Radical Psychology
Volume Eight, Issue 1


Fat panic in Canadian public health policy: Obesity as different and unhealthy

Natalie Beausoleil and Pamela Ward [*]


Introduction

Presently in the Atlantic Provinces and other regions across Canada, the concepts of health and wellbeing are highlighted in a number of key provincial initiatives that utilize the mainstream health literature to identify and address health risks for local populations.  Obesity is at the forefront of the risks identified in recent health promotion and population health documents in Canada, as in other neoliberal Western nations (Fullagar, 2009; Rich and Evans, 2009). Growing concerns about the apparent rising rates of overweight and obesity have resulted in a general conflation of thinness with good health and fatness with bad health. The messages about obesity in health policy documents are most often derived from conventional scientific research that offers dire warnings about the repercussions of what has come to be described as a rapidly growing epidemic. For the most part, this research is replete with generalizations based on assumptions about people’s health practices and morality and fueled by the public’s fascination with the sensational storyline.  While such science both informs and reinforces public discourse, health policy likewise has been shaped by speculation cloaked in the shroud of scientific certainty (Campos, 2004; Gard and Wright, 2005).

This scientific certainty has been implicated in the creation of a health panic that raises concerns around body size and what is considered to be the normative body, contributing to pervasive levels of body dissatisfaction, poor body image, and disordered eating within the population (Rail and Beausoleil, 2003). The association of fat with poor health has translated into a fear of fat within the population and subsequent disdain for those who are different, who do not fit the desired norm (LeBesco, 2004).  LeBesco states “viewed then, both as unhealthy and unattractive, fat people are widely represented in popular culture and in interpersonal interactions as revolting-they are agents of abhorrence and disgust” (p.1). Fatness becomes an aberration (Huff, 2001), an outward marker of deficiency and difference (Murray, 2009). Like sex, race and disability it has become a symbol of a different “devalued identity” (Rice, 2007, p. 170).

Governments, in equating obesity with disease and ill health have reinforced this difference rendering fat people as sick or unhealthy, in need of “treatment” (LeBesco, 2004; Halse, 2009). The prevention of the so-called “condition” of obesity is of paramount importance to governments and policymakers alike and thus has become the focus of initiatives that promote healthy eating, physical activity and weight reduction. The endorsement of individualistic approaches to solving the obesity “problem” we contend has fed into a consumer culture in which health has come to be viewed as a commodity, permitting those in a position to sell health solutions (such as fad diets, pharmaceuticals, and other quick fixes) to prosper while the health panic continues to intensify and the health of the population suffers (Jutel, 2009; Klacynski, Goold, and Mudry, 2004; Monaghan, 2007).

In this article we provide an examination of the obesity discourse and the biopedagogies endorsed through government health documents within the Atlantic Provinces of Canada. Here we draw upon Wright’s (2009) definition of biopedagogies as the “normalizing and regulating practices in schools and disseminated more widely through the web and other forms of media, which have been generated by escalating concerns over claims of global “obesity epidemic”(p.1). We provide an overview of the biomedical approach to obesity as a health problem and a critique of this approach with attention to the medicalization of obesity and the perpetuation of fat hatred and institutionalized intolerance for difference within the context of the current obesity panic. We explicate how fat people, identified as different and unhealthy, have been denied a social space within the dominant health discourse.  We also provide a discussion of the move toward alternative approaches to conceptualizing health and the body with consideration to factors that influence responsible and effective policy development. Finally we identify strategies for change that move us beyond individualistic approaches that seek to restrict body diversity, with specific attention to our work with the Body Image Network, a non-profit organization that strives to prevent disordered eating and promote positive body image in Newfoundland and Labrador.

OBESITY CONSTRUCTED AS A HEALTH PROBLEM

As mentioned previously, obesity is an issue that pervades many of the current discussions on health and wellbeing in the Western world. The rise in obesity rates are widely discussed in the literature and are most often described in extreme terms such as alarming, dramatic, and shocking, to name just a few. The discussions around obesity however, also take place well beyond the realms of research and public policy development. They are interwoven in the fabric of our health conscious society. We are bombarded on a regular basis with ominous messages that remind us of the obesity epidemic which is threatening the health of adults and children alike. As academics and community activists who tackle this issue on a regular basis, we must begin by deconstructing this discourse, considering where it originated and continues to be reproduced, how it has become what is generally considered to be legitimate knowledge, and how this truth has come to influence social interactions and ultimately the health of the population.
 
The obesity discourse has gained great power and been legitimized through its relationship to science and the expert medical voice (Gard and Wright, 2005; Campos, 2004). It is further strengthened through government endorsed strategies which are implemented through such institutions as education and health (Cregan, 2006).  In Foucauldian terms, the obesity discourse has become a “regime of truth” (1973) which has gained such power that disciplining of the body through institutional and regulatory methods has become quite commonplace and generally accepted. Medicine, health institutions and government under the guise of public protection have declared a “war on obesity”. As Monaghan (2007) suggests:
 
“powerful institutions routinely present the message, with certainty, that fatness equals badness and sickness and this is a massive and growing problem. This claim is presented as taken for granted in societies where fatness is disdained and discredited under the rubric of scientific rationality” (p. 584).

