Thou shalt not get fat: Medical representations and self-images of obesity in a Mediterranean society

Mabel Gracia-Arnaiz

Department of Anthropology, Philosophy and Social Work, University Rovira i Virgili, Tarragone, Spain.

DOI: 10.4236/health.2013.57159                

Abstract

This paper examines the link between lipophobia and representations and experiences of obesity in Catalonia (Spain) from two points of view: that of the physicians and other health professionals who diagnose and treat obesity as an illness, and that of their patients, especially those between adolescence and early adulthood. The qualitative data demonstrate that the increasing social rejection of fat people can be traced not only to moralizing discourses on “excessive” food consumption or the commodification of slenderness and health, but also to the recent definition of obesity as a disease. The medicalization of fatness, far from helping to destigmatize obesity, is becoming a way of resignifying it in moral terms. While doctors’ and patients’ perspectives diverge in some ways, they converge in others. In this text, I focus on the points of convergence arguing that biomedical understandings of obesity and overweight are characterized by a profound ambivalence. Young patients are regarded both as innocent victims of a permissive consumer society, and guilty of not following doctors’ orders. Although the family is held accountable for overweight or obesity in children, as young people become more independent, guilt is individualized and environmental causes are limited to inappropriate diet and insufficient exercise. Most narratives of young people with weight problems reflect similar ideas about the causes and the responsibility for obesity. Their acceptance of the basic premise that deviating from weight standards and rules for healthy eating are voluntary actions leads them to lose faith in themselves. The stigmatization of obesity thus becomes a vicious circle: the obese acceptance—even consider normal—the incriminations leveled at them, and blame themselves for their situation and their inability to prevent it.

