Obesity in Canada: Critical Perspectives 9781442624245

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OBESITY IN CANADA Critical Perspectives Edited by Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

Medical professionals, social policy makers, and the media have declared that Canada is in the grip of an obesity epidemic. Defining obesity as a biological condition, many experts insist that it needs to be “prevented” and “managed.” Obesity in Canada takes a broader, critical perspective on this supposed epidemic. Considering obesity in its cultural and historical context, the book’s contributors take a hard look at the ways we measure health and wellness, the historical context surrounding our attitudes to obesity, and the consequences of labelling as “obese” those whose body weights do not match our expectations. A comprehensive survey of the issues surrounding the obesity panic, it is the first collection in the area of critical obesity studies from a distinctly Canadian perspective. jenny ellison is the Curator of Sport and Leisure at the Canadian Museum of History. deborah mcphai l is an assistant professor in the Department of Community Health Sciences in the College of Medicine at the University of Manitoba. wendy mitchinson is a Distinguished Professor Emerita in the ­Department of History at the University of Waterloo.

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Obesity in Canada Critical Perspectives

Edited by Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

© University of Toronto Press 2016 Toronto Buffalo London www.utppublishing.com Printed in the U.S.A. ISBN 978-1-4426-5063-3 (cloth)   ISBN 978-1-4426-2854-0 (paper) Printed on acid-free, 100% post-consumer recycled paper with vegetablebased inks.

Library and Archives Canada Cataloguing in Publication Obesity in Canada : critical perspectives / edited by Jenny Ellison, Deborah McPhail, and Wendy Mitchinson. Includes bibliographical references and index. ISBN 978-1-4426-5063-3 (cloth). – ISBN 978-1-4426-2854-0 (paper) 1. Obesity – Canada.  I. Mitchinson, Wendy, author, editor  II. McPhail, Deborah, 1977–, author, editor  III. Ellison, Jenny, 1977–, author, editor RA645.O23O24 2016   616.3'9800971   C2015-908525-X

University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council, an Ontario government agency.

Funded by the Financé par le Government gouvernement du Canada of Canada

Contents

List of Illustrations  ix Acknowledgments  xi Introduction: Obesity in Canada  3 Jenny Ellison, Deborah M c Phail, and Wendy Mitchinson Part 1: Critical Perspectives on Obesity Science 1 Hearing Noises and Noticing Silence: Towards a Critical Engagement with Canadian Body Weight Statistics  31 Michael Gard 2 “Obesity” as Process: The Medicalization of Fatness by Canadian Researchers, 1971–2010  56 Elise Paradis 3 The Geneticization of Aboriginal Diabetes and Obesity: Adding Another Scene to the Story of the Thrifty Gene  89 Jennifer Poudrier 4 Diabesity, or the “Twin Epidemics”: Reflections on the Iatrogenic Consequences of Stigmatizing Lifestyle to Reduce the Incidence of Diabetes Mellitus in Canada  122 Darlene M c Naughton and Cynthia Smith

vi Contents

5 Spoon Fed: Learning about “Obesity” in Dietetics  148 Julie E. Rochefort, Andrea Senchuk, Jennifer Brady, and Jacqui Gingras 6 Indigenous People’s Clinical Encounters with Obesity: A Conversation with Barry Lavallee  175 Deborah M c Phail Part 2: Who Is Responsible for Obesity? 7 Mother Blaming and Obesity: An Alternative Perspective  187 Wendy Mitchinson 8 Obesity, Risk, and Responsibility: The Discursive Production of the “Ultimate At-Risk Child”  218 Pamela Ward 9 Obesity Panic, Body Surveillance, and Pedagogy: Elementary Teachers’ Response to Obesity Messaging  245 LeAnne Petherick and Natalie Beausoleil 10 Find Your Greatness: Responsibility, Policy, and the Problem of Childhood Obesity  272 Charlene Elliott Part 3: Representations of and Responses to Obesity 11 From “FU” to “Be Yourself”: Fat Activisms in Canada  293 Jenny Ellison 12 Having Your Jiggs Dinner and Eating It Too: Newfoundland Obesity and the Affects of Tradition  320 Deborah M c Phail 13 Screening the Un-scene: Deconstructing the (Bio)politics of Story Telling in a Canadian Reality Makeover Weight Loss Series  342 Moss E. Norman, Geneviève Rail, and Shannon Jette 14 Fat Authenticity and the Pursuit of Hetero-romantic Love in Vancouver: The Case of Online Dating  373 Jacqueline Schoemaker Holmes

Contents vii

Part 4: Inconclusions 15 “Celebrating Unruly Experiences”: Queering Health at Every Size as a Response to the Politics of Postponement  399 Jennifer Brady and Jacqui Gingras 16 Revisioning Fat: From Enforcing Norms to Exploring Possibilities Unique to Different Bodies  419 Carla Rice Contributors  441 Index  445

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Illustrations

Figures 1 Percentage changes in Canadian weight-for-height, ages 20–64, 1953–88 30 2 BMI prevalence in Canada, 1970–98  40 3 Publication vs. weight trends in Canada, 1971–2008  65 4 Obesity and overweight as percentage of sample  67 5 Fat-related terms by degree of medicalization as percentage of sample  68 6 Number of “epidemic” and “risk” publications over time  69 7 BMI-related publications per year as percentage of sample  70 8 Medical solutions as percentage of sample  72 9 Social factors and medical solutions as percentage of sample  74 10 Children and mothers as percentage of sample  76 11 Still from “Find Your Greatness” advertisement (Nike)  273 12 LG5, “La Grosseur: Obsession? Oppression!” (Size: Obsession? Oppression!), special issue of Âmazones d’hier, lesbiennes d’aujourd’hui, December 1992  301 13 Kate Partridge in Canadian Living magazine, August 1982  306 14 Pretty Porky & Pissed Off flyer, c. 1996  311 Tables 1 Sources of data, Canadian obesity trends  63 2 Participant demographics  377

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Acknowledgments

Obesity in Canada began because each of the editors was working on the subject of obesity. For Jenny Ellison and Deborah McPhail it was through their PhD theses and for Wendy Mitchinson it was research started as part of her CRC in Gender and Medical History. We noted there were few books on obesity in Canada at the time and none that introduced scholars from different disciplines. We were especially concerned that the work of the humanities and social sciences was not being heard in the discourses on the obesity epidemic. In 2011 we put out a call for papers for a workshop and applied and received support from the Canadian Institutes for Health Research (CIHR) through a Meeting, Planning and Dissemination Grant program. The CIHR generous support allowed us to bring together scholars in the field to hear the papers that would become the various chapters in the book. Leslie Copp, Associate Director, Funding Agencies and Non-Profit Sponsors, Research Office, University of Waterloo, helped us to wend our way through the application process. Her patience and knowledge about CIHR were both important to the success of our grant application. In addition to the support from CIHR we are indebted for the financial help through the Arts Faculty and the Department of History, Uni­ versity of Waterloo, and from the Canadian Research Chair program through the CRC in Gender and Medical History. Donna (Lang) Hayes, administrator of the Department of History, handled the financial administration of the grant and helped with the organization of the workshop. The Centre for Canadian Studies at Mount Allison University provided funding to bring Wendy and Deborah to Sackville, New Brunswick, where Jenny was the W.P. Bell Postdoctoral Fellow in Canadian Studies. There we presented our work at a public forum on obesity

xii Acknowledgments

and publicized the project through the media. The Centre also provided some of the funding for early meetings between Jenny and Deborah to work on the CIHR application. Paula Jean Cowan shared her artwork with us at the public forum at Mount Allison and we thank her for allowing us to use it for the cover. Anyone who has organized a workshop knows the incredible amount of work that it demands. Fortunately we had Emanuele Sica (PhD, 2011) and Jonathan Crossen (PhD, 2014), who both worked as administrator and main organizer. The workshop took place at the Walper Hotel, Kitchener, which provided us with a comfortable work environment and a very accommodating staff. University of Toronto Press has been helpful throughout, from before the workshop to the creation of the book. Len Husband, Acquisitions Editor in Canadian History, encouraged us when we talked to him about our ideas for a book of essays on obesity, and he attended the workshop. Anne Laughlin, Managing Editor, oversaw the editing of 16 essays (and the introduction), from different disciplines. We were fortunate to have Jacqueline Larson do preliminary editing before we sent our manuscript to the Press. And we are indebted to Noeline Bridge who did the index. We have learned so much from the authors of the chapters and thank them for their contributions which were thoughtful, original, and have expanded our understanding of obesity. Each of us has thanks to give. Jenny Ellison thanks Mount Allison University for support of this project, Deborah and Wendy for being exceptional collaborators, and Kathryn McPherson and Molly LaddTaylor for their mentorship on this subject. Thanks to Duncan Clark, Piper Ellison-Clark, and Sebastian Ellison-Clark for being the best of my day, every day. Deborah McPhail would like to thank Jenny and Wendy, as well as her colleagues at the University of Manitoba, and in particular Drs. Robert Lorway, Sharon Bruce, and Marcia DeCoteau for their unwavering support. She also thanks her family – Dr. Jocelyn Thorpe, and Willa and Leo McPhail – for putting up with her. Wendy Mitchinson would not have engaged in this project without Jenny and Deborah agreeing to be editors with her. Friends and family, as always, are more important than they realize and she appreciates their interest in the obesity project. Rex Lingwood supported her in every way.

OBESITY IN CANADA Critical Perspectives

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Introduction: Obesity in Canada Jenny Ellison, De b orah M c P h ai l , a nd Wendy Mit ch in s on

Canada is currently in the grip of an epidemic of obesity that is sweeping the country from coast to coast to coast. More than one in four Canadian adults is obese according to height/weight, or Body Mass Index (BMI) data, and almost 18 per cent of Canada’s children and youth are obese (Public Health Agency of Canada [PHAC] and Cana­ dian Institute of Health Information [CIHI] 2011). These are alarming statistics given that obesity leads to and/or is associated with chronic illnesses such as diabetes, hypertension, cardiovascular disease, mental illness, and some forms of cancer (PHAC and CIHI 2011; Statistics Canada 2005; WHO 2013). The obesity burden threatens to crush Canada’s public health care system, which is simply too underfunded to deal with the massive onslaught of disease that rising obesity rates will surely bring – the Public Health Agency of Canada recently calculated that obesity has cost Canada $4.6 billion dollars, an estimate they describe as “conservative” (2011, 2). It is clear that drastic interventions are needed to improve the health behaviours of Canadians, whose unhealthy eating habits and lack of physical activity are at the root of this obesity problem. Or at least that’s one perspective. Other perspectives on obesity in Canada suggest that “obesity” is perhaps not the problem it has been made out to be.1 These alternative perspectives come from a group of Canadian fat studies and critical obesity scholars working in a number of disciplines, including sociology, kinesiology, women’s and gender studies, community and public health, and dietetics, to name a few (Beausoleil and Ward 2010; Ellison 2011; Friedman 2012; Gingras 2006; McPhail 2009; Norman 2013; Rail 2009). Drawing on international critical obesity scholarship more generally (Campos 2004; Gard 2011; Gard and Wright 2005; Gilman 2008;

4  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

Herndon 2005, 2010; LeBesco 2004; Monaghan 2008), these scholars argue that obesity is a discursively constructed category, and not simply or only a biological condition. As such, obesity is a culturally produced idea with social effects. The panic surrounding obesity has less to do with the actual health problems precipitated by excess body fat and more to do with reassertions of the status quo and normative identities pertaining to gender, race, class, and sexuality. Such a critique is increasingly supported by medical research in Canada and elsewhere, which suggests that “overweight” and “obese” people are not necessarily unhealthy. For example, Sui and others (2007) found that physically fit adults live longer than adults who are not fit regardless of BMI or waist circumference. Flegal and colleagues’ (2005) work at the US Centers for Disease Control has shown that weight cannot be easily tied to chronic illness development, and that the only definitive relationship between weight and ill health can be found in the very extreme of both underweight and obese categories (the so-called “morbidly obese” category), which categories in fact represent a very small proportion of the population (see also Orpana et al. 2010). In a recent report released by the Manitoba Centre for Health Policy, epidemiologists studied the relationship between BMI and physician use, prescription drug cost, and hospitalization rates, and found that “the health care system is not being overwhelmed by the demand for health services related to obesity” (Fransoo et al. 2011, xiii). The report also maintains that increasing weights are tied most strongly not t­ o  health behaviours but to the population’s aging and its associated natural weight gain: up to a certain point, we gain weight as we grow older (Fransoo et al. 2011, xiii). Given the indications that blood pressure, cholesterol, and blood glucose levels are not necessarily tied to body size, Dr Arya Sharma and colleagues have developed the Edmonton Obesity Staging System to assess health based on risk behaviours rather than on body weight (Padwal et al. 2011). Such research shows that the relationship between obesity and health is complex, and that there is limited medical consensus on the subject. Obesity, then, is a hot topic in Canada, and a site for rich analytical and critical thought. Until now, however, critical commentary on fat and obesity in Canada has been dispersed in books by individual authors, journal articles, PhD dissertations, and conference presentations: no attempt has been made to bring together the array of creative scholarship on the obesity epidemic in Canada into a single collection. This collection thus fills a gap in Canadian literature, gathering together

Introduction 5

leading thinkers in the area of fat studies and critical obesity scholarship who write about Canada. Contributors to this collection come from a wide array of disciplines, but all regard obesity as a discourse, tracing its effects within Canadian society on both micro and macro levels. While not all scholars included here are Canadian, essays in this collection place Canada at the centre, which we believe is important not just because a collection focusing on Canada has yet to be published, but also because discourses of nation and nationalism, and how the nation’s borders are maintained and materialized through colonial processes, are integral to the production of “normal” and “abnormal” embodiments (Adams 1999; Kelm 2005; Perry 2002; Nicholas and Gentile 2013). If, as geographers argue, bodies come to be in and with space (Coleborne and McCarthy 2012; Dyck and Fletcher 2011; Long­ hurst 1995, 2005; McDowell 1999; Nast and Pile 1998; Twohig 2007), then it is worth considering how medical, government, and popular imaginations of the fat body in Canada compare with those in other Western nations such as the United States and the United Kingdom. Further, because Canada has a specific political economy of health, it is crucial to explore how articulations of obesity are caught up in ongoing debates surrounding Canada’s universal, publically funded health care system (McPhail 2010). To study “the nation,” therefore, remains an important scholarly endeavour, and an understanding of the historical and ongoing context of obesity debates in Canada will provide the broader context for the chapters in this collection. Obesity in Canada: Historical Perspectives In 1864 Francois Dancel’s diet manual Obesity or Excessive Corpulence: The Various Causes and the Rational Means of Cure was translated and published by W.C. Chewett and Company in Toronto. Written for “the many individuals of both sexes who are afflicted with an excessive development of fat, rendering the ordinary duties of life not only irksome but oft-times impossible,” the manual offered “an easy method of reducing obesity” (v). Dancel claimed fatness was of little importance, in so far as the happiness of men is concerned; but as regards the gentler sex, such is by no means the case … Beauty, the richest gift of nature, deserves to be carefully guarded by those who happily possess it; corpulence [is] its enemy … It is a painful sight to witness the many instances of women, who, though still of youthful years … lose by degrees,

6  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson in the midst of an overwhelming fat, all this relative and graceful harmony, and whose ever increasing corpulence serves only to render them illfavoured and repulsive. (3)

Following this lengthy exposition of the risks obesity posed to women, Dancel explored the physical consequences of excessive corpulence, presumably for both sexes, which included sterility, hernia, headaches, heart problems, hysteria,2 varicose veins, and somnolence (7, 9, 17, 21, 30, 31, 40, 41). He then laid out his method of weight reduction: patients must eat primarily meat, with small quantities of “vegetable matter.” The reasoning behind this was that “water” fruits and vegetables “have an especial tendency to develop fat.” For this reason, Dancel also recommended reducers abstain from drinking “large quantities of water, beer, cider, brandy or wine” (65). After “ten or twelve days” of this treatment “patients experience a feeling of freedom from oppression, and already reduction of fat has become apparent.” According to Dancel, continuing this treatment for six months would result in a “marked improvement of the general health” (69). Published over 150 years ago, Dancel’s diet advice appears laughable for its focus on meat and its suggestion to abstain from drinking water. And yet it illuminates important continuities in the public and academic conversation about obesity. For example, Dancel tends to see beauty as synonymous with slenderness and slenderness as synonymous with health, reflecting a gendered understanding of obesity. Dancel’s manual also illustrates how those who find excess weight problematic conflate bio-medical, social, and cultural concerns about obesity. His use of the terms obesity and fatness, for example, indicates ongoing ambivalence about the terminology used to describe those who are overweight. In his history of dieting, Hillel Schwartz argued that the range of terms for describing fatness reflects a sense of embarrassment that has “blushed from language itself” (1986, 89). In the twentieth century, obesity was more commonly used in medical texts than in public discourses about weight. In public parlance larger bodies were described as fat, stout, corpulent, and oversized (Ellison 2013). The authors within these pages employ both obesity and fat to describe bodies that have been deemed overweight from the early decades of the twentieth century to the present. Obesity tends to be used by those authors most interested in medical discourses on weight, whereas fatness is used to refer to the social and cultural dimensions of weight. Fat is not used as a pejorative but rather as a descriptive term. This approach,

Introduction 7

wherein obesity and fatness are used differently, reflects developments in the social scientific and historical literature on weight over the last fifteen years. Scholars working in the field of “critical obesity studies” are interested both in how obesity science has been deployed to monitor behaviour and change public policy and in interrogating the impact of contemporary obesity discourses on society and the notion that obesity is unhealthy. Authors employing the term fat might identify their work with the field of “fat studies,” which explores the taken-forgranted understandings of fat/thin, and the relationship of fatness to health, fitness, sexuality, gender, and ability. As Deborah Lupton has argued, fat studies scholars tend more often to identify their work as a political project (Lupton 2012). They also employ the term fat because they are wary of the medical and normalizing connotations of words like overweight and obesity (Wann 2009, xii–xiii). While Dancel’s diet manual provides a glimpse into attitudes towards weight in the mid-to-late nineteenth century, the context for understanding the early history of obesity in Canada is the history of nutrition. As Wendy Mitchinson’s chapter shows, from the beginning of the twentieth century the nutritional value of food was under the microscope to find what specific diet would offset the problem of malnutrition. The concern about children’s health was reflected in the creation of the Department of Health in 1919 and within in it the Division of Child Welfare. Children represented the future of the nation and for a country that had just lost too many members of its younger generation to the First World War, the health of children to replace them was paramount. Infants were of particular concern to public health advocates, who included feminists, philanthropists, the clergy, and physicians, worried about high infant mortality rates across Canada. Infant nutrition programs and education for mothers were some of the successful outcomes of this advocacy (Arnup 1994; Baillargeon 2004). In 1941 the federal government created a Nutrition Services Division, and in 1942 a Canadian Nutrition program (Mosby 2012, 410). These actions were a response to a perceived crisis of malnutrition discovered in dietary studies of the 1930s and 1940s as well as the high rejection rate of young men as recruits into the fighting forces during WWI and WWII (Mitchinson 2008, 3). Prior to World War II the primary focus of government and public health interventions was malnourishment, but in the postwar period “overnutrition,” which led to obesity and physical unfitness, was the focus. Socioculturally and medically, in postwar Canada women were

8  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

positioned as “contagions of obesity” (McPhail 2009, 198). In an era when women were challenging essentialist notions of women’s intellectual and physical capacity, they were also continuously positioned in popular and medical texts as “wives and mothers whose inherently feminine emotional imbalances could cause them to over-feed their families or cause their families to over-feed themselves” (117). Obesity was perceived to be a mental health issue due to patterns people established as children – patterns women in their roles as wives and mothers passed along to their families (McPhail 2009). Although not in the Diagnostic and Statistical Manual of Mental Disorders (DSM), obesity was seen by international experts such as Hilde Bruch and Dr Benjamin Spock as a behavioural problem (McPhail 2009). Bruch, for example, claimed that an angst-ridden relationship with one’s mother, or a mother’s incompetence, could result in overeating and obesity (McPhail 2009). While mothers were frequently blamed in popular and medical texts, we must also understand obesity discourses in the context of changing gender roles, work, and immigration patterns in postwar Canada. Postwar prosperity led to shifting work patterns among middle-class men, many of whom took sedentary “desk jobs.” Concurrently, more women were entering the workforce on a part-time basis, reflecting their desire to continue working after the war and, in many cases, the need for more than one family income (Stephen 2007, 166). These shifts within white, working, and middle-class families were accompanied by major changes to Canadian immigration policies. Whereas in previous decades British and western European people had been ­given preferential status in Canada’s racist immigration policies, gradually southern and eastern European people and citizens of other commonwealth countries, including India and the West Indies, migrated to Canada in large numbers (McPhail 2009, 1034). As numerous scholars, including Sunera Thobani (2007) and Franca Iacovetta (2006a, 2006b) have argued, changing immigration patterns, which brought people who did not seem to adhere to existing Euro-Canadian understandings of appearance, gender, family organization, and food consumption, resulted in some unease in postwar Canada. These anxieties shored up an embodied “norm” that was partially based in white, middle-class understandings and behaviours of health and self-care. Body weight was part and parcel of this new norm, and concerns developed that many otherwise “normal” Canadians (read: white, middle-­ class, and heterosexual men and women) were literally not in good shape (McPhail 2009, 1030).

Introduction 9

One of the ways that obesity was implicated in postwar health promotion strategies was through physical fitness programs. Men were growing fatter and their muscle mass was decreasing thanks to more sedentary work and the technological advancements of postwar life (McPhail 2009, 1032). Fat on men, especially younger men, was problematic in the context of Cold War anxieties about Canadian security. Hearkening back to earlier concerns about malnourishment, physical fitness programs of the postwar era emphasized the need for men to remain strong and agile (McPhail 2009, 1038). Starting with the first National Physical Fitness Act in 1943, and continuing through to the 1961 Act to Encourage Physical Fitness and Sport and then the establishment of Recreation and Sport Canada in 1973, physical fitness became a major priority of postwar governments (Howell and Howell 1981; McPhail 2009). There is plenty of evidence that Canadians were also concerned about their physical fitness and, by extension, their weight. Home fitness programs, like Lloyd Percivals’s “Sports College” radio program and the Department of National Defence’s XBX and 5BX physical fitness programs, were very popular with consumers, both men and women (Jackson 1982; McPhail 2009). Men, however, were the particular targets of early government and at-home interventions. Women’s physical fitness was directed towards achieving a lean and elegant figure (McPhail 2009). The Canadian model for physical fitness promotion and weight promotion began to alter dramatically in the 1970s. This shift can be tied to several overlapping priorities, including reducing health care costs, promoting physical fitness, improving Canadian athletes’ performance on the international stage, and, eventually, explicit concerns about obesity. According to Paul Rutherford, the 1974 Lalonde Report was central to shifting government priorities. The report was initiated because of rising health care costs. Minister of Health and Welfare Marc Lalonde suggested that “health promotion” could be an effective “strategy aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health” (Rutherford 2000, 97). Initially, physical fitness was envisioned as a central plank of federal government health care and disease-prevention programs (McDermott 2008). Social-marketing strategies were used to sell fitness and sport to Canadians through well-known programs like Particip ACTION and the Canada Fitness Test. While obesity was never the primary target of these social-marketing initiatives in the 1970s and 1980s,

10  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

it was implicated in campaigns that reminded Canadians how “fat is not where it’s at,” implying that slenderness and physical fitness were synonymous (Ellison 2011). Just as contemporary conversations about obesity are not monolithic, those in the past also ranged across positions. History shows a rich tradition of alternative perspectives on obesity in Canada. For example, in the 1980s University of Toronto–based researchers Janet Polivy and Peter Herman suggested that “dieting caused at least as many problems as it solved” (1983, 6). They commented that “weight is an especially ambiguous element of appearance” because of “our frequently evident lack of control over it” (31). More than this, they suggested that medical disorders could result from “crash” and “yo-yo” dieting, as well as subsequent overeating resulting from self-starvation; these disorders included hypotension, hair loss, nausea, cardiac disorders, and anaemia (80–1). Polivy and Herman’s ideas were based, in part, on setpoint theory that suggests a person’s metabolism will adjust to changes in calorie intake in order to defend an individual’s set point, that is, their “natural” weight (Campos 2004). Bodies were thought to have different set points, and some are naturally larger. Some researchers believed it was possible to temporarily override the set point and achieve weight loss through “severe calorie restriction in conjunction with vigorous, sustained exercise, but when these extreme measures are discontinued, body weight generally returns to its pre-existing level” (Kassirer and Angell 1998, 55). The body regulates “appetite and metabolism to defend the set point and prevent large fluctuations in weight,” making weight loss and gain difficult (Kassirer and Angell 1998, 53). Polivy and Herman further suggested that weight gain might be physiological in origin: people who ate too much might in fact lack “natural regulatory signals of hunger and satiety” (97). This idea was a significant departure from theories that suggested body weight was exclusively determined by a person’s calorie intake and expenditure. Janet Polivy was part of an influential expert group, convened in 1986, to review and revise weight guidelines for Canada’s Department of Health and Welfare. Other members of the group included weightloss expert John Hunt and David Garner, an eating disorder specialist who helped form Hersize, a weight-prejudice activist group.3 The purpose of the panel was to develop a “national strategy to promote healthy weights and prevent weight problems” (Health and Welfare Canada 1988b, i). The outcome was two 1988 publications, Canadian Guidelines for Healthy Weights (1988a) and Promoting Healthy Weights

Introduction 11

(1988b), that were circulated to dieticians, public health programs, and school officials across Canada. These documents illustrate that the 1980s conversation about weight in Canada focused on a range of issues that included dieting, eating disorders, exercise practices, obesity stigma, obesity, and the gendered dimensions of weight management. Rising obesity rates are mentioned in the documents, but the authors dedicate equal if not more space to the other issues. For example, crash diets, in which a person drastically changed his or her eating habits and lost a large amount of weight in a short period of time, and yo-yo dieting, characterized by ongoing cycles of weight loss and gain, were such pervasive phenomena that the expert group believed Canada was in the midst of an epidemic of “weight preoccupation.” They blamed this problem on the media and commercial dieting programs (CostasBradstreet 2004).4 Seventy per cent of women surveyed admitted to a desire to lose weight, which accounted for the problematic rise in “fad diets, and the sale of weight-loss gimmicks” that were “frequently exploitive” (Health and Welfare Canada 1988b, 1). Weight gain was not the motivation behind the formation of the expert panel, nor did the 1988 documents suggest that obesity was a growing health concern. Instead, Promoting Healthy Weights says that in the field of obesity science there was “confusion” about whether or not excess weight was unhealthy. The risks associated with obesity, the authors argued, depended on the location of fat within the body, the age of onset, and a person’s genetic background. The authors also raised the issue of obesity stigma, which they indicated could be as injurious as the physical risks associated with extra weight. Obesity stigma resulted in overweight people being seen as lazy and lacking will power – their moral character was to blame (Health and Welfare Canada 1988b). The discussion paper ultimately recommended that the best way to promote health would be to “promote personal and societal acceptance of a range of healthy weights and variations in body size” and “to increase knowledge and understanding in both the general public and among professionals regarding healthy weights and factors affecting weight” (53). Likewise, obesity is not the primary focus of the Canada Health Surveys conducted between 1976 and 1981, which collected data on seatbelt use and tobacco and alcohol consumption alongside information on weight and physical activity (Canada Health Survey 1981).5 The same authors were behind the second document released by Health and Welfare Canada in 1988, the purpose of which was to

12  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

“establish appropriate, realistic weights which relate to positive body image” (1988b, 5). Although employing the BMI, this report looks quite different from the 2003 guidelines currently in use by Health Canada. Here, and in the previous Promoting Healthy Weights, we can see a more relational approach to health than the quantitative measures that are currently in fashion. Canadian Guidelines for Healthy Weights outlines zones (A through D) that correspond with different BMI ranges. The “weight” table indicates that BMI is on a continuum. Rather than ­having firm lines and divisions, weight ranges are indicated by an ­arrow. Zone A, classified as a BMI under 20, “may be associated with health problems for some people”; Zone B, BMI 20–25, represents a “good weight for most people”; Zone C “may lead to health problems in some people”; and Zone D indicates an “increasing risk of developing health problems” (Health and Welfare Canada 1988b, 5). The table’s careful language, that is, the use of “some people,” “most people,” and “increasing risk,” is noteworthy because it allows for variations in weight and does not make firm connections between a certain weight and health. Women’s health activists and feminist scholars also made important contributions to government-supported healthy weight initiatives. Build­ ing on second-wave feminist critiques of beauty, women’s health movement activists of the 1980s and 1990s were concerned about marketing’s impact on women’s body image. As Estelle Freedman argued, marketing seemed to “have exacerbated … inequalities by granting more bodily authority to men” (2002, 205). Feminists interpreted eating disorders and chronic dieting as a sign that women were overemphasizing their physicality, resulting in a health crisis among girls and women (Freedman 2002, 208). Feminist-run health centres in Canada pioneered the treatment of eating disorders. Clinics like the National Eating Disorder Information Centre in Toronto and Winnipeg’s Women’s Health Clinic began offering classes to help women break the diet cycle and re-establish “normal” eating patterns (Ellison 2013). Within these clinics women bridged the gap between activism and professional women’s health work, and helped to popularize the notion that self-esteem and body image were women’s health issues. More people began to critique the “fat equals unhealthy” dictate within the wider community in general as fat acceptance and fat activist groups that began in Canada in the late 1970s gained momentum throughout the 1980s. These groups were animated by different understandings of the problems facing fat people and the appropriate

Introduction 13

strategies needed to effect social change. Women created most of these groups for other women, because they believed that being fat was gendered. The movement built on the work of an established American fat-liberation movement, but the degree to which the different groups and individuals identified with their American predecessors and other Canadian activist groups varied. Two Canadian groups sought to ally themselves with the founding American organizations. LG5 (Lesbi­ ennes grosses cinq, 1984–92) was a collective of five fat lesbians inspired, in part, by the Fat Underground (FU) (Los Angeles, 1973–77). LG5 translated the “Fat Liberation Manifesto” and other Fat Under­ ground pamphlets into French and also held events to raise awareness about fat oppression within Montreal’s lesbian community. It was the only group that had a working relationship with fat activists in the United States, a relationship as much social as it was activist. Former FU members and other American fat activists met the future founders of LG5 at the Michigan Womyn’s Music Festival in 1979, and their relationship blossomed from there. LG5 members had no knowledge of the existence of Helena Spring of Toronto, Ontario, or Ruth WylieGillingham of Prince Albert, Saskatchewan, both of whom were attempting to start Canadian chapters of the National Association to Advance Fat Acceptance (NAAFA) in the mid-1980s. Like NAAFA in the United States, NAAFA-Canada was intended for both men and women. The group may have had some male members, but they were not active in the organization of NAAFA-Canada, or in its publications. NAAFA-Canada was formally recognized by the American organization and sometimes used their pamphlets, but there was no working relationship between the two country’s groups. Social sites and services for fat women in Canada were already in place by the time that LG5 and NAAFA-Canada formed. These local Canadian groups of the early 1980s illustrate the importance of local cultures and personal contact to fat women’s organizing. For example, the earliest fat activism in Canada grew out of a 1979 gestalt therapy workshop called “The Forgotten Woman: For Fat Women Only” held on Cortez Island in British Columbia. Three women who met at this workshop went on to form Large as Life (LAL) in Vancouver in 1981. Numerically and in the scope of its activities, LAL was the most significant example of fat women organizing in Canada. LAL also had the greatest geographical reach. Sister groups formed in Calgary (1982– 85) and later in London, Ontario (1997–99). Following the demise of the Vancouver chapter in 1985, LAL members continued to organize

14  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

social sites and services for fat women only. These included a Saturday morning swim, a plus-size modelling school and agency, an aerobics studio, a clothing line available nationally at Eaton’s, and a plus-size clothing store. As the activities of LAL show, fat activism included both organizational events and the activities women undertook in the name of fat acceptance. Activities like clothing swaps, aerobics classes, and fashion retailing show that women looked to fashion, fitness, and health as means of self-empowerment and collective action. As Ellison’s chapter in this collection demonstrates, LAL was the precursor to a more contemporary activist movement in Canada that focused on performance art and questioning body norms. “Pretty Porky and Pissed Off” and “Fat Femme Mafia” were two Toronto groups whose activism took the form of performance art and dance (see Rice in this collection for a discussion of fat activist performance art). Obesity in Canada: Contemporary Issues Since the 1970s, activists have fought against the inequalities and oppressions experienced by fat people. Not much has changed. Oppres­ sions still exist, and in fact may have intensified given the explosion of concern regarding obesity and the so-called obesity epidemic (see Paradis in this volume for a tracing of that “explosion”). Discussions of fat phobia also live on within fat studies and critical obesity scholarship, which often explore not only the effects of fat phobia but also the reasons for it. For example, relying on postmodern feminism, psychoanalysis, and queer theories, some writers attribute fat phobia to the femininity that has been ascribed to body fat: women need fat to menstruate, and fat can therefore be understood as female reproductive material that, in patriarchy, must be contained, restrained, and ultimately eliminated (Hartley 2001; Rice 2006). Other theorists point in similar ways to the racialization of fat, noting the historical conflations between the colonized body and fat (Erdman Farrell 2011; Gilman 1999). In this view, fat is imagined as a “primitive” material that, according to a type of eugenics logic, must be expunged in order to achieve “modernity.” Fat continues to be a marker of the racialized Other today, because Indigenous people in Canada and African American and Hispanic people in the United States are often imagined as the fattest (Campos 2004; Fee 2006; Herndon 2005; Poudrier, this volume). Fat phobia is therefore a process of othering.

Introduction 15

Still others attribute fat oppression and fat phobia to “healthism” (Crawford 1980), or the association of morality and “good” citizenship with “good” health behaviours (McPhail, Chapman, and Beagan 2011; Rich and Evans 2009), which is the theoretical frame writers within this volume most often use to explain fat oppression/fat phobia. Healthism explains the disdain with which the fat are treated: they are regarded as “bad” people who refuse to take responsibility for their own health. Within a neoliberal society, shirking responsibility for the care of the self is unpalatable, if not altogether unacceptable. While different critical obesity scholars attribute fat phobia and oppression to different social processes, they agree that fat people face structural discrimination, generally on an everyday basis. Fat people are thought of as lazy, irresponsible, and out of control. They are routinely denied employment based on their weight and harassed by friends, family, and strangers. The conflation between ill health and fatness has led to the denial of health insurance for fat people in the United States based on weight alone (Wann 2009) and in Canada to discrimination within the health care system (Jeffrey and Kitto 2006; Merrill 2007). Increasingly, fat people’s parenting abilities – particularly mothers’ – are called into question. Recently, social services in the United States and Canada have considered removing children from the homes of their obese parents, citing child abuse and risk to the child (Friedman 2015). These types of discrimination, many of which have been discussed since the 1980s by feminists and fat activists, have only recently been recognized and renamed as “stigma” by some health scholars, medical researchers, and other concerned parties. The Canadian Obesity Net­ work (CON), for example, a professional organization dedicated to lowering obesity rates in Canada, discussed stigma and “weight bias” at a recent summit, and launched a “perfect at any size” campaign in order to reduce obesity stigma in the media. At the same time, ironically, in partnership with diet-industry giants like Jenny Craig and TOPS (Take Off Pounds Sensibly), CON remains dedicated to preventing and “managing” obesity, thus propagating the logic upon which obesity stigma rests (Canadian Obesity Network, n.d.). Apart from CON, many health researchers have also begun to express concern about obesity stigma, noting that obesity stigma is in itself unhealthy, and may actually be at the root of some of the health effects purportedly caused by “excess” weight. The stress of stigmatization is linked to mental health issues like depression and physical health difficulties

16  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

such as cardiovascular disease (Erdman-Farrell 2011). Studies also suggest that patients perceived as obese may even delay or forgo treatment for a range of ailments because of their previously negative experiences with health practitioners (Puhl and Heuer 2009). While the health effects of fat itself are debatable, it seems clear that fat phobia is definitely unhealthy. While fat people in general experience oppression or discrimination, scholars have noted that particular populations have been targeted and organized as at-risk “problem populations” within obesity epidemic discourse (Lupton 2013). Women, due to their association with the “matter” of fat, are one such population, as are racialized peoples, the working class/working poor, rural people, and children/adolescents. Of course, these populations intersect and cut across each other, because working class/poor rural and children/adolescents are, for example, their own “problem” population. Through a rubric of risk (Lupton 2012), problem populations are organized as either ubiquitously overweight or obese (which categories are often lumped together) or soon to become so due to poor health behaviours, “obesogenic environments” (Egger and Dixon 2009), or the “social determinants of health” (Raphael 2002). While these populations are often singled out by public health policy, medical research, and media reports in order to help people – that is, concern for these populations may come from a good-hearted place (see Kirkland 2011) – such attention causes harm in at least two ways. First, the very category of problem populations relies on essential­ ist notions about groups of people that, in turn, rest on well-worn stereotypes about behaviours, knowledge, intelligence, and embodiments. For example, Poudrier’s (this collection) and Fee’s (2006) work on Canadian Indigenous people demonstrates how this problem population is formed through a universalizing understanding of all Indigenous peoples as genetically predisposed to obesity. Such an understanding is troubling. It conjures eugenic typologies that attach racialized meanings to parts of the body, such as skull size, and assign degeneracy or supremacy based on these. In addition, a universalizing narrative that assumes all Indigenous peoples in Canada possess a particular type of fat embodiment conflates the vast array of cultural and embodied differences within the many nations of Indigenous people living within Canada’s borders. Just as any community contains a variety of bodies, thin or fat or in between, so too are Indigenous people in Canada differently embodied.

Introduction 17

The second way the “problem populations” discourse is harmful is that it tends to blame these populations for their obesity. Policy and research concentrating on education and lack of knowledge, for example, characterize individuals in problem populations as irresponsible and unintelligent in their health “choices,” in contrast to policy and research concentrating on obesogenic environments and the social determinants of health that emphasize the structural, rather than individual, reasons for obesity, such as poor food access or built environments that discourage physical movement. However, as Raphael (2002) notes, in the current climate of neoliberalism in Canada, individual responsibility is generally privileged over more complicated discussions about social structure in obesity epidemic discourse (see also Kirkland 2011; Rich and Evans 2009). Individuals, not society, then, are generally seen as at fault for their obesity. Blaming individuals in this way ignores or downplays the structures that help to create states of health and embodiment, shifting the focus instead to health behaviours that, in problem populations, are then judged as “bad” or even “immoral” (McPhail et al. 2011). Obesity discourse can thus be understood as inflections of sexism, racism, and classism. About This Book Authors in this collection work within the theoretical perspectives on fat and obesity established by critical obesity scholars, but they also expand upon these by centring their analyses on the discursive and material production of fat and obesity within the nation-space of Canada. Because medical science has historically and continues to set the Canadian agenda regarding perspectives on health and weight (Ellison 2013; McPhail 2010), the collection begins with critical discussions of obesity science. In the opening chapter, Michael Gard examines the obesity statistics in Canada beginning at the mid-twentieth century, arguing that these statistics paint a complex picture of (mildly) increasing Canadian weight that is “open to multiple interpretations.” Gard’s intention is “to contribute to a less-frenzied and more thoughtful dialogue about what Canadian body weight statistics do and do not say.” Statistics may or may not tell us anything about the health of a population. Gard pushes critical scholars to engage “with the motivations and assumptions of obesity science,” an approach that does not dismiss statistics out of hand but instead regards them as “resources to be mined and exploited for subversive ends.”

18  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

In chapter 2, Elise Paradis similarly demonstrates a disjuncture between obesity statistics and the concern they arouse. Through an analysis of obesity’s medicalization in medical journals, Paradis shows that the paucity of medical evidence regarding increasing obesity rates – and obesity’s supposed poor health effects – does not support the explosion in obesity concern that occurred in the early part of this century. She concludes that the obesity epidemic is less “objective fact” and more moral panic. Paradis makes a unique contribution to the field, as by focusing on Canadian medical literature, she is able to demonstrate how the nation-space matters in how fat becomes organized into “obesity.” In one of the few analyses of Indigenous obesity of its kind, Jennifer Poudrier (chapter 3) also critiques obesity science by employing a combination of historical analysis, interview data, scientific studies, and Trickster stories. She concentrates on the so-called thrifty gene theory that positions Indigenous people in Canada as genetically susceptible to obesity. The thrifty gene, which is said to exist in all humans as a “throwback” to “prehistoric” times of hunting and gathering, stores food energy within the body to prepare for times of famine. Those in the West now live in a time of plenty, but the thrifty gene, no longer necessary, continues to “soldier on,” and obesity ensues. Poudrier traces how medical science positions Indigenous people as more affected by the thrifty gene, due to colonialist and racist imaginings of Indigenous people as more “primitive” and atavistic. Thus, obesity science affirms racist stereotypes about Indigenous peoples in Canada. Darlene McNaughton and Cynthia Smith in chapter 4 take on obesity science by looking specifically at discourses concerning type 2 diabetes. Attempting to wedge apart the tight discursive conflation of diabetes with obesity – the conflation behind the term diabesity – the authors point to the complexity of the evidence, noting, for example, that weight gain is often in fact caused by diabetes, not the other way around. In focusing on the Canadian context, they extend their critique to argue that the imagined causative relationship between obesity and diabetes (in that order) helps to found weight-based discrimination, suggesting by extension that diabetes science may lie at the heart of much obesity stigma. Next in the section on obesity science is a piece by Julie Rochefort, Andrea Senchuk, Jennifer Brady, and Jacqui Gingras (chapter 5), who critique dietetics and nutritional science. Through a unique process of autoethnography, each author reflects on her own experiences of dietetic education, in the process questioning the very precepts about weight, fat, and health upon which that education rests. Their chapter

Introduction 19

gives new insight into how health professionals confront, process, and then incorporate difficult and radical knowledges about weight and the body into professional practice. In the final chapter of this section physician Barry Lavallee, in an interview with one of the collection’s editors, relates how Aboriginal communities in Canada negotiate with and at times outright reject neoliberal articulations of body weight and obesity that individualize health concerns and decontexualize them from ongoing processes of colonialism in Canada. Arguing that obesity operates as a harmful and racialized stereotype often levied against Aboriginal peoples, Lavallee shifts the focus from weight to food access/acquisition and body movement, both of which have been disrupted through colonialism and the Canadian state’s violent processes of cultural assimilation (through residential schools, for example). The second section of the book shifts the focus to notions of responsibility, not for the self but for others. Each author in this section explores the intersections between obesity discourse and discourses of childhood/adolescence and parenting. In one of the first Canadian historical accounts of childhood obesity, Wendy Mitchinson (chapter 7) traces the role of mothers, and in particular the related mother-blame found in “expert” conversations about childhood weight management. Analysing medical journals and public health periodicals from 1920 to 1980, Mitchinson argues that, through obesity conversations, we can see how “mother-blaming is a much older and stronger trope than we often acknowledge.” In their respective pieces, both Pamela Ward (chapter 8) and LeAnne Petherick and Natalie Beausoleil (chapter 9) explore the discourses of childhood/adolescent obesity that ­circulate within institutional spaces. Drawing on her cutting-edge research involving qualitative interviews with children enrolled in a hospital-based childhood-obesity treatment program, Ward demonstrates how children are taking on neoliberal dictums of responsibility, often blaming themselves for their perceived states of ill health and “bad” health behaviours. At the same time, she shows how children subtly resist the “unhealthy” identities pushed upon them by the treatment program’s agents. Ward’s chapter makes an important space for a “risk population” from which we rarely hear – children. While Ward’s work demonstrates how obesity discourse is interpreted by children within institutions, Petherick and Beausoleil’s research with female elementary school teachers provides insight into those who work with children in institutions. Arguing that “it is crucial to understand how teachers perceive and teach about health and the body as a way to interpret what is happening in school culture in relation to

20  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

obesity science messaging,” the authors explore how teachers often walk a fine line between sincere concerns for students’ body image and feeling responsible for children’s health. Teachers thus negotiate complicated expectations that they should both foster good self-­esteem in children and at the same time make children aware of embodied flaws and “poor” health practices leading to obesity. Simultaneously they grapple with their own body-image concerns grounded in patriarchal definitions of feminine beauty. Through an analysis of a Nike commercial that features a twelveyear-old “obese” actor jogging towards the camera, Charlene Elliott (chapter 10) also explores the intersection of notions of responsibility with childhood obesity. Uniquely, however, Elliot focuses not on childhood itself but on the moment between childhood and adulthood, where obesity discourse makes a difficult transition from blaming others for children’s obesity to expecting young people to blame themselves for their obesity – a shift the author describes as “less of a transition than a cliff.” In recognizing the “liminal space” between childhood and adulthood, Elliott challenges the expectation of “adult” responsibility or agency for youth who in other aspects of their lives are not considered adult. Although discussions of agency are woven throughout many of the chapters here, that concept comes into focus in the third section of the book, which highlights representations of and responses to obesity in the Canadian context. The section begins with a focus on representation and shifting representation in chapter 11 by Jenny Ellison that focuses on fat and activism. Ellison describes a group of women claiming fat identity and representations in her historical genealogy of fat activists in Canada. Ellison’s piece addresses a dearth of scholarship regarding fat activists on the Canadian scene, and highlights how Canadian fat activist groups were unique, given nationally framed discussions about fat and obesity, and also connected to feminist responses to feminine beauty ideals. Ellison argues that fat activists grew from those feminist responses, thus showing how “social movements produce new ways of thinking about the body, even as they build on the foundations of earlier generations.” Deborah McPhail (chapter 12) similarly relates a “problem population’s” response and resistance to obesity discourse, in this case concentrating on Newfoundland, the most obese province in Canada according to Statistics Canada. Drawing on qualitative interviews in St. John’s, Newfoundland, McPhail shows how dominant stereotypes of Newfoundlanders as ubiquitously poor, unintelligent, and

Introduction 21

naive underlie obesity concerns about the province. Newfoundlanders are imagined as uneducated about modern understandings of healthy eating, and are thought to be backward in still consuming the fat-laced traditional foods developed by their ancestors. In contrast, McPhail demonstrates that people in her sample were knowledgeable about and invested in “healthy eating” practices, yet at the same time they consumed traditional foods through a complex negotiation with mainstream discourses of healthy eating and obesity. The theme of representation and resistance continues with Moss ­Norman, Genevieve Rail, and Shannon Jette’s analysis of the Canadian weight-loss reality television show Village on a Diet (chapter 13). Interpreting the show through the concepts of bio-politics, biopedagogy, and biocivics, the authors demonstrate how subjects are governed through national representations of obesity such as in Village on a Diet, which reproduce simplistic notions of individual responsibility and “good” citizenship through weight loss in a “uniquely Canadian” cultural context. Their chapter again demonstrates that neoliberal health governmentalities are often nationally contingent, inherently related to the specific political economies, geographies, and national identities from/in/through which they arise. Jacqueline Schoemaker Holmes (chapter 14) also recounts the resistance to obesity discourse of a problem population – women. In her innovative study of online dating practices in a major Canadian city, Schoemaker Holmes uses Goffmanian, Butlerian, and Foucaultian understandings of resistant “self-making” to demonstrate how mainly heterosexually identified fat women looking for dates online took up a “spoiled identity” (being fat) in order to be “authentic.” This process, which the author calls “fat authenticity,” can be regarded as a form of resistance, albeit limited within the heterosexual matrix in which prescribed gender roles hinge upon patriarchal norms. The book ends with “inconclusions.” In the collection’s final section, authors initiate a dialogue about new responses to the obesity epidemic – responses that need to be ethical and socially just. In chapter 15, Jennifer Brady and Jacqui Gingras contemplate and critique the Health at  Every Size (HAES) movement. Although the HAES approach is a promising counter to fat phobia grounded in the conflation of fatness with ill health, Gingras and Brady argue that HAES also maintains the mind/body binaries of Cartesian dualism by understanding the body as natural and removed from culture. HAES, they argue, also reifies healthism by continuing to privilege health behaviours. Placing HAES within an entirely new context, the authors suggest that queer theory,

22  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson

and its messy understandings of embodiment that blur boundaries between body and self, body and society, and, by extension, healthy and unhealthy, could have much to add to the HAES approach to the obesity epidemic. In the closing chapter of this collection, Carla Rice, drawing on constructivist and new materialist approaches to the body, similarly reconceptualizes approaches to obesity and fatness. Interviews with twentyfive adult women who describe their experiences of girlhood and of “becoming the fat girl” inform her rethinking of the fat body to privilege a materially grounded resignification of fatness as an “embodied, even celebrated, identity.” Rice proposes that the work of dis/abled and fat activist performance artists shows the promise of what the body can be and become – not a statically defined, inherently “natural” entity presupposed by obesity science (or by HAES, as Brady and Gingras suggest), but as an always-becoming materiality made meaningful and given form within discourses of embodiment. This “body becoming approach,” the author argues, “aims to refocus energies on improvising the properties and potentialities of big bodies.” As the final two chapters of this book suggest, Obesity in Canada is in fact only a beginning. It is intended as an interruption to mainstream obesity discourse, but it is also intended as the first of what we hope will be many such interruptions. This collection is neither complete nor definitive. Missing here are the stories of other marginalized communities and their experiences of obesity discourse in Canada – new Canadians, African Canadians, Asian Canadians, South-Asian Canadians, and those in queer communities, to name but a few. It is our hope, however, that Obesity in Canada will contribute to a rich critical dialogue on obesity that has begun in this country, a dialogue that even during the time we have worked on this collection has matured and expanded. The dialogue is no longer between what appeared to be oppositional binaries but has become a reaching out and listening to differing interpretations of the meanings of fat and obesity. NOTES 1 In general, critical obesity and fat studies scholars question the use of the word obesity, arguing that it is a medicalized term for a state of embodiment – fatness – that should not be medicalized. Scholars therefore enclose the word in quotation marks to denote their critique of it. While we

Introduction 23

2

3

4

5

whole-heartedly agree with critical scholars on this point, for simplicity’s sake we do not typically place quotation marks around the term throughout this book. Dancel describes the case of a woman who “fell to the ground, foamed at the mouth and clenched her hands, but did not lose consciousness during the fit,” labelling her as a hysteric. He seems to be describing a seizure. Hysteria was used as a catchall term to describe afflictions that affected women. By the late nineteenth century in Canada, doctors used the term to encompass loss of control over one’s emotions and weaknesses in the reproductive system; hysteria was considered the physiological consequence of masturbation, childbirth, menstruation, and uterine disorders (Mitchinson, 1991, 279–98). Garner published an often-cited study of the body size of Playboy centrefolds and Miss America contestants between 1955 and 1979 in which he found that there was a reduction in body size of these women over this period. See Garner et al., 1980. This discourse focusing on “weight preoccupation” is distinct from the more recent “obesity epidemic” panic in that the health issue problematized in the former was society’s obsession with slenderness rather than a perceived increase in the number of people who were overweight. The Canada Health Survey excluded people living on reserves and those who were institutionalized, an estimated 3 per cent of the population at the time the study was undertaken.

WORKS CITED Adams, Mary Louise. 1999. The Trouble with Normal: Postwar Youth and the Making of Heterosexuality. Toronto: University of Toronto Press. Arnup, Katherine. 1994. Education for Motherhood: Advice for Mothers in Twentieth-Century Canada. Toronto: University of Toronto Press. Baillargeon, Denyse. 2004. Un Québec en mal d’enfants: La médicalisation de la maternité, 1910–1970. Montreal: Éditions du remue-ménage. Beausoleil, Natalie, and Pamela Ward. 2010. “Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy.” Radical Psychology 8 (1). http://www.radicalpsychology.org /vol8–1/fatpanic.html. Campos, Paul. 2004. The Obesity Myth: Why America’s Obsession with Weight Is Hazardous to Your Health. New York: Gotham. Canada Health Survey. 1981. The Health of Canadians: Report of the Canada Health Survey. Ottawa: Department of Health and Welfare and Statistics Canada.

24  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson Canadian Obesity Network. n.d. http://www.obesitynetwork.ca/. Coleborne, Catherine, and Angela McCarthy. 2012. “Health and Place in Historical Perspective: Medicine, Ethnicity, and Colonial Identities.” Health & Place 14 (1): 1–11. Costas-Bradstreet, Christa. 2004. “Spreading the Message through Community Mobilization, Education and Leadership.” Canadian Journal of Public Health 95 (S2, May/June): S25–S29. Crawford, Robert. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services 10 (3): 365–88. http://dx.doi.org/ 10.2190/3H2H-3XJN-3KAY-G9NY. Dancel, François. 1864. Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of Cure. Trans. Michael Barrett. Toronto: W.C. Chewett and Co. Dyck, Erika, and Christopher Fletcher. 2011. Locating Health: Historical and Anthropoloigcal Investigations of Health & Place. London: Pickering & Chatto. Egger, Garry, and John Dixon. 2009. “Inflammatory Effects of Nutritional Stimuli: Further Support for the Need for a Big Picture Approach to Tackling Obesity and Chronic Disease.” Obesity Reviews 11 (2): 137–49. http://dx.doi.org/10.1111/j.1467-789X.2009.00644.x. Ellison, Jenny. 2011. “Let Me Hear Your Body Talk: Aerobics for Fat Women Only, 1981–1985.” In Gender, Health, and Popular Culture: Historical Perspectives, ed. Cheryl Krasnick-Warsh, 193–214. Waterloo: Wilfrid Laurier University Press. – 2013. “Weighing In: The ‘Evidence of Experience’ and Fat Women’s Activism.” Canadian Bulletin of Medical History 30 (1): 79–99. Erdman-Farrell, Amy. 2011. Fat Shame: Stigma and the Fat Body in American Culture. New York: NYU Press. Fee, Margery. 2006. “Racializing Narratives: Obesity, Diabetes and the ‘Aboriginal’ Thrifty Genotype.” Social Science & Medicine 62 (12): 2988–97. http://dx.doi.org/10.1016/j.socscimed.2005.11.062. Flegal, K.M., B.I. Graubard, D.F. Williamson, and M.H. Gail. 2005. “Excess Deaths Associated with Underweight, Overweight, and Obesity.” Journal of the American Medical Association 293 (15): 1861–7. http://dx.doi.org/ 10.1001/jama.293.15.1861. Fransoo, Randy, Patricia Maartins, Heather Prior, Dan Chateau, Chelsey McDougall, Jennifer Schultz, Kari-Lynne McGowan, Ruth-Ann Soodeen, and Angela Bailly. 2011. Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes. Winnipeg: Manitoba Centre for Health Policy. http://mchpappserv.cpe.umanitoba.ca/reference/MCHP-Obesity_Report_WEB.pdf.

Introduction 25 Freedman, Estelle B. 2002. No Turning Back: The History of Feminism and the Future of Women. New York: Ballantine. Friedman, M. 2012. “Fat Is a Social Work Issue: Fat Bodies, Moral Regulation and the History of Social Work.” Intersectionalities 1 (1): 53–61. – 2015. “Mother Blame, Fat Shame, and Moral Panic: ‘Obesity’ and Child Welfare.” Fat Studies: An Interdisciplinary Journal of Body Weight and Society 4(1): 14-27. doi:10.1080/21604851.2014.927209. Gard, Michael. 2011. The End of the Obesity Epidemic. Routledge: New York. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. New York: Routledge. Garner, David, Paul Garfinkel, Donald Schwartz, and Michael Thompson. 1980. “Cultural Expectations of Thinness in Women.” Psychological Reports 47 (2): 483–91. http://dx.doi.org/10.2466/pr0.1980.47.2.483. Gilman, Sander L. 1999. Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton: Princeton University Press. – 2008. Fat: A Cultural History of Obesity. New York: Polity. Gingras, Jacqui. 2006. “Throwing Their Weight Around: Canadians Take on Health at Every Size.” Health at Every Size Journal 19 (4): 195–206. Hartley, Cecilia. 2001. “Letting Ourselves Go: Making Room for the Fat Body in Feminist Scholarship.” In Bodies Out of Bounds: Fatness and Transgression, ed. Jana Evans Braziel and Kathleen LeBesco, 60–73. Berkeley: University of California Press. Health and Welfare Canada. 1988a. Canadian Guidelines for Healthy Weights: Report of an Expert Group Convened by Health Promotion Directorate, Health Services and Promotion Branch. Ottawa: Health and Welfare Canada. – 1988b. Promoting Healthy Weights: A Discussion Paper. Ottawa: Health and Welfare Canada. Herndon, April Michelle. 2005. “Collateral Damage from Friendly Fire? Race, Nation, Class and the ‘War Against Obesity.’” Social Semiotics 15 (2): 127–41. http://dx.doi.org/10.1080/10350330500154634. – 2010. “Mommy Made Me Do It: Mothering Fat Children in the Midst of the Obesity Epidemic.” Food, Culture and Society 13: 331–350. Howell, Maxwell, and Reet A. Howell. 1981. History of Sport in Canada. Champaign, IL: Stipes. Iacovetta, Franca. 2006a. Gatekeepers: Reshaping Immigrant Lives in Cold War Canada. Toronto: Between the Lines. – 2006b “Recipes for Democracy? Gender, Family, and Making Female Citizens in Cold War Canada.” In Canadian Woman Studies: An Introductory Reader, ed. Andrea Medovarski and Brenda Cranney, 110–26. Toronto: Inanna.

26  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson Jackson, John J. 1982. Mr. 5BX Canadian Fitness Pioneer: A Biography of William A.R. Orban. Victoria: Sono Nis. Jeffrey, C.A., and S. Kitto. 2006. “Struggling to Care: Nurses’ Perceptions of Caring for Obese Patients in an Australian Bariatric Ward.” Health Sociology Review 15 (1): 71–83. http://dx.doi.org/10.5172/hesr.2006.15.1.71. Kassirer, Jerome P., and Marcia Angell. 1998. “Losing Weight – An Ill-Fated New Year’s Resolution.” New England Journal of Medicine 338 (1): 52–4. http://dx.doi.org/10.1056/NEJM199801013380109. Kelm, Mary-Ellen. 2005. “Diagnosing the Discursive Indian: Medicine, Gender, and the ‘Dying Race.’” Ethnohistory (Columbus, Ohio) 52 (2): 371–406. http:// dx.doi.org/10.1215/00141801-52-2–371. Kirkland, A. 2011. “The Environmental Account of Obesity: A Case for Feminist Skepticism.” Signs (Chicago, Ill.) 36 (2): 463–85. http://dx.doi.org/10.1086/ 655916. LeBesco, Kathleen. 2004. Revolting Bodies? The Struggle to Redefine Fat Identity. Amherst: University of Massachusetts Press. Longhurst, Robyn. 1995. “The Body and Geography.” Gender, Place and Culture 2 (1): 97–106. http://dx.doi.org/10.1080/09663699550022134. – 2005. “Fat Bodies: Developing Geographical Research Agendas.” Progress in Human Geography 29 (3): 247–59. Lupton, Deborah. 2012. “Can a Thin Person Write about Fat?” This Sociological Life. Blog. 27 August https://simplysociology.wordpress.com/2012/08/27/ can-a-thin-person-write-about-fat/. Accessed 21 February 2012. – 2013. Fat. New York: Routledge. McDermott, Lisa. 2008. “A Critical Interrogation of Contemporary Discourses of Physical (in)Activity amongst Canadian Children: Back to the Future.” Journal of Canadian Studies/Revue d’Etudes Canadiennes 42 (2): 5–42. McDowell, Linda. 1999. “In and Out of Place: Bodies and Embodiment.” Chap. 2 of Gender, Identity, and Place: Understanding Feminist Geographies, 37–70. Minneapolis: University of Minnesota Press. McPhail, Deborah. 2009. “What to Do with the ‘Tubby Hubby’? ‘Obesity,’ the Crisis of Masculinity, and the Nuclear Family in Early Cold War Canada.” Antipode 41 (5): 1021–50. http://dx.doi.org/10.1111/j.1467-8330.2009.00708.x. – 2010. “Canada Weighs In: Gender, Race, and the Making of ‘Obesity,’ 1945–1970.” PhD diss., York University, Toronto. McPhail, D., G.E. Chapman, and B.L. Beagan. 2011. “‘Too Much of That Stuff ’Can’t Be Good’: Canadian Teens, Morality, and Fast Food Consumption.” Social Science & Medicine 73 (2): 301–7. http://dx.doi.org/10.1016/j.socscimed .2011.05.022. Merrill, E.L. 2007. “Women’s Stories of Their Experiences as Overweight Patients.” PhD diss., Texas Woman’s University, Denton, TX.

Introduction 27 Mitchinson, Wendy. 1991. The Nature of Their Bodies: Women and Their Doctors in Victorian Canada. Toronto: University of Toronto Press. – 2008. “Obesity: An Introduction to Medical Attitudes.” Paper presented at the Canadian Historical Association Annual Conference, Vancouver, British Columbia. Monaghan, L.F. 2008. Men and the War on Obesity: A Sociological Study. New York: Routledge. Mosby, Ian. 2012. “Making and Breaking Canada’s Food Rules: Science, the State, and the Government of Nutrition, 1942–1949.” In Edible Histories: Towards a Canadian Food History, ed. Franca Iacovetta, Valerie Korinek, and Marlene Epp, 410–32. Toronto: University of Toronto Press. Nast, Heidi J., and Steve Pile. 1998. “Introduction: Makingplacesbodies.” In Places through the Body, ed. Heidi J. Nast and Steve Pile, 1–19. New York: Routledge. Nicholas, Jane, and Patrizia Gentile, eds. 2013. Contesting Bodies and Nations in Canadian History. Toronto: University of Toronto Press. Norman, M.E. 2013. “‘Dere’s Not Just One Kind of ‘Fat’: Embodying the ‘Skinny-Self’ Self through Constructions of the Fat Masculine Other.” Men and Masculinities 16 (4): 407–31. doi:10.1177/1997184X13502662. Orpana, H.M., J.M. Berthelot, M.S. Kaplan, D.H. Feeny, B. McFarland, and N.A. Ross. 2010. “BMI and Mortality: Results from a National Longitudinal Study of Canadian Adults.” Obesity (Silver Spring, Md.) 18 (1): 214–8. http:// dx.doi.org/10.1038/oby.2009.191. Padwal, Raj S., Nicholas M. Pajewski, David B. Allison, and Arya M. Sharma. 2011. “Using the Edmonton Obesity Staging System to Predict Mortality in a Population-Representative Cohort of People with Overweight and Obesity.” Canadian Medical Association Journal 183 (14): E1059–66. http:// dx.doi.org/10.1503/cmaj.110387. Perry, Adele. 2002. On the Edge of Empire: Gender, Race, and the Making of British Columbia 1849–1871. Toronto: University of Toronto Press. Polivy, Janet, and C. Peter Herman. 1983. Breaking the Diet Habit. New York: Basic. Public Health Agency of Canada and the Canadian Institute for Health Information. 2011. Obesity in Canada: A Joint Report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Ottawa: Her Majesty the Queen in Right of Canada. http://www.phac-aspc.gc.ca/ hp-ps/hl-mvs/oic-oac/assets/pdf/oic-oac-eng.pdf. Puhl, Rebecca M., and Chelsea A. Heuer. 2009. “The Stigma of Obesity: A Review and Update.” Obesity (Silver Spring, Md.) 17 (5): 941–64. http:// dx.doi.org/10.1038/oby.2008.636. Rail, Genevieve. 2009. “Canadian Youth’s Discursive Constructions of Health in the Context of Obesity Discourse.” In Biopolitics and the “Obesity

28  Jenny Ellison, Deborah McPhail, and Wendy Mitchinson Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 141–56. London: Routledge. Raphael, Dennis. 2002. Social Justice Is Good for Our Hearts: Why Societal Factors – Not Lifestyles – Are Major Causes of Heart Disease in Canada and Elsewhere. Toronto: Centre for Social Justice. http://www.cwhn.ca/sites/default/files/ resources/heart_health/justice2.pdf. Rice, Carla. 2006. “Out from Under the Occupation: Transforming Our Relationships with Our Bodies.” In Canadian Woman Studies: An Introductory Reader, 2nd ed., ed. Andrea Medavarski and Brenda Cranney, 411–23. Toronto: Inanna. Rich, E., and J. Evans. 2009. “Performative Health in Schools: Welfare Policy, Neoliberalism, and Social Regulation.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 157–71. New York: Routledge. Rutherford, Paul. 2000. Endless Propaganda: The Advertising of Public Goods. Toronto: University of Toronto Press. Schwartz, Hillel. 1986. Never Satisfied: A Cultural History of Diets, Fantasies and Fat. New York: Anchor. Statistics Canada. 2005. Adult Obesity in Canada: Measured Height and Weight. http://www.statcan.gc.ca/pub/82-620-m/2005001/article/ adults-adultes/8060-eng.htm. Stephen, Jennifer Anne. 2007. Pick One Intelligent Girl: Employability, Domesticity, and the Gendering of Canada’s Welfare State, 1939–1947. Toronto: University of Toronto Press. Sui, Xuemei, Michael J. LaMonte, James N. Laditka, James W. Hardin, Nancy Chase, Steven P. Hooker, and Steven N. Blair. 2007. “Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults.” Journal of the American Medical Association 298 (21): 2507–16. http://dx.doi.org/ 10.1001/jama.298.21.2507. Thobani, Sunera. 2007. Exalted Subjects: Studies in the Making of Race and Nation in Canada. Toronto: University of Toronto Press. Twohig, Peter, ed. 2007. “Written on the Landscape: Health and Regionalism in Canada.” Journal of Canadian Studies 41 (3): 166–84. Wann, Marilyn. 2009. “Foreword: Fat Studies: An Invitation to Revolution.” In The Fat Studies Reader, ed. Esther Rothblum and Sondra Solway, xi–xxvi. New York: NYU Press. World Health Organization (WHO). 2013. Health Topics: Obesity. http://www .who.int/topics/obesity/en/. Accessed 4 September 2013.

PART 1 Critical Perspectives on Obesity Science

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1 Hearing Noises and Noticing Silence: Towards a Critical Engagement with Canadian Body Weight Statistics M ich ael G ar d

One of the interesting things about studying the discourse of the “obesity epidemic” is that one learns just how promiscuously it operates. For example, the idea that rising levels of obesity will lead to declines in life expectancy or, in more populist terms, that today’s children will die younger (or even sooner!) than their parents has no obvious empirical roots. The best that we could say about it is that it probably emerged as a throw-away line by United States health officials in media interviews at a time – around the year 2000 – when little was known about the impact of obesity levels on average life expectancy. Since then, not much more research linking obesity and life expectancy has been done, and that which exists refers almost exclusively to the United States. The most widely cited paper to deal with this issue (Olshansky et al. 2005) predicts a small decline in life expectancy in the United States due  to obesity in coming years but has also been severely criticized on methodological grounds. Other researchers, such as Stewart, Cutler, and Rosen (2009), have come to less pessimistic conclusions. At present, I am aware of no empirical studies that support the claim that the children of any country will die younger or sooner than their parents because of rising overweight and obesity. In fact, a recent review article for the Journal of the American Medical Association has confirmed earlier findings that overweight and moderate obesity may not have any implications for overall population mortality (Flegal et al. 2013). While the allure of apocalyptic obesity-driven predictions is a complex matter, what is clear is that they have spread across the world and are repeated by journalists, scientists, and politicians without a hint of qualification. Canada has not been immune to this kind of discursive infection, even though it has been comparatively slow to begin

32  Michael Gard

gathering comprehensive national body weight statistics. With this in mind, this chapter considers body weight–related statistics in Canada over the last fifty years, not to add to the near-deafening chorus of alarm, but to attempt to prise different stories and conclusions out of these statistics. In particular, I invite readers to juxtapose one of the most serious shortcomings of mainstream obesity research – the way findings from one context are carelessly generalized to other contexts – alongside serious consideration of what is particular about Canadian overweight and obesity statistics. Of course, in the space available I can only scratch the surface, but the examples I draw on are intended to contribute to a less frenzied and more thoughtful dialogue about what Canadian body weight statistics do and do not say and what use we might make of them in critical fat studies. Obesity and Epidemiology: A Short Canadian History Readers familiar with the study of obesity in Canada over recent decades will be aware of the dearth of directly measured longitudinal data. Apart from the United States, this is a common situation in Western countries and a point insufficiently recognized when calculations about past and future rates of change are made. However, even alongside countries like Australia, the United Kingdom, and New Zealand, Cana­ dian obesity data are scarce and methodologically heterogeneous. In fact, the first nationally representative, directly measured data set that could serve as the starting point of a systematic body weight surveillance regime did not appear until 2007. This might seem unremarkable. After all, it wasn’t until the beginning of the twenty-first century that obesity became a global news story and health authorities began warning of dire future consequences. And yet I think there are reasons to dwell for a moment on the Canadian data that do not exist. To begin with, in the first years of the twenty-first century a number of researchers pointed out that we needed to go back to the Canadian Heart Health Surveys of the late 1980s and early 1990s to find published accounts of the body weight status of Canadians based on directly measured heights and weights (Katzmarzyk 2002a; Tremblay 2004). By directly measured (the term objectively measured is sometimes also used), obesity researchers ostensibly mean data that are obtained when a suitably skilled person takes and records physical measurements from another person’s body (usually but not only their body

Critical Engagement with Canadian Weight Statistics  33

weight and height) and then records these data for some official or research-related purpose. “Directly measured” data are usually contrasted with “self-reported” data where the people interested in these measurements are not able to collect them themselves. This could be because of cost, time, geography, or a combination of all three. Selfreported data are normally derived when researchers ask people to verbally state or write down their height and weight or the height and weight of someone else, such as their child. Researchers generally ­assume directly measured data to be superior to self-reported data because of the tendency for people to over- or under-estimate their bodily dimensions in directions deemed to be socially desirable. There is, however, some equivocation in the literature concerning the unreliability of self-reported data. For example, in the few empirical examples where the efficacy of self-reported data has been directly assessed, their variation from directly measured data appears somewhat random and, in some instances, negligible (for an example see Strauss 1999; for a review of the literature see Connor Gorber et al. 2007). As we will see below, there are some data from 1970 to 2007 from which statistics about the body weight status of Canadians could be generated. Nonetheless, the paucity of such data during this time is striking given that rising body weights had begun to emerge as a public health concern in Western countries at least as far back as the 1950s (Gard and Wright 2005; Sobal 1995). After all, it is not as if measuring human bodies is a new enterprise. The current epidemiological interest in obesity and the BMI needs to be located within a history of scientific attempts to draw wider social and moral conclusions from the dimensions and capacities of human bodies (Gould 1996). The impulse to measure has been fuelled by centuries of unease over the effects of urbanization and industrialization. In this context, the inspection, testing, and measurement of school children became widespread across the anglosphere from the late nineteenth century and well into the twentieth century (Kirk 1998; see also Mitchinson in this volume for a more detailed account of Canadian childhood body weight research in the twentieth century). During the same period the threat of war and the battle readiness of male populations also became the focus of considerable empirical energy (McElroy 2008). In the second half of the twentieth century and partly as a response to cold-war tensions, the relative physical fitness of North Americans attracted the attention of exercise scientists (in particular, Kraus and Hirshland 1954) and created the

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whole subdiscipline of field-based fitness testing for children that has oscillated in and out of scholarly fashion ever since (for a brief history, see Freedson, Cureton, and Heath 2000; for a recent example of the scholarly tide turning against fitness testing children, see Naughton, Carlson, and Greene 2006). What I think this history suggests is that the impulse to systematically collect population-scale data on the size, shape, and capacities of human bodies flares haphazardly through time and space, triggered by a combination of historical events and local – and sometimes personal – professional interests. In Canada, the work of Lionel Bradley Pett offers a case in point as well as a useful starting point for the remainder of this chapter’s focus on Canadian body weight statistics. In the years leading up to World War II, Pett had been a leading advocate for a scientifically informed, rational approach to eating. By 1944 he was Canada’s director of Nutrition Services and firmly of the view that too much of what people ate was governed by fad, prejudice, and superstition. Quoted in Quebec’s St. Maurice Valley Chronicle newspaper (1944), his advice was a familiar mixture of prescription and pleasure: From the idea that bananas would give the baby convulsions to the theory that fruit and milk should never be taken at the same meal, food fads have, from time to time, swept the country like a prairie fire … The daily “must” are milk, fruits, vegetables, whole grain cereals and meat or one of its alternates. Add at least three or four eggs a week: serve liver, heart or kidney once a week and remember cod liver oil for the children. Those are the simple rules for healthful eating. When the “musts” are looked after, the “likes” can be added. (“Healthful Eating Is Good Eating Says Dr L.B. Pett,” 27 April, 4)

In 1947 Pett and F.W. Hanley published “A Nutrition Survey among School Children in British Columbia and Saskatchewan” in the Cana­ dian Medical Association Journal. Anticipating the mildly paradoxical epidemiological claim repeatedly made in the twenty-first century’s obesity literature, Pett and Hanley urged that population-wide examinations and measurements would lead to solutions for the assumed problems that had inspired data collection in the first place: The present report is the first of a series which, it is hoped, will give a reasonable picture of the nutrition problem among younger school children.

Critical Engagement with Canadian Weight Statistics  35 It is the first attempt in Canada to utilize dietary records, blood tests and clinical examinations on a scale large enough to be representative of regions, and to integrate the findings on each individual in an attempt to diagnose several types of deficiency. The results permit generalizations even for a Province, indicating the type and extent of the nutrition problem and methods for dealing with it. (188)

While the ambition and scope of Pett’s work are noteworthy, it is important to remember that it emerged out of long-standing interest in the role of nutrition in Canadian public health. As Ostry (2006) describes, beginning in the final decades of the nineteenth century, Canada developed a food surveillance system and, in particular, a range of other policy instruments intended to influence childhood nutrition up until the Second World War. Similarly, Mosby (2011) shows that the political, social, and cultural dimensions of food and nutritional science continued to shape public policy during World War II. In 1953 Pett and his colleagues produced results for the “The Canadian Weight-Height Survey” (see Pett 1955; Pett and Ogilvie 1956). Even at this time there are clear signs that, despite Pett’s history of interest in nutritional deficiency, researchers were turning their gaze to the problem of overabundance: The standard of living and way of life of Canadians is similar in may respect [sic] to that of citizens of the United States. Both population groups are endowed with an abundance of foodstuffs and are therefore exposed to the hazards of overnutrition. Before launching or endorsing a campaign against overweight in Canada, a critical study was made of the standards for weight and the criteria used to diagnose obesity. Many sets of tables were in use as “standards” but none had the valid mathematical basis that was desired. Confusion existed over the definition of “overweight” and “obesity” and no objective data were available on different body types. (Pett and Ogilvie 1956, 177)

Pett himself was particularly concerned that terms like overweight and obesity should rest on firm scientific footings. They were often confused or used interchangeably, he argued, and many people were unaware that a person could get heavier without becoming more overweight (as with increased musculature) or get fatter without changing weight (i.e., greater subcutaneous fat coupled with a corresponding reduction in

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fat-free mass). Physicians and the general public were, he said, also in the habit of using weight-height tables of dubious merit and were therefore likely to draw erroneous conclusions: Many people use tables dating back to those of Baldwin-Wood and other studies of forty years ago. Such tables have been copied so much in one place and another, often with small changes, that the origins of some of the figures are unknown. Most of us use insurance tables for adults, but I must remind you that they were originated in a rather complicated manner, including consideration of the purely economic question of losing money on a risk. (Pett 1955, 862)

The Canadian weight-height survey collected data on just under twenty-two thousand Canadians and, according to Pett, was “the first such representative table in the world” (1955, 862). Pett’s hope for the survey appears to have been that it provide scientifically valid information that contributed to an assessment of an individual’s health. It is important to remember that he saw diet, not body weight, as the most important factor in human development and well-being, a point that explains his caution when he considered the uses to which others might put the results of his survey. “No figure for weight,” he and Ogilvie wrote, “can ever be used as an absolute standard” (1956, 187). Pett’s survey found that Canadian children were taller than their parents had been at similar ages, but that their finishing points were essentially the same and that adult heights had not changed much. Comparing his data with two earlier surveys – both from Toronto, in 1923 and 1939 – he also concluded that while Canadian children were heavier than they had been in 1923, the rate of increase in the first half of the intervening thirty years was faster than in the second. In other words, allowing for increasing height, he proposed that childhood weight increases were slowing down. Pett speculated that improved nutrition education might have a played a role in this trend as well changing attitudes towards child development: The emphasis in 1920 was still on big babies and maximum growth rates; such visible results from attention to feeding did much to stimulate the widespread interest in nutrition that we have now. But is faster development really better for health? We now know that big babies are often nutritional problems. Rapid growth may be one of the factors in our increase in degenerative diseases. In the last fourteen years nutritionists have put

Critical Engagement with Canadian Weight Statistics  37 more emphasis on the general effects of a balanced diet rather than on growth rates. I would like to believe that this factor is also operating in this slowing down of the averages, because I believe it is the correct approach to a longer and fuller life. (1955, 866)

With the benefit of hindsight, contemporary obesity researchers would probably see Pett’s optimism as mistaken, not to mention a little nutrition-centric. Still, his observations are interesting because they come at a point in medical history when concern about what he calls the “degenerative diseases” is beginning to grow. The timing of the Canadian height-weight survey tells us something about the shifting priorities of medicine and medical research. As Krieger (1994) shows, the 1950s was also the period in which a new professional field of epidemiology was taking shape, culminating in the publication of McMahon, Pugh, and Ipsen’s highly influential Epidemiologic Methods in 1960. Although Pett’s writing suggests he was uncomfortable with a slavish adherence to categories and averages, his survey is also an expression of the emerging faith in population-level statistics to speak to the individual about his or her conduct. Tellingly, he concludes his article for the American Journal of Public Health by claiming that “weight relationships to health are among the most fundamental problems needing study at the present time for the good of our whole populations” (1955, 868). In one respect, this call went unheeded; only very sporadic attention seems to have been given to population-level body weight statistics for Canadians over the next four decades. Nonetheless, the Canadian height-weight survey is an early example of the individualizing potential of a new epidemio-logic that claimed to be able to identify statistically those most at risk of future disease and, therefore, most in need of public health intervention. The commercially motivated weight-height tables of the past were being superseded by instruments that looked similar but were imbued with a more rigorously scientific ethos and a completely different set of public health aspirations. While still loose, the grip of statistical epidemiology on the direction of the field of public health and, by extension, the thoughts and behaviours of individuals, was beginning to tighten. Noisy and Non-existent Data Although not nearly as pervasive as it is today, scholarly and popular comment about body weight persisted in the English-speaking West

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throughout the second half of the twentieth century. For example, Sobal (1995) describes the increasingly medical use of the term obesity in the 1950s and its subsequent medicalization and professionalization as a field of study. Inevitably, medicalization went hand-in-hand with entrepreneurialism and the manufacture of demand for various kinds of clinical and cosmetic products and procedures. As I have written elsewhere (Gard 2011), the sense that obesity burst onto the scene as a global news story at the beginning of the twenty-first century obscures long-standing concern about body weight among a range of professional groups including those – such as my own field of physical education – with less-than-obvious medical credentials. However, immediately before and after the beginning of the new century, a partially intentional and concerted discursive shift delivered obesity to a massively expanded and, it seems, receptive global audience (see Oliver 2006 for a more detailed account of the institutional machinations behind this shift). It was at this moment that researchers, particularly epidemiologists, began to connect the present with the past and to conclude that changes in the body weights of Western adults and children constituted a public health emergency. I am not claiming that the so-called obesity epidemic was invented out of statistical thin air. It is now clear that the prevalence of overweight and obesity in Western countries increased comparatively sharply in the 1980s and 1990s. This is an important point that tends to be glossed over by some academic critics of mainstream obesity discourse. However, what was and remains less clear is the sense one might make of these statistical trends – do they represent a crisis? – and their future implications – what should be done about them? In Canada, a series of academic publications recorded these statistical trends and announced the need for concerted remedial public health action and more systemic surveillance of Canadian bodies (e.g., Katzmarzyk 2002b; Tremblay 2004; Tremblay, Katzmarzyk, and Willms 2002; Tremblay and Willms 2000; Vanasse et al. 2006). Katzmarzyk (2002a), for example, was one of the first to attempt to paint a longitudinal picture using a disparate collection of data sets, beginning with Pett’s height-weight survey. As it turns out, the original data for Pett’s survey have been lost, which means that neither BMI scores nor overweight and obesity prevalence percentages can be calculated from it.1 Nonetheless, using the 1953 adult weight-for-height results as his baseline, Katzmarzyk concluded that average weight-for-height for adult Canadian males increased by 5.1 per cent between 1953 and 1998 and 4.9 per cent for females (Figure 1).

