Appetite 55 (2010) 219–225
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Appetite
journal homepage: www.elsevier.com/locate/appet
Research report
Fat bodies and thin bodies. Cultural, biomedical and market discourses on obesity§
Mabel Gracia-Arnaiz a,b
a
b
Rovira i Virgili University, Department of Social Anthropology, Tarragona, Spain
Departament d’Antropologia, Filosofia i Treball Social, Facultat de Lletres, Universitat Rovira i Virgili, Avda. Catalunya, 35, 43002 Tarragona, Spain
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 1 July 2009
Received in revised form 1 June 2010
Accepted 2 June 2010
This article addresses the question of why dieting, health, and the care of the body have come to play
such a central role in our daily lives, and explores the relationship of these practices to the emergence of
obesity as a social and health problem. Messages urging people to regulate their food intake and get more
exercise in order to avoid obesity conflict with warnings that anorexia and bulimia are among the
possible consequences of overly strict diets and excessive physical activity. The relationship between
diet, beauty and health has been appropriated and re-elaborated as a marketing strategy with wideranging cultural consequences. ‘‘Being on a diet’’ is no longer only a matter of biology, nutrition, medicine
or science; it is also about culture, politics and society.
ß 2010 Elsevier Ltd. All rights reserved.
Keywords:
Food consumption
Body
Medicalization
Commodification
Obesity
Dieting
This article is part of a larger study that aims to analyze how and
why specific eating behaviors have become social problems and
how dietary norms are constructed in industrialized societies,
particularly in Spain.1 My objective is to show that the growing
problematization of excess weight and food consumption is related
to processes of medicalization, individualization and commodification, which in turn are anchored in a wider historical process of
‘‘civilizing the appetite’’ (Mennell, 1985). In the past five decades
this civilizing process has intensified, resulting in four distinct but
closely linked phenomena: first, the establishment of ideal body
weight and dietary norms; second, the construction of thinness as
an attribute of health, self-discipline and social distinction; third,
the recognition of obesity as an illness; and fourth, the
transformation of health and the body into business opportunities.
§
I am grateful to Susan M. DiGiacomo, Ph.D., my colleague in the Department of
Anthropology of the Universitat Rovira i Virgili, for assistance in translating and
editing the final version of the manuscript.
E-mail address: mabel.gracia@urv.cat.
1
In 2006, with the support of the Spanish Ministry of Education and Science
[MEC] and the Catalan autonomous government, the Generalitat de Catalunya, I
began an ethnographic study in Catalonia (Spain) on the social dimensions of
obesity, a project that was part of a broader program of research and development
in Spain on The emergence of obesogenic societies or obesity as a social problem
(CSO2009-07683) and Images and experiences of obesity in young people (AVJOVES
2008 00017). This study involves three different levels of analysis: (a) a review of
the literature in medical anthropology and epidemiology on food and the body; (b)
a comparative analysis of nutritional recommendations and public policies to
reduce obesity in Spain, France and Mexico; and (c) an ethnographic study
conducted in four Catalan clinics specializing in obesity. This article is a critical
analysis of the social construction of eating problems based mainly on the literature
review, part of which can be found in Gracia (2007, 2009a, 2009b).
0195-6663/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.appet.2010.06.002
The analysis of interactions between these four phenomena makes
it possible to show how the medicalization of food and body
weight paved the way for the marketing of health and demonstrate
why a global issue such as obesity requires a holistic rather than an
individualistic approach.
From normal to normative: dietary regulation of the body
Normativization of food consumption
The modern diet is linked to historical processes of social
regulation and control of human behavior through a normativization of food consumption. The influence of biomedicine on other
medical systems has helped to prioritize the biological functions of
foods not only over time but over space as well (Gracia, 2007). The
medicalization of food can be traced to Hippocratic treatises on
health and the care of the body that enjoined the reader to ‘‘let food
be your medicine.’’ The development of dietary norms was an
attempt initially by physicians and later by physiologists and
nutritionists to subordinate the pragmatic or symbolic motives for
food choices and consumption to biological considerations
(Poulain, 2002), which in turn were shaped by socioeconomic
and political constraints. During the 17th and 18th centuries, the
body came increasingly to be seen as a machine, and even greater
attention was paid to the healthful qualities of foods. The wellknown British physician George Cheyne (1773; cited in Turner,
1982) adopted the mechanical metaphor of the body – an
instrument formed by circuits and flows – to explain how food
constituted the fuel that supplied the human hydraulic machine.