How then did we get to this point? According to Gard and Wright (2005), obesity as a health risk or disease is a relatively recent construction arising out of the medicalization of bodies and the determination by mainstream science that excess body weight contributes to diminished health status and disease. They argue that in no other area of research do we see scientists make such sweeping claims with so little evidence. While overweight and obesity have been suggested to greatly increase the risk of hypertension, heart disease, diabetes and even cancer (Katzmarzyk, and Adern 2004; Reeves et al., 2007), evidence to the contrary exists. Gaesser (2002) for example states that obesity in itself is in fact a poor predictor of hypertension, high cholesterol, hyperlipidemia and atherosclerosis. He argues that for a number of obese people who suffer from these conditions, along with conditions like diabetes mellitus, significant improvements can be realized through an increase in fitness, not necessarily weight loss or a decrease in fatness. Thus, one can be fit and fat. This is completely contradictory to the messages perpetuated through the current obesity discourse.

Campos et al. (2006) argue that the obesity epidemic is more of a moral panic than a health crisis. They state that the claims that obesity is growing at an exponential rate are unfounded and they question the validity of such measurements as the BMI or Body Mass Index (a measure of a person’s weight divided by the square of her or his height) which, although has been used as a standard marker for the measurement of obesity, in fact does not measure adiposity. Scientists and medical practitioners, according to Campos et al., using statistics derived from the BMI, routinely draw grand conclusions and make dire predictions about the impact of obesity that stretch well beyond the realm of scientific evidence. According to Miller (2005), in the field of obesity research scientists “often force data to fit their pre-formulated or pre-existing paradigm or deny the existence of data that fall outside their paradigm” (p. S89).  In declaring a “war on obesity” scientists are therefore breaking from the objective scientific realm and entering into a moral realm where they are able to make claims about individuals and society as a whole in promoting the normative body.

Within such discourse, it follows that if we are declaring a war on obesity because of the moral failings of a gluttonous society than those who are obese become symbols of gluttony. They come to represent our deficiencies, our lack of moral fibre. Halse (2009) highlights the ethical and moralistic qualities of the dominant health discourse in what she describes as virtue discourses which she defines as “ a set of values, beliefs, practices and behaviours that establish regimes of truth and shape subjects and subjectivities by articulating and constructing particular behaviours and qualities as worthy, desirable and necessary virtues” (p.47). Interestingly she views virtue discourses as open ended, meaning that the degree to which one can strive for virtue is limitless. As soldiers in the war against obesity, our efforts in the form of diet, exercise and aesthetic improvement can never be what she refers to as “too diligent” (p.48).  This provides boundless opportunities for those in a position to profit from the public’s obsession with weight while utilizing messages that further marginalize those who are identified as overweight and obese.
 
OBESITY IN GOVERNMENT HEALTH DOCUMENTS

While the present obesity discourse is one that permeates many facets of society, and media has often been the primary target of many of those critical of the discourse, government approaches to health promotion have played a significant role in the social construction of the thin ideal (Halse, 2009; Wright and Dean, 2007; Wright, 2000 ). As Rice (2009) stated, the messages have become dominant in part because “they dovetailed with earlier state sponsored efforts designed to improve health, fitness and competitiveness of nations” (p.143). She highlights the example of ParticipAction, a health promotion campaign launched in Canada in the 1970’s to promote increased levels of activity in Canadians who were conceptualized as both unfit and unhealthy. This campaign reinforces the individualistic approach to health promotion by continuously positioning citizens as unmotivated and in need of some sort of incentive to get moving. The proponents of this program tout its success, and the Canadian government continues to spend millions of tax dollars on this initiative. ParticipACTION has demonstrated success in marketing its brand. Yet it has not demonstrated success in relation to increased physical activity levels, levels of physical activity protocol or levels of obesity, particularly with those people in the lower socioeconomic category (Bauman, Craig, and Cameron, 2005).  According to MacNeill (1999), the government’s approach to social marketing has established brand recognition but has not established its positive impact on the health of Canadians. The mere fact that people are aware of the brand does not prove that the initiative is working. She argues that the approach taken by ParticipACTION is grounded in the notion of individual responsibility and behaviour change as the answer to enhanced health in this country. She also points to the way in which this agency promotes healthism with an extreme preoccupation with fitness and the body.  As Rice (2009) points out, by setting up fatness as the binary opposite of fitness, the ParticipACTION campaign has served to reinforced the dominant obesity discourse and legitimize this healthist approach to the body in Canada.