Critical Engagement with Canadian Weight Statistics  39

Figure 1.  Percentage changes in Canadian weight-for-height, ages 20–64, from 1953 to 1988 (Katzmarzyk 2002a)

In order to compare BMI prevalence across time, Katzmarzyk eliminated 1953 as his baseline and presented the following graphs for adult Canadians (Figure 2). Although generally confirming the narrative of increasing body weights, these data contain some obvious anomalies. Most notably, there are the apparent drops in weight-to-height averages and BMI in the 1970s, 1980s, and 1990s. Volatility in anthropometric data is often attributed to methodological inconsistency. In particular, researchers in this field tend to assume that, compared with directly measured data, self-reported data will underestimate overweight and obesity prevalence because women will underestimate their weight and men will overestimate their height. This assumption is only partially corroborated in Katzmarzyk’s summary. The first four surveys (1971/72, 1978/79, 1981, and 1986–92) represent directly measured data while the last three (1994, 1996, 1998) are self-reported, and the fluctuations seem mostly independent of data collection method. Putting to one side the doubtful possibility that general overweight and obesity prevalence among Canadian adults rose and fell a number of times over the last few decades, there are probably many other explanations for this volatility, including the size, makeup, and location of samples and inconsistency in measurement techniques. It is important to remember that although a number of surveys of Canadian body weights were conducted in the thirty years prior to 2000, the public health context

40  Michael Gard

Figure 2.  BMI prevalence in Canada, 1970–98

during this period was somewhat different from the one that existed after 2000. Furthermore – and returning to my broader interest in the way historical forces shape the kind of research that is done and the methods used to conduct it – both of these contexts are different from the one in which L.B. Pett worked. To be more precise, by 1970 the interest of health professionals in body weight in particular, and its connection with so-called lifestyle diseases generally, had increased sharply over mid-1950s levels. This is almost certainly why body weight surveys start to proliferate at this

Critical Engagement with Canadian Weight Statistics  41

time. However, without the discursive urgency generated by the new millennium’s “obesity crisis,” Canadian researchers between 1970 and 2000 appear to have been relatively comfortable with methodological heterogeneity and – unlike today – they were not at all preoccupied with the precise monitoring of body weights on a continuing year-toyear basis. In the decades prior to 2000, for example, standardized and internationally accepted methods for measuring human fatness or for defining overweight and obese or even constructing a nationally representative body weight sample were either non-existent or only beginning to emerge. So, although some researchers have attempted to build an empirical narrative out of pre-2000 body weight surveys of Canadians, it is not at all surprising that the result appears, statistically speaking, to be very “noisy.” Putting this volatility to one side, the trend in overweight and obesity prevalence over time suggested in these graphs does not seem implausible, particularly in light of more recent data that I discuss in the next section. According to these data, both overweight (which in Figure 2 includes obesity) and obesity among Canadian men appear to have climbed steadily from the 1970s through to the end of the century. The increase seems to have been more marked in obesity – as opposed to overweight and obesity – and this is consistent with international data suggesting that, while many people have put on a little weight, a smaller number of people have put on more weight. In epidemiological terms, this is referred to as a skewing of the distribution towards higher weights. In terms of actual percentages, these data suggest that obesity prevalence among Canadian adults was 9.7 per cent in 1970/72 (7.6 per cent for men and 11.7 per cent for women) and 14.9 per cent in 1998 (15.4 per cent for men and 14.4 per cent for women). For combined overweight and obesity the percentages were 40 per cent in 1970/72 (46.1 per cent for men, 31.7 per cent for women) and 50.7 per cent in 1998 (60.1 per cent for men, 38 per cent for women). While the gap between men and women for combined overweight and obesity appears large, the gap for obesity alone is much smaller and may actually have reversed over this period. More women than men were classified as obese in 1972 while, in some more recent surveys, male obesity is slightly higher (Katzmarzyk 2002a, 2002b). In my view, there are two basic but important conclusions we might draw from these comparisons. First, at the beginning of the 1970s, four decades ago, the percentage of Canadian adults classified as overweight

42  Michael Gard

or obese was already 40 per cent, and nearly 50 per cent for men. It is possible to disagree about the significance of these percentages, but they do cut against the suggestion that overweight and obesity were until recently very low and then “exploded” in the 1980s or 1990s. There are some British data, for example, that suggest that overweight and obesity have been rising in that country at least as far back as the 1950s (Okasha et al. 2003). Second, there appears to have been a significant difference between the prevalence rates for men and women throughout the 1970s, 1980s, and 1990s, and this difference widened over the period. Admittedly there is a risk of over-analysing these data and divining trends that are merely methodological artefacts. Still, taking Katzmarzyk’s data at face value, I am struck by how little change there appears to have been in the prevalence rates for women across this entire period. Obe­ sity, for example, appears to have increased by less than three percentage points in nearly thirty years (11.7 per cent to 14.4 per cent). Although Katz­marzyk does not supply the number, combined overweight and obesity in the 1978–79 survey actually appears to be, if anything, higher than it was in 1998. Of course, the spectre of self-reported data hangs over these conclusions and, as researchers pondered Canadian obesity statistics at the beginning of the twenty-first century, the possibility remained that the “real” extent of overweight and obesity was much higher than existing data suggested. On the other hand, if selfreported data are in fact so unreliable, we might expect to see dramatic break points in the statistical trend when we transition from directly measured to self-reported data. No such break points are apparent, although the possibility remains that the self-report surveys that Katzmarzyk cites conceal underlying and even sharper “real” upswings in prevalence. There are other published accounts of this period that we could consult. For example, Bélanger-Ducharme and Tremblay (2005) point out that the Canadian Heart Health Survey, which collected directly measured data between 1988 and 1992, reported that combined overweight and obesity for adult men was already 58 per cent and 41 per cent for women, percentages that are not much different from Statistics Canada data for 2011. This is a very difficult finding to square with the claim put forward by obesity researchers that Western overweight and obesity rates continued to rise exponentially during the 1990s and 2000s (e.g., see American Medical Network 2005; Norton et al. 2006). As I have argued elsewhere (Gard 2011), in both scientific and popular media contexts the rhetoric of the “obesity epidemic” after

Critical Engagement with Canadian Weight Statistics  43

2000 relied heavily on the idea of obesity prevalence continuing to gallop exponentially out of control. In fact, almost all policy responses and calls for intervention exploit the rhetoric of a sudden and ongoing crisis presumably, at least in part, to make the proposed action seem more reasonable and appropriate. But what if on closer inspection obesity statistics told a different story of much slower, gradual or, in some instances, non-existent change? What if the statistics for men and women showed sharply divergent historical trajectories? My point here is that so long as a single narrative is allowed to dominate, it will be much more difficult to raise important reasonable questions about the direction of obesity-related social policies. After all, if we really are in the middle of an ongoing and exponentially worsening crisis, interventions that we might normally have thought unethical, misguided, ineffective, and potentially harmful are much more likely to be adopted. As many in the obesity science literature argue, desperate times call for desperate measures. The credibility of alternative points of view will, therefore, hinge partly on being able to “fight fire with fire”: telling alternative narratives that are robustly scientific and, in this case, statistical. Overweight and Obesity in Children Historical data for Canadian childhood overweight and obesity are even more scarce and difficult to interpret. For example, drawing on the 1994 National Longitudinal Survey of Children and Youth, Phipps and others (2006) reported that 16.1 per cent of children aged six to eleven years old were obese. However, besides using parent-reported heights and weights, the study defined obesity using Centres for Disease Control (CDC) thresholds that are in turn based on data collected on children in the United States between the 1960s and 1990s, a point Phipps and colleagues acknowledge. Definitions of childhood overweight and obesity based on international data are now available (Cole et al. 2000), widely used in the literature, and tend to deliver lower childhood prevalence percentages than the CDC thresholds. Elsewhere, estimates of Canadian childhood overweight and obesity prior to 2000 tend to vary widely. Tremblay and colleagues (2002) begin with the directly measured prevalences reported by the 1982 Canada Fitness Survey in which 2 per cent of boys between seven and thirteen years old were obese and 11 per cent were overweight or obese. For girls the percentages were 2 per cent and 13 per cent. Combining the results of two surveys based on parent-reported data, by 1996 the rates

44  Michael Gard

are 10 per cent and 33 per cent for boys and 9 per cent and 27 per cent for girls. However, using directly measured data, He and Beynon (2006) reported that in 2006, and using the same CDC thresholds as Phipps and others (2006), 16.6 per cent of all children between six and thirteen years old were overweight (but not obese) and 11.8 per cent were obese. Interestingly, these percentages become 17.5 per cent (slightly higher) for overweight alone and 7.6 per cent (significantly lower) for obesity when the international cut-offs are used. These data are interesting because, if they are to be trusted, they suggest that despite the publicity given to childhood obesity in Canada, by 2006 obesity affected, at most, about 10 per cent of all Canadian children. And despite being based on directly measured heights and weights, these 2006 prevalences are much lower than the parent-reported data for 1996 that Tremblay et al. (2002) describe. There is a sense in which the more one reads about reported childhood overweight and obesity percentages in Western countries prior to the beginning of the twenty-first century, the less one understands. It is clear enough that the body weights of Western children rose significantly in the 1980s and 1990s. Still, one needs also to remember that prior to the year 2000, agreed definitions for childhood overweight and obesity did not exist and it is sometimes debatable how much this changed after 2000. More important, the efficacy of statistical categories for childhood “overweight” and “obesity” remains clinical guesswork. In the case of adults, although a matter of debate, the choice of BMI cut-offs of 25 for overweight and 30 for obesity at least rests on some longitudinal morbidity and mortality data. This is not the case with children, and we know essentially nothing about the clinical significance of a given weight for a child of a given age of a particular sex. In fact, I would suggest that to classify an eight-year-old child as overweight carries with it at least as much moral and cultural meaning as it does medical significance. The End of the Epidemic? There is now evidence from many countries that overweight and obesity prevalence began to level out and in some cases decline from the late 1990s onwards (for more detailed accounts, see Rokholm, Baker, and Sørensen 2010 and Gard 2011). In their summary of these trends, Rokholm, Baker, and Sørensen (2010) note that Statistics Canada data for 2010 show that body weights for children and adults were still

Critical Engagement with Canadian Weight Statistics  45

rising. Interestingly, though, in assessing the quality of evidence from all the countries in their analysis, they classified the quality of the Canadian evidence as “low,” the lowest of four ratings (low, medium, high, and very high). Compared to the zeal with which body weight statistics are collected in some Western countries, this seems a remarkable state of affairs, not to mention one that would disappoint L.B. Pett were he alive to see it. The Rokholm, Baker, and Sørensen summary uses Statistics Canada data from the Canadian Community Health Survey (CCHS). Although it began in 2000, the CCHS has its antecedents in a number of other mostly self-report-based surveys. According to Vanasse and colleagues (2006), the 2003 CCHS results were based on “computer-assisted” interviews with 130,000 Canadians. That is, all data were self-reported and were the result of participants responding to questions over the telephone. The 2003 CCHS results put combined adult overweight and obesity at 49.1 per cent (obesity 15.2 per cent, overweight alone 33.9 per cent). By contrast, the 2004 CCHS, based on direct measurements of a smaller sample, reported 59.1 per cent (23.1 per cent obese, 36.1 per cent overweight). Why Rokholm, Baker, and Sørensen classify the CCHS data as of “low” quality is not made clear, but it probably relates to the different methods used in various iterations of the CCHS and the difficulties associated with comparing its findings to surveys conducted prior to 1999. In 2007 the CCHS was joined by the Canadian Health Measures Sur­ vey (CHMS), an essentially continuous data collection exercise that conducts interviews and measurements in mobile clinics (Statistics Canada 2012a). CHMS data for 2007–2009 estimate adult Canadian obesity to affect 24.1 per cent of the population (24.3 per cent men, 23.9 per cent women) (Shields, Carroll, and Ogden 2011). Interestingly, it is still possible to access and compare both CCHS and CHMS data through the Statistics Canada website. For example, 2011 CCHS data put adult Canadian obesity at 18.3 per cent (Statistics Canada 2012b) and combined overweight and obesity at 52.1 per cent (Statistics Canada 2012c) – percentages that are significantly lower than for CHMS data. Why both sets of divergent statistics remain available to the public, or what sense people should make of these differences, is not altogether clear. These most recent directly measured data appear to confirm that self-reported data collected in the 1990s may have underestimated overweight and obesity in Canada. At the same time as increases in overweight and obesity levels either slowed or stopped altogether in

46  Michael Gard

most Western countries from the late 1990s onwards, it seems unlikely that Canada experienced a completely opposite trend. Indeed, there is some evidence that plateauing has occurred in at least some Cana­ dian provinces (Statistics Canada 2012b, 2012c). On the strength of existing evidence, then, it seems more likely that overall adult body weights continued to rise in the 1990s and then a more mixed set of trends set in after the year 2000. However, as Shields, Carroll, and Ogden (2011) recently pointed out, these levels were still well below its near neighbour, the United States. Obesity and Social Class The general relevance of socioeconomics to body weight statistics is not a topic I can begin to do justice to here. However, there are some data  upon which to base some broad Canada-specific conclusions. To begin with, there is a reasonably long-standing research finding for wealthy Western countries that describes an inverse relationship between overweight and obesity, on the one hand, and socioeconomic status on the other (Sobal and Stunkard 1989; Stunkard et al. 1972). That is, higher-status people, both adults and children, are less likely to be overweight than lower-status people. For poorer countries the reverse has tended to be the case. In a more recent review of international research, McLaren (2007) generally confirmed these earlier findings, although the strength of the statistical relationship tends to vary depending on what indicator for class is used (e.g., household income, parental education, parental employment type). McLaren also found that the difference between the statistical body weight/socioeconomic status relationship for richer and poorer countries might have declined, perhaps because of the effects of globalization. As with earlier research, McLaren also found that the inverse relationship between body weight and socioeconomic status in richer countries applies much more strongly to females than to males. In fact, many studies report no relationship at all between socioeconomic status and body weight for men. If anything, McLaren suggests that this statistical difference between males and females may have declined as increasing overweight and obesity have affected all social groups. In other words, as prevalence in all groups increases, the statistical differences between them become less pronounced. An equally mixed picture emerges for Canada-specific research. Ward, Tarasuk, and Mendelson’s (2007) study of Canadian adults used a variety of

Critical Engagement with Canadian Weight Statistics  47

indicators for socioeconomic status and considered the mediating role of a range of health-related behaviours. They found that while it was not a dominant factor, socioeconomic class was a consistently stronger predictor of body weight and health-related behaviours for women than it was for men. With respect to Canadian children, Willms, Tremblay, and Katzmarzyk (2003) found that the risk of being overweight increased as one moved from west to east in the country and was inversely associated with socioeconomic class. However, while the province in which a child lived was a stronger predictor than their socioeconomic class, the researchers cautioned that the effect of secular trend increases in childhood body weights across time exceeded the impact of both geography and socioeconomics. Do these findings mean that we should ignore socioeconomics when thinking about body weight disparities? In an intriguing though complex set of findings, Phipps and others (2006) compared childhood poverty and obesity statistics for Norway, Canada, and the United States. Using data from the mid-1990s, they found that the prevalence of obesity among children six to eleven years old was highest in the United States (Norway 6.3 per cent, Canada 16.1 per cent, United States 20.7 per cent) while “severity” (a measure of the degree of obesity) was about the same in all three countries. For childhood poverty, prevalence was again appreciably higher in the United States and severity roughly similar. In fact, graphical depictions of obesity and poverty prevalence and severity for the three countries were difficult to tell apart. The researchers then compared obesity levels among poor and non-poor children. The small numbers of both poor and obese children in Norway rendered its data unsuitable for this comparison. Nonetheless, the researchers found that while the severity of obesity was approximately equal for poor and non-poor Canadian children, poor children in the United States were not only much more likely to be obese, but the severity of their obesity was also much greater compared with that of non-poor American children. Although all correlational, these data at least suggest that childhood poverty and obesity share overlapping causal pathways, and the researchers conclude by urging that we should not overlook poverty amelioration when formulating obesity-reduction policies. These data also reiterate the stark, familiar, and yet – at least in my view – not well understood differences between Canada and the United States. A number of researchers have confirmed significant and intertwined geographic and cultural disparities for health and body weight

48  Michael Gard

in Canada. For example, drawing on 2003 data, Vanasse and colleagues (2006) have reported that adult obesity prevalence across 106 Canadian health regions ranged from 6.2 per cent in Vancouver to 47.5 per cent in the predominantly indigenous region of Terres-Cries-de-la-Baie-James in northern Quebec. Bélanger-Ducharme and Tremblay (2005) claimed that obesity among indigenous Canadians was 26 per cent compared to a national average of approximately 15 per cent. Using 2004 CCHS data, Garriguet (2008) put combined overweight and obesity for “offreserve” indigenous adults in Ontario and the western provinces (Manitoba, Saskatchewan, Alberta, and British Columbia) at 67 per cent compared with 55 per cent for non-indigenous adults. The size of this disparity was mostly explained by the difference between the rates for women (64 per cent indigenous, 46 per cent non-indigenous) rather than for men (71 per cent indigenous, 62 per cent non-indigenous). No doubt these disparities make some contribution to the lower life expectancy among indigenous compared to non-indigenous Canadians. At the same time, in their comparison of mortality statistics in ­Australia, New Zealand, Canada, and the United States, Bramley and others (2004) found that the disparity in life expectancy between indigenous and nonindigenous populations was relatively low in Canada and that indigenous Canadians have lower mortality than non-­indigenous Canadians for important disease categories like cancer and heart disease. A Very Canadian Story There is a tendency in the literature to argue that constantly measuring the fatness of populations will lead to solutions to the “obesity epidemic.” The chain of logic behind this claim is never explained, and certainly no evidence is ever offered. It is worth remembering that population obesity statistics change very little from year to year, something that seems to have been true even during the 1980s and 1990s when most of the increases in obesity prevalence in Western countries occurred. This is to say nothing of the growing consensus that overweight and obesity prevalence plateaued or reversed in many Western countries after 2000 (Gard 2011; Olds and Maher 2010; Olds et al. 2010; Rokholm, Baker, and Sørensen 2010). If we must measure fatness, however, the advantage of constant year-on-year surveillance over, say, national surveys every five or ten years is difficult to see. In one respect I am not convinced that obesity researchers are much interested in precise obesity statistics at all. For example, at numerous conferences the response

Critical Engagement with Canadian Weight Statistics  49

among mainstream researchers to my own work describing the levelling off of obesity statistics around the world post-2000 has essentially been to say, “Well, regardless of the numbers, there are still too many fat people.” In other words, mainstream obesity researchers have been happy to invoke statistics to create the impression of a rapidly worsening crisis, but when faced with evidence that paints a less-dramatic picture, they often dismiss these statistics as unimportant. Rather than seeing obesity statistics as elucidating important empirical truths about Canadian bodies, my suggestion is that we might more profitably see them as artefacts that tell us something about prevailing ideologies, anxieties, and policy priorities at given points in time. Rather than explaining the past or charting a precise course into the future, obesity statistics – and, importantly, their absence – recall the particular influence of energetic and committed individuals, the very recent emergence of a global obesity sensibility inclined to make statistical comparisons between nations, and the constantly shifting focus of public health resources. But if one is determined to mine the statistics for scientific facts, even here there are some important counter-crisis narratives to tell. These include the relative stability of female overweight and obesity in Canada over the last forty years (and particularly the last ten to fifteen), the historic and ongoing variability in population prevalence estimates (particularly for children), and the socioeconomically linked (and, perhaps, socioeconomically driven) statistical differences between Canada and the United States. Writing some years before the introduction of the Canadian Health Measures Survey that now continuously assesses the body weight of Canadians, Jutel (2001) compared health policy documents in Australia, the United States, Canada, and France and their approach to obesity. She concluded that while Australian and American documents tended to privilege measured weight and ignore non-quantifiable information such as a person’s history and their own self-assessment, French and Canadian approaches seemed more sensitive to the potential harm of focusing on a particular BMI or body weight. She also noted that, in Australia and the United States, the weight-loss industry was clearly implicated in policy frameworks that refused to acknowledge any difference between people who want to lose weight and those who should lose weight. Was there something peculiarly Canadian about Canada’s apparent tardiness in implementing an intensive publically funded body weight

50  Michael Gard

surveillance system? What I think we can say with more confidence is that, as the empirical history since Lionel Bradley Pett shows, the enthusiasm and resources required to measure and know exactly what people do with their bodies and put into their mouths will wax and wane. While it is debatable whether these statistics help to solve the problem they are purported to address, they are, I think, more obviously a trace of the fleeting and specific anxieties that Western life generates. This does not mean they are devoid of medical significance, but it does suggest that their existence is neither normal nor inevitable and that there are probably sound reasons for keeping a close scholarly eye on the purposes to which they are put and the health policies they spawn. On the other hand, while I have argued that overweight and obesity statistics are open to multiple interpretations, there are risks associated with treating them in an overly cavalier fashion. For example, in the context of a critical obesity/weight/fat studies literature to which I have attempted to contribute, I am inclined to be cautious about making morally flavoured arguments about obesity science in general. To some extent this is unavoidable, but in the hands of some critical scholars the construction of an “obesity epidemic” is, in and of itself, evidence of oppression or prejudice directed at specific groups of people. My concern is that these are rather easy arguments to make, and made easier still if one chooses to ignore the central role statistics have played in generating the phenomena studied by critical scholars of fatness. It is true that obesity science is the product of interested human action, and this makes bias and prejudice an inevitable part of the enterprise. But we must remember also that people involve themselves in science for a range of noble, idealistic, and mundane reasons. Any critique that does not robustly engage with the motivations and assumptions of obesity science, while not completely invalid, is likely to change fewer minds than it otherwise might. Rather than seeing the artefacts of obesity science, and particularly its statistics, as irredeemably tainted, critical scholars could treat them as resources to be mined and exploited for subversive ends. For example, from my point of view, the most important reason for doing critical scholarship into fatness or obesity is to make a contribution to debates about policy. This can take many forms, but for me it has meant writing for and speaking to both academic and non-academic audiences about what policies the findings of obesity science do or do not appear to license. As a physical educator, I have been particularly

Critical Engagement with Canadian Weight Statistics  51

interested in anti-obesity policies and interventions implemented in schools. However, regardless of the context, my argument here is that advocacy almost always means an engagement with differing points of view, and in the sphere of obesity the medico-scientific paradigm is hegemonic. So, rather than avoiding or dealing superficially with them, dissident thinkers need to be able to make careful and credible use of the science and statistics of obesity, not because the language of science is the only one worth speaking, but because those who question dominant orthodoxies will always be held to a higher standard than those who simply recycle them. This is no doubt a double standard, but probably as it should be. Taking a position against obesity orthodoxies immediately raises the suspicion of scientific ignorance, and this is a matter that needs to be dealt with skilfully and decisively. More than this though, as I have tried to show in this chapter, there are interpretations of obesity statistics that speak against the rhetoric of unbridled crisis and the abject pathologization of fatness. But as with all scholarship, what is required is a familiarity with the evidence that might be marshalled for and against the points of view one is inclined to argue for. Without these foundations, one’s arguments will only ever satisfy those who already agree with them. NOTE 1 The Body Mass Index has been the subject of sustained criticism in the literature, mainly because it is an indirect measure of fatness. Despite its obvious potential shortcomings, particularly if used uncritically to assess the health of individuals, it remains the most widely used instrument for collecting population-scale body-weight status data and it enjoys qualified general support among researchers.

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52  Michael Gard Bramley, D., P. Herbert, R.T. Jackson, and M. Chassin. 2004. “Indigenous Disparities in Disease-Specific Mortality, A Cross-Country Comparison: New Zealand, Australia, Canada, and the United States.” New Zealand Medical Journal 117 (1207): U1215. Cole, T.J., M.C. Bellizzi, K.M. Flegal, and W.H. Dietz. 2000. “Establishing a Standard Definition for Child Overweight and Obesity Worldwide: International Survey.” British Journal of Medicine 320 (7244): 1240–3. http:// dx.doi.org/10.1136/bmj.320.7244.1240. Connor Gorber, S., M. Tremblay, D. Moher, and B. Gorber. 2007. “A Comparison of Direct vs. Self-Report Measures for Assessing Height, Weight and Body Mass Index: A Systematic Review.” Obesity Reviews 8 (4): 307–26. http://dx.doi.org/10.1111/j.1467-789X.2007.00347.x. Flegal, K.M., B.K. Kit, H. Orpana, and B.I. Graubard. 2013. “Association of All-Cause Mortality with Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis.” Journal of the American Medical Association 309 (1): 71–82. http://dx.doi.org/10.1001/ jama.2012.113905. Freedson, P.S., K.J. Cureton, and G.W. Heath. 2000. “Status of Field-Based Fitness Testing in Children and Youth.” Preventive Medicine 31 (2): S77–85. http://dx.doi.org/10.1006/pmed.2000.0650. Gard, Michael. 2011. The End of the Obesity Epidemic. London: Routledge. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. London: Routledge. Garriguet, D. 2008. “Obesity and the Eating Habits of the Aboriginal Population.” Health Reports 19 (1): 21–35. Gould, S.J. 1996. The Mismeasure of Man. New York: W.W. Norton. He, M., and C. Beynon. 2006. “Prevalence of Overweight and Obesity in School-Aged Children.” Canadian Journal of Dietetic Practice and Research 67 (3): 125–9. http://dx.doi.org/10.3148/67.3.2006.125. Jutel, A. 2001. “Does Size Really Matter? Weight and Values in Public Health.” Perspectives in Biology and Medicine 44 (2): 283–96. http://dx.doi.org/ 10.1353/pbm.2001.0027. Katzmarzyk, P.T. 2002a. “The Canadian Obesity Epidemic: An Historical Perspective.” Obesity Research 10 (7): 666–74. http://dx.doi.org/10.1038/ oby.2002.90. – 2002b. “The Canadian Obesity Epidemic, 1985–1998.” Canadian Medical Association Journal 166 (8): 1039–40. Kirk, D. 1998. Schooling Bodies: School Practice and Public Discourse 1880–1950. London: Leicester University Press. Kraus, H., and R.P. Hirshland. 1954. “Minimum Muscular Fitness Tests in School Children.” Research Quarterly 25 (2): 178–87.

Critical Engagement with Canadian Weight Statistics  53 Krieger, N. 1994. “Epidemiology and the Web of Causation: Has Anyone Seen the Spider?” Social Science & Medicine 39 (7): 887–903. http://dx.doi. org/10.1016/0277-9536(94)90202-X. McElroy, M. 2008. “A Sociohistorical Analysis of U.S. Youth Physical Activity and Sedentary Behavior.” In Youth Physical Activity and Sedentary Behavior: Challenges and Solutions, ed. A.L. Smith and S.J.H. Biddle, 59–78. Champaign, IL: Human Kinetics. McLaren, L. 2007. “Socioeconomic Status and Obesity.” Epidemiologic Reviews 29 (1): 29–48. http://dx.doi.org/10.1093/epirev/mxm001. McMahon, B., T.F. Pugh, and J. Ipsen. 1960. Epidemiologic Methods. Boston: Little, Brown. Mosby, I. 2011. “‘Food Will Win the War’: The Politics and Culture of Food and Nutrition during the Second World War.” Doctoral diss., York University, Toronto. Naughton, G.A., J.S. Carlson, and D.A. Greene. 2006. “A Challenge to Fitness Testing in Primary Schools.” Journal of Science and Medicine in Sport 9 (1–2): 40–5. http://dx.doi.org/10.1016/j.jsams.2006.01.002. Norton, K., J. Dollman, M. Martin, and N. Harten. 2006. “Descriptive Epidemiology of Childhood Overweight and Obesity in Australia: 1901– 2003.” International Journal of Pediatric Obesity: IJPO 1 (4): 232–8. http:// dx.doi.org/10.1080/17477160600962856. Okasha, M., P. McCarron, G.D. Smith, and D. Gunnell. 2003. “Trends in Body Mass Index from 1948 to 1968: Results from the Glasgow Alumni Cohort.” International Journal of Obesity 27 (5): 638–40. http://dx.doi.org/10.1038/ sj.ijo.0802279. Olds, T., and C. Maher. 2010. “Global Trends in Childhood Overweight and Obesity in Developed Countries.” In Childhood Obesity Prevention – International Research, Controversies and Interventions, ed. J. O’Dea and M. Eriksen, 69–83. Oxford: Oxford University Press. http://dx.doi.org/ 10.1093/acprof:oso/9780199572915.003.0006. Olds, T.S., G.R. Tomkinson, K.E. Ferrar, and C.A. Maher. 2010. “Trends in the Prevalence of Childhood Overweight and Obesity in Australia between 1985 and 2008.” International Journal of Obesity 34 (1): 57–66. http://dx.doi .org/10.1038/ijo.2009.211. Oliver, J.E. 2006. Fat Politics: The Real Story behind America’s Obesity Epidemic. Oxford: Oxford University Press. Olshansky, S.J., D.J. Passaro, R.C. Hershow, J. Layden, B.A. Carnes, J. Brody, L. Hayflick, R.N. Butler, D.B. Allison, and D.S. Ludwig. 2005. “A Potential Decline in Life Expectancy in the United States in the 21st Century.” New England Journal of Medicine 352 (11): 1138–45. http://dx.doi.org/10.1056/ NEJMsr043743.

54  Michael Gard Ostry, A.S. 2006. Nutrition Policy in Canada, 1870–1939. Vancouver: University of British Columbia Press. Pett, L.B. 1955. “A Canadian Table of Average Weights for Height, Age, and Sex.” American Journal of Public Health 45 (7): 862–8. http://dx.doi. org/10.2105/AJPH.45.7.862. Pett, L.B., and F.W. Hanley. 1947. “A Nutrition Survey among School Children in British Columbia and Saskatchewan.” Canadian Medical Association Journal 56 (2): 187–92. Pett, L.B., and G.F. Ogilvie. 1956. “The Canadian Weight-Height Survey.” Human Biology 28 (2): 177–88. Phipps, S.A., P.S. Burton, L.S. Osberg, and L.N. Lethbridge. 2006. “Poverty and the Extent of Child Obesity in Canada, Norway and the United States.” Obesity Reviews 7 (1): 5–12. http://dx.doi. org/10.1111/j.1467-789X.2006.00217.x. Rokholm, B., J.L. Baker, and T.I.A. Sørensen. 2010. “The Levelling Off of the Obesity Epidemic since the Year 1999 – A Review of Evidence and Perspectives.” Obesity Reviews 11 (12): 835–46. http://dx.doi. org/10.1111/j.1467-789X.2010.00810.x. Shields, M., M.D. Carroll, and C.L. Ogden. 2011. Adult Obesity Prevalence in Canada and the United States. NCHS data brief, no 56. Hyattsville, MD: National Center for Health Statistics. Sobal, J. 1995. “The Medicalization and Demedicalization of Obesity.” In Eating Agendas: Food and Nutrition as Social Problems, ed. D. Maurer and J. Sobal, 67–90. New York: Aldine de Gruyter. Sobal, J., and A.J. Stunkard. 1989. “Socioeconomic Status and Obesity: A Review of the Literature.” Psychological Bulletin 105 (2): 260–75. http:// dx.doi.org/10.1037/0033-2909.105.2.260. Statistics Canada. 2012a. Canadian Health Measures Survey (CHMS). http:// www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5071. Accessed 17 September 2012. – 2012b. Health Trends – Obese. http://www12.statcan.gc.ca/healthsante/82-213/Op2.cfm?Lang=ENG&TABID=0&LINE_ID=2110&IND=ASR &SX=TOTAL&change=no&S=9&O=A. Accessed 17 September 2012. – 2012c. Health Trends – Overweight or Obese. http://www12.statcan.gc.ca/ health-sante/82-213/Op2.cfm?Lang=ENG&TABID=0&LINE_ID=2050&IND =ASR&SX=TOTAL&change=no&S=9&O=A. Accessed 17 September 2012. Stewart, S.T., D.M. Cutler, and A.B. Rosen. 2009. “Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy.” New England Journal of Medicine 361 (23): 2252–60. http://dx.doi.org/10.1056/NEJMsa0900459.

Critical Engagement with Canadian Weight Statistics  55 Strauss, R.S. 1999. “Comparison of Measured and Self-Reported Weight and Height in a Cross-sectional Sample of Young Adolescents.” International Journal of Obesity and Related Metabolic Disorders 23 (8): 904–8. http://dx.doi .org/10.1038/sj.ijo.0800971. Stunkard, A., E. d’Aquili, S. Fox, and R.D.L. Filion. 1972. “Influence of Social Class on Obesity and Thinness in Children.” Journal of the American Medical Association 221 (6): 579–84. http://dx.doi.org/10.1001/ jama.1972.03200190023005. Tremblay, M. 2004. “The Need for Directly Measured Health Data in Canada.” Canadian Journal of Public Health 95 (3): 165–6. Tremblay, M.S., P.T. Katzmarzyk, and J.D. Willms. 2002. “Temporal Trends in Overweight and Obesity in Canada, 1981–1996.” International Journal of Obesity 26 (4): 538–43. http://dx.doi.org/10.1038/sj.ijo.0801923. Tremblay, M.S., and J.D. Willms. 2000. “Secular Trends in the Body Mass Index of Canadian Children.” Canadian Medical Association Journal 163 (11): 1429–33. Vanasse, A., M. Demers, A. Hemiari, and J. Courteau. 2006. “Obesity in Canada: Where and How Many?” International Journal of Obesity 30 (4): 677–83. http://dx.doi.org/10.1038/sj.ijo.0803168. Ward, H., V. Tarasuk, and R. Mendelson. 2007. “Socioeconomic Patterns of Obesity in Canada: Modeling the Role of Health Behaviour.” Applied Physiology, Nutrition, and Metabolism 32 (2): 206–16. http://dx.doi.org/ 10.1139/h06-104. Willms, J. Douglas, Mark S. Tremblay, and P.T. Katzmarzyk. 2003. “Geographic and Demographic Variation in the Prevalence of Overweight Canadian Children.” Obesity Research 11 (5): 668–73. http://dx.doi.org/10.1038/ oby.2003.95.

2 “Obesity” as Process: The Medicalization of Fatness by Canadian Researchers, 1971–2010 Elise Par adis

Most people today see obesity as a public health crisis. Nationally representative Canadian data suggest that approximately two-thirds of the population are “overweight” and one-third are “obese.” “Experts” tell us that fat kills, that the current generation of children will not outlive their parents’ generation, and that health care for “the fat of the land” will be extremely costly (Gard 2010). Some note how fat has become “Public Health Enemy Number One” (Thatcher 2004). This discourse has been analysed sociologically as a kind of moral panic: a situation where a marginalized behaviour or group comes to be perceived as a threat to the morals, values, or interests of society as a whole and stands as the reification or embodiment of a generalized social anxiety (Cohen 1980). But it can also be analysed socio-historically within a construction-of-reality framework, which stresses the formation of “facts” through discourse (Berger and Luckmann 1989; Hacking 1999; Latour 1987; Latour and Woolgar 1986). In this chapter, I investigate the transformation of body fat in the Canadian medical literature, using methods inspired by the Stanford School of neo-institutionalism (Drori et al. 2003; Frank and Meyer 2007; Meyer et al. 1997; Meyer and Jepperson 2000; Ramírez, Suárez, and Meyer 2007). Among other things, neo-institutionalism is concerned with processes of legitimation and in the evolution of meaning at the macro or aggregate level. I evaluate how fat has been medicalized (Conrad 1992, 2005; Sobal 1995; Zola 1983) by Canadian researchers by examining their research output in medical publications. Constructing Illness and the Medicalization of Society Sociologists of medicine have built upon a long tradition in the sociology of knowledge that has from its very beginning seen ideas as “reflections

Medicalization of Fatness by Canadian Researchers  57

of the specific historical and social environments in which they are produced” (Barker 2010, 147). The founding fathers of sociology – Durkheim, Marx, and Weber – all recognized the connection between a society’s beliefs and its material and social conditions. Mannheim (1998 [1936]) and Merton (1937) both urged sociologists to study ideas and their socio-historical contexts; and Berger and Luckmann (1989 [1966]), in one of the most cited sociological texts in history, discussed the extent to which ideas shape individual behaviour, arguing that these ideas strongly depend on historical, economic, and social conditions. Sociologists of medicine see health and illness like any other ideas: as actively and socially constructed. They note how a disease does not officially exist until the cultural authority of medicine (Starr 1982) establishes it as a “real,” legitimate disease and creates an associated disease category. For decades now, obesity has figured in the pages of the Inter­ national Classification of Diseases, a catalogue of all “officially” recognized diseases and the supreme authority that distinguishes “real” disease from the fake. For the medical and public health communities, then, obesity is a real disease. Understanding health and illness as social and historical processes rather than merely biological entities makes them amenable to sociological inquiry (Hansen and Easthope 2007; Paradis, Webster, and Kuper, 2013). At the intersection of knowledge and medicine, one avenue of sociology highlights the contingent and cultural nature of disease and maps the different factors that contribute to its “construction” – what Brown (1995) calls the social construction of medical knowledge. Researchers ask such questions as: Who were the main actors in identifying and naming the disease? Which steps enabled its reification? What trajectory (if any) did the disease take in the public consciousness? What types of responses did society develop? Key studies include Fleck’s work on syphilis (1979), Latour and Woolgar’s (1986) laboratory study of the creation of the peptide thyrotropin-releasing factor or hormone TRF(H) (a molecule with several clinical applications), Brumberg’s (2000) study of anorexia nervosa, and Epstein’s (1998) study of HIV/AIDS. The social construction of disease is often framed within the broader context of what sociologists have called “medicalization.” Medicaliza­ tion is “the expansion of medical jurisdiction, authority, and practices into new realms” (Clarke et al. 2003, 161) or, according to another definition, “a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders” (Conrad 1992, 209). To some, medicalization has enabled medicine’s

58  Elise Paradis

dominance over all aspects of life and is a form of social control (Illich 1976; Zola 1972); to others, it also facilitated sociology’s foray into medicine (Hansen and Easthope 2007; Strong 1979). I understand medicalization as the process whereby a previously nonmedical issue – in this case, body fat – comes to be understood in medical terms. It’s also the process through which the medical gaze and its range of diagnostic tools and solutions come to be used in the issue’s evaluation and “treatment.” Medicalization is also partly political, transforming power relations between the previously healthy “sick” and medicine as an establishment (Moynihan, Heath, and Henry 2002, 886). To study the medicalization of body fat through an analysis of publications on the subject, then, is to study the discursive making of obesity into a disease, and so is likely to shed light on the processes whereby fatness was constructed as public health crisis number one today. Previous Perspectives on the Medicalization of Fat The literature on the medicalization of fat is large and growing. Given this chapter’s focus on history, I review only those studies pertaining to the medicalization process over time to generate hypotheses about expected trends in the medical literature on fat. Several historians and feminist scholars (see Ellison and Rice, both in this volume) have studied the evolution of what societies see as “ideal” bodies over time and this ideal’s connection to medicine. Schwartz (1986) stresses the importance of medicine and medical approaches to the history of dieting, tracing our cultural focus on weight back to 1776, a year when angina pectoris was first connected to excess weight. The late nineteenth century was a turning point in the medicalization of fat (Schwartz 1986, Stearns 2002). Fraser (2009) emphasizes the impact that food abundance, mediated by class standards, consumerism, religion, and medicine, had on bodily standards: plumpness, once a sign of wealth and health, became a sign of indulgence, immorality, and sickness. One early sociological account of fat’s medicalization in the United States was written by Sobal (1995), who carefully dissects “obesity” using medicalization theory and a social-problems perspective. He distinguishes between three main models of fatness: a moral/deviance model that condemns fatness as bad; an illness model that medicalizes fat and positions medicine as the ultimate solution to fatness; and a de-­medicalized/political model of fatness, which rejects the medical

Medicalization of Fatness by Canadian Researchers  59

claims of illness and focuses on the rights of fat people. In doing so, Sobal identifies several key aspects of the medicalization of fat, such as the growth of the risk discourse, the rise of organizational activity to fight obesity, and the development of bariatric surgery and weight-­ loss medication. Studying the medicalization of fat over time, Saguy and Riley (2005) showed how the medical literature as it is recorded in the PubMed database preceded the media in positioning obesity as a topic of interest. Starting in the early 1990s, the media coverage of obesity ballooned, along with interest in scientific articles. Both lay and scientific articles blamed individuals for their obesity (rather than the environment or genetics), pushed for individual-level solutions (rather than policy changes), and advocated for surgery. Several studies have shown the importance of social context in shaping attitudes – both lay and medical – towards body fat (Saguy, Gruys, and Gong 2010; Stearns 2002), comparing the French and American attitudes towards dieting and weight. Stearns, in his pioneering work, argues that while the French have an aesthetic/health approach to weight, Americans have a moralistic/health approach to weight. Both cultures have internalized that fatness is bad for your health; for the French, fatness is also seen as ugly, whereas for Americans, fatness is an indication of moral failure and badness. On the basis of another comparative study of France and the United States, Saguy, Gruys, and Gong (2010) argue that financial dominance and cultural dominance are distinct forces that shape national beliefs about obesity and thus the representation of obesity in the media. With this in mind, we can expect the Canadian experience to differ from the American and French experiences. Canada is neither financially or culturally dominant, but nor do its citizens experience the Protestant, individualistic ethic of the United States to the same omnipresent extent (Fetner and Sanders 2012).

The Canadian Experience Canada, as a member of the United Nations and the World Health ­Organization (WHO), has been responsive to the 2000 WHO report Obesity: Preventing and Managing the Global Epidemic, which shows obesity rates to have increased for men, but not for women, between 1978 and 1988 (WHO Expert Committee 2000, 22). Canada started collecting systematic data on nutrition, weight, and height in 2001, as part of its Canadian Community Health Survey. As Gard illustrates in this

60  Elise Paradis

volume, Canada was comparatively late in the global drive to collect population-level height and weight data. Importantly, he notes that “the impulse to systematically collect population-scale data on the size, shape, and capacities of human bodies flares haphazardly through time and space,” pointing to the deeply historical, sociological, and political aspects of the recent Canadian obsession with fatness. Arguably, the Canadian discourse has considered the social and economic factors that underpin rising obesity rates to a greater extent than the American discourse. Jutel (2001, 292), for instance, pointed out that a 1988 document by Health and Welfare Canada (1988) pushed for concern with weight in general rather than overweight and obesity specifically, emphasizing the wide range of acceptable weights and the importance of a positive body image. The Canadian evaluation of materials later evaluated by the (American) National Institutes of Health (1998) also had less fatalistic conclusions about the negative impact of weight and emphasized health rather than weight loss. In recent years, the pressure to make obesity into a priority area for Canadian policy in research has grown and, as we will see, publication rates have followed. Katzmarzyk (2002) almost invented the “Canadi­ an obesity epidemic” in the title of his oft-cited epidemiological paper, noting the importance of making obesity a “public health priority” (673). In 2004, Quebec’s Groupe de travail provincial sur la problématique du poids published a report urging immediate action. It describes the causes behind obesity as a “causal web of factors” (12) that include international, national/regional, community, and individual factors. Similarly, Thatcher (2004, 30) notes that while controlling weight can be seen as a “personal issue, it is, more fundamentally, a matter of politics and economics.” A report by Starky for the Library of Parliament, while uncritically positioning obesity as an epidemic and a large economic burden, concludes with an invitation to consider and address “social, economic, physical and environmental factors” to “support Canadians in making healthy choices” (2005, 13). Statistics Canada (2006) reported on obesity rates as part of its health reports in the same year the Canadian Obesity Network, a leading anti-obesity advocacy group in Canada, was founded. Two years later, Health Canada (2008) discussed obesity trends as part of its Healthy Canadians 2008 Federal Report, and obesity was clearly on the Canadian health agenda. In line with these findings, Jennings (2009) studied the websites of four Canadian provincial governments and found a general absence of policies targeting fat people individually. She also found that Quebec

Medicalization of Fatness by Canadian Researchers  61

mentioned the sociocultural and economic factors behind fatness more often than did Ontario, British Columbia, and Alberta. Holmes’s (2009) analysis of Canadian media portrayals of the obesity epidemic suggests trends that break from those found by other scholars in the United States (Oliver 2006; Saguy and Almeling 2008), the United Kingdom, and Australia (Gard and Wright 2005). She found that although the obesity epidemic largely remains unquestioned, the discourse on Western decadence and decline wasn’t present in news articles. Similarly, Canadians emphasized individual agency and strength rather than weakness and individual failure to exercise weight control. Canadian scholars have been developing alternatives to the mainstream biomedical model of obesity for decades. Polivy and colleagues’ work on the harms of dieting (see McFarlane, Polivy, and McCabe 1999; Polivy and Herman 1987), Ciliska’s (1990) on “non-dieting” approaches to care for obese women, and Gingras’ “Health at Every Size” (2005) are only a few such examples. Methodology My methodology is inspired by the macro-sociological approach of John Meyer, Francisco Ramírez, and colleagues at Stanford University. They study processes of legitimation – how certain ideas come to spread around the world and come to be taken for granted. Among other things, they studied the historical growth of higher education (Frank and Meyer 2007; Schofer and Meyer 2005), the growing importance of science worldwide (Drori et al. 2003), and the rise of the human rights movement (Meyer, Bromley, and Ramírez 2010; Ramírez, Suárez, and Meyer 2007). I have also recently applied this longitudinal, comparative approach to obesity research (2011), analysing obesity-related publications from 1950 to 2010 and establishing a timeline to show where fat as merely fat became “obesity” in the early 1970s, an epidemic in the mid-1990s, and since 2000 has morphed into general anxiety about the future with the turn to childhood obesity. Skolbekken (1995) conducted a similar study of risk using aggregate trends among scientific publications, but constrained data availability and information analysis techniques at the time limited his ability to control for the expansion of medical knowledge. Comparing the literature on body fat (the medicalized, i.e., publications on obesity) with secular trends on obesity (the medical, i.e., the obesity rate in the population) yields a vivid portrait of the process, but so does a closer reading of the medicalized over time.

62  Elise Paradis

Data Sources

Weight Trends Different types of data about weight and height in the Canadian population are available: self-reported and measured. Because self-reported weight and height tend to be systematically distorted (Shields et al. 2011; Shields, Connor Gorber, and Tremblay 2008), the data I used for this chapter come strictly from nationally representative studies where researchers measured them directly. Data were taken from several sources and provide six different time points between 1971 and 2008 (see Table 1). As Gard notes earlier in this volume, Canadian data are far from perfect and haven’t been systematic; they are, however, sufficiently precise here given our comparative emphasis.

Publication Trends Given this chapter’s focus on the medicalization of fat by Canadian researchers, as opposed to the popular press, the search was restricted to medical articles. Data about medical articles on obesity published in or about Canada were collected from the PubMed database on 5 January 2013 using queries of the following form: ((keyword) AND (Canada)) AND (“1950”[Date – Publication]: “3000”[Date – Publication]). The fifteen different “keywords” were: acoria, bariatrics, bariatric surgery, corpulence, gastroplasty, hyperorexia, obese, obesity, obesogenic, polycsarcia, weight gain, and weight loss. PubMed/MEDLINE is the largest medical database in the world, and is maintained by the US-based National Center for Biotechnical Information (NCBI 2013). Although it doesn’t cover all the medical literature published every year, it is the most comprehensive medical database available. I initially chose 1950 as a start date given the rise in scientific enterprise after World War II. Meta-data obtained from these queries were then merged by PubMed ID to keep one record per publication, for a total of 8,283 articles over the 1950–2012 period. Data were then censored to cover either the 1971–2008 time period (for comparison with weight trends; n = 5,703) or the 1985–2010 time period (for longitudinal analyses of titles; n = 7,090). Left censoring was done for data before 1985, given the major shift seen that year in the numbers of publications: from 1950 to 1984, publications range between one and twelve per year (mean = 3; SD = 2.8), and after 1985

Medicalization of Fatness by Canadian Researchers  63 Table 1. Sources of data, Canadian obesity trends Year

Survey

Source

1971

Nutrition Canada Survey, 1970–72

Katzmarzyk (2002)

1979

Canada Health Survey, 1978–9

Tjepkema (2006)

1989

Canadian Heart Health Surveys, 1986–92

Shields & Tjepkema (2006)

2004

Canadian Community Health Survey, Nutrition, 2004

Tjepkema (2005)

2005

Canadian Community Health Survey, 2005

Shields et al. (2011)

2008

Calculated Average from: Canadian Community Health Survey, 2008

Shields et al. (2011)

Canadian Health Measures Survey, 2007–9

Shields et al. (2011)

explode to reach 788 in 2010, with a mean of 273 publications per year (SD = 196.1). Right censoring was done to guarantee a full year’s worth of data since data input into PubMed lags actual publication.

Analysis To analyse publication trends, I identified different aspects of the medicalization of fat and generated hypotheses inductively from the literature (see below). A coding scheme of 190 keywords (see Appen­ dix) was thus developed. To code the titles of the 7,090 publications identified I used Python Version 3.2.3 for Mac OS X; the coding scheme covered 79.4 per cent of all article titles. Both weight and publication data were normalized using 1989 rates to enable comparison of growth. All data were analysed using R version R 2.15.0 for Mac OS X Leopard. Although coding the 6,889 titles between 1985 and 2010 does not give us access to the language and meanings used in the full text of the articles themselves, titles are deliberate choices made by researchers to convey meaning and situate their research within the scientific debates of the day. The importance of titles in summarizing the content of an article and as a strategy to attract readers’ attention suggests that coding titles yields an impressionistic portrait of the literature’s evolution.

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Results

Weight Trends vs. Publication Trends, 1971–2008 Figure 3 shows three different longitudinal graphs representing growth in publications on obesity as I defined it earlier (Panel A), growth of obesity rates in the Canadian population (Panel B), and comparison between both, put on the same scale (with frequencies normalized for 1989 = 100; Panel C). Panel A shows the first dramatic rise of publications in the late 1980s, followed by a linear increase in articles until the late 1990s, where we find a second inflection point. Major growth, however, happened after 2002, when the graph gets almost vertical, peaking at 788 articles in 2010. Panel B shows increased prevalence in the 1970s, a plateau in the 1980s, followed by a linear rise since the early 1990s. The trend for the average of both sexes peaks at 24.6 per cent in 2005. Com­paring Panels A and B shows no obvious connection between obesity rates and the surge in publications in the late 1980s. The first publication growth spurt happened in a period where weights were stable, maybe as a response to the growth seen in the previous decade; similarly, the second publication growth spurt also lagged behind increasing weights. Panel C shows the magnitude of the gap between normalized publication trends and weight trends: the weight trends look almost flat compared to those of publications. Growth among publications was 382 times greater than growth of weight trends (149.5 per cent vs. 57,200 per cent). Similarly, publications in 2008 are just over four times more frequent than they were in 1989, while obesity rates were only 1.7 times greater over the period. These charts clearly show the rising medicalization of fat over the time period: the increase is dramatic and undeniable, dwarfing actual rises in population weights.

Aspects of the Medicalization of Fat in the Literature, 1985–2000 A review of the literature on three main aspects of the medicalization of fat – medical language, medical diagnosis, and medical solutions – helps us to develop and test hypotheses relating to the medicalization of fat in Canadian medical publications. I use Sobal’s (1995) article on the medicalization of fat as a starting point. Because publications were comparatively scarce before 1985 (as Figure 3, panel A, makes clear), my data analysis focuses on articles published in or after 1985.

Medicalization of Fatness by Canadian Researchers  65 Figure 3. Publication vs. Weight Trends in Canada, 1971-2008 450 400

Normalized value

350 300 250 Publications Obesity

200 150 100

0

1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

50

Year

Figure 3.  Publication vs. weight trends in Canada, 1971–2008

Medical Language Medicalization often leads to the creation and adoption of a medicalsounding vocabulary to describe the object being medicalized and give the pursuit of its study a scientific veneer. For example, Sobal (1995, 71) notes the popularization of the term obesity in the 1970s and the associated decline of corpulence in the medical literature. He also points to the creation of the neologism bariatric and to the development of bariatrics as a medical specialty in 1973. In 2000 the World Health Organization released a report called Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation. This report constructed obesity as a global epidemic – a global public health crisis. The increased awareness around this public health crisis has been described by Saguy and Riley (2005) as well as in my own earlier work (2011) as starting in the early 2000s.

66  Elise Paradis

Since the early 1990s, scholars have noted the prominence of risk discourse and defined our contemporary societies as “risk societies” (Beck 1992; Mythen and Walklate 2006), particularly in the public health domain (Lupton 1993; Lupton, McCarthy, and Chapman 1995; McDermott 2007; Skolbekken 1995). The rise of epidemiology over the course of the twentieth century has transformed our understanding of health and illness, and was instrumental in the development of the obesity epidemic discourse (Oliver 2006; see also the chapters by Gard, by Ward, and by McNaughton and Smith in this volume). Based on these studies we can make the following hypotheses with respect to the Canadian medical literature: Hypothesis 1: Obesity and overweight should take up an increasingly large part of the literature. (Codes: obesity, overweight.) Hypothesis 2: The growth of medicalized fat-related terms should be greater than that of lay terms over time. (Codes: high medicalization:­ adipocyte, adipose, lipid, bariatrics, polyphagia; medium: obese, obesity, obesogenic, overweight; low: corpulence, fat, weight.) Hypothesis 3: A stark growth in the use of the term epidemic should be seen starting in the early 2000s. (Code: epidemic.) Hypothesis 4: The use of risk in titles should rise starting in the late 1980s and escalate rapidly over time. (Code: risk.) Figure 4 shows publication trends for “obesity” and “overweight” as a percentage of the sample. The words obese/obesity (4,562 articles, or 66.2% of sample) and overweight (3,075 articles, or 44.6% of the sample) follow similar trends, with a slight decline in the late 1980s before a continued slow growth, rather than unmediated growth. The word obesity is more frequent in the literature throughout the period. Thus the first hypothesis has been confirmed. Figure 5 shows publication trends on fat-related language, broken down by level of medicalization. The literature is dominated by the words obesity, obese, and overweight, which were coded in the middle category of medicalization. This category first declined as a proportion of the sample until the 1990s but has been growing since. Lay language (i.e., corpulence, fat, weight) oscillated over most of the time period, but has been on a slow rise since the early 1990s. Meanwhile, high-­ medicalization language has been on the decline since the late 1980s. We cannot confirm hypothesis 2; rather, it is mid-level medicalization terms that have come to dominate the medical discourse.

Medicalization of Fatness by Canadian Researchers  67 Figure 4: Obesity and Overweight as % of Sample 90 80 70

% of sample

60 50 Obesity/Obese Overweight

40 30 20 10

19

8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 94 19 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 0 20 3 04 20 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 10

0

Year

Figure 4.  Obesity and overweight as percentage of sample

The use of the word epidemic in publication titles is not as prevalent in the Canadian literature as in the American literature, with a count of merely thirty-one articles over the period (or 0.44 per cent; see Fig­ ure  6). The earliest article was published in 1994; the late 1990s and early 2000s saw several new publications but peaked at merely five per year in 2010. Overall, then, the count of publications is too low for us to confirm hypothesis 3. Figure 6 also shows how the use of the term risk (457 articles, 6.4 per cent) has been on a steep upward trend since the early 1990s, after a sharp decline in the late 1980s. It peaked at 10 per cent of the sample in 2009. The use of risk in the Canadian literature lagged behind our expectations in hypothesis 4 by ten years; the growth has been sustained since the early 1990s. Taken together, these charts show the evolution of medical language in line with medicalization theory. The pattern is more complex than expected, however: medicalization has not reached the highest linguistic levels, and the expected dominance of the term epidemic starting in 2000 wasn’t seen, showing a clear contrast with the American literature.

68  Elise Paradis

Figure 5: Fat Related Terms by Degree of Medicalization as % of Sample

90 80 70

% of Sample

60 50 High Medium Low

40 30 20 10

93 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10

92

19

91

19

19

90

89

19

19

88

19

87

86

19

19

19

19

85

0

Year

Figure 5.  Fat-related terms by degree of medicalization as percentage of sample

Medical Diagnosis: Body Mass Index The use of the body mass index (BMI) as a diagnostic tool for obesity is a recent but very important phenomenon (Anderson 2012). Indeed, it was only in 1985 that BMI was advocated as a reliable indicator of pathological levels of body fat in a National Institutes of Health (1985) report. Ten years later, a World Health Organization report written by an “expert committee” proposed “classification of BMI with the cutoff points 25, 30, and 40 for the three degrees of overweight,” namely grades 1, 2, and 3 overweight (1995, 312). Today these categories are called overweight, obesity, and morbid obesity, respectively. For children, it was only in 2000 that BMI standards were established (Cole et al. 2000), which enabled epidemiological research on childhood obesity. From these reports we can make the following hypotheses: Hypothesis 5: The use of BMI in titles should rise in the late 1980s and see increased growth after 1995. (Codes: BMI, body mass index.) Hypothesis 6: The number of articles on childhood obesity should increase dramatically after 2000.

Medicalization of Fatness by Canadian Researchers  69

Figure 6: Number of ‘Epidemic’ and ‘Risk’ Publications Over Time 12

10

% of sample

8

6 Epidemic Risk 4

2

92 19 9 19 3 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 0 20 3 04 20 05 20 06 20 07 20 08 20 09 20 10

91

19

90

89

19

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88

19

87

86

19

19

19

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85

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Year

Figure 6.  Number of “epidemic” and “risk” publications over time

Figure 7 shows publication trends for BMI and for child-associated BMI publications. A total of 151 articles contained BMI in their titles (2.1 per cent of the sample). The first publication on BMI came in 1990; BMI articles have seen a staggered growth as a proportion of the sample since 2000. The growth lagged about five years behind what hypothesis 5 expected. As for childhood and BMI, we see the first publications in the late 1990s and oscillating interest since then, for a total of 35 publications (0.5 per cent of the sample). There has been no dramatic increase in childhood BMI mentions among titles, and we have to reject hypothesis 6. Here again the story of medicalization is more complex than expected: the interest in BMI did increase, but growth was delayed and did not apply to childhood obesity, as was expected.

Medical Solutions Sobal (1995) argues that one aspect of obesity’s medicalization has been the development of medicine-specific “solutions” or “treatments” such as medically supervised dieting, surgery, medication, and psychiatry.

70  Elise Paradis Figure 7: BMI-Related Publications Per Year as % of Sample 5 4.5 4

% of Sample

3.5 3 2.5 BMI Childhood & BMI

2 1.5 1 0.5

19

8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 94 19 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 0 20 3 04 20 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 10

0

Year

Figure 7.  BMI-related publications per year as percentage of sample

Histories of dieting have shown a continued interest in medically supervised diets (Schwartz 1986; Taubes 2007). According to Sobal (1995), the glory days of bariatric surgery were in the 1970s, but recent interest in bariatric surgery in the social science literature (Saguy and Almeling 2008; Salant and Santry 2006; Throsby 2012) indicates a resurgence since the 2000s. Germov and Williams (1996) have suggested that the current public health messages about the problem of overweight combined with cultural imperatives for women to be slim have led to what they call an “epidemic of dieting women” (97). Recent scholarship has highlighted how men and children now also suffer from slimness imperatives (Bell and McNaughton 2007; Dworkin and Wachs 2009; Evans et al. 2002; Isono, Watkins, and Lian 2009; Schwartz 1986). Oliver traces the history of the “diseasing” of obesity to “changes in the supply and demand of medicine” as an institution and the rising importance of the “health-industrial complex” (2006, 617–18), both of which conspired to exert pressure on regulatory bodies to officially medicalize obesity, enable the flow of money from taxpayers and consumers to insurance and pharmaceutical companies, and give food

Medicalization of Fatness by Canadian Researchers  71

corporations a free pass. Accordingly, he sees the pharmaceutical industry as one of the main drivers behind the medicalization of fat. Rasmussen (2012) argues that psychiatry was a major factor in the medicalization of fatness in the 1940s and 1950s, turning fatness into not only a physical illness but also a sign of psychiatric illness (see also Rasmussen 2008). Reviews of the literature (McElroy et al. 2004; Rosen­ gren and Lissner 2008) and population-level data (McIntyre et al. 2006), however, suggest that stigmatization – not actual body size – might be a key contributor to mental health problems among obese patients, and some have noted that mood medication may have contributed to increasing weights in the population (Caplan 2012; Devlin, Yanovski, and Wilson 2000). Psychiatry is still very much involved in the treatment of obesity and hopes to be further involved in its treatment, as the obesity-themed January 2012 issue of the Canadian Journal of Psychiatry attests. Similarly, a sizable (American) literature now deals with the health consequences of weight-related stigma (Bayer 2008; Bell et al. 2010; Major and O’Brien 2005; Puhl and Brownell 2006; Puhl and Heuer 2009, 2010; Puhl and Latner 2007; Scambler 2009). Based on these studies we can make the following hypotheses: Hypothesis 7: Dieting should hold a prominent place among articles throughout the time period. (Codes: diet, dietary, dieting, food, nutrition.) Hypothesis 8: Surgery-related terms should increase in the 1970s, and again in the 2000s. (Codes: surgery, bariatric surgery, gastroplasty, surgical.) Hypothesis 9: Medication-related terms should increase over time. (Codes: anorexiant, appetite suppressant, drug, medication, pharmaceutical, pharmacy, pharmacology, pill.) Hypothesis 10: Mental-health-related terms should increase throughout­the time period. (Codes: anorexi, addiction, behaviour, bingeing, bulimi, compulsive, eating disorder, emotion, mental, mental health, personality, psychiatry, psychology, psychotherapy, stigma, stress.) Figure 8 shows the rates of publication on diet, surgery, medication, and mental health over time. Diet dominates (1,208 articles, 17.0 per cent of the sample). Second-most prevalent is mental health (589 articles, 8.3 per cent of the sample), which saw a small decline from the early 1990s to the early 2000s (see Rasmussen 2008, 2012 on the involvement of psychiatry

72  Elise Paradis Figure 8: Medical Solutions as % of Sample 25

% of Sample

20

15 Diet Surgery Medication Mental Health

10

5

19

8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 9 19 4 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 0 20 3 0 20 4 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 10

0

Year

Figure 8.  Medical solutions as percentage of sample

in obesity treatment). Surgery covered about 3.5 per cent of the sample, and medication was dealt with in 1.7 per cent of the articles. A slight increase in publications on medication can be seen since the late 1990s. Hypothesis 7 is confirmed but hypothesis 8 and 9 are not, because surgery and medication remained low-interest solutions throughout the time period (with an outlier year in 1987 for surgery, when the total number of articles in the sample [denominator] was quite small). Hypothesis 10 cannot be confirmed since the trend is mostly flat throughout the time period. The Canadian approach to the medicalization of fat has not espoused surgery or medication as solutions, nor has it turned to mental health to the extent that was expected. Dieting remains the preferred solution in the Canadian literature, once again suggesting a partial medicalization.

Social Determinants of Health The biomedical model only reluctantly acknowledges the importance of the social determinants of health. The rise of epidemiological research in the late twentieth century has facilitated their study (Hansen

Medicalization of Fatness by Canadian Researchers  73

and Easthope 2007), leading to the emergence of the so-called “risk society” mentioned earlier. Similarly, as Strong noted (1979), the sociological critique of medicine has partly transformed the way medicine studies health. Tensions between the medical model and the acknowledgment of broader forces remain. Indeed, Saguy and Almeling (2008) found rising mentions of individual-level solutions over time. In contrast, based on a longitudinal analysis of medical textbooks, Chang and Christakis (2002) argued that the medicalization of fatness led to a shift in the medical profession’s perception of the obese and increasing mentions of social and material factors. However, solutions to the “obesity problem” are mostly individual (e.g., dieting, surgery, medication) and will likely outweigh broader solutions such as policy or community-based interventions. With this in mind I make the following hypothesis: Hypothesis 11: Mentions of social factors should be rare, confirming the individualistic bias of medicine. (Codes for social factors: community, environment, geography, neighbourhood, obesogenic, policy, poverty, race, school, social, societal, socio-economic; codes for individuallevel factors: above codes about diets, medication, mental health, and surgery.) Figure 9 enables a comparison of trends in mention of social factors with the medical solutions explored within Figure 8. A total of 319 articles (4.5 per cent of the sample) mentioned factors beyond the individual in their titles (e.g., economic, community, politics, race, school, social, societal). Meanwhile, 1,912 articles (27.0 per cent) were written about the medical solutions discussed earlier: diet, medication, surgery, and psychiatry. The share of medical solutions declined until 2000 before picking up again; that of social factors has increased slightly since the early 2000. We can confirm hypothesis 11. This comparison suggests that Canadian solutions to obesity remain individualistic, despite the known importance of social policy in Canada as compared to in the United States. As medicalization focuses on the individual, this finding supports it in the Canadian context.

Families and the Future Anxiety about the future and medicine’s inability to solve all social problems persists. McDermott (2007) notes that while the concept of

74  Elise Paradis Figure 9: Social Factors and Medical Solutions as % of Sample 40 35

% of Sample

30 25 20 Medical Solutions Social Factors

15 10 5

19

8 19 5 8 19 6 8 19 7 8 19 8 8 19 9 9 19 0 9 19 1 9 19 2 9 19 3 94 19 9 19 5 9 19 6 9 19 7 9 19 8 9 20 9 0 20 0 0 20 1 0 20 2 0 20 3 04 20 0 20 5 0 20 6 0 20 7 0 20 8 0 20 9 10

0

Year

Figure 9.  Social factors and medical solutions as percentage of sample

at-risk children has deep roots in the medical and public health traditions, the focus on children as being at risk of sedentary lifestyles and obesity lagged behind concerns with adult obesity, a fact I’ve also confirmed (Paradis 2011). Despite early interest in childhood obesity, with a first Canadian publication in 1935 and Hilde Bruch’s crusade in the 1940s, broader interest in childhood obesity emerged only in the 1980s (Schwartz 1986). There was a growth rate of 1,651 per cent in the number of articles about childhood obesity published and recorded in the PubMed database between 1989 and 2009 (Paradis 2011). I believe that the recent emphasis on childhood obesity reflects anxieties about the financial viability of medical systems and an acknowledgment of the failure of medicine to “solve” the “problem” of obesity. Blaming mothers for the weight of their children has a long history (Schwartz 1986; Mitchinson in this volume), but the proselytizing work of psychiatrist Hilde Bruch, who saw fault in mothers’ feeding practices and emotional imbalance, was critical to the involvement of psychiatry in obesity care (Rasmussen 2012). Several authors have noted the medicalization of childhood obesity and the tendency to blame mothers for the trend (Bell, McNaughton, and Salmon 2009; Boero 2009; Moffat 2010). In Boero’s (2009) analysis, the news media are shown to

Medicalization of Fatness by Canadian Researchers  75

be complicit in disseminating and reproducing the idea that careless, negligent, or overly permissive mothers are partly responsible for the obesity epidemic. “Mother blame” lies more or less explicitly behind both the scientific and common-sense solutions to the obesity epidemic. “The weight of one’s children,” Boero claims, “has increasingly become a litmus test of good mothering” (113). Bell, McNaughton, and Salmon (2009) go further to argue that childhood overnutrition and obesity have been both medicalized and criminalized over the past   decade. They also point out that while mothers are often accused of overnutrition, fathers are “conspicuously absent” from the literature (162). Based on these studies we can make the following hypotheses: Hypothesis 12: Children should be increasingly present in the literature over time, particularly after 2000. (Codes: child, fetal, fetus, infant, juvenile, kid, pediatric, teen, youth.) Hypothesis 13: Mothers should be mentioned regularly throughout the time period, but increasingly so after 2000. (Codes: gestational, maternal, maternity, pregnancy, mother, wife.) Hypothesis 14: Fathers should be mostly absent from the literature. (Codes: father, husband, paternal, paternity.) Figure 10 compares rates of publications on children, mothers, fathers, and families. Publications on children (734 publications, 10.4 per cent) have been rising throughout the time period, but most importantly after 2002, and reached 15 per cent of the sample in 2010. Mentions of mothers and mothering (239 articles, 3.4 per cent) have been relatively stable throughout, with a maximum of 6.6 per cent in 2000. We cannot confirm that mothers have been mentioned increasingly often after 2000, as hypothesis 13 suggests. Not a single article in the sample mentioned fathers, confirming hypothesis 14. These trends confirm that the Canadian medical community has turned to children, and reflect an anxiety about the future of our society. Medicalization has indeed turned to the most vulnerable within our population. Mothers have not suffered the blame as much as expected, but fathers are predictably absent. Discussion of Results The first results of the research showed the extent to which the medical (i.e., obesity rates in the population) has been dwarfed by the medicalized (i.e., publications on obesity) over the time period. The growth of the two is incommensurable even when we take the least conservative

76  Elise Paradis Figure 10. Children and Mothers as % of Sample 16 14

% of Sample

12 10 8 Children Mothers

6 4 2

92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10

91

19

90

89

19

19

88

87

19

19

86

19

19

19

85

0

Year

Figure 10.  Children and mothers as percentage of sample

estimates of population weight gain available – that is, measured obesity rates. The research community’s response has dramatically outgrown the actual phenomenon, which is alarming given the highly debatable effects of obesity on health outcomes (Bacon and Aphramor 2011; Campos et al. 2006; Flegal et al. 2013; Padwal et al. 2011; Wildman et al. 2008). However, this gap is much less prominent in the Canadian literature than it was in the American literature (Paradis 2011), suggesting a more moderate response from the Canadian research community. Following this chapter’s investigation of several aspects of fat’s medicalization in Canadian publications (medical language, medical diagnosis, medical solutions, social determinants of health, and the role of families), we can confirm that the language of obesity and overweight have indeed accrued a larger share of publications over time. The term corpulence is clearly not part of medical parlance today. But contrary to our hypothesis, highly specialized terms did not increase over time. Rather, it was medium-level terms that dominated the discourse, with obesity and overweight dwarfing all other terms. One could argue that the medical connotation of overweight and obesity, combined with their

Medicalization of Fatness by Canadian Researchers  77

familiarity to most North Americans, has facilitated their inclusion in lay discourse, thus enabling the broadening cultural purchase of body fat as a medical problem. Another hint that the Canadian take on obesity as a public health crisis was more moderate than the American one can be found in the fact that the word epidemic has not deeply permeated the Canadian literature. Risk, on the other hand, has established itself as an important part of the medical discourse, with close to 10 per cent of articles by the end of the time period. This suggests two things: first, that epidemiology and its risk discourse have made serious inroads into Canadian obesity research; and second, that obesity is conceptualized both as a risk factor for disease (such as diabetes and cardiovascular disease) and as a disease in itself. Turning to body mass index as the main diagnostic tool for obesity, its prevalence has indeed increased over time among titles, although trends on childhood BMI are not as clear, given their low occurrence. Closer analysis of publication texts would be needed to investigate the prevalence of BMI and its impact on obesity research. Different medical solutions take unequal but nonetheless important places in the literature. Dieting is the main emphasis, followed by mental health. In the aggregate, I found that medical, individual-level concerns or solutions (such as drugs and surgery) dominate publichealth-oriented concerns or solutions (such as community initiatives and policy). However, the slow rise of the public health approach shows that interest within the medical community is shifting to consider the social determinants of health, as expected given the rise of epidemiology and the recognition of the psychosocial bases of health and illness (Hansen and Easthope 2007). Although surgery and medication did not experience the expected growth, they remain of substantial concern in the literature. This is unsurprising in a country with a more collectivist orientation to health care delivery and cost sharing than the United States. Stigma, a hot topic in the United States (e.g., Puhl and Heuer 2009, 2010), was noticeably and unexpectedly underrepresented in the literature (MacLean et al. 2009). Given that stigma is relatively new as a concern among obesity researchers (Puhl and Brownell 2006; Puhl and Heuer 2009; Puhl and Latner 2007), we could still see a literature on stigma emerge in Canada over the coming years. Paradis, Kuper, and Reznick (2012) is one such recent example. Finally, as expected, mothers were mentioned in a large subset of ­articles throughout the time period (3.4 per cent of the sample), and

78  Elise Paradis

fathers were altogether absent. However, the expected rise after 2000 in studies mentioning mothers was not seen. This may be partly due to lesser emphasis on childhood obesity in Canada than in the United States. Conclusion The extent to which and in which amount fat is a medical problem is still highly debated, but the medicalization of fat is now beyond question. Canadian researchers have indeed medicalized fat over the past three decades, although it appears that this has lagged behind fat’s medicalization in the United States. Canadian researchers have been writing about fat as a medical condition – as obesity or overweight – in as many as 6,889 articles since 1985, and in recent years they have become ever more prolific. These publications have increasingly made an appeal to a language of risk, appealed to medical solutions for the obesity “problem,” and expanded their jurisdiction over new populations, most notably children. By association, and because they are typically but culturally the closest individuals to children, mothers and their pregnancies have also been medicalized. This chapter also raises questions about the role of BMI in enabling the medicalization of fat and the ensuing moral panic discussed by other scholars (Boero 2009; Campos et al. 2006; Gard and Wright 2005), and about the seemingly irreconcilable tensions between medicine and its emphasis on individual solutions and the one-on-one care relationship on the one hand, and public-health imperatives on the other. The literature’s rising share taken by population-level risk and its epidemiological language over the past ten years (see Figure 9) suggest that things may be changing in favour of diminished individual responsibility. In the Canadian context, where collective solutions are more frequent than in the United States (Jutel 2001), this will not come as much of a surprise. Similarly, the role of “big pharma,” of for-profit health care, and of the food and diet industries is not as clear in Canada as in the United States, and the analysis provided here suggests a still marginal role for drugs and surgery among academic publications. Food and diet, however, are critical components of the scholarship. The impact these industries have on policy and care provision remains to be investigated. Several of the trends identified here lag behind the hypothesized trends by five years to a decade (e.g., BMI, childhood); several others are

Medicalization of Fatness by Canadian Researchers  79

dampened (e.g., surgery, epidemic). The fact that Canadian population-­ level data were historically scarce and unreliable probably has something to do with this lag, as noted by Gard in this volume. But I would still argue that both universal health care and the relatively small size of the Canadian scientific research apparatus are factors that probably  contributed to this lag and the dampening of the language used by Canadian researchers. The “rhetorical virus” (Gard 2010, 7) of obesity as an epidemic has not caught on among Canadian researchers. The medicalization story of obesity in Canada departs in several ways from the American and predicted story, suggesting several particularities: a lower level of sensationalism, a continued focus on low-­ medicalization solutions such as dieting over medication and surgery, and a relative exoneration of mothers. Individual-level solutions, however, remain central to the Canadian agenda, in contrast to the addressing of social factors. Ultimately, the medicalization of fat raises the fundamental question: Who owns the meaning of body fat? Is it the medical establishment, governments, or the fat and not-so-fat people who suffer in a culture that despises fat and condemns it as a death sentence? As I have tried to show here through a longitudinal analysis of medical publications, the transformation of fatness into a disease has been a process. Language plays a critical role in the definition and transformation of our perception of body fat – as it plays in the construction of any other reality. In this case, as in other medicalization cases, this transformation is political, and its future depends upon the continued critical analysis of our discursive environment and its impacts on our lives. APPENDIX: CODING SCHEME Note: Codes surrounded by “\\b” were not used as roots for other codes. For example, searching for “\\bmen\\b” would not yield links to “menopause,” but “men” would yield, for example, “men”, “menopause”, and “enjoyment”. “abnormal”, “abuse”, “abusive”, “addict”, “adipocyte”, “adipos”, “adolescen”, “aetiolog”, “anorexi”, “anorexiant”, “appetite suppressant”, “arteriosclerosis”, “arthrit”, “atherosclerosis”, “attitude”, “behavior”, “behaviour”, “binge”, “BMI”, “body fat”, “body mass index”, “bulimi”, “cancer”, “carcin”, “cardiac”, “cardiorespiratory”, “cardiovascular”, “child”, “children”, “choice”, “cohort”, “committee”, “community”, “compulsive”, “conference”, “control”, “cost”,

80  Elise Paradis “deviance”, “deviant”, “diabetes”, “diet”, “dieting”, “disability”, “double blind”, “drug”, “eating”, “eating disorder”, “economic”, “education”, “emotion”, “endocrin”, “energetic”, “energy”, “environment”, “epidemic”, “epidemiolog”, “epigenetic”, “esteem”, “etiolog”, “excess”, “exercis”, “experiment”, “expert”, “family”, “families”, “fasting”, “\\bfat\\b”, “father”, “fatty”, “feeding”, “fetal”, “fetus”, “financial”, “\\bfit\\b”, “fitness”, “food”, “genetic”, “geograph”, “gestational”, “global”, “glycemi”, “health”, “heart”, “heredit”, “histor”, “husband”, “hypertension”, “ideal weight”, “income”, “inequality”, “infant”, “infectious”, “infectobesity”, “intervention”, “issue”, “juvenile”, “kids”, “lean”, “lipid”, “longitudinal”, “manage”, “matern”, “medicaliz”, “medication”, “meeting”, “\\bmen\\b”, “mental”, “mental health”, “metaboli”, “moral”, “morbid obesity”, “morbidity”, “morbidly obese”, “mortality”, “mother”, “movement”, “neighbourhood”, “neighborhood”, “neuro”, “neurolog”, “normal”, “nutrition”, “obesogenic”, “organisation”, “organization”, “orthorexi”, “overfeed”, “paediatr”, “pandemic”, “paradox”, “parent”, “paternity”, “\\bpaternal\\b”, “patholog”, “pediatr”, “personalit”, “pharmac”, “pill”, “policy”, “politic”, “polyphagi”, “portion”, “poverty”, “pregnan”, “prevent”, “problem”, “profit”, “psychiatr”, “psycholog”, “psychotherap”, “public health”, “\\brace\\b”, “randomized”, “rates”, “restrict”, “rheumatolog”, “right”, “risk”, “sedentar”, “school”, “sick”, “sickness”, “size”, “slender”, “social”, “societal”, “social class”, “social determinant”, “social mobility”, “socio-economic”, “socioeconomic”, “stigma”, “stress”, “surgery”, “surgical”, “tabagism”, “technique”, “technolog”, “\\bteen\\b”, “teenage”, “therap”, “thin”, “tobacco”, “treatment”, “trend”, “weight”, “wife”, “women”, “world”, “youth”

WORKS CITED Anderson, J. 2012. “Whose Voice Counts? A Critical Examination of Discourses Surrounding the Body Mass Index.” Fat Studies 1 (2): 195–207. http://dx.doi.org/10.1080/21604851.2012.656500. Bacon, L., and L. Aphramor. 2011. “Weight Science: Evaluating the Evidence for a Paradigm Shift.” Nutrition Journal 10 (9). http://dx.doi.org/10.1186/ 1475-2891-10-9. Barker, K.K. 2010. “The Social Construction of Illness.” In Handbook of Medical Sociology, ed. Chloe Bird, Peter Conrad, Allen M. Fremont, and Stefan Timmermans, 147–62. Nashville: Vanderbilt University Press. Bayer, Ronald. 2008. “Stigma and the Ethics of Public Health: Not Can We but Should We.” Social Science & Medicine 67 (3): 463–72. http://dx.doi.org/ 10.1016/j.socscimed.2008.03.017.

Medicalization of Fatness by Canadian Researchers  81 Beck, U. 1992. Risk Society: Towards a New Modernity. Vol. 17. Trans. Mark Ritter. London: Sage. Bell, Kirsten, and Darlene McNaughton. 2007. “Feminism and the Invisible Fat Man.” Body & Society 13 (1): 107–31. http://dx.doi.org/10.1177/135703 4X07074780. Bell, Kirsten, Darlene McNaughton, and Amy Salmon. 2009. “Medicine, Morality and Mothering: Public Health Discourses on Foetal Alcohol Exposure, Smoking around Children and Childhood Overnutrition.” Critical Public Health 19 (2): 155–70. http://dx.doi.org/10.1080/ 09581590802385664. Bell, Kirsten, Amy Salmon, Michele Bowers, Jennifer Bell, and Lucy McCullough. 2010. “Smoking, Stigma and Tobacco ‘Denormalization’: Further Reflections on the Use of Stigma as a Public Health Tool. A Commentary on Social Science and Medicine’s Stigma, Prejudice, Discrimination and Health Special Issue.” Social Science & Medicine 70 (6): 795–9. http:// dx.doi.org/10.1016/j.socscimed.2009.09.060. Berger, Peter L., and Thomas Luckmann. 1989 [1966]. The Social Construction of Reality: A Treatise in the Sociology of Knowledge. New York: Anchor. Boero, Natalie. 2009. “Fat Kids, Working Moms, and the ‘Epidemic of Obesity.’” In The Fat Studies Reader, ed. Esther Rothblum and Sondra Solovay, 113–19. New York: New York University Press. Brown, P. 1995. “Naming and Framing: The Social Construction of Diagnosis and Illness.” Journal of Health and Social Behavior, 35 (Extra), 34–52. http:// dx.doi.org/10.2307/2626956. Brumberg, Joan Jacobs. 2000 [1988]. Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Cambridge, MA: Harvard University Press. Campos, P., A. Saguy, P. Ernsberger, E. Oliver, and G. Gaesser. 2006. “The Epidemiology of Overweight and Obesity: Public Health Crisis or Moral Panic?” International Journal of Epidemiology 35 (1): 55–60. http://dx.doi .org/10.1093/ije/dyi254. Caplan, P.J. 2012. “Elephant in the Living Room: ‘Obesity Epidemic,’ Psychiatric Drugs, and Psychiatric Diagnosis.” Fat Studies 1 (1): 91–6. http:// dx.doi.org/10.1080/21604851.2012.627787. Chang, V.W., and N.A. Christakis. 2002. “Medical Modelling of Obesity: A Transition from Action to Experience in a 20th-Century American Medical Textbook.” Sociology of Health & Illness 24 (2): 151–77. http://dx.doi .org/10.1111/1467-9566.00289. Ciliska, D. (1990). Beyond Dieting: Psychoeducational Interventions for Chronically Obese Women. New York: Brunner/Mazel. Clarke, Adele E., Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman. 2003. “Biomedicalization: Technoscientific

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Medicalization of Fatness by Canadian Researchers  83 Fraser, Laura. 2009. “The Inner Corset: A Brief History of Fat in the United States.” In The Fat Studies Reader, ed. Esther Rothblum and Sondra Solovay, 11–14. New York: New York University Press. Gard, Michael. 2010. The End of the Obesity Epidemic. New York: Taylor and Francis. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality, and Ideology. New York: Routledge. Germov, John, and Lauren Williams. 1996. “The Epidemic of Dieting Women: The Need for a Sociological Approach to Food and Nutrition.” Appetite 27 (2): 97–108. http://dx.doi.org/10.1006/appe.1996.0038. Groupe de travail provincial sur la problématique du poids. 2004. Weight Problems in Québec: Getting Mobilized. Montreal: Association pour la santé publique du Québec. Hacking, Ian. 1999. The Social Construction of What? Cambridge, MA: Harvard University Press. Hansen, Emily, and Gary Easthope. 2007. Lifestyle in Medicine. New York: Routledge. Health and Welfare Canada. 1988. Canadian Guidelines for Healthy Weights. Ottawa: Health Services and Promotion Branch. Health Canada. 2008. Healthy Canadians: A Federal Report on Comparable Health Indicators. Ottawa: Minister of Health. http://www.hc-sc.gc.ca/hcs-sss/pubs/ system-regime/2008-fed-comp-indicat/index-eng.php/. Holmes, B.J. 2009. “Media Coverage of Canada’s Obesity Epidemic: Illustrating the Subtleties of Surveillance Medicine.” Critical Public Health 19 (2): 223–33. Illich, Ivan. 1976. Medical Nemesis: The Expropriation of Health. 1st American ed. New York: Pantheon. Isono, Maho, Patti Lou Watkins, and Lee Ee Lian. 2009. “Bon Bon Fatty Girl: A Qualitative Exploration of Weight Bias in Singapore.” In The Fat Studies Reader, ed. Esther Rothblum and Sondra Solovay, 127–38. New York: New York University Press. Jennings, Laura. 2009. “Public Fat: Canadian Provincial Governments and Fat on the Web.” In The Fat Studies Reader, ed. Esther Rothblum and Sondra Solovay, 88–96. New York: New York University Press. Jutel, A. 2001. “Does Size Really Matter? Weight and Values in Public Health.” Perspectives in Biology and Medicine 44 (2): 282–96. http://dx.doi. org/10.1353/pbm.2001.0027. Katzmarzyk, P.T. 2002. “The Canadian Obesity Epidemic, 1985–1998.” Canadian Medical Association Journal 166 (8): 1039–40. Latour, Bruno. 1987. Science in Action. Cambridge, MA: Harvard University Press.

84  Elise Paradis Latour, Bruno, and Steve Woolgar. 1986 [1979]. Laboratory Life: The Construction of Scientific Facts. Princeton: Princeton University Press. Lupton, D. 1993. “Risk as Moral Danger: The Social and Political Functions of Risk Discourse in Public Health.” International Journal of Health Services 23 (3): 425–35. http://dx.doi.org/10.2190/16AY-E2GC-DFLD-51X2. Lupton, D., S. McCarthy, and S. Chapman. 1995. “‘Panic Bodies’: Discourses on Risk and HIV Antibody Testing.” Sociology of Health & Illness 17 (1): 89–108. http://dx.doi.org/10.1111/1467-9566.ep10934489. MacLean, L., N. Edwards, M. Garrard, N. Sims-Jones, K. Clinton, and L. Ashley. 2009. “Obesity, Stigma and Public Health Planning.” Health Promotion International 24 (1): 88–93. http://dx.doi.org/10.1093/heapro/ dan041. Major, B., and L.T. O’Brien. 2005. “The Social Psychology of Stigma.” Annual Review of Psychology 56 (1): 393–421. http://dx.doi.org/10.1146/annurev .psych.56.091103.070137. Mannheim, K. 1998 [1936]. Ideology and Utopia. New York: Routledge. McDermott, L. 2007. “A Governmental Analysis of Children ‘At Risk’ in a World of Physical Inactivity and Obesity Epidemics.” Sociology of Sport Journal 24 (3): 302–24. McElroy, Susan L., Renu Kotwal, Shishuka Malhotra, Erik B. Nelson, Paul E. Keck, and Charles B. Nemeroff. 2004. “Are Mood Disorders and Obesity Related? A Review for the Mental Health Professional.” Journal of Clinical Psychiatry 65 (5): 634–51. http://dx.doi.org/10.4088/JCP.v65n0507. McFarlane, T., J. Polivy, and R.E. McCabe. 1999. “Help, Not Harm: Psychological Foundation for a Nondieting Approach toward Health.” Journal of Social Issues 55 (2): 261–76. McIntyre, Roger S., Jakub Z. Konarski, Kathryn Wilkins, Joanna K. Soczynzka, and Sidney H. Kennedy. 2006. “Obesity in Bipolar Disorder and Major Depressive Disorder: Results from a National Community Health Survey on Mental Health and Well-Being.” Canadian Journal of Psychiatry 51 (5): 274–80. Merton, Robert K. 1937. “The Sociology of Knowledge.” Isis 27 (3): 493–503. http://dx.doi.org/10.1086/347276. Meyer, John W., John Boli, George M. Thomas, and Francisco O. Ramírez. 1997. “World Society and the Nation State.” American Journal of Sociology 103 (1): 144–81. http://dx.doi.org/10.1086/231174. Meyer, John W., Patricia Bromley, and Francisco O. Ramírez. 2010. “Human Rights in Social Science Textbooks.” Sociology of Education 83 (2): 111–34. http://dx.doi.org/10.1177/0038040710367936.

Medicalization of Fatness by Canadian Researchers  85 Meyer, John W., and Ronald L. Jepperson. 2000. “The ‘Actors’ of Modern Society: The Cultural Construction of Social Agency.” Sociological Theory 18 (1): 100–20. http://dx.doi.org/10.1111/0735-2751.00090. Moffat, T. 2010. “The ‘Childhood Obesity Epidemic’.” Medical Anthropology Quarterly 24 (1): 1–21. http://dx.doi.org/10.1111/j.1548-1387.2010.01082.x. Moynihan, R., I. Heath, and D. Henry. 2002. “Selling Sickness: The Pharmaceutical Industry and Disease Mongering.” British Medical Journal 324 (7342): 886–91. http://dx.doi.org/10.1136/bmj.324.7342.886. Mythen, G., and S. Walklate. 2006. Beyond the Risk Society: Critical Reflections on Risk and Human Security. New York: Open University Press. National Center for Biotechnology Information. 2013. U.S. National Library of Medicine: About PubMed. http://www.ncbi.nlm.nih.gov/pubmedhealth/ about/. Accessed 7 January 2013. National Institutes of Health (NIH). 1985. Health Implications of Obesity. NIH Consensus Development Conference Statement, 11–13 February1985, 5 (9): 1–7. http://consensus.nih.gov/1985/1985Obesity049html.htm. Accessed 1 May 2012. – 1998. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda: Public Health Service. Oliver, J. Eric. 2006. “The Politics of Pathology: How Obesity Became an Epidemic Disease.” Perspectives in Biology and Medicine 49 (4): 611–27. http:// dx.doi.org/10.1353/pbm.2006.0062. Padwal, R.S., N.M. Pajewski, D.B. Allison, and A.M. Sharma. 2011. “Using the Edmonton Obesity Staging System to Predict Mortality in a PopulationRepresentative Cohort of People with Overweight and Obesity.” Canadian Medical Association Journal 183 (14): E1059–66. http://dx.doi.org/10.1503/ cmaj.110387. Paradis, Elise. 2011. “Changing Meanings of Fat: Fat, Obesity, Epidemics and America’s Children.” Doctoral diss., School of Education, Stanford University. Paradis, Elise, Ayelet Kuper, and Richard K. Reznick. 2012. “Body Fat as Metaphor: From Harmful to Helpful.” Canadian Medical Association Journal 185 (2): 152–3. http://dx.doi.org/10.1503/cmaj.120100. Paradis, Elise, Fiona Webster, and Ayelet Kuper. 2013. “Medical Education and Its Context in Society.” In Oxford Textbook of Medical Education, ed. Kieran Walsh, 136–48. London: Oxford University Press. http://dx.doi.org/ 10.1093/med/9780199652679.003.0012. Polivy, J., and C.P. Herman. 1987. “Diagnosis and Treatment of Normal Eating.” Journal of Consulting and Clinical Psychology 55 (5): 635–44.

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3 The Geneticization of Aboriginal Diabetes and Obesity: Adding Another Scene to the Story of the Thrifty Gene Jenni fer Poudrie r

The thrifty gene theory is currently a captivating explanation for the high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) among indigenous peoples globally. Originally proposed in 1962 by population geneticist James V. Neel, the thrifty gene theory is based upon the evolutionary notion that hunter/gatherer populations survived feast-and-famine living conditions because they possessed a thrifty genetic predisposition to accumulate and store fat. Neel (1962) argued that under recent conditions of rapid “Westernization” and related lifestyle and dietary changes, this naturally selected genetic predisposition, which sustained populations during times of famine, has led to the onset of obesity and NIDDM among contemporary populations. In subsequent publications in 1982 and 1999, confronted with evidence showing significant flaws in the original hypothesis, Neel modified its specifics to argue that, while it has never been proven, the thrifty gene does indeed exist. At present, the precise etiology of NIDDM is not known. However, NIDDM and obesity have long been associated with environmental and lifestyle factors such as age, stress, poor nutrition, and sedentary lifestyle as well as low socioeconomic status and social marginalization (Abonyi 2001; Chaufan 2004; McDermott 1998; Ozanne and Hales 1998). While there is a thirty-year span of research that has attempted to delineate the genetic factors that cause NIDDM, typically studies show inconclusive epigenetic and gene/gene relationships. There is An earlier version of this essay appeared in The Canadian Review of Sociology and Anthropology as “Genes and Society: Looking Back on the Future,” volume 22, issue 2, May 2007.

