This document discusses the medicalization of obesity over time. It shows that as fat became defined as a medical problem called obesity, the number of related medical publications grew dramatically from 1950-2009. Obesity was constructed as an epidemic starting in the 1990s. Similarly, childhood obesity emerged as a medical issue and epidemic in the late 1990s. While BMI correlates with mortality and morbidity, there are major confounding factors that make predicting health from BMI uncertain. Nonetheless, there was immense scientific activity to define obesity as a disease despite this uncertainty. The document concludes that fat and medicine are social constructions and our understanding of what fat means is limited.

1. Meanings of Fat:
Obesity, Epidemics, and America’s Children
Elise Paradis, Ph.D. (Stanford)
Currie Postdoctoral Fellow| Wilson Centre
elise.paradis@utoronto.ca

2. F AT

3. Medical
F AT

4. Medical
F AT
Encompasses all the biological and
physiological factors that cause ill health
and disease, as well as the psychological
and sociological factors that influence
them.

5. Medicalized

6. Medicalized
O BESITY

7. Medicalized
O BESITY
The process whereby previously
non-medical conditions come under
medical purview.
Conrad 1992, 2005

8. Medicalized
O BESITY
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.
Conrad 1992, 2005

9. Medicalization
F A T & O B E S I TY

10. Medicalization
F A T & O B E S I TY
 Read secondary literature on the history of fat

11. Medicalization
F A T & O B E S I TY
 Read secondary literature on the history of fat
 Queried PubMed / Medline database, 1950-2010

12. Medicalization
F A T & O B E S I TY
 Read secondary literature on the history of fat
 Queried PubMed / Medline database, 1950-2010
 Normalized data to enable comparisons
(# of publications / total PubMed; 1985 data=100)

13. Medicalization
F A T & O B E S I TY
 Read secondary literature on the history of fat
 Queried PubMed / Medline database, 1950-2010
 Normalized data to enable comparisons
(# of publications / total PubMed; 1985 data=100)
 Mapped publication trends over time

14. Medicalization studies
(Conrad 1992, 2005; Zola 1983)
Neo-institutional studies of science
(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer and Jepperson 2000;
Meyer and Ramirez 2000; Meyer and Rowan 1978)
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)

15. In this framework
M E D IC INE

16. In this framework
M E D IC INE
A set of assumptions about the world

17. In this framework
M E D IC INE
A set of assumptions about the world
A cultural authority with descriptive and
normative powers

18. In this framework
M E D IC INE
A set of assumptions about the world
A cultural authority with descriptive and
normative powers
A legitimating force for individual,
organizational, and institutional beliefs
and actions

19. F AT

20. F AT
Became

21. F AT
Became
O BESITY

33. Obesity Articles (MeSH, T/A) in PubMed
Database, 1950-2009
40,000
30,000
20,000
10,000
0
1950-4 1955-9 1960-4 1965-9 1970-4 1975-9 1980-4 1985-9 1990-4 1995-9 2000-4 2005-9

34. Raw Growth
1950-2009
14,569%

35. Medicalized
O BESITY
Dwarfs population trends –
the medical problem with fat.

36. The Medical: Normalized Growth, 1985-2009
1,000
900
Adult Obesity %
800
Child Obesity % (6-11)
700
600
500
400
300
200
100
0
1985-9 1990-4 1995-9 2000-4 2005-9

37. Normalized Growth
1985-2009
145% (adults)

38. Normalized Growth
1985-2009
173% (children)

39. The Medicalized: Normalized Growth, 1985-2009
1,000
900
Obesity
800
700 Childhood Obesity
600 Adult Obesity %
500
Child Obesity % (6-11)
400
300
200
100
0
1985-9 1990-4 1995-9 2000-4 2005-9

40. Normalized Growth
1985-2009
447% (adults)

41. Normalized Growth
1985-2009
974% (children)

42. Medicalized
O BESITY

43. Medicalized
O BESITY
E PIDEMIC
c. 1993

44. Obesity AND Epidemic (MeSH, T/A) in PubMed Database,
1985-2009
700
600
500
400
300
200
100
0
1985-9 1990-4 1995-9 2000-4 2005-9

