Academic journal article Health Sociology Review

"Obesities": Experiences and Perspectives across Weight Trajectories

Academic journal article Health Sociology Review

"Obesities": Experiences and Perspectives across Weight Trajectories

Article excerpt

Introduction

Obesity stigma and medicalisation

In current biomedical discourse, fatness and "excess" weight is pathologised as "obesity" (Jutel, 2006). While excessive corpulence was always considered medically significant, the use of weight scales, statistical standards, and computer power helped introduce a new diagnostic focus solely on body weight. The significance of weight may now supersede other medical criteria, such as symptoms and medical history, in medical encounters and messaging (Davies, 1998; Guthman, 2011; Jutel, 2006). Obesity, having a Body Mass Index (BMI) in excess of 30, while ostensibly an objectively clinical category, is also a highly ideological construction (Gard & Wright, 2005). A simplistic energy balance model of weight control (calories in > calories out), characterises obese persons as lazy and gluttonous, and equivocal and nuanced findings about obesity and health risks are framed in alarmist and incontrovertible terms (Gard & Wright, 2005).

This catastrophic depiction of obesity renders large bodies as visible confessions of apparent pathology; even in situations in which ill-health is not present (Davies, 1998; Jutel, 2006; Murray, 2009). Obese persons' non-normative appearances assign them discredited "spoiled identities" (Goffman, 1963). In a healthist context, in which maintaining healthiness is considered an individualist moral imperative and the duty of a responsible citizen, an obese person is further discredited as socially deviant (Crawford, 1980; Goffman, 1963). This moralistic construction of obesity compounds the pervasive and damaging stigma experienced by obese persons (Puhl & Heuer, 2010).

In the United States, 40% of people with a BMI > 35 reported experiencing discrimination in a multitude of settings, and obese persons are stereotyped as lazier, or less motivated than thinner people (Puhl, Andreyeva, & Brownell, 2008; Schwartz, Vartanian, Nosek, & Brownell, 2006). Importantly, obese persons may resist this discourse in their everyday lives; fat activism has been active for decades (Ellison, 2007; Schoenfielder & Wieser, 1983), and it now has a significant online presence (Dickins, Thomas, King, Lewis, & Holland, 2011). Among clinicians and patients, the Health-at-Every-Size (HAES) movement is growing, as are the multidisciplinary critical obesity and fat studies disciplines (Cooper, 2010). Nevertheless, dominant messaging asserts obese bodies should be normalised via weight loss (Murray, 2009). However, weight loss is rarely sustainable and is not without health risks (Aphramor, 2005; Gaesser, 2009).

Embodiment

Unlike the often static depiction of bodies in weight loss accounts (Levy-Navarro, 2009), wherein a fat body passes irrevocably to a thin state, material bodies are necessarily fl uid (Longhurst, 2001). Individuals' embodiment may range from subjective and objective periods of various sizes, from thin to fat. Respecting embodiment in research involves treating individuals as "concerned about the management, maintenance and appearance of their bodies," given their practical recognition of their bodies' significance "as personal resources and as social symbols which give out messages about ... self-identity. In this context, bodies become malleable entities which can be shaped and honed by the vigilance and hard work of their owners" (Shilling, 2003, pp. 4-5). A discursive environment rife with weight loss messages will therefore have profound effects on individuals' embodiments. Embodied weight histories and the passage of time likely alter understandings of health and bodies. Given omnipresent messaging on obesity and weight loss, insight into how obese individuals feel about their health and obesity over time and weight trajectories is necessary.

Obese persons' views on health and weight loss

Qualitative research shows obese persons have nuanced views on weight loss and obesity. They believe that weight loss may be beneficial; however, they also indicate exceptions to prevailing obesity messaging, criticise the BMI, and highlight other important aspects of health (Kwan, 2012, Lewis et al. …

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