Paper short abstract:

The present study analyses two Canadian texts meant to improve the health of adults living in fat bodies. Both build upon statistical knowledge of populations, but enact notably different fat bodies - differences that are consequential for care.

Paper long abstract:

Governmental, media, and scientific agencies in Canada mark fat bodies as unhealthy bodies and name health care as an important site to address the 'obesity epidemic'. Knowledge brokers have designed guides for clinicians treating adults, including the 2015 Canadian Task Force on Preventative Health Care guideline (guideline), and the 2012 Canadian Obesity Network's 5As of Obesity Management™ (5As). These two guides vary in what they theorize determines body weight and adiposity, differences that are consequential for care. Informed by narrative analysis, actor-network theory, and especially Mol (2002, 2008), I explored different fat bodies enacted in these texts. The guideline foregrounds a behaviour-determined body. Primary care clinicians are to recommend intensive behaviour change programs to those classified as overly heavy, even though the intervention is unlikely to produce a significant or sustained reduction of body weight. In contrast, the 5As enacts the fat body as a physiological, psychological, social, and economic entity living with a chronic disease. In the 5As, weight is influenced by many mediators (e.g. medication effects; smoking cessation; economic conditions). The 5As does not pre-determine what care should be provided or what goal should be sought based on a single measure as per the guideline. Instead, the 5As recommends clinicians assess and then treat what is likely to have the biggest health impact for the individual, with ongoing follow-up care. The analysis highlights co-existing and incompatible narratives of fat bodies and clinical care, narratives that rely on different uses and assemblages of statistical knowledge of populations.