Paper short abstract:

Drawing from empirical and theoretical sources, this paper will consider how patient, practitioner and policy maker understandings of obesity, stress and responsibility can be used to inform culturally appropriate public health policy and practice.

Paper long abstract:

What are the respective roles and responsibilities of the state and the individual in addressing obesity? In British society, people are expected to make lifestyle changes to reduce obesity. However, obesity is determined to a large extent by social, ecological and polictical forces outside individual control, which is one reason obesity is considered as a health inequality. The behaviour change interventions currently advocated in health policy have limited effectiveness and may carry negative psychosocial consequences, including blame and stigmatisation, which then further perpetuate obesity-generating behaviours. An underexplored piece of the obesity puzzle is the role of stress. Emerging evidence suggests socio-economic inequalities cause psychosocial stress, and can lead to obesity-generating behaviours. A biopsychosocial model of obesity considers the lived experiences of the individual, taking into account the ways people interact with their social and ecological environments, and how those interactions influence obesity-generating behaviours. Drawing from empirical and theoretical sources, this paper will consider how patient, practitioner and policy maker understandings of obesity, stress and responsibility can be used to inform culturally appropriate public health policy and practice.

Paper short abstract:

In recent decades, weight has come to act as a cultural signifier for type 2 diabetes. Drawing on ethnographic fieldwork in diabetes care in south Australia we unpack the contours of this framing its sitgmatising and iatrogenic consequences and entanglement in moralizing discourses surrounding obesity.

Paper long abstract:

Although overweight and obesity are increasingly seen as the key risk factors for Type II diabetes mellitus (T2DM) there are many 'risk' factors for T2DM, including age, genetics, gestational diabetes etc. the interplay of which is not well understood. However, in recent years, the idea that weight is the risk factor and/or central cause of T2DM has become increasingly prevalent and naturalised in media representations, popular discourse, public health campaigns and academic research. In these framings, weight and in particular overweight and obesity have come to act as cultural signifiers for type 2 diabetes (McNaughton 2012, 2013). In this convergence, diabetes (like overweight and obesity) often emerges as self-inflicted: the result of wholly changeable and highly risky behaviours and 'lifestyles' that are seen to be antithetical to a long, healthy, moral life. At the same time, the complexity of the disease's aetiology, limitations in current understandings of its causes are blurred or rendered invisible.

In this paper we examine the potency of this convergence: examining the ways weight and diabetes are framed in the context of diabetes care and education. Drawing on ethnographic fieldwork in southern Australia we unpack the contours of this convergence and its widespread acceptance amongst 'clients' and health professionals. We demonstrate the stigmatising and iatrogenic consequences of this framing, for those deemed 'at risk' or diagnosed with diabetes, while recognising their entanglement in earlier, moralising discourses surrounding obesity, individual responsibility and health

Paper short abstract:

The article presents results of a qualitative, interview-based research study carried out in Poland, which aimed at exploring the main social concepts associated with bodily ‘normativity’ and ‘passability’: the notion of a ‘normal’ body weight and attitude towards over- and underweight individuals.

Paper long abstract:

Our article is based on the empirical material gathered during 60 qualitative interviews conducted in Poland. The subject of the research was the social perception of 'normativity' of the body weight. As in the societies influenced by Western culture, citizens are becoming more and more preoccupied with maintaining the 'proper' body size, we wanted to investigate, what the 'normal' body weight means. We were particularly interested in the common concepts and notions associated with the 'normal' body weight as well as in possible reasons for rejection of people, whose bodies do not fall within the social standards of 'normativity' of the body, for example the obese or the extremely slim. We understand 'normativity' broadly, as "fitting into the social norms" and are vividly interested in the social norms, standing behind the socially shared knowledge of what is the 'right' body. Sander L. Gilman coined the term 'to pass' in order to indicate the moment in which an individual gains the social acceptance of their personal appearance by the rest of the society (Gilman, 2001). We wanted to learn more about the grounds, on the basis of which certain body silhouettes are accepted and other rejected. The study was anchored in the tradition of sociology, yet it used research methods common for both sociology and anthropology (in-depth interviews). The interviews were conducted with the use of visual materials, computer generated images, representing different types of men's and women's silhouettes, ranging from "severe underweight" to "obesity".

Paper short abstract:

In the context of acculturation in Senegal caused by urbanization, while youth assimilate the modern body norms resulting in a stigmatization of fatness, most of aged women want to gain a massive overweight indicating a good integration to the urban sociocultural model of "Progress".

Paper long abstract:

The Senegalese lifestyle mutation by an urbanization process associated with the combined effects of demographic, nutritional and epidemiologic transitions, has consequences on body conceptions: evolution of body size standards, new perceptions of health, diet and aesthetic, which need to be clarified.

To do this, we conducted a comparative qualitative study implemented in a representative sample of Senegalese adults from Dakar (8 focus groups) and a village from the Kaolack region (6 focus groups).

The qualitative study by focus group shows that the urbanization of Senegal has some ambivalent effects on the construction of body size vernacular standards. Indeed, while youth assimilate the modern norms resulting in a stigmatization of any type of fatness, most of aged subjects - especially women - want to gain a massive overweight indicating an economic success and a good integration to the urban sociocultural model of "Progress". Thus, while youth integrate an exigent modern model of body size without fat - diet, intense physical activity - old women integrate an exigent animist model of body size very fatty - fattening practices, corticoid-steroids intake - potentially dangerous for health.

Today, with the acculturation process of Senegal, two models of body size coexist: (i) an extreme animist model where old women living in poor suburbs want to indicate a strong control of the nature, expressed by an important gain of weight, (ii) an extreme modern model where youth influenced by the urban technical development would like to access to a body detached from the nature effects, expressed by a very thin body.