Considering the powerful role that government population health strategies and documents play in the development and implementation of policies that directly impact the lives of the population, we were compelled to examine such documents in our region of Canada; the Atlantic Provinces. In Canada many scholars report that the rates of obesity are increasing, with Atlantic provinces such as P.E.I. and Newfoundland and Labrador being highlighted as areas of particular concern (Canning, Courage, and Frizzell, 2004; Raine, 2005; Statistics Canada, 2005; Tremblay, Katzmarzyk, and Williams, 2002; Twells, 2005). There are however some studies in both Canada and the US which report a recent plateau in obesity rates for both children and adults (Ogden et al, 2007; Statistics Canada, 2008; Starky, 2005). Claims of the continuous increase in obesity rates are still used in much of the current literature on obesity.

The growth of the population health approach in Canada has been quite evident in the government documents we examined which highlighted the role of the social determinants of health in the overall health of the population. Obesity is one example of how health issues are examined from a macrolevel but often applied at the micro or individual level. The obesity rates are highlighted as expansive and thus the individual is expected to do something to help solve the problem. This approach has been criticized as it is seen to be rooted in the epidemiological tradition which assumes that the world can be divided up into categories or variables which are seen to reflect the lived realities of individuals (Coburn et al., 2003). According to Raphael and Bryant (2002), this approach, based predominantly within the biomedical model, fails to address issues of social justice, health inequalities, and the lived experiences of people within the larger social context.

Upon reviewing a number of documents from Newfoundland and Labrador, Nova Scotia, New Brunswick and Prince Edward Island, we noted a number of commonalities.  Each document draws on the population health approach with reference to the numerous factors that influence the health of the population. Obesity is highlighted in each document to varying degrees, viewed in each as a significant contributor to disease and an essential reason for governments to support initiatives that promote physical activities and healthy lifestyles. The Newfoundland and Labrador Provincial Wellness Plan (2006) for example highlights obesity as a risk factor for chronic disease which must be addressed in order to improve the overall health of Newfoundlanders and Labradorians. The Wellness Plan sets the focus of government and communities on developing policies and initiatives for a healthier diet and increase in physical activity to counteract the “high risk” factors of obesity and physical inactivity in the population of the province (Beausoleil, 2009). The Wellness Plan targets youth in particular as a subsection of the population in need of intervention and schools as ideal sites for specific initiatives aiming at preventing or reducing obesity. Framed by the Wellness Plan, the Department of Health and Community Services and the Department of Education have created the Healthy Students, Healthy Schools initiative, currently deployed in order to promote healthier eating and increased physical activity among youth in the province (Beausoleil, 2009).  One evaluation report (Goss Gilroy, 2008) examining the Provincial Wellness Plan describes the Healthy Students, Healthy Schools as a very successful education initiative. Interestingly though while the report draws on the opinions of  a number of key informants including professionals, organizations and stakeholders, no student input was sought in the evaluation.

In Nova Scotia, the Active Kids Healthy Kids Strategy was launched in 2002 and is still being deployed (Government of Nova Scotia, 2007). The Strategy intends to promote an ecological approach to health. The document refers to obesity as a “societal problem” which goes beyond individual responsibility (p.4). In 2008-2009 initiatives coming out of the strategy have focused on physical education in schools, with a particular focus on increasing access and opportunities for girls from grades 5 to 9 to engage in physical activity. In addition to promoting increased physical activity the Strategy advocates healthy eating to prevent or counteract the health risks they see as associated with being overweight. The authors emphasize the importance of weight at the population health level while writing that weight is not in itself a sufficient indicator for assessing individual health status. Ultimately though this Strategy emphasizes changes in individual lifestyle and behaviors as solutions to the health ‘risks’ or ‘problems’ the authors conflate with overweight and obesity.

In many instances the construct of overweight and obesity has been moved beyond the realm of risk, as a contributor to disease, into the realm of the absolute, as a disease itself. For instance, government documents from New Brunswick and Prince Edward Island go as far as to define obesity as a disease. Interestingly, by utilizing this framework, those on the border of overweight and obesity could conceivably be disease free one day and diseased the next or both well and sick in one day depending on normal weight fluctuations throughout the day. Also, depending on the criteria for overweight which may be different in different jurisdictions, an individual could be considered disease free in one place and merely “at risk” in another.

In New Brunswick, the Wellness Strategy Framework (Government of New Brunswick, 2009) advocates increased physical activity and increased healthy eating as ways to counteract and prevent obesity (http://www.gnb.ca/0131/wellness-e.asp). In the Healthy eating section of the New Brunswick Wellness Strategy, obesity is listed as a “chronic” disease along with cancer, heart disease, etc. (http://www.gnb.ca/0131/Healthy-NB-en_sante/healthy_eating-e.asp).  In Prince Edward Island, under the heading the “upwardly spiraling prevalence of chronic disease”, the document Prince Edward Island’s Strategy for Healthy Living (Government of Prince Edward Island, 2003) highlights facts about obesity referring to the number of islanders who not only fall into the obese category but those who fall into overweight category, once again demonstrating the use of overweight statistics to bolster the argument of spiraling trends in obesity (Gard and Wright, 2005). The Prince Edward Island’s Strategy for Healthy Living goes on to discuss the economic cost of obesity to the population suggesting that obesity costs PEI between $9 and $15 million (they do not mention the time factor here). The authors suggest that the strategy is about supporting people in making healthy choices.