He argued that the obesity and mental illnesses from which his
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M. Gracia-Arnaiz / Appetite 55 (2010) 219–225
upper-class patients suffered were attributable to their excessively
rich diet and urged them to modify their eating habits.
During the 19th century, as food production increased and food
distribution became more equitable in western societies, attempts
to impose limits on excessive consumption became more
widespread. This was a further development in the centuries-long
process of what Mennell, following Elias, has called ‘‘civilizing the
appetite’’ (1985). This entailed a gradual shift away from
modifying patterns of behavior principally in response to external
constraints (ecological, economic and symbolic), and toward
modifying behavior in response to internal constraints exercised
by individuals directly over themselves through dieting, hygiene
and exercise. Thus, for example, in areas of Protestant influence,
and in Christian areas in general, dietary recommendations began
to form part of an ethical position: the care of the body as an
individual, economic and social responsibility. Turner (1999) has
observed an affinity between the medical management of diet and
the expansion of capitalism: discipline and restriction prevented
gluttony among the elite, and sufficient nutrition kept the workers
working. In the United States these principles were preached in the
homes of the working classes by representatives of New Nutrition,
a group of nutritionists, social reformers and specialists in home
economics who attempted, without much success, to organize the
workers’ food expenditure by changing their cooking habits
(Levenstein, 1996).
Nutrition became an integral part of culture, economy and
health when the state emerged as a social regulator and food
production and consumption became a state responsibility
(Trentman & Just, 2006). In the 20th century nutrition was
recognized as a branch of scientific knowledge, and as a
consequence of international conflicts and market crises, adequate
diet became a major concern for most European governments, for
civil society, and for social and charitable organizations. Hunger
and poverty were considered social and public health problems
and the provision of food became a basic human right endowed
with a moral dimension. Traditional dietary habits and forms of
agricultural production were seen as potential threats not only to
health and the economy but also to the common good, and
therefore had to be modified. The idea of an optimum diet based on
physiological research into calorie intake and expenditure and
protein, fat, mineral and vitamin requirements was introduced,
and became the basis on which the methods used in dietary studies
were standardized. This, in turn, had wide-ranging repercussions.
According to Barona (2008: 88), ‘‘the role of nutritional experts
not only influences knowledge, but also inspires agricultural and
health policies, education and propaganda programs aimed at
disciplining and changing popular habits.’’ These programs have
generated the nutritional pie charts and food-group pyramids that
have been key instruments for attempting to regulate what and
how much people should eat and for homogenizing food
consumption the world over. If until the 1950s and 1960s, the
working classes of European societies thought of good food as
being, above all, satisfyingly abundant, most people now think that
they eat too much because they are constantly being urged to eat
less. Contemporary nutritional recommendations call for a prudent
energy intake and favor variety over quantity. The optimum diet
has gradually but steadily reduced the consumption of red meat,
eggs and butter in favor of fruits, vegetables, whole grains, fat-free
or low-fat milk and milk products, and olive oil. Although the
current nutritional pie chart includes all food groups, it is now
predominantly vegetarian.
Nutritional standards reflect not only the evolution of scientific
knowledge, but also its relationship to industrial food production
(Nestlé, 2002). Health experts point out that the economic,
technological and social transformations experienced by numerous countries in recent years have been accompanied by an
increase in chronic diseases such as diabetes, hypertension and
obesity. This association constitutes clear evidence of the
relationship between modernization, the ready availability of
food, and public health problems. Current dietary recommendations are legitimized as a response to increasingly sedentary
lifestyles and the replacement of traditional diets by diets that are
higher in fat and added sugars. Curiously, 50 years after they were
first criticized for being deficient, unbalanced and monotonous,
traditional diets are now viewed as healthier. Leaving to one side
the question of what science understands by the term ‘‘traditional’’, it is no coincidence that broad acceptance of biomedical claims
regarding traditional diets has coincided with dietary globalization
and with economic interests in protecting local agricultural
products and exporting these products to international markets.
An example of this confluence of interests is the so-called
Mediterranean diet, which was proposed in 2009 as a candidate
for UNESCO’s Intangible Cultural Heritage status with support
from the governments of Spain, Greece, Italy and Morocco. At this
writing, UNESCO’s decision is expected in September 2010. At
present, however, there is no scientific agreement as to whether
any one of the traditional diets is healthier than the others.
