Editorial

Debating, theorising and researching

obesity in challenging times
The past decade has witnessed a cacophony of calls to combat the obesity
epidemic and the impudent lifestyles claimed to cause it. Reportedly affecting
most adults and a growing number of children (but considered especially
problematic among the poor, notably working-class mothers), overweight/
obesity/fatness is presented by various entrepreneurs (Monaghan et al, 2010)
as a massive public health crisis that not only threatens individual health but also
national wealth. This concern is evidenced across a range of national contexts,
though the obesity epidemic is largely deemed modernitys scourge (Gard and
Wright, 2005, p. 68) and thus the blight of nations such as the United States, or
Britain that is typied by the Academy of Medical Royal Colleges (AMRC, 2013,
p. 3) as the fat man of Europe. The degradation of fatness is not new, but the
sheer scale of this seems to be quite tting under current social, political and
economic conditions. Indeed, concerns about economic tness and fatness have
considerable resonance following the near collapse of capitalism in 2008 and
conditions of (unresolved) global crisis (Wallerstein, 2011). Amidst austerity,
comprising cuts to publicly funded health services and social welfare, the larger
public are routinely extolled to literally exercise greater self-discipline and
tighten their belts. Lean times, we are told, necessitate lean, efcient, healthy
bodies and the cutting of unwanted, aberrant esh that is weighing us all down.
Social Theory & Health (STH) has served as an important forum for debating,
theorising and presenting challenging research on medicalised fatness/weight.
Ruth Grahams (2013, p. 286) endorsement of this journal as a slightly edgy
discursive space wherein everyday health matters are integrated with more
formal, abstract theory is a tting sentiment that goes beyond her substantive
interests in anorexia and death. Indeed, STH offers plenty of food for thought,
so to speak, on related issues of fatness that implicate social and not just eshy
bodies. Hence, it was with considerable interest and pleasure to have been
invited to compile this special issue. My instructions were to select eight
previously published papers from STH on obesity and write an editorial.
There are enough papers on this topic in STH to ll two special issues. My
exclusion of certain contributions is largely a pragmatic decision and is not meant
to imply that such papers are irrelevant to the broader debate. Any omission
should not be interpreted to mean that I am unsympathetic towards other
authors disciplinary and philosophical commitments. For example, to note two
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papers that are not included Crossley (2004) and Patterson and Johnston
(2012) the former is aligned with my own professional disciplinary concerns
(sociology), while both speak to my interest in critical realism as a nonconationary meta-theory that has salience when engaging social and biological
matters (see also Monaghan, 2013). At the same time, certain assumptions in
these writings, wherein obesity is a behavioural problem ultimately caused by
modern lifestyles, must be critically evaluated rather than treated as axiomatic.
Obesity science is an uncertain business but it does suggest there could be many
putative contributors to secular trends in obesity beyond the Big Two (that is,
diet and physical inactivity) (Keith et al, 2006). While fatness or higher levels of
body mass need not be medicalised/pathologised as overweight and obesity,
with some clinicians rejecting such biomedical constructs (Aphramor and
Gingras, 2011), it is also the case that a populations supposedly expanding
waistline might be accounted for in terms of pharmaceutical iatrogenesis,
decreased smoking, sleep debt, endocrine disruptors in the environment (Keith
et al, 2006) or a combination of other factors, including maternal undernutrition
and foetal programming in an inequitable world (see below).
I have also omitted papers for other reasons. For instance, although I have
contributed ve papers on obesity/weight/fatness to STH, given an obvious need
for polyvocality I have only selected one fairly short paper (Monaghan, 2005). I
chose that because it has served as a recurrent point of reference for other
contributors to STH and it was accompanied by two excellent papers in the same
issue, which I wanted to include here (Aphramor, 2005; Rich and Evans, 2005).
These two papers on dietary approaches to weight loss and fat politics have
grabbed the attention of many STH readers as gauged by citation metrics.
