Multiple obesity. Understanding discourses and practices of obesity management in the UK

This thesis explores how obesity is enacted by different social actors in different settings of obesity management in the Brighton and Hove area in Southeast England. It investigates the local trajectories of the hegemonic ‘obesity epidemic’ discourse and how relevant social actors navigate, (re)produce, reinvent, contest or align to it, considering the urgency, pervasiveness and normativity with which obesity is addressed in public health policy and public debate in the UK. Drawing on Mol’s (2002) concepts of body multiple and attending to the practicalities and materialities of obesity-management, this thesis argues that obesity is a composite object. An extensive body of literature critically analyses the epistemologies and body politics of the “obesity epidemic” discourse. This research draws on those works that question the purported neutrality of the medical discourse on obesity and exposes the reproduction of socio-material inequalities and neoliberal technologies of body and self in the current promotion of a healthy lifestyle. This thesis expands this literature by focusing on how obesity management is brought about in practices. Over fifteen months of fieldwork, I interviewed GPs and practice nurses, weight-loss groups’ participants and leaders, and volunteered in three weight-loss programmes. I also applied discourse analysis to national policy related to obesity. The findings produced through this multi-sited ethnography powerfully reveal the multiplicity of meanings and practices inherent to obesity. They show how multiplicity is intrinsic to the authoritative discourse on obesity management and not only to the ways people perform or experience it. Expanding Harwood’s idea of biopedagogies (2009), I use the concept of ‘biopedagogies of healthy eating’ to describe and explore the authoritative approach to food, weight and health that governs obesity-management interventions. I propose that despite the multiplicity inherent to them, these biopedagogies reproduce a normative idea of ‘healthy lifestyle’, identifying personal responsibility and caloric imbalance as privileged sites of interventions and silencing other possible explanations (e.g. socioeconomic factors or epigenetic factors) and solutions. The findings also reveal how challenges to the authoritative discourse of obesity management are performed by and within what are generally considered the sources of authority around obesity, such as healthcare professionals and nutritionists. Lastly, they contribute to unpacking the stigma attached to obesity by locating it into specific activities, practicalities and interactions. Finally, this thesis reflects on the potential implications these findings have for general healthcare practice and public health policy.