Sunday, 22 November 2009

Obese Individuals & British Society

In June 2009, the results of quantitative research into rates of obesity were published and widely reported in the mass media. I conducted a thematic content analysis of a press release issued by the organisation (Nuffield Health) that produced the research and of three news stories which reported the research (from the B.B.C. website, the Daily Mail website and the Daily Express website).
The central purpose of Nuffield Health’s press release was to publicise and highlight the findings of research into the proportion of British people who are currently considered to be overweight or obese. Using a sample of 2023 people, the researchers state that 23% of the people studied were obese and 57% were overweight. The sample population studied is said to have been representative and Nuffield Health generalise on the basis of their findings to the British population as a whole. They have sought to explain current obesity levels and to predict how they are likely to change in future.
Research Method
Firstly, I read the press release from the organisation, Nuffield Health, about their research. This preliminary reading gave me a feel for the researchers’ data and the conclusions that were drawn.
Secondly, I compiled a line-by-line summary of the text of the press release in order to get closer to the data and gain a better familiarity with what Nuffield Health had reported as the research findings.
Thirdly, I constructed an initial coding [Marvasti (2004): pp.86-88; Charmaz (2006): pp.47-49] of the data contained in the press release. This enabled me to identify particular themes that I felt were present in the data.
Fourthly, I developed a focused coding (Marvasti: ibid.) of the press release which allowed me to crystallize my ideas about the themes which I had identified in the data.
Fifthly, having thought further about the themes which I felt were apparent in the press release, I proceeded to select three articles which appeared on the websites of British media outlets (see Appendix). Using the focused coding of the existing data, I then conducted a thematic content analysis of these news reports.
Detailed below are the themes that emerged through the coding process:
Ø Threat
Ø Identity & values
Ø Values as the key determinant of body mass
Ø The struggle over “normality”
Ø Threat
Excess body mass is presented in the press release as a risk to which all members of the British population are exposed. The title of the document highlights the recent increase in the number of people said to be obese: “Obesity levels double within 10 years”. At lines 37-38, the authors recount a statement from a medical practitioner, employed by Nuffield Health, predicting that more people are likely to become overweight. Professor McMahon is quoted as saying, “we could see one in six people [becoming sufficiently overweight to be] eligible for weight-loss surgery within a generation.” At lines 38-40, it is reported that the research indicates that in future the whole population will fall into the “obese” category: “[t]he new research also suggests that the entire British population will be obese before the turn of the century.”
I have included these predictions under the heading, “Threat”, because they are emotive in substance; they suggest negative health outcomes for the entire British population such that, at lines 39-40, the medical practitioner states that the predicted eventualities “cannot be allowed to happen.”
Ø Identity & values
The authors of the Nuffield Health press release portray overweight people as fundamentally different from non-overweight people; from their research, they conclude that people whose body mass is deemed excessive constitute a distinct identity group in society, distinguished by the norms and values by which they live their lives.
According to Nuffield Health, overweight people do not value thinness. At lines 15 & 16 of the data, the authors of the press release state that, “the research shows that one in six (12%) obese Brits still say they are not bothered about their weight.” This point is reiterated (though reported at a rate of one in eight) by the Daily Express, at line 13 of its article. The researchers connect this with the further assertion that overweight people do not want to take action to reduce their weight and are not thinking about taking action to reduce their weight in the future: at lines 18-20, the researchers assert that, “they [i.e. obese people] are extremely reluctant to do anything about it [i.e. their obesity],” and “almost one in five (17%) obese Brits are not contemplating any form of weight-loss action.” This theme is reiterated by the B.B.C. story, at lines 13-14 where people who are overweight are characterised as “apathetic about their weight gain” and at lines 15-19 where “many obese people” are said to have “refused to take any action about their situation”.
In addition to the claim that overweight people do not value thinness, they are also said not even to value being healthy. At lines 13 & 14 of the data, the authors of the press release state that the research found, “a potentially fatal lack of concern about weight and how it affects peoples’ [sic] health.” At line 23 of the press release, the apparent connection between obesity and reduced life-expectancy is made and the reader is told that, “the nation is ‘eating itself to death’.” The Daily Mail’s story expands on this point by stating the degree to which obesity may shorten a person’s life and the ill effects that an overweight person may experience during their lifetime. At lines 10-11 of the Daily Mail story, we are told that, “[o]besity cuts life expectancy by up to ten years and raises the risk of a host of health problems including diabetes, heart disease, infertility and some cancers”.