Although the Prince Edward Island’s Strategy for Healthy Living suggests that the focus should be on increasing levels of activity amongst the population, one action area outlined in the document is healthy weights and obesity. Targets in this area actually include an increase in healthy weights amongst children and adolescents, and a decrease in obesity in adults all evidenced by BMI measurements. This narrow approach to examining the issue of weight and health is what we would consider irresponsible and completely counterproductive as many researchers have argued that constructing overweight and obesity as a disease reinforces dominant discourses of the ideal body and in effect institutionalizes fat hatred (Halse, 2009; Jutel, 2009). Within this document there is no space provided for the larger person who does not fit the prescribed norm. Fat is equated with bad and thus people are expected to subject themselves to surveillance by measurement for the common good.

Upon reviewing government documents, we concur with Jutel (2009) who emphasizes that the diagnosis or labeling of disease has a direct impact on policy development and on profit-driven markets. Even the term overweight at this point in time she argues, carries with it a set of “risk factors, typologies, outcomes, treatment and prevention, all suggestive of overweight as disease” (p.63). She goes on to highlight a number of factors which contribute to the conceptualization of overweight as disease. These factors include the notion that one’s appearance is an important indicator of the person’s makeup, the ability to actually measure a person’s degree of fat which provides scientists with what they would consider an objective quantifiable measure of the “truth” about a person’s body, and finally the medical discourse which provides a space for those who are in a position to market products through the promotion of overweight as a disease.

 This conceptualization of overweight and obesity has resulted in a general risk discourse that serves to boost the fears of the population in relation to fat and disease (Fullagar, 2009) and reinforce neoliberal discourses of individual responsibility (Burrows, 2009). LeBesco (2004) says that defining obesity as a disease is not merely a medical issue but a political one. In bringing this issue into the political realm, we are allowing obese people to be defined in economic terms as financial burdens or as drains to the system, in turn reinforcing the call for individual responsibility thus further equating “fat” with “bad”. Research papers and government documents, such as the previously mentioned Prince Edward Island’s Strategy for Healthy Living, routinely report the “direct” cost of obesity to the system which is often relayed using the term burden (Starky, 2005).  Those who are considered then to contribute to this burden become what many consider a social burden. Government health documents have drawn on this concept of burden to highlight the individual responsibility of good citizens to eat right, exercise and fit the prescribed desirable norm.

THE MOVE TOWARD ALTERNATIVE APPROACHES

While many government documents have been seen to reflect a medicalized individualistic approach to weight and the body, alternative ways of examining obesity science and the relationships between fat and chronic disease have been appearing to a greater extent in the literature recently. Some of this research provides rationales for looking beyond fat as the answer to society’s health problems. Yet much of this research is still situated within the dominant biomedical paradigm which conceptualizes obesity as an emergent problem that must be addressed.  For example, Egger and Dixon (2009) provide a compelling argument that suggests that factors leading to chronic disease, such as climate change, pollution, reliance on fossil fuels, and inequalities in health, are not distinct to people who carry fat above the desired norm. People within the normal weight are also are seen to be affected by lifestyle behaviours that contribute to chronic disease. They suggest that obesity has been targeted because it is an outward marker of a complex set of circumstances which may contribute to ill health. While Egger and Dixon question whether obesity is the problem per se, they fail to address the issue of obesity discourse and the impact of such discourse on the “lifestyle behaviours” that they discuss.

This issue is reminiscent of much of the mainstream literature we have reviewed involving the psychosocial repercussions of obesity. This literature provides useful insight into the issues that people defined as overweight and obese are faced with; yet it often stops short of questioning the way we conceptualize body size and the ethical and moral implications of monitoring bodies through institutions such as medicine and education (Fallon et al 2005; Friedlander et al, 2003; Janicke et al, 2007; Murtagh, Dixey, and Rudolf, 2006; Schwimmer, Berwinkle and Varni, 2003; Williams et al, 2005). Many researchers in the field continue to utilize and reinforce the dominant discourses around health and obesity and simply suggest that the solutions lie in reducing the rates of obesity through lifestyle interventions.

By focusing on lifestyle approaches in health policy development, a number of scholars argue that governments, researchers, and policy makers are in fact shifting responsibility of government away from providing supportive healthy environments (Bercovitz, 2000; Coburn, 2000; Crawford, 2006; Poland et al, 1998; Raphael, 2004). This neoliberal approach fails to hold the market accountable for the way in which the science of overweight and obesity is used to legitimize product claims and ultimately boost sales of pharmaceuticals, diet and exercise merchandise, and cosmetics (Egger, and Dixon, 2009; Rail and Beausoleil, 2003).  Most importantly the biomedical focus on lifestyle excludes fundamental cultural and sociopolitical productions of the body and health (Rich and Evans, 2005).

