Weighing both sides: morality, mortality, and framing contests over obesity

The optics of weight: expert perspectives from the panopticon and synopticon

Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one's vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.

Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.

Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through "fitting in," being "captured by numbers," "dieting: the tyrannic tower," and "the male gaze."

Conclusion: Monitoring and judging body weight have become so normative in Western society that "weight watching" practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

'A radical operation' - a thematic analysis of newspaper framing of bariatric surgery in adolescents

BACKGROUND

Obesity in adolescents is a growing public health issue. Bariatric surgery is an effective, yet controversial treatment option for adolescents. The moral acceptability of this procedure by health-care professionals as well as the general public can be influenced by its portrayal in the news media. Our objective was to analyze how newspaper articles portrayed adolescent bariatric surgery, with attention to the language used and moral arguments made.

METHODS

Using an inductive thematic analysis approach, we analyzed 26 UK and 12 US newspaper articles (2014-2022) on adolescent bariatric surgery for implicit or explicit moral evaluations and use of normative language. Coding was performed after immersive reading, assisted by NVivo. Themes were identified and refined iteratively through consecutive auditing cycles to enrich the depth and rigor of our analysis.

RESULTS

The major themes identified related to (1) defining the burden of adolescent obesity, (2) sparking moral outrage, (3) sensation-seeking, and (4) raising ethical issues. The articles employed moral language, specifically non-neutral and negative discourse regarding surgery. Blame was attributed to adolescents or their parents. Sensationalist wording often reinforced the normative content, drawing the attention of the reader and contributing to stigmatization of adolescents with severe obesity as lacking will power and being lazy. Further moral issues that stood out were the challenges in obtaining an informed consent, and the unequal access to surgery for socially disadvantaged groups.

CONCLUSIONS

Our findings provide insights into how adolescent bariatric surgery is represented in the print news media. Despite frequent citing of experts and studies on the efficacy, safety and unmet need for bariatric surgery, obesity and surgery in adolescents are often stigmatized and sensationalized, with (prospective) patients depicted as looking for an easy way out in the form of a solution brought by others (health systems, society, tax payers). This may increase the stigma surrounding adolescent obesity, and therefore limit the acceptability of specific treatments such as bariatric surgery.

The Na+/K+-ATPase: A potential therapeutic target in cardiometabolic diseases

Cardiometabolic diseases (CMD) are a direct consequence of modern living and contribute to the development of multisystem diseases such as cardiovascular diseases and diabetes mellitus (DM). CMD has reached epidemic proportions worldwide. A sodium pump (Na⁺/K⁺-ATPase) is found in most eukaryotic cells' membrane and controls many essential cellular functions directly or indirectly. This ion transporter and its isoforms are important in the pathogenesis of some pathological processes, including CMD. The structure and function of Na⁺/K⁺-ATPase, its expression and distribution in tissues, and its interactions with known ligands such as cardiotonic steroids and other suspected endogenous regulators are discussed in this review. In addition, we reviewed recent literature data related to the involvement of Na⁺/K⁺-ATPase activity dysfunction in CMD, focusing on the Na⁺/K⁺-ATPase as a potential therapeutic target in CMD.

Machine Learning as a Model for Cultural Learning: Teaching an Algorithm What it Means to be Fat

Public culture is a powerful source of cognitive socialization; for example, media language is full of meanings about body weight. Yet it remains unclear how individuals process meanings in public culture. We suggest that schema learning is a core mechanism by which public culture becomes personal culture. We propose that a burgeoning approach in computational text analysis - neural word embeddings - can be interpreted as a formal model for cultural learning. Embeddings allow us to empirically model schema learning and activation from natural language data. We illustrate our approach by extracting four lower-order schemas from news articles: the gender, moral, health, and class meanings of body weight. Using these lower-order schemas we quantify how words about body weight "fill in the blanks" about gender, morality, health, and class. Our findings reinforce ongoing concerns that machine-learning models (e.g., of natural language) can encode and reproduce harmful human biases.

Responsibility in Medical Sociology: A Second, Reflexive Look

Personal responsibility has emerged as an important element in many countries' public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such "responsibilization" as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual's perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.

A public health framework for reducing stigma: the example of weight stigma

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma (self-stigma).