By implication, overweight and non-overweight people constitute separate identity groups which are differentiated by the value they attach to the thinness and healthiness of their bodies. Seemingly, non-overweight people - in contradistinction to people who are overweight - aspire to thinness and good health.
Ø Values as the key determinant of body mass & health
The authors of the press release argue that excessive weight and obesity is entirely within the control of individuals. At lines 45-46 of the data, the assertion is made that people are overweight because they do not place sufficiently high value on being thin: “[t]here are many ways that people could control their weight if they wanted to.” For the authors, normative action which gives rise to excess body mass is the consequence of the low value that they attach to thinness and healthiness, rather than any structural impediment to actions that could lead to weight reduction. As such, being overweight is portrayed simply as a choice for which individuals are solely responsible. Weight loss is presented as being easily achievable and obesity is seen as optional.
Ø Infantilisation
The authors of the press release infantilise overweight people, by portraying them as ignorant and irresponsible. As shown above, people described as overweight are thought to act primarily to satisfy their immediate urges and to act - in a childlike way - without regard to the consequences of their actions. This point is underlined by the observation at lines 21-22 of the B.B.C. story where it is claimed that the lack of insight of overweight people is such that “many obese people fail to recognise that they have a problem at all.”
The theme of infantilisation and irresponsibility is developed in the press release with recourse to the role of medicine in the social world. Medicine is positioned as a potential source of neutral and expert support to overweight people and overweight people are portrayed as inexplicably failing to avail of that support. At lines 25-27, the authors state that “[t]he report also highlights how incredibly reluctant people are to seek professional help with weight loss in the way they might with other medical problems. Less than one in five (18%) said they would seek out advice from a health professional.” This, again, seems to illustrate the lack of responsibility exercised by overweight people, owing to their, impliedly, deficient values.
Ø The struggle over “normality”
The authors of the press release present excess body mass as deviant, but assert that, for the British population, the meaning of “normal” in the context of body mass, has changed in recent times. This, it is alleged, is because of the appearance in the public eye of people who are deemed to be overweight. They quote the aforementioned Professor McMahon at lines 40-44 who states that, “[t]he increasing profile of larger celebrities, for example James Corden, Eamonn Holmes, Ruth Jones and Beth Ditto, means that being overweight is now perceived as being ‘normal’ in the eyes of the public.” We should pay close attention to the fact that Professor McMahon refers to the public’s perception of normality, rather than normality, itself. Implicit in this observation is the assertion that obesity may seem to be normal, but is - from an objective, medical and informed perspective - deviant.
Professor McMahon is also quoted on the B.B.C., Daily Mail and Daily Express websites. Here, again, the root of the threat posed to the British population from obesity is to be found in the alleged increase of overweight public figures. Medical practitioner, Professor McMahon says that in the past, people who were overweight were obviously deviant. He implies, however, that the values which traditionally have ensured that the majority of people do not become overweight are under threat from popular culture. The B.B.C.s account of the research states that Professor McMahon explains that the threat of commonplace obesity has arisen because public figures function as signifiers of normality. At lines 1-10 of the B.B.C. article, McMahon is said to hold the following view: “Overweight celebrities […] are making dangerous weight gain appear normal” and “fat stars are seen as role models, helping to make being overweight acceptable.” At lines 8-10 of the Daily Express article, he is quoted as saying, “[o]nce upon a time, overweight people stood out. Now a lot of people are overweight and when they turn on the TV they see overweight celebrities who are feted for their success.” McMahon’s claims about the connection between these two social phenomena form the centrepiece of the three news outlets’ stories. The B.B.C.s headline is “Fat stars ‘make obesity normal’”; the Daily Express’s headline is “Chubby Stars Blamed For Obesity” and the Daily Mail’s headline is “How chubby stars ‘are feeding the obesity epidemic’… […]”.
