Dissertation Defense Slides: Changing Meanings of Fat

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In this slides presentation, I review the key findings of my dissertation and discuss the different phases in the medical discourse on body fat.

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  • Dissertation Defense Slides: Changing Meanings of Fat

    1. 1. Changing Meanings of Fat: Fat, Obesity, Epidemics, and America’s ChildrenElise ParadisPh.D. Candidate, M.A. SociologyStanford University School of Educationhttp://www.stanford.edu/~eparadiseparadis@stanford.edu
    2. 2. “Elise: I hope you realize that a dissertation defense is not a boxing match.” - F.O. Ramirez, Informal Conversation, 2009.
    3. 3. Obesity today...
    4. 4. Obesity today...Is perceived as a serious health problem;
    5. 5. Obesity today...Is perceived as a serious health problem;Is discussed as an epidemic;
    6. 6. Obesity today...Is perceived as a serious health problem;Is discussed as an epidemic;And is part of the “risk society” discourse: We are all “at risk” for obesity (Boero, 2007), and our society runs major risks if obesity is not addressed.
    7. 7. In the Literature
    8. 8. In the LiteratureThere have been, schematically and over- simplistically, two main perspectives on obesity (Saguy & Riley, 2005):
    9. 9. In the LiteratureThere have been, schematically and over- simplistically, two main perspectives on obesity (Saguy & Riley, 2005):1. Obesity as a disease, an economic threat, and as requiring forceful intervention (“the main paradigm”);
    10. 10. In the LiteratureThere have been, schematically and over- simplistically, two main perspectives on obesity (Saguy & Riley, 2005):1. Obesity as a disease, an economic threat, and as requiring forceful intervention (“the main paradigm”);2. Obesity as a social construction and a moral panic (“the counter paradigm”).
    11. 11. Dissertation Overview
    12. 12. Dissertation OverviewReview the two paradigms of obesity and adjudicate the evidence each presents (Part I);
    13. 13. Dissertation OverviewReview the two paradigms of obesity and adjudicate the evidence each presents (Part I);Discuss the development of the obesity discourse, particularly in the medical literature –
what I have called the “medicalization of fat” (Part II);
    14. 14. Dissertation OverviewReview the two paradigms of obesity and adjudicate the evidence each presents (Part I);Discuss the development of the obesity discourse, particularly in the medical literature –
what I have called the “medicalization of fat” (Part II);And discuss the way schools and education have been mobilized to solve the “obesity problem” in the United States and in Singapore (Part III).
    15. 15. Dissertation OverviewReview the two paradigms of obesity and adjudicate the evidence each presents (Part I);Discuss the development of the obesity discourse, particularly in the medical literature –
what I have called the “medicalization of fat” (Part II);And discuss the way schools and education have been mobilized to solve the “obesity problem” in the United States and in Singapore (Part III).
    16. 16. Intellectual Tradition, I
    17. 17. Intellectual Tradition, IDissertation falls within a tradition of studies in the social construction of knowledge and scientific facts (Berger 1966; Collins and Evans 2002; Fleck 1935; Hacking 1990, 1990; Latour 2004; Latour and Woolgar 1979; Swidler and Arditi 1994).
    18. 18. Intellectual Tradition, IDissertation falls within a tradition of studies in the social construction of knowledge and scientific facts (Berger 1966; Collins and Evans 2002; Fleck 1935; Hacking 1990, 1990; Latour 2004; Latour and Woolgar 1979; Swidler and Arditi 1994).Here, obesity and the obesity epidemic are “facts” with a history. They are embedded in a social, intellectual, and scientific context.
    19. 19. Intellectual Tradition, II
    20. 20. Intellectual Tradition, IIDissertation also inspired by neo-institutionalist studies of science and of science education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan 1978).