Normativization of body weight
The formulation of dietary recommendations has run parallel to
the progressive medicalization and commercialization of body
weight. Current eating behaviors and practices of the body have
undergone important changes over the past 100 years, in particular
regarding attitudes toward high-energy foods and robust bodies.
At the beginning of the 20th century most people still saw
corpulence as a sign of health, and foods with high fat content were
more desirable in many Western European societies (Flandrin &
Montanari, 1996: 883).
‘‘Being fat’’ is more seductive when thinness means hunger,
illness and poverty. In societies in which the majority of the
population is undernourished and food is a primary concern for all,
this sublimation of corpulence is common. In the majority of preindustrial societies, regardless of their economic system, more or
less vigorous physical activity was the norm for both men and
women. In spite of the effort expended in food production,
however, hunger was a relatively common experience as periods of
scarcity or even famine were not unusual. In such circumstances,
gluttony – condemned by Christianity as one of the seven deadly
sins – was an accepted and even valued social practice. Looking
forward to a feast, a Trobriand islander once commented, ‘‘We will
be happy and we will eat until we vomit’’ (De Garine & Pollock,
1995: 46). In this context, it is not surprising that robustness or
even a certain degree of obesity was often regarded favorably.
‘‘Being fat’’ was a condition to which many aspired, but not
everyone could achieve.
By contrast, in industrial societies the phenomenon of
lipophobia – a systematic aversion to dietary fat and the fear of
becoming fat – became established over the course of the 20th
century (Fischler, 1995), when biomedicine began to regard
corpulence as pathological. During the first decades of the century,
physicians recommended not only moderate consumption of food
among the upper classes but also standards of weight and height
that were decisive in the normativization of the human figure
(Brumberg, 1988: 236). At the same time that excess body weight
started to be thought of as a health risk, mechanisms were
established to control it. The indicators used to measure it, such as
the BMI (Body Mass Index), served to define healthy or
pathological weight levels in relation to the individual’s height,
and the imposition of dietary regimes became the most common
way of trying to control body weight. Ironically, nutritional science
and medical understandings of human metabolism in thermody-
M. Gracia-Arnaiz / Appetite 55 (2010) 219–225
namic terms reinforced Christian morality’s condemnation of
gluttony.
Nevertheless, this does not fully explain the ideal of slenderness
that has prevailed over the past hundred years, during which time
the majority of the population has had both the means and the
opportunity to be fat. A cultural consensus emerged around the
lean body through the convergence of medical, class and industrial
interests when particular markets (insurance, fashion, food,
pharmaceutical) began to promote thin bodies as the ideal body
shape. As fatness came to be equated with illness and was
stigmatized not only as a preventable disease but also as a
synonym for gluttony and laziness, thinness ceased to be a sign of
ill health and poverty, and became a site for the production of new
meanings. Moral attributes of self-control or self-indulgence and
their behavioral correlates were inferred from physical appearance. A slim body was associated with good health, self-discipline,
and social distinction.
Recommendations concerning weight control had a greater
impact on women than on men in the countries at the forefront of
the so-called ‘‘age of progress’’ (Brumberg, 1988). The explanation
for this lies in forms of social mobility, models of gender
socialization, and the uses of food and the body. Although care
of the masculine body shared a number of features in common
with the attention given to women’s bodies, cultural, economic
and political factors focused progressively on the control and
image of the female body. The ideal feminine body became taller,
lighter, and toned by dieting and physical activity. First the upper
classes, and subsequently the middle classes, chose to distinguish
themselves from the working classes by adopting this body ideal
(Bourdieu, 1988: 188). Because thinness first acquired aesthetic
value among upper-class women through their attachment to high
fashion, which had already made ‘‘eating little’’ a class virtue, the
thin body – disciplined and contained – came to be perceived as an
instrument for upward social mobility.
Goods are used not only to satisfy needs or desires, but also to
classify persons and to establish forms of social differentiation, as
much through the differential distribution of material resources as
through the symbolic resources they mobilize. When industrial
capitalism began producing a diversified range of goods and
services at lower relative costs in the middle of the 20th century,
women of the middle and lower middle classes, and increasingly
men as well, began to use these goods and the symbolic capital
associated with them. Food avoidance or restriction, physical
exercise, appetite-suppressing drugs, low-calorie food products,
and surgery became instruments of self-control that facilitated
upward social mobility. . .at least in theory, because ‘‘being thin’’ is
a condition to which many aspire, but not everyone can achieve.