The research and the data produced by it provide a medical perspective on obesity. As such, they are given the authority of medical science and help to make the data and the claims derived from it seem rational and objectively true. At line 1 of the Nuffield Health press release, the research is described as revelatory, advising the reader that the study “reveals” various pieces of information about rates of excess body mass. The claim of “revelation” is repeated at line 21 of the B.B.C. article. At line 6 of the press release, the reader is told that the data and associated claims are “findings”; at lines 13 & 15 of the B.B.C. article, the claims made are presented as facts that have been “found”; and at line 19 of the press release and line 16 of the Daily Mail article the reader is advised that the research has “shown” particular things about people who are overweight.
The effect (and arguably the purpose) of these kinds of descriptions is to position the data and the claims made by the researchers as facts that independently exist within the social world, simply awaiting discovery by qualified, skilled natural scientists. The use of words like “reveals”, “shows”, “found” and “findings” gives authority to the researchers’ claims and thereby helps to portray them as objectively, neutrally and unquestionably true. As we shall see below, there is much to question in the content of these documents.
Identity, values and determination
As observed, earlier, the press release and the news articles present people who are overweight as a distinct social group, distinguished not only my their body mass index, but also by the value system by which they are said to live. That value system was seen to pose a threat to society as a whole. The statistics on which these ideas are founded could have been said, however, to show an entirely different picture to the one presented by the authors of the press release and news stories. To be clear: the documents actually indicate that there is, in fact, only a small subset of overweight people who do not value thinness and aspire toward it. The researchers report that 12% of overweight people are “not bothered about their weight”, but they could, instead, have highlighted the fact that 88% of overweight people are “bothered” by it; and whilst the documents tell us that 17% of obese people “are not contemplating any form of weight-loss action”, this suggests, by definition, that more than 80% of them are considering such steps.
Looked at in this way, we do not see a group of people in society cut off from the values that - supposedly - prevent thin people from becoming fat. Instead we see a group of people who have internalised a set of values that is entirely consonant with those of medical practitioners and thin people - a group of people who are uncomfortable with the fact that they are overweight. It might be argued, therefore, that the values that people hold are not the ultimate determinants of whether a person is thin or fat and that other factors may be implicated in the phenomenon of rising obesity levels.
Threatening normality
Professor McMahon, who has been associated with the research and quoted in all of the documents worries that being overweight will become normal in British society. The documents, however, report that 57% of the U.K. population is already defined as overweight and suggest, therefore, that being overweight is - statistically speaking - already normal. It might be argued, therefore, that rather than “[o]verweight celebrities […] making dangerous weight gain appear normal”, the presence of overweight people in the mass media is, in fact, a reflection of the diversity of the British population.
Professor McMahon’s conception of “normality” is not based on the statistical average and, instead, derives from “that which prevalent social values hold to be acceptable or desirable" [Earle & Letherby (2008): p.25]. Professor McMahon seems to equate "normal" bodies with an idealised vision of what the human body should (in his view) look like; his concern is that being overweight will become acceptable or desirable and that larger bodies will become the ideal. We might allay his fears, however, by observing that of the vast number of actors, pop singers and television presenters who receive regular public exposure, he was able to cite the names of only four people who are overweight and regularly in the public eye [one of whom (James Corden) is a comedian and actor who routinely mocks himself for his weight/size; another of whom (Eamonn Holmes) recently took part in a television programme, the purpose of which was to get him to lose weight]. Admittedly, there are other overweight people who appear in the mass media, but I would suggest that, as a proportion of all celebrities, they account for significantly less than 57% and do not overwhelmingly promote the idea that being overweight is preferable to being thin. I would argue that of all the potential “role models” with which people come into contact via the mass media, most of them are thin.
Furthermore, empirical evidence about people’s willingness to engage in activities designed to reduce body weight is available [Crossley (2004): pp.3-4] which suggests, among other things, that British people’s positive evaluation of thinness is firmly entrenched, showing that health club and gymnasium membership has grown significantly in recent years and that by 2002 almost a third of all British adults were ‘trying to slim’. Neither “normality” nor the values associated with it appear, in reality, to be under threat.
Illness & infantilisation
Having portrayed The Overweight as a distinct social identity group, unified and propagated by a flawed system of values that threaten society as a whole, the authors of the press release and news stories proceed on this basis to characterise this group as naïve and in need of authoritative, expert moral guardianship from the medical profession. Worse still, they are represented as resistant to the idea of medical assistance and are portrayed as peculiar in that regard.