Medicalizing risk: How experts and consumers manage uncertainty in genetic health testing

Given increased prevalence of direct-to-consumer (DTC) genetic health tests in recent years, this paper delves into discourses among researchers at professional genomics conferences and lay DTC genetic test users on popular discussion website Reddit to understand the contested value of genetic knowledge and its direct implications for health management. Harnessing ethnographic observations at five conferences and a text -analysis of 52 Reddit threads, we find both experts and lay patient-consumers navigate their own versions of “productive uncertainty.” Experts develop genetic technologies to legitimize unsettled genomics as medical knowledge and mobilize resources and products, while lay patient-consumers turn to Internet forums to gain clarity on knowledge gaps that help better manage their genetic risk states. By showing how the uncertain nature of genomics serves as a productive force placing both parties within a mutually cooperative cycle, we argue that experts and patient-consumers co-produce a form of relational medicalization that concretizes “risk” itself as a disease state.

Public health in the making: Dietary innovators and their on-the-job sociology

Diet is understood to be one of the most important influences on public health and chronic disease, and is particularly implicated in the so-called 'obesity epidemic'. Yet interventions aiming to improve the population's dietary habits have failed to translate into widespread health improvements. Simultaneously, the knowledge landscape has become increasingly contentious, with fat activism challenging dominant approaches to how obesity is framed and addressed. This paper is based on 24 ethnographic interviews, and explores the work of health practitioners promoting therapeutic carbohydrate restriction ('low-carb' diets) for people with metabolic health conditions. Drawing on Michel Callon's study of technological innovation, I show practitioners engaging in 'on-the-job sociology'-situated sociological work to justify, and forge a space for, innovative dietary intervention. These innovators employ physiological explanations of hormones, satiety (or hunger), and pleasure (or shame), supported with personal experience, to emphasise material connections between particular eating habits and the sustainability of dietary improvement in everyday life. They resist fat activist influence on healthcare practice (that has resulted in practitioners avoiding conversations about diet, fatness and health), as well as the more extensively critiqued practices of health promotion. Deflecting blame/shame from individuals, innovators spotlight the role of the food industry in undermining public understandings of food and physiology, and dietary improvement that is achievable and sustainable. Through on-the-job sociology, innovators forge a space to engage patients in collaborative dietary experimentation and improvement. This study highlights the importance of on-the-job sociology in the contemporary knowledge landscape, providing new insights about public health in the making.

Breasts, Butts, and Thighs—Oh My! Weight Spurt and Body Image Messages in Girls’ Puberty Books

Analyze popular girls’ puberty books to understand what messages they portray about weight spurt and body image. A critical ethnography was conducted of 13 best-selling books about girls’ puberty. This analysis specifically focused on messages about weight gain/spurt and body image presented in the books and whether these were aligned with larger cultural understandings of weight gain and body image. A data-driven thematic analysis was conducted on the portions of each book relevant to weight gain and body image. The cultural fat-phobic scripts were prevalent in the books, contrasting the well-intended developmental messages. Discussions of weight tended to be negatively framed and weight gain expectations were distressingly vague. The books discussed the necessity of and biological rationale for those changes while normalizing variation in timing. The books also focused on developing a positive body image during this time. Understanding this allows us to see the pervasive, conflicting messages about weight-spurts that girls are receiving from these resources, which can be used to tailor book choice and outreach programs.

Tracking sentiments toward fat acceptance over a decade on Twitter

The fat acceptance (FA) movement aims to counteract weight stigma and discrimination against individuals who are overweight/obese. We developed a supervised neural network model to classify sentiment toward the FA movement in tweets and identify links between FA sentiment and various Twitter user characteristics. We collected any tweet containing either "fat acceptance" or "#fatacceptance" from 2010-2019 and obtained 48,974 unique tweets. We independently labeled 2000 of them and implemented/trained an Average stochastic gradient descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) neural network that incorporates transfer learning from language modeling to automatically identify each tweet's stance toward the FA movement. Our model achieved nearly 80% average precision and recall in classifying "supporting" and "opposing" tweets. Applying this model to the complete dataset, we observed that the majority of tweets at the beginning of the last decade supported FA, but sentiment trended downward until 2016, when support was at its lowest. Overall, public sentiment is negative across Twitter. Users who tweet more about FA or use FA-related hashtags are more supportive than general users. Our findings reveal both challenges to and strengths of the modern FA movement, with implications for those who wish to reduce societal weight stigma.

