Overweight, obesity and older Australians: understanding the social context

2017-01-31T04:39:47Z (GMT) by Manton, Elizabeth
In 2000, the World Health Organization called for urgent public health action to prevent and manage the global epidemic of obesity. Seven years later – at the end of 2007 – the incoming Australian Government made obesity prevention a national health priority area, as being overweight or obese is estimated to be the leading cause of premature death and disability. Obesity can be understood in terms of its pathology, but it is also a social phenomenon, dependent on socially and culturally specific values and understandings. The primary research question addressed in this thesis is how social context influences understandings and experiences of overweight and obesity. Drawing on Foucault’s theorising about discourse and power, I show that the obesity discourse in Australia has been shaped by powerful institutions as an economic, medical, political, and public health problem, in ways which are far from objective or disinterested. I demonstrate that the cultural weight given to the power of numbers and the quantitative method has obscured underlying social processes. Like other developed economies, the prevalence of obesity in Australia is inversely associated with socioeconomic status (SES). The secondary research question addressed in this thesis is why this is so. Using an ethnographic approach, I examine the social context of overweight and obesity in late middle-aged Anglo-Australians. My research was conducted in a relatively disadvantaged area of Melbourne over a period of 20 months, from August 2008 to March 2010. While much of the study of this relationship with SES is based on people suffering deprivations associated with poverty, the ethnography was undertaken in a community of ‘ordinary’ working class people to examine other factors which might have been in operation. Based on my research, the key socioeconomic factor influencing the understandings and experience of obesity was occupation. Drawing on Bourdieu’s concept of habitus, I show how working class origins and manual occupations are embedded in people’s functional understandings about health and obesity, leading to a significant disconnection between biomedical and social understandings of obesity; habitus also affected attitudes to exercise but less to diet. Occupation and the working class social environment affected the experience of stigma favourably compared to people in professional occupations, especially women. Despite repeated efforts, failure to achieve significant and sustained weight loss was common. In this social group where weight norms were higher and stigma was lower, there was less incentive to commit to the level of dedication necessary to achieve a ‘normal’ body weight. Yet my participants emphasised their capacity for self discipline through alternative narratives such as difficult but successful smoking cessation. In their conversations with me and each other, a dominant theme was prioritising wellbeing, configured as happiness and contentment, and mental health, over weight and its implications for their health. This research has implications for those framing public health policies and programs. As I illustrate, working class origins and manual occupations underpin people’s understandings of overweight and obesity, and so they may not be easily susceptible to change. The relative lack of stigma over body weight should be celebrated, and the potential use of stigma as a public health tool to effect change is neither ethical nor recommended. Facilitating opportunities for social connection and improved wellbeing are appropriate program responses for people who may have priorities other than health or weight, especially those who are managing poor mental health and stress. Rather than narrowly focusing on weight, my research points to the need to consider the wider social context in which people live and experience being overweight or obese.