45. Raw Growth
1985-2009
32,100%

46. The Medical: Normalized Growth, 1985-2009
5,000
4,500
4,000
3,500 Adult Obesity %
3,000
2,500
2,000
1,500
1,000
500
0
1985-9 1990-4 1995-9 2000-4 2005-9

47. The Medicalized: Normalized Growth, 1985-2009
5,000
4,500 Obesity
4,000
Obesity Epidemic
3,500
Adult Obesity %
3,000
2,500
2,000
1,500
1,000
500
0
1985-9 1990-4 1995-9 2000-4 2005-9

48. Normalized Growth
1985-2009
9,200%

54. Epidemics (MeSH, T/A) as Proportion of PubMed database,
1990-2009
0.0006
0.0005 Obesity AND Epidemic
Diabetes AND Epidemic
0.0004
Cardiovascular Diseases AND Epidemic
0.0003
0.0002
0.0001
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

55. 0.0006
0.0005
0.0004
0.0003
0.0002
0.0001
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

56. 0.0006
0.0005
0.0004
0.0003
0.0002
0.0001
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

57. Medicalized
O BESITY

58. Medicalized
C HILDHOOD
O BESITY

59. Obesity AND Childhood (MeSH, T/A) in PubMed Database,
1980-2009
800
700
600
500
400
300
200
100
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

60. Raw Growth
1980-2009
3,700%

61. Medicalized
C HILDHOOD
O BESITY

62. Medicalized
C HILDHOOD
O BESITY
E PIDEMIC
c. 1999

63. Childhood AND Obesity AND Epidemic (MeSH, T/A) in PubMed
Database, 1980-2009
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

64. The Medical: Normalized Growth, 1985-2009
16,000
14,000 Adult Obesity %
12,000 Child Obesity % (6-11)
10,000
8,000
6,000
4,000
2,000
0
1985-9 1990-4 1995-9 2000-4 2005-9

65. The Medicalized: Normalized Growth, 1985-2009
16,000
14,000 Obesity
Childhood Obesity
12,000
Obesity Epidemic
10,000
Childhood Obesity Epidemic
8,000
Adult Obesity %
6,000
Child Obesity % (6-11)
4,000
2,000
0
1985-9 1990-4 1995-9 2000-4 2005-9

66. Normalized Growth
1985-2009
31,900%

68. Medicalized
O BESITY
The medical bases upon which to call fat a
disease, and to entice people to lose
weight, are still shaky

69. F AT & BMI

70. F AT & BMI
Correlate with

71. F AT & BMI
Correlate with
M ORTALITY
& M ORBIDITY

72. B UT

73. Major confounding factors in
predicting health from BMI

74. Major confounding factors in
predicting health from BMI
Weight Cycling (–)

75. Major confounding factors in
predicting health from BMI
Weight Cycling (–)
Cardiorespiratory Fitness (+)

76. Major confounding factors in
predicting health from BMI
Weight Cycling (–)
Cardiorespiratory Fitness (+)
Stress Levels (–)

77. Major confounding factors in
predicting health from BMI
Weight Cycling (–)
Cardiorespiratory Fitness (+)
Stress Levels (–)
Insurance Coverage (+)

78. Rarely covered in the literature.
Exceptions suggest that BMI may
be useless measure (Bacon, ACLS study,
Ernsberger, Sharma et al.)

79. Medicalized
O BESITY
Immense scientific mobilization
to define obesity as a disease,
in the U.S. and beyond

80. Medicalized
O BESITY
Dramatic expansion of
medical publications on the topic
despite uncertainty.

81. We do not know what
F AT
means.

82. F AT &
M EDICINE

83. F AT &
M EDICINE
As social constructions

84. Meanings of Fat:
Obesity, Epidemics, and America’s Children
Elise Paradis, Ph.D. (Stanford)
Currie Postdoctoral Fellow| Wilson Centre
elise.paradis@utoronto.ca