Do media portrayals and social consensus information impact anti-fat attitudes and support for anti-weight discrimination laws and policies?

Although weight stigma and discrimination are associated with increased body dissatisfaction and eating disorder risk, reduced opportunities, and poorer well-being, there are few legal protections for such discrimination in the U.S. We addressed one barrier to enacting protective legislation - public attitudes toward anti-weight discrimination laws - by assessing the impact of media representations of fatness and information about peer attitudes. Using a 2 × 2 experimental design, participants (N = 525) completed baseline assessments of political conservatism and weight bias and were randomly assigned to view fat-negative or fat-positive media content that was ostensibly supported or not supported by their peers, followed by questionnaires assessing fat phobia and legislative attitudes. Two-way ANCOVAs controlling for baseline weight bias and political conservatism indicated a significant effect for media framing, with greater fat phobia and less support for anti-discrimination laws and policies among those who viewed the fat-negative frame; however, effects for ostensible peer support and interaction effects were not significant. These preliminary findings suggest that efforts to shift media rhetoric may enhance support for anti-weight discrimination laws. Future research should investigate other barriers to anti-discrimination legislation and estimate their impact on body dissatisfaction, eating disorder risk, and other indicators of population health.

Contrasting Narratives of Race and Fatness in Covid-19

The slogan that 'the virus doesn't discriminate' has been belied by the emergence of stark and persistent disparities in rates of infection, hospitalisation, and death from Covid-19 between various social groups. I focus on two groups that have been disproportionately affected, and that have been constructed or designated as particularly 'at-risk' during the Covid-19 pandemic: racial or ethnic minorities and fat people. I trace the range of narratives that have arisen in the context of explaining these disparities, in both the scientific literature and wider expert and public discourse. I show that the scientific and public narratives around these groups have differed significantly, revealing contested and competing conceptions of the basis of these categories themselves. These different conceptions have important impacts on the kinds of interventions that become possible or desirable. I show that in the case of racial or ethnic disparities, genetic narratives have been combatted by a strong focus on structural racism as a driver of pandemic inequalities. However, in the case of fatness, individualising and stigmatising narratives have dominated discussions. I suggest that, given racial or ethnic differences in prevalence of fatness, and scholarship casting anti-fatness as historically racialised, the stigmatisation of fatness disproportionately affects racial or ethnic minorities in terms of placing individual blame or responsibility for the increased burden of Covid-19 on these groups. Despite widespread acknowledgement of the role of structural racism in driving racial inequalities in the burden of Covid-19, anti-obesity rhetoric and research provides a 'backdoor' to placing blame on individuals from racial minorities.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan

BACKGROUND

While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting.

METHODS

This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software.

RESULTS

Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight.

CONCLUSIONS

Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Anti-obesity public health messages and risk factors for disordered eating: a systematic review

In response to the increasing prevalence of overweight and obesity, public health efforts to curb these conditions have been delivered in abundance. There is concern however that the messages used to target these conditions may be increasing risk factors for disordered eating. Therefore, we sought to systematically review the literature on the effects of anti-obesity public health messages on risk factors for disordered eating. Seven electronic databases were searched for articles meeting the inclusion criteria, resulting in the inclusion of 12 studies of various methodologies that measured one or more risk factors for disordered eating following exposure to public health messages. Few studies specifically and accurately measured disordered eating behaviours. Most studies found that messages were stigmatizing towards persons who are overweight/obese, and exacerbate thin ideals and drive for thinness. Interestingly, the same was not found for measures of body dissatisfaction. Messages promoting smaller meals were also thought to be potential triggers for disordered eating. Whilst the studies included in this review offered both quantitative and qualitative insights into how public health messages may have adverse effects on eating behaviours, there was a consistent lack of valid reporting measures and clear classification of outcomes overall. Hence, future research is recommended using valid reporting tools such as validated questionnaires, as well as prolonged exposure to the intervention condition to determine longer-term impact.

