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Dones, obesitat i salut : una visió crítica dels discursos dominants. Geneviève Rail Concordia University. Thanks to CIHR and SSHRC for funding the research program. Universitat de Vic, Spain, May 28, 2013. OVERVIEW. Postcards and counter-postcards Birth of the obesity clinic
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Dones, obesitat i salut : una visió crítica dels discursos dominants Geneviève Rail Concordia University Thanks to CIHR and SSHRC for funding the research program Universitat de Vic, Spain, May 28, 2013
OVERVIEW • Postcards and counter-postcards • Birth of the obesity clinic • Conclusions + discursive effects on women
1 Postcards and Counter-Postcards
Postcard # 1 Obesity is a disease
Obesity: A Socially Constructed Disease • Unnecessarily medicalises the condition • Diverts scarce resources • Distract public health efforts • PRODUCESobesity
Postcard # 2 The BMI is a good way of measuring obesity
BMI: Does Not Measure Fat Quetelet’s BMI = Weight(Kg)/Height(m)2
Postcard # 3 Obesity is directly related to health problems
Obesity and Health Outcomes BMI Health Socioeconomic status Physical activity Weight cycling Psychotropic drug use
+ Morbidity BMI + + Morbidity BMI + BMI and Morbidity Postcard Version Counter-Postcard Version
BMI and Health Outcomes r = .3 r2 = 9% (91% of health outcomes not related to BMI) “Always fatter” people _ _ _ _ _ _ _ “Always thinner” people + + + + + + + + + + + + + VS “Always fatter” people _ _ _ _ _ _ _ “Reduced” fat people ? ? ? ? ? ? ? ? ? ? ? ? ? VS
Postcard # 4 Lifestyle is directly related to obesity… and people choose their lifestyle
Desocialising Obesity Lifestyle Model: No consideration of how historical, political, social and economic conditions substantially determine one’s lifestyle choices. Counter-postcard: Women Standing
Postcard # 5 Obesity is a question of personal responsibility… and individual risk
Individual vs Population Risk Example for Stroke cases: Risk Ratio (RR) = 40/20 = 2 This means: 4 strokes per 10,000 obese women
Postcard # 6 There is a global epidemic of obesity
A Postmodern “Epidemic” • Obesity epidemic not a traditional epidemic of contagion • No clear pathological basis • Language and moral panic of traditional epidemic • Mobilization of fear and panic
A Postmodern “Epidemic” • Concern for individual bodies • Blame for individuals • Focus on individual responsibility for ill health • Lack of attention to social problems
Postcard # 7 When it comes to obesity, experts know best
Foucauldian Confessions
“Confessions of the Flesh” Stages to salvation: • Confession of obesity obtained by authorised confessor • Conversion to the “truth” of the dominant obesity discourse • Codification for a “new life”
Coding a New Life Authority to prescribe treatment comes with responsibility for: • Clinical care of patients • Monitoring treatment efficacy and safety In case of obesity: • Weight loss is main prescription • Lack of safety and effectiveness data • Tendency to downplay treatment risks and failures
Postcard # 8 Weightloss is the right prescription… and it will improve health 25
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Weight Loss: Leading to Health? • No method available to produce significant long-term weight loss • Overweight/obese persons trying to lose weight without success: reduction in mortality rate is equal to those successful • Weight loss/cycling increases mortality hazard ratio while obese people with stable weight have no increase • Most weight loss strategies have serious side effect
Bariatric Surgery • Risky surgery, complications • Lifetime of drugs • Serious side effects
Postcard # 9 Targeting women and “unhealthy” m/others… is a good strategy to fight obesity
Obesity Interventions as Ne0colonizing Tactics • Colonization of women’s bodies • Colonization of pregnant women’s bodies
Obesity Interventions • Women of colour as mothers passing “bad” eating habits • View of “unhealthy” cultures as the problem • Use of essentialising caricatures of “cultures”
2 Birth of the “Obesity Clinic”
Birth of the “Obesity Clinic” • Biomedicalization • Bioeconomics • Biocultural discourses ‘Obesity Inc.’ Bariatric/weight loss surgeons Weight loss practitioners Obesity scientists Public health educationists Drug and insurance companies
The “Obesity Clinic” • Disciplining the masses • Developing biocitizenship
Biopedagogies • Place individuals under constant surveillance • Press them towards monitoring themselves • Thin people have control, virtue, goodness, rationality and self-discipline
Regulating the Abject • Production of neoliberal femininity • Pathologization of working class women • Unruly (working class, fat, racialised, older, disabled) femininities marked as “Other” or “abject”
Classed Processes of Abjection • Elicit disgust of working class women • Elicit disgust of “ungovernable” women • Incite manic desires for improving the self • Offer expert advice on how to live better (productively) • Bind the self to the project of its own identity • Engage the self in life-long monitoring and management
Constructing Health as… • Taking care of the body • Being well, psychologically • The absence of physical problem • Looking “good” and “normal” • Something linked to external factors
Transforming the Abject Abject individuals (i.e., poor, fat, darker) Neoliberal individuals (i.e., bourgeois, thin, whiter) Experts (i.e., with white bourgeois knowledge)
3 Conclusions
Iatrogenic Disaster Obesity as ill health + Weight loss prescription • Oversimplifies and de-socialises a complex issue • Fails to improve health • Blames (racialised, classed) “pre-obese” and “obese” • Has adverse consequences for mental health • May lead to eating disorders • Detracts from preventative care • Distracts us from broader social issues impacting health
Healthy Skepticism vs… • Current research on obesity • Social construction of obesity as disease • Social construction of obesity epidemic • Lifestyle model of disease • Individual, privatized solutions to obesity • Dominant discourses on obesity, body, and health • Neocolonization of women’s bodies and lives
4 Discursive Effects
Constructing Health as… • Taking care of the body • Being well, psychologically • The absence of physical problem • Looking “good” and “normal” • Something linked to external factors
Appropriation of Dominant Discourses of… • Obesity • Individual responsibility for obesity/health • Beauty • Gender normativity, Heteronormativity • Productivity, Meritocracy, Neoliberalism • Medical model of disability • Racism • Obesity and pregnancy, “Fit for two”