Though Professor McMahon seems to see this as a further distinguishing social characteristic of people who are overweight, various pieces of empirical research lead to the conclusion that they are not so unusual in their disinclination to rely on the medical profession. McMahon, the medical practitioner, states that, “[t]he majority of people go to see a doctor within one week of noticing a cold, cough or ingrown toenail, but the same people ignore obesity problems for a number of years before seeking professional help”. In this, however, McMahon draws a false dichotomy: excess body mass is not an acute medical condition with a sudden onset (insofar as it can properly be described as a medical condition, at all). The process of becoming overweight is incremental and takes place over a comparatively long period of time.
Had Professor McMahon instead made the more obvious comparison between people who are overweight and people who suffer from chronic medical conditions, his observation would have been fairer and less dramatic. Successive studies of “illness behaviour” have shown that it is not simply the symptoms of illness that cause people to see a doctor; a number of other variables, including among others, gender, marital status, social class position, ethnicity and subjective pain threshold are all influential factors. One study [see Scambler (2003): pp.39-40], which looked at the ratio of “symptom episodes” to medical consultations showed, for example, that for people suffering from backache the sufferer would only visit the doctor once per every thirty-eight symptom episodes. It showed that for people experiencing muscular and joint pain, the sufferer would see the doctor four times per every seventy-one symptom episodes and that people suffering from depression and associated problems would have a medical consultation once per every seventy-four symptom episodes. This has prompted one medical sociologist to remark, regarding people generally, that,
“Doctors and other healthcare personnel tend to assume that a rational individual will report any symptoms […], they take it for granted that the restoration of ‘good health’ is a natural first priority. Good health, however, is one goal among others; it is not always supreme”
[Scambler (2003): p.42]
So, again, the implicit claims in the data to the effect that people defined as overweight constitute a distinct social identity group seem much less plausible.

So why are obesity rates rising?
If, as I have argued, people who are defined as overweight are not abnormal and do not constitute a distinct identity group, demarcated by a value system that directly leads to unhealthy norms informed by fat role models, how are we to account for the apparent increase in the number of people falling into the “overweight” and “obese” sociomedical categories? If overweight people are not, exclusively, blameworthy, then who (or what) is?
Crossley (2004: p.13) lays out a simple formula by which the physiological process of weight gain takes place. He refers to it as the “energy ratio”, according to which a person’s weight will remain the same if his or her calorific energy intake balances their calorific energy expenditure. He deduces from this that if there is an imbalance of energy intake to energy output such that the person consumes an excess of calories and does not expend a comparable level of calories, then she or he will gradually become overweight or even obese. If this is the case then the method of reducing individuals’ body mass and reducing obesity rates should be perfectly straightforward: all that individuals need to do is act rationally to ensure that their energy intake does not exceed their energy expenditure and thereby achieve an equilibrium. The problem with this neat solution is that it ignores that there are factors, external to the individual, that indirectly influence energy intake and output.
Central to the stability of our society is the idea that it is comprised of autonomous, rationally and freely acting agents who are wholly responsible for themselves and for their actions. As such - and as the data shows - people who are overweight are said to be to blame both for their actions (eating too much and/or not getting enough exercise) and for the consequences of those actions (getting fat). The common sense understanding of overweight individuals seems seductively straightforward. It is descriptive and may - in some senses - be accurate, but as an explanation of the U.K.s intractably high obesity rates it is, in my view, inadequate. Though we should, in every instance, be suspicious of accounts of social phenomena that portray individuals as the hapless victims of environment and circumstance, the purpose (or, at least, one of the purposes) of the sociological enterprise is to direct our attention to the fact that the courses of action that people pursue, the choices that they make and the activities in which they engage all emerge in a social context. What follows is a brief discussion of that context and its influence on the amount of energy consumed and expended by people in British society.
(i) Society & reduced expenditure of physical energy
During the twentieth century, the extent to which most people were required, in the course of their everyday life, to exert themselves, physically, diminished hugely. Crossley notes a remark cited by the National Audit Office, in 2001 publication, “Tackling Obesity in England”:
“the average individual would have to run one marathon (twenty six miles) per week to make up the drop in energy expenditure of the average individual over the last fifty years."