Anti-obesity public health advertisements increase risk factors for the development of eating disorders

Although overweight and obesity are increasing in prevalence, eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder are simultaneously on the rise. It is important to address the burden of disease of overweight and obesity on the population, yet there is concern that some of these efforts may be encouraging unhealthy weight control behaviours (UWCB). Using an online survey, 137 participants were exposed to four anti-obesity public health advertisements presented in random order. Weight satisfaction, shape satisfaction, desire to control weight, desire to control shape and desire to engage in UWCB were measured on a 100-point visual analogue scale. A significant effect of the experimental condition was found after exposure to Image 1 with a decrease in weight satisfaction, and increased desire to control body weight, body shape and engage in UWCB. Mean scores for UWCB also increased, on average, across all four image conditions. Public health advertisements targeting obesity risk encouraging unhealthy weight control and subsequent disordered eating behaviours. Those responsible for the implementation of such advertisements must consider very carefully the potential to cause unintended harm.

Obesity as a "self-regulated epidemic": coverage of obesity in Chinese newspapers

OBJECTIVE

The aim of this study was to investigate how obesity was covered in Chinese newspapers from 1999 to 2018, demonstrating the trends and the characteristics of obesity-related news.

METHODS

Content analysis was conducted to analyze a total of 358 news articles spanning two decades (1999-2018). We explored how Chinese newspapers portrayed obesity in terms of the evidence/sources cited in articles, its impacts, drivers/causes, and solutions; and how such portrayals have evolved over time. We further compared the articles across different types of newspapers (government-sponsored vs. commercial), two subpopulations (children vs. adults), and periods of time (1999-2008 vs. 2009-2018).

RESULTS

Results showed that medical experts' interviews and statistics were the two most cited types of evidence in the articles. When discussing causes and solutions of obesity, factors pertaining to personal lifestyles were mentioned most frequently. Compared to psychological and social impacts, physical health risk was stressed more often. Compared with commercial newspapers, government-funded newspapers mentioned societal drivers of obesity and suggested reforming schools more frequently. Such differences were also found between coverage of child obesity and adult obesity. Our research, furthermore, revealed significant differences of media coverage of obesity across the two decades.

CONCLUSIONS

Our findings indicate that obesity was generally depicted as a "self-regulated epidemic" in Chinese newspapers. Although the revealed causes and consequences of obesity are evidently related to individual factors, more attention should be directed to the roles that the government, media, and the society can play in preventing obesity and mitigating related social/economic burden.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Physicians' political party affiliation and clinical management of obesity

Studies have documented that few patients with obesity receive evidence-based care. One provider characteristic that may impact clinical obesity care, but that has been under studied to date, is political party affiliation. This study sought to evaluate how primary care physicians (PCPs) report managing patients with obesity and assess whether there are differences between Democratic and Republican PCPs. This was a secondary analysis of a cross-sectional survey of 225 PCPs registered to vote as Democrats or Republicans in 29 US States. After reading a patient vignette, the PCPs reported the following outcomes: likelihood of documenting obesity in the medical record; likelihood of discussing obesity with the patient; and likelihood of engaging in eight different obesity management options. Almost all PCPs reported they would document obesity in the medical record (Republican = 97.6%, Democrat = 94.3%) and discuss it further (Republican = 95.2%, Democrat = 92.2%). Among eight obesity management options, PCPs were least likely to say they would prescribe medication (3.9%) or refer the patient to counselling (24.0%), regardless of political affiliation. Republicans were more likely to report that they would inquire about the time course of obesity (73.4% v. 56.2%, P = 0.012) and discuss health risks of obesity (91.0% vs 78.3%, P = .018). Republican and Democratic PCPs report some differences in managing patients with obesity, suggesting that political beliefs may play a role in some clinical care.

Compassion-focused therapy for body weight shame: A mixed methods pilot trial

Individuals with bigger bodies (body mass index greater than 30) often experience body weight shame and are at increased risk for mental health vulnerabilities such as depression and anxiety. To date, there have been no studies specifically designed and pilot tested to help with body weight shame for individuals with bigger bodies that do not have a diagnosed clinical condition. The aim of current study is to investigate the initial feasibility of compassion-focused therapy (CFT) as a 12-session group intervention for the reduction in body weight shame for individuals with bigger bodies. The study used a mixed method repeated measure design, with both quantitative and qualitative measures, to assess the initial feasibility of the CFT group-based intervention. Participants (N = 5) attended a 12-session/2-h group CFT programme aimed to directly target body weight shame by cultivating compassion. Measurements were conducted at three time points (pre-, post- and 3-month follow-up intervention). Results indicated that CFT had a positive impact on reducing body weight shame, increasing compassion and improving health-engaging behaviours. Qualitative feedback indicated the importance of the group dynamics to help with the de-shaming of body appearance for individuals. Results from this feasibility trial are promising, and future research using randomized controlled trial methodologies should be conducted to evaluate the effectiveness of CFT as a treatment option for body weight shame for individuals with bigger bodies.