90  Jennifer Poudrier

no identifiable or isolated genetic component proven to be directly responsible for NIDDM (Fee 2006; McDermott 1998). There are no doubt genetic elements involved in the onset of obesity and diabetes for all populations; however, the seemingly absolute linkages between Aboriginal peoples and the thrifty gene ought to be opened to further dialogue. The thrifty gene theory remains a hypothesis. Its existence is tentative at best, and the multifactorial etiology of NIDDM is not solved (Abonyi 2001). Surprisingly, however, the thrifty gene is very much alive in the current Aboriginal health literature as a powerful explanation for NIDDM. Recently, the theory has received renewed scientific and popular attention in the Canadian context. In March 1999, a clinical geneticist and a group of medical colleagues announced that they had found a genetic link between NIDDM and the Oji-Cree people of Sandy Lake, Ontario (Hegele et al. 1999). They claimed that they had discovered the exact gene variant, namely HNF1A G319S, that was related to the onset of NIDDM. In a later publication, Hegele (1999, S48) describes the research and concludes by stating that “none of these findings … would be inconsistent with the thrifty gene hypothesis of Dr. James Neel.” Shortly thereafter and with much more certainty, David Spurgeon (1999), a news writer for the British Medical Journal, reported the finding with the headline “thrifty gene identified in Manitoba Indians.”1 In January 2005, CBC’s The Nature of Things aired a documentary about the obesity epidemic entitled “The Weight of the World,” which reported that this same community of Sandy Lake was overcoming the thrifty genetic predisposition to obesity and NIDDM through remarkable and inspiring culturally appropriate and community-based programs geared towards diet and lifestyle. This chapter explores the role of the thrifty gene theory as part of a story in the construction of health knowledge about Aboriginal peoples.2 I argue that the full story of the thrifty gene thus far has not included Aboriginal perspectives and should be “decolonized.” As such, the thrifty gene theory should be de-naturalized as a biological or genetic entity and should be thought of as part of an ongoing and transforming story about race, genetics, and disease. Currently, the thrifty gene draws significantly on problematic and intersecting binaries, notably civilized/primitive, Aboriginal/non-Aboriginal, and science/ culture. It is important to open up dialogue that will highlight and value the perspectives of Aboriginal peoples in this story. A new tale of the thrifty gene theory could begin with the mythical Trickster – the paradoxical, the harmful/helpful, the spirit/body, and

The Geneticization of Aboriginal Diabetes and Obesity  91

the transformer – the Raven. A story of the Raven can be used to show how genetic science can be (un)defined as helpful and harmful, as powerful and weak, but certainly deceptive. Like Donna Haraway’s (1999) call to converse with the coyote trickster who is the manifestation of continually problematized binary distinctions, the Raven tale seeks to denaturalize – to demystify the binaries by telling another part of the tale. Raven trickster is the communicator and the mischievous transformer who performs important cultural tasks. Raven is smart, mischievous, unpredictable, and fulfilled through trickery and transformation. Some­times Raven’s trickery becomes instructive. Raven is both helpful and harmful, but he helps only when the people pay attention. In the story Raven Steals the Light written by Haida author Bill Reid (Reid and Bringhurst 1984), Raven is dismayed that the world is dark. He decides to steal the sun for light and hides it inside several boxes in the village. He turns himself into a seed and is unknowingly swallowed by a young woman who becomes pregnant, so Raven is reborn as Raven Child. He infiltrates the village and tricks the people into giving him the sun to play with. Raven intends to keep the sun, but is pursued by Eagle who wants the light for everyone. While attempting to escape pursuit by Eagle, Raven spills pieces of light that become stars and moon and then drops the sun, bringing light for everyone. In this story, Raven’s trickery and transformative potential, combined with the participation of other characters with different perspectives, cause new worlds to become visible. Envisioning the thrifty gene story as Trickster highlights the importance of perspective and Aboriginal knowledge about health, healing, and diabetes. More emancipatory and empowering iterations of the thrifty gene can begin here with a new dialogue that includes Aboriginal perspectives. The story of the thrifty gene is a powerful example of the complex interplay between genes, race, and society and a provocative reason why it is essential to look back at seemingly finished knowledge, to challenge and to produce emancipatory and valid knowledge for the future – indeed, for the purposes of looking back on the future. Decolonizing Genetic Science, Geneticization, and Racialization This work emerges out of a larger decolonizing postcolonial science study and has strong linkages to literature in the social studies of science and knowledge (Biagioli 1999; Burfoot and Poudrier 2005; Haraway 1999; Harding 1998; Nader 1996; Skinner and Rosen 2001) and

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the social construction of biological, genetic, and health sciences ­(Duster 1996; Goodman et al. 2003; Lippman 1991; Rabinow 1994, 1999). It is based on the teachings of indigenous knowledges (Awang 2000; Battiste and Henderson 2000; Harry 2001; Smith 1999; Whitt 1999) and draws conceptually on Linda Tuhwai Smith’s (1999) ideas surrounding decolonizing methodologies and Laurie Anne Whitt’s (1999) “indigenist” critiques of science. In 1991, Abby Lippman coined the term geneticization to describe the condition under which cultures of individuals and groups become defined by scientific and genetic categories through a complex interplay between techniques of prenatal screening and contemporary discourses in genetic prediction. In their more recent edited collection Genetic Nature/Culture, Goodman, Heath, and Lindee (2003) draw together several critical perspectives to shed light upon the nature/culture split. Paul Rabinow’s (1999) provocative conception of “biosociality” refers to a transformative condition under which both nature and scientific work in the life sciences become increasingly revealed as artificial and as cultural practice. Focusing specifically on ethnicity and race in genetics and medicine, Troy Duster (1996, 123) argues that “it is not genetic evidence that drives the engine of scientific inquiry, but the social concerns that drive the engine of the ‘scientific’ attempt to portray and explain these social concerns genetically.” Where ethnic populations are epidemiologically at risk and are considered a financial drain on health care resources, and where medical science is increasingly entrenched (through large investments) in genetics, the hunt for genetic racial susceptibility proceeds. The hunt for genetic susceptibility and related techniques of screening through outpourings of funding, research, and policy is all too familiar. The issues surrounding surveillance and population health are particularly salient for Aboriginal peoples as targeted populations. Although their critique doesn’t focus upon racialization and genetics, John O’Neil, Jeff Reading, and Audrey Leader (1998) address epidemiological knowledge about Aboriginal peoples and describe how it operates as a powerful mechanism of regulatory surveillance. Where epidemiological research is a “response to the political problem of regulating potentially dangerous behaviours,” epidemiological discourse becomes a tool of disciplinary power over “problematic” populations and perilous lifestyles (230). Contemporary portraits of Aboriginal communities reflect images of misery, disease, and poverty that play a commanding role in the construction of Aboriginal identity (O’Neil, Reading, and Leader 1998). Health discourse about Aboriginal peoples represents

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sick, disorganized, uncontrolled, and dependent people (O’Neil , Reading, and Leader 1998; Waldram et al. 1995). According to O’Neil, Reading, and Leader (1998), this image legitimates paternalistic and regulatory management over Aboriginal health in commu­nities, and further marginalizes overarching efforts geared towards self-determination and development. Arguing that biomedicine is “a cultural system itself, and an appendage of the colonial state structure,” Waldram et al. (2000, 37) warn that current medicine must address cultural knowledge, lest it turn into “another form of assimilative pressure.” Robyn McDermott (1998) offers a compelling critique of the thrifty gene theory from an epidemiological standpoint. She argues that it is a historical and narrative construct of genetic epidemiology. The logic that makes a scientific case for genetic predisposition to disease seems to simply match epidemiological clusterings of increased rates of NIDDM. McDermott argues that to non-Aboriginal scientists, diabetes is a problem of race and genes where “race becomes a biological entity and an independent risk factor, reified over and over again in repeated studies of disease which take no account of socio-economic status, history or culture” (1194). Moreover, in the current medical/genetic context, the “genetic paradigm seeks to emphasize the ‘independence’ of the disorder and of the group, making it a ‘special problem’ with no immediate ramifications for the rest of society or for specific interventions to improve the situation” (1192). The important issue that McDermott raises is one of ethics in methodology. Race as a methodological variable is firmly embedded within research design – to the exclusion of other complex variables associated with chronic disease such as social class, levels of marginalization, poverty, racism, history, and so on. Referring to research as reductionist “black box epidemiology” (1193), McDermott argues that epidemiology is currently in crisis because of its obsession with taken-for-granted methodological techniques, causal models, and risk assessment. She also contends that in order to generate any meaning in the context of health, epidemiologists must begin to critically examine the epistemological, ontological, and ethical features of their work and the implications that this knowledge has, not only in the lives of the “diseased,” but also for the trajectory of future health-related research. Indeed, the thrifty gene is ripe for this focus on the epidemiological black box (Poudrier 2003). Closely linked with this critique, scholars from other disciplines have critiqued the easy transition between indigenous communities or ethnicity in general and problematic diabetes genes. More specifically,

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from a science studies perspective, and focused on Mexican American identity, Michael Montoya shows how current research in genetic epidemiology aimed at explaining diabetes undergoes what he refers to as “a process of bioethnic conscription.” This is a process wherein researchers from various backgrounds contribute to a production of diabetes knowledges that sees racial taxonomies and social histories inextricably matched with ethnic identity, which serves to racialize and “naturalize Mexicana ethnicity in order to explain diabetes etiology” (Montoya 2007, 4). From a postcolonial and narrative point of view, Margery Fee (2006, 2988) shows the ways in which discourses about the thrifty gene theory in popular and scientific texts contribute to the “belief in biological ‘race’” as a salient way to understand Aboriginal peoples in Canada. Tracing the powerful paradigm of the thrifty genotype through a range of literatures, she eloquently argues that the problematic use of “race” as a “crude proxy” to understand the incidence of diabetes could be addressed not only in the context of research ethics and funding by including members of minority groups, but also from the location of science studies where “both sides of the constructed divide between science and the social sciences and humanities can discuss issues like ‘race’ and genetics, that have an importance to the whole society” (2995). In the decolonizing scholarship there is some literature that deals specifically with critiques of science from a uniquely Aboriginal or “indigenist” (Whitt 1998) point of view. For example, Smith (1999) explains that decolonization must begin by putting indigenous world views and concerns at the core of any indigenous projects. She provides a context from which we can begin to chart the various indigenous analyses of Western science. Drawing on the work of both Michel Foucault and Edward Said, she frames the current position of indigenous knowledges and peoples from the discursive and material history of imperialist “othering” processes. Moreover, she sees historical and current points of struggle on the part of indigenous peoples from a Foucauldian perspective whereby indigenous positions of marginality provide powerful spaces of critique, resistance, and development. For Smith, decolonization involves critically analysing and challenging Euro-western science and research and making sense of the assumptions and values that this ideological position brings to bear on indigenous peoples and communities. The intent is geared towards the larger project of self-determination in which decolonization (along with healing, mobilization, and transformation) is an important component.

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While she puts forward a formidable critique of Western science, “research through imperial eyes” (42), and the implications of both scientific knowledge and research for indigenous peoples, she does not call for a complete rejection of Western science, but rather for its decolonization: The methodologies and methods of research, the theories that inform [Western scientific projects], the questions which they generate and the writing styles which they employ, all become significant acts which need to be considered carefully and critically before being applied. In other words, they need to be “decolonized.” Decolonization, however, does not mean and has not meant a total rejection of all theory or research or West­ ern knowledge. Rather, it is about centering our concerns and world views and then coming to know and understand theory and research from our own perspectives and for our own purposes. (39)

For Whitt (1998, 72), transforming science involves vitalizing “indigenist” theoretical perspectives that analyse the legacy of Western science, the political role it plays, and its implications for indigenous peoples. She focuses on the philosophy of science and locates decolo­ nization within the context of indigenism, which “insists that the power structures and dynamics that facilitate and maintain the oppression of indigenous peoples be exposed” (Whitt 1998, 72). She also describes the more specific ways in which science is analysed from indigenous perspectives. Indigenist science critics are contesting the legacy of value-neutrality and value-bifurcation: the deflection of normative criticism away from the production of scientific knowledge; its restriction to dilemmas of knowledge application; and the attendant displace of reflection on how relations of power factor practically and morally into both. They do so in order to reveal and resist the implications of such practices for indigenous peoples, cultures and resources. (83).

Whitt suggests that a key assumption and commitment in Western science is value neutrality, or “the belief that science (or science proper) enjoys a certain axiological immunity, and is unaffected by the values [of a society] – ethical, social, political, and cultural” (1999, 415). She also argues that this commitment reproduces seemingly neutral methodological practices that are envisioned as filters through which science is cleansed (Whitt 1999). The scientific ideology of value neutrality also

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lays the groundwork for two other normative features of contemporary science projects. First, a pure/applied distinction is a normative feature of science. There remains the ideology that only applied rather than pure science projects are affected by the messiness of human and cultural interests. Therefore, only applied sciences are open for ethical inquiry whereas pure science projects are seen as immune from ethical concern and analysis. A second normative feature of Western science is value bifurcation, where science projects and ethics are divorced from politics or where there is a sharp ideological distinction between where ethics end and politics begin. To this end, normative critique is not only contained in the realm of “cosmetic” or “surface” ethics, but ethical evaluation is deflected away from domains of politics and power (417). This produces “an apolitical ethics of science, where issues of power in ethics are either overlooked altogether, or are diverted into very narrowly envisioned accounts of informed consent and the violation of individual autonomy” (417). Thus, ethical evaluation and critique of politics and power emerge (if at all) outside of scientific projects, the value-neutrality thesis remains intact, and science projects are protected from moral and political debate. Current indigenist critiques of Western science are vital and have had success in resisting value bifurcation. Such is the case of the successful activism against the progress of the Human Genome Diversity Project (Awang 2000; Harry 2001; Harry and Dukepoo 1998; Lone Dog 1999). Decolonizing Methodologies Research based on decolonizing methodologies is both as simple and as complex as respecting indigenous worldviews, peoples, and traditions. On one hand, the simplicity of decolonizing methodologies involves maintaining a respectful relationship with people, elders, and communities, developing an open and scholarly spirit, and continually reflecting on the research process. On the other hand, the complex reflexivity of this process means continually reflecting upon the research journey, and more specifically, it involves constantly breaking down and rebuilding the methods, the practices, the questions, the language, the spirit, the embodiment – the human beings – that constitute the entire research process. From the work specific to decolonizing critiques of science (Smith 1999), I have drawn out three interrelated themes for decolonizing methodology. First, decolonization involves centring indigenous concerns

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worldviews, epistemologies, and histories. As an important factor in decolonizing methods, I have done this by working closely with two long-term family friends, Flora Fiddler and Elder Albert Fiddler, both of Waterhen Lake First Nation in Saskatchewan. These two voices are not meant to represent all Aboriginal peoples’ views. The primary critical reflection upon the thrifty gene theory and genetic science generally, as well as the hope of telling new stories from the perspectives of Aboriginal peoples, were based upon the traditional teachings of Albert and Flora. As a beginning frame of reference I have drawn upon their traditional teachings around indigenous world views such as holism, interconnectedness, spirituality, and narrative or storytelling. From an indigenous point of view, science can also be seen as a story from a particular perspective. As a Métis scholar, my work here is contingent upon my specific location in relation not only to traditional knowledge at a specific place and time, but also to my relationship with academic institutions. The Trickster tales come from both of these places. Second, decolonized science involves critically understanding, challenging, and resisting the underlying scientific assumptions of value neutrality and methodological objectivity. In this analysis, I am attentive to the complexity of the implications of genetic determinism for Aboriginal peoples and the larger project of empowerment. Finally, decolonizing science involves resisting, rebuilding, and revitalizing practice geared towards the ongoing development of knowledge/healing projects intended to foster self-determination and empowerment (Smith 1999). This work does not aim to delineate the quintessential Aboriginal perspective on genetic science, but a very specifically located one. Here we aim to open the door only to further storytelling. Thrifty Gene Theory The thrifty gene theory is currently used as a simplistic and captivating explanation for the high prevalence of NIDDM in contemporary populations. Over the span of almost forty years, population geneticist James V. Neel wrote three articles specific to the thrifty gene theory, published in 1962, 1982, and 1999. Altogether, these publications aimed at establishing a theory. They are the only written works by Neel that deal explicitly with the conceptualization of the thrifty gene, and together they constitute its theoretical transformation – its historical life. The 1962 document is commonly considered the landmark piece, or

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Neel’s original attempt to launch the concept of the thrifty gene. Twenty years later, in 1982, Neel acknowledged the emerging scientific evidence that undermined the possibility of the thrifty gene theory and ultimately argued that despite the flaws and empirical uncertainties that form the theory’s basis, the concept of the thrifty gene was still scientifically interesting and that the gene itself does exist. The 1999 publication is the last significant piece Neel wrote on the thrifty gene concept before he died in 2000. Currently, Neel’s thrifty gene hypothesis remains highly regarded within the scientific research community and is consistently referred to in scientific and health discourses that seek to explain high rates of diabetes among Aboriginal peoples. In the population health and health promotion literature, some educational discourses are unequivocal in the claim that NIDDM is partially caused by genetic predisposition. For example, the US-based National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) suggests that diabetes among the Pima Indians in Arizona is indeed genetic, and that DNA research could lead to the cure: Why do so many Pima Indians have diabetes? The question is simple, but the answers are not. They are part of a very complex puzzle that NIH researchers are trying to decode through genetic research … A person can’t choose his or her genes … Finding the gene or genes that may increase a person’s risk for getting diabetes and obesity is the most effective way scientists have to learn what’s wrong in a diabetic person ... When scientists find the codes for the genes that contribute to diabetes and obesity, they will be able to study how the genes work, and how the changes that result might contribute to disease. Then they will have the best clues available to design treatments and cures. (NIDDK 2002a, paras. 1–6)

In the case of Aboriginal people globally, some of whom are experiencing higher rates of diabetes, the thrifty gene is often seen as the culprit. In the case of the Pima Indians, NIDDK states that when explaining the onset of obesity, “scientists use the ‘thrifty gene’ theory proposed in 1962 by geneticist James Neel” (NIDDK 2002a, para. 3). However, there is some debate about the existence of the thrifty gene. Both Leslie (1993) in Causes of Diabetes: Genetic and Environmental Factors and Betteridge (2000) in Diabetes: Current Perspectives reflect the suspicion and the assumption, though not the certainty, of a genetic cause. Claudia Chaufan (2004) argues that diabetes has known direct

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lifestyle dependence, while the genetic components have not been established with any degree of certainty. In 1992, Hales and Barker proposed the “thrifty phenotype hypothesis” as an alternate to the thrifty gene theory. The premise of this is that fetal nutritional status determines predisposition to NIDDM later in life. The thrifty phenotype hypothesis has gained momentum over the last decade and is presently given as much credence in scientific literature as the thrifty genotype. Ozanne and Hales (2002), in a review, draw strongly on Hales and Barker’s theory to show that while the link between fetal nutrition and NIDDM is strong, the genetic effects may not play any role in this relationship. Likewise, Chaufan (2004) noted that malnutrition can coexist in people living in poverty, which has implications for a healthy pregnancy, and this can occur irrespective of genetics. Despite the ongoing controversy, the potential genetic basis of NIDDM has been seen as a high priority in medical and scientific research in recent years (Hegele 1998; McDermott 1998). As previously indicated, the voices of Aboriginal people are essential in the story about the Trickster thrifty gene. While Flora’s voice is certainly not meant to represent all Aboriginal voices, from her point of view NIDDM and obesity are inextricably linked to the concept of community wellness. When I asked her if there was a Cree world for health, she stated, “No, no, it’s just overall well-being.” These ideas reflect that the fundamental starting point for health knowledge is holism and balance. According to Flora, conceptions of health are traditionally framed within a circle, reflecting the use of the medicine wheel that represents the interconnected nature of all things in life. Flora explains that healing is represented by a circle “because that’s ... spirituality – life is a circle ... like in a medicine wheel within a circle, you know. Everything interconnects that way.” In terms of explaining NIDDM among Aboriginal people, Flora made two key points from her personal experience. The first relates to the importance of addressing conditions of lifestyle and levels of marginalization when thinking about the onset of diabetes. Flora strongly argued that the emphasis in research should remain focused on safe and inexpensive access to healthy food and on lifestyle, particularly for more isolated communities, instead of on genetic science. She suggested that lifestyle, not genetics, was the primary cause of NIDDM: “I think I heard about the theory that Aboriginals have a certain type of gene or something, or that their bodies are lacking something … Scientists were

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trying to connect it that way [through genetics], but really, it’s the way you eat – the way you live – if you don’t have physical activity … so I don’t believe in that genetic [explanation].” These views are also reflected in academic and popular literature (Abraham 2011; Knight 2011; Paradies, Montoya, and Fullertone 2007). Her second point related to assumptions made when Aboriginal peoples are considered as separate or as homogenous. In further discussion about the specifics of the thrifty gene, Flora questioned the stereotypical Aboriginal starvation scenario and suggested, based on her experience, that it wasn’t just Aboriginal peoples who had to survive: “People survived because … they were survivors … Indian people knew how to eat roots if they didn’t have meat. They knew where the raw potato grew and the onion. They knew how to cook with the herbs. They knew how to stretch and cure their meat and carry it long periods of time. They lived on fish. They lived on wild meat. They lived on berries. They gathered. So I don’t know … white people survived too.” Flora’s important point here speaks to the notion that perhaps the feast-andfamine stereotype was just that. She points specifically to the idea that perhaps in terms of histories of feast and famine, “white” people were not so historically different from Aboriginal people. This point is also raised in current literature (Abraham 2011; Hee 2010; Paradies, Montoya, and Fullertone 2007; Smith 1999). As we shall see, these ideas are the heart of the analysis that problematizes the assumption of genetic homogeneity for Aboriginal peoples. The Thrifty Gene in the Canadian Context There are a number of scientific texts referring to the existence of the thrifty gene, and many that insist there is indeed a thrifty gene. A close reading of a scientific study can exemplify how the thrifty gene theory is constructed. In March 1999, in several news accounts globally, the thrifty gene was reportedly found among the Aboriginal population of the Oji-Cree of Sandy Lake, Ontario. A flurry of press releases and news stories published in several newspapers and medical journals, including the British Medical Journal, announced that a team of Cana­ dian researchers had located the exact gene mutation responsible for high rates of diabetes among the Sandy Lake community members. It was also reported that this gene mutation was likely the thrifty gene. This line of reasoning centres on the idea of genetic homogeneity within the Sandy Lake community. It is based on the assumption that

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shared “geographical location and language are likely to be associated with other shared factors, such as genetic background” (Hegele 1999, S43). This genetic homogeneity was also apparently linked to genetic isolation, because Sandy Lake was described as “isolated and … accessible for most of the year only by air” (S43). In sum, the researcher argued that “small genetic effects upon complex traits can be detected in a population like the Oji-Cree, which can be considered to be relatively homogeneous with respect to the environment and genetic background” (S46). Using a particular type of gene probe and testing system, a genetic mutation was sought. A gene mutation named HNF1A G319S was found to exist within a particular statistical arrangement and significance. This gene was then searched for in the two other supposedly homogeneous control groups, including Keratin Inuit and “white” subjects living in the Keewatin region.3 These groups had very low rates of diabetes compared with the Oji-Cree. Hegele explains that the “white subjects were included as a contrast sample in order to estimate allele frequencies from a reference, regional control Caucasian population” (S44). The results showed that there was a “high prevalence of ‘deleterious alleles’ in samples taken from Canadian Oji-Cree and Inuit communities, compared with a study sample of white subjects” (S48). The results were interpreted to show that the “higher frequency in both the Oji-Cree and Inuit of the ‘deleterious alleles’ [suggested] that both of these groups might be genetically predisposed to atherosclerosis and/ or diabetes and related phenotypes, compared with whites” (S47). In other words, compared with whites, both Aboriginal populations were thought to be genetically predisposed to disease. The difference in rates of diabetes between the Inuit and Oji-Cree might be explained, on the one hand, by different genetic composition and therefore different levels of relative genetic risk (Hegele 1999). On the other hand, Hegele argues that both Aboriginal groups can be considered genetically at risk and that the different prevalence rates can be explained by lifestyle. The Inuit maintain a traditional lifestyle and the Oji-Cree consume highly processed foods and are sedentary; genetic predisposition to obesity and diabetes becomes problematic or unmasked only when it’s combined with a poor diet and sedentary lifestyle. It is then suggested that the “different environments of the Oji-Cree and Inuit are the most likely explanation” (S48). With this, the thrifty gene theory is used as an explanatory component of the research. Hegele claims that “none of the findings presented above would be

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inconsistent with the ‘thrifty gene’ hypothesis of Dr. James Neel” (S48). In addition, he suggests that “these individuals [found to have the thrifty gene] should be encouraged to maintain or return to a more traditional lifestyle until the issue is clarified” (S48). To conclude, he explains that based on the thrifty gene interpretation, he and his colleagues have designed an intervention strategy for the community of Sandy Lake. The intervention strategy involves community-based education regarding nutrition and lifestyle using appropriate language and cultural strategies; educating the community about finding, purchasing, preparing, and consuming non-traditional foods; encouraging community members to select healthy traditional foods; and concentrating all intervention efforts on young community members (Hegele 1999). These intervention strategies are described in much greater detail within the context of other scientific and community-­ oriented publications, communications, and programs (SLHDP 2000). It must be made clear that the genetic research at Sandy Lake was not conducted in isolation from other research and initiatives in the context of the community and its specific histories and needs. Indeed, it was a model project in many ways for how it exemplified many elements of self-determination. However, there are some concerns about the explanatory power of the thrifty gene theory that go well beyond the community of Sandy Lake. There are also some key elements that deserve critical inquiry. These include questions about the ongoing construction of race-based disease genes and their discursive power in the genetic era, and questions about the relationship between indigenous science and Western science. In the case of the thrifty gene, there are also questions about the ideas of genetic homogeneity and comparative categorical groups. The Idea of Genetic Homogeneity One key element to this analysis is the relationship between race, the onset of disease, and the assumption of genetic homogeneity. Race is not a biological phenomenon. And because there is no reference to the term race in the text, we must consider the assumption of genetic homogeneity among the community members of Sandy Lake. Essentially, a relatively homogenous gene pool would have to exist for a researcher to proceed with research leading to conclusions about the implications of that particular genetic composition for rates of diabetes. In this case,

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genetic homogeneity seems to be established by identifying the existence of a shared language and geography among the Oji-Cree. It is also reaffirmed, in part, by describing the community as isolated, where relative isolation would presumably mean a very slight degree of genetic diversity within the population. However, the contemporary notion of isolation (determined by the need for air travel) does not account for other possible means of travel before the existence of mechanized vehicles. Historically, Aboriginal communities, including the people of Sandy Lake, would have travelled by boat or foot or other means (SLHDP 2000). Hegele reported that “the ancestors of the current residents of this region lived a nomadic, hunting-gathering subsistence” (1999, 43). What did that “nomadic” existence contribute to possible intertribal marriage or adoption and therefore the heterogeneity of the community’s gene pool? Are there more complex and local histories of family lineage that might be relevant? The ancestral background of the Sandy Lake community, as described on the SLHDP website, is very diverse in terms of clan membership and travel. As it relates to language, Oji-Cree is a combination of the Ojibway and Cree languages. The history of membership from a traditional perspective, and the ways in which the combination of languages occurred, are important issues. We have some indication of its historical and familial complexity during colonial times. Flora also shared her thoughts on these points. While she wasn’t speaking specifically of the Oji-Cree, she explained that in the context of general Aboriginal histories and communities, people traditionally moved around from place to place. Communities were often smaller than they were today because they had to be more flexible. Sometimes people travelled great distances; other times they didn’t travel quite as far. At still other times they simply followed herds of animals for hunting and trapping, and sometimes travelled with the seasons. People also visited and intermarried. She explained that people had relations or extended families in different communities, so extensive visits, new relationships, and intertribal relations were simply part of history: “People would socialize. They’d go from one environment to another. They’d travel to communities. They’d have extended families and they would, you know, visit that way … in different places.” These very specific histories are either handed down orally in stories or are sometimes, regrettably, lost.

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These histories of travel and nationhood have implications for the idea of genetic homogeneity. We can illustrate these implications by using the same premise of shared geography and language as the standards of genetic homogeneity to argue that New Yorkers are genetically homogenous. New Yorkers, by definition, live in the same geographic location, and for the most part they speak the same language. The only obvious difference is that the movement of people from different backgrounds in the case of New York is well documented and happened well within the purview of colonial history. Yet New York is normally interpreted as a modern metropolitan conglomeration of peoples of all nations and ethnic backgrounds, whereas Aboriginal communities are often seen as racially, genetically, and culturally homogeneous. The ancestral background of the Oji-Cree is described in terms of dates, times, histories, and geographies relevant to colonial history – the signing of treaties. It does not (or perhaps cannot) consider a very complex history before the signing of the treaties from the perspective of Aboriginal peoples. But the inclusion of local histories of family and community could serve to muddy the “cleanliness” of theories around genetic homogeneity. The writings of Harry and Dukepoo (1998) as well as those of Shelton and Marks (2001) help clarify this line of critical inquiry. They argue that modern science is often uninformed about indigenous peoples, or their knowledges, resources, and histories. Shelton and Marks (2001, qtd. in Lyon 2002, 125) explain that “tribes have longstanding complex relationships [and] ... these social historical forces insure that there cannot be any clear-cut genetic variants differentiating all the members of one tribe from those of nearby tribes.” So, to define a stable relationship between genetic markers and indigenous people is based upon stereotypical assumptions (Harry and Dukepoo 1998). These assumptions seem to be founded upon the commonly held notions that indigenous populations lived in isolation and endured an apparent social, cultural, and political abyss prior to the arrival of European settlers, which would entail a certain starkness of circumstances. Drawing out the importance of local and specific histories from Aboriginal perspectives can help clarify, first, that these specific histories and the complexities of the relationship between the peoples and languages are simply absent in the scientific texts. Second, a more complex understanding of the historical relationships between people that comes from an Aboriginal perspective might affect assumptions about shared geography and language, and therefore about genetic homogeneity and genetic predisposition to disease. Such an understanding would most likely complicate assumptions about the genetic

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composition of the community and could therefore undermine the logical relationship between genetic homogeneity, rates of diabetes, and genetic predisposition as these are filtered through ideologies of race-based risk. The Idea of Comparative Methodological Groups Even if we accept the claim that the Oji-Cree are genetically alike, there are other methodological problems. The key feature of this research is the construction of categories from which comparisons can be made. In other words, comparative groups are the essence of the research design, and all conclusions and inferences depend on the observed or empirical differences between three comparative groups: the white, the Oji-Cree, and the Inuit. The category of the Oji-Cree stood on its own as an obvious grouping and was made up of 728 subjects from Sandy Lake (Hegele 1999). The other two groups consisted of 516 subjects from eight communities on the Keewatin region on the western shore of Hudson Bay. The Keewatin subjects were categorized into Inuit and white, with 92 subjects (17.8 per cent of the Keewatin group; 7 per cent of the entire research population) self-identifying on a survey as “being of European background (white)” (Hegele 1999, S44). In sum, the subjects in the Oji-Cree group all came from Sandy Lake while the subjects in the Inuit and the (comparatively very small) white group came from various northern locations. This categorical delineation and its methodological implications are complicated. The idea of self-reporting a European background is complex from the point of view of lived experience, and there are implications to such a small group serving as the comparative norm. A more revealing comparison, even from this research point of view, would involve a non-Aboriginal group that had undergone the exact ongoing colonial transformation. A true comparison that could test “ethnicity” or genetic “race” as a risk factor would need to attend to histories of travel, traditional and contemporary healing methods, environmental changes, access to food, relative wealth, level of marginalization, assimilative pressures, and the ongoing role of power and self-determination. This binary classification between the white and Aboriginal groupings presupposes and implies the automatic distinctions between normal/ abnormal, subject/other, white/Aboriginal, and healthy/unhealthy. The characteristics of the white group end up existing independently as the healthy and normal standard subject, while the characteristics of

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the Aboriginal groups are defined in opposition as unhealthy, abnormal, and “other.” The binary classification as a feature of Western science is open to criticism from a decolonizing perspective. Critiques of Western science revolve around the problem of universality, hierarchical ordering of knowledge, and classification systems (Whitt 1998). These classification systems also depend upon the interrelated principles of reductionism and order. At the same time, the need for reductionism, reflected in the above categories, condenses, quantifies, and then redefines categories and the people within them. These redefined categories can bear little resemblance to the lives of the people defined by them. The thrifty gene is often used as a race-based determining factor in the etiology of obesity and diabetes among Aboriginal peoples globally, and it is now increasingly authorized. The easy transition between ethnic distinction and deleterious genes emerges out of neocolonial cultural traditions and will continue to hold a great deal of explanatory potential in an era of genetic risk. Troy Duster (1996) addresses the relationship between race and genetic risk by referring to a conceptual and cultural “prism” whereby heritability and the notion of genetic fitness are refractions or cultural constructions emerging out of the already well-established racial order that continues to perpetuate the ideology of problematic races with problematic diseases. Where populations are epidemiologically at risk and where scientific explanation proceeds with a hazy inclination to mining, finding, and reifying genetic racial susceptibility, the racialized diseased-gene equation thrives. Put simply, the thrifty gene is appealing and obvious because it matches neocolonial ideologies of racial difference with current and epidemic rates of obesity and diabetes among marginalized populations. There are then concerns about the reification of these ideological racial categories as inscribed and authorized through the genetic prism. Indeed, race as formulated through the term ethnicity is articulated as a risk factor for disease, but it seems that Aboriginal identity can replace race-based genetic predisposition to disease. The Thrifty Gene in the Clinic It is clear that there are a number of research assumptions that, once examined from a decolonizing perspective, undermine the strength of the research and the existence of the thrifty gene. Perhaps it is safe to argue that the thrifty gene is not simply a natural fact but also a story.

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However, even if we accept the existence of the thrifty gene – even if we take its existence as a neutral fact – there is a whole set of new questions that evolve about the nature of the clinical ends to which the gene will be put. Hegele and colleagues claimed that the genetic mutation, HNF1A G319S, was found in the genes of the community members at Sandy Lake, and argued that people could be screened for this culprit gene, and that factors such as poor lifestyle released the gene’s expression and therefore susceptibility to diabetes. These conclusions seem to have obvious clinical applications. In their piece called “Clinical Utility of HNF1A Genotyping for Diabetes in Aboriginal Canadians,” Hegele and colleagues (2000) evaluate the clinical usefulness of genotyping the Oji-Cree to predict the onset of disease. More specifically, their goal is to transform the marker into a measurable risk factor for disease onset. They argue that the HNF1A genotype is the most specific test for “marking an Oji-Cree subject ≥50 years of age as having diabetes or IGT [impaired glucose tolerance] … A positive test result in particular had remarkable diagnostic value. A subject who was positive for [the gene] was virtually certain (95%) of having diabetes or IGT by 50 years of age” (775–6). Individuals who inherit only one copy of the gene are described as twice as likely to develop the disease as those who inherit no copies (775), and those who inherit two copies are more than fifteen times more likely to develop NIDDM. Moreover, “even in the absence of insight into the causative mechanism, the genotype appears to have diagnostic utility that could help identify Oji-Cree subjects who are at risk many years before the onset of diabetes of IGT” (775). In other words, even when no one knows the cause of type 2 diabetes, the gene can still predict who is sure to get it or indicate those whom Neel (1982, 1999) would refer to as pre-diabetics. From a clinical point of view, identifying high-risk subjects is considered beneficial, especially when they are young and when the knowledge of their relative risk would presumably motivate them to make individual lifestyle changes. More specifically, researchers argue that having the ability to identify susceptible individuals at a young age could enable the design of a protocol or intervention strategy to delay or prevent the onset of the disease. The very high specificity and positive predictive value for S319 also means that this information may be used to help improve motivation or compliance regarding traditional intervention strategies such as diet and exercise. (Hegele et al. 1999, 777)

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Again, several issues emerge from such an argument. The first set of issues centre on the clinical usefulness of mining potential diabetic genes. In the face of overwhelming evidence showing that diabetes is a consequence of nutrition, obesity, and physical inactivity – which are highly associated with socioeconomic status and levels of marginalization – there seems to be little purpose in mining gene-based predictors. From the point of view of clinical practice, the genes would determine levels of propensity or evaluative strategies to assess risk where “genetic markers of type 2 diabetes susceptibility could one day be incorporated into a formula of risk evaluation” (Hegele et al. 1999, 33). But is it useful to devise a genetic factor for an already well-established risk formula related to environmental conditions? Identifying those destined to become diabetic is seen as beneficial for two reasons. First, when at-risk people are identified through the authorizing power of a gene marker, then “appropriate preventive measures could then be targeted towards [them], even before the onset of disease and/or complications” (Hegele 1999, 33). But what are these appropriate preventative measures, and what intervention strategies are appropriate when the disease is considered inevitable and there is still no genetic cure? According to the documents, the second benefit seems to answer this question. The revelation that certain individuals are genetically predetermined to become ill will persuade them to initiate a so-called healthy diet and exercise regime. In other words, the emergence of disease, revealed through genetic identification, is to be used as a tool with which to engender fear about the inevitability of disease. This fear would presumably compel individuals to change their individual eating and exercise habits to stave off disease for as long as their genetics would allow. There are several concerns with this line of reasoning. The relationship between disease genes and personal identity is very complex, and crucial issues arise not only from clinical and psychological standpoints, but also from the point of view of culture and community. There is concern about the clinical problems of fatalism associated with learning about one’s genetic susceptibility. For instance, when genetics are seen as the primary cause, diabetes becomes naturalized and can be seen as uncontrollable and inevitable (Sunday, Eyles, and Upshur 2001). From a clinical point of view, in a different publication Hegele (1998) considers the implications of being informed about genetic susceptibility and urges caution when disseminating screening results. Discussing a study associated with the genetics of coronary artery disease, he says that

The Geneticization of Aboriginal Diabetes and Obesity  109 when we informed [the] family members about their gene susceptibility, some of them incorrectly inferred that the development of the condition was genetically predestined and that its future expression was outside their control. However, their attitude changed when we explained to them that ... [the genetic hazard of developing the disease was less substantial than the environmental factors and that] ... the latter are largely within an individual’s control. (1085)

However, the social effects associated with being identified as the embodiment of deleterious genes are not considered in a broader context. In this set of examples, we see evidence of what Whitt (1999) refers to as the pure/applied distinction in the context of value neutrality and value bifurcation. In this sense, power relations and the ethics involved in knowledge construction are completely divorced from the knowledge production phase. Scientific knowledge, ideologically immune from questions of ethics and power, emerges as value free, cleansed of culture, and decidedly finished. Under these conditions, ethics can emerge only outside finished and seemingly neutral knowledge – they become a byproduct of the knowledge itself – and never inside the construction of knowledge. In this sense, ethics are considered only in a supplementary sense and are typically dealt with in an overt political domain rather than within science. The broader context, or that from an indigenous worldview, might consider the role of history, power, and community in the construction of identity. More specifically, the implications of Aboriginal disease based on genetic predisposition should be understood in the context of cultural and individual identity, traditional histories, and the context of knowledge systems. Second, the focus on the individual is complex. The implication of genetic-based research is that while an individual may not be responsible for the gene, individuals are at risk and bear the responsibility to manage both the risk and the effects of the disease. Where the risk of disease is translated into danger that is medicalized and personalized, the focus on individual risk translates into a moral obligation to exercise self-control and the need for constant surveillance (Sunday, Eyles, and Upshur 2001). Likewise, the focus on the individual tends to shift attention away from the environmental, social, political, and economic components of disease. The individual obligation to restore health is not morally neutral. It has a relationship to the primitive/civilized binary where Aboriginal peoples and perhaps cultures become again increasingly problematic and immoral.

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Perhaps the more serious concern is the extent to which Aboriginal ethnicity is a genetic risk factor for disease and Aboriginal bodies are inscribed with a politics of surveillance. In the absence of a cure, the main practical reason for identifying those at risk would be to compel people to change their lifestyle. While there is certainly something important about the individual initiation of preventative health measures and something very important (but not uncomplicated) about warning people of imminent danger, there is also something to be said about socalled neutral health discourse that sees race as a genetic risk factor and inevitably transforms Aboriginal bodies into those needing surveillance. Abonyi (2001, 30) has criticized the genetic/adaptationist paradigm that frames this research: “the implication is that gene therapy may one day better prepare Aboriginal people to live in a modernized context, but until then they should not step outside their genetically and biologically determined boundaries.” A more general question remains. Aside from surveillance pressure, what do those inscribed with genetic risk have to gain by learning of their genetic predisposition, particularly when the general course of preventative action would be the same as it would were they not informed of their genetic susceptibility? From a Foucauldian point of view, it’s about certain kinds of bodies and surveyable subjects being produced under the medical-genetic gaze. From a decolonizing perspective, there is concern regarding the discursive character of health knowledge about Aboriginal peoples. As O’Neil, Reading, and Leader (1998) have argued, certain types of medical/health discourse operate as powerful forms of regulatory surveillance, which are based on the representation and reiteration of Aboriginal peoples as sick, disorganized, and dependent, and which legitimate paternalistic and regulatory management over Aboriginal health in communities. Likewise, we should recall Waldram and colleagues’ (2000) warning that biomedical discourse often acts as a form of assimilative pressure. This analysis resonates with indigenous activists’ and scholars’ concerns, including those of Harry and Dukepoo (1998), who have argued that it is naive to assume genetic science will provide a cure. It is more likely that genetic science would be harmful to Aboriginal communities, especially in the case of multifactorial conditions such as obesity and NIDDM, and because the focus on gene sequencing diverts attention from other basic health requirements like food security, employment, and safe environments. Other problems include those associated with racial categorization and biological/genetic determinism, where those categories and groups of people who have traditionally been

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marginalized will now learn that their genes are inferior and need improvement (IPCB 2000; Lippman 1991). The intention to clarify the role of genetics in NIDDM and obesity is certainly benevolent. Indeed, one could suppose that medical or genetic research was geared towards creating useful knowledge intended to reduce the suffering associated with diabetes. Shedding light on wellness in the context of communities is certainly part of the project of self-determination. But the dialogue about genetic science, as it’s connected to Aboriginal peoples’ wellness and self-determination, should consider genetic science in the larger sociocultural and historical context. It is important to recognize that just as Aboriginal knowledges about healing and self-determination are about cultural norms, values, and assumptions, so too does genetic science also have its own norms, values, and assumptions, which are evident, and therefore transformable. As such, locating the thrifty gene theory in its social, cultural, and historical context and envisioning it as part of an ongoing dialogue about ethnicity, identity, empowerment, and epidemic makes a much better contribution to the construction of the thrifty gene theory and perhaps to future discussions about Aboriginal wellness. Conclusion The thrifty gene story thrives as a consistent and powerful explanation for the recent proliferation of NIDDM among Aboriginal peoples. The thrifty gene can be seen as a story – a cultural product – about disease, Aboriginal peoples, and genetics. The story of the thrifty gene has thus far only begun to include Aboriginal perspectives from decolonizing perspectives. There should be more. Decolonizing projects are about revealing knowledges as parts of a story that sometimes comes from unrevealed and hidden perspectives. Where the thrifty gene almost always emerges as a character in the historical-evolutionary story of diabetes among Aboriginal peoples and in the current genetic era, it is likely to stay in the storyline. By envisioning the thrifty gene story as Raven trickster – as deceptive, sly, but also as the communicator transformer who performs very important tasks – we can discover what is possible in transforming our thinking about genetic susceptibility. We can bring new things to light. This new tale is intended to contribute to an ongoing dialogue that involves the exposition of the thrifty gene story from a decolonizing perspective that had been previously missing. Stories change over

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time and are transformed by the perspectives and experiences of the storyteller. They can also be transformative by providing a shifting basis from which additional knowledges are developed and new things become visible. By seeing new things, we can continue to demystify dominant power/knowledge systems as closed, to value indigenous knowledges and histories, and to contribute to the co-evolution of emancipatory knowledge in Aboriginal health. It is important that this dialogue move forward as we see power/knowledges continue to expand and the stakes surrounding genetics, health, and identity continue to intensify. Afterword It has been almost a decade since this essay was originally published. The tale of the Trickster thrifty gene continues. In February 2011, the debates surrounding the thrifty gene theory resurfaced in a recent Globe and Mail news article by Carolyn Abraham entitled “How the DiabetesLinked ‘Thrifty Gene’ Triumphed with Prejudice over Proof.” Abraham investigates the history and prominence of the thrifty gene by exploring the perspectives of various scholars working within sociology, anthropology, and biology. Researchers who once regarded the thrifty gene theory as a possible explanation for the high rates of diabetes in First Nations communities have more recently acknowledged the importance of lifestyle and environmental factors. That is, the theory alone does not “capture the subtlety and complexity … of type 2 diabetes in First Nations communities” (Hegele, qtd. in Abraham 2011, para. 29). One reason for this shift, Abraham suggests, is that “after four decades in search of thrifty genes, no one can find them” (para. 10). The article outlines two prominent debates: (1) the theory is viewed as “promoting the myth that indigenous people all have the same genes that make their diabetes ‘a special problem’ beyond the reach of publichealth initiatives” (para. 16); and (2) the theory tells only one part of the story: there is no single gene but a collection of “genetic traits that contribute to type 2 diabetes” (para. 46). In the former debate, social context and environmental factors play an important role while genetic explanations are argued to be stigmatizing and, as Jeff Reading acknowledged, “potentially damaging” because a genetic explanation “discounts the social circumstances of poverty – it suggests that you’d be okay if you didn’t have faulty genes” (para. 19). The scholars working from this perspective argue that social and health problems among First Nations communities arose from the history of colonization. The

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latter debate argues that although there is no single gene identified as responsible for diabetes susceptibility, the belief remains that multiple genetic traits may contribute or genetically predispose certain populations to type 2 diabetes. Followers of this perspective believe that the theory does not “stigmatize” anyone because the “thrifty gene” would be seen as a positive trait for its ability to protect the individual during times of famine. Although it is generally agreed that type 2 diabetes is a growing concern for First Nations communities, scholars disagree on its potential risk factors, which has led to the continued environment-versus-­ genetics debate. The article concludes that the Sandy Lake story “played a key role in prompting the government to pay attention to the problem,” and research has helped launch community programs focused on health and wellness initiates (Abraham 2011, para. 52). The thrifty gene story continues in current scientific and health discourses as a possible explanation for the high rates of diabetes among Aboriginal peoples, albeit with nuanced variations given the dearth of literature that explains the role of socioeconomic, cultural, historical, and environmental or lifestyle factors in NIDDM (Campbell et al. 2012; Everett 2011; Gracey and King 2009; Hee 2010; Knight 2011, 2012; Maar et al. 2011; Paradies, Montoya, and Fullertone 2007; Southam et al. 2009; Speakman 2008; Veenstra 2009). In a number of recent studies (Byrne and Nkongolo 2012; Millar and Dean 2012; Prentice, Hennig, and Fulford 2008),4 genetic risk factors continue to play a role as an important explanation for increased rates of diabetes. Importantly, some researchers focusing on genetic risk factors acknowledge the importance of wider sociocultural or historical factors, concluding that lifestyle changes among indigenous people (such as the change from high levels of physical activity to more sedentary lifestyles) contribute to the diabetes epidemic (Byrne and Nkon­ golo 2012). More specifically and, for example, in the conclusion of their article, Byrne and Nkongolo acknowledge stress and other interconnected social conditions as important environmental factors that influence diabetes. They also recognize some of the problems of including race as a genetic risk factor. The authors qualify that “racial and geographical grouping of populations should not therefore be discarded” because “these are some of the few methods available to researchers for separating genetic risk factors among populations in a visible way” (2012, 228). Studies generally following the thrifty gene hypothesis, including a focus on fertility-selective pressures and the evolution of type 2 diabetes in children, have also tended to acknowledge

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but sidestep the significant role of social, cultural, or historical factors or have overemphasized genetic risk factors (Millar and Dean 2012; Prentice, Hennig, and Fulford 2008). More recently, however, there has been a shift within the literature focused on socioeconomic, cultural, and historical factors. Although this research examines possible genetic explanations for the disease, it also suggests that the “wider social and cultural context” is important and presents many factors that operate beyond the individual to cause diabetes (Hee 2010, 18). Hee’s comparative study of indigenous and non-indigenous Australians argues that “many risk factors for type 2 diabetes shared with other Australians are only compounded by the social disadvantage experienced by Indigenous Australians” (18), suggesting that indigenous groups face the same genetic risk factors for diabetes as non-indigenous groups but experience higher social disadvantages that compound those risks. Similarly, Gracey and King (2009) argue that the poor health of indigenous people “is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections” and suggest that “inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation” (65). They also argue that “colonization adversely affected physical, social, emotional, and mental health and wellbeing in traditional societies” and that an understanding of how colonization affected these groups is required when considering health gaps between indigenous and non-indigenous populations (65). Maar and colleagues (2011) suggest that “systematic underfunding of First Nations health and social services, necessary to address the consequences of colonization … and pervasive poverty are major contributors to the inequities of diabetes related complications in First Nations communities” (12). An increasing number of studies have pointed to versions of the thrifty gene hypothesis that perpetuate geneticized and racialized explanations of diabetes (Abraham 2011; Everett 2011; Knight 2011; Maar et al. 2011; Paradies, Montoya, and Fullertone 2007; Veenstra 2009). Paradies, Montoya, and Fullertone (2007) state that “there is at present no consistent evidence to suggest that minority populations are especially genetically susceptible” and that the claim relies on “the misplaced assumption that individuals with different ethnoracial identities are genetically distinct and that this has relevance to ethnoracial health inequalities” (204–5). Similarly, Everett (2011) expressed concern that genetic etiologies, particularly when applied to specific ethnic

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populations, tend to “downplay the role of environmental and social conditions in producing diabetes,” which is often “framed as an ethnoracial disease” in both popular and scientific discussions (1777). In studying experiences of diabetes from the perspective of indigenous groups in a community near Oaxaca, Mexico, Everett (2011) found that “patients appear to search their own biographies and life experiences to understand” why they have developed diabetes, and that family history or genetic inheritance “was rarely seen as meaningful in understanding one’s own individual experience” (1780). People often described experiences of trauma as an explanation for the onset of the disease. The author notes that many patients “pointed to the influence of strong emotions and/or upsetting events to explain why diabetes had touched them” (1779). This research demonstrates how the knowledge and perspectives of indigenous groups who are affected by the disease are vital to understanding the whole story. Contrary to biomedical and genetic explanations, experiences of trauma and connections to wider social, cultural, and historical factors are identified as important to uncovering the causes for the high rates of diabetes present in particular indigenous communities. The recent research that focuses on social, cultural, and historical factors has tended to move away from genetic explanations when considering health disparities and the high prevalence of NIDDM among indigenous groups. Despite these valuable insights, discourses surrounding the links between thrifty genetic traits and NIDDM continue to resurface in both popular and scientific literature. These discourses serve to construct health knowledge about Aboriginal peoples, presenting an incomplete story of the thrifty gene that often remains removed from Aboriginal perspectives. Thus, a new chapter, or rather an extended chapter, in the story of the thrifty gene continues and the ongoing story of race, genetics, and disease thrives, albeit in more complex and nuanced ways. NOTES 1 This report wrongly identified the “Indians” as from Manitoba rather than Ontario. 2 Following the National Aboriginal Health Organization (NAHO) Canada (2003), I use the terms Aboriginal and indigenous to refer to all peoples of Indian, Inuit, and Métis heritage, including non-status Indians. Like many

116  Jennifer Poudrier other scholars, I also use the term First Nations to refer to Aboriginal peoples in Canada. 3 From this point onward, for simplicity, I drop the quotation marks around the term white and use it as it appears in the texts. 4 Recent health promotion literature continues to refer to genetic predispositions, risk factors, and “thrifty genes” (see NDIC 2011 and EatRightOntario.ca). Canadian government health literature identifies a genetic risk factor that they call the “thrifty gene effect.” However, they also refer to the debates on the importance of genetic and environmental factors when considering diabetes susceptibility (Public Health Agency of Canada 2011).

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The Geneticization of Aboriginal Diabetes and Obesity  117 Canadian Broadcasting Corporation. 2005. “The Weight of the World.” The Nature of Things. 24 January. Chaufan, C. 2004. “Poverty vs. Genes: The Social Context of Type 2 Diabetes.” Diabetes Voice 49 (2): 35–8. Duster, Troy. 1996. “The Prism of Heritability and the Sociology of Knowledge.” In Naked Science: Anthropological Inquiry into Boundaries, Power, and Knowledge, ed. L. Nader, 119–30. New York: Routledge. Everett, M. 2011. “They Say It Runs in the Family: Diabetes and Inheritance in Oaxaca, Mexico.” Social Science & Medicine 72 (11): 1776–83. http://dx.doi .org/10.1016/j.socscimed.2011.02.021. Fee, Margery. 2006. “Racializing Narratives: Obesity, Diabetes and the ‘Aboriginal’ Thrifty Genotype.” Social Science & Medicine 62 (12): 2988–97. http://dx.doi.org/10.1016/j.socscimed.2005.11.062. Goodman, A., D. Heath, and S.M. Lindee, eds. 2003. Genetic Nature/Culture: Anthropology and Science beyond the Two-Culture Divide. Berkeley: University of California Press. Gracey, M., and M. King. 2009. “Indigenous Health Part 1: Determinants and Disease Patterns.” Lancet 374 (9683): 65–75. http://dx.doi.org/10.1016/ S0140-6736(09)60914-4. Hales, C.N., and D.J.P. Barker. 1992. “Type 2 (Non-Insulin-Dependent) Diabetes Mellitus: The Thrifty Phenotype Hypothesis.” Diabetologia 35 (7): 595–601. http://dx.doi.org/10.1007/BF00400248. Haraway, Donna. 1999. “Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective.” In The Science Studies Reader, ed. M. Biagioli, 172–89. New York: Routledge. Harding, Sandra. 1998. Is Science Multicultural? Postcolonialisms, Feminisms, and Epistemologies. Bloomington: Indiana University Press. Harry, Debra. 2001. Biopiracy and Globalization: Indigenous People Face a New Wave of Colonialism. Nixon, NV: Indigenous Peoples Coalition Against Biopiracy. http://www.ipcb.org/publications/other_art/globalization.html. Harry, Debra, and F. Dukepoo. 1998. Indians, Genes and Genetics: What Indians Should Know About the New Biotechnology. Nixon, NV: Indigenous Peoples Coalition Against Biopiracy. http://www.ipcb.org/pdf_files/primer.pdf. Hee, M. 2010. “Type 2 Diabetes Mellitus: A Review Comparing Indigenous and Non-Indigenous Australians.” Medical Student Journal of Australia 2 (1): 15–19. Hegele, R.A. 1998. “Lifestyle and Genetic Susceptibility.” Canadian Medical Association Journal 159 (9): 1085–7. – 1999. “Lessons from Genetic Studies in Native Canadian Populations.” Nutrition Reviews 57 (5): 43–50. http://dx.doi.org/10.1111/j.1753-4887.1999 .tb01787.x.

118  Jennifer Poudrier Hegele, R.A., H. Cao, A.J.G. Hanley, B. Zinman, S. Harris, and C. Anderson. 2000. “Clinical Utility of HNF1A Genotyping for Diabetes in Aboriginal Canadians.” Diabetes Care 23 (6): 775–8. http://dx.doi.org/10.2337/diacare.23.6.775. Hegele, R.A., H. Cao, S.B. Harris, A.J.G. Hanley, and B. Zinman. 1999. “The Hepatic Nuclear Factor-1alpha G319S Variant Is Associated with Early-Onset Diabetes in Canadian Oji-Cree.” Journal of Clinical Endocrinology and Metabolism 84 (3): 1077–82. Indigenous Peoples Council on Biocolonialism (IPCB). 2000. Press release. Nixon, NV: Indigenous Peoples Council on Biocolonialism. Knight, Christine. 2011. “‘Most People Are Simply Not Designed to Eat Pasta’: Evolutionary Explanations for Obesity in the Low-Carbohydrate Diet Movement.” Public Understanding of Science (Bristol, England) 20 (5): 706–19. http://dx.doi.org/10.1177/0963662510391733. – 2012. “Indigenous Nutrition Research and the Low-Carbohydrate Diet Movement: Explaining Obesity and Diabetes in Protein Power.” Journal of Media and Cultural Studies 26 (2): 289–301. Leslie, R.D.G., ed. 1993. Causes of Diabetes: Genetic and Environmental Factors. Chichester: John Wiley. Lippman, A. 1991. “Prenatal Genetic Testing and Screening: Constructing Needs and Reinforcing Inequalities.” American Journal of Law & Medicine 17 (1/2): 15–50. Lone Dog, L. 1999. “Whose Genes Are They? The Human Genome Diversity Project.” Journal of Health & Social Policy 10 (4): 51–66. http://dx.doi.org/ 10.1300/J045v10n04_04. Lyon, D., ed. 2002. Surveillance as Social Sorting: Privacy Risk, and Digital Discrimination. London: Routledge. Maar, M.A., D. Manitowab, D. Gzik, L. McGregor, and C. Corbiere. 2011. “Serious Complications for Patients, Care Providers and Policy Makers: Tackling the Structural Violence of First Nations People Living with Diabetes in Canada.” International Indigenous Policy Journal 2 (1): 1–16. McDermott, Robyn. 1998. “Ethics, Epidemiology and the Thrifty Gene: Biological Determinism as a Health Hazard.” Social Science & Medicine 47 (9): 1189–95. http://dx.doi.org/10.1016/S0277-9536(98)00191-9. Millar, Kyle, and Heather Dean. 2012. “Developmental Origins of Type 2 Diabetes in Aboriginal Youth in Canada: It Is More than Diet and Exercise.” Journal of Nutrition and Metabolism 2012: 1–7. http://dx.doi.org/10.1155/ 2012/127452. Montoya, M. 2007. “Bioethnic Conscription: Genes, Race and Mexicana/o Ethnicity in Diabetes Research.” Cultural Anthropology 22 (1): 94–128. http:// dx.doi.org/10.1525/can.2007.22.1.94.

The Geneticization of Aboriginal Diabetes and Obesity  119 Nader, Laura, ed. 1996. Naked Science: Anthropological Inquiry into Boundaries, Power, and Knowledge. New York: Routledge. National Diabetes Information Clearinghouse (NDIC). 2011. Causes of Diabetes: What Causes Type 2 Diabetes? http://diabetes.niddk.nih.gov/dm/pubs/ causes/index.aspx. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2002a. The Pima Indians: Pathfinders for Health. http://diabetes.niddk.nih .gov/dm/pubs/pima/genetic/genetic.htm. Neel, J.V. 1962. “Diabetes Mellitus: A ‘Thrifty’ Genotype Rendered Detrimental by Progress?” American Journal of Human Genetics 14 (4): 353–62. – 1982. “The Thrifty Genotype Revisited.” In The Genetics of Diabetes Mellitus, ed. J. Kobberling and R. Tatersall, 283–93. London: Academic Practice. – 1999. “The ‘Thrifty Geneotype’ in 1998.” Nutrition Reviews 57 (5): 2–9. O’Neil, J., J. Reading, and A. Leader. 1998. “Changing the Relations of Surveillance: The Development of a Discourse of Resistance in Aboriginal Epidemiology.” Human Organization 57 (2): 230–7. http://dx.doi.org/ 10.17730/humo.57.2.b7628vwvg7q127m8. Ozanne, S.E., and C.N. Hales. 1998. “Thrifty Yes, Genetic No.” Diabetologia 41 (4): 485–7. http://dx.doi.org/10.1007/s001250050934. – 2002. “Pre-and Early Postnatal Nongenetic Determinants of Type 2 Diabetes.” Expert Reviews in Molecular Medicine 4 (24): 1–14. Paradies, Y.C., M.J. Montoya, and S.M. Fullertone. 2007. “Racialized Genetics and the Study of Complex Diseases: The Thrifty Genotype Revisited.” Perspectives in Biology and Medicine 50 (2): 203–27. http://dx.doi.org/ 10.1353/pbm.2007.0020. Poudrier, J. 2003. “‘Racial’ Categories and Health Risks: Epidemiological Surveillance among Canadian First Nations.” In Surveillance as Social Sorting: Privacy, Risk, and Automated Discrimination, ed. D. Lyon, 111–34. London: Routledge. Prentice, A.M., B.J. Hennig, and A.J. Fulford. 2008. “Evolutionary Origins of the Obesity Epidemic: Natural Selection of Thrifty Genes or Genetic Drift following Predation Release?” International Journal of Obesity 32 (11): 1607–10. http://dx.doi.org/10.1038/ijo.2008.147. Public Health Agency of Canada. 2011. “Diabetes among First Nations, Inuit, and Métis of Populations.” In Diabetes in Canada: Facts and Figures from a Public Health Perspective, chap. 6. Ottawa: Public Health Agency of Canada. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/ facts-figures-faits-chiffres-2011/chap6-eng.php. Rabinow, P. 1994. Essays on the Anthropology of Reason. Princeton: Princeton University Press.

120  Jennifer Poudrier – 1999. “Artificiality and Enlightenment: From Sociobiology to Biosociality.” In The Science Studies Reader, ed. M. Biagioli, 407–16. New York: Routledge. Reid, Bill, and Robert Bringhurst. 1984. Raven Steals the Light. Vancouver: Douglas and MacIntyre. Sandy Lake Health and Diabetes Project (SLHDP). 2000. http://cbpp-pcpe. phac-aspc.gc.ca/aboriginalwtt/sandy-lake-health-diabetes-project/. Shelton, B.L., and J. Marks. 2001. Genetic Markers – Not a Valid Test of Native Identity. Nixon, NV: Indigenous Peoples Council on Biocolonialism; http:// www.ipcb.org/publications/briefing_papers/files/identity.html. Skinner, B., and P. Rosen. 2001. “Opening the White Box: The Politics of Racialized Science and Technology.” Science as Culture 10 (3): 285–300. http://dx.doi.org/10.1080/09505430120074109. Smith, L.T. 1999. Decolonizing Methodologies: Research and Indigenous Peoples. London: Zed Books. Southam, L., N. Soranzo, S.B. Montgomery, T.M. Frayling, M.I. McCarthy, I. Barroso, and E. Zeggini. 2009. “Is the Thrifty Genotype Hypothesis Supported by Evidence Based on Confirmed Type 2 Diabetes- and ObesitySusceptibility Variants?” Diabetologia 52 (9): 1846–51. http://dx.doi.org/ 10.1007/s00125-009-1419-3. Speakman, J.R. 2008. “Debate: Thrifty Genes for Obesity, an Attractive but Flawed Idea, and an Alternative Perspective: The ‘Drifty Gene’ Hypothesis.” International Journal of Obesity 32 (11): 1611–17. http://dx.doi.org/10.1038/ ijo.2008.161. Spurgeon, D. 1999. “‘Thrifty Gene’ Identified in Manitoba Indians.” British Medical Journal, 318 (7187): 828. http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1115266/. Sunday, J., J. Eyles, and R. Upshur. 2001. “Applying Aristotle’s Doctrine of Causation to Aboriginal and Biomedical Understandings of Diabetes.” Culture, Medicine and Psychiatry 25 (1): 63–85. http://dx.doi. org/10.1023/A:1005638900581. Veenstra, G. 2009. “Racialized Identity and Health in Canada: Results from a Nationally Representative Survey.” I 69: 538–42. http://dx.doi.org/ 10.1016/j.socscimed.2009.06.009. Waldram, J., A. Herring, and T.K. Young. 1995. Aboriginal Health in Canada: Historical, Cultural and Epidemiological Perspectives. Toronto: University of Toronto Press. Waldram, J., J. Whiting, N. Kornder, and B. Habbick. 2000. “Cultural Understandings and the Use of Traditional Medicine among Urban Aboriginal People with Diabetes in Saskatoon, Canada.” Canadian Journal of Diabetes Care 24 (2): 31–8.

The Geneticization of Aboriginal Diabetes and Obesity  121 Whitt, L.A. 1998. “Resisting Value-Bifurcation: Indigenist Critiques of the Human Genome Diversity Project.” In Daring to Be Good: Essays in Feminist Ethico-Politics, ed. B. Bar On and A. Ferguson, 70–86. New York: Routledge. – 1999. “Value-Bifurcation in Bioscience: The Rhetoric of Research Justification.” Perspectives on Science 7 (4): 413–46.

4 Diabesity, or the “Twin Epidemics”: Reflections on the Iatrogenic Consequences of Stigmatizing Lifestyle to Reduce the Incidence of Diabetes Mellitus in Canada D a rlen e M c Naugh t on an d Cy n t h i a S m i t h Type 2 diabetes mellitus (T2DM) is marked by high levels of glucose in the blood, caused by a reduced capacity or inability to produce insulin – a hormone generated in the pancreas that controls blood glucose levels (WHO 1999). It is the most common form of diabetes and is well recognized as a disease of aging that occurs mostly in people aged forty and over (Public Health Agency of Canada [PHAC] 2011). The disease often goes undetected for years, and early symptoms commonly include increased tiredness, thirst, urination, hunger, and weight gain. Diabetes is strongly associated with aging, genetics, a family history of the disease, previous gestational diabetes, nutrition, poverty, and distress – the interplay of which is not well understood (Gard and Wright 2005; Ridderstråle and Groop 2009, 111; Rock 2005, 2013; Vassy and Meigs 2012, 191; Wilson et al. 2007). Genetics and family history are thought to be particularly significant. For example, having a parent with diabetes “increases one’s risk for the disease by 40 percent” (Köbberling and Tillil 1982, 203). Having two parents with the condition increases this risk to 70 per cent (Kaprio et al. 1992; Meigs, Cupples, and Wilson 2000; Poulsen et al. 1999; Ridderstråle and Groop 2009, 111; Vassy et al. 2011, e77; Wilson et al. 2007). Vassy and colleagues (2011, e77) suggest that although parental history (which includes familial and ethnic clustering) and specific gene variants play a significant role, there are likely to be “modest associations” with the environment and with unknown genetic factors. Evidence is also emerging that second-generation antipsychotics – increasingly used to treat anxiety and depression – create metabolic changes that bring on diabetes and lead to significant weight gain (Allison et al. 1999; Leucht et al. 2009; Zimmermann et al. 2003, 193–4).

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Although diabetes appears to be more prevalent among those classified as “obese” (BMI ≥ 30), it is well established that adults from a broad range of body weights and BMIs (including those considered “healthy”) can and do develop the disease (McCarthy et al. 1996, 5). For example, in the 2009–2010 Canadian Community Health Survey (CCHS) 75 per cent of those aged eighteen years and over with diabetes self-reported a so-called unhealthy weight, while 25 per cent reported “healthy weights” (PHAC 2011, 58). In the same survey, 50 per cent of those self-reporting a so-called unhealthy weight did not have diabetes – including 19.1 per cent who identified themselves as “obese” (PHAC 2011, 58). However, despite the complex causal pathways that lead to diabetes and the gaps in current understanding, the disease is increasingly represented in deceptively simple terms (McNaughton 2013b). At the same time, the idea that weight and specifically obesity is the risk factor or central cause of T2DM has become increasingly prominent, prevalent, and naturalized in many countries, including Canada (McNaughton 2013a, 2013b). This is evident in popular imaginings, academic research, public health initiatives, and media commentary across a wide range of fields, populations, and countries (McNaughton 2013a, 2013b). In this new “framing,” weight is commonly emphasized and depicted as the central driver of increases in the incidence of T2DM in a given population, while diabetes (like obesity itself) is imagined as self-inflicted – the result of wholly changeable and risky lifestyle behaviours, factors, and choices. To date, however, the implications, iatrogenic consequences, and stigmatizing effects of this framing have received little attention (McNaughton 2013a, 2013b). In this chapter, we begin by briefly revisiting two papers that have begun to map some of the contours of this framing, and have demonstrated its prevalence in academic, public health, medical, and popular discourses on diabetes in Australia and internationally (McNaughton 2013a, 2013b). We then explore how the idea that weight is the risk factor or central cause of diabetes is being taken up in Canada. To do this, we draw on feminist materialist and post-structural perspectives to undertake a critical reading of academic and public health research, government documents, media representations, and individual commentaries on diabetes and weight. While there is no overarching theoretical framework in critical discourse analysis, by bringing together a variety of materials we demonstrate that similar framings also underpin Canadian discourses around

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weight and diabetes. In particular, we find the representation of weight as the central risk factor or cause of diabetes, the conflation of weight with T2DM, and the capacity for the overweight body to act as a potent cultural symbol for diabetes. We acknowledge from the outset that diabetes and weight have a long and complex history in Canada and elsewhere, the archaeology of which is well beyond the scope of this chapter. However, our results do suggest that these frames are common in Canada and that here, too, weight has come to act as a powerful cultural signifier for diabetes. As such, our aim is simply to highlight and describe the scale and apparent naturalness of these frames and demonstrate how they have been taken up across a range of fields and discourses in Canada. Drawing on studies from Canada, Australia, and the United States, we end the discussion with some preliminary insights into the ethics and likely iatrogenic implications of this for patients’ experiences and interpretations of the disease. From Globesity to Diabesity (Die-Obesity?) Fatness is a mode of “bodily trespass” that has long been the focus of some degree of social and moral scorn (Bell, McNaughton, and Salmon 2011a). However, during the last quarter of the twentieth century a seismic shift began to emerge, in which fat came to represent a “dangerous” and significant threat to global health (Bell, McNaughton, and Salmon 2011a; Saguy and Riley 2005). This shift was driven in part by assertions that we are facing a global obesity epidemic, seen most conspicuously in the World Health Organization’s (WHO) 1998 report “Obesity: Preventing and Managing the Global Epidemic.” In the next decade, the idea that we are in the midst of a global obesity epidemic became widely accepted – so much so that less than a decade after the WHO (1998) report was released, overweight and obesity were frequently said to have overtaken alcohol and tobacco as the leading risk factors for a number of so-called lifestyle diseases, including T2DM, as Bell, McNaughton, and Salmon (2011a) have demonstrated (see also Raine 2004).1 The existence, scale, and consequences of the “global obesity epidemic” have been questioned by a number of scholars (Campos 2004, 2008; Campos et al. 2006; Gard and Wright 2005; Rail 2009; Saguy and Riley 2005). Some argue that the obesity epidemic has all the hallmarks of what Cohen (1972) called a “moral panic,” while others demonstrate that evidence for the health implications of weight is

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conflicted, contradictory, and “replete with flawed and misleading assumptions” (Campos 2004, 2008; Campos et al. 2006; Beausoleil and Ward 2008; Bell, McNaughton, and Salmon 2009; Gard and Wright 2005, 3; Lupton 1995; Rail 2009; Rail and Beausoleil 2003). A central conclusion of these and many other studies is that while being overweight or obese may have health implications, the evidence is far from conclusive on if, how, or to what extent certain health consequences are caused by overweight or obesity. What has emerged from these critical studies is that a wide range of “healthy” weights is clearly possible. Despite the conflicted and inconclusive state of the available evidence, however, overweight and obesity are invariably pronounced as dangerous threats to global and national health in medical, government, and popular discourses – overstating both the current knowledge base and the “risk” (Gard and Wright 2005; Gard, this volume). According to the World Health Organization (2012), for example, “an escalating global epidemic of overweight and obesity – ‘globesity’ – is  taking over many parts of the world.” In the same period, some Canadian studies have suggested an increase in obesity (Canning, Courage, and Frizzell 2004; Raine 2005; Tremblay, Katzmarzyk, and Willms 2002; Twells 2005) while others, including those undertaken by Statistics Canada (2010), have suggested a plateau in obesity rates for both adults and children (Beausoleil and Ward 2008). Although there are clear contradictions in these and other results, most reports suggest a “continuous increase” in obesity rates in Canada, as Beausoleil and Ward (2008, 5) have shown. As a result, the view that Canadians are getting “fatter” remains largely unchallenged in the media, research, or popular imaginings. The wide-reaching and often uncritical acceptance of a global (and Canadian) obesity epidemic has resulted in a disproportionate response to the risks. It has provided many new opportunities for the monitoring, regulating, and stigmatizing of “threatening,” fat bodies while simultaneously perpetuating certain medico-moral assumptions about individuals and the causes of fatness in Canada (Bell, McNaughton, and Salmon 2011a; Bercovitz 2000) and elsewhere (Bell and McNaugh­ ton 2007; Gard and Wright 2005; McNaughton 2011, 2013a, 2013b). Beausoleil and Ward have argued that obesity is increasingly represented and understood not simply as a risk factor in Canada, but as a “contributor to disease” (2008, 3) and in some quarters as a “chronic disease,” medicalizing and politicizing what is essentially a bodily state (Jutel 2009; LeBesco 2004). In such a reconfiguration, the overweight or

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obese body comes to represent an actual state of ill health or a body with the potential for sickness rather than a bodily state. Alongside these developments, the overweight or obese body is increasingly identified with T2DM, as McNaughton (2013a, 2013b) has shown. In short, the overweight or obese body has also come to act as a powerful cultural signifier for diabetes or diabesity in Canada. Overweight and Obesity as the Drivers of Increases in Type 2 Diabetes in Canada The incidence of T2DM in Canada has increased in recent years – a trend that is also evident in other countries with a significant aging population.2 Although there are some conflicting data on the scale and nature of this increase – due in part to the use of different methods and an emphasis on self-reported data in many though not all studies – it is nevertheless widely accepted that there is an increase in disease incidence. For example, in 1978 the Canadian Health Survey estimated that 2.5 per cent of the population had T2DM; in 1996 the National Popu­ lation Health Survey estimated this to be around 3.4 per cent (Health Canada, 1999). By 2001, according to the first C ­ anadian Community Health Survey, 4 per cent of adults (over eighteen years old) were living with T2DM, which had risen a decade later to 6.8 per cent (approximately 2.4 million adults) (PHAC 2011; Statistics Canada 2011). While a rise in the incidence of disease is certainly playing a role here, it is widely acknowledged that an aging population, increased life expectancy, improved survival, and greater access to health care services are also contributing factors. As McCarthy and others have argued, diabetes “has evolved as a major health problem because of increasing life expectancies” in many countries (1996, 1, our emphasis; see also PHAC 2011, chap. 1; Wild et al. 2004, 1047). This rise in incidence is further linked to increases in diagnosis and surveillance through mechanisms like The Canadian Chronic Disease Surveillance System (CCDSS), the introduction of routine testing, and lowering of the age for screening adults from forty-five to forty years in 2003 (PHAC 2011; Vassy and Meigs 2012, 191; Wilson et al. 2007; Zimmet, Alberti, and Shaw 2001, 78). However, since the early 2000s, Canadian researchers, media commentators, policy makers, and government officials have increasingly linked the rise in diabetes directly to rises in obesity in the same population. Although many reasons are given for this rise (including the increased surveillance and diagnosis we noted), most commentators

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argue or appear to assume that the alleged obesity epidemic has become the central driving force behind increases in diabetes rates. For example, in a 2002 publication on diabetes in Canada we find the following statement from two senior researchers in the field, one of whom, Jan Hux, was scientific advisor to the Canadian Diabetes Association at the time. Diabetes mellitus is a serious and growing health problem. Approximately 6 percent of Ontarians are diagnosed with diabetes …; however, with the aging of the population and growing rates of obesity, the numbers with this condition are expected to rise. (Booth and Hux 2002, 35)

Ten years later in an article entitled “Picture of an Epidemic,” diabetes was framed as an epidemic, dramatically shifting the threat it was thought to pose. Michael Cloutier, then CEO of the Canadian Diabetes Association, claimed that diabetes “threaten[s] the sustainability of our health-care system and could be potentially devastating in both social and economic terms.”3 The same article also gives an explanation for the emergence of this “silent epidemic,” notably emphasizing lifestyle and sedentary behaviour: The aging of Canada’s population is one demographic driver for increases in the number of people living with diabetes, and improvements in life expectancy for people with diabetes are another contributor. “But more so, it is the behavioural changes of contemporary society that are a catalyst for increased risks, such as a more sedentary lifestyle,” explains Dr. Hux.

Since the early 2000s the framing of diabetes has shifted from a growing health problem to an epidemic in its own right brought on, most recently, not by an aging population, increased life expectancy, improved surveillance, or poverty but “more so” by changes in our weight, lifestyle, and behaviour. This bears out a point made by Gard and Wright, who argued that “much of the rhetoric around the so-called ‘obesity epidemic’ is based on the spurious claim that obesity causes or is one of the important multiple causes of non-insulin dependent diabetes mellitus” (2005, 101–2) when weight is more accurately understood as a symptom of diabetes. Following from this, McNaughton (2013a, 2013b) has demonstrated that this conflation of diabetes with weight, wherein weight is seen as the emerging or emergent risk factor, driver, or cause of diabetes, is part of

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a larger discourse that cuts across international boundaries. It has come to be known as the obesity-driven diabetes epidemic, the “twin” or “dual” epidemics (of diabetes and obesity), and in some regions as the “diabesity epidemic.” Current Framings: Epidemics, Diabesity, and the Conflation of Weight with Diabetes in Canada As we’ve argued, broad acceptance within biomedicine, public health, and popular discourses that rates of overweight and obesity are skyrocketing globally has led a number of commentators to express concern about the potential emergence (and for some the existence) of a second or twin epidemic, the “diabetes epidemic” (Teixeira and Budd 2010, 527). Invariably this alleged diabetes epidemic is depicted as being driven primarily, or for some entirely, by increasing rates of overweight and obesity in the same population. A similar depiction is seen in Canada. The earliest reference we found to the “twin” or “dual” epidemics in Canada is from 1999, in an article by Birmingham and colleagues – which also corresponds with the emergence of this discourse in Australia and the United States (McNaughton 2013a, 2013b). By the early 2000s, however, the idea of a dual epidemic brought on by obesity was becoming more commonplace. For example, in an early report on complications of T2DM, Booth and Hux (2002) drew on Mokdad and colleagues’ (2001) US study entitled “The Continuing Epidemics of Obesity and Diabetes in the United States” to argue that diabetes was expected to rise in Canada and then to link this increase directly to obesity. In 2009, The Canadian Diabetes Association released a report called An Economic Tsunami: The Cost of Diabetes in Canada. By 2011 the existence of a diabetes epidemic had become further entrenched. For example, Rosella and others called for “national estimates of the upcoming diabetes epidemic” that could be used to “understand the distribution of diabetes risk in the population and to inform health policy” (2011, 613). Studies critiquing the emphasis on individual lifestyle in Canadian government policies and calling for a move away from this focus also fell into the kinds of slippage we have highlighted. For example, Alvaro and colleagues claimed that “medical systems worldwide, including Canada, are ‘swamped’ by an epidemic of non-insulin-dependent diabetes and coronary heart disease … which will be exacerbated if current trends related to obesity continue” (2011, 91).

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As with biomedicine, the media are also replete with examples and commentaries on the alleged diabetes epidemic and its drivers. For example, in an article in the Toronto Sun Vancouver doctor Alissa Zentner has suggested that “we are faced with a national [diabetes] crisis: one that will only worsen as our patient population grows older and more obese.”4 A story called “Canada Diabetes Epidemic Predicts Worse for World,” referring to a study into increased rates of diabetes in Ontario by Shaw and others (2010), claimed “that rates of diabetes in Canada’s most populous province have already zoomed past what was predicted for 2030, which suggests the global epidemic [diabetes] will be far worse than feared” (Reuters 2010). The article went on to explain that “type-2 diabetes is associated with obesity, poor diet and a lack of exercise … [and] … has reached epidemic proportions in many developed countries as people eat a richer diet and exercise less.” The study’s authors were quoted as saying that “rising rates of obesity could be a cause of this striking growth and, accordingly, effective public-health interventions to manage and prevent obesity are sorely needed.” Here again weight, and in particular obesity, is linked directly to diabetes as the most significant or sole driver of the alleged diabetes epidemic. Of note here is the distinctly causative dimension of this notion of the dual or twin epidemics – the idea that obesity leads to or generates diabetes. In some instances the independent identities of overweight, obesity, and diabetes are collapsed entirely. This is most evident in the neologism diabesity. Although the use of diabesity is more prevalent in Australia and the United States, it has also been used in Canada, usually in reference to First Nations peoples (Chateau-Degat et al. 2009; Ng 2012; Thouez et al. 1990; Young et al. 2000). One high-profile international commentator, Paul Zimmet, has asserted that indigenous peoples throughout the world are at great risk of “extinction” “within five to ten years” from diabesity – obesity-driven diabetes (Zimmet 2006; Zimmet, Alberti, and Shaw 2001). He argues that “the UN needs to declare ‘diabesity’ an international health disaster” and that rising international diabetes rates “threaten to consume world economies and bankrupt health systems” (Zimmet 2006; Zimmet, Alberti, and Shaw 2001). Although diabetes rates are often higher in indigenous populations in Canada and elsewhere (i.e., Australia, United States, Aotearoa-New Zealand), the term diabesity serves to reinforce the idea that weight, and particularly obesity, causes diabetes. It also renders invisible the broader structural and historical forces that are play here, such as racism, poverty, distress, duress, undernutrition, and colonialism (Rock 2005,

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2013). As Fee (2006) has demonstrated, heavily racialized statements like this one, with their imagery of death and extinction, are also part of larger, postcolonial interpretations of obesity and diabetes in which notions of “race” are often used uncritically and problematically as a proxy for presumed genetic differences. Whether as the twin or dual epidemics or as diabesity, we see the (all too common) conflation of obesity and overweight on the one hand, and the presentation of these as the cause of T2DM in Canada (McNaugh­ ton  2013a, 2013b). While some writers making such claims may see the link in diagnostic terms – wherein upper body or abdominal overweight or obesity shows the greatest degree of insulin resistance, which in turn might result in T2DM – this is rarely if ever explained or articulated (Kissebah, Freedman, and Peiris 1989). Linking diabetes and weight in such politically charged ways serves to elevate the role of overweight and obesity as risk factors for diabetes in Canada. Indeed, the term diabesity, like the idea of twin epidemics, implies a single all-pervasive cause for diabetes, namely overweight and obesity. This conflation not only overstates the evidence but also underplays the complex and poorly understood relationship between T2DM and body weight. At the same time, it renders invisible the complex casual pathways of this disease: the existence and role of other risk factors for diabetes such as aging and heredity and structural factors such as poverty, migration experience, poor nutrition, distress, and lack of social support, all of which are determinants of health that individuals have no or little control over. In the more extreme commentaries, like those of Zimmet quoted above, “die-obesity” is perhaps a more accurate rendering of what is actually being suggested. Significantly, the iatrogenic consequences of this conflation and framing have not been explored in Canada or internationally (McNaughton 2013b). The Rise in Emphasis on “Modifiable” (Lifestyle) Factors In recent decades, we have seen the re-emergence of lifestyle as a central cause of illness and disease in public health discourse, policy, and programs (Bell, McNaughton, and Salmon 2011a; Petersen and Lupton 1997). In some sectors, the stigmatizing of individual “lifestyles” has also re-emerged as a way to combat chronic diseases like heart disease, lung cancer, and diabetes – most notably in the field of tobacco denormalization. This focus on one’s lifestyle as the cause of disease has also seen increased emphasis placed on publicizing the risk factors

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associated with chronic or “lifestyle” diseases like diabetes (WHO 1999, 2011). In the last decade, overweight and obesity have overtaken alcohol and tobacco, their older comrades in harm, as purportedly the most important risk factors for a number of lifestyle diseases, most notably diabetes T2DM (Bell, McNaughton, and Salmon 2011a). In our critical review of key Canadian government health reports and academic research from the late 1990s, we found that overweight and obesity were increasingly associated with a broad range of illnesses and diseases, including diabetes (CCHS 2008 7; CDPAC 2012; PHAC 2011; Starky 2005; Statistics Canada, 2010). From 2005 onwards, however, diabetes has moved up the list to rank as the first or second disease associated with obesity across key government websites, including Health Canada, the Public Health Agency of Canada, and various provincial ministries of health. But we also see another significant shift in emphasis in how diabetes is framed across these sites. From 2005 onwards, non-modifiable factors or causes of diabetes such as age, genetics, and family history have begun to slip into the background (and down the list), while those factors seen as modifiable lifestyle factors – notably weight, diet, and exercise – are given greater prominence. In short, there is a discernible shift in emphasis away from the non-modifiable to what is deemed open to change and intervention. Over time, lifestyle (weight, diet, exercise) and in particular obesity are increasingly identified as the central drivers of diabetes. Here is an example of this shift. The incidence rates of diabetes rose steeply after age 40 among both sexes, peaking in the 70 to 74 and 75 to 79 year age groups ... Almost half of incident cases of diabetes in 2008–09 were aged between 45 to 64 years old. According to CCHS survey data based on the same age group, among those who self-reported having diabetes, 83.3 percent were of unhealthy weight (including 47.5% obese) compared to 57.8 percent with unhealthy weight (including 19.1% obese) among those without diabetes. This suggests that obesity was a major contributor to diabetes in that age group. (PHAC 2011, 20, our emphasis).

While a number of factors are at play in this apparent increase, the only one mentioned, the only explanation provided, is obesity. Framing diabetes as a disease of lifestyle implies that like obesity, it too is self-inflicted – the result of wholly changeable and risky lifestyle factors (and “choices”), and this is significant (McNaughton 2013b).

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The emphasis in recent decades on individual responsibility and on publicizing the so-called risk factors associated with lifestyle (Petersen and Lupton 1997) has, for diabetes at least, seen those factors deemed modifiable given much greater prominence than those that are beyond individual control. This is evident across health policy, education campaigns, and interventions in Canada and internationally. When the complex etiology of diabetes is presented in such deceptively simple terms, T2DM (like weight) emerges as something “you have done to yourself,” as something a person has brought about because of an unhealthy (and irresponsible) lifestyle. The implications of this framing for the uptake of services and for potential iatrogenic consequences have, however, received little attention to date (McNaughton 2013b). The Fat Body as the Diabetic (Diseased, Unhealthy, Irresponsible) Body Type 2 diabetes comprises 90 percent of people with diabetes around the world … and is largely the result of excess body weight and physical inactivity. (WHO 2011).

In recent decades the overweight or obese body has come to signify a person who engages in risky behaviour and has an unhealthy lifestyle, which places them at risk for a range of health issues and diseases from cancer to diabetes (Bell, McNaughton, and Salmon 2009, 2011a). In many countries, including Canada, that bigger-than-average-body is increasingly read as a sick or diseased body (Austin 1999; Bell McNaughton, and Salmon 2009, 2011a; Campos 2004; Campos et al. 2006; Elliott 2007; Ellison, this volume; Gard and Wright 2005; Kirk and Penney 2010; McDermott 2008; Murray 2008; Norman, Rail, and Jette, this volume; Petersen and Lupton 1997). Both Watson (1993, 248) and Crawford (1984, 70–1) have shown that those whose body weights are in the highest ranges are commonly assumed to be the persons most likely to be “unhealthy.” Drawing on Goffman’s (1963) early work and phrasing, the authors described these individuals as having a “spoiled identity,” because of their perceived inability to control their eating and weight. Similar frames, wherein body size or shape is taken to indicate the presence of T2DM, are also highly prevalent in the discourses around diabetes, weight, risk, and lifestyle in Canada (Kirk and Penney 2010).