Paper short abstract:

This ethnography on bariatric surgery multidisciplinary staff meetings will deconstruct the admission pragmatics, revealing the ontologies on obesity and how evidence-based medicine jointly with social and moral criteria enters into play in the triage of the out-bonds bodies to be operated

Paper long abstract:

This paper presents preliminary results of a broader research currently taking place at the University Public Hospital of Ambroise Paré (Boulogne, Parisian region, France) on bariatric surgery. This research seeks to explain the way obesity is constructed in lay and expert knowledge and how obesity is enacted in clinical settings. It also aims to understand how people whose body is not only out of bounds but also sources of physical and social suffering link in their daily life nutritional norms and eating practices. Drawing from the ethnographical data produced from June 2013 on the multidisciplinary meetings in which hospital staff decides who can be operated or not, I will do a deconstruction analysis of the admission pragmatics to obesity surgery. This analysis will reveal the coexistence of a diversity of ontologies on morbid obesity, on which depend both the medical treatment and the patient-family-professionals relations. By which criteria are selected the candidates willing a bariatric surgery? At what extend do clinical practices rest on the so-called "evidenced-based research" in medicine? How criteria on the social conditions of life are taken into consideration in the description of the profile and bio-history of the "cases" discussed in these meetings? How moral judgments on the habits and the personality of the candidates enter into play in the selection of the operable patients and the decision on the type of surgery?

Paper short abstract:

This presentation addresses the relationship between obesity patients and bariatric surgery as a medical technology. In contrast to common critiques of surgery as coercive and objectifying the paper explores how surgical treatment also enables new configurations of agency for patients

Paper long abstract:

Surgical treatment of severe obesity has consistently been shown to produce better sustained weight loss and health improvements than all other weight loss strategies. Weight loss surgeries carried out on a global scale is increasing and gastric bypass surgery is the most frequently performed surgical weight loss procedure in the world. Despite - or because of - this prevalence weight loss surgery also has its critics. Among feminist scholars weight loss surgery has been criticized for compromising patients' subjectivity and autonomy. It is argued that surgery is paradigmatic of the objectified patient, discursively framed as either incapable and dependent on the technologies, or victimized by them.

This paper examines how surgery instantiates new configurations of both agency and objectification. On the basis of insights gained through ethnographic fieldwork, it describes how weight loss surgery patients engage in eating practices and other forms of body management which make possible 'a notion of agency not opposed by objectification, but pursued in objectification' (Cussins 1996). Attention is focused on strategies for how patients cope with post-operative changes and how surgery promotes the establishment of eating practices that allow patients to exercise agency. It thus explores surgical treatment enables co-constitutive entanglements between patient and technologies.

Paper short abstract:

This presentation lays out techniques of the self that patients having undergone weight loss surgery in the Netherlands employ despite of, or afforded by, the changes the surgery brought about and discusses some implications of moving beyond technologies of the self that involve liberal agents.

Paper long abstract:

In the Netherlands, people diagnosed as 'morbidly obese' increasingly undergo gastric bypass surgery. In this procedure, the intestinal system is rearranged to limit both food intake and uptake. This may suggest that surgery corrects from the outside and thus relieves patients from the difficult task of taking control over their behavior. In the Dutch obesity clinic where I did fieldwork, surgery is part of a more elaborate care assemblage - consisting of dieticians, exercise coaches and psychologists. There, the changed body implies a new, potentially disrupting, reality that patients must learn to cope with. Thus an equally drastic transformation is deemed important in which it is not the obese body, but the person that is targeted: a self is carved out (encouraged, cultivated) that can then engage in self-care. Drawing on interviews with patients and observations of clinical sessions, I trace techniques of the self that patients can employ despite of, or thanks to, the changes the surgery brought about. The self of self-care does not carry a 'burden of freedom' (cf. Nikolas Rose) as it struggles to adhere to biomedical regimes. Rather, it is concerned with acquiring a relation to oneself and developing tools to do what is best for it. The self that emerges throughout the treatment is both distinct from the body and embodied; both actively in control and socially and materially embedded. Thus, the presentation discusses some implications of moving beyond technologies of the self that involve liberal agents.

Paper short abstract:

The lives of ‘obese’ people are portrayed inaccurately in popular accounts and media images. This paper explores the lived experiences of big women as a radical force with reference to alternative images to the norm.

Paper long abstract:

In this paper I will argue that the lives of 'obese' people are portrayed inaccurately in popular accounts and media images and contend that the lived experiences of big women contain radical force which undermines societal 'norms'. My work encompasses filmmaking, ethnography and teaching. Using interviews I undertook for a book project, Lavish (unpublished, 1993) and a film, Undercurrent (2001) I wish to explore various ways in which the 'big woman' can be seen as a radical expression of embodied experience and practice. Lavish followed women from varied cultural backgrounds, questioning sexuality, clothing, relationships, environment, profession etc. Undercurrent featured myself on a trampoline and underwater for a dance work displayed in galleries. I worked on sets with film crews over a number of years and also conducted ethnography with feature film cinematographers. I am very aware of changing representations and varied subjectivities of big women in cinema and television and how these have become more extreme in the last few years. This panel offers an opportunity to display some alternative thoughts and visions that situate ideas about size and shape, surgery and wellbeing, tailoring and culture in comparison ideas of an obese body as defined by the medical professions. The paper will be presented in an experimental fashion - using textiles, film and stills; a combination of auto-ethnography, sensory anthropology and material culture. I will use material from my own work, cinematic representations and photographs from London organisations such as Planet Big Girl and Big Girl's Paradise.