Accordingly, I have sought, as far as possible, to collate a range of critical and
hopefully thought provoking articles, which speak to different aspects of a public
issue and contingent private trouble that traverses other binaries such as: nature/
culture, reason/emotion, majority/minority and normal/deviant. In so doing, I
have not only selected theoretical, or discussion-oriented, articles but also
empirical papers (which are theoretically informed), incorporating contributions
that are attentive to socially constructed discourses, body materiality and/or
embodied health practices. A unifying theme across these papers is a commitment to social justice and challenging hegemonic understandings. My view is
that at a time when there is much misrecognition and symbolic/structural
violence in class-divided, sexist, ageist, ableist and racist societies, the war on
obesity should be challenged in the interests of fostering more peaceful self-body
relations. Moreover, as will be seen, there is scope for traversing disciplinary
silos and deceptive epistemologies as part of a collaborative endeavour that is
well-informed, and, dare I say, well-rounded. In sum, I have included papers that
feed a growing concern to foster critical, reexive knowledge that could have
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implications for a range of parties, including health professionals who are placed
on the frontline in the war on obesity and policymakers who all too often seem to
be looking for evidence to support pre-existing beliefs.
The rst three papers in this collection (Aphramor, 2005; Monaghan, 2005;
Rich and Evans, 2005) reect my own early forays and fortuitously established
alliances within this nascent eld of study. My 2005 Discussion Piece: A Critical
Take on the Obesity Debate was written after my interest was piqued by claims
that most men in England are overweight or obese, that excess weight/fatness
is unacceptable and this must be tackled as a matter of national urgency. The
more I looked into this alleged public health crisis the more critical I became,
much in line with a sociology of rather than for medicine. I therefore approached
the editors of STH with my idea to expand the obesity debate (following
engagements with the United Kingdoms Mens Health Forum in the run up to
their Department of Health-funded conference on mens and boys weight
issues). During this time Lucy Aphramor, Emma Rich and John Evans also
accepted my invitation to write two accompanying articles.
In her 2005 STH paper, the second article in this collection, Aphramor
unhinges certain dietary ideologies and the dominant weight-centred health
framework. Written from the vantage of a practising dietician, her central theme
is that the current weight-loss schema helps to naturalise a fatness discourse that
not only represents large people in offensively stereotyped ways but also fails to
integrate peoples lived experience as gendered, situated bodies in an inequitable
world. Refusing to swallow things whole, Aphramor calls upon fellow
clinicians, policymakers, researchers and others to throw their weight around
in order to effect change that is evidence-based and ethically justiable. Her
article includes challenging insights pertaining not only to gender inequity but
also globalisation, racism as well as biological pathways linking the social body
to ill-health. Such reasoning might disorientate some readers, but she advises:
A rst step in getting to grips with fatness may be to dismantle the old
ordinances and draw up new maps. Aphramor has subsequently authored
numerous works that extend such thinking, often in collaboration with other
critical dieticians in North America who promote alternative clinical paradigms
and arena for debating transdisciplinary concerns (for example, Aphramor and
Gingras, 2011; Bacon and Aphramor, 2011; Brady et al, 2013; see also the Journal
of Critical Dietetics, which was launched in 2009).
The third paper by Rich and Evans (2005) interrogates obesity discourse and
associated negative unintended consequences. For these sociologists of physical
education, problems not only include the unfounded certainty of those seeking to
promote a healthy weight but also the institutionalisation of size discrimination
and the possibility that obesity discourse may propel some people towards illhealth via disordered relationships with food, exercise and the body. Moral and
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ethical issues are again underscored as part of their efforts to reclaim body
politics and the inuence of social factors on health. Related concerns include the
ways in which biomedical narratives, often recycled with a sense of alarm in the
mass media, dominate public understandings and obfuscate social structures
through the culture of healthism and individualism (see also Evans et al, 2008;
Rich et al, 2011).
