Dones, obesitat i salut : una visió crítica dels discursos dominants

1. 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

2. OVERVIEW • Postcards and counter-postcards • Birth of the obesity clinic • Conclusions + discursive effects on women

3. 1 Postcards and Counter-Postcards

5. Postcard # 1 Obesity is a disease

6. Obesity: A Socially Constructed Disease • Unnecessarily medicalises the condition • Diverts scarce resources • Distract public health efforts • PRODUCESobesity

7. Postcard # 2 The BMI is a good way of measuring obesity

8. BMI: Does Not Measure Fat Quetelet’s BMI = Weight(Kg)/Height(m)2

9. Postcard # 3 Obesity is directly related to health problems

10. Obesity and Health Outcomes BMI Health Socioeconomic status Physical activity Weight cycling Psychotropic drug use

11. + Morbidity BMI + + Morbidity BMI + BMI and Morbidity Postcard Version Counter-Postcard Version

12. 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

13. Postcard # 4 Lifestyle is directly related to obesity… and people choose their lifestyle

14. Desocialising Obesity Lifestyle Model: No consideration of how historical, political, social and economic conditions substantially determine one’s lifestyle choices. Counter-postcard: Women Standing

15. Postcard # 5 Obesity is a question of personal responsibility… and individual risk

16. Individual vs Population Risk Example for Stroke cases: Risk Ratio (RR) = 40/20 = 2 This means: 4 strokes per 10,000 obese women

17. Postcard # 6 There is a global epidemic of obesity

19. 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

20. A Postmodern “Epidemic” • Concern for individual bodies • Blame for individuals • Focus on individual responsibility for ill health • Lack of attention to social problems

21. Postcard # 7 When it comes to obesity, experts know best

22. Foucauldian Confessions

23. “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”

24. 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

25. Postcard # 8 Weightloss is the right prescription… and it will improve health 25

26. How Weight Watchers workFood and RecipesFitness and HealthSuccess StoriesCommunityShop Testimonials as Hallmark of Weight Loss Industry Two of our latest Success Stories Losing weight with Weight Watchers, their way. Meetings Doing It For Me After making the big move to New York City, Jeanne decided that was the perfect motivation to shedding the pounds and getting a new look for her new life. Online Smart and Strong Katharine is stronger, happier and more energetic, and she's sure that she is on her way to her best decade yet. *Results Not Typical *Results Not Typical

27. 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

28. Bariatric Surgery • Risky surgery, complications • Lifetime of drugs • Serious side effects

29. Postcard # 9 Targeting women and “unhealthy” m/others… is a good strategy to fight obesity

30. Obesity Interventions as Ne0colonizing Tactics • Colonization of women’s bodies • Colonization of pregnant women’s bodies 

31. Obesity Interventions • Women of colour as mothers passing “bad” eating habits • View of “unhealthy” cultures as the problem • Use of essentialising caricatures of “cultures”

33. 2 Birth of the “Obesity Clinic”

34. 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

35. The “Obesity Clinic” • Disciplining the masses • Developing biocitizenship

36. Biopedagogies • Place individuals under constant surveillance • Press them towards monitoring themselves • Thin people have control, virtue, goodness, rationality and self-discipline

37. 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” 

38. 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

39. 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

40. Transforming the Abject Abject individuals (i.e., poor, fat, darker) Neoliberal individuals (i.e., bourgeois, thin, whiter) Experts (i.e., with white bourgeois knowledge)

41. Limits of Neoliberal Subjectivity

42. 3 Conclusions

43. 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

44. 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

45. 4 Discursive Effects

46. 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

47. 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”