The influence of Grindr, a geosocial networking application, on body image in gay, bisexual and other men who have sex with men: An exploratory study

Recent evidence indicates use of geosocial networking apps is associated with body image-related issues among gay, bisexual, and other men who have sex with men. The current study aims to elaborate upon these findings by investigating how Grindr, the most widely-used dating app among this population, impacts users' body image and body satisfaction. Using an exploratory, qualitative study design, semi-structured interviews were conducted with 13 current and previous Grindr users and analyzed thematically. Our findings suggest Grindr affects users' body image through three primary mechanisms: weight stigma, sexual objectification, and social comparison. In each case, normative user attitudes and behaviours interact with the app's constitutional elements to affect bodily perceptions in a way that differs in form or intensity from social influence via offline exchanges. These interactions are often enabled by features shared with traditional social networking sites, like asynchronous, text-based communication and technology-assisted appearance augmentation, but certain features unique to Grindr may also play an important role. Moreover, participants identified several protective factors and coping strategies which suggest the relationship between Grindr and body image is dependent on a number of complex interactions between technology, user, and environment. Limitations and suggestions for future research are also discussed.

In Biomedicine, Thin Is Still In: Obesity Surveillance among Racialized, (Im)migrant, and Female Bodies

Currently there is a plethora of research literature which constructs obesity as an alarming new global pandemic associated with a multitude of acute and chronic diseases rooted in lifestyle factors. Although most of these claims related to obesity are well accepted in the research community, some challenges remain. For instance, lifestyle factors only partially explain the risks of developing obesity. In this paper, I advocated for greater caution in interpreting some of the medical claims of obesity due to the epistemological and methodological assumptions that inform certain groups of obesity researchers. While most of the literature has reported lifestyle factors and behavior modification as the major mechanisms to achieving health and wellbeing, a few scholars have raised issues about structural factors.

Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine

Despite authority's centrality to the medical profession, providers routinely forgo their medical authority during clinical encounters. Research focuses on patients challenging medical authority but indicates these confrontations are uncommon and providers seldom relinquish their authority in response. Using rare data of 75 audio recordings of adolescent vaccine discussions during clinical encounters and interviews with and observations of medical staff, I examine how staff leverage or abandon their medical authority to convince parents to vaccinate. I find medical professionals use less authority when at risk of stigmatizing patients: Medical professionals are less authoritative when recommending human papillomavirus (HPV) vaccination versus other adolescent vaccines, particularly when addressing the need to vaccinate before sexual onset due to concerns of labeling the child as sexually active. Medical staff defer to parents in ways that potentially discourage HPV vaccine uptake: They encourage HPV vaccination less than other vaccines and infrequently challenge parents' sex-related reasons for vaccine refusal.

The Cultural Competence of Health Journalists: Obesity Coverage in Four Urban News Organizations

This study sought to identify indicators of cultural competence in 670 news stories covering obesity by four urban news organizations: two mainstream newspapers and two ethnic newspapers serving the African-American and Hispanic communities. Through semantic network analysis, the research found that the news organizations converged on five themes: unhealthy lifestyle, food access and education, healthy lifestyle, public policy, and research. Public policy solutions were favored by the mainstream newspapers, while self-efficacy was emphasized in the ethnic papers. In all four newspapers, indicators of cultural competence were mixed. Ethnic newspapers showed particular competence in certain areas, such as community-based sourcing, direct mention of groups at risk for obesity, and lack of medical jargon. Chi-square tests showed, however, that the African-American newspaper discussed obesity less than expected, while the metropolitan daily directly mentioned ethnic groups at risk for obesity less than expected.