While powerful discourses have the ability to influence policy and the activities of daily living, we must assert that such discourses are not fixed or absolute. Such discourses, as suggested by Foucault (1970), are molded by dynamic social relations that transition within specific times and spaces; they are historically situated. Powerful or hegemonic systems of meaning are always open to contestation. Alternative discourses that are pushed to the periphery may gain power through resistance of the dominant discourses. There is space for these alternative discourses, as they provide us with new ways of looking at health and the body (Rich and Evans, 2005).  By conducting research, writing, and accessing sites where the dominant discourses are reproduced we can begin to effect change and diminish the power of the dominant discourse. As LeBesco (2004) argues, we need to “alter the discourse of fat identity within a research context by moving inquiries about fat from medical and scientific discourses to social and cultural ones, and to replace self-help literature with a different way of looking at, and living in fat bodies” (p.2).

Research approaches and community programs designed to explore and address the ways in which health and thinness are conflated and the ways the body is both monitored and regulated can provide us with the tools to consider other more diverse ways of looking at the issue of weight and health. These approaches and programs will allow space for difference and a consideration of the lived experience of individuals presently labeled as overweight or obese. It is our experience that researchers, policy makers and the public at large are not necessarily closed to alternative discourses but that they may not necessarily have been introduced to or have access to research that provides them with alternative conceptualization of the issues at hand. Also, it should be noted that even when provided with research that supports alternative ways of thinking, these modes of examination are often disrupted or countered by competing interests and agendas within the policy arena (Lang and Rayner, 2007).

Furthermore, while researchers may be in a position to positively affect policy outcomes, there is often a disconnection between researchers and policy makers.  Lomas (2000) for example states:

“Researchers and policy makers tend only to connect if they connect at all around the product of their processes. Just at the point of decision, after the issue has bubbled up onto the policy agenda, after it has been framed within a particular context after the various claimants for a voice have been adjudicated, the procedures for negotiation and exchange agreed upon, and often after the limits have been set around feasible options, the researcher arrives brandishing his or her study” (p.140).

Research and policy are developed differently, at different paces and for different reasons. As previously discussed, research in the area of the body, health and obesity, is arising from a number of often divergent perspectives. This according to Banwell, Hinde and Sibthorpe (2005) can lead to confusion on the part of the policy makers. This type of situation has been referred to as “policy cacophony” (Lang and Rayner, 2007).  According to the authors, there are so many competing voices in the “war on obesity” that it becomes more and more difficult for policy makers to interpret the evidence. This confusion is only compounded by the expansive nature of the issue from an individual level to a socioeconomic/environmental level and research that is replete with medical jargon. Even the apparently simple issue of food is related to larger policy issues such as agriculture, manufacturing, retail, education, culture, trade and economics.

Also, as previously stated, policies that impact the health of the population are born out of processes that are not always transparent.  There are other influences aside from research that serve to shape government policy that must also be considered.  Choi et al (2005) suggested that policy makers are placed in a challenging position where their decisions are not always based directly upon research but are framed within the context of the many diverging pressures placed upon them by key stakeholders within government, the private sector and the public at large. In responding to the demands of these groups, policy makers may develop policies that do not address population health concerns but ones which are quick, visible and that best satisfy the demands of the various groups. To further complicate the situation we must recognize the research, the policy planning and implementation are all occurring within the context of the current obesity panic.

We argue that in order to effectively address this issue, researchers, policy makers and the general public must recognize that the pervasive obsession with fat (which has become greatly normalized) is self-defeating and they must move toward strategies that promote health in many sizes (Miller, 2005). Considering the fact that research alone does not determine whether policies are implemented, we would argue that the voice of the researcher could be strengthened by developing strategies that encourage ongoing dialogue between researchers and policy makers. These strategies should be structured to move beyond the norms, perspectives and jargon that Miljan (2008) highlights as major stumbling blocks in communication related to policy making. We would add here that more emphasis should be placed upon qualitative research in the area of health and the body. As Labonte, Polanyi, Labontem, et al.  (2005) suggest, population health research has historically favoured quantitative research with little recognition of the important role of qualitative approaches. They state that there is a “continued dominance of risk factor epidemiology within much public/health promotion research and practice” (p.9). This is particularly true in the field of obesity research. To address this concern, strategies must be developed that promote the dissemination to and use of qualitative research by policy makers. Also, there must be strategies developed that encourage researchers and policy makers to work together (Choi et al, 2005). An increased knowledge and appreciation of the forces that impact each role is vitally important. Researchers must consider the issues of timelines and conflicting demands placed upon policy makers while focusing on strategies that facilitate knowledge translation to ensure that key areas of research are well understood. Policy makers should value research as a resource and strive to develop partnerships with those in research with particular attention to the lived experiences of individuals and families.

