Rosaline S. Barbour r.barbour@open.ac.uk

North East Medical Sociology Group

8th March, 2012

Weighty Matters: Health or Identity Promotion?

Views and experiences of weight management in general practice Weighwell: A scoping study to develop a weight loss intervention for new mothers

Links between obesity and ill health – Coronary heart disease

– Type II diabetes

– Cancer

Discomforting Thoughts …

Impact of maternal weight on child health outcomes

Focus on weight loss rather than lifestyle change

Realistic in terms of timing and priorities?

Unwarranted Assumptions?

Inevitable consequences

Progression through lifecourse

BUT Limited evidence

Cross-sectional rather than longitudinal data

Few cohorts old enough

Obesity as a „Disease of the Will‟

“ … an epidemic of diseases of the will - failures of responsible self-control and self-management, surrender to some baser aspect of the self in compulsive consumption of drink, drugs, gambling, sex … the perils and pitfalls we must avoid in treading the path of the responsible enactment of our all-consuming freedom.”

Nikolas Rose (1999) Governing the Soul: The Shaping of the Private Self, Free Association Books: London; p.266.

Potential for Resistance

Re-defining success

Individualized strategies

„Psy‟ shaped space (Rose)

Confessional stories

Transformational stories

Organized resistance

Confessional Stories & Culpability

It is my own fault because I enjoy my food. (Female, 37 years)

Often when I am sitting watching TV or videos or

chatting, I‟ll have 4 pints of lager, maybe 4 or 5 packets of crisps and a packet of peanuts and I have quite a weakness for pepperoni sticks. I‟ll maybe have 3 or 4 of them… I also enjoy a bottle of Irn Bru … and maybe a bottle of Tizer.

(Male, 42 years)

Challenging „Orthodoxies‟

‘The Jim Royle Effect‟?

“I‟m Scotland‟s most Unsuccessful Slimmer!”

(Male, 56 years)

„Psy‟ Spaces & Valued Identities

I have tried diets, but I am sorry - I am not one of these people for salad and soup … I did once start counting calories but I got fed up with it. I was standing there and cooking something and you‟re thinking „There is 2 calories in that and 5 calories in that‟. I just got bored and thought „bugger it‟. I just stick it on the plate and eat it.

(Female, 37 years)

Interview with Robbie Coltrane

“It‟s glandular……”

“ … I‟ve got this gland that makes me a greedy bastard”

Selective Accounts

Explaining „Thin-ness‟

“See my brother-in-law - now, he‟s a racing greyhound. He can eat anything he likes and he never puts on any weight.” (Male, 52 years.)

Re-visiting Structure & Agency

Husserl and „habitual action‟ intuitively followed

Bourdieu and „habitus‟/dispositions

Incorporates social structure

High degree of affinity in health lifestyle choices among members of the same class

Lesser role for agency?

(Cockerham, 2005)

Insights from BOURDIEU

Sobriety for the

sake of slimness

Convivial Indulgence Bourdieu, P. (1984) Distinction: A Social Critique of the Judgement of Taste, Cambridge, MA; Harvard University Press.

„Habitus‟ as an Open System of Dispositions …

The habitus is “an open system of dispositions that is constantly subjected to experiences, and therefore constantly affected by them in a way that reinforces or modifies its structures”. (Bourdieu & Wacquant, 1992)

“Thus the habitus can be creative and initiate

changes in dispositions.” (Cockerham, 2005) “Weber associated lifestyles not with

individuals but with status groups, thereby showing they are principally a collective social phenomenon.” (Cockerham, 2005)

Challenging „BMI Wisdom‟ Laura - Yeah, I‟d be quite happy to be „overweight‟ in

their categories [laughs] Debbie - The target weight for my height was about

nine and a half stone and I just thought, „Do you know what? There‟s no way that I‟m going to get down to there so they can stick it where the sun don‟t shine!‟

Laura -Mine was something like seven and a half stone and I was like no way, I was maybe that when I was at school. Sorry…

Debbie - It‟s extremely unrealistic the actual BMI, it just was not achievable ... yeah, it just seemed so unachievable that it didn‟t matter, like ideally I‟d like to be about ten and a half, maybe eleven stone, and to even be that and still be told you‟re obese

(Focus Group 1)

Subversion/Performativity Nan -You see, I‟m really evil because my cheese sits in

the fridge and I‟ve got written on it, „Nan‟s diet cheese‟, so as my husband doesn‟t like strong cheese, he likes, like, double Gloucester and all these cheeses. I like cheese that you [voices overlap] and I write, like, „Diet cheese‟, but inside it‟s like seriously strong stuff, and he thinks it‟s diet so he never touches it. I just put „Diet‟ on something even though it‟s not, he goes, „Oh, that‟s my wife‟s diet stuff, I‟d better not touch it‟, and I get it. Oh, I come from an Italian family, I‟m not stupid, I let him think I am.

Alison -Yeah, they‟ve got to think you‟re a little bit stupid.

Nan -Yeah. I just go [inaudible 00:44:58] … that works a lot. But I write, „Diet cheese, or, „Nan‟s diet crisps‟, or diet half-fat chocolate, or card bars, I write on the box and they‟re not, and he thinks, „Oh‟, because he‟s a man and he‟s not allowed in my kitchen anyway, so… „What are you doing in my fridge?‟

(Focus Group 3)

Message to Researchers and Health Promoters

Nan - Tread gently. Eileen - Very gently. Veronica - Don‟t be pushy. Nan - Or patronizing. Nan - Because we know we‟re overweight but we just

don‟t need you telling us we are, we‟ve got mirrors in the house as well.

Eileen - And we‟re not dense. Nan - We know what vegetables and fruit are, we

know we should eat them, but at the end of the day a KitKat is easier to get through than an orange. Orange is like aargh, but a KitKat - done, gone.

Nan - A lot of it is more time management, the convenience of it.

But, seriously …

Nan -If you‟ve got a KitKat you think, „Well, I should have that lovely fresh healthy orange, but, bugger it, I haven‟t got time, and it gets sticky…wash my hands…‟ the KitKat, done.

Nan -Yeah, peel it, and wash your hands, and change your top…

All - Yeah. Nan - And then you get hacked off about it and

think, you know, I still fancy eating a KitKat. Veronica -I think you can get orange KitKats now too

[voices overlap]. (Focus Group 3)

Sociological Alignment? „Health promoting‟

Makeovers/commodification

„Fat activism‟ ‘Jim Royale‟- type resistance

Celebrity chefs