More than meets the eye.
Feminist poststructuralism as a lens towards understanding obesity.
Firstly this paper by Aston et al (2011) opens by accepting the framing of obesity as a health emergency or ‘concern’ and it does so by referencing the World Health Organisation’s (2011) ‘global epidemic’ phrase. Thus it contributes to a value position that obesity is indeed a medical issue with negative health consequences. The position is then taken that obesity is a ‘disease’ arising out of social and environmental conditions. That is to say it accepts that obesity is a disease but that its causes are not rooted only within individuals and their behaviour but as arising from their social position and the environment they live in (the ‘obesogenic’ environment). They argue “Obesity now represents a major public health issue” (p1188) and according to the WHO (1998) is the second most modifiable cause of ill health after smoking. Aston et al use the word alarming to describe Canada’s population where 60% are overweight or obese. The issue as to whether obesity is simply a disease that needs curing regardless whether its aetiology is individual or social, is open to question. However for the purposes of this paper I wish to explore what feminist post structuralism (FPS) can bring to understanding obesity.
Feminist Post Structuralism.
Aston et al argue that FPS seeks to understand the meaning and experience of obesity as arising from our social relationships. It also seeks to understand how power relationships work between individuals as they are constructed through social, institutional and political structures. In other words, what are the power relationships involved in for example daughter-mother family relationships “mum’s on a diet again…and my bum does look big in this!” (social); worker-employer relationships “oi! lard arse, get off yer bum back in the office or we’ll put you on a fitness course!” (institutional); and patient-health policy relationships “I note Mrs Jones, that you BMI is well into the overweight category…we need to reduce that to reduce your risk of diabetes and heart disease…what weight loss programme shall we use, have you seen Change for life?” (policy-political), and how do they affect the individual’s life experiences and chances? In this context, we would seek to examine the talk between the ‘fat’ and the nurse, we would want to understand both their beliefs and values and stereotypes and how this talk and interaction (including body language) constructs the experience of being fat in this encounter. This also examines how the fat are observed and measured, what questions are asked of them and how those questions are put to them and what solutions are put forward (e.g. eat less, exercise more!).
FPS seeks to examine the personal experiences, the relationships people have, and how they understand how power operates in each social setting, be it the family, the workplace or the health clinic. This point of view (perspective) accepts that life is social and therefore our personal experiences (personal troubles) can be understood through examining how social, cultural and institutional beliefs, stereotypes and norms (public issues) affect us.
This perspective is an alternative to a medical discourse (a medical way of thinking and talking about) which accepts as axiomatic, as self-evident, that a person’s health is predominantly under the control of the individual. Therefore a good deal of research within this sort of thinking seeks to understand obesity as arising from psychological and genetic factors and examines personal behaviours involved in weight gain.
Furthermore, health interventions and health professionals may tacitly accept this medical discourse and design interventions around changing personal and behavioural factors (e.g. ‘Change for Life’). This approach has not and will not work. It is largely ineffective in reversing population obesity. Roberts and Edwards (2010) in ‘The Energy Glut’ suggest that whole populations across the globe are ‘getting fatter’; waist circumference and BMI measurements are increasing in developing as well as developed nations. If obesity needs to be understood as part of social relationships and relationships of power at that, then we need to challenge the notion of obesity as only a personal problem (a personal trouble). Applying the sociological imagination (Wright Mills 1959) to obesity we would seek to understand the personal trouble of obesity as a public issue, relating the personal biography of the ‘fat’ individual to historical changes and social structures.
So how does FPS throw light upon this issue?
1. By focusing on discourse.
2. By focusing on power relationships.
3. By focusing on subjectivity (one’s ‘subject position’) and agency.
One’s experience, beliefs and values are shaped by and shape the language we use about obesity. By examining how we talk about it to uncover our stereotypes and beliefs allows us to clarify our personal understanding and how we come to our understanding. When we listen to healthcare professionals talking about obesity as a disease and the need for personal responsibility for behavioural change we may believe that it is down to us to eat less and exercise more. After all that is the main message. We may even use this language to describe our battle with weight.
Individuals and groups have the power to impose a discourse onto interactions. These are supported by contextual factors (where that interaction takes place, for example the GP surgery). Health policies such as Change for Life position the fat as needing to take personal responsibility. Being overweight and its negative connotations is supported by medical research into the health risks and positions it as a ‘bad thing’. The fat can’t challenge this discourse as they don’t have a counter position. There are plenty of places where fat is seen as negative and as a disease (hospitals, clinics, surgeries, health centres, leisure and sports centres) and where it fat and fat people are excluded except as negative stereotypes (magazines, film and TV programmes, advertising, jokes, comedy).
Subjectivity and Agency.
We can come to see our subjective selves as being constructed through the above discourses and power relationships but through our agency (our ability to act) can come to challenge dominate negative or ‘disease’ discourses through dialogue, research, speaking out and open communication. So, on the one hand our subjective self can be beaten down with an acceptance that it is my personal responsibility to get thin and if I cannot then it is my fault. My subjective self may even accept the need for doing so in an attempt to align my body image with some thin ideal and as part of healthy living to prevent disease. I may accept that I am already ‘ill’ by being overweight. However by engaging my ‘agency’, my ability to act, I may challenge some of these assumptions and want evidence for the positions taken. For example, at what stage does extra weight really become unhealthy? How do I balance enjoying life with all that it offers with a rigid abstinence regime in the hope of achieving a thin ideal? Do I want to live longer as a thin person (if that is actually what may occur) if I have to count every calorie and give up beer?
“You call me fat, I feel fat, but actually I don’t think it is my fault entirely…this is not about blame or making me out to be a victim…you have to realise that the food choices I am faced with, the transport options I have are having an impact. It is not easy to change everything about my life when society continues to encourage weight gain. In any case the athletic thin ideal is unobtainable for me and I like a glass of wine and cheese, it what makes for a bon viveur”.
However, what is so F about FPS?
It seems clear from the paper that we need to challenge health, media, medicine and education organisations in their understanding about obesity. Society and the healthcare system has to recognise that the modernisation of our world (Wright Mills’ historical and structural changes) has set the global populations up for failure with respect to maintaining a healthy body weight through increases in opportunity for food intake and decreases in opportunity for energy expenditure, but I fail to see the feminism in this piece. What is the gendered nature of social relationships which would presumably affect women’s experiences? This paper does not make that clear. The obese in this paper are neither male or female.
Aston M, Price S, Kirk S, and Penney T. (2011) More than meets the eye. Feminist poststructuralism as a lens towards understanding obesity. Journal of Advanced Nursing.
Benny Goodman. 2012