In addition, I have selected ve subsequently published papers from STH,
which advance critical thinking. The rst of these, by Warin (2011), focuses on a
four-part television anti-obesity campaign, featuring an English celebrity chef,
Jamie Oliver, whom she typies as Foucaults progeny. This typication is apt
given the ways in which a whole community is selected for health promotion,
with power exercised through networked circuits of deployment. Also going
beyond a mechanistic application of Foucauldian theory, Warin examines the
intersections of different technologies that give rise to specic lifestyle interventions, and the forms of resistance they generate. In particular, she explores how
reality TV qua cultural technology seeks to foster self-governance in a moralising
neo-liberal environment wherein working-class Northern English people (especially inept mothers) are targeted. Her paper is a powerful reminder in our
media-saturated environment that it is all too easy to reproduce and validate the
dominant rhetorical storyline of obesity. Moreover, in learning from townsfolk
who challenged Olivers evangelical crusade, it is necessary to appreciate how
food and the body are deeply enmeshed in the socio-economic and gendered
relations of peoples lives (often across generations) and [these] cannot be
changed overnight (or in four episodes). Of course, one may also ask to what
extent such behaviours and populations should be prioritised in health research
calling for change, especially given the toxic illness behaviours of the very rich
and powerful, the real greedy bastards, which are arguably far more consequential for public health (Scambler, 2009).
Even so, the lifestyles of the poor and socially excluded tend to be prioritised
in (typically state-funded) health research, but even then it is crucial to consider
how human agency is structured. Drawing from interviews with 15 underprivileged young women in Canada, Dumas et al (2014) present a qualitative
study of health, obesity and lifestyle. In order to examine the meanings given to
health and the body, the authors use a branch of contemporary sociological
theory that has largely been neglected in this eld that of Bourdieu on social
classes, the habitus and embodied dispositions. Attuned to the constraining
impact of disadvantaged life circumstances, Bourdieus conceptualisations
sensitise us to how conditions of necessity inuence peoples adaptive responses,
ranging from acquired taste for particular (cheap) foodstuffs to the need to
prioritise obligations to others over oneself (as with gendered child care
responsibilities that eclipse injunctions to take regular exercise as a putative
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antidote to obesity). Dumas et al conclude by arguing that health practices are

less a product of knowledge and more an outcome of the choice of the
necessary in a real material world wherein an instrumental relation to the body
is reective of inequitable social structures.
Rail et als (2010) paper is also critical of the old ordinances insofar as it views
obesity discourse as a good example of micro-fascism. Obesity discourse is
described as a fascist structure insofar as it is saturated with ideology and
intolerance that extend not only to weight/fatness but also alternative forms of
knowledge, such as that generated by qualitative researchers. Rather than
accepting the epistemic authority of state science, including the alarmist claim
made by a US Surgeon General that obesity is a form of domestic terrorism, Rail
et al consider what such discourses mean in practice. More specically, they use
feminist poststructuralist theory to interrogate the politics of evidence marshalled
in the war on obesity among Canadian youth and associated biopedagogies,
that is, disciplining and normalising practices exercised within a broader
apparatus of surveillance, bodily self-regulation and governmentality. Reporting
and analysing the discursive constructions of health and the body among 144
participants from diverse backgrounds, the authors look into the effects of
obesity discourse and show that young people prioritised a limited number of
corporeal themes: personal responsibility for being physically active, eating well
and being neither too fat nor too skinny. Moreover, these preoccupations
entwined with racialised, ableist and gendered injunctions to look good or
beautiful often eclipsed other health promotion concerns, such as: smoking,
unsafe sex and abuse of alcohol and other drugs. Although physical constructions of health were sometimes resisted, they were dominant and also eclipsed
highly consequential macro-social determinants of health, such as socioeconomic status, education and employment. When discussing their ndings,
Rail et al underscore the problematic status of obesity discourse wherein
achieving an ideal body weight and shape is conceivably more signicant than
health (practices) and healthy environments.