CONCLUSION

Recognition of the barriers to effective health policy development and the role of policy in the uptake of dominant health discourses is a vital step in moving toward alternative approaches. While advocating for social change through addressing these barriers and problematic discourses is quite challenging, it is not impossible. This is reflected in our work with the Body Image Network, a non-profit organization based in Canada’s most easterly province of Newfoundland and Labrador. This network, which consists of health professionals, academics, students, and volunteers, struggles to prevent disordered eating and promote positive body image in Newfoundland and Labrador through challenging the dominant health discourses.
 
From a practical perspective, as members of the Body Image Network, we have found that we must be opportunistic in our approach to affecting policy. We have addressed many of the barriers to effective policy making by forming relationships with those in key government departments who are both indirectly and directly involved in policy development. We have positioned ourselves on a number of interdisciplinary research groups that range in focus from body image issues, to eating disorders to obesity. This has allowed us to influence the direction of research and forge a space for alternative directions. We have also disseminated our messages through listserves, presentations to and meetings with government officials in both education and health, and presentations to teachers and health professionals from various areas of the country. Funded by a wellness grant from the Newfoundland and Labrador provincial government we have challenged many of the messages that are present in government documents in relation to health and obesity through a province wide initiative which was designed to address school culture and curriculum in an effort to counteract many of the dominant health and obesity discourses. Our alternative message is reinforced through a website developed to promote positive ways of conceptualizing the body and health. Interestingly, while critical of the healthist approaches taken by government, we now find ourselves in a position where we are being consulted by government representatives on school curriculum in relation to body image issues.    While the Body Image Network continues to develop a number of resistive strategies, we also recognize that our position within the policy making arena is both fluid and tenuous. Even though those in a position to direct policy in the areas of health and education have been responsive to our arguments, they are simultaneously involved in the development of documents and strategies that reinforce the dominant health discourses. The hegemonic forces of these discourses are growing ever stronger as the rhetoric around the obesity epidemic intensifies. The social space for those who fit into these marginalized positions is becoming smaller.  Our goal therefore is to continue to reflect upon our own messages while maintaining a resistance to the dominant discourses around health and the body. We must continue to strategically utilize resources provided within the dominant health promoting framework (those which most often serve to make the dominant discourses so powerful), to neutralize hegemonic understandings of health, fitness and the body. We must access the institutions through which dominant messages are produced and reproduced including schools, health, and post-secondary programs. We plan to utilize the media and remain visible, alert, and reactive to the messages that are transmitted through government endorsed strategies.

As long as governments continue to seek solutions within the context of a narrow view of health and obesity, it is our belief that the problems of exclusion and marginalization will continue to intensify. Simultaneously, the fear of being labeled as overweight or obese will heighten already unhealthy levels of body dissatisfaction and obsession with weight, ultimately resulting in negative health consequences for the population as a whole. We contend that it is vital that those in a position to impact policy in this country consider the context in which the obesity epidemic is being constructed, consider how biopedagogies are produced and reproduced within health promotion and population health documents, and how these documents influence institutions within our society which have the power to regulate and normalize specific forms of thought and social practices.

Finally, the vital role of research cannot be understated.  We must continue to explore the embodied experiences of those who interact on a daily basis with the dominant health discourses. We should strive to seek opportunities to disseminate this research within the fields that in fact reinforce dominant discourses and we must challenge them at the point of delivery. As Rail (2009) suggested, we must continue to practice “subversive scholarship to unsettle and challenge current notions of obesity, health and truth” (p.153).



References



Banwell, C., Hinde, S., Dixon, J., and Sipthorne, B. (2005). Reflections on expert consensus: A case study of the social trends contributing to obesity. European Journal of Public Health,15(6), 564-568.

Bauman, A., C.L., and Cameron, C. (2005). Low levels of recall among Canadian adults of the CESP/Health Canada physical activity guidelines. Canadian Journal of Applied Physiology, 30(2), 246-252.

Beausoleil, N. (2009). An impossible task?: Preventing disordered eating in the context of the current obesity panic. In J. Wright., and V. Harwood (Eds.),  Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Bercovitz, K.L. (2000). A critical analysis of Canada’s “Active Living”: Science or politics? Critical Public Health. 10(1), 19-39.

Burrows, L. (2009).  Pedagogizing families through obesity discourse. In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Campos, P. (2004). The obesity myth: Why America’s obsession with weight is hazardous to your health. New York: Gotham.

Campos, P., Saguy, A., Ernsberger, P., Oliver, E., and Gaesser, G. (2006). The epidemiology of overweight and obesity: Public health crisis or moral panic. International Journal of Epidemiology, 35(1), 55-60.

Canning, P., Courage, M., and Frizzell, L.M. (2004). Prevalence of overweight and obesity in a provincial population of Canadian preschool children. Canadian Medical Association Journal, 171(3), 240-242.

Choi, B.C.K., Pang, T., Lin, V., Puska, P. Sherman, G., Goddard et al. (2005). Evidence based public policy and practice: Can scientists and policy makers work together? Journal of Epidemiology and Community Health, 59, 632-637.

