in social interaction remains less clear. Using a theoretical framework involving "bodily capital"--that is, the value generated from appearance, attractiveness, and physical ability--I investigate the role of appearance in the U.S. fitness industry. Drawing on data from interviews with 26 personal trainers and 25 clients between 2010 and 2011, I find that a trainer's fit-appearing physique imbues their interactions with a degree of moral and health authority. This corporeal credibility engenders trust among clients and allows exercise to be understood as a form of health work. The implications for academics and medical practitioners reach beyond the gym setting and extend recent research linking appearance to health, authority, and medical credibility.

Standards and classification: a perspective on the 'obesity epidemic'

In this paper I critique the increasing standardization of obesity. Specifically, I consider two 'definitional turns': the way language has been standardized to such an extent that it obscures uncertainty and variation, and the appearance of objectivity through quantification and standardized measurement. These, I suggest, have fostered a simplified picture of obesity, promoting the classification of weight and thereby facilitating the emergence of the 'obesity epidemic'. These definitional turns fail to acknowledge the distinctions between fat and mass and intraclass variation within weight categories. A consequence of this process of simplification has been the erroneous application of population level information to individuals in a clinical context, with potentially harmful results.

Empowerment and bariatric surgery: negotiations of credibility and control

Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to "empower" patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals' identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents' identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants "trapped" within the ambivalence of freedom and control.

Qualitative content analysis of online news media coverage of weight loss surgery and related reader comments

The media has the ability to affect public opinion and policy direction. Prevalence of morbid obesity in Canada is increasing; as is the only effective long-term treatment, weight loss surgery (WLS). Limited research has explored media re/presentations of WLS. The purpose of this study was to examine national online news coverage (and reader comments) of WLS using content analysis. We sought to understand the dominant messages being conveyed within the news texts and reader comments, specifically whose voice was represented, who was the intended audience and what was the overall tone. Articles and comments were retrieved from the Canadian Broadcasting Corporation news web site and analysed using line-by-line techniques. Articles were predominantly 'positive/supportive' (63%) in tone and frequently presented the voices and opinions of 'experts' conveying a biomedical perspective. Comments were overwhelmingly 'negative' (56%) and often derogatory including such language as 'piggy' and 'fatty'. Comments were almost exclusively anonymous (99%) and were frequently directed at other commenters (33%) and 'fat' people (6%). The potentially problematic nature of media framing and reader comments, particularly as they could relate to weight-based stigmatization and discrimination is discussed.

Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere

Body weight is a key concern in contemporary society, with large proportions of the population attempting to control their weight. However, losing weight and maintaining weight loss is notoriously difficult, and new strategies for weight loss attract significant interest. Writing about experiences of weight loss in online journals, or blogging, has recently expanded rapidly. Weight-loss bloggers typically write about daily successes and failures, report calorie consumption and exercise output, and post photographs of their changing bodies. Many bloggers openly court the surveillance of blog readers as a motivation for accountability to their weight-loss goals. Drawing from a sample of weight-loss blogs authored by women, we explore three issues arising from this practice of disclosing a conventionally private activity within an online public domain. First, we examine motivations for blogging, focusing on accountability. Secondly, we consider the online construction of self, exploring how weight-loss bloggers negotiate discourses around fatness, and rework selves as their bodies transform. Finally, we consider the communities of interest that form around weight-loss blogs. This 'blogosphere' provides mutual support for weight loss. However, participating in online social spaces is complicated and bloggers must carefully manage issues of privacy and disclosure.

Weight stigma, addiction, science, and the medication of fatness in mid-twentieth century America

Obesity and overweight are today recognised as subject to harmful stigma. Through an analysis of discussions of obesity in major American newspapers, the medical literature, and pharmaceutical advertising in the 1930s, 1940s and 1950s, I document a significant shift in medical thinking about overweight and obesity based in psychiatry, and explore the relationship of that shift to changes in popular understandings of fatness after the Second World War. I argue that the psychiatrically-oriented postwar medical thinking about obesity was more stigmatising as compared with the endocrinologically-oriented thinking of the interwar period, in that the newer biomedical theory linked fatness to the already stigmatised condition of addiction and authorised attribution of moral blame to the fat. I further argue that the pharmaceutical industry cannot be assigned the lead role in medicalisation in this period that some authors attributed to it. These events cast doubt on the received view of fatness as subject to decreasing stigma and increasing medicalisation over the course of the twentieth century, and call for exploration of the social factors influencing specific forms of medicalisation.