'No one is as invested in your continued good health as you should be:' an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics

This article traces the post-surgical relationship between weight-loss surgery (WLS) patients and their home bariatric clinics. Following surgery, there is substantive drop off in patient attendance at both follow-up appointments and support groups. While barriers to follow-up are often discussed with the bariatric literature, patients themselves are typically defined as the problem. Based upon a thematic analysis of 217 blog posts and comments in two top patient-led online forums, I demonstrate that bariatric patients tell a more complex story about their post-surgical lives. I argue that WLS patients constitute a population with highly specialised medical needs that is caught between the requirements for living with surgically altered digestive systems and a lack of sufficient post-operative follow-up care from their home bariatric clinics. Although online forums provide spaces for patients to examine these post-operative social and clinical experiences in critical terms, seek information and get support, ultimately the conversations serve to underline the value of personal responsibility for post-operative outcomes-a framing that echoes that of the bariatric profession. This framing should be understood within a larger climate of weight-based stigma and discrimination as well as neoliberal healthism.

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.

Media representation of the antimicrobial resistance (AMR) crisis: An Australian perspective

BACKGROUND

Antimicrobial resistance and the rise of 'super bugs' has become a major threat to public health worldwide, with authorities warning of an 'apocalyptic future' unless addressed as a matter of urgency. Mass circulation media has traditionally taken an active role in informing the public of important public health issues and the measures needed to address these. The key objective of the larger project informing this article was to describe Australian media representations of the AMR crisis and its role in informing the public about the AMR crisis.

METHODS

Undertaken as an unobtrusive qualitative research enquiry, existing data from Australian media, the websites of select partisan groups and government health departments as well as discipline literature were sourced and analysed using content analysis strategies.

RESULTS

Overall, media coverage was well informed, accurate, balanced, responsive to the issues at stake, and highlighted the seriousness of the issue without being alarmist. Intriguingly, reports relied heavily on the use of content and conceptual metaphors to frame their narratives.

CONCLUSION

The media reports analysed in the context of this study were substantive and well informed. Just what impact they have had on the public in terms of improving its knowledge of the AMR issue or motivating behaviour change to mitigate the AMR crisis was unable to be ascertained. The strategic use of the media to galvanise an effective public response to the AMR crises thus requires further investigation.

Framing Obesity: Effects of Obesity Labeling and Prevalence Statistics on Public Perceptions

The rising prevalence rate of obesity in the United States has accentuated concerns about obesity-related problems as a major public health issue, which has motivated widespread efforts to increase public knowledge and to motivate individuals to change their relevant behaviors. Although health campaign messages commonly include information about prevalence rates for obesity, the impact of obesity labeling and prevalence rate descriptions in such messages has been overlooked by researchers. This online framing experiment fills the research gap by investigating the effects of obesity labeling (disease vs. body type) and prevalence statistics (prevalence rates of obesity, extreme obesity, combined overweight-obesity, or no prevalence information). Our findings suggest that obesity perceptions deviate from reality and that participants use framed cues in the health message as reference points when making judgments related to the nature and prevalence of obesity. Moreover, this study shows that even accurate information might lead to inaccurate perceptions as a result of framing, and perceptions of the nature and prevalence of obesity mediate the effects of framing on behavioral intentions. Implications for obesity framing and the design of public health messages are discussed.

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 Dominant Obesity Discourse Versus Children's Conceptualizations of Health: A Comparison Through Dialogue and Drawings

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health. There is limited research which explores how children's conceptualizations of health are informed by the dominant obesity discourse. To address this knowledge gap, qualitative data were collected from 8- to 11-year-old children ( n = 29) regarding their conceptualizations of health, healthy bodies, and health practices. Results suggest that children's conceptualizations reflected arguments embedded within the dominant obesity discourse, but at times, also contradicted or deviated from it. Study findings can be applied toward children's health promotion programming to offer a more holistic and inclusive perspective on health and well-being.

Some thoughts on phenomenology and medicine

Phenomenology in medicine's main contribution is to present a first-person narrative of illness, in an effort to aid medicine in reaching an accurate disease diagnosis and establishing a personal relationship with patients whose lived experience changes dramatically when severe disease and disabling condition is confirmed. Once disease is diagnosed, the lived experience of illness is reconstructed into a living-with-disease narrative that medicine's biological approach has widely neglected. Key concepts like health, sickness, illness, disease and the clinical encounter are being diversely and ambiguously used, leading to distortions in socio-medical practices such as medicalization, pharmaceuticalization, emphasis on surveillance medicine. Current definitions of these concepts as employed in phenomenology of medicine are revised, concluding that more stringent semantics ought to reinforce an empirical phenomenological or postphenomenological approach.