    21. 21. Intellectual Tradition, IIDissertation also inspired by neo-institutionalist studies of science and of science education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan 1978).Science is seen as:
    22. 22. Intellectual Tradition, IIDissertation also inspired by neo-institutionalist studies of science and of science education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan 1978).Science is seen as: – A set of assumptions about the world;
    23. 23. Intellectual Tradition, IIDissertation also inspired by neo-institutionalist studies of science and of science education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan 1978).Science is seen as: – A set of assumptions about the world; – A legitimating force for choices, actions, and labeling;
    24. 24. Intellectual Tradition, IIDissertation also inspired by neo-institutionalist studies of science and of science education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan 1978).Science is seen as: – A set of assumptions about the world; – A legitimating force for choices, actions, and labeling; – A cultural authority across domains;
    25. 25. Presentation Overview
    26. 26. Presentation OverviewDiscuss some of the evidence that shows that fat is, beyond a “medical” phenomenon, a “medicalized” phenomenon.
    27. 27. Presentation OverviewDiscuss some of the evidence that shows that fat is, beyond a “medical” phenomenon, a “medicalized” phenomenon.Present the different steps of the process whereby fat became medicalized, as seen in major scientific events and in the medical literature over time (proxy: PubMed database).
    28. 28. “The Medical”: Definition
    29. 29. “The Medical”: DefinitionThe biopsychosocial model of health includes the biological / physiological factors that cause ill health and disease, and the psychological and sociological factors that influence or complicate them.
    30. 30. “The Medical”: DefinitionThe biopsychosocial model of health includes the biological / physiological factors that cause ill health and disease, and the psychological and sociological factors that influence or complicate them.e.g., Cancer: The result of uncontrolled growth in a group of cells. Its risk increases with smoking, physical inactivity, and exposure to certain chemicals. It affects a time-varying percentage of the population, and is a stigmatizing condition (Jain 2010; Sontag 1990).
    31. 31. “The Medicalized”: Definition
    32. 32. “The Medicalized”: DefinitionMedicalization (Conrad 1992; Zola 1983) is the process whereby previously non-medical conditions come under medical purview. It is the consequence of the expansion of the medical profession, and seen in the multiplication of publications, loci of intervention, and claims to authority (Starr 1982).
    33. 33. “The Medicalized”: DefinitionMedicalization (Conrad 1992; Zola 1983) is the process whereby previously non-medical conditions come under medical purview. It is the consequence of the expansion of the medical profession, and seen in the multiplication of publications, loci of intervention, and claims to authority (Starr 1982).e.g., Mental illnesses are often discussed as medicalized conditions (e.g., Brumberg 1990; Metzl and Kirkland 2010). Other conditions include baldness (Powell et al. 2005) and erectile dysfunction (Conrad 2005), which were not always seen as medical problems.
    34. 34. Fat as medical condition.
    35. 35. Fat as medical condition.After reviewing the medical literature, I concluded:
    36. 36. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing;
    37. 37. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness;
    38. 38. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as:
    39. 39. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as: • Weight Cycling (–)
    40. 40. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as: • Weight Cycling (–) • Cardiovascular Fitness (+)
    41. 41. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as: • Weight Cycling (–) • Cardiovascular Fitness (+) • Stress Levels (–)
    42. 42. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as: • Weight Cycling (–) • Cardiovascular Fitness (+) • Stress Levels (–) • Insurance Coverage (+)
    43. 43. Fat as medical condition.After reviewing the medical literature, I concluded: – That obesity rates have been increasing; – That obesity correlates with illness; – The data on mortality and morbidity often fails to control for factors proven to be major determinants of health, such as: • Weight Cycling (–) • Cardiovascular Fitness (+) • Stress Levels (–) • Insurance Coverage (+) – Weight loss is not a sustainable, safe, or proven strategy for improving health outcomes.
    44. 44. Fat as medicalized condition.
    45. 45. Fat as medicalized condition.The legitimating force of science has turned fat into a medical problem, in contrast with fat as merely an esthetic concern.
    46. 46. Fat as medicalized condition.The legitimating force of science has turned fat into a medical problem, in contrast with fat as merely an esthetic concern.The medicalization of fat has taken on proportions that exceed the proven medical problem with fat.
    47. 47. Fat as medicalized condition.The legitimating force of science has turned fat into a medical problem, in contrast with fat as merely an esthetic concern.The medicalization of fat has taken on proportions that exceed the proven medical problem with fat.I argue that the medicalization of fat went through three major discursive shifts: from fat to obesity, to epidemics, and finally to concern with America’s children.