[Crossley (2004): 14-15]
This transformation came about largely because of changes taking place in the economic sphere. The British occupation structure changed as the requirements of businesses changed and heavy industry contracted as a portion of the labour market. Work, in general, became less physically demanding. Coupled with this was the growth in the white-collar and service sectors of the economy. Whereas, previously, the effect of a high calorie diet would largely have been burnt off in the course of a week’s labour, people in the twentieth century are much more likely to make a living, sitting behind a desk, typing on a computer keyboard and making or answering telephone calls. The fact that comparatively few people are now employed in occupations that are physically taxing is not the consequence of choices made by individual agents; it is the result of fundamental change in the labour market over which they had no control.
Car use became normalised during the second half of the twentieth century, as did the use of motorised transport, more generally. This, in turn, has reduced the need to travel on foot or by bicycle, again reducing the amount of energy expended by the average Briton in their everyday life. Whereas, in the past, people were likely to live in comparatively close proximity to their workplace, in the twentieth century, workers’ places of residence are much less likely to be located within walking distance of the office. As Crossley (2004: p.16) puts it, “[h]ome, work and leisure have been ‘unbundled’ and the geographical distance between them has grown”.
Housing developments were less likely to be created in crowded urban centres than in outlying suburban areas and where they exist, the costs of accommodation can be prohibitive to many (B.B.C. website: 18/07/2002). Furthermore, the average U.K. employee’s tenure in a particular job commonly lasts between five and six years [Grint (2005): p.326] and it is unsurprising that individuals do not routinely displace themselves and their families when they change jobs, primarily in order to be able to enjoy the dubious pleasure of cycling or walking to and from work.
Elsewhere, it has been argued that more recent changes to the working environment have contributed further to rising obesity levels. Qvortrup (undated essay) has directed attention to increasing deregulation of the economy which, he argues, has given rise to longer working hours and, thereby, reduced the amount of time available to people during which they might otherwise have engaged in leisure pursuits that allow the expenditure of physical energy. Instead of spending time at the gym or playing sports or exerting themselves physically, people are compelled by their jobs to remain inactive for even longer periods of their everyday lives than before.
(ii) Society & increased intake of physical energy
Crossley notes that the evidence about eating patterns is mixed and that it is not clear that people’s calorific intake is higher than in the past. He remarks that, “[s]tatistics on household food purchases suggest, if anything, a drop in energy consumption,” (emphasis added) but suggests that this has been offset by the increase in people dining outside the home, “which tends to involve intake of relatively high calorie foods and drinks" [Crossley (2004): p.15]. In a similar vein, Qvortrup observes that economic deregulation “has created new patterns of life and work, which have had adverse effects on food consumption, exercise, and hence has contributed to the increase in the growth of the obesity epidemic" [(undated essay): p.10]. In short, he argues that increases in working hours (which have arisen as a consequence of deregulation) have left people with less time to cook healthy meals or take part in leisure activities where physical energy might be expended.
A further difficulty with trying to maintain a healthy diet derives from the increase, in recent decades, of families where both adults are engaged in gainful employment and the consequent decline in the number of families where at least one adult is engaged purely in domestic labour [See Grint (2005): p.202 and Mooney (2004): p.21. By 2003, 80% of men and 70% of women were employed in paid work. By comparison, in the 1950s, 54% of women were engaged only in unpaid domestic labour]. This has enabled the development of a market for “convenience foods” with a low fibre, high sugar, high fat content, all of which are likely to cause weight-gain. Bond & Bond (1994) have pointed out that despite the fact that both adult partners in a family are likely to be employed outside the home, the primary responsibility for most domestic labour falls on the shoulders of the female partner and they observe that this is a likely contributing factor in the purchase of unhealthy food, explaining that, “women do most of the cooking and are responsible for food preparation [… and that] they are constrained and influenced by such factors as the competing demands of other tasks, including paid work" (p.70).