Disrupting normal: Toward the ‘ordinary and familiar’ in fat politics

As a nascent movement, fat activism must look critically at the tactics and strategies it chooses precisely because the movement is helping to produce ‘Fat’ as a mode of subjectification and identification. I argue that the desire of some fat activists to bring fatness under the banner of ‘normal,’ particularly through attempts to link certain forms of fatness and health, is a losing battle. Further, this strategy may lead to an ethic of assimilation that leaves behind the very people that fat activism should most benefit and represent. By drawing the connections between queer theory, disability studies and fat activism, I suggest that bodily normativity is an unstable category that must be constantly re/performed because it is always, in effect, failing ( McRuer 2006 ). Given this, fat activism should resist the seduction of normal and instead develop a more critical politics of embodiment and more effective challenge to healthism. I suggest that Eli Clare’s (2002) notion of the ‘ordinary and familiar’ offers one such framework.

"Norwegians fear fatness more than anything else"--a qualitative study of normative newspaper messages on obesity and health

OBJECTIVE

To explore normative aspects of the Norwegian discourse on obesity.

METHODS

We conducted a qualitative study with data from five Norwegian newspapers, focusing normative entries about body weight. Discourse analysis provided a focus on the cultural attitudes when systematic text condensation was conducted. Data comprised 26 normative messages (prescriptions or comments on how obese people are or should be, messages mediating or discussing values prescribing a 'good' body).

RESULTS

Two main normative domains within the obesity discourse were identified. One group of entries warned about obesity from an aesthetic point of view, notifying the reader that beauty would suffer when weight increases, due to reduced attractiveness. These texts appealed to bodily conformity, linking leanness with attractiveness and delight, suggesting that fat people are ugly and unhappy. The other group referred to lack of control in the obese person, linking greediness to lack of responsibility and bad health. Fat people were displayed as undisciplined and greedy individuals who should be ashamed.

CONCLUSIONS

Cultural messages of blame and shame are associated with obesity, but also spreading from body weight to the very scene of life. People with obesity cannot escape this cultural context, only find a way of coping with it.

PRACTICE IMPLICATIONS

Quality care for people with obesity implies that public health and clinical medicine acknowledge the burden of cultural stigma. Developing awareness for cultural prejudices on body weight, doctors could counteract stigmatization and contribute to empowerment and health.

Nutritional health, subjectivity and resistance: Women’s accounts of dietary practices

Food is related to health, both directly and symbolically, in complex ways. Also, social practices around food are highly gendered, and, in the context of family life, fall largely to mothers. This study examines mothers’ talk about nutritional health, and food, health and dietary practices in the context of everyday life, using a discursive analysis of the talk from focus group discussions. Findings show that discourses surrounding nutritional health offer women a variety of conflictual subjectivities. If they do not engage in ‘correct’ dietary practices, women are positioned as immoral, both as individuals and as mothers. Further, their ability to determine which foods are ‘healthy’ or ‘unhealthy’ is undermined through a distrust of ‘facts’ and scientific evidence, and they are rendered susceptible to exploitation through claims made for food as health promoting. Together, these areas of conflict perpetuate subjectivities of anxiety around dietary practices.The women seek to re-position themselves and overcome these contradictions by offering a variety of legitimations for their dietary practices. In doing so, they resist nutritional health messages and reveal how such messages can have unintended effects.

Framing disease: the example of female hypoactive sexual desire disorder

Disease classification is an important part in the process of medicalisation and one important tool by which medical authority is exerted. The demand for, or proposal of a diagnosis may be the first step in casting life's experiences as medical in nature. Aronowitz has written about how diagnoses result from social framing mechanisms (2008) and consensus (2001), while Brown (1995) has demonstrated a complex range of interactions between lay and professionals, institutions and industries which underpin disease discovery. In any case, there are numerous social factors which shape the diagnosis, and in turn, provide a mechanism by which medicalisation can be enacted. Focussing on diagnostic classification provides an important perspective on the human condition and its relationship to medicine. To illustrate how layers of social meaning may be concealed in a diagnosis, this paper uses as heuristic the relatively obscure diagnosis of Female Hyposexual Desire Disorder which is currently surfacing in medical and marketing literature as a frequent disorder worthy of concern. I describe how this diagnosis embodies long-standing fascination with female libido, a contemporary focus on female hypersexuality, and commercial interest of the pharmaceutical industry and its medical allies to reify low sexual urge as a pathological disorder in women.

