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Weighty Matters:Health or Identity Promotion? Rosaline S. Barbour firstname.lastname@example.org North East Medical Sociology Group 8th March, 2012
Views and experiences of weightmanagement in general practiceWeighwell: A scoping study to develop aweight 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 & CulpabilityIt is my own fault because I enjoy my food.(Female, 37 years)Often when I am sitting watching TV or videos orchatting, I‟ll have 4 pints of lager, maybe 4 or 5packets of crisps and a packet of peanuts and Ihave quite a weakness for pepperoni sticks. I‟llmaybe have 3 or 4 of them… I also enjoy a bottleof Irn Bru … and maybe a bottle of Tizer.(Male, 42 years)
Challenging „Orthodoxies‟ ‘The Jim Royle Effect‟?“I‟m Scotland‟s most UnsuccessfulSlimmer!”(Male, 56 years)
„Psy‟ Spaces & Valued IdentitiesI have tried diets, but I am sorry - Iam not one of these people for saladand soup … I did once start countingcalories but I got fed up with it. Iwas standing there and cookingsomething and you‟re thinking „Thereis 2 calories in that and 5 calories inthat‟. I just got bored and thought„bugger it‟. I just stick it on the plateand eat it.(Female, 37 years)
Interview with Robbie Coltrane “It‟s glandular……”“ … I‟ve got this gland that makes me agreedy 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 IndulgenceBourdieu, P. (1984) Distinction: A SocialCritique of the Judgement of Taste,Cambridge, MA; Harvard University Press.
„Habitus‟ as an Open Systemof 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/PerformativityNan -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 PromotersNan - 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)