The penultimate paper, by Fraser et al (2010), focuses on emotions and
theorising emotions as collective social processes. For these authors the
often repeated reference to moral panic within critical writings on the
obesity epidemic invites further theorisation. Advancing a feminist, embodied approach, Fraser et al reect upon the action of emotions rather than
viewing these as individual psychological phenomena. In particular, they
draw on Sara Ahmeds work on the performativity of emotions, arguing that
this theory offers a rich starting point for illuminating the action of emotion in
both the general relationship between public discourse and subjectivity, and
the specic relationship between the self, the body and the oftentimes unmet
imperative to slimness. Issues include the degree to which emotions cannot
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simply be dismissed as destructive, visceral responses that are antithetical

to constructive reason. Rather, emotions dene boundaries and subjectivities
as they emerge and move between bodies, and such processes need to be
theorised when developing a better approach to body size and health. After all,
emotions are often denigrated as feminine (just as fatness and softness are within
obesity discourse), further underscoring the need to reframe emotions as worthy of
careful consideration rather than dismissing them as intrinsically negative or
polluting.
The nal paper by Yoshizawa (2012) discusses the potential value of the
Barker hypothesis when theorising obesity alongside the need for transdisciplinarity and social justice. The Barker hypothesis is also known as the foetal
origins hypothesis or the developmental origins of health and disease
paradigm (similarly noted in Aphramors paper), and it grapples with the social
and temporal distribution of population health and nutritional privilege. This
theory, we are told, does not support solely reductionist, biophysiological
paradigms of health and disease. Instead, in principle it evinces complex
understandings that span biology, social positionality, place and generation.
The basic premise is that foetal development in utero is critical for future health
outcomes: many diseases throughout the life course, such as coronary disease
and stroke, are traceable to maternal undernutrition and inherited metabolisms
across generations. Questions then arise concerning whether emergent health
problems attributed to obesity could be a product of earlier metabolic imprinting as it affects the development of the pancreas, for instance, and its function in
regulating digestion and storage of energy. Yoshizawa demonstrates knowledge
of fat politics and critical studies of obesity/fatness and she responds to the
potential for injustice engendered by the Barker hypothesis, including its
deployment within pre-emptive disciplinary regimes of gendered power and
health surveillance. Accordingly, she calls for greater participation by social
scientists and activists in such debates in order to transform practice through
transdisciplinary collaboration. While fat studies scholars have well-reasoned
grounds for challenging the pejorative status ascribed to medicalised fatness in
this account, and I would surmise that the Barker hypothesis is merely one part
of a much larger jigsaw, Yoshizawas paper is noteworthy. It underscores the
point that we cannot be content to address either social constructions (language,
meanings, ideologies, discourse) or biological and medical facts within a
positivist epistemology. Critically, given the complexity of the social and natural
worlds, human embodiment must be understood as a multidimensional, relational and emergent process that is irreducible to society or biology, and thus any
single source of expertise (Shilling, 2005; Williams and Monaghan, 2013).
I will close with some musings on possible future directions. Three overlapping themes strike me as salient as we proceed into what will likely be an
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extremely challenging time amidst growing inequality in a bifurcating world

economic system, migration as people seek better lives, the resurgence of fascism
as national and embodied boundaries are transgressed, and myriad protestations
against existing power structures. First, as Aphramor (2005) and Yoshizawa
(2012) demonstrate, we must recognise that humans are not only stratied
socially or psychologically but also biologically. Hence, an array of comingling
embodied mechanisms deserve careful consideration without uncritically
(prejudicially, conveniently, efciently) accepting the truth that higher
levels of body mass are necessarily because of an individuals moral failure
to regulate their energy balance (gluttony and sloth). For instance, in the
interests of social justice can we ignore the maldistribution of nutritional
privilege and metabolic imprinting in utero as potentially consequential
mechanisms for health and adiposity, especially when people living in
poverty migrate from (semi-)peripheral to core nations and have children?
Note Aphramors (2005) critical reference to obesity among US Mexican boys,
which undermines prejudicial allocations of irresponsibility to immigrant
mothers. As she explains when reworking a well-known feminist slogan, the
physiological is also political.