Coburn, D. (2000). Income equality, social cohesion, and the health status of populations: The role of neo-liberalism. Social Science and Medicine, 51, 135-146.

Coburn, D., Denny, K., Mykhalovskiy, E., McDonough, P., Robertson, A., and Love, R. (2003). Population health in Canada: A brief critique. American Journal of Public Health, 93(3), 392-396.

Cregan, K. (2006). The sociology of the body. London: Sage.

Crawford, R. (2006). Health as a meaningful social practice. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 10(4), 401-420.

Egger, G., and Dixon, J. (2009). Should obesity be the main game? Or do we need an environmental makeover to combat the inflammatory and chronic disease epidemics? Obesity Reviews, 10(2), 237-249.

Fallon, E.M. et al. (2005). Health related quality of life in overweight and non-overweight black and white adolescents. Journal of Pediatrics,147, 443-450.

Foucault, M. (1970). The order of things: An archaeology of the human sciences. New York: Pantheon.

Foucault, Michel. (1973). The birth of the clinic: An archaeology of medical perception. New York: Pantheon.

Friedlander, S.L., Larkin, E.K., Rosen, C.L., Palermo, T.M., and Redline, S. (2003). Decreased quality of life associated with obesity in school-aged children. Archives of Pediatric and Adolescent Medicine, 157, 1206-1211.

Fullager, S. (2009).  Governing healthy family lifestyles through discourses of risk and    responsibility. In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Gaesser, G.A. (2002). Big fat lies: The truth about your weight and health. California: Gurze.

Gard, M., and Wright, J. (2005). The obesity epidemic: Science, morality, and ideology. New York: Routledge.

Goss Gilroy Inc. (2008, March). Report of the evaluation of the Provincial Wellness Plan - Phase 1:2006-2008. Prepared for Department of Health and Community Services. Government of Newfoundland and Labrador.  St, John’s: Author.

Government of  New Brunswick (2009) . Live well, be well: New Brunswick’s Wellness Strategy. Retrieved March 29, 2009 from http://www.gnb.ca/0131/wellness-e.asp

Government of New Brunswick. Healthy Eating.  Retrieved March 29, 2009, from http://www.gnb.ca/0131/Healthy-NB-en_sante/healthy_eating-e.asp

Government of Newfoundland and Labrador. (2006). Achieving health and wellness: Provincial Wellness Plan for Newfoundland and Labrador. St. John’s: Author.

Government of Nova Scotia. (2007). Active kids, healthy kids strategy: A physical activity strategy for children, youth and families in Nova Scotia. Halifax: Author.

Government of Prince Edward Island. (2003). Prince Edward Island’s Strategy for Healthy Living. Charlottetown: Author.

Grosz, E. (1994). Volatile bodies. Towards a corporeal feminism. Bloomington: Indiana University Press.

Halse, C. (2009). Bio-Citizenship: Virtue discourses and the birth of the bio-citizen. In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Huff, J. L. (2001). Interrogating Bantigism and mid century fat phobia. In Braziel, J, E., and Lebesco, K. Bodies out of bounds: Fatness and transgression. Berkeley: University of California Press.

Janicke, D.M., Marciel, K.K., Ingerski, L.M., Novoa, W., Lowry, K.W., Sallinen, B., J., and Silverstein, J.H. (2007). Impact of psychosocial factors on quality of life in overweight youth. Obesity, 15(7), 1799-1807.

Jutel, A. (2009). Doctor’s orders: Diagnosis, medical authority and the exploitation of the fat body. In J.Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Katzmarzyk, P.T., and Adern, C.I. (2004). Overweight and obesity mortality trends in Canada, 1985-2000. Canadian Journal of Public Health, 95(1), 16-20.

Klaczynski, P. A., Goold, K. W., and Mudry, J. J. (2004). Culture, obesity stereotypes, self esteem, and the "thin ideal": A social identity perspective. Journal of Youth and Adolescence, 33(4), 307-317.

Labonte, R., Polanyi, M., Nazeem, M., McIntosh, T., and Williams, A. (2005). Beyond the divides: Towards critical population health research. Critical Public Health, 15(1),    5-17.

Lang, T., and Rayner, G. (2007). Overcoming policy cacophony on obesity: An ecological public health framework for policy makers. Obesity Reviews, 8(suppl.1), 165-181.

Lomas, J. (2000). Connecting research and policy. ISUMA, Spring, 140-144.

Lebesco, K. (2004). Revolting bodies?: The struggle to redefine fat identity. Amherst, MA: University of Massachusetts Press.

MacNeill, M. (1999). Social Marketing, gender, and the science of fitness. In P. White and K. Young (Eds.), Sport and Gender in Canada (pp.216-231). Don Mills, Ontario: Oxford University Press.
 
Miljan, L. (2008). Public policy in Canada: An introduction. Don Mills Ontario: Oxford University Press.