From normative to pathological: obesity as an illness
The chronic, epidemic and multi-factorial character of obesity
The construction of a normative dietary pattern – the ‘‘balanced
diet’’ – and a normative standard for healthy body weight has
helped to define what is or is not normal eating behavior, and to
turn obesity into an illness (Gracia, 2009a). Since the Body Mass
Index (BMI) was established as the most frequently used scientific
indicator for defining healthy weight (albeit not without controversy; see Basdevant & Guy-Gran, 2004; Hacking, 2005; Sobal,
2001), people have been urged to stay within the limits of their
ideal BMI. According to the biomedical literature, obesity has
dramatically increased both morbidity and mortality in several
countries and driven up health care costs, making it one of the
biggest public health and economic problems in the world (WHO,
2004). The Commission of the European Communities Green Paper
(2005: 4) asserts that ‘‘combating the problem of excess weight
221
will help reduce long term costs for the health services. . . and will
allow citizens to have a productive life even into old age’’ (Green
Paper 2005: 4). Epidemiologists even think of it as a social
pathology because it has a disproportionate effect on populations
with fewer socioeconomic resources and, depending on location
and age group, affects women more than men (Aranceta, 2008).
Defined as an abnormal increase in weight due to an excessive
accumulation of fat, obesity has been accepted as a global illness of
epidemic proportions in which multiple factors are involved. In
general, eating behavior problems, especially those related to body
weight, are often believed to originate in the quantity of food
ingested, as if the bodily effect of eating were a simple matter of
calculating the calories consumed: eating too little results in
weight loss, while eating too much results in weight gain. The
reality is not so simple, given that weight does not depend
exclusively on the quantity of food ingested. It is now recognized
that hereditary factors determine to a considerable extent how
individuals react to an environment of food abundance or scarcity
(Power & Schulkin, 2009). Hormonal and neural mechanisms and
genetic, metabolic and constitutional factors all intervene (Alemany, 2003).
These factors, however, are insufficient in themselves as
explanations of the rapid increase in the rate of obesity across
the world (Sobal, 2001). According to the World Health Organization, more than 700 million persons will be obese by the year 2015.
For decades, medicine has urged people to lose weight, and today
health experts regard epidemiological data showing a rapid
increase in overweight and obesity as symptoms of a society in
which food consumption is out of control (Gard & Wright 2005: 2).
It is regarded as self-evident that fat kills, that obesity in itself is a
disease, and that all obese persons are or will become ill (Campos,
2004: 4).
Caught between uncertainty and caution, researchers, experts
and politicians use statistical data to transmit a pessimistic outlook
(Menéndez, 2009: 24). For example, they often combine the
overweight and the obese into a single group representing a much
larger percentage of the population, although these two groups are
subject to different health risks (Poulain, 2009). While some
studies suggest that a small degree of excess weight is healthy
(Flegal et al., 2005), no consensus has emerged regarding the effect
on mortality of being either above or below normal weight. In
Spain, Canada and Germany, for example, more than half of the
population is overweight. In terms of the prevailing logic, this
segment of the population should be considered either ill or pre-ill.
According to the WHO, if nothing is done to reduce the prevalence
of obesity, it will become the first non-infectious pandemic
disease. In the absence of a pharmacological solution to the
problem, the strategy is to address its putative causes.
Health experts locate these causes in recent social and
economic changes, stressing the relationship between health
and culture and identifying the principal cause as the ‘‘obesogenic
environment:’’ that is, an abundance of high-energy foods coupled
with a sedentary lifestyle (Henderson & Brownell, 2004; Tounain &
Amor, 2008). Both are understood to be a direct consequence of
social change in general and deterioration in the quality of the diet
in particular. Obesity, then, may be considered a logical consequence of constraints specific to modernization, and this has led
many to seek its origins in specifically modern phenomena such as
fast food, passive forms of leisure, central heating, mechanized
transport, food advertising, the weakening of the family, and the
increased pace of life (Lang & Rayner, 2007).