Keywords

Obesity; Medicalization; Lipophobia; Stigmatization; Young People

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Gracia-Arnaiz, M. and Comelles, J.M. (2007) Thou shalt not eat. Narratives on food, body and gender in the new millennium. (No comerás. Narrativas sobre comida, cuerpo y género en el nuevo milenio.) Editorial Icaria, Barcelona.
[2]	Gracia-Arnaiz, M. (2009) Learning to eat: The establishment of dietetic normality on eating disorders. Food, Culture and Society, 12, 191-216. doi:10.2752/175174409X400738
[3]	Lawrence, R.G. (2004) Framing obesity: The evolution of news discourse on a public health issue. The Harvard International Journal of Press/Politics, 9, 56. doi:10.1177/1081180X04266581
[4]	Poulain, J.P. (2009) The sociology of obesity. Presses Universitaires de Paris, Paris.
[5]	Saguy, A. and Ward, A. (2011) Coming out as fat: Rethinking stigma. Social Psychology Quarterly, 20, 1-23.
[6]	Fischler, C. (1990) The (ho)mnivore. Odile Jacob, Paris.
[7]	Csergo, J. (2009) When the obesity of gourmands becomes an ailment of civilisation. Medical discourse 1850-1930. In: Csergo, J., Ed., Too Fat? Obesity and Its Representations, éditions Autrement, Paris, 14-29.
[8]	Vigarello, G. (2010) The metamorphoses of fat. Ed. Seuil, Paris.
[9]	Lupton, D. (1994) Medicine as culture. Sage Publications, London.
[10]	Brumberg, J.J. (1988) Fasting girls. Harvard University Press, Cambridge.
[11]	Saint Pol, T. (2010) The desirable body. Presses Universitaires de France, Paris.
[12]	Gracia-Arnaiz, M. (2009) Obesity as a social problem: Thoughts about its chronic, pandemic and multi-factorial character. In: Fainzang, S., Hem, H.E. and Risor, M.B., Eds., The Taste for Knowledge: Medical Anthropology Facing Medical Realities, Aarhus University Press, Aarhus, pp. 183-198.
[13]	Basdevant, A. (2009) The purpose and abuses of the contemporary medical definition. In: Csergo, J., Ed., Too Fat? Obesity and Its Representations, éditions Autrement, Paris, pp. 112-122.
[14]	Apfeldorfer, G. (2009) From a lack of slimness to a lack of beauty, the obese body is an embarrassment. In: Csergo, J., Ed., Too Fat? Obesity and Its Representations, éditions Autrement, Paris, pp. 136-149.
[15]	Elias, N. (1939) The process of civilization. Fondo de Cultura Económica, Madrid.
[16]	Sontag, S. (2005) Sickness and its metaphors. Aids and its metaphors. Suma de Letras, Madrid.
[17]	DiGiacomo, S.M. (1992) Metaphor as illness: Postmodern dilemmas in the representation of body, mind and disorder. Medical Anthropology, 14, 109-137. doi:10.1080/01459740.1992.9966068
[18]	Bordo, S. (1993) Unbearable weight: Feminism, western culture, and the body. University of California Press, Berkeley.
[19]	Regnier, F. (2009) Obesity, tastes and consumption. Integration of eating guidelines and social belonging. Revue Francaise de Sociologie, 50, 747-773.
[20]	Gracia-Arnaiz, M., et al. (2012) Poor fat youngsters! Obesity and young people’s lives. Servei de Publicacions URV, Tarragona.
[21]	Hacking, I. (2010) Normalisation. The epidemic of obesity. Lesson number 3. http://www.college-de-france.fr/site/historique/ian_hacking
[22]	Le Guen, J.M. (2005) Obesity: The new French disease. (Obesité, le nouveau mal francais.) Armand Colin, Paris.
[23]	World Health Organization (WHO) (1977) International classification of diseases. 9th Edition, WHO, Geneva.
[24]	WHO (1998) Obesity: Preventing and managing the global epidemic. Working Group on Obesity. World Health Organization, Geneva.
[25]	Heshka, S. and Allison, D.B. (2001) Is obesity a disease? International Journal of Obesity, 25, 1401-1404. doi:10.1038/sj.ijo.0801790
[26]	Rubio, M.A., et al. (2009) Consensus foe evaluating overweight and obesity, and the establishment of criteria for therapeutic intervention. http://www.seedo.es
[27]	Aranceta, J. (2008) Infant obesity: New eating habits and new health risks. In: Díaz, C. and Gómez, C., Eds., Food, Consumption and Health, Fundació “la Caixa”, Barcelona.
[28]	Serra-Majem, L.L. and Ribas, L. (2010) Trends in obesity, and eating and physical activity habits in Catalonia revealed by Catalan surveys and the analysis of trends in overweight in infancy and adolescence using several national surveys. http://www.gencat.cat/salut/depsalut/html/ca/dir2649/tenobesi2011.pdf
[29]	(2008) National survey on health in Spain 2006. http://www.msps.es/estadEstudios/estadisticas/encuestaNacional/encuesta2006.htm
[30]	Ortiz, R. (2010) Epidemiological report on obesity and public policies for its prevention. http://www.ua.es/webs/opps/docs/informes/INFORME_DE_EPIDEMIOLOGIA_Y_POLITICA_DE_OBESIDAD_OPPS.pdf
[31]	WHO (2004) Global strategy on diet, physical actitivity and health. http://www.who.int/dietphysicalactivity/strategy/eb11344/en/index.html
[32]	NAOS (2005) Strategy for nutrition. Physical activity and the prevention of obesity. Agencia Espa?ola de Seguridad Alimentaria, Madrid.
[33]	PASS (2006) Comprehensive plan for the promotion of physical activity and a health diet. Departament de Salut, Generalitat de Catalunya, Barcelona.
[34]	Serra, J., et al. (2003) Overweight and obesity. Evaluation of the objectives of the health plan for Catalonia for the year 2000. Medicina Clínica, 121, 47-50.
[35]	Serra-Majem, L.L., et al. (2007) Tendencies in the nutritional status of the Spanish population: Results of the nutricional monitoring systemin Catalonia. Revista Espa?ola de Salud Pública, 81, 559-570. doi:10.1590/S1135-57272007000500011
[36]	Tojo, R. (2008) Obesity in infants and children. A public health crisis. In: Martí, R., Ed., Tribunas de Nutrición, Unidad Editorial, Madrid.
[37]	Lang, T. and Rayner, G. (2007) Overcoming policy cacophony on obesity: An ecological public health framework for policymakers. Obesity Reviews, 8, 165-181. doi:10.1111/j.1467-789X.2007.00338.x
[38]	Lang, T. and Hesman, M. (2004) Food wars: The global battle for mouths, minds and markets. Earthscan, Sterling.
[39]	Gracia-Arnaiz, M. (2010) Fat bodies and thin bodies: Cultural, biomedical and market discourses on obesity. Appetite, 55, 219-225. doi:10.1016/j.appet.2010.06.002
[40]	Bourdieu, P. (1972) Outline of a theory of practice. Esquisse d’une théorie de la pratique. éditions Droz, Genève.
[41]	Giddens, A. (1984) The constitution of society. University of California Press, Berkeley.
[42]	Delormier, T., Fronlich, K.L. and Potvin, L. (2009) Food and eating as social practice—Understanding eating patterns as social phenomena and implications for public health. Sociology of Health & Illness, 31, 215-228. doi:10.1111/j.1467-9566.2008.01128.x
[43]	Garrow, J.S. (1988) Obesity and related diseases. Churchill Livingstone, Edinburgh.
[44]	Shilling, C. (1993) The body and social theory. Sage Publications, London.
[45]	Goffman, E. (1963) Stigma. The deteriorated identity. Amorrortu, Buenos Aires.
[46]	Cahnman, W.J. (1968) The stigma of obesity. The Socio-logical Quarterly, 9, 283-299. doi:10.1111/j.1533-8525.1968.tb01121.x
[47]	Sobal, J. (1995) The medicalization and demedicalization of obesity. In: Maurer, D. and Sobal, J., Eds., Eating Agendas: Food and Nutrition as Social Problems, Aldine de Gruyter, New York, 67-90.
[48]	Tibère, L., et al. (2007) Obese adolescents in the face of stigmatisation. Obès, 2, 173-181.
[49]	Alemany, M. (2003) Mechanisms for controlling body weight. Revista de la Reial Acadèmia de Medicina de Ca-talunya, 18, 44-49.