    48. 48. Medicalized Fat > Medical Fat
    49. 49. Medicalized Fat > Medical Fat16,000 A14,000 Obesity12,000 Childhood Obesity Obesity Epidemic Childhood Obesity Epidemic10,000 Total PubMed Adult Obesity % Child Obesity % (6-11)8,0006,0004,0002,000 0 1985-9 1990-4 1995-9 2000-4 2005-9
    50. 50. Medicalized Fat > Medical Fat16,000 1,000 A B 90014,000 Obesity 80012,000 Childhood Obesity Obesity Epidemic 700 Childhood Obesity Epidemic10,000 Total PubMed 600 Adult Obesity % Child Obesity % (6-11)8,000 500 4006,000 3004,000 2002,000 100 0 0 1985-9 1990-4 1995-9 2000-4 2005-9 1985-9 1990-4 1995-9 2000-4 2005-9
    51. 51. The Changing Meanings of Fat
    52. 52. Before there was obesity, there was...
    53. 53. Before there was obesity, there was... FAT.
    54. 54. Before there was obesity, there was... FAT. Then, through medicalization, fat became
    55. 55. Before there was obesity, there was... FAT. Then, through medicalization, fat became Obesity.
    56. 56. The medical community mobilizes. The Medicalization of Fat USDHHS Childhood Obesity Surgeon General Vision Obesity in International NIH: Consensus Statement Classification of Diseases on Weight-Loss Surgery White House Lets Move! WHO Global Epidemic NIH: Obesity in America IoM Guidelines for Obesity Surgeon General: Shape Up Association for the Study of America Obesity Surgeon General Call NIH Use of BMI WHO Use of BMI Bypass Surgery1950 1960 1970 1980 1990 2000 2010
    57. 57. Associated growth in publications.40,000 Obesity in Titles and Abstracts Ratio Obesity to PubMed (x 1M)30,00020,00010,000 0 1950 2010
    58. 58. Associated growth in publications.40,000 Raw growth, 1950-2009: 14,569% Obesity in Titles and Abstracts Ratio Obesity to PubMed (x 1M)30,00020,00010,000 0 1950 2010
    59. 59. Associated growth in publications.40,000 Raw growth, 1950-2009: 14,569% Obesity in Titles and Abstracts Ratio Obesity to PubMed (x 1M)30,00020,000 Normalized growth, 1950-2009: 1,327%10,000 0 1950 2010
    60. 60. Associated growth in publications.40,000 Obesity in Titles and Abstracts Ratio Obesity to PubMed (x 1M)30,000 USDHHS Childhood Obesity Surgeon General Vision Obesity in International NIH: Consensus Statement Classification of Diseases20,000 on Weight-Loss Surgery White House Lets Move! WHO Global Epidemic NIH: Obesity in America IoM Guidelines for Obesity Surgeon General: Shape Up10,000 Association for the Study of America Obesity Surgeon General Call NIH Use of BMI WHO Use of BMI Bypass Surgery 0 1950 1960 1970 1980 1990 2000 2010
    61. 61. An epidemic (of epidemics).