Biomedical thinking about the origin and evolution of obesity
has identified the same set of social causes in various countries
(Fischler & Masson, 2008). As a result, these countries have
adopted similar measures, drawing up protocols for therapeutic
intervention and preventive strategies to deal with what is
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M. Gracia-Arnaiz / Appetite 55 (2010) 219–225
regarded as a generalized problem of bad diet and lack of exercise.
People are urged to avoid gaining weight by making rational food
choices, since obesity, once established, is difficult to treat. Obese
persons tend to continue gaining weight and to lack interest in
dieting or exercising to lose weight (Basdevant & Guy-Gran, 2004).
Paradoxically, they are regarded both as blameless victims of larger
social forces, and as guilty of a failure of self-control.
Although some clinical nutritionists try to treat the patient as a
whole person and adapt their recommendations to the individual’s
biopsychosocial characteristics (De Labarre, 2004), recriminations
related to eating behavior are frequent and adopt a moralizing
tone, criticizing patients’ judgment and representing them as
incompetent or irresponsible: ‘‘Often. . .when we feel unhappy we
compensate by eating and drinking even though we’re not hungry
and it’s bad for our health and against our better judgment’’ (NAOS
Strategy, 2005: 11). Many doctors who prescribe weight-loss diets
are of the opinion that the overweight are responsible for their own
problem through wilful ignorance of proper nutrition. In the case of
fat children, this responsibility is easily shifted onto the parents, as
recently happened in Great Britain when the mother of Connor
McCreaddie, a 9-year-old boy who weighed 89 kilos, was accused
of negligence and came close to losing custody of her son. In a
similar case in Spain, a boy from Asturias was separated from his
family in June 2006 for the same reason. Since then, as a ward of the
state, he has managed to lose 40 of the 100 kilos he weighed at 10
years of age.
From treatment to prevention
As Lawrence (2004: 57) has observed, public debate on the
rising incidence of obesity as a public health issue tends to be
framed in two ways: ‘‘individualizing frames limit the causes of a
problem to particular individuals, often those who are afflicted
with the problem. Systematic frames broaden the focus, assigning
responsibility to government, business, and larger social forces.’’
Public health policies aimed at controlling obesity are also situated
discursively within one frame or the other. Treating obesity on an
individual basis through behavior modification, an approach used
until recently in several western countries, has met with only
limited success (Levi et al., 2007). This has prompted recognition of
the wider context that conditions individual food choices and
eating habits. As a result, there has been a shift toward preventing
obesity rather than attempting to cure it (Poulain, 2009: 20). The
aim is to promote lifelong maintenance of a healthy body weight
through a balanced diet (eating less and eating a greater variety of
foods) and regular physical activity. Paradoxically, however,
obesity prevention programs currently in place continue to center
on the individual, emphasizing standardized guidelines for
achieving a healthy lifestyle rather than addressing the underlying
structural conditions that favor the development of an obesogenic
society. Health authorities alternately warn that people whose BMI
is above normal may be future victims of hypertension, diabetes
and heart disease (NAOS Strategy, 2005: 8), and offer advice about
healthy ways to lose weight without recourse to unscientific and
potentially harmful miracle diets.
The first international proposal for the prevention of obesity
was the Global Strategy on Diet, Physical Activity and Health
(DPAS), passed by the 57th World Health Assembly (WHA) in May
2004. Since then, many countries have taken specific steps. For
example, Spain has created the Strategy for Nutrition, Physical
Activity and the Prevention of Obesity (NAOS Strategy, 2005),
which has been replicated in other countries. France has developed
the National Nutrition and Health Program (PNNS 2006–2010).
Mexico’s National Health Program 2007–2012, which was initially
intended only to promote an integrated policy for obesity, has gone
further and launched specific campaigns and action plans such as
Mexico is Taking Measures, Measure Your Waist, Exercise for Your
Health’s Sake, Healthy Living, and Let’s Get Control. For its part, the
European Union has created a common framework to support and
complement existing national initiatives Among other programs,
this framework includes the Platform for Action on Diet, Physical
Activity and Health (Commission of the European Communities
Green Paper, 2005); the High Level Group on Nutrition; and the
Strategy for Europe on Nutrition, Overweight and Obesity Related
Health Issues (Commission of the European Communities White
Paper, 2007).