Miller, W. C. (2005). The weight-loss-at-any-cost environment: How to thrive with a health centered focus. Journal of Nutrition Education and Behavior, 37, S89-93.

Monaghan, L.F. (2007). Body mass index, masculinities and moral worth: men’s critical understandings of ‘appropriate’ weight-for-height. Sociology of Health and Illness, 29 (4), 584-609.

Murray, S. (2009). Marked as ‘pathological’: Fat bodies as virtual confessors. In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Murtagh, J., Dixey, R., and Rudolf, M. (2006). A qualitative investigation into the levers and barriers to weight loss in children: Opinions of obese children. Archives of Disease in Childhood, 91,920-923.

Ogden, C.L., Carroll, M.D., McDowell, M.A., and Flegal, A.M. (2007). Obesity among adults in the United States: No statistically significant change since 2003-2004. NCHS data brief  no 1. Hyattsville, MD: National Center for Health Statistics.

Poland, B., Coburn, D., Robertson, A., and Eakin (1998). Wealth, equity, and health care: A critique of a “population health” perspective on the determinants of health. Social Science and Medicine. 46 (7), 785-798.

Rail, G. (2009). Canadian youth’s discursive constructions of health in the context of the obesity discourse. In J. Wright., and V. Harwood (Eds.),  Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Rail. G., and Beausoleil, N. (2003). Introduction: Health panic discourses and the commodification of women’s health in Canada. In N. Beausoleil and G. Rail (Eds) Special issue: health panic and women’s health. Atlantis: A Women's Studies Journal. 27.2., Winter: 1-5.

Raine, K. (2005). Determinants of healthy eating in Canada: An overview and synthesis. Canadian Journal of Public Health, 96(supplement 3), S8-S14.

Raphael, D., and Bryant, T. (2002). The limitations of population health as a model for a new public policy. Health Promotion International, 17(2), 189-199.

Raphael, D. (2004). Social determinants of health: Canadian perspectives. Toronto: Canadian Scholar’s Press.

Reeves, G. K., Pirie, K., Beral, V., Green, J., Spencer, E. and Bull, D. (2007). Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 335, 1-11.

Rice, C. (2007). Becoming the fat girl: Acquisition of an unfit identity. Women’s Studies International, 30, 158-174.

Rice, C. (2009). Exacting beauty: Exploring women’s body projects and problems in the 21st  century. In N. Mandell (Ed.)., Feminist issues: Race, class and sexuality. Toronto: Pearson.

Rich, E., and Evans, J. (2005). “Fat ethics”- The obesity discourse and body politics.  Social Theory and Health, 3, 341-358.

Rich, E., and Evans, J. (2009). Disgusting pedagogies. In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.

Schwimmer, J., Burwinkle, T., and Varni, J. (2003). Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association, 289, 1813- 1819.

Starky, S. (2005). The obesity epidemic in Canada. Ottawa: Library of Parliament.

Statistics Canada (2005). Canadian community health survey: Obesity among children and adults. The Daily (July 6).

Statistics Canada (2008). Canadian community health survey. The Daily (June 18).

Tremblay, M.S., Katzmaryk, P.T., and Willms, J.D. (2002). Temporal trends in overweight and obesity in Canada, 1981-1996). International Journal of Obesity, 26(4), 538-543.

Twells, L. (2005). Obesity in Newfoundland and Labrador. Newfoundland and Labrador Centre for Applied Health Research, St. John’s, NL.

Williams, J., Wake, M.,  Hesketh, K., Maher, E., and Waters, E. (2005). Health related quality of life of overweight and obese children. Journal of the American Medical Association, 293, 70-76.

Wright, J. (2000). Disciplining the body: Power, knowledge, and subjectivity in a physical education lesson. In A. Lee, and C Poynton (Eds.), Culture and text: Social research and cultural studies (pp. 152-169). Sydney: Allen and Unwin.

Wright, J., and Dean, R. (2007). A balancing act: Problematising prescriptions about food and weight in school health texts. Utbildning and Demokrati, 16(2), 75-94.

Wright, J. (2009). Bio-power, biopedagogies and the obesity epidemic.  In J. Wright., and V. Harwood (Eds.), Biopolitics and the “obesity epidemic”: Governing bodies. London: Routledge.


Biographical notes:

Natalie Beausoleil is an Associate Professor in the Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland. Informed by feminist and critical perspectives, her research focuses on the social production of gender, body, health and illness through popular, medical and scientific discourses. Recently she has been involved in projects which explore experiences and meanings of the body, health, and fitness, and the promotion of positive body image among youth.

Pamela Ward is a nurse educator in the Bachelor of Nursing Program at the Centre for Nursing Studies in St. John's, Newfoundland, where she teaches Community Health. Pamela is presently a PhD candidate in the Faculty of Medicine, the division of Community Health and Humanities at Memorial University of Newfoundland. Her PhD research is focused on the discursive production of health and issues of body image and identity formation in children enrolled in obesity treatment.