Disease Campaigns and the Decline of Treatment Advocacy

In the past fifty years, disease advocacy organizations have multiplied and gained political influence, but they have often been reluctant to ask the government to intervene in health care provision. This article asks why. Using original quantitative and qualitative data on the goals and political claims of over one thousand organizations from 1960 through 2014, I find that many early disease advocacy organizations prioritized health care access. But unfavorable political climates discouraged new organizations from focusing on access to treatment. When health care became particularly controversial, even organizations with health care-related missions refrained from pursuing this goal politically. Eventually, politically active organizations began to drop treatment provision from their missions. Over the decades, the troubled politics of health care reshaped the field of disease advocacy, diminishing its focus on medical treatment.

Phantom/liminal fat and feminist theories of the body

This article brings together two concepts, ‘phantom fat’ and ‘liminal fat’, which both aim to grasp how fat in contemporary culture becomes a kind of material immateriality, corporeality in suspension. Comparing the spheres of representation and experience, we examine the challenges and usefulness of these concepts, and feminist fat studies perspectives more broadly, to feminist scholarship on the body. We ask what connects and disconnects fat corporeality and fat studies from ways of theorising other embodied differences, like gender, ‘race’, disability, class and sexuality, especially when thinking through their perceived mutability or removability, and assumptions about their relevance for subjectivity. While it is important to consider corporeality and selfhood as malleable and open to change in order to mobilise oppressive normativities around gendered bodies and selves, we argue that more attention should also be paid to the persistence of corporeality and a feeling of a relatively stable self, and the potential for empowerment in not engaging with or idealising continuous transformation and becoming. Furthermore, we suggest that the concepts of phantom fat and liminal fat can help shed light on some problematic ways in which feminist studies have approached – or not approached – questions of fat corporeality in relation to the politics of health and bodily appearance. Questions of weight, when critically interrogated together with other axes of difference, highlight how experiential and subjugated knowledges, as well as critical inquiry of internal prejudices, must remain of continued key importance to feminist projects.

Healthy habits are no fun: How Dutch youth negotiate discourses about food, fit, fat, and fun

In this article, we use the notion of "biopedagogical practices" to explore how Dutch youth respond to health messages that focus on body weight. Previous studies suggest that such health messages encourage body dissatisfaction in youth. Few studies, however, focus on the local/cultural specificity of youth's responses to these biopedagogical practices. In this article, we address questions about the re-interpretation of and resistance to health messages that Dutch youth engage in and how these can be understood in their local context. The data were drawn from two previously conducted studies in which a total of 64 Dutch teenagers (aged 12-18 years) took part. We employed a variety of qualitative data collection methods and a feminist poststructuralist perspective to analyze how Dutch youth negotiate biopedagogical practices about health. The results show that our participants constructed health in terms of appearance and reproduced negative constructions regarding fat embodiment. Yet they also often circumvented "healthy" lifestyle behaviors prescribed by biopedagogies of health. They did so first by avoiding physical activities because they were afraid of displaying fat embodiment in the settings of sport and physical education where surveillance is omnipresent. Second, they disregarded advice about healthy eating by drawing on having fun as an alternative discursive resource. We argue that having fun is both part of youth culture and characteristic of the discourse about sociability ( gezelligheid) that is a central element of Dutch culture.

Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such 'regulatory interventions' between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as 'obesogenic environments', and the deployment of 'protecting kids', 'industry demonization' and 'economic costs' frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The 'productive power' and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from 'nanny-state' intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict 'evidence-based' policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity.

Message framing in the context of the national menu-labelling policy: a comparison of public health and private industry interests

Objective

We conducted a content analysis of public comments to understand the key framing approaches used by private industry v. public health sector, with the goal of informing future public health messaging, framing and advocacy in the context of policy making.

Design

Comments to the proposed menu-labelling policy were extracted from Regulations.gov and analysed. A framing matrix was used to organize and code key devices and themes. Documents were analysed using content analysis with Dedoose software.

Setting

Recent national nutrition-labelling regulations in the USA provide a timely opportunity to understand message framing in relation to obesity prevention and policy.

Subjects

We examined a total of ninety-seven documents submitted on behalf of organizations (private industry, n 64; public health, n 33).