What is surprising is not only the speed with which some
countries have responded to the call from the WHO, but also the
similarities between the steps proposed, given the disparity in
obesity rates for different countries, and for different regions in the
same country. The Global Strategy (DPAS, 2004) specifies that
national diet and nutrition plans should be flexible and adaptable,
based on local cultural practices and associated culinary traditions,
and sensitive to changing patterns of food consumption. In
practice, however, this has not been the case. In Spain, for
example, the integrated programs devised by the governments of
the 17 autonomous communities are almost identical, despite
important differences in the prevalence of obesity. In Asturias, for
example, only 4.56% of the population between 2 and 17 years old
is obese, but this figure triples to 15.88% in the Canary Islands.
Paradoxically, the regions that have undertaken these initiatives
are not necessarily those with the highest levels of obesity.
The measures adopted in Spain are not very different from those
devised in France or even Mexico. Emphasis is placed on
nutritional education for parents and teachers, the creation of
observatories for monitoring diet quality and the prevalence of
obesity, improvements in nutritional labeling of food products,
media campaigns in favor of healthy diet and lifestyle choices, and
improving the skills of primary health care staff. There have been
some attempts to create alliances between various levels of
government (local, regional, and national), civil society and the
private sector on the one hand, and the food industry and food
service providers on the other. These commitments, however, are
still in their initial phases and have yet to be implemented on a
broad scale, at least in these three countries.
Despite recognition of the obesogenic aspects of modern western
societies, the principal strategy continues to be motivating the
individual rather than developing a broad social consensus on diet
and eating practices. It is certainly easier to promote nutritional
education than to modify the structural factors that condition
lifestyles. The Commission of the European Communities Green
Paper (2005: 8) and White Paper (2007: 3) are based on the
assumption that educating consumers is the first step toward
enabling them to make well-informed dietary choices. This nearly
exclusive emphasis on the need for nutritional education stems from
the idea that the source of the problem lies in an absence of
information, and that the scientifically informed consumer will
make rational decisions. Studies carried out in France (Poulain,
2002) and Spain (Contreras & Gracia, 2006), however, indicate that
most of the population understands the basics of good nutrition,
even if this is not sufficient to guarantee the success of the experts’
recommendations. I share Arrestegui’s (2007) doubts concerning the
efficacy of strategies based on creating better-informed consumers
using highly interventionist methods that are difficult to apply.
‘‘Being on a diet’’: the complementarity of biomedical and
market discourses
The role of dieting in the prevention and treatment of obesity
Paradoxically, despite the best efforts of the health authorities
to inculcate healthy eating habits, the prevalence of obesity
M. Gracia-Arnaiz / Appetite 55 (2010) 219–225
continues to rise although current canons of beauty favor
slenderness, and a wide variety of weight-loss and low-fat foods
are available to consumers.
An increasing number of psychiatrists and nutritionists have
condemned the cult of slenderness generated and sustained by
mass culture, and have issued warnings about the harmful effects
of uncontrolled dieting and its relationship to obesity and eating
disorders. Some have even proposed regulating representations of
the female body in the media and establishing minimum standards
for the weight and appearance of runway models in international
fashion shows. According to new regulations in Spain, for example,
only models whose BMI is between 18 and 25 may be hired, and
the use of makeup that creates an ‘‘unhealthy’’ appearance is
prohibited. The Spanish Ministry of Health and Consumer Affairs
has even signed an agreement with clothing manufacturers and
designers to standardize sizes and promote a ‘‘healthy image’’ of
female beauty, in the apparent belief that eliminating extremes of
thinness and fatness will address the source of the problem. At the
same time, people are exposed daily to conflicting messages urging
them to restrict their food intake and to get more exercise in order
to avoid obesity, and warning them against overly strict diets and
excessive physical activity that may lead to anorexia and bulimia.
Some researchers (Campos, 2004; Finkelstein & Zuckerman,
2008) have noted that a combination of repeated medical
recommendations, consumerism, and social pressure to conform
to an ideal body image has accustomed people to dieting from an
early age. As a result, they enter a vicious cycle of losing and
regaining weight. Although ‘‘being on a diet’’ has become a
permanent rather than temporary condition and is now generalized behavior for most of the population in western postindustrial
societies, it has been demonstrated that many cases of obesity
originate, paradoxically, in this kind of dieting (Garner & Wooley,
1991).