Second, and not unrelated, we need theoretically informed discussion and
research on how sizism is implicated in the reproduction of hegemonic
interests in a capitalist system during a period when usual anti-universal
norms (notably racism and sexism and the biological narratives invoked to
sustain them) have been seriously challenged. To extend Wallerstein (2004)
slightly so as to more fully recognise body politics: how useful is it to view
sizism not as a norm of exclusion but a norm of inclusion at an inferior
status albeit one that tends to be sugar-coated with compassionate appeals
from various entrepreneurs to help people choose health? Surely it is no
accident that obesity is more common among the usual suspects such as the
darker races who are corporeally marked as inferior. Of course, todays suspects not
only include minority ethnic groups who are pathologised for their alleged failure
to adapt to the Western obesogenic environment (for a critique of obesogenic
accounts, see Evans, 2010; Guthman, 2011), or other deviant groups such as
Northern English townsfolk. On a more expansive note, what are we to make of
obesity discourse when it incorporates the majority of the adult population in
core nations? This, I would add, is at a time when US hegemony is in terminal
decline, its macho militarism has proven to be impotent and deep concerns
about national economic tness prevail. Could it be argued that the overweight (read: lazy, greedy and feminised) populations of core Western
nations are being groomed for inclusion in a world-system at an inferior, or
at least much diminished, social status? There is a rich body of social theory
that we may draw upon when considering such questions, ranging from
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anthropologies of corporeal pollution (Douglas, 1966) and gendered studies of

abjection (Kristeva, 1982, see also Monaghan and Malson, 2013), to worldsystems analysis that appears ever more relevant following the 2008 global
nancial meltdown (Wallerstein, 2011). Accordingly, we may be better placed
to engage multidimensional bodies as social as well as biological processes,
lived bodies that are relational and embedded in global, historical, political
and economic structures that are in ux and consequential for health (broadly
conceived). Such a task, I would suggest, is essential even if social actors
are not personally politicised or if they prioritise identity politics and fat
liberation/pride as the primary axis for group mobilisation and activism
(rather than categorical mechanisms that inuence life chances, such as
social class and location).
Finally, in underlabouring for critical weight studies (Monaghan, 2013), it
strikes me that there is much more to be done in order to clear the ground if we
are to develop approaches conducive to human ourishing. Two brief points
should illustrate what I have in mind here. First, in accepting that facts exist
beyond meaning and discourse, is it practically adequate to claim the obesity
epidemic is a medical and social fact as something ontologically awry in the
world that humans are responding to and attempting to x as best they can?
Medicine exerts considerable institutional and cultural authority and is often
invaluable. However, it is hardly controversial to state that its objects of concern
are not always or necessarily pressing problems that elicit well-considered
solutions. Secular trends in overweight and obesity indicate that something is
happening (Crossley, 2004), and critics or sceptics do not necessarily ignore or
black box such concerns (for example, Campos et al, 2006; Guthman, 2013).
However, the question remains: To what extent does weight/fatness dened as
excessive constitute a real and ever expanding public health threat and to what
extent are current interventions necessary, effective and ethical? On the basis of
existing evidence and burgeoning critical studies from social scientists, clinicians
and fat activists, I think there is much here that should be challenged. Second,
knowledge remains fallible and it is important to reexively subject our own
contributions to informed scrutiny and carefully revise these where necessary. At
the same time, we must sweep aside straw men caricatures of critical studies of
weight/fatness/obesity in a broader social context where mass deception (which
is not synonymous with lying), efforts to maintain secrecy and silence, obfuscation and scapegoating are commonplace (Monaghan and OFlynn, 2013; OFlynn
et al, 2014). As discussed in this collection, social class is hardly credited in
health policy outside of its misrecognition as a variable for behavioural interventions comprising calls for heightened personal responsibility, surveillance and
discipline among the poor. Much remains to be done amidst myriad obstacles
within and beyond the social sciences, and I imagine STH will remain an
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important forum for debating, theorising and researching such concerns in these
challenging times.
Lee F. Monaghan
Department of Sociology, University of Limerick, Ireland.
E-mail: Lee.Monaghan@ul.ie

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Correction
This has been corrected online owing to an incorrectly typeset attribution on p. 1.
No other changes have been made (September 2014).

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