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In the idea of an obesity-driven diabetes epidemic we see several assumptions about the dangerousness of fat and the idea that poor health is simply the result of changeable, risky behaviours, which in turn have created another, potentially more deadly “scourge” in the form of a “diabesity” epidemic. Overweight and obese people are imagined either as diabetic or as becoming diabetic (McNaughton 2013a, 2013b). In this framing, the overweight or obese body/person signifies a diseased body/person, or a body/person with high disease potential – both of which are self-inflicted through risky, irresponsible, unhealthy behaviours (Aphramor 2005; Ellison, this volume). There is little room here for the ideas (a) of weight as a symptom of diabetes, (b) that some overweight or obese people never develop the disease, or (c) that some people whose body weight is considered normal will be diagnosed with T2DM. Overweight, Obesity, and Fat Prejudice LeBesco has argued that because fat people embody both unhealthiness and unattractiveness, they “are widely represented in popular culture and interpersonal interactions as revolting – they are the agents of abhorrence and disgust” (2004, 1). As Ellison’s contribution to this collection shows, in Canada and elsewhere the overweight or obese person is commonly cast as stupid and deficient, their bodily forms reviled as grotesque and linked to moral categories such as laziness, irresponsibility, greed, and a lack of willpower or self-control (Bordo 1993; Cossrow, Jeffery, and McGuire 2001; Link and Phelan 2001; Lupton 1995; Puhl and Heuer 2009, 2010; Saltonstall 1993; Schwartz 1986; Schwartz and Brownell 2004). As Rail and colleagues (2010) and Sharma (2012) have shown, overweight or obese Canadians are also constructed as irresponsible citizens who cost the health system millions of dollars. In this context and at a time when global populations are said to be overflowing with corpulent citizens, it is not surprising to learn that the prevalence of weight stigma has increased in many countries in recent years (Andreyeva, Puhl, and Brownell, 2008; Puhl and Heuer 2009, 2010). Several studies strongly indicate that weight bias and weight stigma are prevalent in Canada, and that anti-fat attitudes are “socially acceptable forms of prejudice” in many sectors (Bagley et al. 1989; MacLean et al. 2009; Maroney and Golub 1992; Rail et al. 2010; Sharma

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2012; Stunkard and Sorenson 1993, 1037). It is also well documented that in fat-averse societies, the loathing of fatness is often deeply gendered and a great deal of body scrutiny is directed towards women (Bordo 1993; Chernin 1981, 1986; Lawrence 1984; MacSween 1993; Millman 1980; Orbach 1978, 1986; Spitzack 1990; Wolf 1991), although as Bell and McNaughton (2007) and Monaghan (2008) have demonstrated, this can also be and is increasingly the case for men as well. Although there has been some recognition of anti-fat bias in Canada in recent years, it remains for the most part unchallenged. For example, in 2011 the Canadian Obesity Network (CON) held the Canadian Weight Bias Summit. However, because CON frames obesity as a disease to be fought, this greatly limits their capacity to respond to or address stigma and fat bias. We also find Dr Arya Sharma, scientific director of the Canadian Obesity Network, arguing that obesity is not a “character flaw” and “shaming, blaming and taxing aren’t constructive or positive strategies [for the reduction of obesity]” (Harris 2012).5 The question, then, is: if overweight and obesity are stigmatized categories in Canada and the bigger-than-average body also acts as a powerful cultural signifier for diabetes, what are the implications of the growing conflation between weight and diabetes we’ve examined here? How might anti-fat attitudes affect patient-provider interactions, healthseeking behavior, and the timing of diagnosis and intervention among those deemed to be “at risk” from diabetes? And what are the implications for those who are not overweight but understand diabetes to be caused by fatness? Fat Prejudice, Diabetes, and the Medical Encounter The potency of overweight and obesity as cultural signifiers for T2DM, the ubiquity of this framing, and its stigmatizing and iatrogenic consequences have received little attention in the extant literature (McNaugh­ ton 2013a, 2013b). This is due, in part, to an uncritical acceptance of the idea that weight, and specifically obesity, begets diabetes – a widely held, taken-for-granted assumption that is evident across a range of fields, discourses, and mediums. Because there are no studies examining the conflation identified here, we draw instead on studies examining bias, stigma, and the medical encounter from Australia, the United States, the United Kingdom, and Canada to briefly explore the potential implications of this framing.

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Unlike other stigmatized practices such as smoking, alcohol consumption, or drug use, weight’s high visibility makes it highly susceptible to discrimination. Girth cannot be hidden, not from daily social interactions, not while eating in public, and not during medical encounters (Saguy and Riley 2005). It is also well established that health professionals are no less fixated on weight (particularly female weight) than other members of size-averse societies (Bagley et al. 1989; Bordo 1993; Maroney and Golub 1992; Puhl and Heuer 2009; Schwartz 1986; Sobal and Maurer 1999). Indeed, there is considerable evidence to suggest that health care providers often hold negative and prejudicial attitudes towards people who are overweight (Anderson and Wadden 2004; Ferraro and Holland 2002; Oberrieder et al. 1995; Teachman and Brownell 2001). For example, O’Brien and colleagues (2010) have argued that health care professionals, even those who specialize in obesity treatment, are a common source of weight bias towards obese patients in Britain. Ferraro and Holland’s (2002) US-based study indicated that doctors were more likely to evaluate their female patients as obese even when the women did not have a Body Mass Index greater than 30, and Rice’s (2007) “Becoming the ‘Fat Girl’” highlights the stigma that fat women experience when seeing a general practitioner in Canada. In Joanisse and Synnott’s (1999) Canadian-based study of obesity and stigma, female interviewees were much more likely than their male counterparts to have experienced abuse and bullying by health professionals. Women attending medical appointments for issues quite unrelated to weight (e.g., bladder infections, a broken arm, a nose bleed) were often lectured about their body size by doctors. In this study, a number of women also described more subtle and insidious forms of stigma and judgment on the part of both male and female doctors in the form of callous jokes and comments about their weight. One respondent was told by her doctor that “fat was unattractive to men,” another was asked how many chairs she had broken in the waiting room. And when one woman complained that her new medication made her vomit, her doctor responded that at least she would lose weight (57). A number of studies (Cossrow et al. 2001), including two undertaken in Canada (Bagley et al. 1989; Maroney and Golub 1992), have demonstrated that health care providers, in all their variety, can convey a lack of empathy towards overweight patients that further contributes to the stigmatization of this population. Puhl and Heuer (2009) have argued that health care providers, like other professionals, are in positions of

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power that are often perceived as authoritative, and as such may exert more of an influence on the lives of the stigmatized. As a result their prejudices can have greater impact. The internal and external obstacles to seeking care for diabetes have been well documented and include the ability to finance or follow diet and exercise regimes, affordability and availability of health care providers and services, language and cultural differences, and provider communications (Chin et al. 2001). However, as Teixeira and Budd (2010) have shown, little is known about the influence of obesity stigma on care seeking. They demonstrate that fat prejudice among health professionals also acts as a barrier to diabetes management. Diagnostically, the response to the onset of TD2M or indications that it may be developing involves glycemic control via diet, weight loss, exercise, and medications including, in some cases, insulin. However, if patients are not losing weight or are struggling to do so, health staff may lose patience or express a lack of empathy, shaming, or further stigmatizing (Cossrow et al. 2001; Teixeira and Budd 2010). Patients may also blame themselves for their “failure” or be made to feel responsible for their diabetes in a way that is shaming or stigmatizing. Conversations about weight, weight loss, diet, and exercise are commonplace in health care encounters around diabetes, and several studies suggest that experiencing or expecting weight discrimination may be causing people to evade or delay health care or treatment. For example, Mitchell and others (2008) have demonstrated that cervical cancer screening rates were lower in overweight Canadian women who perceived a lack of respect by health providers and felt embarrassed. Earnshaw and Quinn’s (2011) US-based research with people living with chronic illnesses, including diabetes, suggests that those who experienced or anticipated stigma in health care settings were less likely to access care and had decreased quality of life. Teixeira and Budd (2010) suggest that the shame of not having lost weight and the fear of being reprimanded are key factors in T2DM patients postponing or avoiding follow-up visits in the United States. Similarly, the CrossNational Diabetes Attitudes, Wishes and Needs (DAWN) study into psychological barriers to diabetes care, undertaken in thirteen countries, found that many participants with T2DM felt very anxious about their weight (Peyrot et al. 2005). In a similar vein, a survey undertaken in Aotearoa-New Zealand by Simmons and colleagues (2007) indicated that obesity was an obstacle to patients seeking diabetes support, along with other health conditions

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and economic barriers. Another study by Drury and Louis (2002) from the United States indicated a direct correlation between avoidance or delay of health care and women’s perceptions of weight and weight stigma. Although this study did not consider diabetes, or men’s experiences, broader arguments about men, service use, and weight stigma suggest that they too may be avoiding health care (Bell and McNaughton 2007; Monaghan 2008). Teixeira and Budd (2010) claim that obesity stigma is a likely barrier to ongoing diabetes management in the United States and elsewhere. Health providers, they assert, need to improve their sensitivity, devote more time to interactions with overweight patients, and reflect more self critically on their own assumptions about weight and how these are being communicated to clients. They also call for health staff to employ particular counselling strategies with their “obese” T2DM patients that will improve disease management and reduce patients’ experience of weight stigma in the United States and in other size-averse societies. Of course, the assumption here is that most diabetics are overweight – indeed, this is assumed by most of these studies – overlooking those who may not be overweight but are still at risk for the disease. Conclusion In many countries, including Canada, the overweight or obese person is commonly framed as lacking in beauty, desirability, willpower, responsibility, self-control, discipline, and health. They are seen as morally inferior, grotesque, sick, out-of-control, irresponsible citizens who cost the health system and the taxpayer millions of dollars (Bell, McNaughton, and Salmon 2011a). While some people may resist these constructions or counter them with alternative and more positive discourses, they are nevertheless surrounded by messages that speak to their “lifestyles,” their bodies, and their selves as irresponsible failures. There is also a large body of literature demonstrating that a fat body/person provokes a range of moralistic and prejudicial attitudes from the person themselves, their families, peers, and their health care providers – especially in fat- or size-averse societies. The greatest risks to health tend to coalesce around specific (often poor) populations and particular substances and practices, notably tobacco, alcohol, nutrition, and illicit drugs (Bell, McNaughton, and Salmon 2011a, 2011b). In recent decades, these practices are increasingly presented as wholly preventable if individuals simply take charge of

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their health and their irresponsible lifestyles, and avoid smoking, drinking, drugs, and overeating (Bell, McNaughton, and Salmon 2011a, 2011b). However, this focus on lifestyle-induced risk factors produces some disturbing alignments, like the “fatness causes diabetes” conflation we’ve discussed here. This conflation of weight with diabetes has become increasingly prevalent in Canada, and is evident in a variety of discourses both medical and lay. Framing diabetes in this way not only overstates the evidence, but also turns symptoms into causes and grossly understates the complex causal pathways of the disease, emphasizing the modifiable and masking the non-modifiable (McNaughton 2013a, 2013b). It also places responsibility for diabetes and health on the individual, while rendering invisible the very structural forces that create these behaviours and ill health in the first place. In doing so, it masks the social determinants of diabetes (and obesity) while reinforcing the idea that diabetes is something people did to themselves. Given that T2DM can emerge in people from a range of weights – including those considered “healthy” – this conflation of weight with diabetes also has ethical implications for how we experience and interpret the symptoms of the disease, its prevention, diagnosis, and treatment. We know that diabetes occurs in people from a broad array of weight ranges. However, there is little research to indicate how those at risk of T2DM might be responding to (a) the increased stigma associated with weight and diabetes, (b) the conflation of weight with diabetes, (c) broad acceptance that weight begets diabetes, and (d) increasing assertions about the existence of “diabesity” or the “twin epidemics.” We hope that this research currently being completed will provide further insights into these issues and the iatrogenic consequences and violence of current framings that, among other things, leave one with the distinct impression that diabetes is something one did to oneself. NOTES 1 This is the position of the Public Health Agency of Canada, the Canadian Institute of Health Information and the Canadian Population Health Institute. See, for example, “Overweight and Obesity in Canada: A Population Health Perspective” (Raine, 2004). 2 For example, in Australia, a country that also has a significant aging population, national health surveys based on self-reported data show a rise in the incidence of T2DM from 193,000 (1.3 per cent) in 1989–90 to 818,000

Diabesity, or the “Twin Epidemics”  139 (3.9 per cent) in 2007–8 (Australian Institute of Health and Welfare 2012, 210, 299). 3 “Picture of an Epidemic,” Globe and Mail, 12 November 2012, http://www .theglobeandmail.com/partners/advsanofi1112/picture-of-an-epidemic/ article5101007/ (accessed 5 March 2013). 4 “Diabetes Conference Told Canada Is Facing National Obesity Crisis.” Toronto Sun, 13 October 2012, http://www.torontosun.com/2012/10/13/ diabetes-conference-told-canada-is-facing-national-obesity-crisis. 5 It should also be noted that Sharma advocates for bariatric surgery, ­arguing that it is a better alternative than diet and exercise.

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Diabesity, or the “Twin Epidemics”  145 Rail, G., D. Holmes, and S.J. Murray. 2010. “The Politics of Evidence on ‘Domestic Terrorists’: Obesity Discourses and Their Effects.” Social Theory & Health 8 (3): 259–79. http://dx.doi.org/10.1057/sth.2009.10. Raine, K. 2004. Overweight and Obesity in Canada: A Population Health Perspective. Ottawa: Canadian Population Health Initiative. – 2005. “Determinants of Healthy Eating in Canada.” Canadian Journal of Public Health 96 (3): S8–14. Reuters. 2010. “Canada Diabetes Epidemic Predicts Worse for World.” http:// www.reuters.com/article/2007/03/02/us-diabetes-worldidUSN0140746620070302. Accessed 15 March 2012. Rice, C. 2007. “Becoming the ‘Fat Girl’: Acquisition of an Unfit Identity.” Women's Studies International Forum 30 (2): 158–74. http://dx.doi.org/ 10.1016/j.wsif.2007.01.001. Ridderstråle, M., and L. Groop. 2009. “Genetic Dissection of Type 2 Diabetes.” Molecular and Cellular Endocrinology 297 (1–2): 10–7. http://dx.doi.org/ 10.1016/j.mce.2008.10.002. Rock, M. 2005. “Classifying Diabetes; or, Commensurating Bodies of Unequal Experience.” Public Culture 17 (3): 467–86. http://dx.doi.org/10.1215/ 08992363-17-3-467. – 2013. “Sweet Blood and Social Suffering: Rethinking Cause-Effect Relationships in Diabetes, Distress, and Duress.” Medical Anthropology: Cross-Cultural Studies in Health and Illness 22 (2): 131–74. Rosella, L.C., D.G. Manuel, C. Burchill, and T.A. Stukel. 2011. “A PopulationBased Risk Algorithm for the Development of Diabetes: Development and Validation of the Diabetes Population Risk Tool (DPoRT).” Journal of Epidemiology and Community Health 65 (7): 613–20. http://dx.doi.org/ 10.1136/jech.2009.102244. Saguy, A.C., and K.W. Riley. 2005. “Weighing Both Sides: Morality, Mortality, and Framing Contests over Obesity.” Journal of Health Politics, Policy and Law 30 (5): 869–923. http://dx.doi.org/10.1215/03616878-30-5-869. Saltonstall, R. 1993. “Healthy Bodies, Social Bodies: Men’s and Women’s Concepts and Practices of Health in Everyday Life.” Social Science & Medicine 36 (1): 7–14. http://dx.doi.org/10.1016/0277-9536(93)90300-S. Schwartz, H. 1986. Never Satisfied: A Cultural History of Diets, Fantasies and Fat. New York: Doubleday. Schwartz, M.B., and K.D. Brownell. 2004. “Obesity and Body Image.” Body Image 1 (1): 43–56. http://dx.doi.org/10.1016/S1740-1445(03)00007-X. Sharma, A. 2012. Dr. Sharma’s Obesity Notes. http://www.drsharma.ca/ obesity-canadian-council-on-weight-bias-and-discrimination.html. Accessed 9 January 2013.

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5 Spoon Fed: Learning about “Obesity” in Dietetics Ju li e E. R oc h e f ort, An dre a S e n c h u k , Jenni fer Br a dy, an d Jacqui Gin g r a s

If you participate in the field of fat studies, you must be willing to examine not just the broader social forces related to weight but also your own involvement with these structures. If you do fat studies work, you are always already part of the topic. Every person who lives in a fat-hating culture inevitably absorbs anti-fat beliefs, assumptions, and stereotypes, and also inevitably comes to occupy a position in relation to power arrangements that are based on weight. None of us can ever hope to be completely free of such training or completely disentangled from the power grid. Wann 2009, xi

Dietitians have declared war on what they (and other allied health care professionals) have called an “obesity epidemic” that is jeopardizing the health of Canadians and placing an insurmountable strain on our health care resources (Beausoleil and Ward 2010; Inthorn and Boyce 2010; Rich 2011). Using nutrition as their weapon, registered dietitians have been called to the front lines of the “war on obesity” to rein in expanding waistlines by “helping” individuals achieve and maintain their body weight within the very narrow range of so-called normal body weight (BMI > 18 kg/m2 and < 25kg/m2) (Lau et al. 2007). Given their professional identity as “weight management experts” (Parham 1999), dietitians have long reinforced the supposed relation between weight and health. Dietetics’ weight-centred paradigm prevails despite emerging research (Aphramor 2005; Bacon and Aphramor 2011; Campos et al. 2006; Kuk et al. 2011) that reveals a far less tenacious relationship between “overweight/obesity” and morbidity than antiobesity scientists would have us believe. Research has been unable to

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determine a cause-effect relationship between obesity and the health complications said to result from being “overweight” or “obese.” Con­ versely, research has shown that in some cases, being “overweight” is linked to reduced mortality in conditions such as diabetes (Ross, Langer, and Barrett-Connor 1997) and cardiovascular disease (Dietz 1998; Morse, Gulati, and Reisin 2010). At the core of dietetics is a commitment to evidence-based practice, which is also a guiding principle of dietetic education and training programs in Canada. Still, despite the research that suggests a change in how dietitians promote health, the weight-centred paradigm and the consequent war on fat remains entrenched in Canadian dietetic practice and curricula. Given the stark contrast between emerging research and dietetic practice, a critical exploration of the forces that support and maintain the weight-centred paradigm in dietetic practice is crucial to move towards a more socially just, weight-neutral model of practice and education. As Wann (2009) suggests in the epigraph to this chapter, part of this work necessitates an exploration of self and the relationship we all have to the dominant, weight-biased, patriarchal paradigm. Using reflexive methods, we aim in this work to reveal the “complex ways in which knowledge circulates” (Walkerdine 2008, 200) by investigating dietetic attitudes towards “overweight” and “obesity” (hereafter referred to as fatness) from four professional perspectives, those of an aspiring dietitian (Andrea), an entry-level dietitian (Julie), a dietetic educator (Jacqui), and an academic dietitian-survivor (Jennifer). Through individual reflexive writing and collective dialogue, we explore how our attitudes towards obesity were shaped by our dietetic education and training and reflect on how the relationships to what we know constitute our being, becoming, or unbecoming dietitians (see Rice, this volume). As we “turn back” on our multiple histories in relation to the research question, we afford an uncompromising view of how we promoted, reinforced, contested, and rejected an anti-fat attitude within the dietetic profession. Moreover, we see how we are differently situated in relations of power by way of intersecting categories of privilege, including white, thin, and class privilege. These textual and collaborative methods name the weight-centred approach and in so doing identify its marginalizing and violent consequence. This process is “crucial for [dietitians] to begin to articulate the education possibility of a poststructural, socially just dietetic education and practice” (Gingras 2009b, 189). Like Wann (2009), we acknowledge that as fat studies scholars and practitioners, we “are always already part of the topic” (xi). We invite

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others who are already part of the topic within and outside dietetics to engage with this text and self-reflexively transform how health care professionals are constituted pedagogically, thus becoming critical obesity/fatness practitioners and scholars. Methods We used autoethnography (Davies 1999; Ellis 2004; Ellis and Bochner 2000) and collective biography (Davies and Gannon 2006) to explore the research question, “How were my attitudes towards fatness shaped in becoming a dietitian?” Autoethnography enables a thorough, ethical, and transparent account of how personal, disciplinary, and sociocultural history has influenced us as variably positioned members of the dietetic profession. We first collaboratively developed the research question and then wrote individual reflexive autoethnographies (hereafter referred to as reflexives) in response to it. We then came together again to analyse these reflexives. Just prior to the collaborative analysis, one member of our team (Julie) spent time reviewing all of the individual reflexives and summarized their coincident themes for us to consider. We reviewed each other’s reflexives and Julie’s summary document and then met via Skype to discuss these texts, as well as to determine next steps. We confirmed and elaborated upon the themes that Julie had identified. Finally, we discussed the structure of the essay and who would draft each section accordingly. As one aspect of this collaborative method, we considered how contentious it seemed to conflate fatness with “overweight” and “obesity.” The terms overweight and obesity are defined medically according to body mass index ranges and thus represent a very specific view of body weight that we have come to contest. Given the literature that problematizes the medicalization of bodies (Bordo 1993), we opted for the term fatness as a political gesture to resist this dominant discursive preoccupation with quantifying bodies and bodily experiences. We use fatness instead of the words overweight and obesity,” which signify specific categories of fatness measured by BMI, to avoid having to define “how fat” and instead promoted the complexity and uncertainty that comes when attempting to discuss bodies – others’ and our own. Reflexive Autoethnographies The following sections were written individually in response to our research question. They are presented here alphabetically by last name.

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We note that the undergraduate education in dietetics of three authors (Jennifer, Julie, and Andrea) was completed between 2008 and 2011, while that of Jacqui was completed fifteen years earlier (1992–95).

Jennifer Brady: Academic Dietitian-Survivor This is a story about becoming and unbecoming a dietitian, about forgetting and remembering, about trying to measure up and then reclaiming my (unbecoming) body. It has been important for me to take a step back from dietetics. Although I focus on dietetics in my research, I am not immersed in dietetic culture to the extent that I once was. (I initially planned to be immersed for the duration of my professional life.) My unbecoming is about taking this step back for my own survival. It took me five years to become a registered dietitian. This process of becoming had a profound effect on how I perceived fat/ness. Fat, whether in food or on bodies, was to be measured, carefully. How many grams of fat per serving? How many calories per gram? Body mass index equals kilograms of body weight over height in metres squared. The purpose of this scrutiny was to avoid getting fat, or if you were already fat, to lose weight. Fat became triglycerides and fatness became obesity, abdominal adiposity, kg/m2. Being fat meant being unhealthy; it meant being at risk for a slew of diseases that carried both medical and moral diagnoses. Fatness, it seemed, was an affront to science, to our expertise, and to our collective (altruistic or self-serving?) desire to “help” people. Armed with the language of “patient-centred” practice and the facts derived by nutrition science, I was trained to seduce fat bodies and assert dietetics’ weight-loss imperative. It was so simple – fat people ate too much of the wrong kinds of foods and didn’t exercise. Could this be true? Nutrition science answered with an emphatic yes, although I struggled to accept that response. Conflict arose in my body as I tried to reconcile what I was learning and what I knew to be true about food, eating, bodies, and fat. As a graduate of women’s studies, I was versed in critiques of science and capital-T Truth. As a feminist, I saw the diet industry for what it was – a capitalist incarnation of body hatred and misogyny. What changed for me as I moved through my dietitian training? How and why did I lose sight of my feminist ethic and accept the anti-fat discourse espoused by nutrition science? In the face of the power and privilege conferred by becoming a professional, I lost sight of what and how I knew about bodies and fat. I was so enamoured by the promise of being a professional, an expert,

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someone others looked to for guidance, that I managed to choke down dietetics’ reductive view of fat/ness. More than that, I internalized dietetics’ censure of fat/ness. Becoming a professional meant more than simply learning to talk the talk. Becoming a professional meant looking the part, donning the knowledge of nutrition science, and embodying a dietitian identity by securing my professional and thin privilege. I dieted, restricted, and finally purged my way to extreme weight loss. I was being eaten whole. In part, it was the rhetoric of science that lent authority to dietetics’ anti-fat curriculum. However, it was the promise of professionalism or, as I see it now, the promise of privilege that secured my abeyance. Being a professional involves claiming the power of occupying the centre – of having the power to name and colonize the “Other” body (i.e., clients’ or patients’ bodies) while remaining ignorant of one’s own subjectivity. Surviving has meant acknowledging my complicity with an institution that censures fat/ness. Although I know now that there are a number of dietetic practitioners working against the anti-obesity paradigm through Health at Every Size (HAES) activism and scholarship, this was not introduced as part of my becoming a dietitian. I offer this story not to excuse my complicity but as a means of thinking through my experience and inviting dialogue about the way that dietetic training shapes practitioners’ perspectives of fat/ness. My unbecoming has reshaped how I perceive fat/ness and has allowed me to reclaim my body-knowledge and remember myself as a feminist, activist, and critical scholar. An important part of my unbecoming was connecting with the bloggers, activists, and scholars doing work in fat politics, mainly online in the “fat-o-sphere.” The HAES movement played a critical role in helping me to reclaim the bodily knowing of food and fatness that I lost sight of throughout my dietetic training. Looking back on my experience, I wonder if I am alone in my struggle with how to situate myself in dietetics. Am I going to swallow whole its science and practice of fat hatred? Am I the only one who experienced their dietetic becoming in this way?

Jacqui Gingras: Dietetic Educator I was drawn to dietetics for two reasons: to learn how to manage my Crohn’s disease and to learn how to control my weight. Remembering

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that now makes me feel sad, since that is such a limited view of becoming a food and nutrition professional. However, the curriculum being what it was, I was satiated in my desire to know of these two domains. I learned well and I managed and controlled my weight and my Crohn’s, but that was all to change when I started my internship, when I started actually interacting with real bodies and real feelings about those bodies. Although the process has changed since I was a student, I had to compete with my peers for an internship in British Columbia. The process in Ontario is similar (Brady et al. 2012). There were three internship options in BC with about twenty available spots, but there were forty students in my program. Many qualified students were not going to be accepted. I mention this because the competition had a real effect on my body and likely on the bodies of my peers. I strove to shape my body into what I perceived a dietitian’s body should be. I worked out intensely, feeling guilt if I missed an aerobics session, feeling superior when I finished one. Again, looking back, it was such a restricted view on the world. I wonder how my educational experience would have been different if I had been more critical of the process of becoming a dietitian. How might my own criticality have informed my dietitian socialization? It was 1995–96, during my internship year at Royal Columbia hospital, when my mind turned to questions about how our identity as “weight management experts” fostered or contradicted our messages about health. I don’t remember exactly what sparked that exploration, but I did one of my intern rounds’ presentations on dietitians’ attitudes and perceptions towards body weight. I was in touch with dietitians Joanne Ikeda and Barbara Seed, among others, to learn what I could of weight bias and to find out what I could about how to assess weight bias among dietitians and dietetic interns. The session where I presented my ideas and asked people to complete a survey assessing their attitudes towards weight was somewhat provocative for those who were used to more typical nutrition-based presentations. And it turned up some fascinating comments about how we manage our bodies and how we perceive others’ bodies in order to maintain our presumed identity as “weight management experts.” For example, one intern said, “I spend more time working on my own body through exercise and diet than almost everything else in my life. I don’t want to gain weight. Respected dietitians are not overweight.” This seemingly innocuous seminar revealed many of the contradictions that I am now much more aware of as a seasoned practitioner – that we might

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promote a size-acceptance, non-diet, health-centred approach with our clients, but with ourselves we promote something much more rigid and less forgiving. What is a dietitian supposed to look like? Can a fat dietitian be taken seriously as a nutrition and food professional? Can dietitians of all sizes appreciate their bodies, nourish their hungers, and move joyfully? If not, why not? As I have learned over the years, it is very difficult to accept our bodies, especially in a culture like dietetics where the primary aim of our efforts is to help others conform and contort their bodies into a narrow range of BMI possibilities – all in the name of health. Except it isn’t really only in the name of health, because if it was we all would have shifted our thinking by now due to the overwhelming amount of research stating that people can be healthy at a very diverse range of body weights. What it is really about is a moral code that we have internalized that fat is bad. The fat we eat and the fat on our bodies must be reduced at all costs. This is the tyranny that I lived under during my undergraduate years. It wasn’t that my undergraduate education formed that belief in my head – I learned that fat was bad long before I went to UBC. What my dietetic education did is reinforce that belief, solidify that belief, and promote that belief when it allowed me to learn that there is a certain BMI associated with health and anything below or above is unacceptable. My dietetic education’s practice guidelines stated that, in order to reduce fat by one pound every week, one should reduce daily caloric intake by 500 kcal. This education promotes flagrantly erroneous information about health. We are all complicit. As I finished my internship and moved on to my graduate work in Edmonton, I continued to explore non-dieting, as it was known then (1996–98). I discovered the writings of fat activists and took a first-year women’s studies course. My tenacious hold on old weight-centred, fat-hating paradigms quickly loosened and I found myself smashing scales, shredding diet books, and speaking publically about size acceptance. I was becoming radical in the dietetic world, and I was mostly oblivious to how far the research I consumed was leading me from the norm. I also started my own nutrition counselling/consulting company and was asked to work with school-aged children around body image and intuitive eating. I loved that work because my experiential learning was very rich compared with my theoretical learning. Kids have a way of bringing you to the moment and doing so with unflinching authenticity. I needed that.

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The ensuing years were filled with more activism, more advocacy, and more learning. I had moved back to Vancouver, I was growing my business, and I was becoming more comfortable in my practice – the learning curve was still curling upward, just not as exponentially. I started my doctorate in education to critically examine the process by which we become dietitians. I spoke with many dietitians about whether they felt prepared for the complexities of their dietetic practice. They did not and they told me why. I wrote a book about that research and opened up further conversations with readers of that book. I took a job in Toronto and shared the book with students who wrote their own stories of becoming dietitians. Finally, I offered graduate students a taste of critical obesity studies and all hell broke loose – in a highly generative way, of course. My early days of activism and advocacy around health-centred approaches were reignited, and now I find myself refashioning my relationship with fat through critical fat studies, through social media, and through sharing with other dietitians how we might “shift our focus” in our understanding of bodies and health.

Julie E. Rochefort: Entry-Level Dietitian Critical theorists believe that power and knowledge are “interwoven and are products of socially constructed truths that support the agendas of the dominant ideologies that created them” (Powers 2003, 230). In a pedagogical context, these “truths” come from course materials such as textbooks, which determine what students need to know in order to become a nutrition professional. Like trophies and awards, my textbooks stood perfectly aligned on my bookshelf, congratulating me for becoming a registered dietitian. Covering nutrition through the life cycle to community nutrition in action, the common textbooks used throughout my education were indeed weight biased. Using biomedical-focused studies, each textbook reminded me that obesity was a crisis that required my nutrition powers as the remedy. Teaching a fat individual how to eat “healthily” (read: to diet) and take more exercise dominated my view of what being a dietitian entailed. Obesity was an individual problem of overeating and lack of physical activity. It was a simple problem of energy imbalance. With my nutritional powers at their peak, I transferred the theories learned from my textbooks into the next step of my professional upbringing: the dietetic internship. In 2009 I began my dietetic internship after four years of undergraduate nutrition education. Following my internship I was left with

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a feeling of incompleteness. What I was missing was an opportunity to explore issues of oppression as it relates to our assumptions as dietitian professionals and also as human beings. During my dietetic internship I felt varying emotions regarding fat patients ranging from irritation to failure. I often felt frustrated because I didn’t understand why the lowfat diet I had recommended was not resulting in weight loss. I simultaneously felt like a complete failure and often questioned what I had done wrong. Did I forget to write something down from the intake interview? Did I miscalculate the energy requirements? Did I weigh them properly? How could my patient not lose weight? While my perspectives have drastically changed since my undergraduate studies and internship, I am bewildered and disappointed by the level of weight bias and shame I carried. Why wasn’t my education regarding obesity balanced with alternative views from critical obesity scholars? And why I didn’t I question what I was learning? What prevented me from thinking outside traditional dietetic ideologies? Perhaps it was my desperate desire to be accepted into a dietetic internship. I believe that professors hold the same symbolic and political power and control over students that health care professionals often hold over patients. A major contributor to this power imbalance between professors and their students is the academic appraisal required from each prospective internship applicant. When I applied for my internship in 2009, the academic appraisal was described to me as a round-table discussion at which selected faculty members would consider my potential success as a registered dietitian. With the added dependency of receiving a “good” appraisal from professors along with the 50 per cent success rate in obtaining an internship, questioning the information that my professors presented didn’t seem like a strategic move to solidify my spot within the profession. What disruption would have occurred if I had expressed an alternative view of fatness? What would have happened if I claimed that the textbooks were indeed biased? Things would likely be very different today. My attitude towards fatness was significantly influenced by the pedagogical hegemony of my academic and professional instructors. Dismissing alternative perspectives led me to believe that all fat individuals were in need of my help, and in doing so, I may have caused harm. While I was fortunate to enrol in graduate studies and learn from critical obesity scholars, not all students will have this opportunity. The dietetic curriculum needs to go beyond biomedical ideologies and encourage students to explore alternative way of knowing,

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keeping in mind the power and vulnerability that exist between professors and students.

Andrea Senchuk: Aspiring Dietitian Far from entering dietetics with an attitudinal tabula rasa, I began my journey of becoming a dietitian with pre-established attitudes towards fatness. I shared society’s general contempt for fatness. Fatness was bad, ugly, and weak, while thin was good, beautiful, and strong. On the first day of classes in my first year of dietetics, my negative view of fatness was evident in the shock I felt upon observing that one of my nutrition professors was fat. I wondered, how could a nutrition professor, with all her knowledge of food and health, be fat? I quickly recognized that my attitudes could hinder my capacity as a dietitian to provide fair and appropriate care to larger patients. To neutralize my attitudes, I readily subscribed to the positivist approach to fatness that my textbooks and professors taught. Terms like overweight and obesity medicalized the body and made fatness a “condition” defined by a number: body mass index (BMI). Overweight and obesity were reported with statistics that emphasized the “grave” health consequences of excess body fat. There was no humanity – no subjectivity – in fatness. In an attempt to understand obesity beyond the numbers and with the hope that greater knowledge would make me a more compassionate dietitian, I took an elective senior-level course on energy balance. In this course we contextualized obesity within the framework of the determinants of health and, as a result, I felt I better understood the whys and hows of obesity. In my personal life, I began defending fat people against my own negative thoughts and against the comments of others. This was my first foray into shifting my perspective from that of a long, lithe nutrition “expert” towards how a fat person might see things. For the first time in my journey to becoming a dietitian, fatness became a lot less “bad.” In my four years of undergraduate study I was not explicitly exposed to critical obesity scholarship, though the concept of fit and fat was mentioned from time to time here and there throughout my degree. I graduated with the belief that fat is unhealthy, and that by addressing the determinants of health, including personal behaviours, access to health care, and socio-economic status, health professionals can help obese people lead healthier lives. Essentially, as I adopted the dietetics discourse over the course of my degree, words such as fat and bad were

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replaced, respectively, with the euphemisms obese and unhealthy. Had I gone on to do an internship and then obtain my licence, I imagine I would now be happily espousing and practising the current rhetoric that obesity is unhealthy and all obese people should lose fat, exercise, and eat well. Fortunately, I studied critical obesity under the thoughtprovoking instruction of a radical thinker in a graduate studies course, and as a result, I not only defend fat people against negative thoughts and comments, I also defend fat people (in my mind and to others) against the all-too-pervasive assumption that fat is unhealthy. In fall 2012 I began my dietetic internship. I was truly excited about the prospect of being a registered dietitian, but the closer I got to this point, the more I was plagued by questions such as “How would the internship shape the kind of dietitian I was to become?” and “Would I be forced to practise, as a dietitian, in a way that conflicted with my beliefs about fatness and health, and if so, how could I respond?” I didn’t not know how the rest of my becoming a dietitian would unfold, and I didn’t know who and what I would become as a dietitian, but I did know that in terms of my attitudes towards fatness, the place I was in then was much more critical and, I hope, ethical than the place I was in when my journey began with my first year in undergrad. Analysis The following themes emerged from our collective analysis of the reflexive autoethnographies: promises of professionalism, professional imperative to be thin, professional obligation to help, and professional disruptions. Quoting from the reflexives, we elaborate on how gender intersects with and interconnects the themes. Instead of designating it as a singular emerging theme, we acknowledge the themes as gendered; none can be understood as separate from the constituting force of gender of which we offer a brief analysis.

Promises of Professionalism Professionalism refers to the attributes, behaviours, and ethics that are expected of individuals occupying a professional standing (i.e., being and becoming a registered dietitian). Even before entering the formal professionalization process, aspiring dietitians are constituted as nutrition experts (McLellan, Lordly, and Gingras, 2011) as they imagine themselves in future food and nutrition roles. This informal professionalization

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experience establishes an attachment to the promise of professionalism, which initially appears “liberatory, since becoming a professional involves bringing new ideas into public discourse and thus possessing the power to enact change” (Gingras 2010, 447). However, as DeVault (1999) argues, the reality is that professionalism is ultimately a conservative project: dietitians are trained into established paradigms, they gain competencies associated with the field, and they become practitioners of a science with its own canons and traditions. Given that one of the primary dietetic subjectivities is as a weight (management) expert, students carry a double burden in becoming dietitians “to become familiar with specialized processes routinized as dietetic performativity and then … to regulate [themselves] as [nutrition] professionals” (Gingras 2010, 450). A question that has surfaced in previous work (Gingras 2010) addresses the dilemma posed by the double burden of professionalization: “Can dietitians challenge and reconstitute those discourses that have their bodies and the bodies of others scrutinized, disciplined, and ostracized?” (450). What dietitians do and how this doing constitutes a particular dietetic culture can be thought of as a performance (Gingras 2009a, 2009b). In this way professionalization processes are indelibly intertwined between dietetic education and practice. “Dietitian subjectivity and performativity transpire concomitantly, retroactively initiated through discourse accessed and offered formally in undergraduate dietetic programs” (Gingras 2010, 446). Through the process of professionalization, dietetic practice becomes routine and dietitian performativity is accomplished (Butler 1997). In entering this conversation we are faced with a “paradox of natality” (Levinson 2001, 13) – as aspiring, entry-level, practising, and academic/survivor dietitians we are arriving late to an already established critique of how the dietetic profession has expected its members to participate in upholding anti-fat attitudes and hegemonies. These are longstanding practices that were not of our making, which we now resist. Invoking Butler’s (1997) theorizations of power and agency is an act of resistance that helps us further support reflexivity as our method. As revealed in our reflexives, we have experienced melancholia, sadness, shame, anger, and regret in realizing that our educators withheld widely known alternative perspectives on and approaches to understanding what we have come to know through a biomedical lens as “obesity.” We have responded emotionally to the belated realization that our pro­ fessionalization has painted us into a corner. We have been taught to promote “healthy weights” among patients and clients and dutifully

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maintain our own body weight in a healthy range all while truculently ignoring the critical perspectives that would have us practise otherwise. In a similar way to teachers’, those of dietitians “are scrutinized on multiple levels as they try to model rational approaches to health and good citizenry” (Petherick and Beausoleil, this volume). In response, our rising knowledge of our belatedness has prompted bold subversions that have been socially mediated (via Twitter and Facebook), physically mediated (by scale smashings), and discursively mediated (by Critical Dietetics publications). As Butler (1997) noted, melancholia has not precluded our agency, but rather has become a further site of subversion that has inspired a reflexive turn wherein the subject “turns back upon itself” (168). Our melancholia contains the possibility of regenerated or renegotiated dietitian subjectivity (and performativity) that we hold out for all in our profession to consider.

Professional “Thinness” Our analysis reveals the experience of an unspoken pressure during our undergraduate studies to align the size and shape of our bodies with that of the thin dietitian ideal. This is even more pertinent given that historically and still today, the overwhelming majority of dietitians in Canada are women. Andrea spoke of her surprise in facing a fat nutrition professor whose body did not conform to her expectations of how a dietitian should look. That is, the dietitian is expected to live by the principles in which she has been indoctrinated as a professional. The body of a thin dietitian is the symbol of her knowledge, competence, and credibility while the body of a fat dietitian represents her hypocrisy and lack of credibility. The weight of the thin ideal is so great that it nearly forecloses any possibility for the dietitian body to be anything other than that which is idealized in the professional discourse: thin. Our exchange during the analysis of our reflexives underscores this theme: To accept that [the dietitian] was fat because she was not following the nutrition rules would have meant what? (Jacqui) Hypocrisy means she isn’t credible. This speaks to the idea that dietitians should be thin because this indicates they’re eating healthy. (Andrea) A dietitian not following nutrition rules is almost an impossibility ... there’s a legitimate dietitian. The dietitian that flagrantly doesn’t follow

Learning about “Obesity” in Dietetics  161 the rules, in terms of dietetics, is shut out. They become Puff the Magic Dragon – surreal, noncompliant, and invisible. (Jennifer)

Dietitian identity is indelibly constituted as a weight management expert. Dietitians have asserted that they are the professionals best suited to counsel fat clients about reducing their weight (Barr et al. 2004). Moreover, Dietitians of Canada (2012) touts dietitians as the most “trusted source of information about nutrition and food.” The “scientific knowledge of food and human nutrition” informs the dietitian’s identity as an expert where dietary interventions are applied to promote weight loss with the intention of promoting health. The following excerpt from Jennifer’s reflexive illustrates this point: Fat, whether in food or on bodies, was to be measured, carefully. How many grams of fat per serving? How many calories per gram? Body mass index equals kilograms of body weight over height in metres squared. The purpose of this scrutiny was to avoid getting fat, or if you were already fat, to lose weight.

As a symbol of professional competency, the dietitian’s body becomes an object that can and should be manipulated through diet and exercise regimes (Trethewey 1999). As a physical manifestation of the values and expectations in becoming a professional, fat dietitians are portrayed as hypocritical while their slim-figured colleagues are seen as knowledgeable and legitimate. This point was raised during our dialogue when Andrea noted that a fat dietitian is perceived as “impossible” and thus relegated by her peers to the fringes of the profession, where she is no longer considered a legitimate dietitian. There is also an expectation that dietitians will eat in ways that uphold the imperative of healthy eating so central to dietetic ontology. In other words, the professional and personal identity of a dietitian is closely tied to the degree to which “she practises what she preaches” (Trethewey 1999). Research has shown that dietitians consider practising what they have learned to be an important part of their professional selves and that the public perceives dietitians as role models for healthy living, with dietitians’ body size and shape serving as a model for some clients (Cant 2009). Within the field of dietetics, a culture of body conformity prevails wherein thin bodies are valued and fat bodies are rejected. By learning to value thinness through professional socialization forces, nutrition students and dietitians are developing anti-fat attitudes and values.

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These negative attitudes towards obesity are also evident in the literature, which has revealed weight bias among dietetics students and other health professionals working in obesity (Puhl, Wharton, and Heuer 2009; Schwartz et al. 2003). Puhl, Wharton, and Heuer (2009) uncovered fat phobia in dietetics students and noted other stigmatizing weightrelated beliefs, including the belief that obese clients are less compliant with treatment than their thinner counterparts. In response to their alarming findings, the researchers called for the adoption of interventions within the dietetics curricula to reduce weight bias and stigma. It is likely that dietetics education and culture need more comprehensive renovations that move beyond superficial interventions to address the malignant values, such as thin professional bodies, that form the framework of dietetics practice and dietetic identities.

Professional Obligation to Help Applicants to dietetic undergraduate programs are motivated to enter nutrition by their desire to help others with their nutrition problems (Atkins and Gingras 2009), a motivation that was evident in our own histories. Unfortunately, unlike other more critical professional education curricula, such as social work or disability studies, the concept of “help” or “care” is not critically examined or problematized in dietetic education. This lack of a critical view works to maintain dietitians as experts and their clients as needing guidance regarding nutrition and food, which promotes a practice orientation where there’s an exceedingly high likelihood that a patient or client is objectified. An important development in the discourse of illness and disease prevention was the concept of risk, defined by Harding as “a self-evident danger that is to be avoided” (qtd. in Powers 2003, 228). Lupton (1995) has written extensively on the relationship between risk, healthseeking behaviours, and healthism. See also Ward (this volume) for a more thorough account of risk in relation to a neoliberal health agenda. The following excerpts from our own reflections highlight the risk discourse central to dietetic knowledge as it relates to weight and health: Being fat meant being unhealthy; it meant being at risk for a slew of diseases that carried both medical and moral diagnoses. (Jennifer) I graduated with the belief that fat is unhealthy … health professionals can help obese people lead healthier lives. (Andrea)

Learning about “Obesity” in Dietetics  163 My dietetic education … reinforce[d] … that there is a certain BMI associated with health and anything below or above is unacceptable. (Jacqui)

The recurrence of the authors’ association of fatness and poor health illustrates the power of a biomedical and reductionist discourse that positions weight as an objective measure of health. Similarly, a study of the views and practices regarding obesity and weight management among Canadian dietitians demonstrated that almost all dietitians (96 per cent) agreed that obesity contributed to morbidity and mortality and that they believed even small weight losses can produce important health benefits (Barr et al. 2004). In order to comply with their professional obligation to help protect society from nutrition-related illness and disease (i.e., fatness), dietitians routinely try to manipulate individuals’ dietary intake in an effort to help them achieve and maintain a healthy body weight. Teaching a fat individual how to eat “healthy” and exercise more dominated my view of what being a dietitian entailed. Obesity was a problem of overeating and lack of physical activity. It was a simple problem of energy imbalance. (Julie)

Controlling diet and exercise in the name of health is described by Murphy (1995) as the “rational ascetic” conceptualization of the body whereby scientific knowledge of foods and human nutrition disciplines fat bodies to “rational” conduct around food and body movement. Consequently, rational asceticism reinforces the idea that obesity results from individual, irrational efforts to control weight. This individualistic frame has been identified as one of the most morally problematic features of the obesity discourse given that it excludes the social, political, and cultural determinants of health (Rich 2011). As Norman, Rail, and Jette summarize (this volume), the dominant neoliberal ideology places the responsibility for making proper health decisions squarely on individuals’ shoulders, including decisions about what and how much to eat. Accordingly, the rational ascetic and individualistic tendencies within dietetic practice are also reflected in dietetic education. Gingras (2009b) observed that the learning process for dietetic students in Canada is “sequential and generally apolitical, while the knowledge acquired is largely decontextualized from the social world in which knowledge is embedded” (185). Coterminous with dietetic education,

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anti-fat discourse claims to be apolitical and continues to reinforce empiricist, scientific ideologies that demonize fatness as antithetical to health. At the same time and virtually ignored by obesity scientists touting anti-fat discourse, weight-loss programs have yet to demonstrate sustained weight loss or metabolic health improvements in biochemical indices such as blood pressure, blood glucose, and blood lipids (Bacon and Aphramor 2011; Have et al. 2011; Mann et al. 2007). When the dietitian’s professional role is considered in a narrow sense – that by sharing highly specialized diet information with the obese patient, a dietitian can resolve obesity – a professional moral conflict emerges for the dietitian when her advice does not produce the desired result, as Julie’s reflexive aptly described. This experience for the novice dietitian can leave her feeling powerless and morally traumatized (Martinez 2000, 36), especially as she works to reconcile her experience within health care institutions and professional associations that deny a diversity of perspectives regarding weight and health, as has been the experience of at least one of the authors (Gingras 2006).

Professional Disruptions One final theme that emerged from our reflexive explorations of becoming dietitians was the suppression of curiosity and critical thinking. Threads of this theme are woven into each of our stories of becoming, and are exemplified by the following excerpts: During my dietetic internship I felt varying emotions regarding fat patients, ranging from irritation to feelings of failure. I often felt frustrated because I didn’t understand why the low-fat diet I had recommended was not resulting in weight loss. I sometimes simultaneously felt like a failure and often questioned what I could have done wrong ... why didn’t I question what I was learning? (Julie) How and why did I lose sight of my feminist ethic and accept the anti-fat discourse espoused by nutrition science? (Jennifer)

This theme raises serious concerns about the kind of professionals that current dietetic education and training programs are producing and makes it seem unlikely that dietitians will take up the call being issued by critical fat studies and Critical Dietetics (Aphramor and Gingras 2009). Nevertheless, given the increasingly complex political

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milieu surrounding food, bodies, and health, it is imperative that dietitians become politicized and begin to think critically about how their work fits within the greater biopolitics of the so-called obesity epidemic (Walkerdine 2008; Wright and Hardwood 2008). What can also be heard in these excerpts, and what is perhaps more compelling in terms of moving forward, is our individual struggles to come to terms with our own silence in the face of fat oppression, as well as our complicity in perpetuating anti-fat discourse. These excerpts suggest that we each forfeited agency in the process of becoming professional. DeVault’s (1999) work on professional socialization sheds light on our shared experiences. Describing her effort to honour her feminist ideals in the process of becoming an academic, DeVault (1999) writes: Feminist scholars enter the academic world with an oppositional purpose. We bring new perspectives, and we intend to challenge the dominant modes of scholarship that have too often left women’s experiences unexplored. In spite of considerable success in that project, we often find that becoming professional is an enterprise that leads in other directions, to some peculiar dilemmas. As we learn to be sociologists, nutritionists, historians, lawyers, theorists – as we accept the discipline of any field – we often find that we must struggle to sustain and act upon the feminist insights and intentions with which we began. (141)

For us, becoming dietitians presented a significant challenge to heeding alternative epistemological and ontological understandings of food, bodies, and health. Although it is not an official lesson in the dietetic curricula, we appear to have each received a similar message about what it means to become a dietitian: learn how and when to remain silent. In this context of professional socialization the “collective professional hush” regarding the political aspects of food and doing food work in the public and private spheres pervades dietetic culture (Gingras 2008, sec. 2, par. 2). Perhaps the silencing is also a product of realizing “the broken promises of professionalism [that] appear to constitute a melancholic performativity among dietitians” (Gingras 2010, 451). The painful emotions associated with unfilled dreams of becoming an emancipatory nutrition professional sometimes culminate in the ultimate professional silence: “an increasing desire to leave the profession” (Gingras 2010, 451). Ending this silence requires that dietitians-­ in-the-making are politicized or are enabled to further explore their

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political commitments in a critical and compassionate manner throughout their education and training. Across our reflexive pieces we see that an awakening to the political nature of dietetic education and practice occurred for each of us, albeit at different points along the professionalization process. This awakening is about gaining a new politicized consciousness around fat, bodies, and health. For Jennifer, this awakening was similar to what DeVault (1999) experienced and was more about her (somewhat unsuccessful) struggle to hold on to her already established feminist values throughout the process of becoming. Conversely, Jacqui’s and Julie’s awakenings, or politicizations, can be better understood as what Levinson calls “the paradox of natality” (1997, 436). Levinson argues that “at the most fundamental level [the paradox of natality] refers to the fact that humans are constantly born into the world, and are continually in need of introduction to the world and one another” (437). In other words, while we are each continually newly arriving to various understandings, relationships, and so on, we are all already late. Although it is easy to be overwhelmed by our own belatedness, Levinson suggests that we take this feeling to signify an opportunity for learning and growth. DeVault (1999) also says that the experience of becoming professional is inherently emotional. So too is the process of unlearning, as demonstrated in the writing we have shared, or learning how to differently perform our professional identities in ways that resist the dominant dietetic paradigms. In addition to the feeling of belatedness, guilt, and self-blame, the fear of vulnerability and isolation can be heard in our writing: Looking back on my experience, I wonder if I am alone in my struggle with how to situate myself in dietetics. Am I going to swallow whole its science and practice of fat hatred? Am I the only one who experienced their dietetic becoming in this way? (Jennifer) The closer I get to this point, the more I am plagued by questions such as: “How will the internship shape the kind of dietitian I become?” “Will I be forced to practise in a way that conflicts with my beliefs about fatness and health, and if so, how will I respond?” (Andrea)

It is imperative that we do not let action that may arise from this new consciousness be stifled by what are important, but potentially unproductive, emotions. Critical race theory, and specifically two concepts

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that are central to this work – white guilt and white privilege – can shed light on how we can conceptualize power within the dietetic profession and move beyond some seemingly insurmountable barriers to learning and growth. American author James Baldwin (qtd. in Jensen 2005) claimed that “no curtain under heaven is heavier than that curtain of guilt and lies behind which Americans hide” (46). The weight of Baldwin’s metaphorical curtain originates in feelings of guilt and fear, which create barriers to action and change. White guilt refers specifically to white people’s feelings about their role as members of the dominant group in the legacy of violence against the racialized “other.” In critical race theory, white guilt is seen as an unproductive emotion that prevents white people, regardless of their intention, from individually and collectively questioning and surrendering their privilege as members of the dominant group. White guilt allows critical race theorists to conceptualize this problem and thus address it with the hopes of moving past the barriers to ending the racism that guilt creates. This concept is useful here because it allows us to conceptualize and talk about similar feelings that arose upon our individual awakenings to the fundamental problems of the weight-based paradigm that we had uncritically adopted in becoming dietitians. Once we have awoken to the politics of dietetic practice, the question becomes how to negotiate our roles as HAES dietitians in a professional climate that maligns fat bodies and dismisses alternative views of fatness. Here, Patricia Hill Collins’s concept of the “outsider within” points to a way forward (2004, 103). Defining and summarizing Hill Collins’s work on the outsider within, Ryan claims that “while individuals in these unique locations appear to be members of the dominant group based on possession of the necessary qualifications for, and apparent rights of, member standing, they do not necessarily enjoy all of the experiential benefits afforded to formal members” (2007, par. 1). We suggest that dietitians critical of the dominant anti-fat discourse who align themselves with the HAES paradigm are outsiders within. In particular, as registered members of their local regulatory colleges, HAES-minded dietitians are marginalized within their professional communities, and are ousted even further from the centre if they themselves are fat. The inequity of oppression even among dietitians requires attention. Although dietitians as a group are marginalized within the hierarchy of  medical and allied health professionals, power is also inequitably

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distributed among dietitians. We must heed Hills Collins’s warning about the tendency to assume an “equivalency of oppression” among members of marginalized groups (2004). Of course, power is distributed differently according to race, class, sexuality, ability, and gender. But there are two additional lines along which power is unevenly divided that are particularly pertinent to the dietetic community. One we have already addressed: the adherence to a dominant weight-centred paradigm that has long served as the epistemological foundation of dietetic knowledge and practice. The second is thin privilege. Even among HAES-affiliated dietitians (the outsiders within a marginalized profession), power is garnered differently based on body shape and size. Again, drawing on critical race theory and the concept of white privilege, we can conceptualize how being thin means having greater access to power. Thin privilege is a means of conceptualizing how those who meet today’s ideas about what is an appropriate body shape and size garner advantages compared to those who do not. Thin privilege is wrought with a web of fine lines that intersect with privilege accessed via race, class, gender, and other social categories. Indeed, thin privilege remains an area in vital need of further inquiry in dietetics. Themes as Gendered From a historical perspective, women were excluded from early dietetics or “medical cookery” because the purview of medicine was outside the home, and was thus the domain of men. Liquori (2001) writes that “by excluding women from an academic education, the university erased their ‘competence’ to care for the sick outside of their homes and to prevent sickness through cooking – the basis of medical cookery” (235). In first entering the academy, women enrolled in subjects that were the extension of their work in the home, such as home economics, which to this day remains highly feminized, like dietetics. Unlike dietetics, home economics resisted becoming a science as a means to becoming more visible in the academy over the next century. This ultimately led to its demise as an academic discipline. Mining Smith’s (1987) theoretical framework, Liquori describes how men predominated in generating abstract knowledge in the nutrition and healthrelated sciences, while women were the facilitators of experiential knowledge as food and nutrition practitioners. In becoming dietitians, women could occupy a double position as food educators with access to the abstract knowledge so often relegated to men while we could

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also fulfil our desires to be legitimated in the academy without losing connection with the more base desire associated with eating. DeVault (1999) elaborates on this phenomenon as seemingly paradoxical: Science, in its traditional construction, claims to produce knowledge that is abstract, timeless, replicable, and universal. The social activities of producing, distributing, and using food, on the other hand, are more obviously relational, contextualized, politicized, and embodied activities. (166)

How gender scripts play out for women in dietetics is complex and rife with tensions revealing what kind of bodies women must have (thin) and how our appetites for food are to be publically displayed (restrained). At the same time, we are expected to appear as credible (and pleasant) nutrition professionals with a science degree (capable). Being professionals means being part of a medical hierarchy of visibility, with physicians occupying the top and dietitians relegated to somewhere near the bottom. This positioning, likely because dietitians are still seen as those who determine patients’ food preferences in hospitals, not those who save lives, has led to a profession primed to be rife with horizontal violence (Freshwater 2000), although much more inquiry is required on the topic. Horizontal violence includes the transgressive acts committed among colleagues who hold similar positions within institutional and organizational structures. In this case, horizontal violence would describe these acts among dietitian colleagues within the medical hierarchy. As dietitians trained in Canada, our experiences are informed by various aspects of dietetic knowledge, practice, and pedagogy that are uniquely Canadian. These unique aspects are related to the wider context of health and health care policy, as well as various social, cultural, political, and economic factors that shape Canadian society and that differ from other nations of the Western world. However, it is important to note that our experiences are in many ways informed by discourses of health, bodies, fatness, and professionalism that reach far beyond Canada’s borders. The prevalence of positivism and the scientization of food and eating, weight-based stigma and the war on “obesity,” the moralization of health and the rise of healthism, and perhaps most important, neoliberalism were fundamental to our training as dietitians. The ubiquity of these discourses demands that we consider  how our training as dietitians in Canada is relevant to the wider international and global contexts. By exploring our own becoming

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as  dietitians, we attempt to grapple with these ruling discourses – ­discourses that underlie dietetic practice in Canada and abroad. Conclusion We have reflexively engaged with our own and each other’s stories of becoming in order to more deeply explore how it was that our ideas about fatness came into being. In so doing we offer two strategies: (1) an invitation to our dietetic and allied health colleagues who are pushing back on hegemonic obesity (anti-fat) discourse to employ the reflexive autoethnographic method in a similar fashion to our own; and (2) a clarion call to action for educators holding pedagogical power in dietetic curricula to offer for close scrutiny new literatures from critical obesity and fat studies as a means for a more ethical and scholarly treatment of what we have come to know as the “obesity epidemic.” We might start by a robust examination of the recent review by Bacon and Aphramor (2011), who offer myriad paths inward. It is imperative that dietetic professionals and educators engage students in dialogue that brings to light how and to what effect undergraduate training bears on the dietetic student body. This influence is only now being explored by dietetic theorists in relation to dietetic students’ and interns’ education and training (Atkins and Gingras 2009; Lordly and McLellan 2008; McLellan and Lordly 2008). Like other critical obesity scholars (Gard and Wright 2005, qtd. in Gard 2011), we are attempting to “destabilize received ideas about obesity” (10) and, more specifically, ideas about obesity that were taught to us as dietetic students (Aphramor and Gingras 2009). We are not striving for a unified voice or position regarding “obesity.” This chapter and the vista from which we narrate remain necessarily unfinished. It is our view and that of others (Gard and Wright 2005) that the message coming from obesity scientists to date has been relatively uncritical and monolithic in scope. By inviting an open engagement with fat studies, we wish not to reproduce the extreme and hegemonic standpoints we were initially taught regarding fatness. What is needed now is attention to multiple views, questions about who benefits from such views, and ongoing debates regarding how certain views inflame weight bias. This is the radical mandate of a new movement called Critical Dietetics (Aphramor et al. 2009), where scholars are taking up the call to destabilize common and somewhat intractable notions of “obesity” – notions that we have pried apart and delved into mercilessly with our transgressive and collective inquiry.

Learning about “Obesity” in Dietetics  171 WORKS CITED Aphramor, L. 2005. “Is a Weight-Centred Health Framework Salutogenic? Some Thoughts on Unhinging Certain Dietary Ideologies.” Social Theory & Health 3 (4): 315–40. http://dx.doi.org/10.1057/palgrave.sth.8700059. Aphramor, L., Y. Asada, J. Atkins, S. Berenbaum, J. Brady, et al. 2009. “Critical Dietetics: A Declaration.” Practice 48: 1–2. http://www.criticaldietetics.org. Aphramor, L., and J.R. Gingras. 2009. “That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice.” In Fat Studies Reader, ed. E.D. Rothblum and S. Solovay, 97–105. New York: New York University Press. Atkins, J., and J.R. Gingras. 2009. “Coming and Going: Dietetic Students’ Experiences of Their Education.” Canadian Journal of Dietetic Practice and Researc 70 (4): 181–6. http://dx.doi.org/10.3148/70.4.2009.181. Bacon, L., and L. Aphramor. 2011. “Weight Science: Evaluating the Evidence for a Paradigm Shift.” Nutrition Journal 10 (9): 1–13. Barr, S.I., K.V. Yarker, R. Levy-Milne, and G.E. Chapman. 2004. “Canadian Dietitians’ Views and Practices regarding Obesity and Weight Management.” Journal of Human Nutrition and Dietetics 17 (6): 503–12. http://dx.doi.org/10.1111/j.1365-277X.2004.00562.x. Beausoleil, N., and P. Ward. 2010. “Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy.” Radical Psychology 8 (1). http://www .radicalpsychology.org/vol8-1/fatpanic.html. Bordo, S. 1993. Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley: University of California Press. Brady, J.L., A. Hoang, R. Tzianetas, J. Buccino, K. Glynn, and J. Gingras. 2012. “Unsuccessful Dietetic Internship Applicants: A Descriptive Survey.” Canadian Journal of Dietetic Practice and Butler, Judith. 1997. The Psychic Life of Power: Theories in Subjection. Stanford: Stanford University Press. Campos, P., A. Saguy, P. Ernsberger, E. Oliver, and G. Gaesser. 2006. “The Epidemiology of Overweight and Obesity: Public Health Crisis or Moral Panic?” International Journal of Epidemiology 35 (1): 55–60. http://dx.doi .org/10.1093/ije/dyi254. Cant, R.P. 2009. “Communication Competence within Dietetics: Dietitians’ and Clients’ Views about the Unspoken Dialogue – The Impact of Personal Presentation.” Journal of Human Nutrition and Dietetics 22 (6): 504–10. http:// dx.doi.org/10.1111/j.1365-277X.2009.01017.x. Collins, Patricia Hill. 2004. “Learning from the Outsider Within: The Socio­ logical Significance of Black Feminist Thought.” In The Feminist Standpoint

172  Rochefort, Senchuk, Brady, and Gingras Theory Reader: Intellectual and Political Controversies, ed. S. Harding, 103–26. New York: Routledge. Davies, C.A. 1999. Reflexive Ethnography: A Guide to Researching Selves and Others. New York: Routledge. Davies, B., and S. Gannon. 2006. “The Practices of Collective Biography.” In Doing Collective Biography, ed. B. Davis and S. Gannon, 1–15. Berkshire, UK: Open University Press. DeVault, M. 1999. “Whose Science of Food and Health? Narratives of Profession and Activism from Public Health Nutrition.” In Revisioning Women, Health and Healing, ed. A.E. Clarke and V.L. Olsen, 139–55. New York: Routledge. Dietitians of Canada. 2012. A Career as a Dietitian. http://www.dietitians.ca/ Career/A-Career-as-a-Dietitian.aspx. Accessed 24 April 2012. Dietz, W.H. 1998. “Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease.” Pediatrics 101: 518–25. Ellis, C. 2004. The Ethnographic I: A Methodological Novel about Autoethnography. Walnut Creek, CA: AltaMira. Ellis, C., and A. Bochner. 2000. “Autoethnography, Personal Narrative, Reflexivity: Researcher as Subject.” In The Handbook of Qualitative Research, 2nd ed., ed. N. Denzin and Y. Lincoln, 733–68. Newbury Park: Sage. Freshwater, D. 2000. “Crosscurrents: Against Cultural Narration in Nursing.” Journal of Advanced Nursing 32 (2): 481–4. http://dx.doi.org/10.1046/ j.1365-2648.2000.01499.x. Gard, Michael. 2011. The End of the Obesity Epidemic. New York: Routledge. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. New York: Routledge. Gingras, Jacqui. 2006. “Throwing Their Weight Around: Canadians Take on Health at Every Size.” Health at Every Size Journal 19 (4): 195–206. – 2008. “The Vulnerable Learner: Moving from Middle to Margin in Dietetic Education.” Transformative Dialogues: Teaching and Learning Journal 1(3). http://kwantlen.ca/TD/TD.1.3/TD.1.3_Gingras_Vulnerable_Learner.htm – 2009a. Longing for Recognition: The Joys, Complexities, and Contradictions of Practicing Dietetics. York, UK: Raw Nerve Books. – 2009b. “The Educational (Im)possibility for Dietetics: A Poststructural Discourse Analysis.” Learning Inquiry 3 (3): 177–91. – 2010. “The Passion and Melancholia of Performing Dietitian.” Journal of Sociology 46 (4): 437–53. Have, M., D. Beaufort, P.J. Teixeira, J.P. Mackenbach, and A. van der Heide. 2011. “Ethics and Prevention of Overweight and Obesity: An Inventory.” Obesity Reviews 12: 669–79.

Learning about “Obesity” in Dietetics  173 Inthorn, S., and T. Boyce. 2010. “‘It’s Disgusting How Much Salt You Eat!’: Television Discourses of Obesity, Health and Morality.” International Journal of Cultural Studies 13 (1): 83–100. http://dx.doi.org/10.1177/ 1367877909348540. Jensen, R. 2005. The Heart of Whiteness: Confronting Race, Racism, and White Privilege. San Francisco: City Lights. Kuk, J.L., C.I. Ardern, T.S. Church, A.M. Sharma, R. Padwal, Xuemei Sui, and Steven N. Blair. 2011. “Edmonton Obesity Staging System: Association with Weight History and Mortality Risk.” Applied Physiology, Nutrition, and Metabolism 36 (4): 570–6. http://dx.doi.org/10.1139/h11-058. Lau, D.C.W., J.D. Douketis, K.M. Morrison, I.M. Hramiak, A. Sharma, and E. Ur. 2007. “Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children.” Canadian Medical Association Journal 176 (8 suppl.): 1–117. http://dx.doi.org/10.1503/cmaj.061409. Levinson, N. 2001. “The Paradox of Natality: Teaching in the Midst of Belatedness.” In Hannah Arendt and Education: Renewing Our Common World, ed. M. Gordon, 11–36. Boulder: Westview. Liquori, T. 2001. “Food Matters: Changing Dimensions of Science and Practice in the Nutrition Profession.” Journal of Nutrition Education 33 (4): 234–46. http://dx.doi.org/10.1016/S1499-4046(06)60036-5. Lordly, D., and D. McLellan. 2008. “Acknowledging and Adapting to Dietetic Students’ Changing Needs.” Canadian Journal of Dietetic Practice and Research 69 (3): 126–30. http://dx.doi.org/10.3148/69.3.2008.126. Lupton, D. 1995. The Imperative of Health: Public Health and the Regulated Body. London: Sage. Mann, T., A.J. Tomiyama, E. Westling, A.M. Lew, B. Samuels, and J. Chatman. 2007. “Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer.” American Psychologist 62 (3): 220–33. http://dx.doi. org/10.1037/0003-066X.62.3.220. Martinez, R. 2000. “Professional Role in Health Care Institutions: Towards an Ethic of Authenticity.” In Educating for Professionalism: Creating a Culture of Humanism in Medical Education, ed. D. Wears and J. Bickel, 35–48. Iowa City: University of Iowa Press. McLellan, D., and D. Lordly. 2008. “The Socialization of Dietetic Students: Influence of the Preceptor Role.” Journal of Allied Health 37 (2): e81–92. McLellan, D., D. Lordly, and J. Gingras. 2011. “Professional Socialization: A Review of Literature and Implications for Dietetic Practice.” Canadian Journal of Dietetic Practice and Researc 72 (1): 37–42. http://dx.doi.org/ 10.3148/72.1.2011.37.

174  Rochefort, Senchuk, Brady, and Gingras Morse, S., R. Gulati, and E. Reisin. 2010. “The Obesity Paradox and Cardiovascular Disease.” Current Hypertension Reports 12 (2): 120–6. http:// dx.doi.org/10.1007/s11906-010-0099-1. Murphy, Peter. 1995. “The Body Politic.” In Troubled Bodies: Critical Perspectives on Postmodernism, Medical Ethics, and the Body, ed. Paul Komesaroff, 103–24. Durham: Duke University Press. Parham, E.S. 1999. “Meanings of Weight among Dietitians and Nutritionists.” In Weighty Issues: Fatness and Thinness as Social Problems, ed. J. Sobal and D. Maurer, 183–205. New York: Walter de Gruyter. Powers, P. 2003. “Empowerment as Treatment and the Role of Health Professionals.” ANS: Advances in Nursing Science 26 (3): 227–37. http:// dx.doi.org/10.1097/00012272-200307000-00007. Puhl, R., C. Wharton, and C. Heuer. 2009. “Weight Bias among Dietetics Students: Implications for Treatment Practices.” Journal of the American Dietetic Association 109 (3): 438–44. http://dx.doi.org/10.1016/j.jada.2008.11.034. Rich, E. 2011. “‘I See Her Being Obesed!’ Public Pedagogy, Reality Media and the Obesity Crisis.” Health 15 (1): 3–21. http://dx.doi.org/10.1177/ 1363459309358127. Ross, C., R.D. Langer, and E. Barrett-Connor. 1997. “Given Diabetes, Is Fat Better than Thin?” Diabetes Care 20 (4): 650–2. http://dx.doi.org/10.2337/ diacare.20.4.650. Ryan, J.M. 2007. “Outsider-Within.” In Blackwell Encyclopedia of Sociology, ed. G. Ritzer, doi: 10.1111/b.9781405124331.2007.x. Schwartz, M.B., H. O’Neal Chambliss, K.D. Brownell, S.N. Blair, and C. Billington. 2003. “Weight Bias among Health Professionals Specializing in Obesity.” Obesity Research 11 (9): 1033–9. http://dx.doi.org/10.1038/ oby.2003.142. Smith, D.E. 1987. The Everyday World as Problematic: A Feminist Sociology. Boston: Northeastern University Press. Trethewey, A. 1999. “Disciplined Bodies: Women’s Embodied Identities at Work.” Organization Studies 20 (3): 423–50. http://dx.doi.org/10.1177/ 0170840699203003. Walkerdine, N. 2008. “Biopedagogies and Beyond.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. J. Wright and V. Hardwood, 1–14. New York: Routledge. Wann, M. 2009. “Foreword. Fat Studies: An Invitation to the Revolution.” In Fat Studies Reader, ed. E.D. Rothblum and S. Solovay, ix–xxv. New York: New York University Press. Wright, J., and V. Hardwood. 2008. Biopolitics and the “Obesity Epidemic”: Governing Bodies. New York: Routledge.

6 Indigenous People’s Clinical Encounters with Obesity: A Conversation with Barry Lavallee D ebor ah M c Phail

Dr Barry Lavallee is a family physician who holds a master’s of clinical sciences degree in family medicine. He is currently director of student affairs at the University of Manitoba’s Centre for Indigenous Health Education, director of curriculum development in Indigenous Health, and teaches in the university’s medical school. In addition to his clinical work as a family doctor, Dr Lavallee conducts research on type 2 diabetes in Indigenous communities, the experience of Indigenous patients within the patient-physician therapeutic relationship, pap-smear-screening programs in Indigenous communities, collaborative practices, and international Indigenous health. Dr Lavallee is a member of the Saulteaux and Métis Indigenous communities of Manitoba and belongs to the Bear clan. Over two days in February 2013, I sat down with Dr Lavallee to discuss obesity in Indigenous communities, which has become a key issue for obesity researchers and health policy makers. As a result of this research and policy, Indigenous people have become organized as a “risk population” within obesity discourse (see Poudrier, this volume). Throughout the discussions, Dr Lavallee emphasized the negative effects of such a designation. Viewing the issues through an anti-­ neoliberalist lens, he addressed some of the dominant assumptions and discourses that circulate within the medical system about Indigenous peoples, obesity, and type 2 diabetes. Due to his interest in the patientclinician relationship, and the violence that can occur there, Dr Lavallee also emphasized the importance of critical medical education, suggesting a new, respectful encounter between clinician and patient that deemphasizes the language of risk, individual behaviour, and weight and instead acknowledges health to be an embodied and structural effect of colonial-capitalist processes.

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deborah mcphail: You are a medical educator, and you have also been educated by a medical school. Do you think it’s fair to say that really complicated health problems, which are social in nature, are often compartmentalized and depoliticized in medical education? If so, in terms of obesity in Indigenous populations, can you describe the approach medical education can take, and if there are any problems with this approach? barry lavallee: Yes, it is fair. In most of the teaching, there is an undercurrent of a hidden curriculum. It occurs in one-to-one engagements with a learner and a teacher, in areas that are emotionally charged: emergency rooms, operations, near death, at birth. That hidden curriculum, I believe, is where reductionism is reinforced and stereotypes are perpetuated. The hidden message about obesity is that it is a moral failure. Obesity is an individual’s failure. When this is considered in the context of a large woman, and add on top of that someone who’s coloured, it’s even worse. Or someone who’s “Indian,” or someone who’s disabled at the same time. The multiplicity of oppressions weighs heavy on one individual, as you might imagine. What ends up happening is that students are taught that if a person doesn’t want to lose weight, whatever that might mean, then whatever happens to him or to her is [that individual’s] problem. That obesity is a singular equation, energy in and energy out. So, in a really bizarre way, I think what we teach students, other health providers, is that “I don’t have to be responsible with engaging with you in a dialogue and finding out who you are. Can I look beyond your blue eyes? Can I look beyond the fact that you might be overweight compared to somebody else? Or dark? Or gay? Or whatever? Can I really engage with you and find out who you are?” So, obesity is thought of in a reductionist way. Now let me state there are many practitioners and learners who understand and appreciate the complexity associated with the obesity epidemic and there are many who do not judge their patients. In medicine, we believe people are centred in a position of such power, individually, no matter where you are on the scale of the social determinants of health, that … you can make a personal choice and act on it. Just pull your socks up and get on with it, right? That is where obesity is centred. The thing that we have a problem with is getting people to think about the structures and influences in a person’s life that might make them obese. People are vulnerable, they are under threat in a capitalist-driven society. But also, that

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kind of thinking blinds you to seeing that people who might be really thin or in fact really big can actually be healthy and happy. It doesn’t position you in a way to see people, to see in a different way. There are obese people who are cardio-vascularly in better shape than people who have a normal BMI. Yet we’re not allowed to think critically about that and what it means. More so, when it comes to Indigenous peoples who are overweight, the added burden of racism and classism may complicate and present more barriers. The deficit model knows no colour distinction. dm: Can you explain what you mean by a deficit model? bl: Based on literature I was reading a number of years ago, deficit theory comes out of educational literature. The predominant belief that the child held within her or his person the ability to succeed or not in school framed a deficit view. The child simply couldn’t do the work – the child had deficits. It meant that the teacher or educator, as a representative of a system, chose to look at the child as a problem for not achieving educational goals, for not attaining different levels of education, for not reaching higher levels of education. So the process, what Sherene Razack talks about, is “I’m not going to look at myself, that is, as a person or as a clinic or as a government. I’m not the problem. You’re the problem.” So if you have a high level of diabetes, it’s because you don’t take care of yourself. It’s because you don’t exercise. You don’t eat the right foods and you don’t do yoga. The point is that deficit thinking means that we choose to blame the person. It’s not blaming the victim – I don’t like that terminology. But it’s blaming the person for things that are beyond his or her level of control. I recall as a medical student, I felt very uncomfortable with my own identity as an Indigenous person in the context of the pathologization of my community. You know, the stereotypes about the lazy Indian, the drunken Indian, not caring for his or herself strengthened and supported deficit thinking. Deficit thinking permits the systems and practitioners to look away from oppression and racism as central determinants of health for First Nation, Métis, and Inuit communities. To maintain the status quo we perpetuate inertia in the light of evidence that the unacceptable deaths and disease for Canada’s First Peoples stem from structural racism. And that simple interventions like access to good quality and quantity of water, access to land, resources, autonomy, and collaboration will reduce the immense burden of death and disease.

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This is the way we think about chronic disease. And then, partly being exposed to some American literature, but more from being around my colleagues in New Zealand and Australia, I learned that there are strengths in people. For example, the deficit theory about the genesis of type 2 diabetes is completely untrue – that the proximal behaviours (or what is seen as the origin) in a person as causes are not as powerful as the upstream issues. And for Indigenous peoples that’s really linked to colonization. It’s around oppression. It’s around Indian residential schools. It’s around the trauma that’s carried from one generation to the next. Those proximal issues, concerns, or traumas that people have, as a people – and I’m talking racialized, at this point in time – actually have more to do with why there are high rates of type 2 diabetes right now. The health care system is blind, in a real way. Those within the system blame people, and obesity is a medical condition for which they blame the individual. The attitude is that people are lazy – that they don’t care about themselves. So the medical community and the nursing community, in many ways, are not poised or in the position to facilitate change or to accept people. We define what is pathology or not. We define who’s healthy or not. And it’s not completely true because it also rests on power. Here’s an example of deficit thinking. One community I work in has a serious problem with diabetes. People I diagnosed twenty years ago are dying. They’re dying. And a lot of people who are getting sick are getting really sick. I’ve heard people, you know, perpetuate stereotypes around community health workers in communities: “Oh, they don’t really care. They don’t help their people.” But Liz [a pseudonym], one of our community health workers, whom I’ve known for twenty years, does care. I was talking with her one time and said “Liz, we gotta do something about X, Y, and Z. What do you think?” “Well,” she says, “I took fifty women to have their mammograms.” “Who did you work with, Liz?” – because I thought the nurses were supposed to arrange mammograms. “Well, nobody,” she says, “I just arranged it myself with our regional health authority and we got a bus and took people on this rough road for a three-hour round trip. And fifty women who needed them got their mammograms.” There are many such examples of First Nation community workers who tirelessly work to increase access to health care for their citizens. The big injustice about being locked into deficit thinking is that one cannot see the strength and commitment of many First Nation people.

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As physicians, too, often we blame. We ask, “Did you lose any weight this month?” We look for the achievement. And when it isn’t there we put another goal before you for the next month. And so you come back to me, but you don’t want to come back to me, because perhaps you haven’t achieved the goal. What’s the next thing that’s going to come out of my mouth? “Oh, you haven’t gotten it?” Look at my behavior: “Oh, you haven’t gotten it.” What do I display to you? Hopelessness and that you are the problem, not me. That’s deficit and that’s micro-aggression in some ways, even if I don’t intend it to be. It does nothing but diminish you. In practice, I choose not to engage patients in such magical thinking. I never talk about weight. If somebody wants to, they can. But I never do. I wait for a person to raise the issue and then I’ll just talk about “What does that mean to you?” You know – all those kinds of things. And it’s no wonder people don’t take their medications. I wouldn’t either. I cannot blame some patients for not returning for a follow-up appointment. dm: Researchers are now beginning to talk about “obesity stigma” and weight bias in health care. I have heard you in the past talk about racism in the clinical encounter as “micro-aggression.” Do you think that we could also talk about fat peoples’ clinical encounters as “micro-aggressive,” and if so, could you explain what micro-aggressions are and, if you can, talk a bit about obesity within that conversation? bl: Micro-aggressions are violent acts that are so everyday and seemingly benign that they are almost imperceptible. Micro-aggression is not about the person who might be considered obese. Microaggression is about the person sitting in front of that person and how he or she conveys word behaviour and physical behaviour that leads the person they’re talking to – to become uncomfortable. And to realize that the behaviour that makes you feel uncomfortable is really about you being considered obese. That’s what microaggression is about. For example, if I ask you a general medical question, “Do you ever exercise?” or “Tell me some of the things you do to keep active,” the two questions are quite different. I can ask any person, “Tell me some of the things you do to keep active.” Underneath the question, I’m making an assumption that you do something. And you could say, “You know what, Lavallee? I actually don’t do too much right now. I just get some walking done.” I say “Okay, great.” Or you could say, “In fact, I spend a lot of time lifting weights,” whatever it is. But if I ask you, “Don’t you

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exercise?” what am I saying? I have committed a micro-aggression against you. Underneath micro-aggressions are stereotypes – uneducated assumptions we make about people. They’re ways that we convey what we believe about a person. dm: So do you think that because there’s a lot of talk in health circles and medical schools about type 2 diabetes in Indigenous people – and related to that, high obesity rates – micro-aggressions regarding obesity can also be racialized for Indigenous peoples? Are conversations about obesity also a racialized micro-aggression in the clinical encounter for Indigenous people? bl: Yes, in a sense, when stereotypes about obesity become connected to stereotypes about Indigenous peoples. In med school, we talk about obesity rates in First Nations people. And it’s hammered into us in terms of risks. Being overweight is a risk for developing diabetes. If you’re a type 2 diabetic and you are overweight, it’s about insulin resistance, and so the weight makes the diabetes worse. And so there are different levels about how important it is to lose weight to militate against any advancement or the development of type 2 diabetes. But when you add Indigenous people on top of that, the old stereotypes come in. “Are you sure you don’t drink?” And the questions keep coming. Do you exercise? Do you smoke? Do you have a job? Did you finish grade twelve? So when you add the complexities of race to obesity, the weight of the “isms” can be overwhelming. And I think that’s what’s operant. What really freaks people out in medicine is when we have thin type 2 diabetics who have never been obese. They just can’t conceptualize that, because they believe, and indeed, they are correct, the average weight of Indigenous people has gone up. But diabetes is more associated with changes, structural changes in everyday life, as a result of external forces. dm: In medicine, and particularly in public health initiatives regarding obesity, there is a great deal of emphasis on education and health promotion, which has been critiqued as a neoliberal approach to health and weight. What do you think of this health promotion approach? bl: Education may have some benefit for some, but I question the rationality of this approach. I do so in the context of realizing the impact of oppression upon the collective and individual behaviours of those oppressed. Promoting family-based skills for women and men living in poverty does address the reason they live in poverty.

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Teaching a young parent, if she is having her first baby, how to bathe the baby or how best to feed the baby, how to breastfeed, that’s teaching. It’s immediate; it has an impact. But with diabetes, in the communities, the people who make the diagnosis are sisters and aunties. They have the glucometers and they go around checking people’s blood. And they send people into the clinics. It’s not because of the knowledge that we, as doctors, impart to the communities that we see these cases come in. It’s because community people actually do that. And I think sometimes we forget that community people actually probably have more of the answers than anything. So people don’t need to be educated – they are already educated. That’s why I don’t do too much typical health promotion in my practice. For example, I don’t promote exercise anymore, I promote movement activities couched in local culture ... fish, walk, hockey, camping, pow wow, etc. dm: Why? bl: People in the exercise rooms are like that because the structures around them made them that way. What I promote is things like “Go visit your girlfriend and walk over there.” “Take the kids down to swim and get in the water with them” – just the everyday things where you consume energy. It’s also getting people to go back to the kitchen. Cook with your kids. If you talk with your kids when you cook, you’re going to find out what happened at school. You’re going to problem solve with them. You’ll be there for them. But that’s not really going to reduce weight, but these are the things that actually promote health. And so that’s what I do. I do not promote exercise. In fact, I just poke fun at it when I talk about cross-country skiing and eating tofu up in the communities. dm: That reminds me of the Health At Every Size approach. Is that what you’re advocating, the idea that you can be any size, and be healthy, given particular health behaviours and if structure and opportunity are there to have those health behaviours? bl: Absolutely. And that’s what we do. In our diabetes program, I have this patient who would be classified as morbidly obese medically – a young man. And I know, biologically, if he were to get some weight down, if that was possible, I know his sugar would normalize. But I’ve never been able to assist him to think about that, and I wonder, should that be a priority for me right now? It’s not a defeatist way. When I see him, his weight’s probably down a little bit. He has a beautiful family, his kids are in hockey. They’re

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doing community stuff. His wife is great. And he’s got kids and he’s teaching them. And he participates in ceremony. So, he’s happy. And he’s healthy in his way. So, we don’t talk about weight reduction anymore in our diabetes clinic. We advise people: “Here’s the science that we have. And here’s what we believe happens in First Nations communities.” I tell them if I look at my grandma and my aunties, they’re thin as bones. They look outrageously skinny. But in reality, their life was different. So the impact of colonization and oppression on peoples has effects on bodies. dm: Can you expand a little bit more about the effects of colonization on bodies, and the role of tradition in interrupting or resisting those embodied colonial processes? bl: Pre-colonization, there was no diabetes or hypertension. And it’s not about returning to an ideal time, whatever that may have been. Rather, it’s thinking about how the structural influences on their descendants differ, and our biologic response differs accordingly. People might not call me obese, relative to what’s happening today, with my family. But in fact, fifty years ago they would look at me and say, “You don’t even work.” Because to work was to chop the wood, to go trapping. Those things are devalued by the larger economic community – for example, when the people who were worried about seals in England. They had no clue about what they did to the health of Inuit people, when the seal hunt went down. And … the upper-class women in England didn’t want to wear any more pelts, they had no clue what it did to communities over here. Our economy, after colonization, relied on the fact that we hunt. And people just have no clue. And so, we see the residue of that today in people’s bodies – in diabetes rates, obesity rates. Add to that the ambient racism in everyday Canada, person to person and system mediated … a toxic environment for those living daily under threat. My advice is, “Get money for a skidoo and get people to go away for two weeks into the bush.” They still know how to obtain country food. It’s probably not going to be any drugs or alcohol either. Everybody will have a purpose. Dad has his thing to do. Mom has hers. And the older daughter, oldest son – everybody has something to do. And it’s a really safe environment for people. What’s been created by the Indian Act and colonization in the communities is often unsafe. Going to the bush is going to a refuge in

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many ways. Feeling you’re safe and you belong is a huge, huge determinant of well-being. I want gasoline to help people go to the bush, and you know, for them to use their own collective wisdom not to drink or take drugs and to experience an Indigenous refuge, of sorts. So, I teach medical students that they have to think of the structural obstacles that go on. Going back to being an “Indian” is not the solution. It’s the fact that we recognize and that we uncover and we deconstruct what has happened to us in the current state today and find solutions to that. dm: You touched a little bit, there, on food-access issues and the fact that many isolated communities are “food deserts” that do not have continued, seasonal access to particular foods. There is a discourse within health circles that this lack of food access leads to obesity in Indigenous communities, because rather than fresh, “healthy” foods like fruits and vegetables, people are eating “unhealthy” processed foods that are high in fat. So what is suggested, especially for northern communities that actually do not have great access to foods for a variety of reasons, is that we can transport up more fruits and vegetables, and that’s the answer. bl: Yes – but that’s the economy. Who benefits from that, really? Who benefits? It’s the airlines, and the companies. That doesn’t work, because what you’re doing is relying on external things. Fruits and vegetables? We have to try to stop framing health promotion from a middle-class view. The problem is not fruits and vegetables. The problem is that people in the north can’t hunt because of the pollution caused by destruction and pollutants … mining, forestry, and hydro. So the problem is structural, and there are some real problems. And we have a universal health care system, but underlying the “universal health care system” are costs. So if my relatives are told, “You need to see a dietician because you’re diabetic,” they have to have the money to get the bus to go see the dietitian, if they are able to gain access to one within the insured health care system. Or they might have to have insurance to see a dietitian, because if you wait for the one at the Winnipeg regional health authority, you’ll wait for a year or two. And if you’re just worried about money because you’re on social assistance, where are you going to get the time to sit for an hour or two, to talk to a dietitian about the foods you eat, versus actually what you feel, and the condition that you

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find yourself in? Yet we continue to talk to people about fruits and vegetables? It is the problem of a poorly deconstructed system of supports, its rhythm is not holistic. dm: How have the Indigenous communities that you work with approached obesity, or do they? bl: The communities don’t talk about obesity. They talk about walking. Communities address the increasing weight of members through school interventions like traditional activities, cooking classes, instruction by elders on the old ways, supporting parents, inviting parents. They invite experts to engage with community, it happens very often. There is much work and activity based in community going on. dm: To conclude, do you have any “take-home messages” for health care providers with regard to what we’ve been talking about? bl: I think one important take-home message is that taking the time to learn about your patient, to be literate to their story and to not judge, will probably do more to help someone who might be overweight, poor, or from a community under threat. Read some of the stories about the personal and family impact of the residential schools. There are many literary resources available. You might also consider going to visit a community and have a cup of tea.

PART 2 Who Is Responsible for Obesity?

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7 Mother Blaming and Obesity: An Alternative Perspective W en dy Mitc hin s on

We live in a weight-obsessed society. It is not a new phenomenon, but the panic that has emerged from governments, health experts, nutritionists, and the popular media about the “obesity epidemic” is unique in its depth. One aspect of that panic is the fear concerning obesity in children and teens. They are the most vulnerable of our citizens and also the most significant, as they represent our future. According to the Canadian Health Measures Survey, many of our children are deemed overweight and obese (19.8 per cent overweight, 11.7 per cent obese as of 2009–11, aged five to seventeen) (Roberts et al. 2012).1 In attempting to understand the reason for such statistics, health, medical, and lay authorities are often willing to blame parents for any weight problems their children have. Someone needs to be responsible, and we live in a society in which children and adolescents are not seen as fully responsible beings. They are in a liminal or “becoming” period of their lives prior to reaching the age of responsibility. Until then, responsibility to protect children and teens from becoming obese (and even overweight) lies with their parents (Jefferson 2011; Williams 2012). While the use of the word parents suggests a shared responsibility, it is most often the mother who is blamed because she has traditionally been the caregiver and controller of the family’s meals.