    62. 62. An epidemic (of epidemics).Year First Instance of1954 Epidemic AND Diabetes1960 Epidemic AND CVD1976 Epidemic AND Obesity1993 "obesity epidemic" OR "epidemic obesity"1994 "childhood obesity" AND epidemic
    63. 63. An epidemic (of epidemics).0.0006 Obesity AND Epidemic0.0005 Diabetes AND Epidemic Cardiovascular Diseases AND Epidemic Obesity AND Epidemic AND Childhood0.0004 Year First Instance of 1954 Epidemic AND Diabetes 1960 Epidemic AND CVD0.0003 1976 Epidemic AND Obesity 1993 "obesity epidemic" OR "epidemic obesity" 1994 "childhood obesity" AND epidemic0.00020.0001 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
    64. 64. An epidemic (of epidemics).0.0006 Obesity AND Epidemic0.0005 Diabetes AND Epidemic Cardiovascular Diseases AND Epidemic Obesity AND Epidemic AND Childhood0.0004 Year First Instance of 1954 Epidemic AND Diabetes 1960 Epidemic AND CVD0.0003 1976 Epidemic AND Obesity 1993 "obesity epidemic" OR "epidemic obesity" 1994 "childhood obesity" AND epidemic0.00020.0001 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
    65. 65. An epidemic (of epidemics).0.0006 Obesity AND Epidemic0.0005 Diabetes AND Epidemic Cardiovascular Diseases AND Epidemic Obesity AND Epidemic AND Childhood0.0004 Year First Instance of 1954 Epidemic AND Diabetes 1960 Epidemic AND CVD0.0003 1976 Epidemic AND Obesity 1993 "obesity epidemic" OR "epidemic obesity" 1994 "childhood obesity" AND epidemic0.00020.0001 Fat wins. 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
    66. 66. 800700600500400 Childhood Obesity300200 Let’s Move!100 0 1980 1985 1990 1995 2000 2005
    67. 67. Concern with obesity then turned to children.800700600500400 Childhood Obesity300200 Let’s Move!100 0 1980 1985 1990 1995 2000 2005
    68. 68. Concern with obesity then turned to children.800700 Raw growth, 1980-2009: 3,700%600500400 Childhood Obesity300200 Let’s Move!100 0 1980 1985 1990 1995 2000 2005
    69. 69. And schools and education were mobilized.500 Education400 School Childhood and Education Childhood and School Epidemic, Childhood and Education Epidemic, Childhood, and Schools300200100 0 1980 1985 1990 1995 2000 2005
    70. 70. And schools and education were mobilized.500 Education400 School Childhood and Education Childhood and School Epidemic, Childhood and Education Epidemic, Childhood, and Schools300 Surgeon General Call200100 0 1980 1985 1990 1995 2000 2005
    71. 71. Medical vs. Medicalized Fat
    72. 72. Medical vs. Medicalized FatIn sum, my research has shown that fat is not merely a medical phenomenon; it is a medicalized one.
    73. 73. Medical vs. Medicalized FatIn sum, my research has shown that fat is not merely a medical phenomenon; it is a medicalized one. - The medical bases to call fat a disease, and to entice people to lose weight, are still shaky;
    74. 74. Medical vs. Medicalized FatIn sum, my research has shown that fat is not merely a medical phenomenon; it is a medicalized one. - The medical bases to call fat a disease, and to entice people to lose weight, are still shaky; - Immense scientific mobilization to define obesity as a disease, in the U.S. and beyond;
    75. 75. Medical vs. Medicalized FatIn sum, my research has shown that fat is not merely a medical phenomenon; it is a medicalized one. - The medical bases to call fat a disease, and to entice people to lose weight, are still shaky; - Immense scientific mobilization to define obesity as a disease, in the U.S. and beyond; - Dramatic expansion of medical publications on the topic.
    76. 76. Medical vs. Medicalized FatIn sum, my research has shown that fat is not merely a medical phenomenon; it is a medicalized one. - The medical bases to call fat a disease, and to entice people to lose weight, are still shaky; - Immense scientific mobilization to define obesity as a disease, in the U.S. and beyond; - Dramatic expansion of medical publications on the topic.Fat is a social construction.
    77. 77. Steps in the medicalization of fat.
    78. 78. Steps in the medicalization of fat.First, there were fat people.
    79. 79. Steps in the medicalization of fat.First, there were fat people.By 1970, they were obese. By 1985, they were defined by a BMI above 30. In 1990, obesity officially became a disease.
    80. 80. Steps in the medicalization of fat.First, there were fat people.By 1970, they were obese. By 1985, they were defined by a BMI above 30. In 1990, obesity officially became a disease.Early 1990s: Obesity emerges as an epidemic. By 1999, trumps other epidemics of non-contagious diseases.
    81. 81. Steps in the medicalization of fat.First, there were fat people.By 1970, they were obese. By 1985, they were defined by a BMI above 30. In 1990, obesity officially became a disease.Early 1990s: Obesity emerges as an epidemic. By 1999, trumps other epidemics of non-contagious diseases.At the turn of the century, concern with children explodes. Governmental action targets them - and their parents - specifically.
    82. 82. Thank You!

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