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Sociology of obesity : Controversies over obesity
 

Sociology of obesity : Controversies over obesity

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Controversies over obesity

Controversies over obesity
The risks of political agenda building and the thematization obesity
By Jean Pierre Poulain

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    Sociology of obesity : Controversies over obesity Sociology of obesity : Controversies over obesity Presentation Transcript

    • SAS Toulouse, janvier 2009 Controversies over obesity The risks of political agenda building  and the thematization obesity Jean Pierre Poulain  Socio‐anthropologue Professeur à l’Université de Toulouse 2 CERTOP‐TAS UMR CNRS 5044 1
    • Sociology and obesity: two approaches Sociology « in » … Sociologie « of » … Links between SES and obesity Medical discourse on obesity Social stigmatization of obese Preventing obesity: practical people details and what’s at stake Modern dietary habits and obesity Social controversies Transformation of social representations of fat bodies and of fat Obesity as a social construction Obesity as a multi-factorial disease that sociology seeks to analyze
    • Plan Controversies Obesity : Definition and measurement Obesity: how many deaths? Obesity and life expectancy Controversies : a price to pay for agenda setting Controversies as part of the process of thematization 3
    • The agenda building theory, COBB et ELDER 1972] Problem stream Window of opportunity Prevalence : build-up and exaggeration of the issue Definition : Epistemological transformation Manipulation of the threshold of social Aligning the 3 streams acceptance Solution stream Proposal of solutions based upon optimistic evaluations Entrepreneurs More rhetorical prevention than Crossed real problem-solving Policy stream Experts Obesity is often used as a tool to gain political capital Financing Publicity 4
    • Agenda building : decision makers and windows of opportunity Entrepreneurs Experts 5
    • Thematization Theory of Communicative Action There are contexts in which knowledge is unstable (justification of the Thematization Precautionary principle). Organizing, forming questions Scientific rationality cannot account for based upon the social the social questions involved. imagination and in relation to Science does not deal with human other social issues. problems alone, since decisions are made through consensus Value-rationalities are negociated, discussed, socially constructed Structure and function of public debate 6
    • Sociology of science Theoretical framework Empirical data : Mertonian sociology Scientific documents (peer reviewed articles, Ethos of the researcher expert statements, Influence of contexts books) The « strong program » (Bloor, 1976) Lobbyists’ work (web Science as a large market sites, publications, ads) Resource conquest logic and on Press articles (analyses Moderate contextualism (Berthelot, 2002 et 2008) and interviews) Conceptual Contextualist 7
    • Plan Controversies Obesity : Definition and measurement Obesity: how many deaths? Obesity and life expectancy Controversies : a price to pay for agenda setting Controversies as part of the process of thematization 8
    • Body Mass Index Quételet’s formula Weight / HeightX Height Categories BMI values En kg en m Underweight < 16,0 degree 3 Underweight 16,0-16,9 degree 2 Underweight 17,0-18,4 degree 1 Underweight < 18,5 Normal range 18,5-24,9 Overweight >= 25,0 Mild obesity 25,0-29,9 Obesity class 1 30,0-34,9 Obesity class 2 35,0-39,9 Obesity class 3 >= 40
    • How weight became the n°1 problem of the United States   Depuis 1998  Avant 1998    Femmes et  Femmes  Hommes  hommes  Obésité   >30 >30 >30 Surpoids   25‐30 27,3‐30 27,6‐30 Poids  18,5‐25 20‐25 20‐25 normal   Minceur  <18,5 <20 <20   38 % overweight versus 60 % 10
    • How weight became the n°1 problem of the United States In one night, not less than « Current interpretations of the revised 35 million Americans guidelines stigmatize too many people as became overweight. overweight; fail to account for sex, race/ethnicity, age, and other differences, and ignore the serious health risks associated with The change of the limit low weight and efforts to maintain an between the categories of unrealistically lean body mass. normal range and This seeming rush to lower the standard for underweight from 20 to 18, overweight to such a level that 55% of which effectively American adults find themselves being standardizes a weight declared overweight or obese raises serious concerns ». previously considered Strawbridge, Wallhagen, Shema, 2000, American insufficient. Journal of Public Health. 11
    • The French Rugby team, before and after Before After 1998 Normal weight 17 3 Overweight 7 21 Obesity 6 6 12
    • Justification of the new guidelines Scientific argument ? Controversy : Diabetes Overweight and longevity (Flegal et al. ) Or private interests Lobbying power of pharmaceutical/drug companies Researchers’ own motives (Kopelman, 2000). 13
    • The definition of obesity : an epistemological forceful takeover? « Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.» The text follows saying that “Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying overweight and obesity in adult populations and individuals. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). » The writer continues « However, it should be considered as a rough guide because it may not correspond to the same degree of fatness in different individuals. » (OMS, 2006). Then a slight shift and the same text states « The World Health Organization (WHO) defines "overweight" as a BMI equal to or more than 25, and "obesity" as a BMI equal to or more than 30. » (OMS, 2006). 14
    • The construction of childhood obesity in France : paternalist manipulation ?
    • Fatten… the numbers, Le monde 20 janvier 2006.
    • Plan Controversies Definition and measurement of obesity Obesity: how many deaths? Obesity and the life expectancy Controversies : a price to pay for agenda setting Controversies as part of the process of thematization 18