I thank the Canada Research Chair program, the Canadian Institutes of Health Research, and the Faculty of Arts, University of Waterloo, for financial support for this project. I also thank Alyshia Bestard and Dr Carol Cooper, who were my main research assistants, and Nicole Fera, Kristin Hall, and Adrienne Byng for their help.

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This chapter examines mother blaming in the obesity discourse on children and teens in Canada between 1920 and 1980.2 These were years of significant change for Canada in the areas of food supply and consumption, nutrition, weight, and health, all of which became part of obesity awareness, which by 1980 had become a major concern for those in the health professions. The sources I examined were medical journals and public health periodicals that published widely on nutrition and general health, including topics such as exercise, healthy diets, and weight. I also looked at several popular Canadian magazines that published advice to readers on nutrition, meal plans, body image, and how a mother might get her child to eat in a healthier way. The literature found in the medical and public health journals was written by experts in health and nutrition, and much of their advice came from the various food guidelines the government of Canada produced over the years (Ostry 2006).3 These experts also wrote in the popular magazines so that the message of good nutrition could more easily reach Canadians. In turn, popular magazines published advice to mothers on how to implement the various nutritional messages. Ironically, these magazines, health periodicals, and medical journals also contained advertisements for food products that stressed their nutritional value and taste appeal, but overlooked the problematic issue of some of their ingredients or their negative impact on health. In addition to these published sources were thirty interviews done for this study with people who self-defined as fat during the years I was researching.4 Like Michael Gard’s chapter that accepts obesity statistics in order to assess what they represent, I examine the way in which practitioners (and dietitians to a lesser extent) have used the studies of nutrition and weight over the decades.5 While there were ongoing criticisms of the height/weight charts underlying the studies and hence their findings, my point is not to criticize their use but to probe how their use had consequences vis-àvis mother blaming.6 All the sources represent how information transference worked. With respect to the current “obesity epidemic,” mothers of obese children are often considered bad mothers who have not fed their children well: not encouraged them to be physically active, not set a good example for a healthy lifestyle, and not protected them from outside forces. They are, in some cases, thought to be the origin of psychological problems that have led their children to overeat. In her work, April Michelle Herndon has pointed to two main issues that lead to mother blaming: nostalgia for a past when mothers did not work outside the

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home and the rise of surveillance to protect children from risks (Bell, McNaughton, and Salmon 2009; Herndon 2010; Landsman 2000; Lupton 2008; McNaughton 2011). While Herndon’s work, and that of others, acknowledges a historical trajectory in mother blaming, the past has not significantly been the focus in much research. Indeed, the historiography on children and teen obesity is limited. Literature on weight and malnutrition at times touches upon obesity, but the major concern has been about those who were underweight (Lovett 2005; Ostry 2005; Sealander 2005). The topic of childhood obesity is mostly limited to references in general histories of obesity, which use a cultural approach to child-raising as a determinant of differences in obesity rates and reactions to them among groups and nations (Gilman 2004, 2008, p. 62; Levenstein 2003b; Stearns 2002). As this chapter argues, mother blaming is a much older and stronger trope than we often acknowledge – we are dealing with something socially systemic.7 The first section of the chapter examines the nutritional concerns regarding the most vulnerable in Canada and how the trope of blaming mothers emerged from them. As the central individual in feeding her children and teenagers, the mother had to wend her way through a morass of nutritional advice. How well she did so was evident by her child’s body – thinness being a sign of malnutrition and a failure to protect her child’s health. The second section traces nutrition studies’ conclusion that being overweight was also a form of malnutrition. Not surprisingly, blaming mothers was easily transferred to the discourse of child and teen obesity. Contrary to what some scholars have suggested (Herndon 2010), the recent focus on childhood obesity is not new. The third section argues that those who blamed mothers did not take into account the complex and contradictory nature of the advice they were given, the wider cultural/social context that directed mothers to a different image of health for their children than that of the “experts,” their own body image problems, the agency of children and teens to reject eating well, and the varying dynamics of family. I am not arguing that mothers were or are blameless in how and what they feed their children. But as Deborah Lupton argues, “the ways in which [a child’s] needs are met (or not met), and the meanings that surround them, are the products of acculturation into social and cultural norms” (2008, 117). And those norms are not always clear or accessible. Different cultures see weight and hence body image differently (Black 2004, 20). If blame is to be apportioned, it needs to be shared, especially among the various advice givers (Singh 2004, 1196).

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Nutrition The history of nutrition is a significant context for understanding the history of mother blaming connected to obesity. Throughout much of the twentieth century the nutritional worth of food was under the microscope to find what specific diet would offset the problem of malnutrition. By the 1920s the discovery of various nutritional substances, especially vitamins, introduced a new way of looking at food: the focus was not its flavour or its quantity but its nutritional value. Nutritionists emphasized what foods to eat in order to get the right balance of nutrients (Levenstein 2003a, 13; Warsh and Strong-Boag 2005, 11).8 Of particular concern was the health of the young. For decades the high infant mortality rates in Canada had been known, but the high rejection rate of young men as potential recruits for World War I due to their poor health raised questions about how many Canadian children were growing up to be healthy. Subsequent experiences seemed to place any positive outcome in jeopardy: the Depression, the Second World War and its high rejection rate of potential recruits, and the emergence after that war of what many critics called lazy and self-absorbed youth. The reaction to these problems was increased “social regulation” (Lupton 2008) that was evident in the creation of the Department of Health in 1919 and within in it a Division of Child Welfare; the work of the Child Welfare Council and the Canadian Public Health Association in the 1920s in their support of milk as a significant “food” for children and teens; relief assistance throughout the Depression at the local, provincial, and national level; the introduction of family allowances; the ongoing work of the national government in providing dietary standards; the development of universal medicare; and the creation of ParticipACTION, in part, to promote fitness for children. All had strong connections to the concern for children’s and teens’ health. Central to these responses was concern over malnutrition, which had been confirmed by a myriad of school and family studies throughout the decades. Many of these studies used height/weight charts as a measurement method to suggest or determine malnutrition; those who were underweight were designated as malnourished. Such studies gave a scientific aura to the panic about children’s and teens’ health, and given the number of young people found to be malnourished, ongoing surveillance was justified. As Petherick and Beausoleil as well as Ward note in their chapters in this volume, surveillance of school children and their health (and weight) continues today. While the results of

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the studies in the past varied statistically, the conclusions were the same – Canadian children and teens were not as well nourished as they should be. A 1921 nutritional study of Toronto schools determined that 26 per cent of children were “in a serious state of health.” In the early 1940s, a Quebec survey of children aged ten to fourteen found “physical abnormalities.” A study after the war determined that while there might not be significant malnutrition among children, there were “dietary inadequacies.”9 Throughout the 1950s, 1960s, and 1970s nutritionists and others continued to argue that children were not healthy, that too many were too thin, and that they did not have access to the right kind of food.10 Of particular concern were teenagers who were growing quickly, experiencing “nervous and mental instability,” and who needed more rest and good food. Especially worrisome were teenaged girls who focused too much of their attention on trying to be slender.11 What was new in the 1960s and 1970s were studies focused on groups of children and teens overlooked in previous studies, specifically Aboriginal and Inuit youth. Increased weight among them did not signal anything positive, caused as it was by an increase in sugar consumption and a lessening of animal protein intake.12 The nutritional health of Canada’s children and teens appeared substandard. If any doubt existed about the scope of the problem, the Nutrition Canada Survey (NCS) (1970– 71), the most significant nutritional study undertaken in Canada at the time, emphasized what most in the field had long known – that children were below standard in their intake of several nutrients, especially iron and vitamin C, and teenagers were not getting enough calcium.13 So concerned were Canadians about child and teen malnutrition that a market emerged for products to address it. In the 1920s Virol, “a food, scientifically prepared,” promised to bring “thin weedy and delicate” children to health. Its advertisements in both popular and medical publications were particularly appealing, with testimonies from parents on how Virol had been “a miracle” for their child. Stand-alone nutrients emerged and their numbers expanded. But not all the products being advertised were as benign as nutrient supplements, so their advertisements were generally limited to professional medical journals. For example, in the 1960s the manufacturers of Winstrol, an oral anabolic steroid, advertised it as good for “undernourished, underweight children and adolescents.” Medical journals continued to publish advertisements for weight gain aids in the 1970s, although some of those advertisements seemed more socially aware than in previous decades. An advertisement for Periactin (essentially an antihistamine

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– hydrochloride cyproheptadine) claimed that “in a fat-fearing country there is a thin forgotten minority – the otherwise healthy, active people, for whom an increase in body weight would be desirable. PERIACTIN* ... is available for them and it can promote an increase in body weight in some adults and children.”14 How was the continuing problem of malnutrition explained? The increasing standards of expectation for better health over time made sure that the nutritional health of children and teens always seemed less than it could be. It is part of what some scholars have referred to as “healthism” (Crawford 1980), the dominance of health as a societal concern and the fear of the problems not being healthy posed. Lacking that perspective, experts in the past focused on two streams of blame to account for ongoing malnourishment: one societal, poverty and lack of support for families to feed their children properly; and the other individual, parents’ ignorance or lack of interest about feeding their children well. The latter dominated with focus on the mother (Mosby 2011, 324–5, 328).15 Throughout the decades, feeding the family was a mother’s responsibility, so it was not surprising that the frustration of practitioners, nutritionists, and public health workers often settled on the person who chose her children’s food. Such blame provided an explanation for continuing malnourishment in spite of the establishment of a variety of educational programs in a myriad of venues. To make the situation worse in the eyes of the experts, there was little they could do without mothers’ cooperation, as mothers served as the gatekeepers to their children and, to a lesser extent, their teens ( Ostry 2006, 23–4).16 And too many of these gatekeepers sabotaged the nutrient message through “lack of home control” and home discipline.17 Even in the 1930s, when the Great Depression might have focused attention on economic causes of malnutrition, many continued to blame mothers (Hermiston 2005, 132; Ostry 2006, 85). From the perspective of experts, all that was being asked of mothers was to follow a “few fundamental health rules,” yet they didn’t seem to be able to do even that.18 A nutritional study of Brantford, Ontario, for example, concluded that housewives on relief spent too much money on sugar and other carbohydrates and not enough on milk and vegetables.19 But it was not only those on relief who needed educating; most mothers seemed to need help. If the various nutrition studies were accurate, eating habits right across the country were problematic.

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And the blame continued. The author of a 1941 article in Chatelaine argued that mothers at the very least should understand the basics of nutrition. Less than sympathetic were the hypotheses of some researchers. A 1953 study of two Toronto grade schools aimed to determine the impact of an employed mother on children’s eating habits. The results were not what were expected. A mother’s absence from the home did not affect her children’s diets – a working mother was not a bad mother. But women were not off the hook. If it wasn’t a mother’s absence that was the problem, some focused on what they saw as mothers’ “indifference and ignorance.” In the January issue of the 1953 Canadian Journal of Public Health, an article by G.T. Haig entitled “Suppose Tommy Won’t Eat,” introduced readers to the work of Dr Clara Davis, who argued that children were good diet balancers if left alone, that is, from day to day or week to week they “naturally” adjusted their diets, and in doing so they seemed to cover the nutritional bases. Such a finding was certainly in the spirit of a more lenient view of children’s eating habits and asked parents (mothers) to take their cues from their children.20 All mothers had to do was to give children the right variety of food from which the children in turn would choose. The child would know better than mother what to eat. But mothers still were accountable. In 1973, an article in Health, a journal for both lay and professional readers, blamed Canadian mothers for failing to teach their daughters how to shop for food. And once again in the medical literature, women’s increased participation in the workforce was put forward to account for the bad eating habits of children.21 Obesity If eating nutritionally was and is part of maintaining health, experts also deemed it preventative against becoming obese. While the main concern about children in the early decades was the perceived high rate of malnutrition, studies of children and teens and families’ eating habits revealed not only those who were underweight, but also those who were overweight. They, too, became part of the malnourished group.22 In 1941 Dr Lionel M. Lindsay of Montreal published an article in the Canadian Medical Association Journal that was one of the first overviews of obese children in Canada. Dr Bernard Laski began the decade of the 1950s warning that the “overnourished” child was more at risk than one who was underweight, signalling an important change given the

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decades of concern about the underweight. Others picked up his concerns, and by the mid 1970s Toronto professor and physician A. Angel was willing to accept the American statistics of 2 to 15 per cent of children and teens being obese as being likely true for Canada as well.23 Once child and teen obesity was recognized, the next step was determining causation. In the past, obesity experts considered family heredity, food intake, and lack of exercise as the main contributors to childhood and teen obesity. Of the three, overeating was the most important. It exacerbated family heredity, resulted in obesity in those without a hereditary predisposition, and caused weight gain that most exercise could not rectify. And because mothers were responsible for how their children and teens ate, as with malnourished children, mothers were considered at fault for obese children and teens. Indeed, the blaming that originated in the nutrition studies was easily carried over to obesity. Commentators in the 1920s were concerned about the increasing amount of sugar that children ate in the form of candy,24 without their mothers stopping them.25 Too many mothers seemed to offer their children unhealthy, fattening meals.26 As seen above in the Brantford study during the Depression, mothers were blamed for spending too much relief money on sugar and other carbohydrates.27 By the 1940s and 1950s there was no doubt in Lindsay’s and others’ minds about the cause of childhood obesity: such children ate too much and too much of the wrong kind of food.28 Teenagers especially didn’t seem to have any sense of nutrition, focused too much as they were on eating candy and drinking soft drinks. And underlying their actions was the “inculcation of the habit by an overzealous or misguided mother.”29 But it wasn’t only physicians and other experts who were talking about obesity in children and blaming mothers. In 1966 Chatelaine advertised its “Miss C Diet Book” that asked the reader, “Is your daughter overweight?” In other words, it accused mothers with an implied “How could you have let this happen?” Dr Elizabeth Chant Robertson reminded mothers that a fat child experienced social ostracism – teasing, inability to keep up with others in sports, isolation – and issued a wake-up call for mothers to do something. New theories of obesity linked to food intake emerged in the 1970s when physicians began to refer to the multiplication of fat cells up to a certain age. If infants and young children ate too much, those cells became more numerous and they never disappeared, the assumption being that their very presence would make the individual more prone to putting on weight.30 Again it was mothers who were in control of what their infants and children ate.

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Adelaide Daniels, founder and leader of Weight Watchers in Ontario, reinforced the criticism of mothers. The people she worked with in their efforts to lose weight told the same story: “‘My mother forced me to clean my plate as a child.’ ‘My mother gave me chocolate cookies when the boys bullied me.’ My mother this, my mother that. They don’t understand that although mother meant well, she was misguided by today’s standards.”31 Mothers couldn’t keep up with nutritional science; only the experts could, or that was the belief. Some of the people interviewed for this study also had memories of their mothers and food. One interviewee, Doris, remembered that “there was always desserts ... my mother had a wicked sweet tooth.” But Doris found this frustrating because of her weight. The temptations were all around her and yet her mother would remind her that “you don’t need it,” “you’re heavy.” As Doris recalled, when she came home from school and looked for a snack, she had a choice between cookies and an apple. She certainly wasn’t going to choose the apple: “Kids just don’t do that.”32 Underlying overeating were the psychological dynamics of the family. In the 1940s and 1950s, the work of German-American psychoanalyst Hilde Bruch with fat children in the United States focused on the psychological relationship between the child and the mother. She saw the mother as the key person, often overprotective of her children and, at the same time, ambitious for them. Such mothers tended to “do” for their children, not letting them assume the normal responsibilities of childhood. Mentioned in the Canadian medical journals, Bruch’s theories of the psychological causes of obesity became the standard by which to compare other explanations (Bruch 1996).33 Hers was the most significant voice in the study of childhood obesity. Treatment of childhood and teen obesity mirrored its perceived causes, and causes didn’t vary much over time. Exercise didn’t loom large with respect to obesity except as an adjunct to other treatments – dieting, use of drugs, and counselling. All three were intertwined; loss of weight was the goal, dieting was the solution, and drugs and counselling were tools to make the solution possible. From a practitioner’s perspective, treating children meant having to deal with other family members, in particular the mother. But treatment was a practitioner’s solution – the solution’s failure was the mother’s, especially given that much of the treatment was under her control and surveillance, whether watching what her children and teens ate or did, being supportive of them in a way that would encourage them to exert self-control, or overseeing the “medical” treatment prescribed. For both malnourishment and obesity,

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the frustration of physicians, nutritionists, and at times educators was palpable and was reflected in mother blaming. They had a health message to deliver but they could not ensure that it would be implemented. Rochefort, Senchuk, Brady, and Gingras echo this frustration in their chapter in this volume. In their self-reflections as dietitians, however, these authors don’t blame individuals for not following the dietary message, but rather challenge the dominant dietary discourse. Those in the past seldom disputed the discourse; consequently, their frustration led to the need to blame someone for its apparent failure. Another Perspective Mother blaming was in large part a result of the medical, health, and education commentators believing in the message they were delivering. It seemed to have science behind it and reflected a form of scientific modernity. While it is easy to find the mother-blaming trope in nutrition, and hence obesity discourses, there is very little sympathy for the mother of a fat child. Nor is there evidence that mothers didn’t want what was best for their children (Lupton 2008). Rather, so many things not of her making complicated a mother’s response: the problematic aspect of nutritional advice that was directed at women from so many sources; the popular perception of what a healthy body looked like; the worrisome nature of women’s own eating; recalcitrant children and teens; and specific family situations. Throughout the decades under study, mothers were bombarded by advice from physicians, public health workers, schools, different levels of government, films, radio, TV, and popular magazines, each offering advice that was often patronizing. Magazines played a major role in what could easily be seen as usurping a mother’s responsibility. The articles’ details – for example, the use of sandwiches for school lunches, their size, and their fillings – left little for mothers to do.34 A mother didn’t need to think, she just had to follow instructions. Women’s magazines like Chatelaine were also full of advertisements that often used the reference to nutrition as a selling point. As Elliott’s chapter reveals, the power of advertisements is significant, even if readers don’t always take in the messages the way marketers might want (Lupton and Chapman 1995, 489). In looking at the nutritional advertising for the years 1930–45, Alana Hermiston found three frameworks that were used: “instilling fear, inspiring patriotism, or a ‘soft-sell’ approach” that, while appealing to patriotism, also praised the role of women

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(2005, 124, 132). Within those frameworks almost any food could be marketed as nutritional. The 1930s advertisements by Neilson for their milk chocolate bars pointed not only to their taste but also to their richness in vitamins. The appeal to mothers was blatant: “Mothers, Here is the perfect Chocolate for Kiddies. Neilson’s Jersey Milk. The natural craving of your children for sweets should be satisfied ... Keep a box of Neilson’s Jersey Milk Chocolate bars on hand and give each child a bar a day ... Nourishment and health for growing children in every bar.”35 So many themes emerge from such an ad: mothers’ perceived need to know what to feed their children and to understand nutrition; marketers’ ability to use health to sell candies; seeing the craving in children for sweets as natural and as a way of selling a product; the suggestion that if a craving was natural then mothers should meet that craving and not worry about it; and the moral aspect of meeting a natural need. Just as vitamins were given once a day, you have here a once-a-day chocolate bar with the comforting reassurance that it was good for your child. Such advertisements are the forerunners of the advertisements for products such as Fruit Loops that Elliott describes in her chapter. Other products went further and appealed to parental fear about whether their children were getting what they needed.36 Surveillance was key, and though Herndon (2010, 346) sees this as new, it was very much part of the public health movements in the late nineteenth and early twentieth centuries. Books such as Alan Brown’s 1923 The Normal Child told mothers that weighing the child every month after six months of age was important since it was “the best guide to the child’s physical condition.” Such a weigh-in emphasized the importance of weight in society, the worry about lack of weight gain in children, and the ideal that a healthy body was a larger body. In the 1930s J.W.S. McCullough, Ontario’s chief medical officer, similarly recommended that every school have weight scales and keep a weight chart on its students, weighing them every month.37 Eating properly was complex when “new” nutrients were deemed necessary. In the 1920s a child’s diet was supposed to consist of 50 per cent carbohydrates, 35 per cent fat, and 15 per cent protein, with specific sources of each recommended. But standards kept changing. Charts in the 1920s and 1930s laid out the caloric needs for children and teens based on sex and age, but were inconsistent in their claims. For example, in the chart for the 1930s the calorie spread for girls aged 14 to 15 was lower than that in the 1920s, and for boys it was higher. Mothers needed to be educated about the finer details of calories, about who in

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their family might need more “fuel” than others, and they were urged to look at the scientific tables that would help them in working through the complexity of food. For his part E.W. McHenry, professor of public health nutrition, School of Hygiene at the University of Toronto, suggested that Canada’s Food Rules were perhaps too “complex” for those without a nutrition education.38 Advice was often contradictory as well as complex, leading to a sense of uncertainty on the part of those trying to implement the advice (Rich and Evans 2005). While milk was certainly accepted as a major food for growing children and teens in the 1920s, some worried that younger children were consuming too much milk, resulting in inadequate intake of fresh fruits and vegetables and cereals and leaving the child lacking in certain key nutrients. In the 1930s, some advised mothers that their children needed a pint of milk per day, others suggested a quart.39 Alton Goldbloom in his popular text The Care of the Child rethought much of what had passed for conventional wisdom in what children could eat. While in 1928 he suggested prohibiting sausage, veal, mutton, smoked meats, shellfish, radishes, cucumbers, fried food, and spices to children under twelve, by 1948 he was quite willing to entertain many more foods, including some of those he had earlier prohibited, such as veal, pork, and mutton.40 The problem for some commentators in the 1950s was that there seemed to be too many experts in the field, and new mothers could easily become confused since each source insisted on the expert nature of his or her own advice.41 Under­ lying all the advice was the message that the nutritional world was filled with risk. As concern about childhood obesity increased in the 1960s, J.E. Monagle, chief of the Nutrition Division of the Department of National Health and Welfare, in discussing the shift from Canada’s Food Rules to Canada’s Food Guide, noted that one of the Food Rules’ problems had been recommending foods that were too high in calories for young children. In 1968 the Canadian Council on Nutrition revised the Dietary Standard for Canada downward for protein; for those sixteen to nineteen years of age, it was a 22 per cent decrease. The “right” food and the “right” amount were constantly put forward as the solution to health problems and a route to attractiveness and vitality, but what was right kept changing. In 1977 Nutrition Canada increased the dairy needs of adolescents, adult women, and older men. And perhaps as a response to people eating fattening food, they also encouraged eating less fat, only 5 to 8 per cent of total calories.42 Trying to determine whether or

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not to worry about your children’s eating habits wasn’t simply a matter of deciding whether they ate according to age and size. Children’s appetites shifted as rates of growth increased and decreased. And complicating the assessment of the child’s needs was that the ups and downs of growth rates were not always visible.43 Underlying all the advice was the assumption that mothers controlled what their children and teens ate. But what kind of control could mothers exert over what their children and teens ate when school vending machines were offering poor choices and school cafeterias were run for profit by private companies for whom the nutritional needs of the young were not part of their bottom line? One study in Manitoba discovered that 56 per cent of schools (containing 70 per cent of the school children) had vending machines of which only 1.4 per cent sold only nutritious food, while 42 per cent sold only “non-nutritious” food.44 School lunch programs could also be problematic. In a Winnipeg school study reported on in 1977, the authors feared that the response to malnourishment through lunch programs was actually causing a gain in “excessive” weight among some children.45 But what was “excessive” weight? Over time it had varied from any weight over the norm to 20 per cent over.46 Such measurements created the limits to what was considered a normal body (Canguilhem 1991; Davis 2006; Garland-Thomson 1996). Equally significant, however, was the changing cultural perspective on body image. Throughout the decades the ideal or popular body image of children went a long way to explain why mothers may have encouraged their children to overeat, at least from the perspective of the “expert.” Throughout a child’s infancy, the healthy image was a fat baby. And that image continued for young childhood as well. For many decades the idea of a skinny child was worrisome. In some clinics run for children in the 1920s, those who put on the most weight were given a special treatment/award. At the mid-century, L.B. Pett understood that reaction and suggested that there was a tendency to make children big so that they could measure up to some kind of standard based on their height and weight.47 The fear of having an unhealthy child drove parents – a mother learned early on that her status as a good mother would be measured by her children’s bodies. Decades of highlighting malnutrition had done its work. Mothers’ specific image of what a healthy child should look like had become iconic. Chubbiness signified that the child was getting enough food (the assumption being that the food was nutritionally good) and would

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pave the way for a healthy childhood and adulthood. Fat was a reserve that was needed to fight off disease. While some may have criticized the child who was “large,” the image of health and eating did go together, and the conduit of this message was largely advertisements emphasizing the goal of eating and growth for children and appealing to mothers’ fear if their children didn’t eat. For example, in the 1960s, Swift’s premium “franks” had a telling advertisement in Chatelaine. The visual was a chubby boy carrying an armful of hotdogs. Part of the text said, “No fair counting how many ... A youngster may be finicky about everything else, but somehow he managed to down four of these appetizing favourites without batting an eye. And that’s A-OK, Mom! Because here is Meat Power from Swift – a good dietary source of protein.”48 No wonder mothers were overjoyed if their children had a hearty appetite. It meant they were good mothers. For teens the popular body shape was quite different. From the 1920s onward slender was the ideal. Fat was the enemy. Teenaged girls’ concern about their bodies was such that they were often willing to write to magazines like Chatelaine asking for advice about their weight and how to lose what “extra” weight they had. An article in the Canadian Home Journal emphasized the need for teenaged girls to remove a “bulge here, a bump there.” The title of another article was “Every Girl Her Own Girdle.”49 Unlike when they were children who were supposed to be chubby, teenage girls were told their health now involved other standards. As they left childhood, the shift to being slender was emphasized even though girls’ bodies were accumulating fat (Ball and McCargar 2003, 131). For boys, the message was different: be bigger than girls and more muscular. And little changed over time. An article in the October 1971 issue of Chatelaine gave a detailed resume of teenaged hopes: “Body Builders and Reducers” – the body builders being the boys and the reducers the girls.50 Mothers were caught between what they thought a healthy child’s body was and what their teenagers saw as attractive, which was different for daughters and sons. And in the 1970s, what was attractive for teenage girls was increasingly deemed very “thin.” Mothers were also caught between their own body image and the reality of its health. Like their teenaged daughters, they were to remain slender to maintain their attractiveness. The 1934 Canadian Home Journal in one of its articles made the sweeping comment that “most mothers and home-makers are over-weight” and needed “to see their doctors regarding reducing.”51 At the same time most nutritional studies noted

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that women were among the poorest fed members in the family. In the late 1930s a study of nutrition in one hundred low-income Toronto families found that women took in an average of 1,720 calories a day, which was only 70 per cent of the recommended standard (men took in 77.5 per cent). Other studies found similar results. An article in 1951 warned that women between twenty and thirty-nine faced a range of nutritional problems – “anaemia, thinness, overweight (which can result from malnourishment), protein and vitamin A deficiencies.” By the 1970s, the situation was more complex in that generalities were more difficult to make. The Nutrition Canada Survey determined that women were more likely to become obese than men, which was a sign of poor eating habits and perhaps malnourishment. Among the Inuit and First Nations, women experienced vitamin A and C deficiencies and in the general population correlations between lacking nutrients and being poor were more noticeable for women than for men.52 Mothers clearly took their responsibility seriously as the controllers of food, and that meant seeing that their children and husbands were fed well.53 Their own nutritional needs came last. Seeing that their children ate well, however, was not a straightforward process whether the children were underweight, average, or overweight. Mothers were caught between trying to get their children to eat and trying to meet the demands of food rules.54 Implementing the messages about food intake often conflicted with the wants of recalcitrant children and teens. Seldom acknowledged was that children had some agency to refuse to eat what their mothers wanted them to eat. One who did recognize this was F.W. Tidmarsh, who in his 1923 article described a “type” of child who refused nutritious food. Such children were left to “rule” the household and to exert their power.55 Others in the popular press offered the supposed insight that children ate candy during the day because they needed “nourishment” and so they should be given fruit, as if that was a straightforward offer that was going to be accepted.56 Remember Doris and her rejection of fruit in favour of sweets. Getting children to eat well was an ongoing challenge. In the 1960s the popular health advice to parents (mothers) on how to get young children to eat was to give them small portions; don’t fuss; give them few snacks; let them feed themselves; and do not show concern.57 Essentially any child’s consumption would match their nutritional needs.58 But after generations of advice that placed mothers in charge of what their children ate, how could mothers be expected to let their children take over?

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The gap between children’s agency and that of teens was significant. As Elliott’s chapter argues, a fat teen had more responsibility than a fat child. This was true for the earlier decades for teens that were both underweight and overweight. Teenaged girls were especially more difficult to influence. In fact, journalists acknowledged their agency by writing specifically to them and giving them advice.59 Teenaged girls seemed not to want to eat “good plain food,” but preferred “sweets and pickles.” That being the case, the mother’s dilemma was meeting the larger appetites of her sons and “coaxing” her daughters to eat.60 Mothers were to exert their influence. In the 1940s, the guidance offered to mothers of teenaged girls who thought they needed to lose fat was for the mother to tell her daughter that being thin was no longer fashionable. Such advice was laughable.61 All around teenaged girls was evidence to the contrary. Image trumped nutrition and the constant reference to teens’ poor eating habits suggests an agency that mothers would be hard pressed to overcome. As E.W. McHenry noted, teenaged girls had been taught the rules of nutrition and yet “they had failed to learn the simple rules to be followed in the choice of foods for health.” By the 1960s and 1970s, complaints about teenagers’ eating habits abounded62 and the solution offered was more nutritional education through the schools.63 Decades of nutritional education had come to naught but still it was the best on offer. Few paid attention to the fact that how teenagers ate was part of adolescent culture and took place increasingly away from home. In Daniel Cappon’s 1973 book, Eating, Loving and Dying, the only comfort he had to offer the parents of teenagers was that the eating “madness” didn’t usually last for more than a few years.64 Ignored was the fact that the health of teenagers and the population as a whole was better than it had been. It was the nutritional standards of experts that always seemed out of reach. The agency of children and teens is heard in the voices of those interviewed who saw themselves as fat before adulthood. They recognized the appeal of eating and devised ways to hide it from their mothers. Grace remembered that she was too short to reach the cookies at home but she could reach the package of Tang in which she would put her finger and then lick the powder off. Lucy learned how to become a “secret” eater, stealing food from her brother in a way that wasn’t noticeable. When she was alone in the kitchen she excelled at opening the refrigerator with little noise. She would take off the icing from the bottom of home-baked cakes where it wasn’t evident. She was able to time the toaster before it went off so she could toast her bagels without

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anyone hearing her. Irene had the same talent in that she knew enough when eating from a can to eat all of its contents and then bury the can under other garbage so no one would be any the wiser. Olive hid a jar of peanut butter in her room. She loved eating peanut butter but her Hungarian parents thought it disgusting. A number of individuals interviewed also recalled stealing money to buy sweets. Grace stole from her blind grandmother and bought chips, chocolate, and McDonald’s sundaes. Experts seldom mentioned this kind of agency but it was what many mothers faced.65 They also faced the dynamics of their families. The so-called experts proffered generic advice but mothers were members of a specific family and there was often a disconnect between the two. Sometimes it was the family economic situation that caused the disconnect. The Depres­ sion dictated Alice’s eating when she was a child. She remembered sometimes having meals of only bread and milk with some brown sugar for several days at a time. When eggs were not needed for market, her family would eat mostly eggs. For Nina eating had no limits when she was growing up. Her mother ran a boarding house and, as a result, food was plentiful. “Two or three pieces of pie if you wanted it.” When asked what her mother’s concern was, her answer was poignant. “Her concern was ... money and keeping a roof over our heads.” Tammy noted “Our parents went through the Depression and the war times. So chubby kids were a good thing.” Connie’s mother, a single mom, came from war-torn Europe and although Connie had issues about her mother and the food she piled on her plate, Connie acknowledged it was her own mother’s experiences of deprivation that led to such behaviour. And she admitted the meals served were healthy and her mother was a good cook. Only rarely did nutritional “experts” acknowledge economic problems for families on an individual level.66 A family is a complex entity. It is a cultural institution with its own norms and traditions. Different families eat different foods, eat the same food differently, and see food in different ways. Food is enmeshed in a heritage that is central to how a family sees itself. Traditional customs surrounding food were such that “new” nutritional advice was not always easy to incorporate into a daily schedule. As McPhail’s chapter indicates, traditional food came with a deep cultural meaning and could not be jettisoned easily. And that difficulty was seldom recognized. How did nutritionists and practitioners expect a mother to cope with a family with an eye to meeting the differing needs of young children, teenagers, husbands, overweight members, and underweight members,

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not to mention their own nutritional needs? If a child or teen needed to be on a diet the advice proffered was for the whole family to partake in the child’s diet.67 Such advice seemed to ignore other members of the family. Would other children in the family feel that somehow they were being punished for their sibling’s fat? The focus for Tammy’s parents was on her younger brother who was thin and didn’t eat well. Tammy did what children were supposed to do – she ate what was placed in front of her so she would be healthy. It was the thin child who didn’t eat that was the problem child. Based on the interviews, mothers (and fathers) did try to help their obese children. Most parents talked to their children, but for many children talk seemed more like nagging than an expression of concern. Children knew their parents were concerned, but from the child’s perspective the child was blamed for being overweight. Parents told them what to eat, what not to eat, or refused to let them eat certain foods. As Lucy concluded, “I just remember feeling very oppressed, very oppressed and very controlled.” And she wondered what her weight would have been like without the control. Some parents sought outside help for their child, be it from an hypnotist, Weight Watcher’s, or medical practitioners. Some did little. Nina, whose mother ran the boarding house, remembered her mother taking her out for French fries as a treat despite Nina being overweight. Looking back, Nina sees that eating fries together was a special time when mother and daughter were able to get out of the house together. Money was tight and fries were an affordable treat for both of them. Sometimes parents didn’t know why their children started to overeat. Stephanie thought the age of six was crucial for her when she and her best friend followed her friend’s mother’s happy eating behaviour. But she also noted that her candy fixation appeared after a neighbour had abused her.68 Conclusion Those working with obesity in the young saw its cause as multidimensional. As one pediatrician noted in 1959, “there are as many kinds of obesity as there are fat children, and all of them are different.” Eight years later Dr. A.M. Bryans, Head, Department of Pediatrics, Queen’s University, concluded that “juvenile obesity is probably a reflection of undefined, complex, and inherited and metabolic factors, aggravated by diet, lack of exercise and other environmental influences. There seem to be both psychological and physiological reasons which make

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obesity, once established, a self-perpetuating entity.” An article in the 1975 Canadian Medical Association Journal was entitled “Problem of Obesity Said Frustrating to Doctor and Patient.”69 Where any of these views left the obese child, his/her parents, nutritionists, and physicians is unclear. In the 1940s, Lindsay didn’t think any of the treatments that he suggested – dieting, exercise, or use of drugs – would change the constitution of the child. The best that could be hoped was that such efforts were palliative, to offset any immediate physical and psychological problems “until such time as nature can establish a more normal balance for the fat regulating mechanism.” In 1975 little had changed vis-à-vis prognosis. Estimates were that any “long-term” success in treating obesity in children was under 20 per cent.70 Treating children and teens was problematic since it also meant having to deal with other family members, in particular the mothers who, as we have seen, were often blamed for their child’s obesity. For much of the twentieth century the preoccupation with the weight of children and teens focused on those who were underweight, which was deemed a sign of malnourishment. Concern about it led to numerous school and family studies that revealed that some children were also overweight. They, too, must be malnourished. Both groups were outside the measurements of normality as represented by the weight/ height charts. While the numbers can indicate a possible need to pursue more investigation into the health of a child or teen, they are not in and of themselves a diagnosis. How can they be? Norms reflect aggregate data and not anything particular to an individual child. And it was the individual child that was the concern of mothers.71 The underweight and overweight groups were tied together. Nutri­ tional weaknesses dominated the perception of both groups and the solution for both was to follow a nutritious meal plan. This placed the understanding of nutrition at the centre. Given that concern about children who were underweight dominated the early decades, it is not surprising that the literature on those who were overweight was somewhat similar. The underweight were to follow an eating regimen to put weight on and maintain the weight and the overweight were to follow an eating regimen that would see a loss in weight without hurting health and similarly maintain a healthy weight. It was all about food. But getting children to eat what was deemed best for them posed more of a problem than acknowledged or expected. Why? Who was to blame? Choosing the mothers to blame made a certain amount of sense in the past; a mother’s responsibility was seen as controlling food for her

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family and the trope of mother blaming was familiar to many Canadi­ ans. Yet when looked at from a mother’s perspective, and considering the world in which many mothers lived, blame was not helpful or a solution to weight problems, nor is it today. NOTES 1 Figures are based on World Health Organization measurement. 2 The chapter does not address the issue of infant obesity even though it was acknowledged in the past. That topic deserves a separate study. 3 For the food guides see http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/ context/hist-eng.php (accessed 7 October 2015). 4 Alisha Bestard, my research assistant, conducted thirty interviews of five men and twenty-five women between 4 May 2009 and 9 July 2010. Of the thirty people, three were born in the 1930s, seven in the 1940s, eleven in the 1950s, eight in the 1960s, and one in the 1970s. Those interviewed lived in provinces from British Columbia to Ontario; unfortunately, Quebec and the eastern regions are not represented. Some were immigrants, but most were Canadian born; one was mixed “racially” and the rest were white; some were well-off individuals and others had trouble making ends meet. Although some came from farming communities and small towns, the urban areas dominate. Some were raised in single-parent families. Three were sexually abused during their ­childhood, and one was a victim of violence. Two had significant health issues as children. For more on women remembering their past, see Carla Rice’s (2007) study of obese women, many of whom were women of colour and/or with disabilities. On the issue of memory and experience and the debate over what is “authentic” in voice, see Joan Sangster (2011). 5 Even today, there is debate about whether overnutrition in children is responsible for some children being overweight or obese except in those cases of extreme obesity. See Bell, McNaughton, and Salmon 2009, 159. 6 For criticisms see Alan Brown, The Normal Child: Its Care and Feeding (Toronto: F.D. Goodchild, 1923), 59; Bird T. Baldwin, “The Use and Abuse of Weight-Height-Age Tables as Indexes of Health and Nutrition,” Journal of the American Medical Association 82, 1 (1924): 1; G.A. Lamont, “The PreSchool Child,” Canadian Nurse 25, 12 (1929): 709–10; H. Medovy, “The Malnourished Child,” Canadian Nurse 27, 3 (1931): 117; Hugh Grant Rowell, “Weighty Matters,” Maclean’s 48, 15 (1935): 32; E.P. Cathcart,

Mother Blaming and Obesity  207 “Standards in Food and Nutrition,” Canadian Medical Association Journal (henceforth cited as CMAJ) 41, 4 (1939): 397; Alton Goldbloom, The Care of the Child, 3rd ed. (Toronto: Longman’s Green, 1940), 9; Lionel M. Lindsay, “The Overweight Child,” CMAJ 44, 5 (1941): 504; H. Jean Leeson, E.W. McHenry, and W. Mosley, “The Value of the Wetzel Grid in the Examination of School Children,” Canadian Journal of Public Health 38, 10 (1947): 494; L.B. Pett and F.W. Hanley, “A Nutrition Survey on a Nova Scotian Island,” CMAJ 59, 3 (1948): 232; Lionel Bradley Pett, “A Canadian Table of Average Weights for Height, Age and Sex,” American Journal of Public Health 45, 7 (1955): 862; Helen Evans Reid, “Is Your Child Underweight?” Canadian Home Journal 53, 4 (1956): 70; Stanley M. Garn, “The Applicability of North American Growth Standards in Developing Countries,” CMAJ 93, 17 (1965): 918; R.B. Stennett and D.M. Cran, “CrossSectional, Percentile Height and Weight Norms for a Representative Sample of Urban, School-Aged Ontario Children,” Canadian Journal of Public Health 60, 12 (1969): 465; H.M. McFarlane and Brian P. O’Connell, “Morbidity in Family Practice,” CMAJ 101, 5 (1969): 262; J.P. Welch, E.J. Winsor, and S.M Mackintosh, “The Distribution of Height and Weight, and the Influence of Socio-Economic Factors, in a Sample of Eastern Canadian Urban School Children,” Canadian Journal of Public Health 62, 5 (1971): 377; and Howard McEwen et al., “Experience with a Hospital-Based Weight Reduction Program,” CMAJ 107, 1 (1972): 43. 7 On motherhood see Dodd 1991; Baillargeon 2009; and Comacchio 1993. Each of these works is concerned with advising mothers because of their ignorance on how to raise children “properly.” For a more specific look at mother blaming, see Singh 2004; Ladd-Taylor and Umansky 1998; and Caplan 1998. In 1985 Caplan and Hall-McCorquodale (1985), in a review of major clinical journals for 1970, 1976, and 1982, identified seventy-two types of psychopathologies blamed on mothers. 8 For concern about malnutrition see Olive Matthews, “Child Welfare,” Canadian Nurse 16, 1 (1920): 15; “Public Health Nursing Department,” Canadian Nurse 16, 6 (1920): 361; B.A. Ross, “Distribution of Milk in Toronto Schools” (from “Public Health Nursing Department”), Canadian Nurse 18, 4 (1922): 222. 9 Alan Brown and G. Albert Davis, “The Prevalence of Malnutrition in the Public Schools of Toronto,” CMAJ 11, 2 (1921): 125; J. Ernest Sylvestre, “Nutrition and School Children,” Canadian Journal of Public Health 38, 4 (1947): 186; L.B. Pett and F.W. Hanley, “A Nutrition Survey Among School Children in British Columbia and Saskatchewan,” CMAJ 56, 2 (1947): 191–2.

208  Wendy Mitchinson 10 See M.T. Doyle, M.C. Cahoon, and E.W. McHenry, “The Consumption of Recommended Foods by Children in Relation to Sex, the Use of Sweet Foods, and Employment of Mothers,” Canadian Journal of Public Health 44, 7 (1953): 259–62; Sidney Katz, “A Report on Eating,” Maclean’s 68, 12 (1955): 90; “Food for All the Family,” Health 24, 1 (1956): 23; Helen Evans Reid, “Is Your Child Underweight?” Canadian Home Journal 53, 4 (1956): 70–1; “Are Canadian Children Well Fed?” Canada’s Health and Welfare 12, 5 (1957): 6; E.W. McHenry, “Do School Children in Toronto Follow Canada’s Food Rules?” Health 25, 1 (1957): 14; Elizabeth Chant Robertson, “Do Toronto Children Eat the Right Kinds of Food?” Health 27, 2 (1959): 14–15, 26–7; G.H. Beaton, “Nutritional Status of Canadians – An Unknown Entity,” Canadian Journal of Public Health 61, 3 (1970): 193; J. Ellestad-Sayed, J.C. Haworth, and H. Medovy, “Nutrition Survey of Schoolchildren in Greater Winnipeg,” CMAJ 116, 5 (1977): 490–2. For a discussion of surveillance see Elliott 2009 and Holmes 2009, 229. 11 See Sidney Margolius, “Lady, You’re Starving Yourself,” Maclean’s 64, 2 (1951): 20–1; Department of National Health and Welfare, “Food for All the Family,” Health 24, 1 (1956): 24; Elizabeth Chant Robertson, “Does Your Teen-ager Get the Right Food?” Chatelaine 29, 10 (1956): 128–9; E.W. McHenry, “Do School Children in Toronto Follow Canada’s Food Rules?” Health 25, 1 (1957): 27; Elizabeth Chant Robertson, “The Tragedy of The Fat Child,” Chatelaine 31, 1 (1958): 46; Dorothy Comeau, “You Are What You Eat,” Canadian Nurse 56, 2 (1960): 128; Catharine Hoare Mahoney, “Teen Talk about Food,” Health 28, 4 (1960): 32, 40; Elizabeth Chant Robertson, “Food and Fitness,” Health 33, 6 (1965): 19, 29; Estelle Mongeau, “Nutrition in Adolescence,” Canadian Health Journal 62, 4 (1971): 330–31; Elizabeth Chant Robertson, “Teen-Age Meals,” Health 38, 3 (1972): 17; Daniel Cappon, Eating, Loving and Dying: A Psychology of Appetites (Toronto: University of Toronto Press, 1973), 39; Gertrude Lapointe, “A Nutrition Course for Nurses,” Canadian Nurse 71, 1 (1975): 31. 12 M.W. Partington and Norma Roberts, “The Heights and Weights of Indian and Eskimo School Children on James Bay and Hudson Bay,” CMAJ 100, 11 (1969): 506; N. Steinmetz, “Medical Care of Eskimo Children,” Canadian Nurse 63, 3 (1967): 30–1; O. Schaefer, “Pre- and Post-natal Growth Acceleration and Increased Sugar Consumption in Canadian Eskimos,” CMAJ 103, 10 (1970): 1059–68; M.K. Rajic et al., “Height-Weight Comparison of Canadian Schoolchildren,” in Physical Fitness Assessment: Principles, Practice and Application, ed. Roy J. Shephard et al. (Springfield, IL: Charles C. Thomas, 1978), 73; Otto Schaefer, “Health in Our Time?” Canadian Nurse 74, 9 (1978): 36.

Mother Blaming and Obesity  209 13 Z.I. Sabry, “The Cost of Malnutrition in Canada,” Canadian Journal of Public Health 66, 4 (1975): 291; Z.I. Sabry, “Nutrition in Canada,” Canadian Journal of Public Health 65, 4 (1974): 343. 14 For Virol advertisements see Maclean’s 39, 22 (1926): 62; Maclean’s 42, 1 (1929): 53. For advertisements of nutrients see Maclean’s 49, 21 (1927): 86 (Scott’s Emulsion, a cod liver oil); L’Union Médicale du Canada 75, 12 (1946): 1705 (L’Orical: calcium, phophorus, and vitamin D); CMAJ 79, 2 (1958): 151 (Trophite: B1 and B12); The Canadian Doctor 26, 1 (1960): 57 (Redisol: B12). For a Winstrol ad see The Canadian Doctor 30, 1 (1964): 26. For a Periactin ad see CMAJ 102, 1 (1970): 66–7. 15 Today the emphasis on individual responsibility is called neoliberalism. See Ward; Norman, Rail, and Jette; Elliott; and Petherick and Beausoleil in this collection. For a focus on the state see Holmes 2009, 230. 16 Brown, The Normal Child, 139–40, 145–6. 17 F.W. Tidmarsh, “Lack of Home Control,” CMAJ 13, 6 (1923): 426. On home discipline see Alton Goldbloom, “Feeding Problems of Older Children,” CMAJ 13, 12 (1923): 893. 18 Gertrude Gray, “The Family Diet,” Health 1, 3 (1933): 14. 19 C.C. Alexander and Will L. Hutton, “Nutritional Studies in Brantford, Ontario,” Canadian Public Health Journal 23, 12 (1932): 579. See also Mildred D. Goodeve, “Food Budgeting: A Study of Thirty Food Budgets in the City of Montreal,” Canadian Nurse 26, 12 (1930): 634; Margaret S. McCready, “Considerations of Nutrition in Relief Work: IV – Relief Food,” Canadian Public Health Journal 24, 5 (1933): 221; Elizabeth Chant Robertson, “Food and Health,” Canadian Nurse 35, 7 (1939): 380. 20 Helen G. Campbell, “Serve Them Right,” Chatelaine 14, 9 (1941): 51. For the 1953 study see M.T. Doyle, M.C. Cahoon, and E.W. McHenry, “The Consumption of Recommended Foods by Children in Relation to Sex, the Use of Sweet Foods, and Employment of Mothers,” Canadian Journal of Public Health 44, 7 (1953): 259–62. For “indifference and ignorance” see E.W. McHenry, “Do School Children in Toronto Follow Canada’s Food Rules?” Health 25, 1 (1957): 27. For Haig see “Suppose Tommy Won’t Eat,” Canadian Journal of Public Health 44, 1 (1953): 16–19 (reprinted in Canadian Nurse 49, 1 [1953]: 38–40). 21 On shopping see Adelaide Daniels, “Who’s to Blame?” Health 39, 3 (1973): 22–3. On working mothers see “Nutrition’s Vital Role in Health Maintenance,” Health 42, 2 (1976): 18. Some recent non-Canadian studies have specifically argued that child obesity and the employment of mothers are the only things correlated (Bell, McNaughton, and Salmon 2009, 162).

210  Wendy Mitchinson 22 K.E. Dowler, “Co-Relating Health Education in a City Secondary School,” Canadian Nurse 25, 10 (1929): 625; M. Frances Hucks, “Food and Health,” Chatelaine 7, 5 (1934): 68. 23 Lionel M. Lindsay, “The Overweight Child,” CMAJ 44, 5 (1941): 504–06; Bernard Laski, “The Overnourished and the Undernourished Child,” Health 18, 4 (1950): 21. For obesity risk in children see Elizabeth Chant Robertson, “Here’s Sound Advice for Parents,” Health 23, 5 (1955); 6. See also “Obesity” film notice, Canada’s Health and Welfare 10, 2 (1955): 7; Jean Grignon, “L’obésité et la maigreur,” L’Union Médicale du Canada 81, 11 (1952): 1308; “Cours de perfectionnement à Sainte-Justine,” L’Union Médicale du Canada 87, 12 (1958): 1580; Elizabeth Chant Robertson, “The Tragedy of the Fat Child,” Chatelaine 31, 1 (1958): 45; W.A. Cochrane, “Nutritional Excess in Infancy and Childhood,” CMAJ 81, 6 (1959): 454. For statistics see A. Angel, “Pathophysiology of Obesity,” CMAJ 110, 5 (1974): 540. 24 A.J. Aubin, “Quelques observations sur le système nerveux,” L’Union Médicale du Canada 50, 12 (1921): 459; Hector Palardy, “Hygiène scolaire,” L’Union Médicale du Canada 53, 10 (1924): 509; Lexa Denne, “Nutrition,” The Public Health Journal 19, 9 (1928): 443; “Sugar-Saturated, Vitamin-Starved America,” The Canada Lancet and Practitioner 72, 5 (1929): 195. 25 For the need to place limits on children’s sweet tooth, see A.J. Aubin, “Quelques obeservations sur le systèm nerveux,” L’Union Médicale du Canada 50, 12 (1921): 459; Brown, The Normal Child, 139–40, 145–6; Alton Goldbloom, “Feeding Problems of Older Children,” CMAJ 13, 12 (1923): 893. 26 Lexa Denne, “Nutrition,” The Public Health Journal 19, 9 (1928): 443. 27 C.C. Alexander and Will L. Hutton, “Nutritional Studies in Brantford, Ontario,” Canadian Public Health Journal 23, 12 (1932): 579. 28 Lionel M. Lindsay, “The Overweight Child,” CMAJ 44, 5 (1941): 504, 506; L.B. Pett, “Nutrition,” Health 17, 2 (1949): 10; Elizabeth Chant Robertson, “My Child Is Too Fat,” Chatelaine 21, 2 (1948): 10. 29 Department of National Health and Welfare, “Food for All the Family,” Health 24, 1 (1956): 24; Alan Brown and Elizabeth Chant Robertson, The Normal Child (Toronto: McClelland and Stewart, 1948), 151; CMAJ 93, 16 (1965): 45 (Preludin advertisement). For mother-blaming see D.E. Rodger, J. Grant McFetridge, and Eileen Price, “The Management of Obesity,” CMAJ 63, 3 (1950): 266; see also Lawrence Galton, “Overfeeding Your Baby?” Chatelaine 37, 2 (1964): 12. 30 Chatelaine 39, 3 (1966): 79 (advertisement); Elizabeth Chant Robertson, “How to Help the Overweight Child,” Chatelaine 34, 11 (1961): 127. For cell

Mother Blaming and Obesity  211

31 32 33

34 35 36 37

38

39

40

41

division see Richard Goldloom, “Obesity in Childhood,” CMAJ 113, 2 (1975): 139; Linda Oglov, “Canadian Dietetic Association Delegates at Annual Meeting Study Relationship of Diet to Exercise,” CMAJ 117, 3 (1977): 290; Anne Scott Beller, Fat and Thin: A Natural History of Obesity (New York: Farrar, Straus and Giroux, 1977), 152; A. Angel, “Pathophysiologic Changes in Obesity,” CMAJ 119, 12 (1978): 1402; “Early Weaners More Obese?” Chatelaine 51, 11 (1978): 24. Adelaide Daniels, “Word to the Wise: ‘Let’s Stop Being Our Own Worst Enemy,’” Health 39, 1 (1973): 26. Interview with Doris, born 1942, interviewed 30 July 2009, Guelph, ON. On Bruch see Edward H. Rynearson and Clifford F. Gastineau, Obesity ... (American lecture series, no. 36, American lectures in endocrinology) (Springfield, IL.: Charles C. Thomas, 1949), 26–7; Daniel Cappon, “Review Article: Obesity,” CMAJ 79, 7 (1958): 571–2; Sheila Kieran, “Why Diets Fail,” Chatelaine 39, 12 (1966): 16; D.E. Rodger, J. Grant McFetridge, and Eileen Price, “The Management of Obesity,” CMAJ 63, 3 (1950): 265. Helen G. Campbell, “The School Lunch,” Chatelaine 3, 9 (1930): 20. See advertisements in Health 1, 2 (1933): 17 and Health 2, 3 (1934): 58. Chatelaine 6, 6 (1933): 21 (Cream of Wheat advertisement). Brown, The Normal Child, 144; see also Brown, The Normal Child, 2nd ed. (Toronto: McClelland, 1926), 153. John W.S. McCullough, “Are You Sure of Their Health,” The Chatelaine 3, 12 (1930): 9. For diet breakdown see Alfred P. Hart, “A Health Food in Relation to the Pre-School Child,” Canadian Public Health Journal 20, 3 (1929): 151–2. For calories see Helen G. Campbell, “Balanced Menus,” Maclean’s 47, 16 (1934): 46. For tables see M. Frances Hucks, “Food and Health,” Chatelaine 7, 5 (1934): 68, and E.W. McHenry, “A Specific, Simple Nutrition Effort,” Canadian Nurse 44, 8 (1948): 646. For failure of education see also E.W. McHenry, “Nutrition and Child Health,” Canadian Public Health Journal 33, 4 (1942): 154. See also “Nutrition,” special supplement number 10, Canada’s Health and Welfare 4, 2 (1948): n.p. Elizabeth Robinson Scovil, “Danger in Milk Diet,” Canadian Nurse 16, 9 (1920): 546. On a pint see Helen G. Campbell, “Children’s Meals,” Maclean’s 47, 17 (1934): 50. On a quart see Hugh Grant Rowell, “Eating,” Maclean’s 48, 4 (1935): 50. Alton Goldbloom, The Care of the Child (Toronto: Longman’s Green, 1928), 153, 159, 161; Alton Goldbloom, The Care of the Child, 4th ed. (Toronto: Longman’s Green, 1945), 166–7 R.H. Johnson, “What Mothers Should Know About Child Feeding,” Health 23, 3 (1955): 6.

212  Wendy Mitchinson 42 J.E. Monagle, “Canada’s Food Guide: A Route Map to Health,” Health 30, 5 (1962): 28; “Recommended Intakes of Protein” (editorial), CMAJ 102, 12 (1970): 1406; “Nutrition Canadian Reports on Eating Patterns,” CMAJ 116, 5 (1977): 552. 43 W.D. Snively Jr, “Nutrition Problems of the Preschool Child,” Health 29, 6 (1961): 10–11. 44 “Nutritional Standards in School Cafeterias,” Health 40, 3 (1974): 12. See also Adelaide Daniels, “Study of Nutrition and Teenage Health,” Health 40, 1 (1974): 20. 45 J. Ellestad-Sayed, J.C. Haworth, and H. Medovy, “Nutrition Survey of School Children in Greater Winnipeg,” CMAJ 116, 5 (1977): 490. 46 On being over the norm, see F.W. Tidmarsh, “Malnutrition,” CMAJ 13, 6 (1923): 426. 47 On early decades see F.W. Tidmarsh, “Malnutrition,” Canadian Nurse 20, 1 (1924): 779. See also Anne Elizabeth Wilson, “Schools for the HomeMaker,” Maclean’s 40, 22 (1927): 64; H. Medovy, “The Malnourished Child,” Canadian Nurse 27, 3 (1931): 117; M. Frances Hucks, “Food and Health,” Chatelaine 7, 5 (1934): 68; L.B. Pett, “Nutrition,” Health 17, 2 (1949): 10; Elizabeth Chant Robertson, “Feeding Difficulties,” Chatelaine 16, 10 (1943): 87; Elizabeth Chant Robertson, “Your Questions: Our Answers,” Chatelaine 21, 1 (1948): 53–4; G.T. Haig, “Suppose Tommy Won’t Eat,” Canadian Journal of Public Health 44, 1 (1953): 18. 48 Chatelaine 36, 5 (1963): 9–10 (advertisement for Swift’s). 49 Annabelle Lee, “Your Beauty Problem,” Chatelaine 6, 10 (1933): 43; Grace Garner, “Every Girl Her Own Girdle: Teens and Twenties Indoors Winter Sports – For a Super Figure,” Canadian Home Journal 41, 9 (1945): 16. 50 For the male image, see Dorothy Thomas’s story “Sweet Summer,” Canadian Home Journal 38, 7 (1941): 8–9, 34, 36, 38; Una Abrahamson, “More Ways to Lose Money,” Chatelaine 44, 10 (1971): 18. 51 Eva Nagel Wolf, “Looking Forty in the Face,” Canadian Home Journal 30, 10 (1934): 22, 29. 52 For the Toronto study see E.W. McHenry, “Nutrition in Canada,” Canadian Public Health Journal 30, 1 (1939): 431 and also Marion Harlow, “Nutrition in the Health Mosaic,” Canadian Nurse 35, 7 (1939): 375; Gordon E. Swallow, “Anorexia,” CMAJ 49, 1 (1943): 43. For other studies see George Hunter and L. Bradley Pett, “A Dietary Survey in Edmonton,” Canadian Public Health Journal 32, 5 (1941): 262–5; Gaston Gosselin, “L’alimentation en temps de guerre,” L’Union Médicale du Canada 71, 10 (1942): 1036. For nutritional problems see Sidney Margolius, “Lady, You’re Starving

Mother Blaming and Obesity  213

53

54 55

56 57 58 59 60 61 62

63 64

Yourself,” Maclean’s 64, 2 (1951): 20. For the NCS survey see Doris Gillis, “Seniors: A Target for Nutrition Education” (Part 3), Canadian Nurse 76, 7 (1980): 28; for First Nations and Inuit see Otto Schaefer, “Health in Our Time?” Canadian Nurse 74, 9 (1978): 36; and for the correlation between poverty and nutrients see W. Myers and Danièle Kroetsch, “The Influence of Family Income on Food Consumption Patterns and Nutrient Intake in Canada,” Canadian Journal of Public Health 69, 3 (1978): 208, 216. Rica McLean Farquharson, “Startling Army Revelations,” Canadian Home Journal 38, 9 (1942): 23; Joan Phillips, “Keep that House, Hold that Job, Feed that Man,” Canadian Home Journal 44, 1 (1947): 48. Alfred P. Hart, “A Health Food in Relation to the Pre-School Child,” Canadian Public Health Journal 20, 3 (1929): 151. F.W. Tidmarsh, “Malnutrition,” CMAJ 13, 6 (1923): 426. For reprint of the article see Canadian Nurse 20, 1 (1924): 777–9. See also William Fleming French, “Making Children Healthy,” Maclean’s 34, 18 (1921): 57 for lack of discipline in children. William Fleming French, “There’s Amazing Food Value in Dried Fruits,” Maclean’s 34, 19 (1921): 52. Elizabeth Chant Robertson, “How to Avoid Those Feeding Problems,” Health 30, 5 (1962): 8. Johanne Bentzon, “Food Rules for Babies to Teen-agers,” Chatelaine 41, 12 (1968): 80. Annabelle Lee, “Good Morning! These Simple Exercises Will Keep You Slim and Supple,” Chatelaine 5, 9 (1932): 26. Charles E. Snelling, “No Excuse for Dietary Anaemia,” Health 6, 4 (1938): 92; Helen G. Campbell, “Feeding the Teens,” Maclean’s 50, 8 (1937): 78. Joan Phillips, “Teen-Age Eating for Good Health and Good Looks,” Canadian Home Journal 41, 5 (1944): 38, 40. E. W. McHenry, “A Specific, Simple Nutrition Effort,” Canadian Nurse 44, 8 (1948): 646. For failure of education see E.W. McHenry, “Nutrition and Child Health,” Canadian Public Health Journal 33, 4 (1942): 154. For eating habits of teenagers see Elizabeth Chant Robertson, “Food and Fitness,” Health 33, 6 (1965): 29; CMAJ 93, 16 (1965): 45 (Preludin advertisement); Eveleen Dollery, “Your Diet That Lets You Eat Your Cake and Look Slim, Too,” Chatelaine 33, 3 (1960): 102; Elaine Collett, “Canadians Eat Too Much – And Badly,” Chatelaine 47, 5 (1974): 77. Bentzon, “Food Rules for Babies to Teen-agers,” 82. See Rail (2009, 150) for the recent failure of nutrition education. Daniel Cappon, Eating, Loving and Dying, 39.

214  Wendy Mitchinson 65 Interview with Grace, born 1965, interviewed 27 July 2009, Guelph, ON; with Lucy, born 1970, interviewed 28 July 2009, North York, ON; with Irene, born 1957, interviewed 14 May 2010, Ottawa, ON; and with Olive, born 1959, interviewed 28 July 2009, Toronto, ON. 66 Interview with Alice, born 1935, interviewed 12 August 2009, Mitchell, ON; with Nina, born 1957, interviewed 3 September 2009, London, ON; with Tammy, born 1945, interviewed 29 June 2009, Amhurstburg, ON; and with Connie, born 1969, interviewed 9 July 2010, Toronto, ON. L.B. Pett, “Food Makes a Difference,” Canadian Public Health Journal 33, 12 (1942): 568; “Prices and Availability,” in special supplement no. 10, “Nutrition,” Canada’s Health and Welfare 4, 2 (1948): n.p. 67 Earl Damude, “Fat Children,” Chatelaine 41, 9 (1968): 14. 68 Interview with Lucy, born 1970, interviewed 28 July 2009, North York, ON; with Nina, born 1957, interviewed 3 September 2009, London, ON; and with Stephanie, born 1957, interviewed 17 July 2009, London, ON. 69 Quoted in Dorothy Sangster, “The Tragedy of the Fat Child,” Maclean’s 72, 16 (1959): 23; A.M. Bryans, “Childhood Obesity – Prelude to Adult Obesity,” Canadian Health Journal 58, 11 (1967): 488; “Problem of Obesity Said Frustrating to Doctor and Patient,” CMAJ 112, 3 (1975): 350. 70 Lionel M. Lindsay, “The Overweight Child,” CMAJ 44, 5 (1941): 506; “Obesity in Children Equally Intractable,” CMAJ 112, 3 (1975): 350. 71 This indicates the weakness of epidemiology as a predictor for individuals, since epidemiology focuses on populations of people (McNaughton 2011, 181).

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Mother Blaming and Obesity  215 Black, Tara Leanne. 2004. “Understanding Excessive Parental Weight Gain Among First Nations Women.” Master’s thesis, University of Alberta. Bruch, Joanne Hatch. 1996. Unlocking the Golden Cage: An Intimate Biography of Hilde Bruch, M.D. Carlsbad, CA: Gurze Books. Canguilhem, Georges. 1991. The Normal and the Pathological. New York: Zone Books. Caplan, Paula J. 1998. “Mother-Blaming.” In “Bad” Mothers: The Politics of Blame in Twentieth-Century America, ed. Molly Ladd-Taylor and Lauri Umansky, 127–44. New York: New York University Press. Caplan, Paula J., and Ian Hall-McCorquodale. 1985. “Mother-Blaming in Major Clinical Journals.” American Journal of Orthopsychiatry 55 (3): 345–53. http://dx.doi.org/10.1111/j.1939-0025.1985.tb03449.x. Comacchio, Cynthia R. 1993. “Nations are Built of Babies”: Saving Ontario’s Mothers and Children 1900–1941. Montreal, Kingston: McGill-Queen’s University Press. Crawford, Robert. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services 10 (3): 365–88. http://dx.doi. org/10.2190/3H2H-3XJN-3KAY-G9NY. Davis, Lennard J. 2006. “Constructing Normalcy: The Bell Curve, the Novel and the Invention of the Disabled Body in the Nineteenth Century.” In The Disability Studies Reader, ed. Lennard J. Davis, 3–16. New York: Routledge. Dodd, Dianne. 1991. “Advice to Parents: The Blue Books, Helen MacMurchy, MD and the Federal Department of Health, 1920-1934.” Canadian Bulletin of Medical History 8 (2): 203–30. Elliott, Charlene D. 2009. “Kid-Visible: Childhood Obesity, Body Surveillance, and the Techniques of Care.” In Surveillance: Power, Problems, and Politics, ed. Sean P. Hier and Josh Greenberg, 33–45. Vancouver: UBC Press. Garland-Thomson, Rosemarie. 1996. “From Wonder to Error: A Genealogy of Freak Discourse in Modernity.” In Freakery: Cultural Spectacles of the Extraordinary Bodies, ed. Rosemarie Garland-Thomson, 1–19. New York: New York University Press. Gilman, Sander L. 2004. Fat Boys: A Slim Book. Lincoln: University of Nebraska Press. – 2008. A Cultural History of Obesity. Cambridge: Polity Press. Hermiston, Alana J. 2005. “‘If It’s Good for You, It’s Good for the Nation!’ The Moral Regulation of Nutrition in Canada, 1930–1945.” PhD dissertation, Carleton University. Herndon, April Michelle. 2010. “Mommy Made Me Do It: Mothering Fat Children in the Midst of the Obesity Epidemic.” Food, Culture and Society: An International Journal of Multidisciplinary Research 13 (3): 331–49.

216  Wendy Mitchinson Holmes, Bev J. 2009. “Media Coverage of Canada’s Obesity Epidemic: Illustrating the Subtleties of Surveillance Medicine.” Critical Public Health 19 (2): 223–33. http://dx.doi.org/10.1080/09581590802478048. Jefferson, Cord. 2011. “Is Having Obese Children Child Abuse?” 14 July. Good: The Social Network for Social Good. http://www.good.is/posts/is-havingobese-children-child-abuse. Accessed 6 February 2012. Ladd-Taylor, Molly, and Lauri Umansky, eds. 1998. “Bad” Mothers: The Politics of Blame in Twentieth-Century America. New York: New York University Press. Landsman, Gail. 2000. “‘Real Motherhood’: Class, and Children with Disabilities.” In Ideologies and Technologies of Motherhood: Race, Class, Sexuality and Nationalism, ed. Helen Ragone and France Winddance Twine, 169–187. New York: Routledge. Levenstein, Harvey A. 2003a. Paradox of Plenty: A Social History of Eating in Modern America. Berkeley, Los Angeles: University of California Press. – 2003b. Revolution at the Table: The Transformation of the American Diet. Berkeley, Los Angeles, and London: University of California Press. Lovett, Laura. 2005. “The Popeye Principle: Selling Child Health in the First Nutrition Crisis.” Journal of Health Politics, Policy and Law 30 (5): 803–38. http://dx.doi.org/10.1215/03616878-30-5-803. Lupton, Deborah. 2008. “‘You Feel So Responsible’: Australian Mothers’ Concepts and Experiences Related to Promoting the Health and Development of Their Young Children.” In Emerging Perspectives in Health Communication: Meaning, Culture, and Power, ed. Heather M. Zoller and Mohan J. Dutta, 113–128. New York, London: Routledge. Lupton, Deborah, and Simon Chapman. 1995. “‘A Healthy Lifestyle Might Be the Death of You’: Discourses on Diet, Cholesterol Control and Heart Disease in the Press and Among the Lay Public.” Sociology of Health & Illness 17 (4): 477–94. http://dx.doi.org/10.1111/1467-9566.ep10932547. McNaughton, Darlene. 2011. “From the Womb to the Tomb: Obesity and Maternal Responsibility.” Critical Public Health 21 (2): 179–90. http://dx.doi .org/10.1080/09581596.2010.523680. Mosby, Ian. 2011, “‘Food Will Win the War’: The Politics and Culture of Food during the Second World War.” PhD dissertation, York University. Ostry, Aleck. 2005. “The Early Development of Nutrition Policy in Canada.” In Children’s Health Issues in Historical Perspective, ed. Cheryl Krasnick Warsh and Veronica Strong-Boag, 191–206. Waterloo: Wilfrid Laurier University Press. Ostry, Aleck. 2006. Nutrition Policy in Canada, 1870–1939.Vancouver: University of British Columbia Press.

Mother Blaming and Obesity  217 Rail, Geneviève. 2009. “Canadian Youth’s Discursive Constructions of Health in the Context of Obesity Discourse.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. J. Wright and V. Harwood, 141–156. New York: Routledge. Rice, Carla. 2007. “Becoming the Fat Girl: Acquisition of an Unfit Identity.” Women's Studies International Forum 30 (2): 158–74. http://dx.doi. org/10.1016/j.wsif.2007.01.001. Rich, Emma, and John Evans. 2005. “‘Fat Ethics’ – The Obesity Discourse and Body Politics.” Social Theory & Health 3:341–58. Roberts, Karen C., Margot Shields, Margaret de Groh, Alfrid Azziz, and Jo-Anne Gilbert. 2012. “Overweight and Obesity in Children and Adolescents: Results from the 2009-2011 Canadian Health Measures Survey.” http://www.statcan.gc.ca/pub/82-003-x/2012003/article/11706eng.htm. Accessed 6 December 2012. Sangster, Joan. 2011. “Invoking Experience as Evidence.” Canadian Historical Review 92 (1): 135–61. http://dx.doi.org/10.3138/chr.92.1.135. Sealander, Judith. 2005. “Perpetually Malnourished? Diet, Health and America’s Young in the Twentieth Century.” In Children’s Health Issues in Historical Perspective, ed. Cheryl Krasnick Warsh and Veronica Strong-Boag, 161–190. Waterloo: Wilfrid Laurier University Press. Singh, Ilina. 2004. “Doing Their Jobs: Mothering with Ritalin in a Culture of Mother-Blame.” Social Science & Medicine 59 (6): 1193–205. http://dx.doi. org/10.1016/j.socscimed.2004.01.011. Stearns, Peter N. 2002. Fat History: Bodies and Beauty in the Modern West. New York: New York University Press. Warsh, Cheryl Krasnick, and Veronica Strong-Boag, eds. 2005. Children’s Health Issues in Historical Perspective. Waterloo: Wilfrid Laurier University Press. Williams, Mary Elizabeth. 2012. “Is Childhood Obesity Abusive?” http:// www.salon.com/2011/11/29/is_childhood_obesity_abusive/ Accessed 6 February 2012.

8 Obesity, Risk, and Responsibility: The Discursive Production of the “Ultimate At-Risk Child” Pa mela War d

Health is an issue at the forefront of many present-day conversations whether within the medical, education, political, or public realm. It has been argued, for example, that within our current environment, health has become more than a simple desire in life – it’s an ongoing preoccupation (Crawford 2006; Halse 2009). This preoccupation is reinforced through dominant health discourses that emphasize individual risk and responsibility in achieving and maintaining a so-called healthy status. These discourses, which reflect the contemporary health promotion milieu, are powerful in shaping the way we think about our own health practices, the practices of others, and the expectations placed upon us. The drive towards optimal health has thus resulted in an intense focus on the body and concerns related to body size that have culminated in what a number of critical obesity scholars have called an “obesity panic” (Beausoleil 2009; Campos et al. 2006; Gard and Wright 2005). Given that obesity in Canada has grown at a relatively steady rate over the past three decades, with self-reported prevalence rates between 2009 and 2011 of close to 19 per cent for adults (Statistics Canada 2011) and 11.7 per cent for children and youth (Roberts et al. 2012), much attention is presently being paid to the issue in terms of research, policy, and strategies focused on prevention and treatment (Abou-Rizk and Rail 2012; Beausoleil 2009; Beausoleil and Ward 2010; Gard, this volume). People are regularly bombarded with messages that warn of the negative consequences of overweight and obesity while simultaneously emphasizing personal responsibility in the pursuit of weight reduction. Childhood obesity has been represented as an issue of particular concern. Of those children who present with a BMI greater

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than the ninety-fifth percentile, upwards of 69 per cent or more will continue to be obese in adulthood, thus calling into question the health outcomes and potential longevity of future generations (Heinberg and Thompson 2009; Shields 2006). While the parameters used for childhood obesity are complicated by the fact that, unlike adults, children are in a phase of growth, and there is some debate over cut-offs for categorizing obesity in children (Limbert, Crawford, and McCargar 2012; Roberts et al. 2012; Shields and Tremblay 2010), growing numbers of Canadian obesity researchers are highlighting the severity of the childhood obesity “problem” and calling for action through prevention and treatment (Ball and McCargar 2003; Canning, Courage, and Frizzell 2004; Twells et al. 2011; Willms, Tremblay, and Katzmarzyk 2003). However, while obesity has been constructed as the “ultimate” risk or health concern, others have argued that the discursive production of obesity as an “alarming” problem may actually be what threatens the future health of our children and the global population (Monaghan, Hollands, and Pritchard 2010; Rice 2007; Wright 2000). The general conflation of health and the thin body and the medicalization of the body, it is suggested, are contributing to increasing levels of body dissatisfaction, stigmatization of larger people, and an overall dieting mentality that affects how children and adults alike view their bodies and the bodies of others (Dworkin and Wachs 2009; Flodmark 2005; Fullagar 2009; Larkin and Rice 2005; O’Dea 2005). Recently, critical obesity scholars have begun to explore the experiences of individuals defined as obese, and there is growing attention to this issue within the Canadian context (Norman 2010; Rail and Lafrance 2009; Rice 2007; Ward 2012). While these studies contribute greatly to our understanding and appreciation of people’s experiences of fat, studies that examine the experiences of larger children are extremely rare. I addressed this gap by exploring the embodied experiences of a group of so-called obese children enrolled in an obesity treatment program. This study took place in an Atlantic province in Canada where rates of both overweight and obesity are significantly higher than in some other regions within the country and where much emphasis is placed on the physical and economic burden of obesity. This area of Canada is regularly offered up as an example of a population in crisis (Beausoleil and Ward 2010). For example, one province in this region, Newfoundland and Labrador, is regularly touted as the “fattest province in Canada” because the population exhibits a combined rate of overweight and obesity of over 40 per cent (Beausoleil and Petherick,

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and McPhail, this volume; Statistics Canada 2011; Vancouver Sun 2011). This chapter reflects a major theme that arose out of my doctoral research that illustrates the children’s constructions of health in relation to risk and responsibility (Ward 2012). The medicalization of obesity and the production of obesity as the ultimate risk factor leading to disease and death function to restrict larger children from achieving a healthy identity and inevitably construct them as “ultimate at-risk” children. Framing the Research: Theory and Methodology Using a feminist post-structural approach, I illustrate how children are produced as responsible “at-risk” subjects within the dominant obesity and health discourses. Foucault’s notion of governmentality is helpful in exploring the role of obesity discourse and the relationship between knowledge, power, and the at-risk identity. The children’s stories illustrate in their own words how they have both taken up the messages of self-responsibility and how they integrate these messages into their identities. Because discourse is made up of the ideas, beliefs, language, codes, and practices that function to construct and form peoples’ sense of reality, what we consider to be our own realities are discursive social realities. These discourses provide us with various subject positions into which we insert ourselves in an effort to make sense of the world and adopt an identity. According to this reasoning, there is no preexisting identity. As Judith Butler in her book Gender Trouble explains, subjects are formed in and through the discursive social and historical practices and identities “through certain exclusionary practices that do not ‘show’ once the juridical structure of politics has been established” (Butler 1990, 3). The goal of this research, therefore, is not only to explore people’s realities, but also to examine the discursive environment in which these realities are produced within the context of existing power relations. Feminist post-structural research recognizes that subject positions are also constrained or made less “habitable” through discourses that privilege certain identities on the basis of age, race, gender, and sexuality. In Western society, for example, the young, thin, white female is constructed as the “ideal” to the exclusion of those of a different age, race, ethnicity, or physical ability. Such discourses provide people with a limited repertoire of subject positions they can inhabit. The neoliberal assertion that body size is effectively within the control of the

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“responsible” individual further serves to limit the possible subject positions for those considered obese. People are forced to manoeuvre through a variety of discursively produced meanings related to class, gender, sexuality, body size, and so forth. For those people identified as overweight or obese, the intersection of the various subject positions further limits the availability of positive identities and restricts them to a “fat identity” (Rice 2007). This study was conducted with children (ranging from age ten to sixteen) enrolled in an obesity-treatment program within a children’s hospital in Atlantic Canada. This particular treatment program was designed using a multidisciplinary approach that promotes positive selfesteem and body image while limiting focus on weight and measurement. Dominant beliefs about weight and health are challenged, while an acceptance of natural sizes is reinforced. Using a post-structural feminist approach to explore the children’s constructions of health and the body, and their experiences as so-called obese children, allowed me to move beyond how these children function in the midst of the “obesity epidemic,” to explore how they negotiate and resist dominant discourses that permeate every institution that influences their daily lives, and to examine how these discourses are produced, reproduced, and challenged. This approach is particularly useful in studying the experiences of children because it provides the researcher with an opportunity to actively explore the children’s own meanings of social experiences, removing the assumption that we as adults can know for children (Darbyshire, MacDougall, and Schiller 2005). Data were generated using multiple methods that included individual participant interviews, observation, and focus groups. Once the ­local university and hospital-based ethics boards granted ethical­permission, I collected data over a period of eleven weeks while the children attended the program for one two-hour session per week. A total of eleven children were enrolled in the program at the time of my study, and all consented to participate. The children chose their own pseudonyms. The following children are highlighted within this chapter: Jenny (eleven-year-old girl), Joel (sixteen-year-old boy), Billy (thirteen-­ year-old boy), Pete (eleven-year-old boy), Jordan (twelve-year-old girl), Nicholas (eleven-year-old boy), and Ethan (eleven-year-old boy). This was not a typical age distribution for this group (because teenagers are not typically included with pre-teen children), so I recognized that this inevitably would have an impact on data. For example, the younger children would often wait for the older children to begin discussions

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and were eager to listen as the older children spoke. The older children, however, while eager to speak, may have been less inclined to speak about more sensitive topics related to adolescence and sexuality because of the age difference among participants. I analysed the narratives by examining the discourse with consideration for the local context in which it is produced and used, and then further considered the broader social historical context. This helped me to reflect on how subjectivities are formed in and through the discourse while simultaneously making visible the power relations that make such discourses workable and apparently “natural.” This type of analysis allowed me to explore how these children constructed their own identities within both “dominant and resistant discourses” (Rail 2009, 144), with consideration to risk and obesity discourses and the binaries that position large children as “the other” in a world preoccupied with thinness. Reflecting the research setting’s demographics, the children were relatively homogenous in terms of race and ethnicity, all coming from white lower- to middle-class families. Racialized differences therefore did not emerge from the data. There was some variation in terms of social class, but this was not clearly established upon entry to the study, and no distinct differences in terms of discourse were evident in the narratives. While the children’s discussions quite often reflected a white middle-class, gendered, heterosexual approach to health and the body, I should acknowledge that the gendered aspect was not clearly articulated in discussions of risk, but rather was evident in their constructions of health and social life (which are not covered here). Risk as a Means of Regulation Risk is a concept that has come to pervade many aspects of our lives in recent years, leading to what Beck (1992) refers to as a contemporary “risk society.” Along with Beck, a number of authors have argued that risk and the evaluation of risk have become the basis upon which we structure our daily activities in the ever-elusive search for “health” (Crawford 2004; Evans and Davies 2004; Lupton 1993,1995, 1999a, 1999b; McDermott 2007; Moynihan, Heath, and Henry 2002). Risk is embedded in a “healthist” approach to modern life in which health has been positioned as a “supervalue” (Crawford 1980, 365) or the ultimate goal in life. This fixation centres on the individual. One can never achieve a “healthy” status without significant work upon the body – work tied to a continual evaluation of risk (Crawford 2006).

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Recently a number of Canadian authors have taken up the discussion of risk with particular emphasis on how risk is both constructed and used in the monitoring and surveillance of the “fat” body (Beausoleil and Ward 2010; Rail, Holmes, and Murray 2010). The concept of risk, they argue, has been endorsed through the health promotion realm that permeates the institutions to which we are exposed on a daily basis. Risk consciousness is also evident in the broader social environment through media and strategically marketed health-promotion campaigns. Given that the present social environment is laden with neoliberal healthist values (Crawford 1980, 2006; Monaghan 2005; Rail and Beausoleil 2003; Rawlins 2008; Rich and Evans 2005), we are expected as good citizens to work upon our bodies to produce a “product” – our own body – that represents health (Evans et al. 2002; Guthman and DuPuis 2006; Macdonald, Wright, and Abbott 2010). In this risk environment, obesity is constructed as the ultimate risk factor for disease that can be prevented or controlled, and hence those who are obese or outside of the normative body size become marked as “abnormal” and come to represent the fear of impending doom that permeates many health messages. As Samantha Murray suggests, these deviant bodies are virtual confessors (Murray 2009). The “risky” fat body becomes a visual representation of risk. “We read a fat body on the street, and believe we ‘know’ its ‘truth’: just some of the characteristics we have come to assume define fatness are laziness, gluttony, poor personal hygiene, and lack of fortitude” (Murray 2005, 154). As Wendy Mitchinson notes in her chapter in this book, Canada has transitioned from concerns over children being underweight to an excessive fear of overweight and obesity. These concerns remain focused on risks of the “visible” body. While this evolving discourse has led to a new and strengthened form of mother blaming, it also shapes the embodied experiences of children, with particular implications for larger children. The “Ultimate At-Risk” Child In order to fully explore how the children in my study used risk discourse, it was important to consider how the concept of childhood in general is constructed in today’s risk society. The idea of childhood, as a construct, is continually being produced and amended based upon the particular social climate of a given time (Burrows and Wright 2004). In Western society, the child has traditionally been understood as being in opposition to the adult. Children have been thought to possess an

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innocence that must be moulded, nurtured, and ultimately protected. But, as Burrows and Wright point out, the child is simultaneously seen as reckless and in need of protection and instruction on safe and proper behaviour. The child is an “incomplete subject” within the neoliberal context – someone who must be normalized to become a healthy “governmental subject” (Norman 2010). This conceptualization of childhood is pertinent in the social construction of the obese child. Scientific and mainstream articles regularly report on the growing worry about childhood obesity, suggesting that all children are at risk as long as we continue to function within the present obesogenic environment that encourages sedentary behaviour and the consumption of energy-dense foods (Ball and McCargar 2003; Canning, Courage, and Frizzell 2004; Etelson et al. 2003). Obesity discourse therefore is coupled with a discourse of risk. Because obesity is seen as a “killer,” the need to identify and protect children at risk operationalizes as a series of surveillance mechanisms. Consequently, those children who fall into weight categories above the norm are constructed as the “ultimate at-risk” children, giving rise to organizations, government departments, and research groups devoted entirely to the issue of childhood obesity and the components of risk it entails. This conceptualization of risk is regularly reinforced to children and parents through risk messages imbedded in the “biopedagogies” that permeate the school system, the broader media, and social environments (Evans et al. 2008; McDermott 2007; Saguy and Almeling 2008). Based upon Foucault’s notion of “biopower,” or the power to give and sustain life, by biopedagogies I mean those mechanisms that work through various institutions within structures of power to guide the population towards health. As the intense focus on the preservation of life has translated into an intense focus on the body, biopedagogies function to provide individuals and the population with the instructions and criteria through which we should work upon our bodies to reduce the “risks” associated with obesity (Rail and Lafrance 2009). These instructions may be delivered through direct strategies such as health promotion and active living campaigns carried out through the school system or the media or presented in more subtle ways through everyday experiences with people and various media, including websites, television, radio, or print material, that provide us with examples of normative body expectations (Wright 2000). This is the context in which children utilize the agency they do possess as well as the growing agency they are afforded by society. As Charlene Elliott notes in her

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chapter in this book, we grapple with the position of children who are transitioning into the adolescent phase where they are held more responsible for their consumer and lifestyle behaviours. This growing into “agency,” in other words – where children are simultaneously protected and given greater responsibility for their own health behaviours – is an important point at which researchers should consider how children are taking up and using discourses of risk and responsibility. Governmentality, Risk, and the “Body Project” Within risk discourse, children are expected to deny the pleasures of sedentary activities in favour of what Foucault calls the “project of the  self,” which involves working upon the body in a more physical manner to produce the “healthy subject.” This “project of the self” is grounded in governmentality, knowledge, power, and control as conceptualized by Foucault. According to Foucault (1991), governmentality does not merely represent the power that a government exerts over a population but rather reflects the dynamic ways in which power is exerted through both “technologies of domination” and “technologies of the self.” By providing the repertoire of resources and biopedagogies with which citizens can work upon themselves, governments in effect gain power over citizens by directing their activities and thereby marking their identities. Through what is considered objective scientific research, governments utilize epidemiology to provide the population with indicators of health (or disease, as it may be) that are ultimately translated into tangible risks. Regular reports on the weights of the Canadian population provided by Statistics Canada and Health Canada are prime examples here. A risk vocabulary works well within the obesity discourse. It provides the population with the clear markers of disease that call for action (McDermott 2007). If governments are to gain power in relation to people’s lives through shaping their health-related activities, risk is a logical place to begin (Leahy and Harrison 2004). This strategy permits surveillance and monitoring of the population in terms of BMI and other weight-based statistics that supposedly provide us with a measure of health. The ongoing surveillance of anthropometric measurements across segments of the population (including children) is justified as a means of public health promotion and protection (Evans and Colls 2009). In this environment people come to measure themselves and others by the degree to which they are seen to abide by  the prevailing health guidelines (Crawford 2006). Success in the

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adoption of healthy practices, therefore, presupposes a certain level of responsibility. Using Risk Discourse The children in my study were very much in tune with the discourse of risk that produces them as subjects of risk. Knowledge of risk was evident in their talk, and they regularly drew upon risk discourse throughout our interactions. For example, when they were asked to imagine they were stranded on a desert island, their discussion focused more on risk avoidance and the prevention of disease than on mere survival. Speaking of what they felt they would need on that island to stay healthy, the children provided examples such as sunscreen to prevent skin cancer, “good” food to ensure (as Ethan put it) “a healthy heart and stuff,” and regular exercise as Nicholas said, with “thirty minutes of exercise every day.” These statements all reflect children’s growing awareness of risk that permeates through the broader health discourses. Throughout our discussions, the notion of risk in relation to cardiovascular health was particularly prominent. The children regularly spoke of heart health, cholesterol, and the implications of inactivity and “fatty” or “bad” foods. The following exchange provides an example of such talk. This interaction took place during a regular program activity, as Billy explained to me why he came to the program in the first place. Pam: Why do you think you are here in the program? Billy : Well, I suppose it’s because of my weight … I went to the doctor with pain in my knee and the doctor said I gotta lose weight. Pam: Do you mean the doctor said your bad knee was due to your weight? Billy : Yeah, the doctor said I need to work on eating healthy and moving around more. Pam: Do you think you’re active? Billy : Well, I play hockey and I go out and around with my friends a lot but I play a lot of video games like Call of Duty and I like to watch TV so ... I know I need to exercise and eat right if I don’t want to end up with clogged arteries and stuff … or a heart attack or stuff like that.