Doctors recommend diets for both preventive and therapeutic
reasons. As a preventive measure, the scientifically based optimum
diet described above has come to be viewed not just as a mainstay
of the healthy lifestyle but as a panacea believed to confer social,
economic and psychological benefits as well. From this perspective, not only does an optimum diet provide the nutritional and
caloric balance necessary to maintain a healthy and appropriate
weight; it also imposes order and structure on everyday life,
establishing on a daily basis what, how much, how and with whom
a person should eat. Individual responsibility for health is
emphasized, and people are urged to develop true nutritional
competence. Dietary prevention involves a double process of
medicalization and moralization that entails changing inadequate
dietary habits and transforming them through learning into a new
set of good practices. According to doctors, healthy eating not only
satisfies the palate, but also allows people to feel better physically
and psychologically about themselves and with others (Ascher,
2005).
Nutritional education has become the bastion of this preventive
process. Children are taught at increasingly younger ages to control
their food intake because it is believed that habits begin in
childhood, become more established during adolescence and tend
to be consolidated in later life (NAOS Strategy, 2005: 21). The aim is
to get individuals to correct or adjust their eating behavior in
accordance with scientific recommendations that will help them
avoid becoming ill. The overzealous pursuit of prevention may,
however, end by increasing the number of potential patients.
Thousands of Spanish people, for example, seek medical treatment
for weight problems despite the fact that they are not obese, only
slightly overweight (Gracia & Comelles, 2007).
Dietary recommendations for therapeutic ends are also
grounded in notions of self-control and individual responsibility
for health. In clinical settings, the central axis around which the
223
treatment of obesity revolves is the concept of nutritional
rehabilitation. Its aim is to get patients to achieve and maintain
their normal body weight and to adopt healthy eating habits
(Gracia, 2009a, 2009b: 200–201). Doctors see nutritional rehabilitation as fundamental to ensuring that patients recover from the
illness not just physically and psychologically, but also socially,
and in this it resembles the use of dietary recommendations as
prevention. They believe that the diet must be followed to the
letter over months or even years if necessary, because it makes
patients feel secure, provides order in their lives and helps them to
combat their obsession with weight and food (Zamarrón, 2003:
171). Maintenance of a strict dietary routine is based on the belief
that patients’ eating behavior lacks structure; that they alternately
adhere to self-imposed food restrictions that have no rational
foundation, and indulge in eating binges. Consequently, nutritionists demand that patients improve their dietary knowledge
and change their misguided dietary practices, replacing them with
what clinicians define as a normal diet based on structured meals
and regular eating times (Fernández & Turón, 2001: 123). The goal
is to inculcate healthy habits by means of the optimum diet, which
is administered almost as if it were a medicine.
Nutritional intervention is oriented toward inculcating a strict
dietary model regarding what patients must eat, in what
quantities, where, with whom and with what frequency and
timing (2009b: 199). Paradoxically, treatment consists of replacing
one set of dietary obsessions judged to be pathogenic with another
that conforms to the biomedical nutritional model.
Lipophobia in obesogenic contexts
The powerful health products and body care industries have
taken up the recommendations of medical professionals and public
health authorities in favor of the optimum diet and normative body
weight, issuing numerous and contradictory messages of their own
(Gracia & Comelles, 2007). This market not only reflects and to
some extent drives profound cultural changes; it also sustains
numerous professions and business enterprises. Advertising offers
clues for understanding the role of the food industry, aided by
scientific and technological innovations, in this shift in perceptions. These marketing strategies have created and popularized the
rhetoric of well-being, and are principally responsible for the
commercialization of the term ‘‘health’’, an umbrella concept that
subsumes a broad range of other concepts: pleasure, beauty,
convenience and psychological well-being (Dı́az Rojo, Morant, &
Westall, 2006: 154). Products advertised as ‘‘-light’’ or ‘‘-free’’ – as
in cholesterol-free, sugar-free, alcohol-free, fat-free – are some of
the many examples. Fats, sugars and calories are represented as
being incompatible not only with health but with the ideal figure.
Conversely, products containing fiber, lactic acid bacteria, minerals, and fatty acids represent a new generation of health products
designed both to protect a sense of well-being and to prevent
illness (Contreras, 2002).