More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers

This paper presents the findings of a qualitative study conducted in the United Kingdom of the perceptions of overweight individuals, as well as health professionals and policy makers working in the area of obesity prevention and weight management. In 2006-2007, we conducted interviews with 34 men and women (18-50 years old) who self identified as being overweight; 20 health professionals; and 9 policy makers. We explored their understandings of the causes of obesity/overweight; beliefs about factors that enabled or inhibited weight loss/gain; and opinions regarding effective obesity/overweight interventions. We found a range of views, which corresponded with biomedical and socio-ecological perspectives of health and disease. The lay overweight respondents viewed the problem of obesity arising from their personal shortcomings (i.e. motivational and physical), juxtaposed to blame-absolving accounts often involving specific challenges associated with day-to-day living. All respondents presented personal stories of complex battles of short-term weight loss and longer-term weight gain, usually characterised by a sense of failure. All expressed a strong sense of personal responsibility to overcome their weight problems, and looked to another not-yet-tried, technocratic weight loss programme to address the problem, despite all reporting past failures. Health professionals and policy makers on the other hand viewed obesity as a socio-ecologically determined problem, detailing social and environmental explanations. Health professionals were more inclined towards individual-orientated weight management interventions as effective responses. Policy makers considered environmental and social policy changes as most likely to make a substantial difference to current obesity trends, but considered it unlikely that such policies would be implemented without the political will and popular support. Our data highlight dissonance between policy maker, health professional and public obesity perceptions and points to a challenge for those who believe that wholesale systemic change is required if obesity trends are to be reduced or halted.

Older women and suntanning: the negotiation of health and appearance risks

This paper examines older women's experiences and perceptions of sunbathing, sun avoidance, and suntanned appearances. Using data from in-depth interviews with 36 women aged 71 to 94, we elucidate the motivations behind the women's sunbathing practices. Specifically, we explore how the women responded to the health and appearance risks associated with exposure to and avoidance of ultraviolet radiation as well as extant feminine beauty norms. The majority of women put their experiences of sunbathing in an emergent historical context. Although most of the women suggested that suntanned appearances were indicative of health and beauty, sunbathers tended to downplay their health risks by distancing themselves from those they considered to be most at risk, namely tanning bed users and individuals who acquired overly dark suntans. Sunbathers also emphasised the benefits of sun exposure for adequate vitamin D absorption. In contrast, the women who did not suntan tended to have experienced negative health and appearance consequences from their past sunbathing practices. Thus, these women emphasised the importance of future health over immediate appearance dividends. We discuss our findings in relation to the extant research on suntanning and the literature pertaining to health, risk, and beauty work.

Medicalisation of food advertising. Nutrition and health claims in magazine food advertisements 1990-2008

Food advertising increasingly portrays food as a type of medicine. A content analysis of magazine food advertisements in 1990 through 2008 shows that this was manifested with time more in the (a) nutrition claims and (b) health claims made in food advertisements, as well as the (c) food groups and (d) media genres to which nutrition and health claims in food advertising pertained. This so-called "medicalisation" of food advertising may promote images of the body and mind as malfunctioning unless remedied by the use of--advertised--products.

Where there is no patient: an anthropological treatment of a biomedical category

This work anthropologically applies the concept of 'personhood' to the Western biomedical patient role, and through cross-cultural comparisons with wellness-seeker roles (e.g. among the Maya of Guatemala and others) it seeks to discern the implications for global healthcare of assuming the universality of the "patient" role. Here, particular ethnographic attention is given to the presumption of the "patient" role in places and situations where, because of cultural and linguistic variation in local wellness-seeker roles and practices, there may be no "patient." It is hoped that establishing the biomedical patient role (with the clinical expectations, communicative and comportment practices that prefigure it) as acquired rather than intuitive, will help redirect cultural competence to the acquisition of patienthood, broadening it from an endless accrual of cultural inventories by physicians. Also it aims to shift existing biomedical associations of cultural variations in wellness-seeking away from a priori assessments of clinical defiance towards deeper understandings of the kinds of cultural differences that may make the difference treatment outcomes.

Beyond evidence-based nursing: tools for practice

AIM

This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions.

BACKGROUND

As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach.

EVALUATION

This article summarizes nursing's simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making.

KEY ISSUE

I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale.

CONCLUSION

Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more.

IMPLICATIONS FOR NURSING MANAGEMENT

This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important decision-making skills which provide an even stronger foundation for robust nursing decisions.

“You Think You’re the Only One”: Comparing Descriptions and Lived Experiences of Polycystic Ovarian Syndrome

This article examines the biomedical diagnosis of polycystic ovarian syndrome (PCOS) from the perspectives of medical anthropology and science and technology studies (STS), addressing two main questions: what does a historical, medical anthropology and STS perspective reveal about how PCOS is described and understood in contemporary North America, and what are the lived experiences of people with this diagnosis? Common descriptions of PCOS are based in normative gendered assumptions. Drawing on interviews with people diagnosed with PCOS and on analysis of historical and contemporary biomedical literature discussing PCOS, I argue that the lived experiences of people with PCOS vary significantly from mainstream (biomedical and popular) descriptions of the diagnosis.