Billy in this instance drew upon dominant risk discourse in discussing his increased risk for cardiovascular disease. He demonstrates his knowledge of the discourse through directly associating activity levels and eating with “clogged arteries” and “heart attack or stuff like that.”

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He also employs the pervasive message that playing video games and watching TV are risk factors in the development of coronary artery disease. What I found particularly intriguing is how Billy seems to downplay the fact that he plays hockey and spends time being active with his friends by qualifying his initial statement with “but I play a lot of video games.” Throughout my time with the children, I interacted with Billy and his family on a number of occasions. Along with playing hockey, Billy stated that he regularly walked to his friend’s houses and was involved in outdoor activities, including basketball and street hockey. His mother stated that he was active and spent time outside playing with his friends most days after school and on weekends but did enjoy playing video games, as is common for that age group. Billy saw playing video games or participating in behaviour not considered conducive to health as negating his more active endeavours. Obesity discourse, in this sense, does not provide room for children, particularly obese children, to engage in pleasurable sedentary activities even though they may be physically active. The negative consequences of media engagement as underscored in the obesity discourse completely outweigh any pleasure derived from such activities. It is assumed that any engagement in sedentary behaviour by the fat child is contributing to their “unhealthy” subjectivity. For example, while Gard and Wright (2005, 60) argue that the research suggesting “that the relationship between television watching and overweight is at best complicated or at worst tenuous,” larger children in the media are regularly portrayed sitting lazily in front of the television set, quite often with “junk food” in hand, an example of which can be found in a 2011 article by Stephen Adams in The Telegraph entitled “Television Creates Perfect Storm of Childhood Obesity.” The pervasiveness of the message about videos games and TV watching as “bad,” along with the association of these activities with fatness and illness, limits these children’s opportunities for a balanced identity, restricting them to a “fat” identity (LeBesco 2004). I would argue that the scrutiny related to video games and sedentary behaviour is in fact much greater for obese children than for children who do not present as overweight or obese. Obese children are provided very little space to identify as healthy or feel good about their bodies. According to LeBesco (2004), the fat identity, within the context of the present obesity discourse, has moved beyond Goffman’s (1963) notion of the “spoiled identity” to an “uninhabitable” subject position in which there is no room for one to accept and appreciate her or his

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own body. Within the dominant obesity discourse people considered obese are positioned as the “fat other” (Erdman-Farrell, 2011). The socalled fat person is situated and examined in opposition to the “thin” person, and within the realm of dualistic thinking is placed on a lower plane because within this form of thinking, according to Grosz (1994, 7), “either one or the other of the binary terms is “really” its opposite and can be explained by or translated into the terms of its other.” The fat/thin binary is aligned with other binaries such as active/sedentary, good/bad, and motivated/lazy. The position of the “fat other,” therefore, is defined by characteristics that are seen in opposition to the thin, active, responsible healthy person. For the fat child, as is seen frequently in discussions regarding obesity, grand assumptions are being drawn from a body of literature where there is little consensus on the impact of video gaming. In contrast to the mainstream thinking related to video gaming, for example, Kautiainen and colleagues (2005) in a study that examined the behaviours of over six thousand adolescents, concluded that video gaming was not related to overweight or obesity. Furthermore, Barnett, Cerin and Baranowski (2011) in a systematic review of the gaming literature found that active video games actually have the potential of increasing youth’s energy expenditure to meet physical activity guidelines. Given the inconsistencies in the literature, caution must be exercised when drawing conclusions related to video gaming and the risks it entails. The social construction of media use as detrimental to the health of children and adolescents and as representative of the growing apathy towards corporeal well-being shapes how children view themselves. While researchers and the broader media frame media use as a major risk factor in the growing rates of childhood obesity (Vandewater, Shim, and Caplovitz 2004; Yang, Smith, and Graham 2008), researchers are entering this realm with preconceived, socially constructed notions of children as passive dupes who fall victim to the ill effects of a progressively sedentary self-indulgent society (Monaghan 2010,;Vander Schee and Boyles 2010). However, there are other ways to examine issues such as media use that affect children and are implicated as risks to health. We must openly explore and critique the ideological foundations of research on children, risk, and media use. In moving beyond the “adult knows best” perspective and being open to children as active agents in the use of video gaming, we must move beyond the restrictive and simplistic notion of video gaming as a “useless activity” that leads to sedentary habits to consider how children use media and how this

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intersects with their daily activities and contributes to their emerging identities. Reinforcing Responsibility Throughout my interactions with the children in my study, the concept of responsibility arose on numerous occasions, within both the interviews and the broader program setting. The participants were acutely aware of how weight categories are defined as a measure of success and responsibility and articulated some of the widely held beliefs around the implications of body weight. They drew regularly upon common discourses of weight that infuse school, home, and leisure environments. In the following discussion within a regular program session, the children describe their experiences with the Wii Fit gaming system and discuss the concept of obesity, its negative connotations, and how this affected their initial perceptions and expectations of the treatment program. The Wii system is marketed to children and parents as an alternative gaming format that addresses the so-called problem of sedentary video gaming, which as we saw above has been implicated in childhood obesity (Graves et al. 2008; Robinson 1999; Tremblay and Willms 2003). The game also serves as a source of measurement and surveillance (Jin 2009). The Wii Fit game reinforces the broader obesity discourse by introducing the game player (in most cases children) to body measurement and monitoring in an effort to help “solve” the problem of obesity. Each player is also given the opportunity to create their own avatar or “Mii” character that can be adjusted to visually represent a certain height and weight. Gamers are then provided with regular opportunities to measure their BMI, which is charted on a graph to enable regular self-surveillance. Through this system customized to each player, the player is provided with regular unsolicited “encouragement” to work harder to achieve an ideal BMI. Here is what the children had to say about Wii Fit messages: Jenny : I have Wii Fit … it’s not very nice at all. My mom knows this person who got on it and it said “You’re too heavy – get off.” Joel : Wii Fit called me obese. Pete : Yeah, I’m obese too apparently. Billy : But it’s only telling the truth. Jorda n : It told me to lower my BMI. I tried to lose weight before but it didn’t work.

230  Pamela Ward Ethan : I don’t like to be called obese. Billy : But you are … we all are or we wouldn’t be here. Pam: And do you think that there is a problem with the categories we put for obese and overweight? Jor da n : Yeah but … you can be healthy and be bigger. Joel : Obese is actually twenty pounds overweight, and depending on your body frame, that could actually be healthy. I can’t get much under two hundred. Billy : Like I said, weight is a problem or we wouldn’t be here.

The children struggle with the measure of weight as a reflection of who they are. They recognize how the negative ways obesity is represented in society serve to diminish their positive sense of self; as Ethan summarized it, “I don’t like to be called obese.” The children implicate the Wii video-gaming system in reinforcing the negative nature of the broader obesity discourse, for example when Jordan suggests that Wii Fit “is not very nice at all.” While they voice their discomfort with being categorized as obese, Billy reminds them that whether they like it or not they do fit into that category and their presence in the program reinforces this fact. Others like Jordan and Joel actively resist this message, suggesting that how weight is defined and categorized is problematic. Billy again emphasizes the obesity discourse in stating, “Like I said, weight is a problem or we wouldn’t be here.” Obesity discourse reinforces a knowledge of weight categories, the social values placed upon these categories, and the imperative that we are responsible for doing something about it (Evans et al. 2008; Rail 2009). The children in the discussion highlighted their knowledge of the categories and also their recognition of the negative connotations of the category in which they fit. They also recognize that they are expected to act. As Jordan reflected, “It told me to lower my BMI. I tried to lose weight before but it didn’t work.” This is consistent with the findings of Emma Rich (2011) in research with school-age children in New Zealand. The children in this study, while speaking about Wii Fit, illustrated how the game serves as a mechanism of instruction while reinforcing dominant health beliefs related to the body. The author states: With the advent of a range of digital platforms that merge entertainment with the regulation of the body, such as Internet-based nutrition games, and the use of games consoles such as Nintendo Wii Fit, the use of exergaming in schools (Vander schee, 2010) cyberspace becomes more recognizable to young people as contexts for learning. (Rich 2011, 74)

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I contend that the heightened awareness of BMI and its corresponding levels of acceptability may negatively affect the emerging identities of children who do not fit the prescribed norm. Instead of becoming an incentive for improved health, it serves to further marginalize a segment of the population and inhibit participation in and enjoyment of “healthy” activity because focusing on BMI increases concerns about fitting in or feeling abnormal (Evans and Colls 2009). The use of the BMI in the surveillance of children “ensures children (and parents) remain in a state of anxiety about the possibility of their (or their children’s) bodies being revealed to be abnormal” (Evans and Colls 2009, 1077). The children in my study discuss how the Wii system reminds them of where they stand with regard to the norm, in a position of “abnormality.” They also reiterate the discourse that suggests that they are in a position where they can control their BMI. As noted by Frohlich, Alexander, and Fusco (2013, 7), exergames like Wii Fit that insert dominant health messages into children’s play may in fact be damaging. The introduction of exergaming for children explicitly suggests that adults need to use deception to encourage children and youth to engage in physical activity, with the implicit supposition being that children are bereft of agency, creativity, skills or motivation to create their own ways of being active.

Such strategies, they contend, are in complete contradiction to the notion of free play. Free play (play that is child directed, pleasurable, and not goal oriented) is progressively being used as an instrument of regulation in health promotion strategies in an effort to thwart the risks related to sedentary behaviour. While the increasing rates of obesity and concerns over child health are often attributed to a decline in free play, the promotion of strategies to reintroduce the correct types of free play, the authors argue, is in itself paradoxical. By introducing games such as Wii Fit that are designed to monitor and regulate, we are in essence restricting the children’s agency in terms of allowing for choice in pleasurable activity. Using play as a tool to combat childhood obesity, as a means to an end, contradicts the very notion of play; it may also have unintended effects, as highlighted by children in my study. While there is research that suggests that allowing children to create their ideal avatar in the Wii system generates greater motivation for change (Jin 2009), exergaming endorses a commercialized focus on the body (Vander Schee and Boyles 2010) and a message that play involves working on the body in the name of health. It also illustrates how biopedagogies

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have moved into new spaces, including the virtual realm (Rich 2011). This is an important area to explore because much research in this area is conducted from a positivist ideological perspective that often neglects the lived experiences of participants and presents children’s relationships with such media as uncomplicated. Adopting Healthist Labels While the fear of being labelled as “abnormal” is pervasive, people considered obese who suffer from stigmatization may come to accept the stereotypes placed upon them as a means of coping (Brownell and Puhl 2003). LeBesco (2004, 3) spoke to the power of the “fat” identity, suggesting that people identified as fat often come to accept it and “abhor their own bodies.” When viewed as different and marginalized, she suggests, one must negotiate the idea of being “abnormal.” Taking on the fat identity has numerous implications for the embodied experiences of these individuals, because this identity transcends the many realms in which we live. Children defined as obese must work to find ways to resist the messages that limit their ability to position themselves as healthy. During one regular program session, the children were provided with a large piece of paper with a nondescript outline of a body form. The children were asked to use the form to represent themselves. They could write their characteristics on the form or draw anything on the form that they felt represented themselves. Some worked together and some worked individually. I took note of one particular boy, Nicholas, who carried out his project in the corner facing away from the other participants. When I approached him and asked him if I could view his worked, he obliged. He had written words in large uppercase letters with marker on various body parts that reflected how he felt about himself. On the right leg he had written “lazy” while on the left leg he had written “couch potato.” On one arm he wrote “unpopular” while on the torso of the body he had written “unhealthy” in large letters. When asked to explain these things, he stated matter-offactly that he was not popular and that he thought he was unfit and unhealthy because he was fat. He considered himself a couch potato because he loved playing video games and could sit for a long time doing that. He also said he was lazy and not very active. In exploring his meaning of “active,” I asked him what activities he was involved in. He mentioned that he played rugby twice a week and he regularly walked and participated in cross-country skiing activities. I was intrigued that

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even while being involved in such activities, he still considered himself a couch potato. Nicholas in this instance is drawing upon the broader conceptualization of the at-risk child, particularly the “ultimate at-risk” child, as lazy and inactive. While he can articulate that he has a perceivably high or socially acceptable level of physical activity, he simultaneously categorizes himself as a “couch potato.” As Hann and Peckham see it, “the alleged generation of couch potatoes is accused of watching too much television, playing too many computer games and not doing enough sport” (2010, 123). The children ultimately draw on this pervasive message in forging their identities in relation to broader social desires. Later in an interview when I asked him to elaborate on why he felt he was unfit and unhealthy, he answered “Ah, I dunno [laughs] … I don’t have enough willpower to stop eating and stuff. I love eating, I just don’t know why … I just need more willpower.” Nicholas in this statement was drawing on the neoliberal public health imperative that we are all responsible for our own health and that we must demonstrate a certain level of fortitude, strength of character, or “willpower” that allows us to deny certain pleasures (food, as one example). Nicholas’s idea of willpower is similar to how Evans and colleagues describe it: “in the disciplined world of ‘healthy eating’ they learn that health, goodness and moral virtue lie not in what they eat but in what and how much they can ‘resist’” (2008, 59). Nicholas, through his experiences with the new health knowledge, struggles with the fact that he cannot overcome the pleasure of eating to attain a disciplined diet. This is also consistent with his behaviours, which he sees as reflective of the “couch potato” generation. He views himself as weak and lacking in self-restraint because he both enjoys and partakes in these “unhealthy” activities while presenting in a non-normative body. In keeping with the current obesity discourse, the suggestion that he needs more willpower points to what he views as a flaw or defect in his character. He recognizes the mandate inherent in the health promotion messages suggesting that behaviours that produce pleasure are subordinate to those that produce health – that people who can control their hunger for pleasurable food and activity are more deserving of good health (Guthman and DuPuis 2006). The role of pleasure in relation to food and leisure is considered secondary “in an economy of risk structured through the metaphor of balancing energy ‘inputs and outputs’” (Fullagar 2009, 111). This is an ongoing struggle for the children highlighted in this study, as the powerful dominant messages provide

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little room for alternative positions or resistance. However, it must be noted that identities, and in particular fat identities, are not necessarily stable or fixed (Sykes and McPhail, 2008). While Nicholas continues to struggle with healthist labels that are infused in obesity discourse, on a number of occasions he resisted the dominant assumption that one must be thin to be healthy and eagerly drew upon alternative discourses of health. This resistance speaks to the fluid nature of identity formation and the agency children exercise in developing mechanisms to resist fat phobia and forge positive subjective experiences. It also speaks to the potential of alternative health messaging that supports broader, more fluid subject positions. As noted by Rail (2009), while institutions are attempting to “territorialize” youth’s bodies, there is a need for increased prominence in subversive discourses and enhanced attention to the mechanisms at play. Denial of Pleasure in the Name of Health The tension between the pleasure of and the ever-present pressure to avoid certain risky foods and leisure behaviours such as television and video games is apparent in the children’s talk. The children simultaneously speak about the pleasure they receive from so-called risky behaviours, the negative impact of such behaviours, and the need to deny those pleasures in the name of health. The tension between the pleasure derived from certain foods and activities highlighted as risky and the guilt that arises out of “giving in” to those pleasures is apparent. Focusing on the rules of healthy living, Coveney (2002) suggests that nutrition in this era is problematic for how it is presented as science without recognition of the moral and ethical imperatives imbedded in it. He later claims that “nutrition is not only a science but also an ethos which presents a problem for modern individuals in regard to their food choices and pleasure” (Coveney 2006, xvi). A so-called responsible health-conscious person therefore must resist energy-dense foods from which s/he derives certain pleasures in an effort to remain healthy and avoid a position considered morally deficient. In the following conversation from a focus group, for example, the children discuss take-out or fast food. Within this exchange, the children articulate both the pleasure they derive from the food produced by these franchises and the feelings of guilt it produces: Nich o l a s : I miss McDonald’s. Pam: You miss McDonald’s?

Obesity, Risk, and Responsibility  235 Adam : I miss Wendy’s for lunch. Pam: Did you cut out McDonald’s? Nich o l a s : Yeah. Pam: So why did you cut out McDonald’s? Why did you cut it out? Nich o l a s : Well, I didn’t – Mom did. Pam: Your mom did? Billy : I love Wendy’s. But I can’t have it because it’s bad for me … But I miss it … I really love it … especially the Baconator. Jor da n : We’ve been doing that too – we had McDonald’s last week, I think, but I felt a bit guilty … It was so good though. Joel : Man … We haven’t had McDonald’s in over two months. Pam: So why do you think your parents made that decision? Jor da n : Because we joined the group. Pam: Because you joined the group? Joel : Yeah … Mom has this big thing on the go, she had to measure everything out. Pete : Because I am a cow. Jenny : There’s enough carbs and calories in McDonald’s to kill a cow … so I don’t see why we should be eating it.

I noted that the children very eagerly talked about the food they enjoyed at the various fast-food restaurants. I also noted, however, that they qualified the fact that they had eaten there with statements of how their parents now regulated the frequency at which they eat at such establishments. A number of the children said that they were no longer allowed to eat fast food, but as Billy highlighted in his “I love Wendy’s” statement, there was definite pleasure derived from eating such food. The tension between the enjoyment of fast food and the guilt related to indulging in it – that is, food in direct opposition to what biopedagogies dictate – is highlighted in Jordan’s statement: “we had McDonald’s last week, I think, but I felt a bit guilty … It was so good though.” The children recognized that they are not only expected to deny themselves the pleasure of such food because it’s considered bad or unhealthy but also because they are obese. They regularly talked about how they were restricted in what they ate because of their weight. All children had been on a diet at some point and understood the expectation that they should not indulge, particularly in fast food, because it is seen to contribute to their weight status. This is reflected in Pete’s response to my question regarding why he no longer visited McDonald’s: “because I am a cow” – a response that Pete gave during a number of our conversations throughout the duration of the program.

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In response to the discussion about how they miss this sort of food, Jenny draws on her knowledge of what constitutes unhealthy foods by highlighting that there are “enough carbs and calories in McDonald’s to kill a cow … so I don’t see why we should be eating it.” This statement falls in line with dominant messages that urge us to control our hunger and consider health before pleasure. This is consistent with the findings of Shea and Beausoleil (2012), who note that youth within their study, while identifying fast food as unhealthy, also spoke of how they enjoyed this type of food. It also reflects a moralistic view of fast-food consumption that depicts fat people as indulgent and lacking control (Braziel and LeBesco 2001). These findings are also consistent with those highlighted by McPhail, Chapman, and Beagan (2011) who, in interviews with 132 teenagers, found that youth conceptualized fast food as “unhealthy” and “bad.” Drawing on Lamont’s (1992, 2000) notion of “moral boundary work,” the authors concluded that the youths’ formation of self was very much linked with the consumption of what is perceived as good and bad foods. Teens from all classes in our study positioned themselves within moralist narratives of healthy eating by reciting three basic fast food-related narratives: teens believed fast food to be unhealthy, and claimed to completely avoid fast food for health reasons; teens regarded fast food as unhealthy, and claimed to consume fast food but feel guilty and bad for doing so; and less often, teens claimed to consume and enjoy fast food without feelings of guilt or concerns for health, even while knowing fast food was bad and unhealthy. (McPhail, Chapman, and Beagan 2011, 306)

While there remains a general assumption within the mainstream literature that children and youth are not cognizant of the consequences of food choice and consumption and therefore must be educated about nutrition, this research illustrates a more complex relationship that exists for children and food. It is essential that we continue to explore the ways in which children negotiate lifestyle and discourse and how these messages serve to shape the way they conceptualize food, themselves, and those around them. Conclusion The present “war” on childhood obesity in Canada is embedded in a discourse that is detrimental to the health of children. The children in

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my study, who live in an area of Canada with the highest rates of obesity, are shaping their identities within a neoliberal healthist paradigm that teaches them that they are responsible for their own health outcomes. Given the conflation of health and weight and the powerful push towards thinness that is evident in Canadian public health policy, educational institutions, and the broader social environment (Beausoleil and Ward 2010; Rail 2009), weight has come to represent a significant marker of the level to which one is seen to deserve “healthy” status. Children who do not fit the normative body standard are therefore limited in terms of achieving a healthy subject position. While there has been recent progress in accepting size diversity in policies within at least two Atlantic Provinces, concern about the so-called alarming rate of childhood obesity continues to dominate health discourses. The narratives I have presented here explicate how children attempt to negotiate the obesity discourse and the implications of its dominant messages that mark obesity as a product of a flawed character. The children demonstrated a keen awareness of the social implications of obesity and drew regularly upon the discourse of personal responsibility for health in describing their embodied experiences. They struggle in terms of where they fit in this paradigm that categorizes them as unfit and therefore not in keeping with the broader social ideal. This discourse reinforces the concern with health risk that serves to shape how they view their bodies and their relationships with activity and food. Given that in Canada we are presently faced with a barrage of antiobesity messages, we must continue to explore the often confusing ­effects of the neoliberal risk discourse. This discourse is not only selflimiting but damaging to the emerging identities of children in general and in particular so-called obese children, like those in my study, who are conceptualized as the “ultimate at-risk” children. If children are to accept the potential for harm that risk employs, how do they ever attain a satisfying level of health or enjoyment of living? If the population is continuously bombarded with risk information, at what point do people stop listening? If health is something to be achieved, then at what point do we succeed? As researchers we need to move beyond the rhetoric that is produced through the obesity panic to consider how powerful discourses serve to influence and shape the experiences and subjectivities of children who have been marginalized due to their body size. By conducting research that is sensitive to the embodied experiences of children and others, we can begin to alter our current conceptualizations of health and allow room for more positive alternatives.

238  Pamela Ward WORKS CITED Abou-Rizk, Zeina, and Genevieve Rail. 2012. “‘ Disgusting’ Fat Bodies and Young Lebanese Canadian Women’s Discursive Constructions of Health.” Women’s Health & Urban Life 11 (1): 94–123. Adams, Stephen. 2011. “Television Creates ‘Perfect Storm’ of Childhood Obesity.” The Telegraph. 27 June. http://www.telegraph.co.uk/health/ healthnews/8599452/Television-creates-perfect-storm-of-childhoodobesity.html. Accessed 26 April 2013. Ball, Geoff D.C., and Linda J. McCargar. 2003. “Childhood Obesity in Canada: A Review of Prevalence Estimates and Risk Factors for Cardiovascular Diseases and Type 2 Diabetes.” Canadian Journal of Applied Physiology 28 (1): 117–40. http://dx.doi.org/10.1139/h03-010. Barnett, Anthony, Ester Cerin, and Tom Baranowski. 2011. “Active Video Games for Youth: A Systematic Review.” Journal of Physical Activity & Health 8 (5): 724–37. Beausoleil, Natalie. 2009. “An Impossible Task? Preventing Disordered Eating in the Context of the Current Obesity Panic.” In Biopolitics and the Obesity Epidemic: Governing Bodies, ed. Jan Wright and Valerie Harwood, 93–107. New York: Routledge. Beausoleil, Natalie, and Pamela Ward. 2010. “Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy.” Radical Psychology: A Journal of Psychology, Politics, and Radicalism 8 (1). http://www.radical psychology.org/vol8-1/fatpanic.html. Accessed 23 November 2012. Beck, Ulrich. 1992. Risk Society: Towards a New Modernity. Thousand Oaks: Sage. Braziel, Jana E., and Kathleen LeBesco. 2001. Bodies Out of Bounds: Fatness and Transgression. Berkeley: University of California Press. Brownell, Kelly D., and Rebecca M. Puhl. 2003. “Stigma and Discrimination in Weight Management and Obesity.” Permanente Journal 7 (3): 21–3. Burrows, Lisette, and Jan Wright. 2004. “The Discursive Production of Childhood Identity and Health.” In Body Knowledge and Control: Studies in the Sociology of Physical Education and Health, ed. John Evans, Brian Davies, and Jan Wright, 83–95. New York: Routledge. Butler, Judith. 1990. Gender Trouble. New York: Routledge. Campos, Paul, Abigail Saguy, Paul Ernsberger, Eric Oliver, and Glenn Gaesser. 2006. “The Epidemiology of Overweight and Obesity: Public Health Crisis or Moral Panic?” International Journal of Epidemiology 35 (1): 55–60. http:// dx.doi.org/10.1093/ije/dyi254. Canning, Patricia M., Mary L. Courage, and Lynn M. Frizzell. 2004. “Prevalence of Overweight and Obesity in a Provincial Population of

Obesity, Risk, and Responsibility  239 Canadian Preschool Children.” Canadian Medical Association Journal 171 (3): 240–2. http://dx.doi.org/10.1503/cmaj.1040075. Coveney, John. 2006. Food, Morals and Meaning: The Pleasure and Anxiety of Eating. New York: Routledge. – 2002. Food, Morals and Meaning: The Pleasure and Anxiety of Eating. New York: Routledge. Crawford, Robert. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services 10 (3): 365–88. http://dx.doi. org/10.2190/3H2H-3XJN-3KAY-G9NY. – 2004. “Risk Ritual and the Management of Control and Anxiety in Medical Culture.” Health 8 (4): 505–28. – 2006. “Health as a Meaningful Social Practice.” Health: An Interdisciplinary Journal for the Social Study of Health, Illness, and Medicine 10 (4): 401–20. Darbyshire, Philip, Colin MacDougall, and Wendy Schiller. 2005. “Multiple Methods in Qualitative Research with Children: More Insight or Just More?” Qualitative Research 5 (4): 417–36. http://dx.doi.org/ 10.1177/1468794105056921. Dworkin, Shari L., and Faye Linda Wachs. 2009. Body Panic: Gender, Health and the Selling of Fitness. New York: New York University Press. Erdman-Farrell, Amy. 2011. Fat Shame: Stigma and the Fat Body in American Culture. New York: New York University Press. Etelson, Debra, Donald A. Brand, Patricia A. Patrick, and Anushree Shirali. 2003. “Childhood Obesity: Do Parents Recognize This Health Risk?” Obesity Research 11 (11): 1362–8. http://dx.doi.org/10.1038/oby.2003.184. Evans, Bethan, and Rachel Colls. 2009. “Measuring Fatness, Governing Bodies: The Spatialities of the Body Mass Index (BMI) in Anti-Obesity Politics.” Antipode 41 (5): 1051–83. http://dx.doi. org/10.1111/j.1467-8330.2009.00706.x. Evans, John, and Brian Davies. 2004. “Sociology, the Body, and Health in a Risk Society.” In Body Knowledge and Control: Studies in the Sociology of Physical Education and Health, ed. John Evans, Brian Davies, and Jan Wright, 35–51. New York: Routledge. Evans, John, Rhianedd Evans, Ceryn Evans, and Janet Elizabeth Evans. 2002. “Fat-Free Schooling: The Discursive Production of Ill-Health.” International Studies in Sociology of Education 12 (2): 191–214. http://dx.doi.org/10.1080/ 09620210200200090. Evans, John, Emma Rich, Brian Davies, and Rachel Allwood. 2008. Education, Disordered Eating and Obesity Discourse: Fat Fabrications. New York: Routledge. Flodmark, Carl-Erik. 2005. “The Happy Obese Child.” International Journal of Obesity 29: S31–3. http://dx.doi.org/10.1038/sj.ijo.0803060.

240  Pamela Ward Foucault, Michel. 1991. “On Governmentality.” In The Foucault Effect: Studies in Governmentality, ed. Graham Burchell, Colin Gordon, and Peter Miller, 87–105. Chicago: University of Chicago Press. Frohlich, Katherine L., Stephanie A.C. Alexander, and Caroline Fusco. 2013. “All Work and No Play: The Nascent Discourse on Play in Health Research.” Social Theory & Health 11 (1): 1–18. http://dx.doi.org/10.1057/ sth.2012.18. Fullagar, Simone. 2009. “Governing Healthy Family Lifestyles through Discourses of Risk and Responsibility.” In Biopolitics and the Obesity Epidemic: Governing Bodies, ed. Jan Wright and Valerie Harwood, 108–26. New York: Routledge. Grosz, Elizabeth A. 1994. Volatile Bodies: Toward a Corporeal Feminism. Bloomington: Indiana University Press. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality, and Ideology. New York: Routledge. Goffman, Irving. 1963. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall. Graves, Lee, Gareth Stratton, N.D. Ridgers, and N.T. Cable. 2008. “Energy Expenditure in Adolescents Playing New Generation Computer Systems.” British Journal of Sports Medicine 42: 592–4. Guthman, Julie, and Melanie DuPuis. 2006. “Embodying Neoliberalism: Economy, Culture, and the Politics of Fat.” Environment and Planning. D, Society & Space 24 (3): 427–48. http://dx.doi.org/10.1068/d3904. Halse, Christine. 2009. “Bio-citizenship: Virtue Discourses and the Birth of the Bio-Citizen.” In Biopolitics and the Obesity Epidemic: Governing Bodies, ed. Jan Wright and Valerie Harwood, 45–59. New York: Routledge. Hann, Alison, and Stephen Peckham. 2010. “Constructing the Obesity Epidemic: Loose Science, More Money and Public Health.” In Public Health: Ethics and Practice, ed. Stephen Peckham and Alison Hann, 117–36. Bristol: Policy. Heinberg, Leslie J., and Kevin J. Thompson. 2009. “Introduction: The Obesity Epidemic in Children and Adolescents.” In Obesity in Youth: Causes, Consequences, and Cures, ed. Leslie J. Heinberg and Kevin J. Thompson, 3–14. Washington, DC: American Psychological Association. http://dx.doi .org/10.1037/11868-000. Jin, S.A. 2009. “Avatars Mirroring the Actual Self versus Projecting the Ideal Self: The Effects of Self-Priming on Interactivity and Immersion in an Exergame, Wii Fit.” Cyberpsychology & Behavior 12 (6): 761–5. http://dx.doi .org/10.1089/cpb.2009.0130. Kautiainen, Susanna, Leena Koivusilta, Tomi Lintonen, Suvi M. Virtanen, and Aarja Rimpelä. 2005. “Use of Information and Communication Technology

Obesity, Risk, and Responsibility  241 and Prevalence of Overweight and Obesity among Adolescents.” International Journal of Obesity 29 (8): 925–33. http://dx.doi.org/10.1038/sj.ijo.0802994. Lamont, Michèle. 1992. Money, Morals, and Manners: The Culture of the French and the American Upper-Middle Class. Chicago: University of Chicago Press. http://dx.doi.org/10.7208/chicago/9780226922591.001.0001. – 2000. The Dignity of Working Men: Morality and the Boundaries of Race, Class, and Immigration. Cambridge, MA: Harvard University Press. Larkin, June, and Carla Rice. 2005. “Beyond ‘Healthy Eating’ and ‘Healthy Weights’: Harassment and the Health Curriculum in Middle Schools.” Body Image 2 (3): 219–32. http://dx.doi.org/10.1016/j.bodyim.2005.07.001. Leahy, Deana, and Lyn Harrison. 2004. “Health and Physical Education and the Production of the ‘At Risk’ Self.” In Body Knowledge and Control: Studies in the Sociology of Physical Education and Health, ed. John Evans, Brian Davies, and Jan Wright, 130–39. New York: Routledge. LeBesco, Kathleen. 2004. Revolting Bodies? The Struggle to Redefine Fat Identity. Boston: University of Massachusetts Press. Limbert, Joanne, Susan M. Crawford, and Linda J. McCargar. 2012. “Estimates of the Prevalence of Obesity in Canadian Children.” Obesity Research 2 (4): 321–7. http://dx.doi.org/10.1002/j.1550-8528.1994.tb00071.x. Lupton, Deborah. 1993. “Risk as Moral Danger: The Social and Political Functions of Risk Discourse in Public Health.” International Journal of Health Services 23 (3): 425–35. http://dx.doi.org/10.2190/16AY-E2GC-DFLD-51X2. – 1995. The Imperative of Health: Public Health and the Regulated Body. London: Sage. – 1999a. Risk. London: Routledge. – 1999b. Risk and Sociocultural Theory: New Directions and Perspectives. Cambridge: Cambridge University Press. Macdonald, Doune, Jan Wright, and Rebecca Abbott. 2010. “Anxieties and Aspirations: The Making of Active Informed Citizens.” In Young People, Physical Activity and the Everyday, ed. Jan Wright and Doune MacDonald, 121–35. London: Routledge. McDermott, Lisa. 2007. “Governmental Analysis of Children at Risk in a World of Physical Inactivity and Obesity Epidemics.” Sociology of Sport Journal 24 (3): 302–24. McPhail, Deborah, Gwen E. Chapman, and Brenda L. Beagan. 2011. “‘Too Much of That Stuff Can’t Be Good’: Canadian Teens, Morality, and Fast Food Consumption.” Social Science & Medicine 73 (2): 301–7. http://dx.doi .org/10.1016/j.socscimed.2011.05.022. Monaghan, K. 2010. “The Oeuvre of Risk in Health Promotion: A Reflexive Metatheoretical Critique.” Doctoral diss, Memorial University of Newfoundland.

242  Pamela Ward Monaghan, Lee F. 2005. “Discussion Piece: A Critical Take on the Obesity Debate.” Social Theory & Health 3 (4): 302–14. http://dx.doi.org/10.1057/ palgrave.sth.8700058. Monaghan, Lee F., Robert Hollands, and Gary Pritchard. 2010. “Obesity Epidemic Entrepreneurs: Types, Practices and Interests.” Body & Society 16 (2): 37–71. http://dx.doi.org/10.1177/1357034X10364769. Moynihan, Ray, Iona Heath, and David Henry. 2002. “Selling Sickness: The Pharmaceutical Industry and Disease Mongering.” British Medical Journal 324 (7342): 886–91. http://dx.doi.org/10.1136/bmj.324.7342.886. Murray, Samantha. 2005. “(Un/be) Coming Out? Rethinking Fat Politics.” Social Semiotics 15 (2): 153–63. – 2009. “Marked as ‘Pathological’: ‘Fat’ Bodies as Virtual Confessors.” In Biopolitics and the Obesity Epidemic: Governing Bodies, ed. Jan Wright and Valerie Harwood, 78–92. New York: Routledge. Norman, Moss E. 2010. “Living in the Shadow of an ‘Obesity Epidemic’: The Discursive Construction of Boys and Their Bodies.” Doctoral diss., University of Toronto. O’Dea, Jennifer A. 2005. “Prevention of Child Obesity: ‘First, Do No Harm.’” Health Education Research 20 (2): 259–65. http://dx.doi.org/10.1093/her/ cyg116. Rail, Genevieve. 2009. “Canadian Youth’s Discursive Constructions of Health in the Context of Obesity Discourse.” In Biopolitics and the Obesity Epidemic: Governing Bodies, ed. Jan Wright and Valerie Harwood, 141–56. New York: Routledge. Rail, Genevieve, and Natalie Beausoleil. 2003. “Introduction: Health Panic Discourses and the Commodification of Women’s Health in Canada.” Atlantis: A Women’s Studies Journal 27 (2): 1–5. Rail, Geneviève, Dave Holmes, and Stuart J. Murray. 2010. “The Politics of Evidence on ‘Domestic Terrorists’: Obesity Discourses and Their Effects.” Social Theory & Health 8 (3): 259–79. http://dx.doi.org/10.1057/sth.2009.10. Rail, Genevieve, and Marc Lafrance. 2009. “Confessions of the Flesh and Biopedagogies: Discursive Constructions of Obesity on Nip/Tuck.” Medical Humanities 35 (2): 76–9. http://dx.doi.org/10.1136/jmh.2009.001610. Rawlins, Emma. 2008. “Citizenship, Health Education and the Obesity ‘Crisis.’” ACME: An International E-Journal for Critical Geographies 7 (2): 135–51. Rice, Carla. 2007. “Becoming the ‘Fat Girl’: Acquisition of an Unfit Identity.” Women's Studies International Forum 30 (2): 158–74. http://dx.doi.org/ 10.1016/j.wsif.2007.01.001. Rich, Emma. 2011. “Exploring the Relationship between Pedagogy and Physical Cultural Studies: The Case of New Health Imperatives in Schools.” Sociology of Sport Journal 28 (1): 64–84.

Obesity, Risk, and Responsibility  243 Rich, Emma, and John Evans. 2005. “‘Fat Ethics’ – The Obesity Discourse and Body Politics.” Social Theory & Health 3 (4): 341–58. http://dx.doi.org/ 10.1057/palgrave.sth.8700057. Roberts, Karen C., Margo Shields, Margaret de Groh, Arnold Aziz, and Jo-Anne Gilbert. 2012. “Overweight and Obesity in Children and Adolescents: Results from the 2009 to 2011 Canadian Health Measures Survey.” Health Reports 23 (3): 37–43. Robinson, Thomas N. 1999. “Reducing Children’s Television Viewing to Prevent Obesity.” Journal of the American Medical Association 282 (16): 1561–7. http://dx.doi.org/10.1001/jama.282.16.1561. Saguy, Abigail C., and Rene Almeling. 2008. “Fat in the Fire? Science, the News Media, and the ‘Obesity Epidemic.’” Sociological Forum 23 (1): 53–83. http://dx.doi.org/10.1111/j.1600-0838.2004.00399.x-i1. Shea, Jennifer M., and Natalie Beausoleil. 2012. “Breaking Down ‘Healthism’: Barriers to Health and Fitness as Identified by Immigrant Youth in St. John’s, NL, Canada.” Sport Education and Society 17 (1): 97–112. http:// dx.doi.org/10.1080/13573322.2011.607914. Shields, Margot. 2006. “Overweight and Obesity among Children and Youth.” Health Reports 17: 27–42. Shields, Margot, and Mark S. Tremblay. 2010. “Canadian Childhood Obesity Estimates Based on WHO, IOTF and CDC cut-points.” International Journal of Pediatric Obesity; IJPO 5 (3): 265–73. http://dx.doi. org/10.3109/17477160903268282. Statistics Canada. 2011. “Overweight and Obese Adults (Self-reported).” http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11664-eng.htm. Accessed 23 November 2012. Sykes, Heather, and Deborah McPhail. 2008. “Unbearable Lessons: Contesting Fat Phobia in Physical Education.” Sociology of Sport Journal 25 (1): 66–96. Tremblay, Mark S., and J. Douglas Willms. 2003. “Is the Canadian Childhood Obesity Epidemic Related to Physical Inactivity?” International Journal of Obesity 27 (9): 1100–5. http://dx.doi.org/10.1038/sj.ijo.0802376. Twells, Laurie, John Knight, Reza Alaghebandan, D. MacDonald, T. Bridger, and B. Barrett. 2011. “Obesity and Its Impact on a Provincial Health System in Canada.” Canadian Journal of Diabetes 35 (2): 217. http://dx.doi.org/ 10.1016/S1499-2671(11)52285-3. Vancouver Sun. 2011 “Weighted Issue: Who is Canada’s Fattest Province?” 27 July. http://www.vancouversun.com/Weighted+Issue+Canada+fattest+ province/5541961/story.html. Accessed 23 November 2012. Vander Schee, Carolyn J., and Deron Boyles. 2010. “‘Exergaming,’ Corporate Interests and the Crisis Discourse of Childhood Obesity.” Sport Education and Society 15 (2): 169–85. http://dx.doi.org/10.1080/13573321003683828.

244  Pamela Ward Vandewater, Elizabeth A., Mi-suk Shim, and Allison G. Caplovitz. 2004. “Linking Obesity and Activity Level with Children’s Television and Video Game Use.” Journal of Adolescence 27 (1): 71–85. http://dx.doi.org/10.1016/ j.adolescence.2003.10.003. Ward, Pamela. 2012. “Exploring the Role of Discourse in the Emerging Identities of Children Enrolled in an Obesity Treatment Program.” Doctoral diss., Memorial University of Newfoundland. Willms, J. Douglas, Mark S. Tremblay, and Peter T. Katzmarzyk. 2003. “Geographic and Demographic Variation in the Prevalence of Overweight Canadian Children.” Obesity Research 11 (5): 668–73. http://dx.doi. org/10.1038/oby.2003.95. Wright, Jan. 2000. “Disciplining the Body: Power, Knowledge and Subjectivity in a Physical Education Lesson.” In Culture and Text: Discourse and Methodology in Social Research and Cultural Studies, ed. Alison Lee and Cate Poynton, 152–69. Maryland: Rowman and Littlefield. Yang, Stephen, Brian Smith, and George Graham. 2008. “Healthy Video Gaming: Oxymoron or Possibility.” Innovate: Journal of Online Education 4 (4). http://www.innovateonline.info/index.php?view=article&id=186.

9 Obesity Panic, Body Surveillance, and Pedagogy: Elementary Teachers’ Response to Obesity Messaging LeA nn e Pethe rick an d N atal ie B e au s o l e i l

In the crusade against childhood obesity, schools have become a crucial site in the transmission of health knowledge (Rail, Holmes, and Murray 2010). Schools operate as sites of intervention as health messages focus on saving children and youth from the grips of obesity. In particular, elementary schools and by extension teachers are positioned to help address the public’s concerns for the so-called ill health or risk conditions facing today’s children (Kater, Rohwer, and Londre 2002). Teachers are positioned in difficult territory, as they both willingly desire to shape future health contexts of Canadian children and must navigate educational expectations and the diverse realities of their students’ lives. Using this relational approach to both education and health, simply promoting lifestyle behaviour change strategies is complex, and particularly complicated when thinking about teachers’ roles, expectations and knowledge of their communities. Confronting these tensions, critical scholars in health and education call us to challenge societal ­attitudes about fat, fatness, and fat prejudice, especially in relation to body knowledge (see Beausoleil 2009; Beausoleil and Ward 2010; Burrows 2008, 2009, 2010; Burrows and Wright 2004a, 2004b; Burrows, Wright, and McCormack 2009; Evans et al. 2008; Halse 2009; MacNeill and Rail 2010; Norman 2011; Petherick 2013; Petherick and Beausoleil 2015; Pringle and Pringle 2012; Rail 2009; Rail, Holmes and Murray 2010; Shilling 2010; Walkerdine, 2009; Welch and Wright 2011; Wright, O’Flynn and Macdonald 2006). There is an international group of critical scholars who interrogate health-related messaging’s impact on students’ and teachers’ relationship with their bodies and health. In particular, leading-edge work is being conducted in Australia, New Zealand, Sweden, and the United

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Kingdom (see Burrows and McCormack 2012; Humberstone and Stan 2011; Rich and Perhamus 2010; Webb and Quennerstedt 2010; Welch, McMahon, and Wright 2012; Wright 2009). These scholars are examining the multiple and competing discursive practices that shape health knowledge within school environments. Despite the fact that the shifting fabric of Canadian school curricula and the resulting pedagogical processes remain relatively unknown, a range of health-promotion initiatives are being implemented in schools across the country. For instance, Canadian schools are changing nutritional policies, increasing physical activity time in the regular school day, and promoting active transport to and from school as ways of promoting a health culture that erases the boundaries between home, community, and school (Canadian Association for School Health 2013). The concern for childhood obesity has affected school culture, and in particular how health information is shared within the broad school environment. The organization of the school day with more physical activity opportunities built into the day, or less access to unhealthy foods on school premises, combined with revised provincial health and physical education curricula, shape how school cultures are adapting to but also producing body-focused pedagogy. While some notable Canadian researchers have investigated teachers’ recent responses to curricular change (Fraser-Thomas and Beaudoin 2002; Petherick 2013), the effects of obesity-driven health culture on elementary teachers’ pedagogy in Canada remain relatively unknown. If obesity science is to be taken seriously, we need to know how Canadian elementary teachers navigate the effects of obesity-driven health concerns and their interactions with students. This chapter explores female teachers’ understandings and use of health-informed messaging as they affect relationships with their own bodies and their interactions with students. As part of a larger research project exploring the implementation and evaluation of a cross-­ curricular elementary school resource on body image, we invited teachers from four schools in Newfoundland to share their thoughts and understandings of body image, body satisfaction, and other health-related issues. The resource itself, Healthy Bodies Come in Different Shapes and Sizes, provides grade two and four teachers with lesson plans to address body image issues that may arise in the classroom while also meeting curricular outcomes (The Body Image Network 2009). One of the curriculum resource’s aims was to shift the focus from the individualized approach to physical activity and healthy-eating messages

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currently dominating the Canadian landscape towards broader understandings of human movement and nutrition practices that focus on fostering a sense of community and connection. Using regional knowledge and culture, the cross-curricular resource includes a book with a story about differently shaped and skilled children in St. John’s, Newfoundland, looking to solve a mystery, with local illustrations and story details. In addition, the resource contains educational tools to inform parents about body-based harassment, ways of identifying body discrimination practice, and posters and bookmarks with images and logos to promote body shape and size differences. As part of the larger research project, teachers were invited to participate in interviews to contextualize the school setting and the impact of the so-called obesity epidemic on teachers and the classroom space. Based on interviews with thirteen female elementary teachers from four different schools on the Avalon Peninsula of Newfoundland, this chapter provides insight into the everyday practices of being a teacher in a climate where obesity is considered a major public health issue. We examined teachers’ experiences of health and the body and their professional practice of mediating health information and teaching health curriculum to students within a climate where obesity and obese and overweight bodies are stigmatized in the name of health – a climate that also makes for unhealthy school environments. We started from the premise that it is crucial to understand how teachers perceive and teach health and the body as a way to interpret what is happening in school culture in response to dominant obesity-science messaging. Educational Contexts, Healthism, and Biocitizenry Pedagogical practices – both in Newfoundland and across Canada – are increasingly informed by the neoliberal values of individual responsibility, self-choice, and self-improvement. In the midst of obesity-laden information about child and youth health, public schools are being tasked not only with preparing students for a knowledge economy but also with addressing the supposed decline in positive lifestyle practices affecting youth’s future health. The values circulating within these discursive practices shape individuals’ relationships with their bodies and form the basis for individualist ideas about health – the notion that ­everyone can simply make lifestyle adjustments and “choose” health. Using Crawford’s notion of healthism “which sites the problem of health and disease at the individual level,” lifestyle change focuses on

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the individual and the will to take up healthy practices to receive the positive benefits of choosing health (1980, 365). Healthism, this seemingly innocent practice of learning to take responsibility for one’s health, often results in moralistic views of bodies, both one’s own and others. But as Mikkonen and Raphael (2010) suggest, “choosing health” is in fact a fallacy designed to disguise the health inequities caused by individuals’ living conditions, income, work, identity, and location. The fallacy both enables and constrains any one person’s ability to choose health. We use this idea of healthism because the notion of taking personal responsibility for health, within the educational context, is part and parcel of institutional expectations guiding teachers’ practices. Thus, it is not surprising that many teachers want to assist their students in learning the “proper” ways to be healthy, to both enhance their learning opportunities and to promote particular health practices. Teachers take up and use healthism as a way to engage students in learning how to be “healthy,” but there are often underlying contradictions in the application of this approach. Given the relationship teachers have with students, the simple proclamation to promote active living or healthy eating is called into question when teachers speak about the conditions and complexity of their students’ lives. As mentioned previously, neoliberal ideologies shape current educational curricula and school policy. Yet, as teachers talk about the realities of their students’ lives, the tension between knowing what is identified as a healthy choice and understanding the complexity of people’s lives vividly illustrates the limitations of individualistic approaches to health. Teachers share stories of some of the constrained life choices their students have concerning health, including families living on a limited budget, or the difficulties some mothers face when their husbands work offshore or in the west. The social relations and realities of knowing their students affect how teachers attempt to ameliorate their theoretical understanding for choosing health with the everyday realities of their communities. These teachers are grappling with their educational responsibilities within a culture that deems particular bodies, based on their size and shape, as healthy and by extension “good.” Confronting and confounding the daily tensions shaping who is a “good” citizen and who is socially and culturally positioned to be a “good” and healthy subject is part of teachers’ everyday dilemma. Teachers are a collective group of individuals with legal obligations and professional duties, but they are also an eclectic group of individuals who are called into being through social norms and conditions

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circulating within their profession and everyday lives. Nikolas Rose (1999) highlights these dual positions when he looks at how processes of political rationality transform the biological citizen from being a subject with legal and constitutional rights and duties into a citizen shaped by the social conditions and practices of the time. This process produces what Halse (2009) refers to as “biocitizenry.” The good citizen is an “‘active’ citizen, and active citizenship is the means by which one both commits to and becomes immersed in and part of the social world of a community” (Halse 2009, 50). Biocitizenry can be thought of as a contemporary manifestation of Crawford’s 1980s notion of healthism. In particular, teachers’ bodies and their knowledge about health are read through a social, political, economic, and cultural lens that can lead to a moral approach to teaching and learning about bodies and health. The process for promoting active citizenship, however, is not linear or straightforward. The bodies of teachers are scrutinized on multiple levels as teachers try to model rational approaches to health and good citizenry. Teachers’ abilities to be good citizens are not simply connected to their response to professional obligations, but are compounded by their personal commitment to present themselves as individuals who desire to be healthy and help construct their students’ futures. Healthiness is then read or not read from a teacher’s own bodily appearances and health-related practices. All participating teachers in this study are female, and when asked to comment about the gender of elementary teachers in their schools, they noted that there were only a few male elementary teachers. In some ways, the ethics of care permeated teachers’ identities as they discuss the pressures of both educating and caring for the students in their schools. Both professionally and personally, the pressure to be good citizens affects teachers. Dominant notions of concern for the future of today’s youth correspond with the need to help children today shape their health practices not only for their current health status but also for their future success. It seems for many participants that female subjectivities inspire a sense or duty of care to promote “good” health practice. In this process, dominant ideas about health portray the children at risk of ill health and call upon those in the education profession to help militate against these very powerful forces that seemingly draw children into situations that are unhealthy. This process of calling into question children’s health affects everyone. For example, teachers are working to deliver an educational curricula while also exercising vigilance in watching, educating about, and by extension caring about

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children’s health status. This sense of caring arises in response to the overbearing messages concerning the so-called obesity epidemic. Contextualizing the Pedagogical Terrain Some scholars have recently begun examining how teachers take up and transmit health messages to their students (Webb and Quennerstedt 2010; Webb, Quennerstedt, and Öhman 2008; Welch and Wright 2011). Most teachers interviewed in these studies initially adopt the dominant discourse of healthism to describe their health practices, perceptions, and aspirations, as well as their observations of others. The strong adoption of dominant health messaging is not surprising given the currency of normative discourses on health and the body, which are often associated with appearance-based issues but framed as health-related issues. But these studies also uncover nuances, tensions, and contradictions in teachers’ accounts of the body and health. Seeing and hearing such dominant discourse in the trenches, so to speak, teachers negotiate ideas of body and health, and at times adopt positions that challenge the idea that health can be simply read on the body and that large ­bodies are necessarily unhealthy (Webb and Quennerstedt 2010). While these studies have focused specifically on the experiences of physical education teachers, we find that they also apply to generalist or classroom teachers in the elementary school system. Classroom teachers regularly see and hear students talking about body-related issues in the corridors and on the playground. Research on teachers’ responses to body-talk among students indicates that teachers express greater concern for the obese body and obesity-related comments. Consequently, the thin body comes to represent the healthy body without consideration or concern for disordered eating or eating disorder pathologies (Cliff and Wright 2010; Webb and Quennerstedt 2010). Thin body ideals are not just a concern of the students within school culture – adults also describe and assess the bodies of other teachers within the school. Teachers survey each other and adopt “virtue discourses” in evaluating their own and other teachers’ bodies and health practices (Halse 2009; Webb and Quennerstedt 2010). Such surveillance practices seem commonplace within our obesity-panicked culture. The effects of obesity discourse increase surveillance and strengthen the social and biological call to be a particular person – someone who is thin and attractive and always vigilant about monitoring his or her health.

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These attributes are only superficial markers of so-called health, yet they have powerful effect. Those individuals who are not practicing what dominant society deems healthy, or whose bodies are not normatively shaped, are often judged and criticized for not being concerned about health, being a burden on the economy, and not being “good” citizens. Biocitizenry is produced as these ideas of “goodness” and “healthiness” spread through education spaces and the larger society. Schools are implicated because they are locations where individuals learn and teach others about being “good” healthy subjects. Leahy (2009) argues that expert knowledge is cultivated as ideas about bio­ citizens develop. In addition, she notes the powerful affects being mobilized through teaching and learning about “goodness” and ­ “healthiness”: disgust, guilt, shame, and pride. Because teachers are expected to be role models for their students, their own bodies become teaching tools (Webb and Quennerstedt 2010; Webb, Quennerstedt, and Öhman 2008). Teaching about health and embodying healthy pursuits necessarily become emotional processes, invoking a range of feelings and affecting teachers’ sense of self. Teachers’ relationships with their bodies come under scrutiny as they consider their own health expectations as well as the perceived pressures placed upon them as educators. The health behaviours of teachers, both inside and outside the school setting, are increasingly monitored – including their weight, what they eat, and what food they buy (Webb and Quennerstedt 2010). The guilt, shame and disgust related to ‘good’ bodies do not evade teachers’ reading of their own bodies. Ironically, teachers seem to be more understanding of the varied bodies they teach than they are of their own cohort as they scrutinize, observe, monitor, and regulate each other. Teachers whose bodies deviate from normative ideas of body shape and size are stigmatized. Therefore teachers’ experiences and perspectives are a crucial, albeit under-examined, aspect of health-surveillance practices within educational contexts. Pedagogies of disgust are transmitted between teachers in the public and private areas of work that seemingly further encourage a culture of body surveillance. Within a “fat phobic” culture, students identify teachers as contributing to the oppressive practices that construct a normalized view of bodies, and subsequently constitute ideals of “healthy” bodies, circulating within schools (Burrows and Wright 2004b; Sykes and McPhail 2007;Welch and Wright 2011). In other words, students pick up on both spoken and unspoken messages from teachers.

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Methods This chapter draws attention to the complicated narratives linking bodies, body image, and health in schools. Rejecting notions of any fixed or unified self, feminist post-structuralism enables us to explore the shifting subjectivities produced through discourse. In particular, Weedon (1997) highlights the relationships between discursive fields and individuals’ subjective positions. Youngblood Jackson (2001) notes that subjectivities themselves emerge through disruptions in being. With this in mind, we suggest that obesity-driven school initiatives may challenge, shift, and disrupt teachers’ sense of self. In an attempt to recognize the difficult terrain teachers navigate as they mediate health messaging for their students, we share those moments when dominant messages are commonly reproduced. But teachers’ experiences are also ripe with moments of disruption. Contextualized within a backdrop of obesity-driven panic filtering through social contexts of schools, healthism becomes a less-than-tidy approach to considering tomorrow’s biocitizen. In semi-structured interviews with thirteen female elementary school teachers with varying years of teaching experience (between two and fifteen years), we see how the effects of the “war on obesity” are felt both professionally and personally. The teachers we spoke with were classroom teachers of either grade two or grade four students at the time of the interviews. Face-to-face interviews took place in the lunch hour or after-school time period. The primary interviewer was a trained researcher who had experience working in elementary school settings as a teacher. The interviewer and other researchers identified key themes that arose from the sessions and then collaborated to develop more in-depth analysis. The teachers’ narratives illustrate how they negotiate ideas about students’ bodies and health in relation to their own bodies in the context of obesity discourse. Teachers confront, challenge, or collude in the moralism that follows normative body ideals in relation to common obesity “talk.” Teachers occupy a place of authority enabling them to shape how children think about and see their bodies, yet there is a ­cautious and tempered connection to the pedagogical practices of talking about bodies of various shapes and sizes. Teaching others about healthy body image implicates teachers’ relationships with their own bodies. As teachers occupy various subject positions, their relationship

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with their own bodies and the bodies of others appears to be guided by dominant healthist discourses, primarily focused on self-­regulation. How they guide others is also tempered by resistive moments when complexities emerge to challenge normative ideas about bodies, health, and individualism. In what follows we focus on two broad themes emerging from our analysis of conversations with teachers. These two themes speak to teachers’ negotiation of biocitizenry within the school context. Teachers’ Health and Body Image: Surveillance of Self and Others

Emotional Connections with the Body Participants in our study mostly talked about health in terms of the physical body and lifestyles: being active/keeping in shape and eating healthy foods. Some participants also defined health in terms of stamina, endurance, and overall energy. Moreover, our participants saw selfesteem and mental and emotional health/happiness as essential parts of health, therefore producing a somewhat more holistic portrait of health, at least throughout parts of the interviews. For instance, in answer to the interviewer’s question about what it means to be healthy, one grade-two teacher, Julie, said: I find that emotional health is one of the most important things to me. Even within my own family and focusing on loving yourself and who you are and where you are right now in life. Knowing that you can do anything if you have the right mindset and strength of character. You know – and – it doesn’t depend on what somebody else thinks of you or thinks about where you live, or what car you drive or anything like that. In the final analysis, none of that really matters. That’s how I see my life and it’s how I try to enforce it with my own kids. (grade 2, site 2)

Julie said she has lost and gained weight over the years but that she has always remained herself: Once again that comes back to your core of who you are inside and what you believe about yourself. I’ve been 300 pounds, and I’ve lost 117 pounds. I’ve gone up and down in my weight and it never changed me from the kind of person that I wanted to be … To me it’s like, alright, I’m going to be

254  LeAnne Petherick and Natalie Beausoleil turning forty in December, and I want to be healthy. I want to be around for my kids … I want to look good and I want to be healthy. (grade 2, site 2)

Julie’s weight loss provided a sense of belonging that is mediated by her desire to be with her children. Through a connection to weight she establishes a sense of stability by claiming that she has never changed, and her emotional connection with her body is through herself and others. Like several participants in Welch and Wright’s study (2011), this participant’s narrative reflects a negotiated position in relationship to the dominant health discourse. On the one hand, she asserts that what matters is “inside,” yet losing weight was very important to her. She is drawing on contradictory discourses but resolves this contradiction by emphasizing the importance of knowing herself. The woman carries around her “real” self within a biological body (Bordo 1993) living in a socio-cultural context that on the one hand encourages women to distance themselves from their body but on the other hand preoccupies them with their bodies. Julie, who aspires to emotional health as a holistic goal, brought up the issue of emotions as something negative when they are not controlled. Emotions and appearance are all connected in the effort to re/ shape the body towards health. But in dominant discourses of health, particularly in relation to eating practices, the very notion of emotion signifies “excess” and psychopathology. For example, Some people eat because of emotion. There are people who eat because they are just emotional eaters. They eat out of boredom. I used to eat at the computer, eat while I’m surfing the net. (grade 2, site 2)

This participant saw her past eating practices as tied to her emotions in unhealthy ways. The connection between unhealthy eating and the computer in particular reflects health promotion’s condemnation of media use in combination with overeating. Health-promotion campaigns typically depict time spent in front of a computer or television as symptomatic of an inherently unhealthy sedentary lifestyle that brings about weight gain (Monaghan 2010; Stephenson-Herr and BanetWeiser 2007). These campaigns target children and the “problem of childhood obesity,” as Elliott demonstrates in this volume. In contrast to what she did in the past, our participant implies that her current eating and physical activity practices reflect healthy or positive emotions. In that regard, we suggest that “emotional eating” and media use are

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connected with certain relationships to the body. Feminist scholars have denounced how the psychopathological notion of “emotional eating” in particular has been used to stigmatize women and ultimately feminize obesity, by associating “emotional eating” with excess of the flesh (LeBesco 2004; McPhail 2010). Concerns for emotional excess are not only at the heart of the dominant health and weight discourse – they also permeate the analytical language of many obesity studies (Fraser, Mahera, and Wright 2010). The emotional connection to fat shapes how political and scientific communities respond to obesity. Rather than negating the emotional connection to the body, and one’s own body, Fraser, Mahera, and Wright turn to the work of Sara Ahmed to acknowledge the resonance of ­emotion’s role in social life. Emotions are not internal states, but rather work in and through collective meanings and structures. As these authors deconstruct the maternal body they expose the way bodies are imbued with meaning and affect. Affect is not momentarily produced  but a ­historical and contemporary reaction to the obese body. McPhail’s (2010) work on the history of emotion and obesity in Canada also highlights the emotional connection to traditional eating and its affect on population.

Appearance Concerns Teachers’ accounts of body surveillance suggest that emotional health and self-esteem require effort and energy. Time constraints, work commitments, family support, or family obligations are all negotiated in the pursuit of personal health. When talking about health, women in this study seemed to foreground appearance rather than their health status. While emotional connections with the body are important, so too are the appearance-based bodily relationships: Delo re s : I could tell you that there are parts of my body that I will not look at in the mirror. And you know, I don’t necessarily feel real happy but not – it’s kind of tricky – I’m not totally unsatisfied. I feel like I’m healthy, I run fairly long distances and I’m fairly active. But I’ve had two children, and I look sometimes and say why can’t my belly be flat? That’s probably the biggest thing with me. You know, I look at that and go “bblugh.” But not every day and it’s like, not – I don’t dwell on it. But if you were to ask me how I feel about my body I would say, could you just slice off that couple of pounds there and I will be good to go. (grade 4, site 2)

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The desire to lose weight is rampant among women and girls in Western society, and the participants in our study are no exception. But body image is not only about weight, and some teachers talk about different aspects of appearance. In the following passage, Mauve describes how she feels about her height as well as her weight: mauve : I’m not very tall. And I have a couple extra pounds on right now … So I would like to – just because of my stature – I would like to lose a little bit of weight. But I find that a lot of people make a lot of comments about my height. And I find it gets a little bit old after a while. You know some people might – they think it’s joking and stuff like that and they joke. And I guess it depends on what kind of a mood I’m in. But like I do … like I’m pretty easygoing but you know I’m thirty-four years old, and I’ve been this height now for quite a while, and I’ve almost heard every comment there is to hear. (grade 2, site 4)

For Mauve, “joking” sometimes goes too far when others feel as though they can comment on her stature. Much like the pre-service primary teachers in Welch and Wright’s (2011) research, the women in this study use body knowledge and health discourses to construct their relationship with the body. There is a fine line between “joking” about height and “joking” about weight. While height appears to present subtle but accepted forms of bodily notation, references to weight are common in talk that often leads to bullying. Both comments result in body dissatisfaction and a reproduction of dominant ideas about bodies. If this type of talk is part of everyday culture, it circulates and participates in normalizing self-critical assessment, body-based judgments, and even harassment. Some researchers have demonstrated the need to take body-based harassment more seriously, like student bullying in schools (Larkin and Rice 2005).

Food and Dieting Appearance, bodies, food, and physical activity are certainly common topics of conversation among teachers. All teachers in our study report significant talk between teachers about weight loss, dieting, and calories. In the staff room, at lunchtime in particular, teachers recall conversations similar to this one:

Elementary Teachers’ Response to Obesity Messaging  257 Mary : There are people who often say, “Oh, I need to lose five pounds”; “I need to lose thirty pounds”; or “I wish my stomach wasn’t so flabby.” We tend to do that. I mean a lot of times people take out their lunch and say, “All I have is a salad today, I’m trying to lose weight” or “I have one piece of bread with some meat on it.” That goes on every day in the staff room. It does come up quite often. (grade 4, site 2)

Teachers comment on their bodies and eating practices, but they also watch what others eat. Although our participants all reported a positive atmosphere in their current schools, they nonetheless emphasized surveillance around food among staff. Surveillance and food monitoring are a normalized “body regulation practice” that is not benign in how it constructs individuals’ relationships with eating (Kater, Rohwer, and Londre 2002). Food and individuals’ relationship with it (eating, bringing food into the staffroom, packing a lunch, etc.) therefore become an important signifier of health. Er in: I do find sometimes there’s – I can’t say judgmental, although it is in a way, you know – very idealistic people have views of what health should be. Versus my view, which is everything is okay, just not too much of it. You know, a cupcake here and there is not gonna hurt anybody. But they’re very, “Oh my God, you’re not gonna eat that,” looking at your lunch, that kind of judgmental view of, of what you’re eating ... There’s only a few of those personalities, but it’s there, definitely there. (grade 4, site 1)

Erin rejects many teachers’ insistence on reducing the amount of sweets brought into the staffroom. Her comment that “a cupcake is not going to hurt anybody” very much contrasts with other teachers’ ­attempt to regulate what is being brought into the staff room. Not surprisingly, then, other participants noted how teachers have in fact  restricted the amount of sweets brought in to share among themselves. Sharo n : Everyone kind of eats healthy and you know, everybody’s got a lot of dietary issues ... some food allergies, and you know, everybody’s aware and they’re for each other. We all discuss as a staff. Like we used to have treats, two teachers used to bring treats every Monday. Everybody was starting to complain about it.

258  LeAnne Petherick and Natalie Beausoleil Darl e n e : And another thing is that there are eighteen women on staff. There are only two men. Well, there are more than eighteen of us. IntE RVI E W E R: How did you change the idea of telling those couple of people ... Darl e n e : Everybody agreed. Sharo n : We all discussed it … Darl e n e : If people are doing their individual things, then that is fine, like with their food allergies and that, but everybody decided this was too much junk. Let’s do it once a week, and then that was going to be too much. (grade 2, site 2)

This exchange shows the extent of teachers’ active surveillance of each other’s eating practices within the school. The change the teachers discussed did not seem to arise from a specific policy direction from the school, but rather from what our participants describe as a group decision to reduce “treats” or “junk” in the staff room. But here we do not have the perspective of the two teachers who used to bring treats every week, and whether or not they saw this change as positive. Sharon and Darlene suggest that these two colleagues have effectively been stopped in their unhealthy eating and feeding practices. The teachers also connect the issue of food, and presumably food monitoring, to gender. For Darlene, the fact that teachers are overwhelmingly women speaks to how preparation of and concern with food are very much part of women’s lives and responsibilities. Women’s responsibilities in promoting healthy eating for themselves and others are also implied in the participants’ comment.

The Body as a Weight-Loss Project Along with making decisions about the kinds of food that can be shared in the staff room, teachers also commonly engage in weight-loss contests among themselves. Norman, Rail, and Jette’s chapter illustrates the impact of weight-loss programs and normative healthist discourse though a critical analysis of Village on a Diet, a Canadian reality television series within the town of Taylor, BC. Similar body-surveillance and weight-loss projects occur across Canada in various contexts. Elementary schools participating in this study also hosted weight-loss challenges among staff. In two of the four schools, teachers noted a staff-organized weight-loss challenge. Christine recalls that a scale was

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brought into the staffroom the preceding year because teachers in her school had “something on the go, like, like the Biggest Loser type thing” (grade 2, site 3). The promotion of health was framed through weightloss programs and practices. Restricting eating practices and increasing physical activity were the two primary factors promoted, monitored, and in some cases regulated in the staff room. The ensuing health messages can provide constructive and supportive environments, but always in relation to the physical body. When health is discussed within a social context, the focus is on individualism and “good” practices. For example, teachers share information about walking or running groups formed at the school for staff by staff, and there seems to be an overwhelming amount of support for weight-loss endeavours. However, the group approach to “new” healthy behaviours people don’t seem to discuss the emotional connections to the body. Ursu l a : Last year a group of us started a walking group. So two or three times a week after school we would go for a walk around the community. I know this year there is a group of teachers doing the Biggest Loser like they do on TV … so it is, it is open. And we talk about it openly. If somebody lost weight you know people make an effort to congratulate them or whatever. (grade 4, site 4)

Weight loss is part of an open dialogue among participants and individual efforts to lose weight are noted, illustrating the pervasiveness of weight-related and body-based comments within school staff cultures. As in other locations, body-based comments are offered as forms of helpfulness and an everyday part of life. Teachers are part of a neoliberal culture that focuses on weight and weight-related practices as though these were healthy pursuits. The school staff room has thus become a place of health surveillance: teachers restrict the kinds of treats that staff eat, watch what others eat, organize walking and running groups, and engage in weight-loss ­contests. The staff room is at the heart of teachers’ self-monitoring and monitoring of each other’s appearance, body size, eating practices, and levels of physical activity. Practices of bodily scrutiny circulate openly in these spaces. Participants negotiate ideas about their bodies, in comparison to and in relation with their colleagues’ bodies. Moreover, teachers’ concerns about body and food reflect a particular middleclass “health conscious” ethos that seems very difficult to challenge.

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Our study therefore resonates with other studies of teachers’ experience of body and health surveillance and monitoring (Webb and Quennerstedt 2010; Webb, Quennerstedt, and Öhman 2008). Talk about body and appearance within the “health” rubric takes on particular importance among teachers who are expected to “embody” healthy practices as educators and role models (Webb and Quennerstedt 2010; Webb, Quennerstedt, and Öhman 2008). How are teachers’ concerns reflected in their views of, and interactions with, their students? Since teachers clearly show a range of affect in their relation to health, food, and the body, one wonders whether these feelings are mobilized in their teaching, as Leahy (2009) suggests. Negotiating Professional Practice: Teaching about Healthy Bodies Regardless of the specific dynamics occurring among staff, teachers see themselves as role models in school and beyond, particularly in small communities where they are very visible. Simultaneously, because teachers have to convey health knowledge through their professional endeavours, their personal and professional practices cannot be easily separated. The women in this study feel a personal and professional responsibility for constructing a positive, non-discriminatory environment for their students. They want to engage their students in emotional connections related to bodily knowledge so that discriminatory views of the fat body can shift beyond disgust, fear, or terror. Yet classrooms are only one environment within schools. Body attitudes in the playground, the hall, or the change room are sometimes beyond teachers’ scope (Gore 1998). In some ways these informal encounters become dominant sites of knowledge exchange and provide a rich environment for both the production and resistance to normative bodily knowledge (Evans et al. 2008). Alarmingly, teachers’ accounts of what they notice about students’ interactions show awareness of an informal curriculum that marks fat bodies as shameful. Linda : Ahh, we tend to notice that bigger kids won’t take their coats off, won’t take their sweatshirts off, that kind of thing – trying to hide, I guess. There’s some kids you know – a twelve year old can be a lot bigger than others. But they might all, you know, even out as they go through puberty. But, yeah, kids notice … and we got kids who won’t take off their sweatshirt or their coat off. IntE RVI E W E R: Do other kids pick up on it? That they’re doing ...

Elementary Teachers’ Response to Obesity Messaging  261 Linda : Yeah, they do. IntE RVI E W E R: And do you, do they ever say anything or …? Linda : They’ll say things but not for that person to hear. Like you’ll hear them in little conversations but not around that person. IntE RVI E W E R: Right. And is there any time that you think of – any situations where you’d have to sort of step in if someone made any comments to others about being a certain size? Linda : I would step in, but no, I haven’t had to. (grade 4, site 3)

Leahy (2009) notes that the potential impact of shame about bodies (the covering of the body) in relation to how young people might come to know and understand themselves requires recognition, especially how people in everyday life respond to pathological understandings of obesity. Pedagogies of shame, guilt, and disgust circulate within educational spaces, and processes of marginalization and discrimination of the fat body are visible, if not always confronted. In navigating the professional responsibility to educate others, teachers from each school emphasized their support of students in a “do no harm” approach. O’Dea in her review of child-obesity-prevention strategies, highlights the medical principle of “first, do no harm” (2005, 116). Children are entrusted to educators who will support and guide their learning and development. The use of common obesity-informed messaging in the school system assumes that teachers are capable of preventing obesity-related practices among children they teach. However, elementary teachers are also a force within many biocitizenry projects working to effect change in what some might call an obesogenic environment. Participants in our study indicate that they notice “big” students and their behaviours, but add they are very careful about their comments to students. Susan n e : I try to not mention size around children either. If I do say something, it’s like “nice haircut” or just try to emphasize that part of it. IntE RVI E W E R: Well, that’s what I was going to ask you about. Do you notice students based on their appearance? Nich o l e : Honestly, I look at a child who is really overweight and think that is really sad that child is so overweight. I would never mention it. Now, I don’t have anyone in my room right now that I really feel is like that. But a child that’s, let’s say obese, I would notice that. And I would think, someone’s got to intervene here. Parents have to look at what they are feeding their children or they’ve got to make sure their child is more

262  LeAnne Petherick and Natalie Beausoleil active. I would look at it from that point of view. And I have done that, but I would never vocalize that to a child. I have looked at children and said, “whoa – that child is too big.” I don’t know if that is right or wrong … I don’t ever recall anybody ever saying to a child, “you have to do something about that.” (grade 4, site 2)

Nichole emphasizes parents’ responsibilities for their children’s body size, nutrition, and levels of physical activity. She is careful not to “blame” an obese child for his or her size, though she finds that size problematic. While disgust is not mentioned, there is a call for someone to intervene. She is cautious about her own observation practices, but the call to help resonates loudly when an obese body is identified. Mitchinson, in this volume, outlines the socio-historical significance of mothering and how the cultivation of both a physical and social body implicates motherhood. Ward (2012) shows how mothers in particular are blamed and feel responsible for their children’s weight. In the following conversation, Ann focuses on parental responsibility for children’s healthy or unhealthy behaviours, in particular with regard to food. IntE RVI E W E R: Are you seeing that children are probably even more, sort of knowledgeable about nutrition, than their parents? Ann: They are taught it. But I don’t know, I don’t know the answer to that. I know in a lot of cases I’ve had parents say to me, “It’s cheaper to buy pop than it is milk.” And when you’re on a budget, what do you do? If you look at healthy food in comparison to, like, your fruit and vegetables, fresh stuff like, and compared to what you can get, a box of chips, say. They’re gonna go for what spreads their money around more. IntE RVI E W E R: Do you ever feel like you want to say something? If they [parents] say anything like that to you, or do you just listen and you don’t offer a comment or something? Ann: I offer a comment, but there’s really not a lot you can say if you know what kind of financial situation they are in. Because, really, I mean you can buy, say, three two-litres of pops for the price of one two-litre milk. (grade 4, site 3)

Ann in a rural location was aware of the social and economic realities of living in a rural coastal community where food security issues are associated with health practices. The story highlights the difficulties of

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always choosing the more “healthy” option. McPhail (2013) identifies how Newfoundland is constructed by government documents, policy, and messaging as a “problem population” (1). Dominant messaging suggests that Newfoundlanders are uneducated and do not care about their own health. Yet, McPhail exposes how this is not the case but rather a product of dominant ways of being taught about bodies and health. Ann’s narrative above points to a similar conclusion that individuals and families are not ignorant to the “healthiness” of their environments, but rather sometimes live in a location and situation where financial realities require immediate attention and nourishment is key to survival. Later in the same interview, Ann emphasizes how many teachers are mostly concerned with “kids who have nothing to eat” and “who come to school with no food.” Her understanding of how healthy practices are negotiated and acknowledgment of students’ social contexts are a reality of being an educative professional. Welch and Wright (2011) suggest that pre-service teachers’ reflections on their own experiences lead some to shift their view regarding the dominant obesity discourse. In addition to Welch and Wright’s observations about teachers’ reflections on their own lives, we suggest that teachers’ knowledge of students’ living conditions offer a potential for, at a minimum, rejecting a simplistic approach to thinking and teaching about health (see also Piran 2004). Teachers share how age and gender intersect in how students present themselves and respond to their bodily changes. For instance, teachers note that students’ concerns with appearance begin early but seem to peak in grade four and five. Overwhelmingly, teachers in this study identify concerns about femininity among increasingly younger girls. Teachers note that issues of femininity in particular can be “all consuming” or “elicit feelings of insecurity as girls try to relate to their bodies” or “it can be a scary time,” with girls feeling tremendous pressure to be pretty. The following teacher, Alyssa, typifies this concern: Alyssa : The girls – you know you can tell the very insecure ones. You know their feelings are changing. They don’t know, they don’t understand. And that’s when you see, see them kind of drift off, either one way or the other. You know and it’s – I dunno – a risk zone. I don’t know what way you’d like to put it. But when they’re heading into junior high they’re not quite sure who they are or if they feel good about themselves ... IntE RVI E W e r: Do you see it predominantly in girls?

264  LeAnne Petherick and Natalie Beausoleil Alyssa : Predominantly in girls. And it’s an undercurrent, you know like you don’t always hear it, you don’t always see it, and that’s when you see the mean words and the under, undercurrents of bullying. Sometimes, quite often. (grade 4, site 1)

Feminist scholars have demonstrated how the oppression and marginalization of girls occur through the shaming and objectification of their bodies (Larkin and Rice 2005; Rice 2007, 2009; Rice and Russell 2004). With puberty and adolescence – a crucial time for shaping girls’ social identity through bodily attributes – girls are stigmatized and experience considerable body embarrassment and shame. This teacher refers to the “risk zone” of puberty and adolescence presumably in reference to the oppression and marginalization of girls. But she also sees girls’ insecurity and body dissatisfaction before they reach junior high school. Moreover, she refers to “undercurrents of bullying” that call for an examination of the phenomenon of body-based harassment among students at school starting at a very young age (Larkin and Rice 2005). Through their narratives, female elementary teachers illustrate the range of affects connecting personal and professional relationships with bodies. The complex and intersecting factors of location, social class, gender, and the relationships with body shape and size both connect with health and cannot be underestimated within a school climate. Conclusion Our interviews reveal that teachers are caught between competing discourses of the healthy body and attempt to do the best they can to construct positive body cultures in their classrooms and in the school. We found that teachers aim to be biocitizens and fully embrace a “do no harm” approach to helping children achieve health. In an attempt to promote self-esteem, teachers try to keep their own body dissatisfactions separate from their relationships to students, and they also try to avoid “projecting” their understanding of the healthy body on their students. Dominant health messages seemingly promote narrow ideals about a healthy body and its appearance, which teachers feel obliged to challenge while also mediating a need to take care of the students they teach. As Elliott’s chapter in this book demonstrates, adults are considered at fault if they themselves are fat, but they are also responsible for children’s weight.

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Given the broader social pressures facing teachers and elementary children, a cross-curricular resource provides a means to shift the individualized approach to health to a more complex, social and relational approach; however, in this attempt greater attentiveness to the emotional aspects of health and body relations is needed. Supporting teachers in their efforts to confront and challenge dominant body-based relations is necessary to give them more freedom to actively resist dominant health activities. Broadening the notion of health to body shape and size is imperative for school environments to disrupt the normative ideals of “healthy bodies” that will shape everyday lives, social relations, and ultimately health. The affective turn highlights the continuum of body-based relations and how these are felt in different contexts and at different times. A continual identification of the factors that enable and constrain individuals’ abilities to make healthy choices may help address the dominant prescriptive approaches to obesity-related lifestyle change models, facilitating elementary teachers’ attempts to highlight the barriers that individuals encounter when trying to disrupt the moral assumptions circulating within obesity science. Teachers face incredible pressure, both personally and professionally, as they ascribe to and simultaneously challenge biocitizenry. In their own lives, participants work to be good, healthy citizens, but these embodied realities are different for everyone. Teachers navigate health messages and talk about learning to feel good in light of work demands and negative body-focused or body-related issues. In addition, teachers talk about the emotional aspects of health, illustrating the difficulties and rewards that come from the ongoing struggle to achieve a positive relationship with one’s body. Contradictory and competing ideas about health are entangled in teachers’ specific body experiences. In particular, their understandings of the complexities of students’ lives illustrate the broader community-relational aspect of health. The shifting nature of individual responsibility and community understandings is identified as teachers talk about the affective connection to the individual body and the bodies of their community. Foregrounding of the emotive component of body relations and the value of learning to feel good about the body is needed within school cultures from both an individual and community perspective . The curriculum resource Healthy Bodies Come in Different Shapes and Sizes provides an alternative to traditional health-promotion initiatives in schools in that it addresses weight-based practices. On the one hand, teachers acknowledge the impossibility of promoting narrow ideals of

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health to students and the desire to shift students’ sense of satisfaction with their bodies. On the other hand, teachers’ willingness to challenge the dominant health practices of their more private spaces within the school remains less of a concern. In other words, teachers value and acknowledge the complexity of the elementary students’ lives; however, the same complex understanding is pushed aside when they consider some of the practices upheld by their colleagues within the school environment. From an evaluative perspective, based on teachers’ communications about healthy bodies, we can infer that the resource might not push far enough to disrupt the body shaming and weight-based assumptions of health that continue to circulate within our society. However, we hope that raising public awareness of the devastating impacts of shame, guilt, and loathing about bodies will shift how communities respond to body-regulating practices. Because both teachers and students live within a culture emphasizing strict bodily ideals, the complexities of body-related health projects are never straightforward “successes.” Feelings of guilt, shame, and disgust circulate within broader social contexts, and these need to be critically interrogated and disrupted in school environments. In the name of health, many practices can be legitimated, but when we think more holistically about health, bodies, diversity, and difference can provide space for alternative ways of thinking about bodies and health. Challenging normative bodily practices and expectations leaves space for social and cultural change. Teachers do identify what we have called biocitizenry circulating within their schools. The seemingly culturally appropriate practices for the good of the staffroom or the promotion of group exercise and weight loss have regulatory and normalizing effects on teachers’ bodies and understandings of health. More opportunities are needed for teachers and students to think creatively and critically about how local and contemporary ideas about the value of bodies of various ages, shapes, and sizes affect the whole school community. It seems disingenuous to ask students to confront body-based discrimination (i.e., verbal harassment, wearing coats inside, feeling ashamed of their lunch) when similar practices occur in the more private spaces of the school (i.e., staffroom weigh-ins and restrictive food practices in the staffroom). Thinking creatively about how health is a relational concept and appreciating the value of local context can effect more positive body-based relations and provide an opportunity to promote an affective connectivity that transcends the physical body and invites a more complex, dynamic perspective of bodies and health.

Elementary Teachers’ Response to Obesity Messaging  267 WORKS CITED Beausoleil, Natalie. 2009. “An Impossible Task? Preventing Disordered Eating in the Context of the Current Obesity Panic.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 93–107. London: Routledge. Beausoleil, Natalie, and Pamela Ward. 2010. “Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy.” Radical Psychology: A Journal of Psychology, Politics, and Radicalism 8 (1). www.radicalpsychology. org/vol8-1/fatpanic.html. Body Image Network. 2009. Healthy Bodies Come in Different Shapes and Sizes. Department of Education, Newfoundland and Labrador. Bordo, Susan. 1993. Unbearable Weight: Feminism, Western Culture and the Body. Los Angeles: University of California Press. Burrows, Lisette. 2008. “‘Fit, Fast and Skinny’: New Zealand School Students ‘Talk’ about Health.” Journal of Physical Education New Zealand 41 (3): 26–36. – 2009. “Pedagogizing Families through Obesity Discourse.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 127–140. London: Routledge. – 2010. “Kiwi Kids Are Weet-bix Kids: Body Matters in Childhood.” Sport, Education and Society (15) 2: 235–51. Burrows, Lisette, and Jaleh McCormack. 2012. “Teachers Talk about Health, Self and the Student Body.” Discourse (Abingdon) 33 (5): 729–44. http:// dx.doi.org/10.1080/01596306.2012.696502. Burrows, Lisette, and Jan Wright. 2004a. “The Discursive Production of Childhood, Identity and Health.” In Body Knowledge and Control: Studies in the Sociology of Education and Physical Culture, ed. John Evans, Brian Davies, and Jan Wright, 83–95. London: Routledge. – 2004b. “The Good Life: New Zealand Children’s Perspectives of Health and Self.” Sport Education and Society 9 (2): 193–205. http://dx.doi.org/10.1080/ 1357332042000233930. Burrows, Lisette, Jan Wright, and Jaleh McCormack. 2009. “Dosing Up on Food and Physical Activity: New Zealand Children’s Ideas about Health.” Health Education Journal 68 (3): 157–69. http://dx.doi. org/10.1177/0017896909339332. Canadian Association for School Health. 2013. CSH Consensus Statement. http://www.cash-aces.ca/index.asp?Page=Consensus. Accessed 16 February 2013. Cliff, Ken, and Jan Wright. 2010. “Confusing and Contradictory: Considering Obesity Discourse and Eating Disorders as They Shape Pedagogies in

268  LeAnne Petherick and Natalie Beausoleil HPE.” Sport Education and Society 15 (2): 221–33. http://dx.doi. org/10.1080/13573321003683893. Crawford, Robert. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services 10 (3): 365–88. http://dx.doi. org/10.2190/3H2H-3XJN-3KAY-G9NY. Evans, John, Emma Rich, Brian Davies, and Rachel Allwood. 2008. Education, Disordered Eating and Obesity Discourse: Fat Fabrications. London: Routledge. Fraser, Suzanne, Jane Marie Mahera, and Jan Wright. 2010. “Between Bodies and Collectivities: Articulating the Action of Emotion in Obesity Epidemic Discourse.” Social Theory & Health 8 (2): 192–209. http://dx.doi.org/10.1057/ sth.2009.28. Fraser-Thomas, Jessica, and Charlotte Beaudoin. 2002. “Implementing a Physical Education Curriculum: Two Teachers’ Experiences.” Canadian Journal of Education 27 (2): 249–68. http://dx.doi.org/10.2307/1602223. Gore, Jennifer. 1998. “Disciplining Bodies: On the Continuity of Power Relations in Pedagogy.” In Foucault’s Challenge: Discourse, Knowledge and Power in Education, ed. Tom Popkewitz, 231–51. New York: Teachers’ College Press. Halse, Christine. 2009. “Bio-Citizenship: Virtue Discourses and the Birth of the Bio-citizen.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 45–59. London: Routledge. Humberstone, Barbara, and Ina Stan. 2011. “Health, (Body) Image, and Primary Schooling: ‘Why Do They Have to Be a Certain Weight?’” Sport Education and Society 16 (4): 431–49. http://dx.doi.org/10.1080/13573322 .2011.589641. Kater, Kathy, John Rohwer, and Karen Londre. 2002. “Evaluation of an Upper Elementary School Program to Prevent Body Image, Eating and Weight Concerns.” Journal of School Health 72 (5): 199–204. http://dx.doi. org/10.1111/j.1746-1561.2002.tb06546.x. Larkin, June, and Carla Rice. 2005. “Beyond ‘Healthy Eating’ and ‘Healthy Weights’: Harassment and the Health Curriculum in Middle Schools.” Body Image 2 (3): 219–32. http://dx.doi.org/10.1016/j.bodyim.2005.07.001. Leahy, Deanna. 2009. “Disgusting Pedagogies.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 171–82. London: Routledge. LeBesco, Kathleen. 2004. Revolting Bodies? The Struggle to Redefine Fat Identity. Amherst: University of Massachusetts Press. MacNeill, Margaret, and Genevieve Rail. 2010. “The Visions, Voices and Moves of Young ‘Canadians.’” In Young People, Physical Activity and the

Elementary Teachers’ Response to Obesity Messaging  269 Everyday, ed. Jan Wright and Doune Macdonald, 175–93. London: Routledge. McPhail, Deborah. 2010. “‘This Is the Face of Obesity’: Gender and the Production of Emotional Obesity in 1950s and 1960s Canada.” Radical Psychology 8 (1). http://www.radicalpsychology.org/vol8-1/McPhail.html. McPhail, Deborah. 2013. “Resisting Biopedagogies of Obesity in a Problem Population: Understandings of Healthy Eating and Healthy Weight in a Newfoundland and Labrador Community.” Critical Public Health 23 (3): 289–303. http://dx.doi.org/10.1080/09581596.2013.797566. Mikkonen, Juka, and Dennis Raphael. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. http://www.thecanadianfacts.org/The_Canadian_Facts.pdf. Monaghan, Kelly. 2010. “The Oeuvre of Risk in Health Promotion: A Reflexive Metatheoretical Critique.” Doctoral diss., Memorial University of Newfoundland. Norman, Moss Edward. 2011. “Embodying the Double Bind of Masculinity: Young Men and Discourses of Normalcy, Health, Heterosexuality, and Individualism.” Men and Masculinities 14 (4): 430–49. http://dx.doi.org/ 10.1177/1097184X11409360. O’Dea, Jennifer. 2005. “Prevention of Child Obesity: ‘First Do No Harm.’” Health Education Research 20 (2): 259–65. http://dx.doi.org/10.1093/her/ cyg116. Petherick, LeAnne. 2013. “Producing the Young Biocitizen: Secondary School Students’ Negotiation of Learning in Physical Education.” Sport, Education and Society (18) 6: 711–30. Petherick, LeAnne, and Natalie Beausoleil. 2015. “Female Elementary Teachers’ Biopedagogical Practices: How Health Discourse Circulates in Newfoundland Elementary Schools.” Canadian Journal of Education 38 (1): 1–29. http://www.cje-rce.ca/index.php/cje-rce/article/view/1428. Piran, Neva. 2004. “Prevention Series,.” Eating Disorders: The Journal of Treatment and Prevention 12 (1): 1–9. http://dx.doi. org/10.1080/10640260490267724. Pringle, Richard, and Dixie Pringle. 2012. “Competing Obesity Discourses and Critical Challenges for Health and Physical Educators.” Sport Education and Society 17 (2): 143–61. http://dx.doi.org/10.1080/13573322.2011.607947. Rail, Genevieve. 2009. “Canadian Youth’s Discursive Constructions of Health in the Context of the Obesity Discourse.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 141–56. London: Routledge.