Results

Public health focused on positive health consequences of the policy, used a social justice frame and supported its arguments with academic data. Industry was more critical of the policy; it used a market justice frame that emphasized minimal regulation, depicted its members as small, family-run businesses, and illustrated points with humanizing examples.

Conclusions

Public health framing should counter and consider engaging directly with non-health-related arguments made by industry. Public health should include more powerful framing devices to convey their messages, including metaphors and humanizing examples.

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.

When Sex and Power Collide: An Argument for Critical Sexuality Studies

Attentive to the collision of sex and power, we add momentum to the ongoing development of the subfield of critical sexuality studies. We argue that this body of work is defined by its critical orientation toward the study of sexuality, along with a clear allegiance to critical modalities of thought, particularly feminist thought. Critical sexuality studies takes its cues from several other critical moments in related fields, including critical psychology, critical race theory, critical public health, and critical youth studies. Across these varied critical stances is a shared investment in examining how power and privilege operate, understanding the role of historical and epistemological violence in research, and generating new models and paradigms to guide empirical and theoretical research. With this guiding framework, we propose three central characteristics of critical sexuality studies: (a) conceptual analysis, with particular attention to how we define key terms and conceptually organize our research (e.g., attraction, sexually active, consent, agency, embodiment, sexual subjectivity); (b) attention to the material qualities of abject bodies, particularly bodies that are ignored, overlooked, or pushed out of bounds (e.g., viscous bodies, fat bodies, bodies in pain); and (c) heteronormativity and heterosexual privilege, particularly how assumptions about heterosexuality and heteronormativity circulate in sexuality research. Through these three critical practices, we argue that critical sexuality studies showcases how sex and power collide and recognizes (and tries to subvert) the various power imbalances that are deployed and replicated in sex research.

The Obesities: An Overview of Convergent and Divergent Paradigms

The study of obesity lends itself to difficulties not only due to our imprecise ability to measure body composition, food consumption, and physical activity but also, even more important, due to complexities involved in defining and conceptualizing obesity. For centuries, obesity has been considered a disease, although researchers and clinicians cannot agree on definitions of "disease" or, if it is one, whether obesity is a disease of metabolism, inflammation, brown fat, chronobiology, the blood-brain barrier, the right brain, or even of infectious origin. The concept of "obesity" as a disease remains controversial to some because not everyone who has excess adipose tissue has any evidence of disease. Obesity, though, has also been considered a sin, a crime against society, an aesthetic crime, a self-inflicted disability, an example of body diversity, a failure in the regulation of energy balance, an appropriate or even inappropriate adaptation to our increasingly obesogenic environment, a genetic disorder, and a psychological/behavioral disorder of overeating involving self-regulation or even addiction. Five major paradigms-medical, sociocultural, evolutionary, environmental, and psychological/behavioral, all with their own subcategorical models-have been identified. All 5 paradigms are required because we are dealing not with "obesity" but with a plurality, the "obesities."

Framing and the health policy process: a scoping review

Framing research seeks to understand the forces that shape human behaviour in the policy process. It assumes that policy is a social construct and can be cast in a variety of ways to imply multiple legitimate value considerations. Frames provide the cognitive means of making sense of the social world, but discordance among them forms the basis of policy contestation. Framing, as both theory and method, has proven to generate considerable insight into the nature of policy debates in a variety of disciplines. Despite its salience for understanding health policy debates; however, little is known about the ways frames influence the health policy process. A scoping review using the Arksey and O’Malley framework was conducted. The literature on framing in the health sector was reviewed using nine health and social science databases. Articles were included that explicitly reported theory and methods used, data source(s), at least one frame, frame sponsor and evidence of a given frame’s effect on the health policy process. A total of 52 articles, from 1996 to 2014, and representing 12 countries, were identified. Much of the research came from the policy studies/political science literature (n = 17) and used a constructivist epistemology. The term ‘frame’ was used as a label to describe a variety of ideas, packaged as values, social problems, metaphors or arguments. Frames were characterized at various levels of abstraction ranging from general ideological orientations to specific policy positions. Most articles presented multiple frames and showed how actors advocated for them in a highly contested political process. Framing is increasingly an important, yet overlooked aspect of the policy process. Further analysis on frames, framing processes and frame conflict can help researchers and policymakers to understand opaque and highly charged policy issues, which may facilitate the resolution of protracted policy controversies.

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.