Theorizing health at every size as a relational–cultural endeavour

The ruling of weight: An institutional ethnography investigating young people's body weight surveillance work

RATIONALE

Dominant framing of childhood obesity as a public health burden has increased weight stigma towards young people in larger bodies. However, weight stigma literature is generally limited by its focus on individuals' attitudes and beliefs, overlooking the broader social conditions shaping stigma. Further, few weight stigma studies have been conducted from young people's standpoint; little is known about how they navigate stigmatizing environments while growing up.

OBJECTIVE

This study aimed to examine the social organization of young people's everyday work of growing up in a larger body, interpreting work generously as any activity requiring thought and intention.

METHODS

Using institutional ethnography, we conducted individual interviews in Alberta, Canada with 16 informants aged 15-21 who grew up in larger bodies. Five, repeated group interviews were then held with a subset (n = 5) of these informants.

RESULTS

Weight surveillance work (e.g., self-weighing on scales, social comparison) was informants' most common form of weight-related work while growing up. Surveillance results instructed them on next steps, whether that be working to fit in (literally and figuratively) or resisting social conformity altogether. Informants' bodies were monitored by nearly everyone around them: family, peers, educators, and healthcare providers. Informants learned how and why to do the work expected of them through social relations. Despite their (mostly) good intentions, surveillance by respected adults conveyed to informants that their self-worth depended on their weight. Biomedical, individuated health and weight discourses guided the enactment of institutional policies and practices in healthcare and education, such as those related to the Body Mass Index. These ruling discourses objectified bodies as normal or abnormal, healthy or unhealthy, good or bad.

CONCLUSION

Overall, study findings show how young people's experiences of growing up in their bodies were predictably organized by dominant weight and health discourses, identifying possible levers for public health intervention.

(Re)claiming our bodies using a Two-Eyed Seeing approach: Health-At-Every-Size (HAES®) and Indigenous knowledge

We originally proposed a study to examine changes in disparities in "obesity" between Indigenous and non-Indigenous Canadian populations, as called for in the Truth and Reconciliation Commission, Article 19 (2015), which calls for ongoing monitoring of disparities in health outcomes. Instead, we questioned the importance of reducing the prevalence of "obesity" as a health goal for Indigenous peoples. This critical commentary provides an overview of Canadian Indigenous populations' weight, its relationship with health outcomes, and weight stigma and discrimination, using an Indigenous feminist lens. We introduce the applicability of a Two-Eyed Seeing approach utilizing a Health-At-Every-Size (HAES®) model and Indigenous ways of knowing, as a starting point, to understand weight, health, and our bodies. A new paradigm is needed to identify and close health gaps as noted in Article 19 of the Truth and Reconciliation Calls to Action (2015). We respectfully call upon health professionals and public health bodies to acknowledge the harm of weight stigma and discrimination in their practice and policies, and we encourage Indigenous peoples to (re)claim and (re)vitalize body sovereignty.

Weight Inclusive Practice: Shifting the Focus from Weight to Social Justice

Obesity is framed by mainstream media and health care professionals as an "epidemic" contributing to the ill health of the population. This paper reviews literature related to dominant discourses about weight in dietetics, drawing on literature from other health care disciplines, and how these discourses influence patient care. Emerging, competing discourses are also reviewed. Literature highlighted that dietitians and dietetic students are often biased and hold stigmatizing beliefs toward "overweight" and "obese" patients. No research has been conducted in Canada addressing this question, leaving this as an opportunity for future research. Weight stigma and interventions focused on weight have multiple negative implications for individuals, especially those living in larger bodies, including reluctance to seek health care, poor body image, subsequent weight gain, and increased disordered eating. There are alternative discourses emerging, which shift the focus away from weight and toward social justice. The ways in which dietetic students are trained to "manage" weight, and how dominant discourses influence this training, is an important area of future exploration. Dietetic professionals are encouraged to reflect on their weight biases and educate themselves on weight inclusive approaches to health, such as Health at Every Size and Well Now.

Obesity, bodily change and health identities: a qualitative study of Canadian women

Medicalised concerns about an obesity crisis persist yet more needs to be learnt about everyday orientations to weight (loss). This article reports and analyses data generated using qualitative methods, including repeated interviews and fieldwork conducted over one year in Canada with women (n = 13) identifying as (formerly) obese. Three ideal types are explored using empirical data: (1) hopeful narratives; (2) disordered eating distress; and (3) weight-cycling or stagnation. Core themes include women's desire to embody a thin(ner) future and the good life, the harms of intentional weight-loss, and resignation to living as a fat woman whilst nonetheless challenging stigma. The article contributes to critical studies of weight/fatness, the sociology of bodily change and the embodiment of health identities. In concluding, we call for reflexive change in bodies of health knowledge, policy and practice.

Positioning of Weight Bias: Moving towards Social Justice

Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.