    • Obesity: how many deaths? Allison, and al., 1999, “Annual deaths Mokdad and al., 2004, Prevalence of Flegal and al. 2005. Excess deaths attributable to obesity in the United obesity, diabetes, and obesity-related health associated with underweight, overweight, States”, JAMA, 282, 1530–38. risk factors, JAMA, Vol. 289, n ° 1, 76-79. and obesity. JAMA 293(15): 1861–67. 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 2000 2001 2002 2003 2004 2005 19
    • 300,000 deaths…obesity or ? Michael Mc Ginnis and William Foege attribute a high mortality rate in the United States--300, 000 deaths--to sedentary lifestyles and vad dietary habits, but not weight in itself. (Mc Ginnis et Foege, 1993). Paradoxically, this study will become a main scientific reference for defending the idea of a link between mortality and obesity. An analysis of electronic data bases shows that in the span of 3 years, it is cited over a thousand times to support the link between mortality and obesity. Mc Ginnis and Foege are so upset by the misuse of their work that in 1998 they publish a letter in New England Journal of Medicine wherein they denounce the « misrepresentation » of their study. Regardless, the debate continues. 20
    • Plan Controversies Obesity : Definition and measurement Obesity: how much deaths? Obesity and life expectancy Controversies : a price to pay for agenda setting Controversies as part of the process of thematization 21
    • « Life expectancy in the United States will diminish as a result of an obesity epidemic that will creep through all ages like a human tsunami » Jay Olshansky Reduction of life expectancy due to obesity, separated according to race and sex, United States 2002 S. Jay Olshansky et al., "A Potential Decline in Life Expectancy in the United States in the 21st Century", New England Journal of Medicine 352, vol. 11: 1138-45. 22
    • « I doubt that obesity will negate the effects of other medical progress in improving mortality. » Vaupel « His perspective is that of an advocate making a case rather than a scientist evaluating the body of conflicting evidence.“ "There is a small chance -- less than one in 100 -- that Olshansky's prediction of declining life expectancy might possibly prove correct." Vaupel, 2005, directeur du Max Plant Institut Kenneth Thorpe, d'Emory University, « way much simplistic » Even Jo Ann Manson, more or less in the alarmist camp, explains in the Associated Press, « the calculations that were done aren’t exactly perfect… ». 23
    • 24
    • Plan Controversies Definition and measurement of obesity Obesity: how many deaths? Obesity and the life expectancy Controversies : a price to pay for agenda setting Controversies like component of the process of thematisation 25
    • Agro-industry and fast-food Agro-industry plays a triple game. Via forceful marketing and advertising, they fill the market with products that encourage people to eat more and to eat high caloric foods (snacking between meals, increased portion size), Supporting intervention in human nutrition by public authorities and nutritional councils. To relieve themselves of responsibility, they stress the individual responsibility of consumers (Nestle, 2000 et 2007) 26
    • Which interpretations? Who benefits from the media attention given to problems tied to weight and obesity? On answer is the pharmaceutical industry The market of “medicalized” weight- loss products has developed has the science that drives their production (discovery of new molecules) advances. 27
    • Public policies…. Tim Lang shows the impact of agricultural policies and of advertising regulation. Marion Nestle writes about the result of shareholder pressure on agro-industries. By demanding higher and higher dividend earnings, they force companies to increase sales in an already saturated market. Companies respond to this pressure by looking for new markets and new sale opportunities. In order to achieve their goals, they encourage behaviors that were once looke down upon, such as snacking between meals. They also seek to change social norms that had previously restricted food consumption to specific contexts. (Nestle, 2007). 28
    • Interest of researchers and of research organizations June 23, 2004, the director of the CDC orders an internal review of a study that had evaluated the number of deaths caused by obesity at 400,000 and assigns the responsibility to the research team of Dr. Stephen Thacker. Conclusions : Error in calculation? Problems of bias At her Congressional hearing, Julie Gerberding had argued for a 6 billion-dollar budget for the CDC. 29
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    • How to explain the situation? Game of musical chairs where each actor passes the responsibility to the next person. Need to share responsibility for the situation. Theoretical framworks Agenda-building theory Thematization 31
    • The agenda building theory Problem stream Prevalence : build-up and exaggeration of the issue Definition : Epistemological transformation Manipulation of the threshold of social acceptance Solution stream Proposal of solutions based upon optimistic evaluations More rhetorical prevention than real problem-solving Policy stream Obesity is often used as a political tool Financing Publicity 32
    • Thematization of obesity Concrete evidence of its effects : Bad eating habits Food crises General feeling that we don’t know what to do Culpability for the abundance of food in northern countries The legitimization of the obsession with loosing weight 33
    • 34
    • The consequences of thematizing obesity Scientists’ demands for caution go unheard People who dramatize the problem dominate the discourse on obesity Media saturation Obesity as a scientific problem with much at stake socially 35
    • Body image as an axis of prevention Effects of dramatization ? Justification of the skinny beauty standard Development of eating disorders Dietary socialization of children 36
    • « What causes the most damage is not the actual weight itself, but the fear of weight ». Hillel Schwartz, Never statisfied. 37
    • Further reading… 38