The personal care industry fuels many business enterprises
whose prosperity depends on awakening and encouraging people’s
desire to improve their appearance as a way of improving their
quality of life (Hubert, 2004: 8). Neo-capitalism has made deep
cultural inroads, not only encouraging the transformation of excess
body weight and food consumption into a health and social
problem but turning thinness and fatness into business opportunities. While the medical establishment warns against excess
weight as a threat to health, the consumer economy is inundated
with relatively cheap food products of doubtful nutritional quality,
while the cost of more healthful foods has progressively increased.
The body is no longer manipulated only through food and diet;
today the pharmaceutical and biotechnology industries not only
complement the diet but also supplant it, offering new possibilities
224
M. Gracia-Arnaiz / Appetite 55 (2010) 219–225
for improving health and physical appearance. Achieving a sense of
well-being has come to depend in large measure on having an
attractive and healthy-looking body. The lipophobic and obesogenic marketplace has grown to include body care products and
services directed primarily at women, but also increasingly at men.
These include pharmaceutical and cosmetic products, fitness
programs and, more recently, reconstructive surgery. Under these
circumstances, it is difficult to separate interests related to health
from interests related to the market in biomedical discourses.
One of the effects of these processes is, paradoxically, the
increase in fatness. Possible explanations for obesity, however,
should be located not only in the progressive medicalization and
commercialization of food and body weight, but also in the farreaching lifestyle changes that have occurred. One of the causes of
obesity can be found, at least in part, in the construction of contexts
that discourage fatness discursively, but encourage it in practice. In
a society whose economy depends increasingly on sedentary jobs
and activities but also demands greater and greater flexibility from
the work force, people find it harder and harder to follow
recommended dietary routines, and are more likely to gain weight.
Impelled by complex and at times divergent rationalities, people
make dietary choices that are increasingly diversified and
irregular. Maintaining an optimal diet requires adherence to a
daily routine.
The difficulty involved in establishing such a routine in these
circumstances is one of the reasons why it is so hard to follow
nutritional recommendations. People’s lives are full of unpredictable micro-events, work and family demands, and financial
constraints that constitute obstacles to control of dietary routines.
The amount of time spent on the preparation and consumption of
meals is decreasing and people increasingly favor highly processed
foods that can be prepared rapidly, often in the microwave. What is
driving this trend is the need to save time and manage family
members’ conflicting schedules and food preferences as efficiently
as possible. If preventive strategies focus on changing unhealthy
food choices and/or eating behaviors instead of the socioeconomic
conditions that cause them, both the diagnosis and the treatment
of the problem appear to be mistaken.
Conclusions
Many explanations for the rising incidence and prevalence of
obesity, as well as the strategies proposed for reversing this trend,
are based less on scientifically demonstrated fact than on probable
or possible causal factors and relationships. This is a cause for
concern on several grounds, not the least of which is the high cost
of the resources currently being mobilized to prevent obesity.
Although obesity is widely regarded as a pathology partly
determined by social causes, few of the studies in which both
medical and public health interventions are grounded have
explored seriously the socio-cultural sources of certain eating
behaviors. The ‘‘environment’’ is not a nebulous and complex
abstraction, but a specific and specifiable form of social organization resulting from equally knowable historical processes. In
contemporary societies, this means making a serious effort to
understand the economic and political conditions associated with
consumer capitalism. These conditions affect everything and
everyone, although not necessarily in the same way. Not all fat
people are ill, and not everyone eats badly. The occurrence of
obesity is very uneven both within and across cultures. How
people eat and manage their health varies according to socioeconomic status, gender, age and ethnic origin. Food practices depend
on the interaction between micro- and macro-structural factors
that vary from one society to another.
Current strategies have not been designed to deal with these
kinds of social questions. Many obesity prevention programs are
based on a biologically reductionist and homogenizing conception
of good dietary practice (an optimum diet) and healthy lifestyles
(regular exercise), according to which obesity and its associated
illnesses can be combated if individual behavior is suitably altered.
The socio-cultural context in which obesity is produced is
approached, if at all, as a series of individual ‘‘lifestyle choices’’
without regard for the ways in which these choices are channeled
and constrained by larger forces. Food preferences and eating
behavior are inseparable from the lifeworld of which they form
part. Socially and culturally decontextualized attempts to change
health-related behavior in other domains – smoking cessation or
safe sex, for example – have shown that providing people with
scientifically correct information about diet does not necessarily
lead them to make scientifically rational choices. The same is true
of attempts to change diet.
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