The fast food and convenience food industries should also be taken into consideration when seeking to explain rising obesity rates. As noted above, the changes to economic and family life that have taken place during the last half-century have created a marketplace for foods that can be purchased and prepared quickly and with a minimum of effort. Society, in the twenty-first century, is saturated by multi-million pound advertising campaigns, designed to induce the consumption of unhealthy foods. Qvortrup points out, for example, that, in one year alone, McDonalds recently spent over one billion dollars on advertising aimed at children. Certainly, it can argued that people choose whether or not to eat fast food and convenient, pre-prepared foods, but we should not overlook the fact that it is a choice that is made in a context that influences the decision-making process. As Qvortrup (undated essay) observes - and as we have seen, above - contemporary social and economic conditions have evolved, “which are conducive to the over-consumption of high-energy foods" (p.18).
To recap and conclude, then, I have found that the authors of the documents studied present people who are overweight as culturally separate from society: according to the authors’ and researchers’ account, people who are overweight are supposedly cut off from the norms and values that obtain in society, generally. Not only are they “different” from the general population, they are (allegedly) too ignorant to be able to look after their own health without supervision from medical practitioners; too irresponsible and too apathetic to curb the urge to indulge their appetites and too lazy get up from the television set to take some exercise, preferring instead to idolise fat celebrities.
This kind of account of overweight people as greedy and slothful is typical of the kind of “everyday stories” that people deploy as an explanation of what goes on around them, generally. Charles Tilly describes the process thus:
“people across the world typically package their social experience in stories: explanatory narratives incorporating limited numbers of actors, just a few actions, and simplified cause-effect accounts in which the actors’ actions cause all the significant outcomes. […E]veryday stories radically simplify cause-effect connections. They trot out a few actors whose dispositions and actions cause everything that happens in a limited time and place. […] As a result, stories inevitably minimize or ignore the intricate webs of cause and effect that actually produce human social life."
(2008: pp.20-21)
I have tried, in my brief discussion of the individuated explanation of rising obesity rates, to redress some of the ubiquitous problems observed by Tilly by drawing attention to sociological ideas and evidence that demonstrate that individual behaviour is actually part of a process of extended interdependent action that generates - and is generated through - society. I have sought to introduce to the discussion, the idea of societal context as the overarching backdrop which shapes human action.
Those who assert that being fat is a free choice may well maintain that people who are overweight reflectively choose to consume unhealthy foods and that they actively choose to engage in a way of life that doesn’t include much physical exertion. To an extent, they are right to do so; nobody is forced to eat fast food or to lead a sedentary life. The idea that obesity rates can, however, be simply and easily reduced by encouraging individuals to go to the gym or join Weightwatchers overlooks the wider structural factors that have given rise to the problem in the first place. The fact that the number of overweight people in British society continues to increase in an era of, perhaps, unprecedented body consciousness makes that point abundantly clear.

The data sources can be found online at the following web addresses:

Armstrong, D.: The Social Role of Medicine (pp.23-32) in Earle, S. & Letherby, G. (eds.) (2008): The Sociology of Healthcare: A Reader for Health Professionals. Palgrave Macmillan. Basingstoke.
B.B.C. website (18/07/2002): Build castles in the sky.
Bond, J. & Bond, S. (1994): Sociology and Health Care: An Introduction for Nurses and other Health Care Professionals. Churchill Livingstone. Edinburgh.
Charmaz, K (2006): Contsructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage Publications. London.
Crossley, N. (2004): Fat Is A Sociological Issue: Obesity Rates in Late Modern, ‘Body-Conscious Societies’
Grint, K. (2005): The Sociology of Work. Polity Press. London.
Marvasti, A.B. (2004): Qualitative Research In Sociology. Sage Publications. London.
Mooney, G.:“Exploring the Dynamics of Work, Personal Lives and Social Policy” pp.1-38 in Mooney, G. (ed.) (2004): Work, Personal Lives and Social Policy. The Policy Press. Bristol.
Qvortrup, M. (undated): Big Fat Globalisation: Towards a Sociology of Obesity. (This essay is available for download on the internet, by typing the title into the Ask Jeeves search engine.)
Scambler, G.: “Health and Illness Behaviour” (pp.37-48) in Scambler, G. (ed.)(2003): Sociology as Applied to Medicine. Saunders. Edinburgh.
Tilly, C. (2008): Credit and Blame. Princeton University Press. Woodstock, Oxfordshire.

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