270  LeAnne Petherick and Natalie Beausoleil Rail, Geneviève, David Holmes, and Stuart J. Murray. 2010. “The Politics of Evidence on ‘Domestic Terrorists’: Obesity Discourse and Their Effects.” Social Theory & Health 8 (3): 259–79. http://dx.doi.org/10.1057/sth.2009.10. Rice, Carla. 2007. “Becoming the ‘Fat Girl’: Acquisition of an Unfit Identity.” Women’s Studies International 30 (2): 158–74. http://dx.doi.org/10.1016/ j.wsif.2007.01.001. – 2009. “Exacting Beauty: Exploring Women’s Body Projects and Problems in the Twenty-First Century.” In Feminist Issues: Race, Class and Sexuality, ed. Nancy Mandell, 131–60. Toronto: Pearson. Rice, Carla, and Vanessa Russell. 2004. “Embodying Equity: Creating a Space for the Body in Equity Education.” Orbit (Amsterdam, Netherlands) 34 (1): 19–20. Rich, Emma, and Lisa Michelle Perhamus. 2010. “Health Surveillance, the Body and Schooling.” International Journal of Qualitative Studies in Education : QSE 23 (7): 759–64. http://dx.doi.org/10.1080/09518398.2010.529475. Rose, Nikolas. 1999. Powers of Freedom: Reframing Political Thought. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511488856. Shilling, Chris. 2010. “Exploring the Society-Body-School Nexus: Theoretical and Methodological Issues in the Study of Body Pedagogics.” Sport Education and Society 15 (2): 151–67. http://dx.doi. org/10.1080/13573321003683786. Stephenson-Herr, Rebecca, and Sarah Banet-Weiser. 2007. “Super-Sized Kids: Obesity, Children, Moral Panic, and the Media.” In The Children’s Television Community, ed. J. Allison Bryant, 227–91. London: Lawrence Erlbaum. Sykes, Heather, and Deborah McPhail. 2007. “Unbearable Lessons: Contesting Fat Phobia in Physical Education.” Sociology of Sport Journal 25: 66–96. Walkerdine, Valerie. 2009. “Biopedagogies and Beyond.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 199–207. London: Routledge. Ward, Pamela. 2012. “Exploring the Role of Discourse in the Emerging Identities of Children Enrolled in an Obesity Treatment Program.” Doctoral diss., Memorial University of Newfoundland. Webb, Lousia, and Mikael Quennerstedt. 2010. “Risky Bodies: Health Surveillance and Teachers’ Embodiment of Health.” International Journal of Qualitative Studies in Education : QSE 23 (7): 785–802. http://dx.doi.org/ 10.1080/09518398.2010.529471. Webb, Louisa, Mikael Quennerstedt, and Marie Öhman. 2008. “Healthy Bodies: Construction of the Body and Health in Physical Education.” Sport Education and Society 13 (4): 353–72. http://dx.doi.org/10.1080/ 13573320802444960.

Elementary Teachers’ Response to Obesity Messaging  271 Weedon, Chris. 1997. Feminist Practice and Poststructural Theory. Cambridge: Blackwell. Welch, Rosie, Samantha McMahon, and Jan Wright. 2012. “The Medicalization of Food Pedagogies in Primary Schools and Popular Culture: A Case for Awakening Subjugated Knowledges.” Discourse (Abingdon) 33 (5): 713–28. http://dx.doi.org/10.1080/01596306.2012.696501. Welch, Rosie, and Jan Wright. 2011. “Tracing Discourses of Health and the Body: Exploring Pre-service Primary Teachers’ Construction of ‘Healthy’ Bodies.” Asia-Pacific Journal of Teacher Education 39 (3): 199–210. http:// dx.doi.org/10.1080/1359866X.2011.588310. Wright, Jan. 2009. “Bio-power, Biopedagogies and the Obesity Epidemic.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 1–14. London: Routledge. Wright, Jan, Gabrielle O’Flynn, and Doune Macdonald. 2006. “Being Fit and Looking Healthy: Young Women and Men’s Constructions of Health and Fitness.” Sex Roles 54: 707–16. http://dx.doi.org/10.1007/s11199-006-9036-9. Youngblood Jackson, Alecia. 2001. “Multiple Annies: Feminist Post-structural Theory and the Making of a Teacher.” Journal of Teacher Education 52 (5): 386–97. http://dx.doi.org/10.1177/0022487101052005005.

10 Find Your Greatness: Responsibility, Policy, and the Problem of Childhood Obesity Cha rlene Elliot t

“Greatness. It’s just something we made up. Somehow we’ve come to believe that greatness is a gift reserved for a chosen few. For prodigies, for superstars. And the rest of us can only stand by watching. You can forget that.”

So begins Nike’s “Jogger” commercial, one of a series of advertisements in the company’s “Find Your Greatness” campaign that was launched during the 2012 summer Olympics. The campaign sought to celebrate “every single person in sport, everyday athlete and professional alike, who push their limits to achieve new goals” (Leftfoot 2012). Yet the Jogger commercial is unique: its sixty-second spot features a lone child – twelve years old, five foot three inches, and two hundred pounds – jogging with great effort down a country road at dawn. As the boy slowly approaches the camera, the voiceover concludes, “Greatness is no more unique to us than breathing. We’re all capable of it. All of us.” Nike’s commercial immediately seized popular and media attention. Views on YouTube have topped 1.7 million, with the accompanying comments being overwhelmingly positive. Viewers found it “inspirational” and “epic” – even “life changing” – although the commercial was not without controversy. A writer on the popular website Jezebel quipped that “Nike Uses Fat Kid to Sell Shoes, Nation Rejoices” (West 2012) while the Huffington Post featured a commentary by David Katz, editor of the journal Childhood Obesity, observing how Nike “went down the wrong road” to greatness by actually propagating obesity stigma rather than remedying it (Katz 2012). A Washington Post headline questioned, “Is the Nike Olympics ‘Greatness’ Ad Great?” (D’Arcy 2012) while Time magazine queried, “Does Nike’s ‘Greatness’ Ad

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Figure 11.  Still from “Find Your Greatness” advertisement, Nike

Exploit Fat People?” In the article, journalist Bonnie Rochman pondered: “Was this an attempt to tackle the stigma surrounding childhood obesity … or was it a publicity stunt?” (Rochman 2012). My interest in Nike’s “Jogger” commercial does not reside in this “inspiring vs. exploited” debate. Rather, I am interested in how the ad provides a foil to explore – and trouble – the dominant themes circulating when it comes to broader questions of childhood obesity, consumer responsibility, and policy in Canada. In particular, I use Nike’s commercial featuring twelve-year-old Nathan Sorrell, along with its popular and media response, as a platform for discussing the multiple, and ­often tricky, themes and actions related to childhood obesity, food marketing, and policy. Such themes pertain to consumerism and commercialization, freedom and protection, responsibility and irresponsibility, agency – and even greatness. Since childhood obesity is generally framed as a social problem, examining these themes, initiatives, and the assumptions behind them will help to illuminate how the obese child is situated (as a consumer and an individual) and what this means for rethinking fat politics in Canada.

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Commercial(ization)/Consumerism The starting point for understanding Nike’s “Jogger” commercial is to recognize it for what it is: a commercial. As such, the basic answer to the question Rochman posed in Time magazine – “Was this an attempt to tackle the stigma surrounding childhood obesity … or was it a publicity stunt?” – is that it’s neither. It was an attempt to sell Nike products. Nike, Inc., in keeping with emotional branding techniques, sought to create an inspirational message in order to promote brand loyalty as a way to retain and grow market share (i.e., to sell goods) (Thomson, MacInnis, and Park 2005). With 31.5 per cent of Canadian children overweight or obese (Statistics Canada 2012), the question of childhood obesity in Canada similarly cannot be viewed in isolation from the commercial environment (and corporate players) that work to promote food consumption to children. The corporate mandate to grow profits for shareholders has meant the food industry needs to continuously create new products and eating occasions. As Raj Patel details, the oligopoly that is the food industry has transformed what we eat, how we eat it, and what we think of food (Patel 2012). This means not only promoting occasions to eat via the promotion and normalization of snacking, on-the-go eating, and all-the-time eating, but also creating entirely new categories of food (such as specific packaged food products intended for consumption by toddlers, children, tweens, teens, and so on). The resulting food environment has been variously called “toxic” (Brownell and Horgen 2004), “obesogenic” (Swinburn, Egger, and Raza 1999), and even an “eat more environment” (Nestle and Nesheim 2012) by public health advocates because of the ways that it promotes constant eating, typically of highly processed food, junk food, and fast food. Indeed, a recent (controversial) commentary published in the Canadian Journal of Cardiology pushes this nomenclature one step further, advocating for a language that “fits the risk” of the high-sugar, high-salt, and high-fat foods being sold to Canadians (Campbell, Raine, and McLaren 2012). Such processed foods should no longer be labelled “junk” foods, the authors argue, since “‘junk’ connotes a certain ease in removing them from the diet” (403), but instead should be identified as pathogenic foods. Regardless of the nomenclature, the recognition that childhood obesity is bound up with commercial products and the selling of processed foods is commonplace. It is the very attempts by brands to foster an emotional attachment to, say,

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Twinkies or Pop Tarts (rather than sneakers) in light of childhood obesity that sets the stage for policy intervention and discussion. As Steven Kline (2011) has observed, childhood obesity is promotional culture written on the child’s body. Nike’s “Jogger” commercial, then, presumably starts with the evidence of successful food promotion already “written” on Nathan’s two-hundred-pound body – although the inspirational message of “Find Your Greatness” does not ask viewers to question how he got to that size in the first place. As one person wryly observed about the debate over whether Nike was exploiting an obese child to sell sneakers, “McDonald’s exploited him first, and nobody cared then” (cnote306 2012). Freedom/Protection Of course, people do care whether children are being exploited, which sets up a completely different framework for understanding how to deal with the issue of food promotion and obesity. Typically, public health discourse surrounding obesity is disciplinary, urging individuals to self-monitor and regulate (LeBesco 2010). Media reinforce this discourse via their tendency to provide individual-level explanations (Wallack 1990) to public health problems and to highlight “symptoms and personal failures” rather than causes and social conditions (Wallack 1990, 42). Public attitudes on obesity also reinforce this in regarding obesity “primarily as a case of individual moral failure rather than the result of the food environment or genetics” (Oliver and Lee 2005, 925). Yet it must be emphasized that this “responsibilization” frame is   reserved for adults, in which obesity as a problem of individual behaviour (Lawrence 2004) is “solved” by self-discipline and self-surveillance. Children represent an utterly different category – a social responsibility (Elliott 2009). As Gleason’s (2005) work on the “public child” in Canada details, a “recognizable sense of community responsibility” for children’s well-being was firmly in place by the late 1940s. Such notions of the public child partly explain why childhood obesity is consistently understood as a public and social problem, rooted in a host of parental, public policy, and environmental failures that are not of the child’s own making (Elliott 2009). So while the media and popular discourse around adult obesity underscores personal responsibility (Elliott 2007; Oliver and Lee 2005), discussions of childhood obesity emphasize the collective: it is always childhood obesity. Even feminist scholars seeking to

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redefine the terms of fat politics by providing strategies to “reclaim one’s fatness” (Murray 2005) – an individual initiative – have remained silent on what an overweight child might do in such reclaiming. Are the strategies the same? Or different? Our public responsibility for (and to) overweight children has thus prompted a series of initiatives that seek to protect them from the commercial, obesogenic, “eat more” environment in which they reside. Food marketing to children has come under particular scrutiny, with recommendations from the World Health Organization (among others) to limit the promotion of high-sugar, high-fat, and/or high-salt foods to children (WHO 2010). And these recommendations seem just: as Saguy and Almeling (2008) observe in their study of the American news media’s treatment of the obesity epidemic, “discussion of public policy solutions was especially common when children were mentioned” (71). Public opinion in Canada also supports this. A recent survey of 1,222 Canadians found that 60 per cent “strongly support” restricting “the marketing of unhealthy foods and beverages to children” (Ipsos Reid 2011). Such food marketing is sometimes broadly conceived. For example, in December 2011, San Francisco passed an ordinance that prohibited McDonalds from providing free toys in their Happy Meals, which did not meet specific nutritional standards. City councillors and advocates of the ban claimed that the toys were a form of manipulation. As food author, activist, and professor of nutrition Marion Nestle argued, “the toys are the only reason kids want Happy Meals and the only reason parents buy them” (Strom 2011). The previous year, the lobbyist group Center for Science in the Public Interest had filed a lawsuit against McDonald’s and their Happy Meals in California seeking to ban the “predatory” and unscrupulous practice of “marketing directly to unsuspecting little children by offering appealing toys.”1 (The lawsuit was dismissed in 2012.) Even Sesame Street’s Cookie Monster has been caught up in the food-promotion fray, critiqued for encouraging children to desire foods of poor nutritional quality. As such, Cookie Monster changed his popular “C is for Cookie” mantra in 2005 to instruct that “A Cookie is a Sometimes Food.” 2 In Canada, the most focused initiatives that seek to protect children from the commercial “eat more” environment are the industry-driven Children’s Food and Beverage Advertising Initiative (CAI) launched in 2007 and, specific to Quebec, the Consumer Protection Act, which has prohibited all commercial advertising to children under age thirteen

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since 1980. It is important to underscore that both the industry-driven CAI and Quebec’s Consumer Protection Act recognize that advertising to children is a problem, although in different ways. With the Children’s Food and Beverage Advertising Initiative, eighteen of Canada’s leading food and beverage manufacturers have committed to either not directly advertise to children under age twelve or to promote only “healthier dietary choices” (CAI 2015). The initiative is framed as a response to the “serious and complex global issue” of childhood health and obesity (Advertising Standards Canada [ASC] 2015) and currently covers food and beverage advertising on television, radio, in print and on the Internet, along with video and computer games, DVDs of G-rated movies, and mobile media advertising primarily directed to children under age twelve. CAI’s stated “vision” is to market “products to Canadian children in a responsible way to help prepare them to make wise decisions about nutrition and health” (ASC 2015, 1). However, participating members create their own nutritional criteria for what counts as “better for you.” Under these criteria, Kool-Aid Jammers, Dunkaroos cookies, and Fruit Gushers fruit snacks, along with Frosted Flakes, Lucky Charms, Reese Puffs, and Froot Loops cereal, have been advertised as “healthier dietary choices” to children (Elliott 2012). While one might reasonably query how promoting cookies and marshmallow-laden cereals as healthy dietary choices helps to prepare children to “make wise decisions about nutrition” (as per CAI’s “Vision”), the implications of the CAI extend beyond this, which I shall take up shortly. In stark contrast to the CAI, which frames the marketing of “betterfor-you” food products to children as a part of virtuous and “dedicated” corporate-driven “journey” (ASC 2015) that both protects kids from the dangers of poorly nutritious food while empowering them to make wise choices, the Quebec ban takes a hard line on advertising to children. Commercial advertising to children under age thirteen in Quebec is verboten based on the premise that it is inherently manipulative, irrespective of the types of products being promoted. Although this restriction was implemented in 1980, the logic behind the ban was explicitly articulated nine years later by no less than the Supreme Court of Canada when a toy company took the Province of Quebec to court. Irwin Toy argued that sections 248 and 249 of Quebec’s Consumer Protection Act – which blocked advertising of toys (and other commercial goods) to children – violated its freedom of expression. The Supreme Court disagreed. Its decision in Attorney General of Québec v. Irwin

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Toy Ltd (1989) observed that the legislation’s purpose “is for the protection of a group which is particularly vulnerable to the techniques of seduction and manipulation abundant in advertising.”3 In its eightynine-page ruling, the Supreme Court referred to a 1981 US Federal Trade Commission’s report pertaining to children’s advertising, which concluded that young children (ages two to six) place “indiscriminate trust in the selling message” of child-oriented television advertising (988). The Supreme Court observed that the FTC report “provides a sound basis on which to conclude that television advertising directed at young children is per se manipulative. Such advertising aims to promote products by convincing those who will always believe” (988). The Supreme Court then proceeded to extend the report’s conclusion to advertising aimed at older children, suggesting that consumer protection legislation is not “obliged to confine itself solely to protecting the most clearly vulnerable group” (989), that is, very young children. In reviewing the evidence, the court opined that “on the balance of probabilities,” children under age thirteen are manipulated by commercial advertising. Moreover, the ban had no evident “deleterious effects” on companies, since the law implies only “that advertisers will have to develop new marketing strategies for children’s products.” Advertisers, the court opined, “are always free to direct their message at parents and other adults. They are also free to participate in educational advertising.” Since this ruling, advertisers have indeed developed new marketing strategies for children’s products. However, the strategies are not necessarily what the Supreme Court intended, and over the past few years – in light of rising concerns over childhood obesity – several food companies have been taken to court for violating the ban. In 2009, Saputo was fined forty-four thousand dollars for distributing icing-filled “Igor cakes” and merchandise in daycare centres (effectively advertising to preschoolers) (Hamilton 2009); General Mills pled guilty for advertising to children on their Lucky Charms website (featuring Lucky the Leprechaun) (Pole 2009); and Burger King was fined twelve thousand dollars for including advertising messages with the free toys found in children’s meals sold in the fast food chain (Young 2009). The point of detailing the CAI initiative and the Quebec ban on commercial advertising to children is to draw attention to their two opposing frameworks for dealing with “responsibility” when it comes to food marketing to children. Quebec’s understanding of the vulnerable, trusting, and easily manipulated child stands as the powerful

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organizing logic driving the need for protection from food (and other) advertisers. This framework corresponds with what Alan Hunt outlines as the typical treatment of children in a risk society, namely that adults view children as “a special category of ‘innocents’” (2003, 174). Protecting children is not merely an individual anxiety, but a shared one (what Hunt deems a social anxiety). Such anxiety has “significant practical consequences”: it “not only gives rise to specific conduct” (i.e., actions on the part of protective parents) “but also leads to the launching of regulatory projects” (174). For Hunt, “risk” in contemporary society is understood in a particular way that generally conflates it with “anxiety” and has “safety” or “security” as its particular endpoint (174). Viewed in light of the Quebec ban on commercial advertising to children and the problem of childhood obesity, the risk becomes the manipulation of innocent children into desiring, pestering their parents for, and ultimately consuming highly processed fast food/junk food that will compromise their health. The concomitant social anxiety is over childhood obesity and its health implications, buoyed both by media reports lamenting the state of our children’s health and governmental reports similar to the Healthy Weights for Healthy Kids report issued by Canada’s House of Commons Standing Committee on Health in 2007 (House of Commons 2007). In Healthy Weights for Healthy Kids, the committee opens by pointing to the well-documented “range of preventable chronic diseases and premature death” associated with overweight and obesity in today’s children. It somberly claims to share “the fears of many experts who predict that today’s children … will have poorer health outcomes and a shorter life expectancy than their parents” due to obesity (1). Indeed, this type of dire rhetoric has been labelled “shrill” by some scholars, who assert that the warning that children may die younger than their parents is a type of “rhetorical virus” (Gard 2010, 7; also see Gard’s chapter in this book). Due to its dramatic effect, this rhetorical virus spreads and is repeated “in scientific journal articles, popular books, newspapers, [and] television news bulletins” (2010, 7). Shrill or not, such discursive constructions certainly function to heighten anxiety in parents (and policy makers) on behalf of children. In this regard, the Quebec ban represents a formal regulatory project that – to reprise Hunt – aims to safeguard or provide security to children vulnerable to the persuasive appeals of food marketers. In this framework, responsibility resides in the hands of bureaucrats, lobbyists, and policy makers – that is, in the hands of adults, who need to protect children.

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The CAI, in contrast, provides a tiered sense of responsibility when it comes to children and food marketing, which is a neoliberal model with a bit of a twist. In committing to either not market food to children under age twelve or to market only “healthier” dietary choices, the CAI tacitly acknowledges that food advertising to children is, in fact, a problem. Stated differently, the food industry can no longer skirt around the reality that childhood obesity is an “issue” in which they play a part. Hainsworth (1990) defines an “issue” as “a point of conflict between an organization and one or more of its publics … [that] arises as a consequence of some action taken, or proposed to be taken, by one or more of these parties” (33). In this case, the food industry’s promotion of poorly nutritious products to children, publicly understood as contributing to childhood obesity, is the issue at stake. By affirming that they will not advertise or will promote only healthier dietary choices to children, CAI participants such as PepsiCo (Canada), McDonald’s (Canada), and General Mills Canada Corporation position themselves as responsible, caring corporate citizens. Simultaneously, CAI par­ ticipants seek to militate against government intervention in their food-promotion efforts by arguing that regulatory action remains unnecessary, since they have already taken steps to address the issue. Under the CAI, the “risk” that food marketing presents to children is resolved in a fashion that suggests it is not a crisis. But this is not accomplished by banning all advertising to vulnerable children like Quebec does; rather, it is achieved by restricting advertising for “bad” food and promoting “better” products to Canadian children “in a responsible way to help prepare them to make wise decisions about ­nutrition and health” (CAI 2015, 1). Such language – emphasizing “responsible” advertising that helps children “make wise decisions” – is significant because it simultaneously positions the food industry as responsible for children while consigning actual responsibility for health to children themselves. Advertising “better-for-you” products such as Dunkaroos and Froot Loops in order to help children wisely take care of their health isn’t about protecting children from advertising’s influence per se. Rather, it employs a frame akin to what Karpf (1988) has identified as the “look after yourself” approach or what Miller and Rose (2008) consider to be the “self-policing” required of the responsibilized subject. And yet, this is not exactly the same as the neoliberal ideologies that “incite good citizens to take care of their own health” (LeBesco 2010, 78) by making proper choices. Although the mechanisms of responsibilization “demand that we make [choices] in a

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context that requires us to treat our lives as a project over which we should exercise a deliberate and long-term calculative effort” (Hunt 2003, 169), children still need help. They cannot be expected to understand long-term consequences of immediate choices. Therefore, the CAI limits children’s choices to certain choices, specifically to the “better-­for-you” ones (2015). The inherent contradiction is that the CAI’s limit on advertising for “bad” foods suggests that kids are vulnerable and in need of protection from advertising while at the same time suggesting that children are responsible and able to make wise decisions about nutrition. Responsibility/Irresponsibility Detailing the (duelling) strategies to combat childhood obesity when it comes to food promotion – one embodied by the Quebec protectionist stance and the other by CAI’s “choice within limited choices” model – does not tie up the freedom/protection theme into a neat little bow. The situation is far more complex than that, in part because both strategies remain silent on what happens once children reach the age of thirteen. The Quebec ban, which some advocates frame as Canada’s most progressive legislation around food marketing, suggests it is manipulative and exploitative to target children up to the end of age twelve.4 The CAI identifies age twelve as the expiry date for limiting promotions to only “better-for-you” products. Thirteen-year-olds, we might thus presume, should be responsible for their consumption choices since the age cut-off implicitly suggests that one graduates from the “limited freedom versus protection” frame to greater responsibility and agency. This increasing responsibility represents a “double movement between collective and individual responsibility” that involves “an increased space for individuals to acquire the capacities of self-regulating subjects” (Rous and Hunt 2004, 33). This is not to suggest that agency doesn’t exist with younger children. “Pester power” and the “nag factor” (marketing strategies that encourage children to pester their parents to buy goods) certainly communicate that children have power when it comes to influencing consumption choices. Such agency is also affirmed by marketing books like James McNeal’s On Becoming A Consumer (2007), which argues that ­enculturation of our children is “mainly teaching them consumer behavior patterns” (McNeal 2007, xvii) (i.e., agency is tied to the ability to choose). Daniel Cook’s analysis of the rise of the child consumer

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similarly affirms that “children’s participation in the world of goods as actors, as persons with desire, underpins their current emergent status as rights-bearing individuals” (Cook 2004, 12). Yet – even in light of this affirmation of the agency and rights of the child – there is something slightly uncomfortable about accepting that a thirteen-year-old should shoulder the burden of the “right” to the (sometimes weighty) consequences of relentless food promotion. Part of this discomfort might reside in how our society deals with the problem of childhood obesity. Mothers are often blamed for their child’s atypical embodiment (Saguy and Almeling 2008), a sentiment both noted and explored in this book by Mitchinson, who probes the “mother blaming” in obesity discourse in Canada. (See also Norman, Rail, and Jette’s chapter, which observes that mothers, in particular, are made responsible for the problem of childhood obesity.) This mother blaming is linked, in part, to the fact that women continue to act as the primary food provisioners: their efforts in the kitchen are viewed as an important indicator of motherliness (Bugge and Almas 2006), just as providing meals is seen as an act of caring for the family. Since mothers are regarded as the primary gatekeepers when it comes to food, they are typically held responsible for children who display the excesses of food consumption on their bodies. But where does the mother’s “responsibility” for this end and children’s responsibility begin? If children are understood to have agency, as both the marketers and cultural theorists affirm (Buckingham 2000), how far does that agency reach when it comes to issues of marketing and childhood obesity – and to what extent should it be applied? Once again, returning to Nike’s Jogger commercial can productively illuminate these points for consideration. It is no coincidence, I suggest, that the obese child featured in Nike’s advertisement is twelve years old – which is the precise “expiry” age of the CAI and Quebec ban. If such initiatives are considered instructive, this is the point at which children start to assume responsibility (rather than making choices within limited choices) and take up what Karen Smith positions as “the relatively novel conception of children as ‘competent social actors’” (2011, 29). I suggest that age twelve is the starting point for such competency, as Nike’s Jogger commercial underscores. To reprise the advertisement, Nathan, a two-hundred-pound boy, treads slowly down a country road as a voiceover speaks about “greatness” and the fact that “we’re all capable of it.” Viewers are to be inspired by this commercial, and Nathan’s age factors strongly in this. None of the popular or media commentary on the commercial raises

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any questions about where Nathan’s mother is, or about his safety in jogging all alone on a road at dawn (this certainly might cross a viewer’s mind should Nike have featured an eight-year-old child). Nor was the commentary disparaging about the fact that Nathan himself was obese, which would have been more likely had the ad featured an ­eighteen-year-old, since adults are considered to be “responsible” for their consumption choices (Berlant 2010; Elliott 2007; LeBesco 2010; Murray 2005). Instead the critique centred on Nike’s casting of an obese child: that is, the critique focused on the company, not the child. Nestled somewhere between the concern we might feel over seeing an obese eight-year-old and the critique that seems yoked to representations of obese adults is the potential of twelve-year-old Nathan – and that is what Nike taps into to make the commercial inspiring. Nathan is old enough to perform the role of competent social actor. His solitary jog at dawn represents the ethos of taking responsibility for one’s own health – even though he is young enough that we do not blame him for being that size in the first place. Nathan represents potential. As a foil for understanding the relationship between children, obesity, and (food) promotion, Nathan embodies the point where the “protection” offered by the CAI or the Quebec ban ends and the individual is expected to assume personal responsibility. Nathan embodies the threshold at which the social problem of childhood obesity gets recast as an individual lifestyle choice. At twelve, it is certainly not Nathan’s fault that he is obese. However, his solitary jog represents his ownership of the problem, and this ownership is positioned as a movement towards greatness. As Poland argues, “the ethos of ‘taking responsibility for one’s actions’ functions as a sort of internalized policing and self-control in accordance with dominant values and discourses that in effect legitimate and reproduce the social order” (2000, 6). Nike’s commercial seems to represent the start, the kick-off to this self-control. Taking responsibility, it suggests, is the first step to greatness. Greatness Although this chapter focuses on childhood obesity, promotion, and policy, the lofty theme of “greatness” is, perhaps strangely, an important component. Initiatives that seek to protect children from food advertising because of its obesogenic and negative health outcomes are ultimately about protecting children’s potential – about honouring who children are and what they should (hopefully and healthfully) become.

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Similarly, the viewers, bloggers, posters, and journalists who found Nike’s commercial inspirational were not merely focused on who Nathan was, but also on who he might become. Two critical strategies for creating emotional brand attachment in people are at play in Nike’s ad, focused on both the consumer’s actual self and his or her ideal self. Typically, advertisers seek to persuade by foregrounding how a product will bring consumers closer to “achieving an ideal vision of themselves (an ‘ideal self’)” (Malär et al. 2011, 35). Alternatively, advertisers might present products that harmonize with “how the majority of consumers actually see themselves (an ‘actual self’)” (35). Yet given the obesity epidemic in adults and children, Nathan’s Jogger commercial speaks to both the actual self and the ideal self of many viewers. Several YouTube viewers of the commercial posted how the ad inspired them to go out and jog despite being markedly out of shape; the general sentiment was “If he can do it, so can I” (the actual self). Yet I suggest that the commercial also embraces the ideal self because the “greatness” is not simply that obese Nathan is becoming better in the moment (the fact that he is out running represents an act of greatness). Greatness also resides in the fact that he is taking steps towards an even better Nathan. The commercial is compelling because it represents the “body in transition” that Samantha Murray (2005) deems is expected of overweight people. Fat bodies represent the “failed body project,” Murray avers. The fat body “exists as a deviant, perverse form of embodiment” and is rejected for its aesthetic transgressions (154). Fat bodies are therefore expected to be in transition, and Murray emphasizes such transformation is necessary “in order to be accorded personhood” (155). In concrete terms, this means overweight individuals should never feel their bodies are acceptable as is. One should be on a diet/exercise program or readying oneself to start one. Nike’s greatness commercial purports to be about inclusivity – that one does not need to be an Olympic athlete to be great – but the body-in-transition theme in fact works to support the notion that the “obese” Nathan isn’t especially acceptable. And the message Nike offers is one where individual responsibility in tandem with commercial goods is the path to greatness. Of note is that the “greatness” Nike represents in the Jogger commercial is a fiction. As media and public attention blossomed after its airing, it was revealed that Nathan was selected for the commercial because he answered a casting call that was seeking a boy with a specific profile. This prompted Adweek to declare, cheekily, “It turns out Nathan is not actually an early-dawn runner” (Cullers 2012). To this

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critique one might respond that Nike was making an advertisement, not a documentary, and perhaps it is irrelevant to Nike’s inspirational message that Nathan later explained to Matt Lauer on the Today show that he applied to be in the spot because he liked Nike and wore Nike gear. Nathan also explained that being hired to act in the commercial had inspired him to try to lose weight, while his mother expressed her pride and excitement over the fact that Nike chose her son over all the other applicants. Again, while this backstory is perhaps irrelevant to Nike’s inspirational message, it remains relevant to this analysis because the driving motive for Nathan was a brand, not health. Nathan’s post-hoc inspiration to assume responsibility for his health stemmed from acting in the commercial and liking the brand, while his mother applauded her son’s (literal and figurative) commercial participation. At base, the inspirational message driving “Find Your Greatness” is the depiction of an obese child taking responsibility for his size. More cynically, the inspiration is a child taking responsibility for living in a commercial environment – also greatness. This matters in a broader sense because a similar process is unfolding when it comes to food advertising, policy, and childhood obesity. Terms like pathogenic foods, the obesogenic environment, and the “eat more” environment establish that children live in a commercial environment where they are constantly exposed to food marketing messages. Regulatory limits on the marketing of high-fat, high-salt, and/or high-sugar foods to children or restrictions on toys in Happy Meals – or even reworking the Cookie Monster’s signature phrase – suggest that children must be protected. And yet the protection offered, be it through an absolute ban on commercial advertising or the CAI promise to only promote (socalled) better-for-you foods to children, is completely jettisoned after age twelve. Despite the robust discourse about the risks of childhood obesity, the social responsibility to the public child, and the issue of food marketing and children’s health/obesity, by age thirteen children are seemingly left to take responsibility for their health and weight (perhaps while mothers provide support on the sidelines, as per Nathan’s case). All the responsibility for food promotion shifts away from industry and falls on the individual. From a policy standpoint, whether industry or government driven, the collective, societal problem of childhood obesity transitions abruptly at age thirteen into an ­issue of individual responsibility. How children are supposed to accumulate the tools for navigating the “eat more” foodscape remains unclear, although one can assume it involves the guidance of parents

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and educators. Thus a stumbling block emerges – one that goes largely unnoticed – when it comes to rethinking fat politics as it pertains to childhood obesity, policy, and food marketing. The problem is tricky. It starts from recognizing that healthism is a discourse and that personal health habits are foregrounded in the media and popular discourse as the “principal determinants of Canadians’ health” (Gasher et al. 2007). Taking responsibility for one’s own personal food consumption habits and size is thus presented as the way it should be. But when it comes to children what we need is not a new nomenclature introducing pathogenic foods or “eat more” environments. Instead of creating catchy new terms, what we need is a critical assessment of the fact that only two paradigms exist for dealing with the problem of food marketing, policy, and childhood: a protectionist model that catapults immediately into the individual-responsibility model. This dual paradigm is troubling because it exists from a policy perspective, not simply a popular one. The shift from “protection” to “personal responsibility” for children reaching the end of age twelve is less of a transition than a cliff, and there is a real opportunity to recognize that a liminal space exists between protection (up to age twelve) and personal responsibility (starting at age thirteen) where the terms of the debate must be renegotiated. This likely starts by recognizing that applying the personal responsibility mantra to thirteen-year-olds is wrong-­ headed, and also recognizing that it is flawed without resorting to the “mother blaming” typifying discourses about younger overweight children. This liminal space, I suggest, can open the door for advocating for a third paradigm that emphasizes environmental and socio-cultural determinants of health along with the agency appropriate to a particular age (parents should not be removed from the equation). The point is to change society, not merely the child, and this can be accomplished only when we recognize the opportunity to do so. It’s a different path to greatness, but one certainly worth taking. NOTES 1 Center for Science in the Public Interest (CSPI) v. McDonald’s USA, LLC, 22 June 2010. The quotation is taken from http://cspinet.org/new/pdf/ mcdonalds-demand-062210.pdf, p. 3. 2 “Cookie Monster Curbs Cookie Habit,” BBC News, 11 April 2005, http:// news.bbc.co.uk/2/hi/entertainment/4432415.stm (accessed 6 September 2013).

Responsibility, Policy, and Childhood Obesity  287 3 Irwin Toy, Ltd v. Quebec (Attorney General) [1989] 1 S.C.R. 927, 987. 4 In fact, over the years, several federal bills have been introduced into the House of Commons to extend this ban to the rest of Canada. The most recent is Bill C-430 (with its first reading 6 June 2012) titled “An Act to amend the Competition Act and the Food and Drugs Act (child protection against advertising exploitation).”

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288  Charlene Elliott Cullers, Rebecca. 2012. “Nathan Sorrell, Nike’s Fat Jogger, Vows to Get Thin; Unlikely Ad Star from the Olympics Wants to Prove His Greatness.” Ad Week, 6 August. http://www.adweek.com/adfreak/nathan-sorrell-nikesfat-jogger-vows-get-thin-142543. Accessed 6 September 2013. D’Arcy, Janice. 2012. “Is the Nike Olympics ‘Greatness’ Ad Great?” Washington Post, 8 August. Elliott, Charlene. 2007. “Big Persons, Small Voices: On Governance, Obesity and the Narrative of the Failed Citizen.” Journal of Canadian Studies/Revue d’Etudes Canadiennes 41 (3): 134–50. – 2009. “Kid-Visible: Childhood Obesity, Body Surveillance and the Techniques of Care.” In Surveillance: Power, Problems, and Politics, ed. Sean P. Heir and Josh Greenberg, 33–45. Vancouver: UBC Press. – 2012. “Marketing Foods to Children: Are We Asking the Right Questions?” Childhood Obesity 8 (3): 202–5. Gard, Michael. 2010. End of the Obesity Epidemic. New York: Routledge. Gasher, Mike, Michael V. Hayes, Ian Ross, Robert A. Hackett, Donald Gutstein, and James R. Dunn. 2007. “Spreading the News: Social Determinants of Health Reportage in Canadian Daily Newspapers.” Canadian Journal of Communication 32 (3): 557–74. Gleason, Mona. 2005. “From ‘Disgraceful Carelessness’ to ‘Intelligent Precaution’: Accidents and the Public Child in English Canada, 1900–1950.” Journal of Family History 30 (2): 230–41. http://dx.doi. org/10.1177/0363199004270785. Hainsworth, Brad E. 1990. “The Distribution of Advantages and Disadvantages.” Public Relations Review 16 (1): 33–9. http://dx.doi .org/10.1016/S0363-8111(05)80035-9. Hamilton, Graeme. 2009. “The Junk Food Wars: Quebec Scores Sweet Victory in Battle against Childhood Obesity.” National Post, 27 January, A3. House of Commons Canada. 2007. Healthy Weights for Healthy Kids: Report of the Standing Committee on Health. Ottawa: Communication Canada – Publishing. Hunt, Alan. 2003. “Risk and Moralization in Everyday Life.” In Risk and Morality, ed. Richard Ericson and Aaron Doyle, 165–92. Toronto: University of Toronto Press. Ipsos Reid. 2011. Canadian Perceptions of, and Support for, Potential Measures to Prevent and Reduce Childhood Obesity: Final Report. November. Ottawa: Public Health Agency of Canada. http://www.sportmatters.ca/files/ Reports/Ipsos%20Obesity%202011.pdf. Accessed 30 April 2012. Karpf, Anne. 1988. Doctoring the Media: The Reporting of Health and Medicine. London: Routledge.

Responsibility, Policy, and Childhood Obesity  289 Katz, David. 2012. “Nike’s Notion of Greatness, and the Road Not Taken.” Huffington Post, 14 August. http://www.huffingtonpost.com/david-katzmd/find-your-greatness-nike_b_1776298.html. Accessed 6 September 2013. Kline, Stephen. 2011. Globesity, Food Marketing and Family Lifestyles. New York: Palgrave Macmillan. Lawrence, Regina. 2004. “Framing Obesity: The Evolution of News Discourse on a Public Health Problem.” Press/Politics 9 (3): 56–75. LeBesco, Kathleen. 2010. “Fat Panic and the New Morality.” In Against Health: How Health Became the New Morality, ed. Jonathan J. Metzl and Anna Kirkland, 72–82. New York: New York University Press. Leftfoot, Lucas. 2012. “Video: Nike ‘Find Your Greatness’ Ad Launched.” Nikeblog.com, 25 July. http://www.nikeblog.com/2012/07/25/video-nikefind-your-greatness-ad-launched/. Accessed 6 September 2013. Malär, Lucia, Harley Krohmer, Wayne D. Hoyer, and Bettina Nyffenegger. 2011. “Emotional Brand Attachment and Brand Personality: The Relative Importance of the Actual and the Ideal Self.” Journal of Marketing 75 (4): 35–52. http://dx.doi.org/10.1509/jmkg.75.4.35. McNeal, James. 2007. On Becoming a Consumer. Oxford: ButterworthHeinemann. http://dx.doi.org/10.1016/B978-0-7506-8335-7.50004-0. Miller, Peter, and Nikolas Rose. 2008. Governing the Present. Cambridge: Polity. Murray, Samantha. 2005. “(Un/Be)Coming Out? Rethinking Fat Politics.” Social Semiotics 15 (2): 153–63. http://dx.doi. org/10.1080/10350330500154667. Nestle, Marion, and Malden Nesheim. 2012. Why Calories Count: From Science to Politics: California Studies in Food and Culture. Berkeley: University of California Press. Oliver, J. Eric, and Taeku Lee. 2005. “Public Opinion and the Politics of Obesity in America.” Journal of Health Politics, Policy and Law 30 (5): 923–54. http://dx.doi.org/10.1215/03616878-30-5-923. Patel, Raj. 2012. “Abolish the Food Industry.” The Atlantic, 6 February. http:// www.theatlantic.com/health/archive/2012/02/abolish-the-foodindustry/252502. Accessed 6 September 2013. Poland, Blake. 2000. “The Considerate Smoker in Public Space: The Micropolitics and Political Economy of ‘Doing the Right Thing.’” Health & Place 6 (1): 1–14. http://dx.doi.org/10.1016/S1353-8292(99)00025-8. Pole, Corrinna. 2009. “General Mills Not So Lucky.” Record 27 (February): 5. Rochman, Bonnie. 2012. “Does Nike’s ‘Greatness’ Ad Exploit Fat People?” Time 13 (August). http://healthland.time.com/2012/08/13/does-nikesgreatness-ad-featuring-an-obese-boy-exploit-fat-people. Accessed 6 September 2013.

290  Charlene Elliott Rous, Trevor, and Alan Hunt. 2004. “Governing Peanuts: The Regulation of the Social Bodies of Children and the Risks of Food Allergies.” Social Science & Medicine 58 (4): 825–36. http://dx.doi.org/10.1016/S0277-9536(03)00257-0. Saguy, Abigail, and Rene Almeling. 2008. “Fat in the Fire? Science, the News Media, and the ‘Obesity Epidemic.’” Sociological Forum 23 (1): 53–82. http:// dx.doi.org/10.1111/j.1600-0838.2004.00399.x-i1. Smith, Karen. 2011. “Producing Governable Subjects: Images of Childhood Old and New.” Childhood 19 (1): 24–37. http://dx.doi.org/10.1177/ 0907568211401434. Statistics Canada. 2012. “Body Mass Index of Canadian Children and Youth, 2009–2011.” Fact sheet. http://www.statcan.gc.ca/pub/82-625-x/2012001/ article/11712-eng.htm. Accessed 6 September 2013. Strom, Stephanie. 2011. “Toys Stay in San Francisco Happy Meals, for a Charge.” New York Times, 30 November. Swinburn, Boyd, Garry Egger, and Fezeela Raza. 1999. “Dissecting the Obesogenic Environments: The Development and Application of a Framework for Identifying and Prioritizing Environmental Interventions for Obesity.” Preventive Medicine 29 (6): 563–70. http://dx.doi.org/10.1006/ pmed.1999.0585. Thomson, Matthew, Deborah J. MacInnis, and C. Whan Park. 2005. “The Ties That Bind: Measuring the Strength of Consumers’ Emotional Attachments to Brands.” Journal of Consumer Psychology 15 (1): 77–91. http://dx.doi. org/10.1207/s15327663jcp1501_10. Wallack, Lawrence. 1990. “Mass Media and Health Promotion: Promise, Problem, and Challenge.” In Mass Communication and Public Health: Complexities and Conflicts, ed. Charles Atkin and Lawrence Wallack, 41–51. Newbury Park, CA: Sage. West, Lindy. 2012. “Nike Uses Fat Kid to Sell Shoes, Nation Rejoices.” Jezebel, 6 August. http://jezebel.com/5932248/nike-uses-fat-kid-to-sell-shoesnation-rejoices. Accessed 6 September 2013. World Health Organization (WHO). 2010. “Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children.” Geneva: WHO. http://whqlibdoc.who.int/publications/2010/9789241500210_eng .pdf. Accessed 6 September 2013. Young, Jen. 2009. “Burger King Pleads Guilty, McDonald’s Accused.” Record 11 (May): 3.

PART 3 Representations of and Responses to Obesity

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11 From “FU” to “Be Yourself”: Fat Activisms in Canada Jenny Ellison

In 1973 Judy Freespirit and Aldebaran (a.k.a. Vivian Mayer) were growing increasingly frustrated with the apolitical stance of the Los Angeles chapter of the National Association to Aid Fat Americans, now known as the National Association to Advance Fat Acceptance, or NAAFA. NAAFA was, at the time, primarily a social organization for fat people and fat admirers. Freespirit and Aldebaran felt that the organization lacked a feminist and a political analysis. It focused too much on persuading people that it was okay to be fat and not enough on challenging the medical, social, and corporate structures that oppressed fat people. Together with a handful of other women, Aldebaran and Freespirit formed the Fat Underground. The aptly named “FU” argued that fat women were oppressed by the normalizing, prescriptive ideologies that have defined appropriate body weight and shape (Fishman 1998; Mayer 1977; Wilson 1976). The group’s “Fat Liberation Manifesto” (1973) critiqued the diet industry for exploiting fat women’s bodies “as objects of ridicule” and then profiting from the “false promise of avoidance of, or relief from, that ridicule” (Freespirit and Mayer 1983, 52). It also called for equal rights for fat people and “an end to discrimination … in the areas of employment, education, public facilities and health services.” The manifesto ended with a call for “fat women of the world to unite” because they have “nothing to lose” (Freespirit and Mayer 1983, 52–3). Fat liberation was defined in this document as freedom from discrimination, from pressure to diet, and from feminine norms. FU’s basic ideas – that it is okay to be fat, and that feminine norms and the pressure to be thin oppress fat women – have in the years since been taken up in different ways by a variety of different social actors. Academic literature on fat activism is limited, and has yet to document the transnational, material, and intellectual links between groups over

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time. This may be because activists themselves are not aware of, or do not necessarily acknowledge, the important links between different ideological and national iterations of the movement. For example, Canada’s most popular fat activist group, Large as Life (Vancouver 1981–85, Calgary 1983–85, and London 1997–99), also sought to challenge fat oppression, but emphasized personal acceptance rather than liberation from feminine norms. In the inaugural issue of The Bolster, the group’s newsletter, founder Kate Partridge called on members to refuse “second-class status” because they deserved the “freedom to express and be” themselves. Partridge cited a “growing body of scientific research about obesity telling us that it is not a product of a weak will or moral slackness” and reminded women that even if they were “large” they could “be healthy and … be beautiful.”1 Partridge was aware of the Fat Underground but did not see her activism as a direct extension of their earlier work. She formed Large as Life to help women achieve “freedom” through personal development and sociality. Partridge’s goals were not at all unlike those of the FU, but she denied any significant connection with that branch of fat activism. This chapter offers a genealogy of fat activism in Canada and explores how Canadian women have taken up the notions of fat oppression, acceptance, and liberation first articulated by radical American activists in the 1970s. As Charlotte Cooper reminds us in The Fat Studies Reader, fatness and the notion of an obesity epidemic are not unique to the United States, and yet much of the literature to date has spoken about and to Americans (Cooper 2009). This chapter aims less at decentring the United States in the history of fat activism – for the work in that country has been rich and influential – and more towards adding complexity to what we know about the transnational and Canadian dimensions of the movement. In Canada fat activism has been given new and sometimes unexpected meaning as it has travelled and been taken up by different groups of women (Davis 2007). Looking at differences within Canada further suggests that it is not just the national but the linguistic, social, and historical context in which fat activism has been articulated that has shaped the movement’s contours. Fat activism is a set of ideas and practices that transforms as women have applied it to the parts of their lives that matter most.2 Fat (American) Activism Academic accounts of fat activism, including Elana Dykewomon’s entry in the Lesbian Herstories and Cultures: An Encyclopedia (2000) and

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Charlotte Cooper’s Fat and Proud (1998), focus on the American movement. These accounts focus primarily on the schism between NAAFA (1969–present) and the Fat Underground (c. 1973–79). William J. Fabrey was inspired to form NAAFA after reading a 1967 Saturday Evening Post article titled “More People Should Be Fat.” The author, Llewellyn Louderback, believed that fat people were allowing themselves to be “browbeaten into slimming down toward an arbitrary image” (1967, 10). In the United States it had become so “‘in’ to be thin that fat people’s civil rights” were being violated: college admissions officers admitted to discriminating against fat students and employers were reluctant to hire fat people. As a result, the waistline had “replaced the accent as a handy guide to class” (Louderback 1967, 10). Thrilled to discover there were other people concerned about the plight of fat people, Fabrey wrote to ask Louderback if he would be interested in founding an association “dedicated to the removal of the prejudices” cited in his article.3 NAAFA promised to “attack the problem” of fat oppression from all angles, including media awareness campaigns.4 Soon thereafter this mandate shifted to fundraising dances, annual conventions, and a dating service.5 Until the late 1980s, challenging fat oppression was set aside in favour of focusing on developing a pan-American social network of fat people and fat allies. The Fat Underground was part of the “long explosion” of US feminist ideologies in the 1970s (Lent 2001, 63). Like other radical feminists groups, the FU rejected the “liberal feminist solution of integrating women into the public sphere” (Echols 1989, 3). Many radical feminists thought the pursuit of legal changes and the Equal Rights Amendment (ERA) ignored the underlying problem of women’s subordination in a patriarchal society (Echols 1989). FU applied a similar analysis to fat oppression. They believed that persuading the public that fat people were just like anyone else would not change the underlying structures (medicine, looks-ism, and sexism) that contributed to fat oppression. The problem, for Aldebaran, was that medical doctors and psychologists refused to interpret fat in political terms and insisted that being “overweight” was a disease (Mayer 1977). Following Llewellyn Louder­ back, Aldebaran argued that fat people’s health problems were the result of social stigma and exclusion (Mayer 1983). The brief histories of fat activism that are published end around 1979, when the Fat Underground disbanded. In the years between 1974 and 1979, however, the group’s papers were circulating among lesbian feminists in the United States. While the FU’s primary critique was of medical and therapeutic approaches to fat people, the women who took up

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their message tended to see fat oppression as a lesbian feminist issue. This “second generation” of fat liberation, as Judith Stein called it in a 2012 interview, came together in women’s centres and consciousnessraising groups across the United States in the late 1970s.6 Stein’s fat activism began with a fat women’s consciousness-raising group at the Cambridge Women’s Centre. The group, which later became known as Boston Area Fat Liberation, defined fat oppression as a “social reality” that included having to shop in special stores, avoiding certain chairs and turnstiles, and being immersed in a culture that devalued fat women. They acknowledged that fat oppression affected all women, and proposed uniting with other sympathetic women to “fight real oppression: standards which dictate to us how we ought to look, or how we ought to live.”7 Members of the Boston Area Fat Liberation saw FU documents as a reflection of their experiences as fat lesbians, even though it wasn’t the intended message of the original text. By 1980 Stein had connected with former FU member Aldebaran, as well as activists from several American cities. Many of these women met at the Michigan Womyn’s Music Festival in 1979, where concerns about fat oppression became a catalyst for a fat women’s meeting onsite.8 One year later, twenty women came together for a fat activists’ working meeting during a women’s health conference in New Haven, CT. Their goal was to “present fat issues to a feminist conference, and also to meet by ourselves to work together on developing the feminist fat liberation movement.”9 This group went on to publish Shadow on a Tightrope: Writings by Women on Fat Oppression, which brought together articles by feminist fat liberationists in the 1970s and early 1980s (Schoenfielder and Wieser 1983). Shadow on a Tightrope would later inspire the work of some Canadian activists. While the assimilationist/radical divide described in the literature to this point may characterize the earliest years of the movement, it does not capture the complexity of what followed or the long reach of fat activism. In the early years of fat American activism, the boundaries of and within the movement were always shifting. What began with NAAFA as an “assimilationist” social movement also developed more radical and feminist branches. By the 1980s, the lines dividing fat liberation and fat acceptance were blurred. Likewise, over the course of the 1980s, NAAFA gradually began to incorporate more radical perspectives on gender and health into the organization (Farrell 2011).10 What these shifts show us is that fat activism has not had a strict ideological focus. Rather, fat acceptance and liberation have sparked a

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diverse array of activisms around sexuality, fitness, dance, and fashion that do not fit easily into the assimilationist/liberationist frameworks (Ellison 2009). This pattern can be observed in Canada, where over the course of the late 1970s and 1980s fat activism emerged. Virtually all of these organizations had an intellectual or material connection to the American movement, through key texts, the Michigan Womyn’s Music Festival, or feminist activism, but rarely do the groups see their work as an extension of earlier activism. Instead, activists have adapted the notion that it is okay to be fat in ways that they felt reflected their unique circumstances and needs. Fat (Canadian) Activism Critiques of fat oppression were circulating in Canada from at least the mid-1970s. Among the earliest examples is a 1975 article called “Fat Liberation: A Wages for Housework Perspective,” which was published in a radical feminist paper, The Other Woman. In this article Wages for Housework member Lorna Boschman argued that fatness was a refusal to participate in the heterosexual system. Boschman called on fat women to unite and fight. While her intervention echoes the Fat Underground, she herself did not encounter American activisms until the 1980s.11 Elsewhere, there is some evidence of Canadian women meeting to discuss texts like Fat Is a Feminist Issue (1980), but these women did not see their work as an extension of the earlier American activism.12 There were exceptions. Two Canadian groups sought to ally themselves with the founding American organizations. LG5 (Lesbiennes grosses cinq, 1984–92) was a collective of five French Canadian fat lesbians who were inspired, in part, by Shadow on a Tightrope. LG5 member Louise Turcotte had encountered fat liberationist ideas at the Michigan Womyn’s Music Festival. In the mid-to-late 1980s, LG5 translated the “Fat Liberation Manifesto” and other texts from Shadow and published them in a lesbian feminist journal. Like the FU, LG5 wanted people to acknowledge that they perpetuated oppression by buying into stereotypes about fat and thin. Evidence of the subtle reworking of earlier American messages can be found in prefaces appended to each translation. Inspired by French feminist theorist Monique Wittig, with whom Louise Turcotte worked closely, LG5 argued that lesbians who rejected fat women were reproducing patriarchal, capitalist heterosociety. By refusing to acknowledge the way that femininity and slenderness contributed to women’s disempowerment

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in a heterosexual system, lesbians were contributing to the development of a class of thin women (les minces) who believed themselves to be superior to the other class, fat women (les grosses).13 So, for LG5, critiques of medicine and dieting took a back seat to challenging the power complex that produced fat oppression. NAAFA has also had a presence in Canada, albeit not a very prominent one. NAAFA Canada formed after LG5, and neither group seemed aware that the other existed. NAAFA Canada was a chapter of the American organization and sometimes used their pamphlets, but otherwise there was no working relationship between the two. Perhaps because of Canada’s status as a nation-wide chapter, rather than a separate entity, it did not fare well. Geography presented a major problem, because there were only about two hundred members spread across Canada. A second reason the group may not have gotten off the ground was conflict between the two Canadian NAAFA organizers. Ruth Gillingham of Prince Albert, Saskatchewan, wanted to develop a Canadian newsletter, and was willing to use her own funds to get the group off the ground. By contrast, Helena Spring of Toronto resented the fact that the American organization was unwilling to fund more activities in Canada.14 Later, Gillingham resigned her role and Spring attempted to start a Canadian Association for Size Acceptance (CASA) and a glossy magazine, CANADA Wyde, which folded after two years (1996–97). Beyond these examples, fat activists in Canada tended to deny or reject the idea that their work had any links to American organizations. Charlotte Cooper has observed a similar pattern in the United States and United Kingdom, going so far as to suggest that calling fat activism a “movement” is misleading because it implies common aims and objectives (1998). Historically, however, loose connections and informal networks of individuals simultaneously working on other issues have also characterized feminist, gay, and lesbian rights movements in Canada (Smith 1999). Rather than undermining the movement, discontinuities are evidence of the flexibility and fluidity of fat activisms. Canadian women have reinvented fat activism again and again. As Kathy Davis has observed of the book Our Bodies, Ourselves, ideas undergo “dramatic revisions in the process of being translated and adapted” in different local and national contexts (2007, 78). Canadian women picked up on the basic idea that it was okay to be fat and rearticulated it in different ways in the 1980s and beyond. The notion of shared experience is the common denominator between fat activists across Canada, which may be why they deny links to

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other activists who don’t share the same (fat) identity politics. This is a contradiction within the movement as a whole, because groups claim to represent all fat women and yet are divided by their approaches to feminism, femininity and sexuality. As primary sources, interviews reveal the ways activists use personal experience to make claims about the experiences of all fat women. Informed by feminist philosopher Sonia Kruks, I understand experience as something that is “‘lived from the inside out’: shaped by material forces and social practices, yet also discursively mediated and interpreted” (Sangster 2011, 141). Women’s subjective experiences help us to understand how they relate to the “cultural and institutionalized discourses in which they are embedded” (Davis 2007, 133). Looking at the experiences of fat activists shows that they were actively engaged in dialogue about gender norms, and in thinking through how and why their bodies mattered. Whether or not they named their actions as feminist, the activism I examined offers an ­example of women “deliberately and strategically interpreting” their shared experiences and “actively pursuing potentially empowering courses of action” based on this knowledge (Davis 2007, 139). Fat Activism and Feminism By the 1980s tensions within the feminist movement led to its fragmentation in both the United States and Canada. Because of some women’s groups’ tendency to make overly general and universal claims about women, there was an explosion of activisms based on different types of embodied identities. Fat activism was part of this trajectory of feminism, in that it was situated in a “cultural moment” that saw a major realignment of American and Canadian feminism away from the ideological divisions of the 1970s towards “cultural feminism,” which was intended to value differences (Echols 1989; Vickers 1992). As feminism in itself became fragmented, it became difficult to speak of women in general terms. Fat activism, in retrospect, was the product of the identity politics that emerged within feminism and other social movements in the 1980s. Not necessarily organized around a belief system, identity politics claim group distinctiveness and challenge negative characterizations of particular groups (Heyes 2002). Identity politics of the 1980s and 1990s departed from other earlier social movements in their demand for “respect” for a group “as different” (Kruks, qtd. in Heyes 2002, 2). More than this, many fat activists hoped to reproduce “the identity” by developing social sites and services for fat women (Bernstein 2002, 534).

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This pattern, in which fat activism was produced as a critique to existing feminist organizing, characterizes a number of Canadian groups. It was because of frustration with lesbian feminists that LG5 formed. One of the group’s primary activities was to stage surprise “interventions” at Montreal-area lesbian and feminist events, to challenge attendees to think about fat oppression (Le collectif LG5 1985). LG5 founders Louise Turcotte and Michèle Charland realized that they had felt the same reluctance about using the word fat (grosse) to describe their bodies as they initially had about using the word lesbian (lesbienne). This reluctance led to a second observation that body size and beauty were topics that were “never addressed in the lesbian world.” Turcotte and Charland saw a parallel between their experiences as fat lesbians and the lesbian-feminist tensions of the 1970s. The parallel was that body size, like sexuality, was being treated as though it were a personal issue.15 LG5 argued that body ideals were patriarchal constructions imposed on women in a heterosexist society. In failing to recognize the experiential, embodied truths of their fat sisters, lesbians and feminists had perpetuated fat oppression. LG5’s last public action was a special issue of Amazones d’hier titled “La grosseur: Obsession? OPPRESSION!” (Figure 12). In the journal, Turcotte’s editorial took aim at an increasingly popular interpretation of body morality as an “obsession” with weight. She was referring to a handful of feminist texts on body weight, including Fat Is a Feminist Issue (Orbach 1979), Obsession: Reflections on the Tyranny of Slenderness (Chernin 1981), and possibly also The Beauty Myth (Wolf 1990) that explored women’s apparent obsession with their weight and food, among other topics. Turcotte suggested that the notion of “weight obsession” depoliticized fat and refocused the problem on women’s internal struggles (1999, 57). Fat people were oppressed by prescriptive heterosexual ideals, so obsession was beside the point. Like some activists working on gay and lesbian rights in this time period, LG5 believed that politics were never just personal; such issues needed to be aired publicly to set in motion a “process of discovery and revelation, of transparency and honesty,” through which fat oppression would be understood and then eradicated (Churchill 2003, 119). Fat Activism and the Women’s Health Movement In Canada there was extensive feminist support for weight obsession, non-dieting, and Health At Every Size messaging through the women’s health movement. In this way, Canadian fat activists had closer ties

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Figure 12.  LG5, “La grosseur: Obsession? OPPRESSION!” (Size: Obsession? Oppression!), special issue of Âmazones d’hier, lesbiennes d’aujour d’hui, December 1992

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with “mainstream” feminism than their American counterparts (Farrell 2011). Canadian feminists have tended to work closely with the government to develop health-care programs and policies. While almost all of this funding has been cut, in the 1980s and early 1990s Canadian federal and provincial health bodies were partially funding women’s health clinics and research, as well as more activist sites like the feminist journal and collective “Healthsharing,” which received some funding through the Secretary of State’s Women’s Program (Feldberg 2004). The relationship between fat activists, women’s health activists, and government-funded health care initiatives is reflected in the activities of a cluster of Toronto-based researchers and activists in the 1980s. In 1983 Janet Polivy and Peter Herman of the University of Toronto Mississauga published Breaking the Diet Habit, a book that challenged the logic of dieting, suggesting that weight-loss programs are often ineffective and can be actively harmful, and that maintaining a stable weight is more important than being slim. Polivy and Herman were not the only Toronto-based researchers investigating questions related to weight and health. David Garner, then based at the Clarke Institute/ University of Toronto, published his well-known research on the sociocultural dimensions of weight in a series of articles, including “Cultural Expectations of Thinness in Women,” an article that revealed a “a gradual but definite evolution” towards slimmer “ideal” body shapes for women as well as a growing cultural preoccupation with dieting (Garner et al. 1980, 489). During this period Donna Ciliska completed a PhD at the University of Toronto under Garner’s supervision, with Janet Polivy as a committee member.16 Ciliska’s Beyond Dieting (1990) discussed the outcomes of this research and served as the basis for nondieting support programs launched in many women’s health and public health units through to the early 1990s (Forrest 1993).17 This activity in Toronto was concurrent with the explosion of available commercial dieting programs, like Weight Watchers, and weightloss aids, like diet pills, available in Canada in the 1970s (McPhail 2009). This phenomenon, combined with physical fitness surveys that revealed high levels of weight preoccupation among Canadian women, was a cause of concern for Health and Welfare Canada (Fitness and Amateur Sport 1983, 1984) – so much so that Garner and Polivy were part of an expert panel formed by Health and Welfare Canada to investigate the phenomenon of yo-yo and crash dieting and to develop a new “national strategy to promote healthy weights and prevent weight problems” (Health and Welfare Canada 1988, i). Reporting in 1988 in

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the published study Promoting Healthy Weights, the expert panel blamed the epidemic of “weight preoccupation” among all women on the rise in “fad diets, and the sale of weight-loss gimmicks” (1). The expert group recommended that Health and Welfare Canada change their messaging to promote “personal and societal acceptance of a range of healthy weights and variations in body size” (53). Concurrent with the formation of the expert panel in the mid-1980s, Garner began to organize a “political group” of women who might try to take on the issue of weight preoccupation at a grass-roots and activist level. Garner approached young women with whom he had some prior clinical and professional association to start a “political group” that might “contribute to the prevention and treatment of eating disorders.”18 The “group would not function as [sic] therapy group of any sort, but rather as a political force.”19 This “action group” was initially known as F.E.D. (Freedom from Eating Disorders) and eventually became Hersize.20 A key difference between Hersize and other groups is that it was open to women of all sizes who experienced weight preoccupation. Nonetheless, the group was drawing on at least some of the literature of earlier American fat liberationists (Rice 1988). Not unlike Boston Area Fat Liberation, Hersize defined weight preoccupation as a feminist issue because it affected women predominantly, and because a woman’s worth in society was measured by her appearance.21 Hersize’s solution to weight preoccupation was to use their experiences as women who had struggled with weight and shape issues to “invite women to join a counterculture in which they are encouraged to divest their energy from the obsession with weight and shape” (Jasper 1993, 423). Hersize’s public actions took different forms. Early on, the group monitored a range of Canadian and American magazines for demeaning images of women. If a member found an advertisement to be particularly objectionable, she would raise the issue at a Hersize meeting and draft a letter that would be revised at a meeting and sent to the publication in question. Hersize members developed a slide show about “changing standards of beauty” to demonstrate how feminine ideals have changed over time. The slide show compared paintings by Peter Paul Rubens (1577– 1640) and images of voluptuous women like Marilyn Monroe to contemporary advertising images of submissive and emaciated women.22 In the 1970s, Jeanne Kilbourne popularized this technique of using advertisements to illustrate changing images of women. Kilbourne’s film Killing Us Softly: Advertising’s Image of Women (1979) demonstrated that

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women in advertising images had become slimmer over the years, and also that media images were portraying women in increasingly violent, pornographic, and submissive poses (Kilbourne 1999; Rutherford 2007). Hersize showed Kilbourne’s remake Still Killing Us Softly (1987) at their “Exploding Media Myths” workshop in 1989, supplementing the film with their slide show.23 This technique represents a distinctive approach to women and health that was developing in the 1980s, which was to link media images to weight preoccupation and eating disorders. The appeal of this narrative of women, beauty, and the body is demonstrated by the two-year run of Naomi Wolf’s The Beauty Myth (1990) on Canadian bestseller lists (Ellison 2010). Wolf’s book suggests that as many as 60 per cent of college-aged American women were suffering or had suffered from eating disorders. Wolf popularized a growing feminist concern that ideals of slenderness were resulting in the “mass self-immolation by hunger” of a generation of American women (Wolf 1990, 149; see also Chernin 1981; Squire 1983; Woodman 1980). Although their activities predated Wolf’s book by three years, one Hersize member recalled that the release of The Beauty Myth gave the group “more credibility” and resulted in “more requests for speaking engagements and more requests for media commentary.”24 Hersize had tapped into a generation of women’s desire for a feminist analysis of popular culture and gave their audience a framework for understanding weight preoccupation (Ellison 2010). In doing so, the group took the concept of fat oppression in a different direction from their predecessors in the United States and Canada. Hersize’s focus on weight preoccupation and eating disorders reflected concerns about women’s health and women’s oppression of the late 1980s and early 1990s. Their critique was particularly timely since it coincided with growing government and media interest in eating disorders, binge dieting, and plastic surgery, as well as the publication of The Beauty Myth. Hersize’s activism can be seen as the product of a particular cultural moment when critiques of fat oppression met a more general concern about the impact of media images on women, and when public health officials began to be interested in this issue. Fat Activism outside the Women’s Movement Not all fat activists saw their work as feminist. Canada’s most popular fat women’s organization of the 1980s, Large as Life, rejected the feminist and activist labels. Large as Life formed in Vancouver in the spring of 1981, catalysed by an article published in The Vancouver Sun about

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the dearth of fashion choices for plus-sized women. Readers were encouraged to contact Vancouverite Kate Partridge if they were interested in doing something about this problem. These phone calls generated so much interest that Partridge called a public meeting at a local community centre in June 1981: fifty women attended.25 Large as Life described itself as an action group, but they did not see their work as feminist because the group was interested in finding ways to better enjoy and participate in feminine culture. Although they shared the goal of social inclusion for fat people, feminist groups sought to challenge gender and body norms, while pleasure and sociality were the goals of LAL. Members working towards fat acceptance did not think they needed theory or ideology to explain what they experienced to be true: women faced greater marginalization and social exclusion for being fat. As historian Anne Enke has observed, however, the true impact of feminism can be understood only by looking at how concepts of empowerment were enacted in everyday life (2007). Like the members of softball clubs and organizers of coffeehouses Enke explored in her history of American feminism, LAL is evidence of the productive nature of feminism: new ways of thinking about being fat emerged as women sought liberation from body norms. Fashion, in particular, seemed to be an issue that drew new members to LAL. The group made its single most significant gain in membership during the summer of 1982 when a story called “Big Can Be Beautiful” featuring Kate Partridge appeared in Canadian Living magazine (Fig­ ure  13). Partridge modelled clothing by Pennington’s, Addition-Elle, and LAL member Jan Mindlin in this article. Accompanying the story was a contest. Women who agreed to fill out a survey on the fashion needs of large women were eligible to win a five-hundred-dollar shopping spree at Addition-Elle (Hobbs 1982). Over three thousand women submitted surveys, which, unfortunately, have been destroyed.26 In response to the article, LAL itself received over 350 letters from all over Canada.27 An idea of how women may have responded to this questionnaire can be gleaned from these letters, some of which were published in LAL’s newsletter The Bolster. Ann Leslie of Riverview, New Brunswick, wrote that she was “most interested in the Large as Life Association and whole-heartedly agree with you that many women promise to look after themselves ‘after’ they have lost weight … I like myself as a human being … I wish there was clothing available that would help me reflect those feelings.”28 Nancy Kaizer of Middleton, Nova Scotia, also mused, “perhaps it is time to get on with my life.” Kaizer told LAL members, “I consider this the first step, actually admitting to a stranger that I am

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Figure 13.  Kate Partridge in Canadian Living magazine, August 1982

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big.”29 Shannon Andrew of Grand Prairie, Alberta, similarly wrote that the article was a “heart-warming experience” for her because she realized “others share my most personal yet most obvious problem.”30 Through Canadian Living and LAL, fat women found a community of other fat women with whom they might engage. Women from other parts of Canada wrote to the group to identify with the “problem” that their size represented and to express their pleasure at reading an article featuring a fashionable, plus-sized woman. In these letters, women express enthusiasm and excitement that this important women’s issue is finally being addressed. LAL’s public actions spoke to women who felt marginalized by their body size, and many such women experienced a “click” moment on discovering the group existed. While the issues they addressed would not have been considered feminist at the time, LAL can be seen as an extension of the era’s feminist movements. Women created the group for women, it offered a site of consciousness raising and action, and it problematized fatness and femininity in a way that feminist groups of the era had failed to recognize. LAL’s meeting format paralleled CR groups of the 1960s and 1970s where women met to “uncover their oppression by speaking their ­experiences” (Vickers 1992, 49). As in LAL, in consciousness-raising groups women sought to share experiences and in the process turn “what had previously been seen as individual idiosyncrasies into commonalities” (Murphy 2004, 127). Along with repeated, failed attempts at dieting, LAL members found that they all had experienced the social stigma of being fat. At the “Many Facets of LAL” meeting, Joan Dal Santo claimed that LAL should play a role in “responding to and dealing with put-downs” of large women.31 Dal Santo believed that members had a responsibility to each other to take action when someone or something “robs us of our dignity.”32 This common experience was recorded in The Bolster in a way that assumed members and readers understood what it meant to attend a diet club weigh-in and to be stereotyped as a fat woman. Talking about their experiences became the basis for solidarity among a group of women who had had limited prior contact with one another. Silences Large as Life, LG5, and Hersize understood fat oppression and weight preoccupation premised on a universalized category of woman. “Wom­ en” deserved fashionable clothing and exercise. “Women” felt pressure

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to be thin. “Women” needed to let go of heterosexual beauty norms. For Judith Stein, Kate Partridge, and other activists of the 1980s, differences between women did not matter because fat was the exciting and new identity category they wished to explore. By the 1990s, however, groups like Hersize began to ask which women? Some members of that group were troubled by the lack of representation of “women of colour” in the organization and felt Hersize could not claim to be representative of a diverse range of women (Jasper 1993, 427).33 The group attempted to reach out to women of colour through an ad placed in their newsletter: ATTENTION: WOMEN OF COLOUR HERSIZE is interested in hearing about the experiences of weight and shape issues of women of colour. For some time the HERSIZE steering committee has been struggling to better understand the impact that fat prejudice might have on various groups of women. We would greatly value input from our readers on this subject. Please call or write to HERSIZE.34

Placed around 1990, this ad appears to have had no impact on the group’s homogeneity. A few months earlier, a planned special issue of the newsletter around women of colour had been shelved because group members did not feel that they could adequately address the topic.35 The realization that media images were primarily a “white women’s” issue left members of the group feeling uncertain. Had Hersize overlooked the concerns of “women of colour”? This debate within Hersize was concurrent with debates within the academy and women’s organizations about the extent to which second-wave liberal feminist approaches reflected the experiences of all women. In particular, black feminists were attempting to destabilize how concepts like family were dealt with by feminists to reveal the “racist and ethnocentric assumptions of white feminists” (Barrett and Phillips 1992, 4). Some Hersize members began to feel that their critique was out of step with the times.36 This debate within Hersize was never resolved, and the group slowly disbanded in 1992. For the most part, Canadian fat activists of the 1980s and 1990s were silent on matters of race and did not articulate critiques of ability. This was partly due to these groups’ focus on fatness itself. Fat was the revelation, and finding other fat women to talk and work with was the

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goal. For this reason, it is rare to see explicit engagement with race and ability issues by fat women’s organizations of the 1980s. The idea that fat people might be financially marginalized became the subject of social scientific study in the 1990s and 2000s. Reviewing data from the late twentieth century, researchers have acknowledged that women in lower socio-economic groups are more likely to be “obese,” and that women of colour are more likely to fall under the medical category “obesity” than white women (Yancey, Leslie, and Abel 2006; Rothblum 1992). But in the last decades of the twentieth century, fat activists were struggling to address this issue. The tendency to universalize and essentialize the “experience” was also seen in the women’s movement in Canada and the United States at this time. By the 1980s, black women, Latinas, and other women of non-white ancestry condemned feminists for speaking “only about middle-class white women’s experience” (Mukherjee 1992, 166). The women’s movement, critics charged, had failed to acknowledge that “major systems of oppression are interlocking” (Combahee River Collective 2003 [1977], 164). Queering Fat Activisms As Laura Kipnis has observed, the fat activism that emerged subsequent to debates in the early 1990s about identity politics and sexuality took on a “a more mutinous tone than the earlier generation’s lamentations about social prejudice” (1999, 106). Influenced by queer theory, feminist and gay and lesbian activists of the late twentieth century began to contest the concept of identity. Queer theory challenges the idea that we have a fixed identity (as woman, man, gay, straight) and suggests that the boundaries between these categories are fluid. Fat activism of the 1990s reflects these changes in that it was less concerned with defining the boundaries of fatness, fat lesbianism, or fat oppression, and instead focused on permeating the overwhelmingly negative social messaging about larger women. Activists sought a “specific reworking of abjection into political agency” that was intended to disrupt accepted social norms of body size, gender, and ability (Butler 1993, 21). Toronto’s Pretty Porky and Pissed Off (c. 1996–2005) were the forerunners of Canadian performance groups that reclaimed and redeployed stereotypes about fat women to challenge the notion that being fat was and is grotesque and undesirable (Mitchell 2005). The group’s first demonstration took place in June 1996 on Toronto’s Queen Street West

310  Jenny Ellison

(Figure 14). PP&P members “wore tight-fitting crazy outfits, rock-stardiva wear, loud prints, hot pink polyester dresses, and feather boas” (Mitchell 2005, 217). They handed out leaflets to passers-by that read: We’re tired of bursting at the seams. Binding waists, bursting buttons and slim pickings are getting us down … the average North American woman is size 14 and UP. Most stores don’t carry these sizes. Us plumped-up ladies are fed up with clothes that don’t fit and feel bad. Being fat doesn’t have to mean feeling gross. (Pretty Porky and Pissed Off 1999, 23)

Mariko Tamaki later summed up PP&P’s position on fat fashion in an article for the feminist journal Fireweed when she wrote: “All welldressed fat people should be fucking worshipped and hailed as the Gods they are” (1999, 25). This approach was significantly different in tone from their feminist predecessors who sought acknowledgment of fat oppression. PP&P took for granted that fat oppression existed. The group was not interested in persuading people about the problem, but rather in using stereotypes to reveal the ways that fat women are marginalized. Like the drag queens Judith Butler used to explain her notion of performativity, the group’s aim was to show that fat was a construct, it was “something made up” (Mitchell 2005, 219). PP&P confronted weight morality by putting fatness in the public eye. They challenged expectations about the ways in which fat women moved, using their physicality to confront, entertain, and provoke their audiences. The emergence of PP&P further suggests that in Canada self-­ identified fat women of the 1990s wanted to refocus attention on fat oppression after a decade of women’s health work focused on eating disorders and weight preoccupation. PP&P was naming fatness as the issue at a time when women’s apparent “obsession” with slenderness was at an all-time high (Johnston and Taylor 2008). This reassertion of fat women’s oppression is an example of the productive nature of feminist activism of the 1970s and 1980s. Although PP&P were notably less focused on debates about identity and the self than their counterparts from the 1980s, we can still find conceptual links to earlier forms of feminist action in PP&P’s focus on questions of femininity and gendered power. Activists were grappling with the relationship between gender and fatness, and they were also pushing at the boundaries of the women’s movement in this time period. Coming together to discuss gender issues produced for these women new ways of thinking about the body.

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Figure 14.  Pretty Porky & Pissed Off flyer, c. 1996

312  Jenny Ellison

Conclusion Whether liberal or radical, looking inward or outward, the women discussed in this chapter wanted to find ways to think and talk about fatness, weight, and health. When they could not find resources or sympathy within existing women’s organizations, they established new groups where they could comfortably explore their experiences of being fat and female. The issues each group took up depended on what mattered to members, and also, to a certain extent, whether and how they saw themselves as feminist. For this reason groups like LAL, Hersize, and PP&P addressed separate, but overlapping, issues. Each of these groups was concerned about fat oppression, but the meaning of oppression depended on what members experienced to be most frustrating. LAL and PP&P took on fashion, while Hersize took on oppressive media representations of women. LG5 and PP&P each in their own way addressed sexuality, the former by challenging women to reject “heterosexual” beauty norms and the latter by challenging the public to see fat women as sexual. Many individual members of these groups were familiar with the founding American organizations, but few felt compelled to take up the movement in the same way. Of most interest from the perspective of women’s movements and social movements, few Canadian groups felt compelled to brand their activism as liberal, radical, socialist, and the like. Fat activists drew from a range of other personal and political perspectives to articulate their demands for fat acceptance and fat liberation. In a climate of growing concern about the weight of Canadians, fat activism helps us to understand the negative impact of body norms. Fat activists targeted multiple issues: exercise, fashion, medicalization, selfesteem, and sexuality. The diversity of actions indicates that women experienced fat oppression in many different ways, and that “obesity” has never been only a health issue, but also about achieving an aesthetically pleasing appearance. Fat activists approached femininity and health critically, while at the same time demanding the right to be represented as beautiful and physically fit. The complexity of their actions suggests that women approached femininity and health critically. Women were not simply passive consumers or victims of beauty culture – they thoughtfully and actively responded to feminine culture in ways that reflected their world view. Cultural and institutional messaging about the body mattered, but it did not define or determine the subjectivity of fat activists. This does not mean that activists were

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self-reflexive or that they debated the complexity of fatness or femininity. Most saw their personal experiences as a litmus test for what it truly meant to be fat and female. In this way, we can see that women took up fat activism and feminist concepts of embodied liberation in a variety of ways. Using personal experience as a baseline allowed clusters of women working in different national and linguistic contexts to pursue new activities and relationships and to let go of some of the shame and frustration they felt about their weight. National and linguistic differences did not appear to define the fat activist movement of the 1980s and 1990s. Ideas about what it meant to be fat and female were rearticulated and transformed as they circulated between women. Thus we see the ideas of fat acceptance and liberation inspiring a range of activities from the 1970s onward, from lesbian feminist protests to anti-dieting workshops to fashion shows. Despite the ideological and strategic diversity found within fat activism, intellectual connections and patterns emerge across the movement. Core principles, including the idea that it is okay to be fat and that fat women experience greater discrimination than men, shaped each of the groups I discussed here. Likewise, key texts like Shadow on a Tightrope animated activisms in different sites, among women with very different interpretations of how to best liberate or accept their bodies. In this way, fat activism serves as a reminder of the way that social movements produce new ways of thinking about the body, even as they build on the foundations of earlier generations. Discontinuities and differences within the movement – the “identity politics” of each group – can be seen as a sign of the ongoing resilience of fat activism, which continues to adapt as new generations of activists encounter discrimination and frustration with body norms. NOTES 1 Kate Partridge, “Dear Friends ...,” Large as Life (newsletter), August 1981, 1. Canadian Women’s Movement Archives (CWMA), University of Ottawa, Ottawa. 2 Fat activism in Canada was organized primarily by women, for women. The group L’Aide aux personnes obeses handicapées du Quebec (c. 1979– 90) was formed by Gilles LeBlanc and had several male members, but is not included here because the group did not challenge medical or ­social definitions of fatness, but rather sought better infrastructure to

314  Jenny Ellison accommodate people who were disabled as a result of their weight. Another example of male involvement can be found in the National Film Board documentary Fat Chance (1994) about a Canadian man travelling to an American NAAFA convention. 3 Bill Fabrey, letter to Llewellyn Louderback, Hampstead, Long Island, New York, 21 January 1968, personal collection of William J. Fabrey. 4 William J. Fabrey, “What is NAAFA?” (pamphlet), June 1969, personal ­collection of William J. Fabrey. 5 Bill Fabrey, Bearsville, New York, letter to Jenny Ellison, Toronto, Ontario, 23 July 2008. 6 Judith Stein, interview by author, Cambridge, Massachusetts, 14 April 2012. Other sites of activism of the late 1970s include Minneapolis, Iowa City, Las Vegas, New Haven, and San Francisco. 7 “Statement from the Fat Lesbian Group,” 1, Cambridge Women’s Centre, Judith Stein Fonds 2005-MIS8, Radcliffe Institute, Schlesinger Library, Cambridge, Massachusetts. 8 Stein, interview. 9 Judith Stein, Cambridge, Massachusetts, letter to Feminist Fat Activists, 15 February 1980, Judith Stein Fonds 2005-MIS8, Radcliffe Institute, Schlesinger Library, Cambridge, Massachusetts. 10 See also Karen W. [Scott-Jones] Stimson, “Fat Feminist Herstory, 1969– 1993: A Personal Memoir,” http://largesse.net/Archives/herstory.html (accessed 12 November 2006); Fabrey, letter to Ellison. 11 Lorna R. Boschman, interview by author, Vancouver, 30 April 2012. 12 Notices announcing the formation of “fat is a feminist issue groups” ­appeared in some feminist newsletters: “We Are Organizing a CR Group,” Calgary Women’s Newspaper, July/August 1980, 6; Manitoba Action Committee on the Status of Women, “Fat Is a Feminist Issue,” Action: MACSW, December 1981, 29. I also spoke to two members of a Winnipegbased group for this research: Susan White, Winnipeg, 11 July 2006, and Julie Levasseur, Winnipeg, 14 July 2006. 13 Le collectif LG5, “Présentation,” Amazones d’hier, lesbiennes d’aujourd’hui 4 (1) (July 1985): 81–2. 14 Ruth Gillingham, interview by author, Prince Albert, Saskatchewan, 27 July 2006; Kaca Henley, interview by author, Lindsay, Ontario, 8 March 2006; Helena Spring, interview by author, Toronto, 5 January 2006. 15 Michèle Charland and Louise Turcotte, interview by author, Montreal, 22 October 2006. 16 Donna Ciliska, interview by author, Hamilton, Ontario, 11 January 2006.

Fat Activisms in Canada  315 17 Catrina Brown, “Self-Perceived Overweight Support Group,” Womanly Times: Women’s Health Clinic, February 1985; Winnipeg Women’s Health Clinic Library, Winnipeg; Andrea Siegler and Donna Ciliska, “Beyond Dieting,” Bulletin: National Eating Disorder Information Centre, April 1991 (Canadian Women’s Movement Archives [CWMA], University of Ottawa). 18 TGH (Toronto General Hospital) Political Group, “Meeting notes,” 18 June 1987, personal collection of the author, anonymous donor. 19 TGH Political Group, “Meeting notes,” 18 June 1987. 20 For details on the formation of F.E.D. and Hersize see F.E.D., “Meeting minutes,” 31 August 1987; Hersize, “Meeting minutes,” 4 October 1987. The only history of Hersize that has been recorded to date, by founding member Karin Jasper, excludes any reference to Garner and his role in starting the group. Garner became a controversial figure not long after Hersize formed. In February 1988, the Ontario Board of Examiners in Psychology suspended his licence for two years after he pled guilty to ­professional misconduct with a client. He was also fired from his job at Toronto General Hospital. In 2008 Garner faced similar charges in Ohio. “Eating Disorder Expert Faces Sex Charges,” Edmonton Journal, 12 Decem­ ber 2003, A10; Tracey Tyler, “Psychologist Fired in Metro Scandal Now Forced to Leave Job in Michigan,” Toronto Star, 9 February 1989, A29; Hersize, “Meeting minutes,” 22 November 1987, 16 May 1988; Jasper 1993; Julie McKinnon, “Sylvania Psychologist Cedes License in Sex Charge, Female Patient Complained,” The Toledo Blade, 22 October 2008, http:// www.toledoblade.com/local/2008/10/22/Sylvania-psychologist-cedeslicense-in-sex-charge.html (accessed 8 October 2015). 21 “Hersize: A Weight Prejudice Action Group” (pamphlet), Hersize, c. 1988, personal collection of the author, anonymous donor. 22 Mary Frances Ellison, interview by author, Toronto, 15 December 2005. 23 “Exploding Media Myths: Women Reclaiming the Mirror,” Hersize, 24 October 1989, personal collection of the author, anonymous donor. 24 Ellison, interview. 25 Kate Partridge, interview by author, Crediton, Ontario, 20 September 2005. 26 Partridge, interview; Ingrid Laue, “Editor’s Sphere,” The Bolster, September 1982, 21. 27 “BIG can be BEAUTIFUL,” The Bolster, September 1982, 11. CWMA HQ 1459 .B7 B64. 28 Anne Leslie, “Letter to the Editor,” The Bolster, September 1982, 5. CWMA HQ 1459 .B7 B64.

316  Jenny Ellison 29 Nancy L. Kaizer, “Letter to the Editor,” The Bolster, October 1982, 4. CWMA HQ 1459 .B7 B64. 30 Shannon Andrew, “Letter to the Editor,” The Bolster, October 1982, 5. CWMA HQ 1459 .B7 B64. 31 Janet Walker, “October Meeting,” The Bolster, November 1982, 19. CWMA HQ 1459 .B7 B64. 32 Walker, “October Meeting”; Joan Dal Santo, interview by author, Sechelt, British Columbia, 7 October 2005. 33 Ellison, interview. 34 “Hersize: A Weight Prejudice Action Group,” in Hersize: A Weight Prejudice Action Group (newsletter), c. 1990, 4, personal collection of the author, anonymous donor. 35 Hersize, “Meeting minutes,” 4 July 1989, personal collection of the author, anonymous donor. 36 Ellison, interview.

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Fat Activisms in Canada  317 Davis, Kathy. 2007. The Making of Our Bodies, Ourselves: How Feminism Travels across Borders. Durham: Duke University Press. http://dx.doi.org/10.1215/ 9780822390251. Dykewomon, Elana. 2000. “Fat Liberation.” In Lesbian Histories and Cultures: An Encyclopedia, ed. Bonnie Zimmerman, 290–2. New York: Garland. Echols, Alice. 1989. Daring to Be Bad: Radical Feminism in America, 1967–1975. Minneapolis: University of Minnesota Press. Ellison, Jenny. 2009. “Not Jane Fonda: Aerobics for Fat Women Only.” In The Fat Studies Reader, ed. Sondra Solovay and Esther Rothblum, 312–19. New York: New York University Press. – 2010. “Large as Life: Self-Acceptance and the Fat Body in Canada, 1977– 2000.” Doctoral diss., York University. Enke, Anne. 2007. Finding the Movement: Sexuality, Contested Space, and Feminist Activism. Durham: Duke University Press. http://dx.doi.org/ 10.1215/9780822390381. Farrell, Amy Erdman. 2011. Fat Shame: Stigma and the Fat Body in American Culture. New York: New York University Press. Feldberg, Georgina. 2004. “Holism and History in Toronto’s Women’s Health Movements.” In The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America, ed. Robert D. Johnston, 181–94. New York: Routledge. Fishman, Sara Golda Bracha. 1998. “Life in the Fat Underground.” Radiance, Winter, 32–5, 50. Fitness and Amateur Sport. 1983. Fitness and Lifestyle in Canada: A Report. Ottawa: Fitness and Amateur Sport Canada. – 1984. Changing Times: Women and Physical Activity. Ottawa: Fitness and Amateur Sport Canada. Forrest, Diane. 1993. “Stop the Diet, We Want to Get Off! These Large Women Learn to Quit Worrying about Their Weight and Start Living Their Lives.” Canadian Living, January, 48–52. Freespirit, Judy, and Vivian [Aldebaran] Mayer. 1983. “Fat Liberation Manifesto.” In Shadow on a Tightrope: Writings by Women on Fat Oppression, ed. Lisa Schoenfielder and Barb Weiser, 52–3. Iowa City: Aunt Lute. Garner, David M., Paul E. Garfinkel, Donald Schwartz, and Michael Thompson. 1980. “Cultural Expectations of Thinness in Women.” Psychological Reports 47 (2): 483–91. http://dx.doi.org/10.2466/pr0.1980.47.2.483. Health and Welfare Canada, Health Services and Promotion Branch. 1988. Promoting Healthy Weights: A Discussion Paper. Ottawa: Health and Welfare Canada.

318  Jenny Ellison Heyes, Cressida. 2002. “Identity Politics.” In Stanford Encyclopedia of Philosophy, ed. Edward Zalta, 1–24. Stanford: Metaphysics Research Lab, Center for the Study of Language and Information, Stanford University. http://plato .stanford.edu/entries/identity-politics/. Accessed 27 June 2008. Hobbs, Anna. 1982. “Big Can Be Beautiful: Solving Fashion Problems When You’re Size 16 and Up.” Canadian Living, August, 84–90. Jasper, Karin. 1993. “Hersize: A Weight-Prejudice Action Group.” In Consuming Passions: Feminist Approaches to Weight Preoccupation and Eating Disorders, ed. Catrina Brown and Karin Jasper, 421–28. Toronto: Second Story. Johnston, Josée, and Judith Taylor. 2008. “Feminist Consumerism and Fat Activists: A Comparative Study of Grassroots Activism and the Dove Real Beauty Campaign.” Signs (Chicago, Ill.) 33 (4): 941–66. http://dx.doi.org/ 10.1086/528849. Kilbourne, Jean. 1999. Deadly Persuasion. New York: Free Press. Kipnis, Laura. 1999. Bound and Gagged: Pornography and the Politics of Fantasy in America. Durham: Duke University Press. Lent, Adam. 2001. British Social Movements since 1945: Sex, Colour, Peace, and Power. New York: Palgrave. Louderback, Llewellyn. 1967. “More People Should Be Fat.” Saturday Evening Post, 240, no. 22 (4 November): 10–12. Mayer, Vivian [Aldebaran]. 1977. “Fat Liberation – A Luxury? An Open Letter to Radical (and Other) Therapists.” State and Mind 6 (June/July): 34–8. – 1983. “Foreword.” In Shadow on a Tightrope: Writings by Women on Fat Oppression, ed. Lisa Schoenfielder and Barb Wieser, ix–xvii. Iowa City: Aunt Lute. McPhail. Deborah. 2009. “Canada Weighs In: Gender, Race, and the Making of ‘Obesity,’ 1945–1970.” PhD dissertation, York University, Toronto. Mitchell, Allyson. 2005. “Pissed Off.” In Fat: The Anthropology of an Obsession, ed. Don Kulick and Anne Meneley, 211–25. New York: Penguin. Mukherjee, Arun. 1992. “A House Divided: Women of Colour and American Feminist Theory.” In Challenging Times: The Women’s Movement in Canada and the United States, ed. Constance Backhouse and David H. Flaherty, 165–74. Montreal/Kingston: McGill-Queens University Press. Murphy, Michelle. 2004. “Immodest Witnessing: The Epistemology of Vaginal Self-Examination in the US Feminist Self-Help Movement.” Feminist Studies 30 (1): 115–47. Orbach, Susie. 1979 [1978]. Fat Is a Feminist Issue: A Self-Help Guide for Compulsive Overeaters. New York: Berkley.

Fat Activisms in Canada  319 Polivy, Janet, and C. Peter Herman. 1983. Breaking the Diet Habit. New York: Basic. Pretty Porky and Pissed Off. 1999. “Queen Sized Revolt.” Fireweed: A Feminist Quarterly 67: 22–3. Rice, Carla. 1988. “Flesh of Hope and the Slimness of Despair.” Rites Magazine For Gay and Lesbian Liberation 5 (2): 15. Rothblum, Esther. 1992. “The Stigma of Women’s Weight: Social and Economic Realities.” Feminism & Psychology 2 (1): 61–73. http://dx.doi.org/10.1177/ 0959353592021005. Rutherford, Paul. 2007. A World Made Sexy: Freud to Madonna. Toronto: University of Toronto Press. Sangster, Joan. 2011. “Invoking Experience as Evidence.” Canadian Historical Review 92 (1): 135–61. http://dx.doi.org/10.3138/chr.92.1.135. Schoenfielder, Lisa, and Barb Wieser, eds. 1983. Shadow on a Tightrope: Writings by Women on Fat Oppression. Iowa City: Aunt Lute. Smith, Miriam Catherine. 1999. Lesbian and Gay Rights in Canada: Social Movements and Equality-Seeking, 1971–1995. Toronto: University of Toronto Press. Squire, Susan. 1983. “Is the Binge-Purge Cycle Catching? A New Outbreak of Eating Disorders.” Ms, October, 41–5. Tamaki, Mariko. 1999. “Angry Naked Fat Woman.” Fireweed: A Feminist Quarterly 67: 24–6. Turcotte, Louise. 1999. “Queer Theory: Transgression or Regression?” In Canadian Woman Studies: An Introductory Reader, ed. Nuzhat Amin, 53–9. Toronto: Inanna. Vickers, Jill. 1992. “The Intellectual Origins of the Women’s Movement in Canada.” In Challenging Times: The Women’s Movement in Canada and the United States, ed. Constance Backhouse and David H. Flaherty, 39–60. Montreal/Kingston: McGill-Queen’s University Press. Wilson, Jane. 1976. “Fat Underground Throws Weight into Obesity War.” Los Angeles Times, 8 January, 8. Wolf, Naomi. 1990. The Beauty Myth. Toronto: Random House. Woodman, Marion. 1980. The Owl Was a Baker’s Daughter: Obesity, Anorexia Nervosa and the Repressed Feminine. Toronto: Inner City. Yancey, Antoinette K., Joanne Leslie, and Emily K. Abel. 2006. “Obesity at the Crossroads: Feminist and Public Health Perspectives.” Signs (Chicago, Ill.) 31 (2): 425–43. http://dx.doi.org/10.1086/491682.

12 Having Your Jiggs Dinner and Eating It Too: Newfoundland Obesity and the Affects of Tradition D ebor ah M c Phail

In 2005, Statistics Canada’s Community Health Survey reported that of all Canadians, those living in the east-coast province of Newfoundland and Labrador were the fattest; 34 per cent of Newfoundlanders and Labradorians were purported to be obese, a number over 10 per cent higher than the national average of 23 per cent (Statistics Canada 2005). Because dominant discourses of obesity link it to instances of cardiovascular disease, type 2 diabetes, some cancers, and increased rates of health services utilization in the province (Twells, Knight, and Alaghehbandan 2010), high rates of obesity are a concern for the popular press, health scholars, and government policy makers in Newfound­land and Labrador, who have focused on how to both measure and prevent obesity in the province (Alphonso 2004; Canning, Courage, and Frizzell 2004; Canning et al. 2007; Department of Health and Community Services 2002, 2006; Stokes Sullivan 2004; Twells 2005; Twells and Newhook 2010; Walsh 2008). Inevitably, part of the discourse on Newfoundland obesity and the panic surrounding obesity rates in Newfoundland has also been devoted to answering the question: why Newfoundland? The answer often rests in two related places: first, Newfoundlanders’ low socio-­economic status or SES (Newfound­land and Labrador 2006; Twells 2005); and second, a lack of knowledge about healthy eating (Newfoundland and Labrador 2006), which is sometimes ascribed, especially by non-Newfoundlanders, to the stereotypical notion of the

Funds for the study recounted in this chapter were provided by the Institute for Social and Economic Research and by the J.R. Smallwood Foundation, Memorial University of Newfoundland.

Newfoundland Obesity and the Affects of Tradition  321

Newfoundlander as “backward,” uneducated, and overly traditional (Everett 2009). Both of these explanations are rooted in the fact that Newfoundland and Labrador has been one of the poorest provinces in Canada, with high numbers of poverty and unemployment exacerbated by the 1990s closing of the fisheries, for centuries the province’s primary source of income ­(Everett 2009). Despite a new booming oil economy, SES in the province remains low (Newfoundland and Labrador 2006; Statistics Canada 2005). Because Newfoundland and Labrador is a province of low SES in stereotype and in fact, discourses of Newfoundland and Labrador obesity are similar to those concerning the working and lower classes in general (McPhail, Chapman, and Beagan 2011). Obesity narratives place the blame for obesity rates squarely on the uneducated individual, while the solution to the problem is located in health promotion and lifestyle change (Beausoleil and Ward 2010). I explore discourses of Newfoundland obesity to challenge the classed assumption that people in the province are obese due to low SES, lack of education, and excessive traditionalism. I focus in particular on one aspect of traditionalism in Newfoundland and Labrador, eating practices, which very often include the consumption of highly preserved, high-salt, and high-fat foods. The chapter is an analysis of interviews I conducted in St. John’s, the major urban centre in Newfoundland and Labrador, which challenges the notion that New­ foundlanders are too poor, traditional, or uneducated to “know” how to eat healthily. Theorizing participants’ responses using the concept of affect, I propose that affects of tradition complicate Newfoundlander’s healthy eating choices, as they might for any number of populations with “traditional” or culturally related eating practices, but they do not wholly determine them. Rather, participants struggled to rectify their affective experiences of traditional foods with the knowledge that those foods were unhealthy and obesogenic. Method and Methodology Food and eating in general are central to identity-making practices (Bourdieu 1984; DeVault 1991; Germov 2008; Johnston and Baumann 2010; Lupton 1996; Penfold 2008). Not surprisingly, then, Newfoundland food literature suggests that traditional foods continue to be ontologically important in the province because the very identity category of “Newfoundlander and Labradorian” and ideas about what Newfound­ land is and is not rely in part on traditions of food and food cultures

322  Deborah McPhail

(Everett 2007, 2009). At the same time that traditional eating remains integral to regional identity, a culture or discourse of panic has arisen in Newfoundland and Labrador in response to the high rates of obesity in the province, and in particular the statistic that Newfoundland and Labrador is the most obese province in the nation. This panic has fuelled a recent barrage of medical studies and anti-obesity government policies (Beausoleil 2009; Beausoleil and Ward 2010) and resulted in local newspaper headlines such as “Too Many Children Obese” (Alphonso 2004) and “Newfoundland Country’s Porkiest Province” (Stokes Sullivan 2004). Since traditional foods are unhealthy due in part to their high fat content and potential as obesogenic agents, the importance of traditional food seems to be in conflict with obesity discourse. Questions arise about the effects of obesity discourse not only on traditional food practices, but also on the identity and social fabric of Newfoundland and Labrador. I undertook a multi-region, qualitative study called “Cod Tongues and Corpulence: The Relationship between Obesity Discourse and Traditional Eating in Newfoundland and Labrador,” to explore the relationship between traditional eating and obesity discourse in New­ foundland and Labrador, and to discern whether the obesity panic organized by government policy, medical literature, and the popular press is influencing traditional food practices in the province. The study pays particular attention to how regional and traditional food cultures interact with or have been changed by fears about obesity, and whether or not local inflections of Newfoundland and Labrador identities that are tied to the preparation and consumption of traditional foods are shifting through this interaction. Data used for this chapter are gleaned from semi-structured interviews with twenty-eight participants from the St. John’s area, including the surrounding suburban communities. Participants were recruited by posters that I placed in public spaces such as cafes, bookstores, community centres, reception areas in doctors’ offices, and around the university campus. I also placed advertisements on two listservs directed at those interested in food sustainability. Participants were also recruited through snowball sampling. Participa­ tion was voluntary, and participants were offered a twenty-dollar gift certificate to the grocery store of their choice in appreciation for their time and efforts. I employed some purposive sampling with regard to class. The class categories I used are drawn from previous work with collaborators (McPhail et al. 2011, 2012), which divide participants by income and occupation into upper class (those with the top 3 to 5 per

Newfoundland Obesity and the Affects of Tradition  323

cent of overall income); upper middle class (university-educated managers and professionals); lower middle class (lower-status white-collar workers and highly skilled blue- or pink-collar workers); working class (those working manual and clerical jobs requiring fewer formal skills and education); and working poor and underclass (those with unstable jobs and insecure incomes that fall at or below the poverty line according to Statistics Canada [2009]). In total, seven participants were upper middle class; thirteen participants were lower middle class; three were working class, and five were working poor and underclass. Participants were mostly women, possibly the result of social discourses positioning food work as “women’s work” (DeVault 1991). While the data therefore cry out for a gender analysis of food and eating in Newfoundland and Labrador, I will, however problematically, set aside this detailed analysis of gender for now. Participants were interviewed twice for approximately fifty to sixty minutes each time. During the first interview, I asked questions about typical food consumption, weight concerns, traditional food consumption, and the local food environment. During the second interview, I probed deeper into the same topics. As well, I included a photo-voice project as part of the interview process in order to “get at” the unspeakable and everyday nature of food practices (see Power 2003), so between the first and second interviews participants took photographs of the foods they ate and the places they ate them, the contents of their fridge and pantry, as well as the foods they would never eat. We discussed their photographs during the second interview. Inter­ views were recorded using an audio device, transcribed, and coded for emerging themes. Literature Review and Theory Two notions of affect are helpful in my analysis of interview data. First, I employ the concept of “affective biopolitics” (Clough 2010) to explore how embodied affects of hunger and taste are organized both by obesity panic and what I call “affects of tradition” in ways that are sometimes in conflict. Second, I use Sara Ahmed’s (2010a, 2010b) discussion of “affect aliens” to think through Newfoundlanders’ affective and consciously unintended resistances to anti-obesity discourse through traditional eating. Affect theory has yet to be taken up substantively within critical obesity scholarship other than by geographer Bethan Evans, who relates

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the concept of affect to obesity rhetoric in her article “Anticipating Fatness” (2010). Evans understands affect as something that is more than emotions, though affect may be represented by them. Thus, when Evans speaks of affect, she focuses in particular on the emotions of “hope” and “fear,” though she does not presume that these are affect, but rather what we can know or imagine of affect. Evans is in this respect much like other scholars of affect (Ahmed 2010a, 2010b; Anderson 2006; Barnett 2008; Clough 2010; Crang and Tolia-Kelly 2010; Lorimer 2008; Massumi 2010; McCormack 2003; Seigworth and Gregg 2010; Thien 2005; Tolia-Kelly and Crang 2010; also see Pile 2010), who argue that while no one can really know what affect physically is (Anderson 2010), affect exists outside of language and, as such, exists prior to describable emotions. Affect is not only expressed in emotional states, however, but in embodiments as well; after all, emotions are lived through and in the body (crying, for example, is an embodiment of sadness). Affects happen in the in-between moment of the body’s contact with a material object, in the moment of “becoming” in relation to the “outside world.” Through these in-between moments, the body can take on a number of affects, a few of which are then translated into consciousness and experienced as known emotions. Evans traces how affects of obesity are organized in relations of power and regimes of truth about body size and health, and through the manipulation and creation of emotions. In her article, she describes how affects represented in fear are encouraged through health policy that describes an “inevitably dystopic obese future” where almost everyone is obese, suffering from obesity-related heart disease, diabetes, cancers, and joint immobility, and state-sponsored health care has collapsed under the literal and figurative weight of a totally obese society. At the same time, policy elicits a hope that the right government interventions, based on good science, will restore the nation’s (supposedly lost) virility and vitality. Evans argues that this affective biopolitics of hope and fear about the future is necessary to the very integrity of obesity policy because there is very little else in the way of definitive evidence for policy writers to hang their hats on. Removing obesity from biomedical rhetoric, Evans and other critical scholars reframe obesity discourse as a technology of biopower that reinstitutes social norms concerning gender, race, class, sexuality, and space, helping to maintain inequitable power relations and social structures (see, in this volume, Mitchinson; Norman, Rail, and Jette; and Rice).

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But because affect is not at all predictable, neither are responses to affective biopolitics. Expressed affects are sometimes surprising (Ander­ son 2010; Brown and Tucker 2010). For example, Ahmed writes of unexpected affect in her discussion of happiness: If we are disappointed by something that we expected would make us happy, then we generate explanations of why that thing is disappointing. Such explanations can involve an anxious narrative of self-doubt (why am I not made happy by this, what is wrong with me?) or a narrative of rage, where the object that is “supposed” to make us happy is attributed as the cause of disappointment, which can lead to a rage directed toward those that promised us happiness through the elevations of this or that object as being good. We become strangers, or affect aliens, in such moments. (2010b, 37)

Ahmed points to the fact that affective biopolitics inherently carry with them, through the very “nature” of affect itself, the potential for failure that often creates extreme discomfort and engenders hostility not only in individuals but also in those around them. Though Evans does not explore the concept of the obese person as the “affect alien” in her piece, I suggest that the hostility expressed against obesity may be a response to failed biopolitics. The materialization of “excess” fat is an embodiment that is not supposed to happen in our fat-hating society, and yet it does. Similarly, within an anti-fat regime of health, where so much of affective biopolitics is currently dedicated to healthy eating, “unhealthy” eating is not supposed to happen. Yet embodied affects of taste and desire for unhealthy foods continue to “bloom,” to use Seigworth and Gregg’s (2010) term. Affects of Tradition While Evans’s analysis of obesity’s affects is crucial to understanding gaps between the lack of evidentiary basis for an obesity panic and the feelings of urgency about obesity that nonetheless persist, one important place to go from Evans is to the past. Within affects of fear and hope concerning an obese future lies a yearning for an idealized past in which people were thinner and more fit and, by extension, more healthy. This is a discourse that is incongruent with a past that was literally plagued by contagious illnesses (McPhail 2010). Nevertheless,

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a discourse has emerged that represents the past as free of processed foods, automated transport, and obesogenic environments (Gard and Wright 2005). Such nostalgia is particularly evident in discussions of eating that advocate a return to traditional ways of food consumption and preparation. Generally, such exertions of tradition smack of ethnicity, and are reserved for racialized peoples in so-called developing countries or Indigenous peoples in the West (Health Canada n.d.; WHO 2002).1 In Newfoundland and Labrador, however, traditional eating means something quite different. Newfoundland eating practices are steeped in histories of not only keeping the cultural identities of Newfound­ landers and Labradorians alive but also, quite literally, keeping families alive in unforgiving environments where agricultural development was both difficult and discouraged by governments wishing to develop the fishing industry (Omohundro 1994; Tye 2008). Processes of curing, canning, and salting were important in food preservation and were integral to the survival of Newfoundlanders, and traditional foods reflect this history. Salt meat, for example, which is a staple of the traditional dish “Jiggs dinner,” is a piece of high-fat, high-salt beef that is boiled for hours in water along with root vegetables such as turnips and potatoes and some type of pudding made of dried peas as in “peas pudding.” The salt meat is generally served with another type of meat such as chicken, as well as stuffing (referred to as dressing), and is smothered in gravy. Due in part to the relative isolation and remoteness of the island of Newfoundland, traditional foodways continue to live on, though modes of acquisition, preparation, and consumption have changed. For example, due to a moratorium on cod fishing, Newfoundlanders are less likely to purchase their cod from a local fisher than from a major grocery store chain, which in turn acquires its cod from fish farms located elsewhere in the world. Technological change has also heralded the development of “new” traditional foods such as those processed at the local Purity food factory. Purity Jam-Jams, a type of cookie, is among the best known of the Purity products, and is often considered traditional by locals (Everett 2009). Vienna sausages, a processed and canned meat product produced by the Maple Leaf corporation, occupy a similar status in the hearts and minds of the Newfoundlanders I spoke with. The consumption of traditional foods also differs depending upon race. Literature points to how disparate cultural identities within the province have been articulated through food traditions, as in the case of Indigenous people, who have

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struggled to maintain traditional foodways and identities in the face of ongoing and varied colonial projects (Alton Mackey and Bernard 1988; Hanrahan 2008). Since traditional foods are not always fresh or unprocessed, it is no surprise that they are also not always considered healthy. For instance, health researchers have linked the high nitrate content of traditional foods such as salt beef and other canned foods to colorectal cancer (Squires et. al. 2010). Researchers have yet to make connections between traditional foods and the high obesity rates in the province, though it is certainly true that, unlike WHO and Health Canada, provincial obesity policy and health research on the whole do not encourage the consumption of traditional foods (but see Newfoundland and Labrador 2006 for the incorporation of traditional foods into a “healthy” diet based on the Canada Food Guide). Traditional foods are also regarded as unhealthy and linked to obesity in the popular imagination – though this depends upon the food in question. In a study of tourist responses to Newfoundland food, for example, Holly Everett (2009) found that most visitors regarded fish and chips as unhealthy and obesogenic because they are fried, while pan-fried cod and local root vegetables such as turnip were considered healthy. A discussion of traditional foods and the affects related to them within obesity narratives is therefore inherently different from an analysis of traditional affects in global or national obesity policy; Newfoundland foods are considered unhealthy while, both globally and nationally, traditional foods are regarded as healthy alternatives to more “modern” fare. In addition, unlike those foods featured in global and national discussions of traditional eating, traditional foods in Newfoundland and Labrador are not imagined as “ethnic” or racialized, despite the fact that they are rooted at least partially in Indigenous foodways (Everett 2009). Rather, Canadians imagine Newfoundlanders as a group not as racialized but as classed – as working class/poor. Everett argues that Newfoundland and Labrador is regarded nationally as a “welfare ghetto.” In their sociolinguistic study of the word newfie, a derogatory term often used to describe Newfoundlanders, King and Clarke (2002) argue that this low SES is linked to stereotypes about Newfoundlanders’ intelligence or lack thereof. Noting that Newfoundland is often stereotyped by mainland Canadians as poor and “marked” by low socioeconomic status (538), they claim that “what began to emerge to replace the traditional culture of Newfoundland [in the minds of outsiders] was ‘Newfieland’ peopled by ‘Newfies’ – a place out of step with time,

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inhabited by the numskull figure of the ‘Newfie’ joke, too stupid to realize his own ineptitude and alien status vis-à-vis mainstream North American society, but eternally happy, embarrassingly hospitable, and full of fun, [and] deferential to his betters (read any non-Newfoundlander)” (qtd. in Byrne, 540–1). Through her interviews with tourists to Newfoundland, Everett (2009) suggests that the stereotype of the poor and unintelligent Newfoundlander relates to the ways in which food choice in the province is  perceived by non-Newfoundlanders. Given that working-class or working-poor people’s obesity is generally attributed to a lack of knowledge and understanding about healthy eating (McPhail, Chapman, and Beagan 2011), it stands to reason, Everett implies, that Newfoundland obesity is also blamed on a classist belief that people in the province who are backward and steeped in tradition “just don’t know” or understand “modern” ways to eat healthy – or that they are happily naive about the consequences of unhealthy eating practices, all of which contributes to high obesity rates. Newfoundlanders’ eating is positioned in this way not just by non-Newfoundlanders, but also by Newfoundlanders in health policy documents and other government and government-sponsored literature (Department of Health and Community Services 2006; Dietitians of Canada and Newfoundland and Labrador n.d.[a], n.d.[b]; Newfoundland and Labrador 2006). While government policy does not explicitly reproduce classist stereotypes about Newfoundlanders, Newfoundlanders’ apparent lack of knowledge and education about healthy eating and healthy weights is implied by a continued emphasis on the need for education and health promotion. In the words of one policy document: “Achieving health and wellness in our province will require raising awareness and supporting healthy behaviours among the population” (Newfoundland and Labrador 2006, 32). In addition, some provincial government and government-­sponsored documents continue to circulate notions of Newfoundland as ubiquitously poor, at times discussing Newfoundland’s obesity rates and generally low SES in the same breath (Newfoundland and Labrador 2006; Twells 2005). As an “impoverished region” in both the provincial and national imaginations, then, Newfoundland has come to be associated with class-based stereotypes in discussions about healthy eating and obesity, which already carry classist connotations in national conversations about the obesity “epidemic.” The effects of classism and class stereotyping in affects of tradition must therefore also be considered in discussions of Newfoundland obesity.

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Discussion of the Data Interviews with participants reflected a struggle between the two types of affective clusters that I have discussed.2 First, participants acknowledged the affective biopolitics of obesity panic and healthy eating as elicited by policy, medical concern, and the popular press. To this end, participants spoke at length about healthy eating practices and their desire to be healthy by avoiding obesity/overweight. Second, and often in conflict with the first, were affects – cravings, hungers, a sense of home, nostalgia, and familiarity – associated with traditional eating. Participants knew they should eat healthy, knew traditional foods to be unhealthy, but also yearned for traditional foods. Many participants in the study were therefore “affect aliens,” experiencing embodied affects of desire and longing for traditional foods, knowing full well that these affects differed from what is expected or required of healthy subjects. Occasionally no affective disjuncture existed because a participant did not like the taste of traditional food. While I detail below the responses of participants who did not like traditional foods, in the main participants were often torn between their desire to be healthy and their preference for traditional fare. This affective disjuncture was frustrating to participants, who responded by continuing to consume traditional foods, thus demonstrating an unspoken resistance to the affective biopolitics of obesity panic, but also regulating and restricting their consumption of such foods. Despite the stereotype that Newfoundlanders simply do not understand or know about healthy food or healthy eating, almost all participants in my study identified as healthy eaters. For example, almost all photographs participants took, which we then discussed in the second interview, demonstrated their commitment to healthy eating, even as I encouraged them to take photos of “unhealthy” foods they may have consumed. Indeed, one lower-middle-class woman fulfilled my request for pictures of “unhealthy foods” by copying images of burgers and fries from the internet, as she claimed to never eat unhealthy foods and therefore could not take any photos of them. By way of another example, one working-poor/underclass woman who was an occasional foodbank user would give back foods included in her hamper that she regarded as unhealthy. This participant demonstrates the commitment of most study participants to healthy eating to the best of their abilities. In general, participants’ definitions of healthy eating mirrored those that are currently dominant in Canadian society (Beagan and Chapman

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2012); when asked what healthy eating means, participants generally referred to the food groups and the Canada Food Guide, as well as to diets low in fats and sodium. As one participant put it, “I like healthy, tasty food. I try when I cook to prove that ‘look what you can make, and look how tasty it is, and you don’t have to have a lot of salt and fat’” (woman, lower middle class). Another woman echoed that “eating is eating by the Canada’s Food Guide, to me, right?” (working poor/underclass). Aligning themselves with the now ubiquitous conflation of “health” with the thin ideal (Chapman and Maclean 1993; Guthman 2011), study participants also equated healthy eating with lower weights and weight loss, as the following exchange with a workingpoor/underclass woman suggests: INTE RVI E W E R: So in terms of like, you’re wanting to watch your weight, do you think that’s related to the expense of food? PAR T I CI P A N T : Yes, it is. To eat healthy, you have to be able to afford healthy. And unfortunately, if you’re not a higher income than what I am, you really can’t continuously keep [weight loss] at a steady pace, as it should be.

When asked about obesity in Newfoundland, almost every one of my participants knew of and did not directly challenge the affective biopolitics of the province’s obesity “epidemic,” as government policy, the medical community, and the popular press present it. As one participant said, “[obesity] is from overeating and inactivity … I think that, as a population we’re growing. I think there is more obesity now” (uppermiddle-class woman). One exception to this was a lower-middle-class woman who, when asked her opinion on the purportedly high rates of obesity in Newfoundland, responded with scepticism: Is that true? I have heard that statistic, but I don’t know if it’s true. I feel like people are concerned about our weight in general. But I don’t know if they really know what to do in order to deal with it. There’s people who want to help and it’s somewhat misguided … But I also think, people have ideas – stuff like eating fat makes you fat. And I would say that most people believe that. I don’t think that’s true. I think you need fat – I eat fat all the time.

This woman, however, was an exception to the rule. Most participants in the study knew about and believed in the “obesity problem” in

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Newfoundland and the supposed health problems associated with “excess” adiposity, and they tried to eat accordingly. Because most knew what healthy eating was, and tried their best to eat healthy, all foods that participants talked about consuming were drawn into, judged according to, and talked about through healthyeating discourse. Traditional foods were no exception. By far, Jiggs dinner and salt meat in particular were identified as the least healthy traditional foods of all. One lower-middle-class woman originally from Labrador said, “I know salt meat isn’t the healthiest, from what I’ve heard … Like I heard it’s like, really high in cholesterol and stuff. And I’ve heard red meat isn’t [healthy].” Another lower-middle-class participant echoed: “Jiggs dinner … It’s cooked with the meat and everything. And it’s very salty. You cook it with salt beef as well … It’s cooked together. If it’s cooked separately, it doesn’t taste the same … So everything is quite salty, and all the juices are mixing together … And it’s, it’s delicious [but] it’s not healthy.” With a slightly different variation on the theme and linking traditional eating directly to obesity, one lowermiddle-class man maintained that the Newfoundland diet was not unhealthy within the particular time and place it originated, but was unhealthy given what he perceived as present Newfoundlanders’ more sedentary lifestyle: The traditional Newfoundland diet – it was a survival diet. It gave you fat, it gave you carbohydrates, it gave you protein. And, if you worked all day, fine. Boom. No problem. Maybe a few more nutrients and vitamins, you’d need, but other than that, it was basic, but I think it did the job. And people just don’t work the way they used to … [And now there are] the trans fats and the processed stuff on top of the Newfoundland diet, with people working less, I think that’s the contributor [to obesity].

An upper-middle-class woman raised in St. John’s expressed similar sentiments in relating a combination of traditional foods and more modern, processed fare to weight. When I questioned her about her partner’s experiences growing up in rural Newfoundland, she related: PAR T I CI P A N T : Two out of three of [my partner’s] brothers are chubbier than they should be … [They grew up in] such an isolated place, and it’s always been difficult to get vegetables. I mean, [my partner] said he never saw a fresh vegetable until he came into town [St. John’s]. You know, they were all raised on, you know, the carrots, the potatoes, the

332  Deborah McPhail turnips, and that’s kind of all they had … I think that’d probably be the only thing with even a tinge of green to it. That’s just, you know, that’s just the way they grew up. And that’s all they could buy in their stores … [That] traditional Newfoundland, kind of boiled-up dinner and salt meat and too many potatoes and not enough green vegetables obviously isn’t very good for people … People still eat that stuff … And I mean, you just see it, the people in Sobey’s, overweight and they still got six big two litres of Pepsi in their cart. And I’m thinking, “Oh, you really don’t need to be eating that.” INTE RVI E W E R: Right. So they still eat the boiled dinner but then they add, maybe the Pepsi to it? PART I CI P A N T : [laugh] Right. Just to take a bad thing and make it worse.

Overall, then, traditional foods were regarded as unhealthy and sometimes obesogenic by most participants in the study, who were also committed to eating healthy in various degrees. At the same time, though, many participants liked traditional foods – indeed, many “loved” them and found them “delicious” – and therefore continued to consume them through a complicated negotiation between healthyeating discourse and food practice. Some participants restricted their intake, eating traditional foods irregularly. Jiggs dinner, for instance, which traditionally would be consumed every Sunday, was now a treat for many participants, who enjoyed it only on special occasions. For example, one lower-middle-class participant brought to her interview a series of photos of the Jiggs dinner she had recently enjoyed for Thanksgiving. When I asked how often she would eat the dish, she said, “Oh, not often … Traditionally, it was every Sunday. Now, I’ve had three in the last two months [laughs] and that’s a lot. Because we’ve had a lot of family visiting. Everybody – when they come home, they want to have a Jiggs dinner, so my mom cooks it for them.” Another lower-middle-class participant described her infrequent consumption when asked about traditional fare: INTE RVI E W E R: How often do you eat or cook traditional Newfoundland food? PAR T I CI P A N T : Ah, rarely. Yeah, maybe a couple times a year. [My husband] loves it, but he doesn’t … maybe twice a year … We try to stay away from it ... Like the salt meat and stuff like that … But I figure everything in moderation, so you know, like a couple of times a year is no big [deal], or say if I went to my mom’s house and she had it, I might eat some.

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Similarly, a working-class participant echoed: “Easter and Christmas. There’s no other time for salt meat.” For this same participant, however, leaving the salt meat for holidays allowed her to consume Jiggs dinner more frequently than she otherwise would: We just randomly had Jiggs dinner [the other night] … I’d like to do it every Sunday as a tradition every Sunday like some people I know, but it doesn’t work out that way. So I still love it. I love Jiggs dinner. So I’ll have it whenever I can … Probably it’s not supposed to be called Jiggs dinner, without salt meat. I don’t know. I calls it Jiggs dinner … I love [salt meat]. But I avoid it.

This participant thus employed a further way to negate what she regarded as the unhealthy effects of desired traditional foods, which was to change or reduce certain ingredients to make the dish more healthy. Not all participants were affect aliens. Some genuinely “couldn’t be bothered” with traditional foods, in the words of one working-poor/ underclass woman living on assistance. Calling herself “a diabetic [with] high blood pressure, high cholesterol,” this participant noted that she did “not like” Jiggs dinner even though she cooked it weekly for her husband. “I’m not a traditional eater,” she stated, “but my husband is, right?” Another working-class participant was hierarchical in her dislike for traditional food. While she did not like dishes such as salt meat or other preserved or processed traditional foods, she did enjoy fresh seafood and in particular the archetypal Newfoundland fish, cod: “I myself, I love seafood. I don’t believe in the fat pork; I don’t eat that. But I do love fish, and my son, he eats scallops and shrimp. We loves fish, and I [recently] got a big load of cod.” At times, the dislike for traditional foods took a generational bent when participants would describe unhealthy traditional eating as something in which their parents’ or grandparents’ generation indulged. Such participants challenged the idea of Newfoundlanders as atavistic by passing the yoke of tradition to an earlier generation – it was they who were traditional and “backward,” or who did not know about modern definitions of healthy eating. But the current generation of Newfoundlanders, they imply, are thoroughly modern in their foodways and health practices. One participant stated: “Well, I get the fish, the cod fillets, and I freeze it. I dip it in flour and fry it in olive oil … Like, when Mom gets a feed of fish, she batters it and deep fries it … But I don’t even own a deep fryer. I threw mine out a couple years ago”

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(working class). Another woman described her mother as “really traditional” and outlined how her parents prepared cod tongues: They put them, you know, they wrap it in, ah, flour and then fry them, that way. And I don’t like cod tongues. My parents love them. They eat them all the time … they’ll get them from fishermen … [They prepare them] with butter, so they’re cooking with butter, instead of, you know, and oils whereas me and [my fiancée] try not to add any, any salt, or any extra fats when we’re cooking. We try to use a little bit of olive oil, we try to get the extra virgin olive oil and that kind of thing. (upper-middle-class)

Similarly, one lower-middle-class young man described eating “traditional Newfoundland meals” such as fish and brewis (a fish stew) with scruncheons (fried pork fat) at his grandparents’ house, which he found unpalatable: “When we go to my grandparents’ house, it’s always really salty and greasy and stuff. I have to drink a lot more water after one of my grandmother’s meals … They kind of eat more like people would back before the health craze.” When I asked what he meant by “the health craze,” he elaborated, in the process linking “old” ways of eating to obesity: PAR T I CI P A N T : I guess more like what you’d think of traditional Newfoundland meals. [People] were probably like, less health conscious about what they were eating. Then with the World Wide Web and studies and all that stuff that came out, then people realized that they should be eating better … INTE RVI E W E R: The statistic is that Newfoundland has the highest rate of obesity in Canada … Does that surprise you too, or no? PAR T I CI P A N T : No, not really. Not after watching how my grandparents eat.

Discussion Newfoundlanders’ accounts of traditional eating demonstrate the circuitous and often-obstructed routes that affective biopolitics of obesity and healthy eating might take. The words of participants recounted here also show – perhaps obviously – that affective biopolitics are often failed biopolitics that do not materialize without, at the very least, some form of resistance. At times, as my study demonstrates, this resistance may not be intentional, but results from unintended affects that have

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“bloomed” alongside, in relation to, because of, simultaneously with, or up against the affective biopolitics of obesity panic. In the case of Newfoundland and Labrador, affects of obesity panic and healthy eating are often, though not always, challenged by the embodied affects of traditional eating – participants “liked” and “loved” traditional foods, which they found “delicious” and which reminded them of “home” and “place.” The fact that many participants ate traditionally only at “mom’s house” or described eating more traditional foods than usual to celebrate the homecoming of family members gives a glimpse into the powerful affects of familiarity, nostalgia, and comfort that seem to frame or even engender the remembered tastes of salt meat, boiled vegetables, and peas pudding. At the same time, even those participants who desired traditional foods were also touched by the affective biopolitics of obesity panic and healthy eating, in which case an affective negotiation occurs whereby participants might have their Jiggs dinner and eat it too. In such cases, participants described regulating and restricting the consumption of traditional foods, or cooking them in particular ways that they believed to be more healthy. These participants interrupt the notion that Newfoundlanders do not know or understand what healthy eating is because they are undereducated or have a low SES (a derogatory stereotype that should be dispelled). As my study suggests, the Newfoundlanders of all classes I talked with did know what healthy eating is, and they practised it to the degree to which various social and affective structures allowed. Data analysis from this study therefore continues a larger project I began elsewhere with colleagues (McPhail et al. 2011), which questions easy conflations among working-class/working-poor/underclass people, “unhealthy” or “obesogenic” food choice, and obesity, and in particular challenges the assumption that individuals of low SES are to blame for obesity rates in Canada (however dubious these statistics may be, as outlined in the introduction to this volume) because they do not know the difference between healthy and unhealthy eating. This chapter, along with a growing literature on the topic (Johnston and Cappeliez 2012; McPhail, Chapman, and Beagan 2011), demonstrates that food choices are complex for people of every class and, while influenced by a number of social factors including food environment and cultural tradition, food practices are certainly not removed from dominant knowledge of healthy eating and obesity. Having said this, one shortcoming of the data presented here is that participants all lived in the major urban

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centre of Newfoundland and Labrador. It may be that living in more rural areas of Newfoundland creates more pronounced barriers to eating healthy due to food inaccessibility. In turn, these barriers may affect rural Newfoundlanders’ perceptions of what healthy eating is. However, previous Newfoundland and Cana­dian research has shown that both urban and rural people in general do know what healthy eating for a healthy weight is purported to be (Beagan and Chapman 2012; McPhail, Chapman, and Beagan 2013; Petherick and Beausoleil 2010), but this knowledge does not necessarily or neatly translate into practice for a variety of reasons – nor should it. Many of the people I spoke with were not only grappling with how to eat healthy in order to avoid obesity, but also with how to eat healthy without losing an important part of their cultural identity. In the process of fighting obesity, Newfound­landers are also fighting for their culture. This fact raises new and different as well as pressing questions for those invested in obesity discourse, regarding the ethical implications of upholding an affective biopolitics that positions some cultural and traditional practices, and by extension some cultures and traditions, as “backward” and unhealthy. NOTES 1 For example, the WHO attributes a rise in obesity in the global south to the globalization of the food system and the subsequent shift from traditional to “modern” fast and processed foods. As the agency argues in Global Strategy on Diet, Physical Activity and Health (2002), a document intended as a response to the global obesity epidemic, “[we recognize] the socioeconomic importance and the potential health benefits of traditional dietary and physical-activity practices, including those of indigenous people” (16). It goes on to urge member states to “preserve and promote traditional foods and physical activity” (17). Canadian obesity policy makes similar conflations between obesity and a lack of traditional food in racialized peoples, with a specific focus on Aboriginal peoples. As the Public Health Agency of Canada argues in its recent report Obesity in Canada, “community consumption of traditional foods has been shown to be associated with lower rates of obesity among First Nations children” (2011, 21). Similarly, Health Canada (n.d.) claims that “a rapid transition to energydense foods and away from the traditional hunting, gathering and fishing, combined with lower levels of physical activity, is likely associated with the dramatic increase in the rates of overweight and obesity in the Aboriginal populations in the last several decades.”

Newfoundland Obesity and the Affects of Tradition  337 2 In the traditional Newfoundland dialect of this area, many words end with the letter s that do not in most mainland English – for example, “I loves it.” To respect the culture and background of participants, I have left the dialect as is within my account of participants’ words, along with other expressions of the region, such as ending sentences with the query “right?”

WORKS CITED Ahmed, Sara. 2010a. “Happy Objects.” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 29–51. Durham: Duke University Press. – 2010b. The Promise of Happiness. Durham: Duke University Press. http:// dx.doi.org/10.1215/9780822392781. Alphonso, C. 2004. “Too Many Children Obese: Study.” The Telegram, 4 August. Alton Mackey, M.G., and L. Bernard. 1988. “I Eats Them Like That”: Changing Food Patterns of the Micmac of Conne River. Portugal Cove: Alton Mackey and Associates. Anderson, B. 2006. “Becoming and Being Hopeful: Towards a Theory of Affect.” Environment and Planning. D, Society & Space 24 (5): 733–52. http:// dx.doi.org/10.1068/d393t. – 2010. “Modulating the Excess of Affect: Morale in a State of ‘Total War.’” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 161–85. Durham: Duke University Press. Barnett, Clive. 2008. “Political Affects in Public Space: Normative Blind-Spots in Non-representational Ontologies.” Transactions of the Institute of British Geographers 33 (2): 186–200. http://dx.doi.org/10.1111/j.1475-5661.2008 .00298.x. Beagan, B., and G. Chapman. 2012. “Discourses of Food and Consumption: Constructing ‘Healthy Eating’/Constructing Self.” In Critical Perspectives in Food Studies, ed. M. Koc, J. Sumner, and T. Winson, 136–51. Toronto: Oxford University Press. Beausoleil, Natalie. 2009. “An Impossible Task? Preventing Disordered Eating in the Context of the Current Obesity Panic.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. J. Wright and V. Harwood, 93–107. New York: Routledge. Beausoleil, Natalie, and Pamela Ward. 2010. “Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy.” Radical Psychology 8. http://www.radicalpsychology.org/vol8-1/fatpanic.html. Bourdieu, Pierre. 1984. Distinction: A Social Critique of the Judgment of Taste. Trans. Richard Nice. Cambridge: Harvard University Press.

338  Deborah McPhail Brown, S.D., and I. Tucker. 2010. “Eff the Ineffable: Affect, Somatic Management, and Mental Health.” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 229–49. Durham: Duke University Press. Canning, P.M., M.L. Courage, and L.M. Frizzell. 2004. “Prevalence of Overweight and Obesity in a Provincial Population of Canadian Preschool Children.” Canadian Medical Association Journal 171 (3): 240–2. http://dx.doi .org/10.1503/cmaj.1040075. Canning, P., M.L. Courage, L.M. Frizzell, and T. Seifert. 2007. “Obesity in a Provincial Population of Canadian Preschool Children: Differences between 1984 and 1997 Birth Cohorts.” International Journal of Pediatric Obesity; IJPO 2 (1): 51–7. http://dx.doi.org/10.1080/17477160601124613. Chapman, G., and H. Maclean. 1993. “‘Junk Food’ and ‘Healthy Food’: Meanings of Food in Adolescent Women’s Culture.” Journal of Nutrition Education 25 (3): 108–13. http://dx.doi.org/10.1016/S0022-3182(12)80566-8. Clough, P.T. 2010. “The Affective Turn: Political Economy, Biomedia and Bodies.” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 206–25. Durham: Duke University Press. Crang, M., and D.P. Tolia-Kelly. 2010. “Nation, Race, and Affect: Senses and Sensibilities at National Heritage Sites.” Environment & Planning A 42 (10): 2315–31. http://dx.doi.org/10.1068/a4346. Department of Health and Community Services. 2002. Healthier Together: Strategic Health Plan for Newfoundland and Labrador. St. John’s: Department of Health and Community Services. http://www.health.gov.nl.ca/health/ publications/healthytogetherdocument.pdf. – 2006. Provincial Wellness Plan. St. John’s: Department of Health and Community Services. http://www.swsd.gov.nl.ca/publications/pdf/ provincial_strategies/nlprovincialwellnessplan.pdf. DeVault, M. 1991. Feeding the Family: The Social Organization of Caring as Gendered Work. Chicago: University of Chicago Press. Dietitians of Canada and Newfoundland and Labrador. n.d.(a) “What Moves You? Eat Well, Play Great: Healthy Eating for You and Your Family.” St. John’s: Newfoundland and Labrador. – n.d.(b) “What Moves You? Eat Well, Play Great: Make the Healthy Choice the Easy Choice.” St. John’s: Newfoundland and Labrador. http://www.health. gov.nl.ca/health/publications/healthy_eating_recreation_centres.pdf. Evans, Bethan. 2010. “Anticipating Fatness: Childhood, Affect and the Preemptive ‘War on Obesity.’” Transactions of the Institute of British Geographers 35 (1): 21–38. http://dx.doi.org/10.1111/j.1475-5661.2009.00363.x. Everett, Holly. 2007. “A Welcoming Wilderness: The Role of Wild Berries in the Construction of Newfoundland and Labrador as a Tourist Destination.” Ethnologies (Québec) 29 (1–2): 49–80. http://dx.doi.org/10.7202/018745ar.

Newfoundland Obesity and the Affects of Tradition  339 – 2009. “Vernacular Health Moralities and Culinary Tourism in Newfoundland and Labrador.” Journal of American Folklore 122: 28–52. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. London: Routledge. Germov, J. 2008. A Sociology of Food and Nutrition: The Social Appetite. Oxford: Oxford University Press. Guthman, J. 2011. Weighing In: Obesity, Food Justice, and the Limits of Capitalism. Berkeley: University of California Press. Hanrahan, M. 2008. “Tracing Social Change among the Labrador Inuit and Inuit-Métis: What Does the Nutrition Literature Tell Us?” Food, Culture, & Society 11 (3): 315–33. http://dx.doi.org/10.2752/175174408X347883. Health Canada. n.d. “Diabetes in Canada: Facts and Figures from a Public Health Perspective.” http://www.phac-aspc.gc.ca/cd-mc/publications/ diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php. Johnston, J., and S. Baumann. 2010. Foodies: Democracy and Distinction in the Gourmet Foodscape. New York: Routledge. Johnston, Josee, and Sarah Cappeliez. 2012. “You Are What You Eat: Enjoying (and Transforming) Food Culture.” In Critical Perspectives in Food Studies, ed. Mustafa Koc, Jennifer Sumner, and Tony Winson, 49–64. Toronto: Oxford University Press. King, R., and S. Clarke. 2002. “Contesting Meaning: Newfie and the Politics of Ethnic Labeling.” Journal of Sociolinguistics 6 (4): 537–54. http://dx.doi .org/10.1111/1467-9481.00200. Lorimer, H. 2008. “Cultural Geography: Non-representational Conditions and Concerns.” Progress in Human Geography 32 (4): 551–9. http://dx.doi.org/ 10.1177/0309132507086882. Lupton, D. 1996. Food, the Body and the Self. London: Sage. Massumi, B. 2010. “The Future Birth of the Affective Fact: The Political Ontology of Threat.” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 52–70. Durham: Duke University Press. McCormack, D.P. 2003. “An Event of Geographical Ethics in Spaces of Affect.” Transactions of the Institute of British Geographers 28 (4): 488–507. http:// dx.doi.org/10.1111/j.0020-2754.2003.00106.x. McPhail, Deborah. 2010. “Canada Weighs in: Gender, Race, Class and the Making of ‘Obesity’ in Canada, 1950–1970.” Doctoral diss., York University, Toronto. McPhail, D., B. Beagan, and G.E. Chapman. 2012. “‘I Don’t Want to Be Sexist, But …’: Denying and Re-inscribing Gender through Food.” Food, Culture, & Society 15 (3): 473–89. http://dx.doi.org/10.2752/175174412X13276629246046. McPhail, D., G.E. Chapman, and B.L. Beagan. 2011. “‘Too Much of That Stuff Can’t Be Good’: Canadian Teens, Morality, and Fast Food Consumption.” Social Science & Medicine 73 (2): 301–7. http://dx.doi.org/10.1016/j.socscimed.2011.05.022.

340  Deborah McPhail – 2013. “The Rural and the Rotund? A Critical Interpretation of Food Deserts and Rural Adolescent Obesity in the Canadian Context.” Health & Place 22: 132–9. http://dx.doi.org/10.1016/j.healthplace.2013.03.009. Newfoundland and Labrador. 2006. Eating Healthier in Newfoundland and Labrador: Provincial Food and Nutrition Framework and Action Plan. http:// www.health.gov.nl.ca/health/publications/provincialnutritionplan.pdf. Omohundro, J.T. 1994. Rough Food: The Seasons of Subsistence in Northern Newfoundland. St. John’s: Institute of Social and Economic Research. Penfold, S. 2008. The Donut: A Canadian History. Toronto: University of Toronto Press. Petherick, LeAnne, and Natalie Beausoleil. 2010. “Body Image and Healthy Living in School Environments: Results From a Pilot Study.” Paper presented at People’s Health Matters: Community Health and Humanities Seminar Series, 26 November, St. John’s, NL. Pile, S. 2010. “Emotions and Affect in Recent Human Geography.” Transactions of the Institute of British Geographers 35 (1): 5–20. http://dx.doi.org/10.1111/ j.1475-5661.2009.00368.x. Power, E. 2003. “De-centering the Text: Exploring the Potential for Visual Methods in the Sociology of Food.” Journal for the Study of Food and Society 6 (2): 9–20. http://dx.doi.org/10.2752/152897903786769670. Public Health Agency of Canada and the Canadian Institute for Health Information. 2011. Obesity in Canada: A Joint Report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Ottawa: Her Majesty the Queen in Right of Canada. http://www.phac-aspc.gc.ca/ hp-ps/hl-mvs/oic-oac/assets/pdf/oic-oac-eng.pdf. Seigworth, G.J., and M. Gregg. 2010. “An Inventory of Shimmers.” In The Affect Theory Reader, ed. M. Gregg and G.J. Seigworth, 1–28. Durham: Duke University Press. Squires, Josh, Barbara Roebothan, Sharon Buehler, Zhuoyu Sun, Michelle Cotterchio, Ban Younghusband, Elizabeth Dicks, John R. Mclaughlin, Patrick S. Parfrey, and Peizhong Peter Wang. 2010. “Pickled Meat Consumption and Colorectal Cancer (CRC): A Case-Control Study in Newfoundland and Labrador, Canada.” Cancer Causes & Control 21 (9): 1513–21. http://dx.doi. org/10.1007/s10552-010-9580-z. Statistics Canada. 2005. “Measured Obesity: Adult Obesity in Canada; Measured Height and Weight.” http://www.statcan.gc.ca/pub/82-620-m/ 2005001/article/adults-adultes/8060-eng.htm. – 2009. Low Income Cut-Offs for 2008 and Low Income Measures for 2007. Ottawa: MinisterofIndustry.http://www.statcan.gc.ca/pub/75f0002m/75f0002m2009002eng.pdf. Accessed 7 May 2013.

Newfoundland Obesity and the Affects of Tradition  341 Stokes Sullivan, D. 2004. “Newfoundland Country’s Porkiest Province.” The Telegram, 26 February. Thien, D. 2005. “After or Beyond Feeling? A Consideration of Affect and Emotion in Geography.” Area 37 (4): 450–4. http://dx.doi. org/10.1111/j.1475-4762.2005.00643a.x. Tolia-Kelly, D.P., and M. Crang. 2010. “Affect, Race and Identities: Guest Editorial.” Environment & Planning A 42 (10): 2309–14. http://dx.doi. org/10.1068/a43300. Twells, Laurie. 2005. Obesity in Newfoundland and Labrador. St. John’s: Newfoundland and Labrador Centre for Applied Health Research. http:// www.researchgate.net/publication/251307563_Obesity_in_Newfoundland_ and_Labrador. Twells, L.K., J. Knight, and R. Alaghehbandan. 2010. “The Relationship among Body Mass Index, Subjective Reporting of Chronic Disease, and the Use of Health Care Services in Newfoundland and Labrador, Canada.” Population Health Management 13 (1): 47–53. http://dx.doi.org/10.1089/pop.2009.0023. Twells, L., and L.A. Newhook. 2010. “Can Exclusive Breastfeeding Reduce the Likelihood of Childhood Obesity in Some Regions of Canada?” Canadian Journal of Public Health 101: 36–9. Tye, D. 2008. “‘A Poor Man’s Meal’: Molasses in Atlantic Canada.” Food, Culture, & Society 11 (3): 335–53. http://dx.doi.org/10.2752/175174408X347892. Walsh, P. 2008. “Province Tops the Scales.” The Telegram, 19 June. World Health Organization (WHO). 2002. Global Strategy on Diet, Physical Activity and Health. http://www.who.int/dietphysicalactivity/en/.

13 Screening the Un-scene: Deconstructing the (Bio)politics of Story Telling in a Canadian Reality Makeover Weight Loss Series M o s s E. Nor man, Ge n e viè ve Rai l , a nd Shannon Je t t e Canada is in the midst of a childhood obesity epidemic that will have dramatic effects on the health of Canadians and our health care systems – for the first time in more than a century, the children of today may have less healthy and possibly even shorter lives than their parents. (Our Health Our Future: A National Dialogue on Healthy Weights, Public Health Agency of Canada 2011b)

Stories warning against the sins of gluttony and sloth are not new (Gilman 2004; McPhail 2009; Prose 2003), but recently these moral tales have been recuperated within public health discourse to alarm citizens of an impending “obesity epidemic.” The story of the purported obesity epidemic, replete with apocryphal claims of immorality, illness, and death, is being told and retold in various forms through institutions of medicine and education as well as through popular media (see Holmes 2009; Rail, Holmes, and Murray 2010; Rich 2011). Growing concerns and even panic (see Fraser, Maher, and Wright 2010) over the health “crisis” of overweight and obesity have been fuelled by a dramatic increase in epidemiological, physiological, and medical literature (see an overview in Gard 2011; Gard and Wright 2005). The World Health Organization has even declared a “global obesity epidemic” (WHO 2006). In Canada, the situation is no different, and in March 2011 the federal government launched the National Dialogue on Healthy Weights (NDHW), a pan-Canadian strategy to combat obesity. As in most Western countries, in Canada lifestyles of sedentary living and calorically rich diets have been blamed for the rising levels of overweight and obesity; more crucially, the Canadian government has identified such levels as posing serious risks to the health of both the nation

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and its citizens (Public Health Agency of Canada [PHAC] 2011b). As the NDHW outlines, a “national crisis” requires a “national response,” to be achieved by engaging and mobilizing private and public interests in combating the causes of obesity, as well as empowering “individuals, families and communities to take action and adopt positive behaviour changes” (PHAC 2011a, 2). The Canadian Broadcasting Corporation’s reality television makeover series called Village on a Diet (VOD) epitomizes the sort of collective engagement and mobilization that the government of Canada seeks in combating “obesity.” However, our reading of VOD is more cautionary than celebratory. We situate VOD as an example of “governing at a distance” (Miller and Rose 1990; see also Ouellette and Murray 2009) that characterizes emerging forms of authority within our neoliberal epoch. Our reading of VOD is influenced by the burgeoning critiques of the “obesity epidemic” that tell a different story about fat, body weights, shapes, and health (Boero 2009; Colls and Evans 2009; Gard 2011; Monaghan 2008; Rail 2009, 2012; Rich 2011). The “Story” of the Obesity Epidemic Stories are wondrous things. And they are dangerous. Thomas King (2003, 9)

Telling any story draws upon and highlights some plots while obscuring and shutting down others. For a convincing story to hold together in a meaningful way, it must present its narrative as “truthful” and “authentic.” In other words, it must construct legitimacy by foreclosing those stories that complicate, contradict, and undermine The story. After all, one does not want to be caught “telling stories” (i.e., multiple, decentred, non-teleological tales); rather, one aims to tell The one, singular, truthful story. The story of the “obesity epidemic” achieves legitimacy through a number of contiguous “truths” about obesity (e.g., excess weight equals lack of health; losing weight improves health status; permanent weight loss is possible), and these “truths” are disseminated through institutions such as the media (Boyce 2007; Gard 2011; Roy, Faulkner, and Finlay 2007), schools (Evans et al. 2008; Gard and Wright 2005), and medicine (Monaghan, Hollands, and Pritchard 2010; Rail 2012; Rail and Lafrance 2009; Wright 2009). Many individuals affiliated with these institutions are positioned as privileged storytellers of

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obesity “truths,” including obesity scientists, health professionals (e.g., medical doctors, dieticians, public health nurses), and other health experts and pseudo-experts such as physical educators, fitness trainers, and psychologists. Each of these experts might have a slightly different obesity truth to tell – for example, a dietitian might emphasize energy-in (eating) over energy-out (exercise). Nonetheless, these health “experts,” and the institutions they are associated with, produce and reproduce an obesity discourse that is both dominant and normative (Rail 2012; Wright 2009). “Obesity truths” are constructed within a particular ideology that excludes alternative forms of knowledge. They forge a dominant obesity discourse within which obese and “at-risk” bodies are constructed as lazy and expensive bodies that should be submitted to disciplinary technologies, expert intervention, and regulation (Colls and Evans 2009; Rail, Holmes, and Murray 2010; Wright 2009). However, “obesity” is not a scientifically determined “fact or static condition of a body, but a process whereby regulatory norms materialize obesity” (Rail, Holmes, and Murray 2010, 262) by privileging some stories, knowledges, or institutional practices as “truth” while denigrating, excluding, and foreclosing other stories and ways of knowing. In other words, there are other stories about fatness and health, but these stories are rarely heard and often dismissed as non-scientific and biased (Campos 2004; Campos et al. 2006). In terms of alternative understandings of fatness, for instance, recent biomedical and social scientific research has challenged the notion of obesity as a “disease” (Gaesser 2003a; Oliver 2006), the causal attribution of illness or death to obesity (Campos et al. 2006; Farrell et al. 2002; Flegal et al. 2005, 2010, 2013; Flegal and Graubard 2009; Gaesser 2003b, 2006; Kuk et al. 2011; Lenz, Richter, and Mühlhauser 2009; Lloyd-Jones et al. 2009; Mark 2005; Oliver 2006), and the use of the term epidemic (Campos et al. 2006). Indeed, in this volume, Paradis points to how the obesity rates in the Canadian population (measured in terms of the BMI, a problematic tool in itself) have been “dwarfed” by the medical publications on obesity. The gap between obesity and research reporting on obesity, while less than the gap found in the American context, nonetheless points to an ideological intensification of the “problem of obesity” (see Paradis, this volume). Other critics of mainstream obesity science have condemned the mediated “moral panic” associated with obesity (Boero 2007; Saguy and Almeling 2008) and the pathologizing of fat people (LeBesco 2011; Murray 2008), suggesting that the burden

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of responsibility for obesity is not evenly spread across the population. For example, women – mothers in particular (see Mitchinson and Paradis in this collection), as well as economically disadvantaged and racialized individuals – are disproportionately made responsible for the purported health crisis associated with obesity (see Harper and Rail 2011, 2012; Jette 2008, 2009; Kendrick 2008; Rich 2011; Saguy and Almeling 2008). Obesity scholars also critique the putative solutions to the obesity crisis (e.g., diet and exercise), suggesting that they are founded in individualist, market-oriented solutions (Colls and Evans 2009; Gard and Wright 2005) and are largely ineffective interventions (see Lyons 2009; Monaghan 2008) that ultimately leave the broader social structural attributions for ill health and unhealthy living uninterrogated (Herrick 2007). The acceptance of the dominant obesity discourse as “truth” over alternative narratives reflects on how the “energy balance model” has been privileged within Western biomedicine (with the veracity of the model having been questioned – see Gard and Wright 2005). It also mirrors the dominance of neoliberal ideology whereby responsibility for health is “downloaded” to the individual, who is pressed to manage his or her body weight through appropriate diet and exercise, and who faces stigmatization if s/he fails to do so. Authors of alternative stories (i.e., critical obesity scholars and obesity sceptics) have thus been viewed as engaging in a naive conspiracy theory about the dangers of the dominant obesity discourse (Monaghan, Rich, and Aphramor 2011). However, and as a handful of critical obesity scholars have recently pointed out (see Gard 2011; Monaghan, Rich, and Aphramor 2011), some of these alternative narratives have been presented in a manner that makes them rather easy to dismiss as the rants of those with an ideological bone to pick, for they employ such strategies as constructing oneself as more objective and truthful than the obesity scientists/ alarmists, or setting up a “them-versus-us” dichotomy between obesity alarmists and sceptics, with the former being accused of intentionally and malevolently creating conditions in which the “fat” are shamed and blamed. For our part, and following Gard (2011) and Monaghan and his colleagues (2011), we do not posit that obesity alarmists are “active and/or deliberate agents of a neo-liberal agenda” (Gard 2011, 150) because we argue that in many cases, they honestly believe obesity is a health risk that can be best solved if people deemed above “normal” weight simply slim down. Good intentions, however, do not mitigate the harm imposed by biopedagogies underpinned by the dominant

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obesity discourse.1 We are concerned about how the uncertainty surrounding obesity science is often painted over with morality tales and neoliberal ideology that blame and shame overweight individuals. Reality TV: Making Over the “Story” of Obesity The dominant storyline of the “obesity epidemic,” with its focus on lazy, out-of-control citizens gorging themselves to the point of illness and even death, offers a particularly appealing narrative frame for reality makeover television. This appeal can be witnessed in the proliferation of weight-loss-focused reality shows, many of which are syndicated globally, including Honey, We’re Killing the Kids (see Kendrick 2008; Rich 2011), The Biggest Loser (see Sender and Sullivan 2008), Jamie’s Ministry of Food (see Rich 2011; Warin 2011) and, we would argue, Canada’s own Village on a Diet. Within makeover programming, the theme of selftransformation is central whereby, with the help of many health, beauty, fitness, and consumer experts, abject or degenerate subjects (fat, working class, consumer illiterates, and so on) are transformed into clean or respectable, self-governing citizens (Kendrick 2008; Ringrose and Walkerdine 2008; Wood and Skeggs 2011, 2005). In this regard, Blackman (2011) argues that reality television operates as a “technology of citizenship,” outlining the contours of the preferred, normative, self-governing neoliberal subject. Insert the “crisis of obesity” into the makeover storyline, where the health and well-being of entire populations are purportedly at stake, and the transformational imperative of makeover television acquires a self-vindicating logic (Ringrose and Walkerdine 2008). In other words, the overt mockery, ridicule, and public humiliation that fat people experience in reality programs such as The Biggest Loser (see Sender and Sullivan 2008) are justified as a necessary means to an end because such humiliation is “for their own good.” The explicit health imperative of some weight-loss-makeover television, however, erases from view those other, insidious aspects of the makeover genre where, for instance, class antagonism is implicitly deployed to incite desires for “self-improvement.” Here, discourses of health are entangled with social norms of class, gender, and “race,” for instance, in the intensification of psychic and bodily anxieties (Palmer 2004; Ringrose and Walkerdine 2008; Sender and Sullivan 2008; Wood and Skeggs 2011, 2005). In this way, “staying put” ceases to be a viable option; rather, the perpetual albeit elusive journey from a degenerate “here” (fat, unhealthy, and unhappy) to a “better” tomorrow is positioned as the normative desire.

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Many of these weight-loss reality programs tend to focus on individual health or the health of the family unit, with little consideration of the broader community. In fact, programs such as The Biggest Loser remove individuals from their communities and relocate them within a social and physical context that is supposedly more conducive to their weight-loss journeys, or so we are led to believe (Sender and Sullivan 2008). Here, “transformation” is located in the self and in the family unit, not the broader social, cultural, and physical environment. How­ ever, with the increased focus on the “obesogenic environment,” a new subspecies of weight-loss reality TV has been born, where ostensibly community health is the central focus of the program (Warin 2011). We situate VOD within this emergent reality makeover genre and systematically critique the presumption of community-focused representations of “transformation,” suggesting instead that VOD remains marred by the same ethos of neoliberal social governance that has characterized makeover television more broadly (see Blackman 2011; Palmer 2004; Sender 2011). Overview Against the backdrop of dominant obesity stories, then, we shine a critical poststructuralist light on the Canadian reality TV makeover series VOD. Our objective is to chronicle the scene, or that which is in focus and included as the privileged story, as well as the out-of-focus and unacknowledged “absent presence” that remains un-scene. Through our critical reading of VOD, we focus on some of the bodily, cultural, and political issues generally overlooked in an obesity research field overwhelmingly colonized by biomedicine and positivist accounts of obesity as a transparent, biomedical, or public health problem. We also hope to expand a body of knowledge about reality makeover tele­ vision that is focused predominantly within the United States (see Ouellette and Murray 2009; Peltier and Mizock 2012; Sender and Sullivan 2008), United Kingdom (see Rich 2011; Skeggs and Wood 2012; Warin 2011; Wood and Skeggs 2005), and Australia (see Kendrick 2008; Ringrose and Walkerdine 2008) by examining the discursive effects of this genre in the Canadian market. Finally, we hope to contribute to the existing obesity scholarship by using Foucauldian-inspired concepts not only to theorize and draw attention to the scene and unscene, but also to explore the biopedagogical mechanics of VOD and its obesity discourse as components of a broader political apparatus for “governing at a distance.”

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Methodological Considerations We viewed all eleven episodes of the VOD reality series on the CBC website (www.cbc.ca) and analysed each using a poststructuralist discourse analysis approach (see Rail 2002, 2009; Weedon 1997; Wright 2004). Central to such analysis is the concept of discourse or the relationship between knowledge, language, and power. According to Foucault (1972), language is not a neutral medium of communication. Rather, what is “sayable,” indeed thinkable, is embedded within historical conditions of possibility. Knowledge and the production of “truth” figure prominently in shaping what is culturally available or sayable within an epoch – they incite some ways of thinking, talking, and acting while foreclosing others. To return to our story metaphor, not all stories, according to Foucault and other poststructuralist theorists, carry equal weight: the ones told by scientists and other experts are constituted as more “truthful” and thus more weighty or powerful than others. For instance, the “truth” of obesity (e.g., that it is a problem or a disease) shapes governmental policy, media representations, and individual understandings and practices. Thus, the dominant discourse of obesity is inserted into a web of power relations where it has discursive effects that regulate populations and shape the conduct of individuals. Our task, therefore, was to submit VOD to a poststructuralist discourse analysis in order to: (a) draw out how, if at all, it deploys the dominant discourse of obesity as well as other related social and bodily discourses in telling its story; and (b) investigate the potential effects of such discourses for both people and the nation. The following three scenes and their corresponding un-scenes present the results of our analysis. Screening the Scene and Critically Unpacking the Un-scene

Scene 1: The Premise and Its Promise The premise of Village on a Diet rests on a challenge posed to the town of Taylor, British Columbia: to lose two thousand pounds, or one ton, in three months. The task was facilitated through the expertise of six outof-town “butt-kicking experts” (Fraggalosch 2011c). VOD was aired during prime-time hours on Canada’s national public broadcaster, the CBC. Over the course of eleven weeks (January to March 2011), viewers were privy to the personal and community struggles as Taylor set out to transform itself from a state of “obesity, sickness, and heart disease”

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to a future of “health, happiness, and hope,” according to VOD’s British narrator (Fraggalosch 2011c). The show is consistent with the CBC’s broader mandate to “inform, enlighten, and entertain” (www.cbc.radiocanada.ca/_files/cbcrc/documents/strategy-2015/document2015-en. pdf, accessed 3 November 2015). John Ritchie, the executive producer of VOD, conceived the program as primarily entertainment, but suggested that it is entertainment with a twist because it serves what he calls a “socially transformative” function (qtd. in McPhee 2010). The socially transformative potential of VOD relates to the broader obesity discourse. The media, in Canada (Holmes 2009; Roy, Faulkner, and Finlay 2007) and elsewhere (Boero 2009; Gard and Wright 2005; Saguy and Almeling 2008), have already chronicled the health perils of increasing levels of overweight and obesity, a trend that has generated a global “war on obesity” (see Rail, Holmes, and Murray 2010). Read alongside and in relation to the broader war on obesity, the goal of losing one ton of weight in the name of individual and community health was indeed understood to be a socially transformative responsibility that all Cana­ dians could and should get behind. On numerous occasions, TV viewers were urged to join the challenge and embark on a journey of transformation and salvation. For instance, at the conclusion of the final episode, “celebrity trainer” Mike Veinot implored Canadians to “get outside of your house, get off your couch, make the change” (Fraggalosch 2011a). With the aid of various so-called health and lifestyle “experts” (e.g., a physician, a dietitian, a chef, and fitness trainers), both the citizens of Taylor and the citizenry of the Canadian viewing public were schooled in various lifestyle practices, particularly lessons related to careful self-management and “proper” lifestyle choices as a means of losing weight and transforming body, self, and ultimately nation – the holy trinity of good citizenship and patriotic duty. These life lessons were often packaged in the form of weekly community physical activity challenges. Each episode featured one of these challenges, during which the citizens of Taylor were divided into teams where they had to work together to complete physically onerous and competitive tasks, such as a car-pushing relay race, a race to assemble a community garden, and racing to the top of the local ski hill. The community challenges were accompanied by weekly individual challenges where citizen dieters would partake in a timed walk-run around the local golf course. These individual and communal challenges were pivotal to the narrative thread of VOD, as viewing audiences gained inside

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access to the emotional and physical struggles and victories of Taylorites as they strived to transform their bodies and lives. In addition to physical challenges, VOD also featured a number of life lessons about food and eating, and the tensions these lessons created between the citizens of Taylor and the out-of-town, butt-kicking experts proved to be a primary source of entertainment for the show. Indeed, chef Jonathan Chovancek had his work cut out for him if he was going to change the eating habits of the people of Taylor. This was made clear by one resident who had been eating fatty, greasy foods for his entire life, as he explained that he was not going to change: “I like what I like and I have a right to eat it, and nobody can take that away from me” (Fraggalosch 2011c). VOD went beyond an individualist approach to changing diets, however, as Jonathan also vowed to change the food environment of Taylor by redoing the menu at the local pizzeria, which according to Jonathan, served “meat [… and] cheese bomb” pizzas (Fraggalosch 2011b). Indeed, the clashing food and dietary sensibilities of the people of Taylor and Jonathan served as a central site of class antagonism (see Wood and Skeggs 2005), as villagers were filmed mocking the bland, boring, tasteless dishes that Jonathan served, while Jonathan, for his part, commented on the unhealthy and classed dietary practices of villagers. The tension that was generated by the out-of-town experts who endeavoured to transform the lifestyles of Taylorites who were resistive to and suspicious of such changes, was deployed to elicit a wide range of emotions in viewing audiences, including laughter, empathy, disgust, and even anger, but the entertainment value of the show should not be taken as undermining the serious biopedagogical function that VOD serves. The biopedagogical strategy of VOD did not stop with the television show. Indeed, VOD was featured on the CBC website, where web visitors could acquire information from the show’s panel of experts on things such as healthy gourmet recipes, working out at home, targeting “problem” areas such as “saddle-bags,” and various techniques for motivating the self in lifestyle change. The website also featured a national weight-loss challenge, “The Million Pound Challenge,” where citizendieters could “pledge” their weight loss – and presumably their status as good responsible citizens – into a national scale. Although the show was ostensibly designed to “entertain,” its “socially transformative” aspirations were in full evidence in the Live Right Now social healthmarketing campaign that was featured on the CBC website and the VOD webpage. Live Right Now was a “national [health] initiative”

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partnered with the major players in the Canadian health promotion scene (e.g., Heart and Stroke Foundation, ParticipACTION, the Cana­ dian Obesity Network) and backed by a multinational corporation (Loblaw’s, which belongs to George Weston Limited, a multinational food-processing and food-retailing company). When VOD first aired, the Live Right Now website proclaimed that Live Right Now aims to “inspire Canadians to join together and change the health of this country. The idea is built around the small steps everyone can take in their life to improve their health” (accessed 20 March 2011). VOD, its broadcaster, sponsors, and consultants exemplify the sort of synergistic collaboration that is outlined in the NDHW initiative that aims to “engage and mobilize all sectors of society” (PHAC 2011a, 2) in combating obesity. But despite its “inspiring” and “socially transformative” message, what remains un-scene in both the script of VOD and its associated social marketing interface is how its transformative promises function as an emergent form of neoliberal governance.

Un-Scene: Neoliberal Promises Informative, enlightening, and entertaining though it may be, there are powerful and insidious ideological assumptions underlying the storyline of VOD – ideologies that function as components of a more expansive apparatus of “governing at a distance” (Miller and Rose 1990; see also Ouellette and Murray 2009). In advanced liberal democracies, governance is not located exclusively within the formal institutions of a centralized state. As Rose suggests, it increasingly operates through a “plethora of indirect mechanisms that can translate the goals of po­ litical, social and economic authorities into the choices and commit­ ments of individuals” (1996, 58). The shift from a centralized governance structure to one that increasingly makes individuals responsible for their own economic, social, and physical well-being has been broadly – and not unproblematically (see Rose 1999) – referred to as “neoliberalism.” Neoliberalism is a term used to characterize policies that aim to “liberate” the entrepreneurial spirit through reducing government regulations, fostering an ideology of individual liberty, bolstering private property rights, reducing market regulations, and liberalizing trade (see Brodie 2007; Harvey 2007). More specifically, neoliberal policies are characterized by the proliferation and dissemination of “apparatuses and knowledges through which people are reconfigured as economic entrepreneurs of their own lives” (Davies and Bansel 2007, 251). With

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their “powers of freedom” (Rose 1999) purportedly acquired under neoliberalism, empowered subjects are incited to secure mastery over their own social, cultural, economic, and – of particular import for this chapter – health destinies through a range of judiciously managed projects of the self (e.g., financial management, healthy diet, active living). Such self-transformations and improvements are presented as a moral imperative in achieving responsible citizenship. Within the context of the purported “obesity epidemic,” achieving a normal, “healthy” shape and size has become one such body project where individuals are supposedly instilled with the power, resources, skills, and desire to take control of their flesh through self-­management, consumerism, healthy choices, and other practices aided by the advice of various experts of subjectivity. Inserted into the medium of makeover reality TV, obesity offers rich opportunities for melodrama as “millions of lost, overweight and deluded souls all in need of rescue” (Palmer 2008, 8) search for salvation through expert guidance in practices of self-transformation. VOD serves a biopedagogical function, teaching the art and practice of a life of healthy living at the level of both the “citizen body” and the “body of the citizenry” (Rose 2007). In other words, the biopedagogies of VOD simultaneously operate at the two poles of governance articulated within Foucault’s (1978) concept of biopower,2 both disciplining the individual body and regulating the “species body” or the population as an aggregate. The operatives of biopower are evident in how the biopedagogies of the show itself, its affiliated website, and the attendant social health-marketing campaign aim to inspire the country to come together and change the health destinies of its citizens through the “small steps everyone can take.”3 In this sense, CBC’s Village on a Diet represents an archetype of the neoliberal social model of governance envisioned in the National Dialogue on Healthy Weights, with its goal of forging partnerships between citizens, government and non-governmental organizations, and industry in engaging all Canadians in fighting the war on obesity. However, the apparent synergy between CBC and the federal government’s NDHW is not as straightforward as might at first appear, but is instead a partnership realized within a specific geopolitical context. Importantly, the neoliberal promise of salvation through weight loss offered on VOD was not aired on just any media outlet, but on the CBC, Canada’s national publicly funded broadcaster. In this case, the medium (i.e., CBC) is indeed as important as the message. It reveals a lot about the geopolitical context in which stories about body weight and

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its relationship to health are told. As Sender (2011, 1) reminds us, the “global circulation and local adaptation of reality TV formats” must be taken into account in order to avoid producing stagnant and decontextualized critiques of the reality television format. Therefore, the story of makeover transformation is not a free-floating, universal story, but is embedded within culturally specific, localized contexts that shape its telling, even if in subtle and barely discernible ways. Rather than accepting the dominant story of obesity and lifestyle transformation, we are more interested in exposing the unscene story of the power relations that enabled this particular telling on the Canadian Broadcasting Corporation’s airwaves. As others have noted, within the Canadian media context, health-­ related stories disproportionately emphasize the biomedical, health-­ promotion approach to health, which focuses on individual choice and the “holy trinity of risk” – diet, exercise, and smoking cessation (Raphael, Curry-Stevens, and Bryant 2008, 224; see also Hayes et al. 2007; Raphael 2011). Raphael (2011) traces such a focus back to the intensification of corporate control of Canada’s media outlets. He argues that the corporatist media agenda favours stories that feature freemarket and individualized solutions to population health, as opposed to the social-determinants-of-health model, which conducts a complex and intersectional analysis of the underlying social and economic conditions (e.g., economic inequality, food security, affordable housing, gender identity, and so on) that shape the individual and collective health of Canadians. At first glance Raphael’s analysis of the corporate control of private media broadcasters does not seem to apply to the CBC, which has historically received most of its funding from the federal government of Canada. However, given the intensified neoliberal turn in the Canadian federal government (Brodie 2007; Raphael, Curry-Stevens, and Bryant 2008), the CBC has, like most residual institutions of social liberal policy, undergone relatively aggressive funding cuts, not to mention ideological attacks, and has thus been forced to re-imagine itself as a commodified, increasingly market-based institution, forging public-private partnerships as a means of survival (Contenta 2012; Raphael 2011). This turn to private dollars comes at a price. In particular, CBC loses some control of the stories it tells, as it must increasingly align its plot with the interests of its corporate sponsors. The Live Right Now campaign and its synergistic relations with VOD are examples of this trend, where private corporate interests (e.g., Weston Food Group) meld with

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those of public and not-for-profit institutions, such as the CBC, ParticipACTION, and the Heart and Stroke Foundation of Canada, in producing health entertainment (e.g., VOD) that is almost completely shorn of critical commentary on the social determinants of health (Raphael 2011). Critics in other contexts have noted how public-private partnerships of this sort produce strange bedfellows where, for example, sponsorships from the food and drink industries – industries that are typically understood as primary “culprits” in causing the “obesity epidemic” – provide financial support and thus join forces with healthpromotion institutions and their affiliated health professionals in the “war on obesity” (Herrick 2009). As Herrick points out, these sorts of partnerships powerfully shape the stories that are told about eating, exercise, body weight, and their relationship to health. The neoliberal promises forged at the nexus of private-public partnerships are thus constrained by the competing economic interests of their various funding agencies so that alternative stories about body weight and its relationship to health are often foreclosed. For example, the multibillion-dollar commercial diet and weight-loss industries have deep financial interests – albeit competing interests, at times – in the dominant story of the “obesity epidemic” and its putative solutions (e.g., diet, exercise, pharmaceuticals and, more recently, bariatric surgery). As such, these industries have relatively little investment in alternative stories that critique the promise of lifestyle transformation and permanent weight loss as a practical and realistic goal (Campos 2004; Rail 2012). This promise is all the more pernicious given the detrimental health consequences of weight cycling (Campos 2004), eating disorders (NEDIC 2011), or disordered body image (Beausoleil 2009), which can result. Furthermore, there is little interest in telling the story that the vast majority of individuals who are in a position to invest time and money in the individual bodily practices required to produce a leaner body either fail to do so or eventually regain the lost weight (Gaesser 2009; Lyons 2009; Monaghan 2008). Moreover, the failure to lose weight or maintain weight loss takes an emotional toll, given the moral value ascribed to the thin, fit body (Colls and Evans 2009; Gard 2011). Indeed, even an individual’s status as a proper and worthy citizen rests on his or her ability to embody a normative weight and shape.

Scene 2: The Tale of Taylor the Idyllic Village on a Diet is set in Taylor, British Columbia, a small, “picturesque” (Fayerman 2011) town located on mile 36 of the Alaskan highway.

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Taylor, the show explains, “could be anywhere in Canada,” an unremarkableness that is achieved through representations of the community as idyllic, yet imperilled. Taylorites, we are told, have “eaten their way to disaster” (Fraggalosch 2011c), and their community is thus facing a “huge” obesity threat. Dr Zentner, the VOD physician, underlines the link between Taylor and other Canadian communities, commenting that “the obesity we see in Taylor is a reflection of what we are seeing across this country. People are eating too much and making bad choices” (Fraggalosch 2011b). Nevertheless, the narrator, experts, and villagers themselves all give cause for hope, speaking of the support, spirit, and powerful sense of community that characterizes Taylor, and suggesting that the enthusiastic zeal with which villagers have taken to the challenge bodes well for individual and community success. Indeed, Dr Zentner explains that “one of the appealing parts about this town is that, from a health perspective, they’ve insisted on a different future” (Fraggalosch 2011c). Taylor, we are told, has collectively chosen a new life, making a “revolutionary decision” with “the whole town … wag[ing] war on [its] weight” (Fraggalosch 2011c). The community’s war on weight, however, will be successful only if “every individual participates and buys into it” (Fraggalosch 2011c), according to “town motivator” Glen Cross. While the VOD scene is rendered palatable – and the community weight-loss goal “do-able” – via the representation of an idyllic rural Canadian town where everybody knows everybody and is willing to join together to work towards a common goal, the VOD un-scene is somewhat more sinister.

Un-Scene: Co-opting the “Idyllic” to Mobilize the “Idle” Taylor, BC, is not “anywhere Canada” as the show suggests, but rather has its own textured geopolitical context that, when brought into the scene, complicates the rather simplistic story of obesity that the show draws upon. For example, unlike many of Canada’s rural, geographically isolated communities, which are undergoing processes of rural restructuring as a result of the effects of environmental degradation, natural resource depletion, globalization, and the resultant patterns of out-migration (Epp and Whitson 2001; Ommer 2007), processes that have all been linked to diminished individual and community health (Dolan et al. 2005), Taylor seems to buck these trends. Indeed, Taylor is the self-declared “industrial capital of the north,” a distinction that is reflected in the median annual income, which is over ten thousand dollars higher than the provincial median, and an unemployment rate that

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is less than one-third of the province’s. While Taylor differs from many rural Canadian communities in its economic and social stability, the news is not all good because Taylor’s prosperity is not evenly distributed across the town’s population. For instance, the median average salary for employed women in Taylor is less than half ($21,064) that of their male counterparts ($45,952) (Community Facts 2012). Despite women being almost twice as likely to achieve a high school certificate, college diploma, or university degree, Taylor’s women continue to be underemployed in the formal economy, and are presumably involved in informal, un(der) paid economies, a trend of gendered economic and social inequality that has been identified in other rural Canadian contexts (Status of Women Canada 2012). These place-specific demographics (and the stories they tell) are relevant because gender figures prominently in how the show represents (indeed, incites!) lifestyle change (Norman, Rail and Jette 2014), yet this particular aspect of gender inequality and its relationship to health status remains unscene. Moreover, 9 per cent of Taylor’s residents self-identify as Aboriginal, a figure that is more than double the provincial average.4 Interestingly, this fact also remains unscene in the VOD script when Taylor is represented, using visual markers of ethno-racial identity, as a homogenously white community, with the only visible racial minority being one of the urban, out-of-town “butt-kicking experts.” The erasure of Aboriginal people is a particularly pernicious omission, albeit a convenient one for the producers of VOD, because any discussion of the health of indigenous people in Canada is incomplete without a consideration of the social determinants of indigenous health, including “factors related to colonization, globalization, migration, loss of language and culture, and disconnection from the land” (King, Smith and Gracey 2009, 76). If the complicating story of indigenous health were told in the script of VOD, it might well undermine the seemingly well-intentioned motives of the out-of-town experts who enter Taylor to “save” the unhealthy, obese, and presumably ignorant bodies and souls of the villagers. The inclusion of such a story might inadvertently draw attention to the power imbalances between, for example, the urban and rural, expert and Other, healthy and unhealthy – oppositions that recall the spectre of other oppressive and geographically situated binaries (e.g., the frontier and the metropolis, saviour and the saved, colonizer and the colonized) that mar the history of Canada. Rather than outlining these stories, VOD re-imagines rural

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Canada as an idealized, homogenously white, and tacitly romanticized masculinist working-class community within its script, a representation that is shorn of the complexities of gender, class, and racial disparities, legacies of colonization, processes of rural restructuring, and other stories that, if brought into the scene, would problematize the one, totalizing story of obesity and health. Characterizing Taylor as any-town-Canada does serve a function, however. Removing the village from its situated context allows the story of Taylor’s transformation to operate as a free-floating biopedagogy that, when divorced from place-based specificities, can provide a model for healthy living everywhere in Canada. Central to this strategy is the discourse of community. Consistent with the “rise in the communitarian ethic” (Rose 2007, 27) that characterizes strategies of governance in advanced liberal democracies, Cavender (2004) highlights the presumption of an idealized community that underlies reality TV genres. The idyllic communities of reality TV, however, are neither organic nor stable, but are forged by telling particular stories while foreclosing others. In mobilizing the citizens of Taylor and the viewing public, the “communitarian ethic” was central to the biopolitics5 deployed to transform their lifestyles and, as a consequence, their lives. Indeed, the VOD script constructs certain “citizen bodies,” namely those who perform a selfmanagerial subjectivity, as “good” citizens. Good citizens, through submission to and uptake of expert knowledge and discipline, productively contribute to the betterment of not only the self, but also the broader body of the citizenry. Actively and visibly embodying the “virtues” of “health” (e.g., normal body weight and shape) and “healthy living” (e.g., diet and exercise) is thus constructed as more than an ethical responsibility to the self; such activities are positioned as a moral imperative of citizenship, or what Halse (2009) would call “biocitizenship.” Good Taylorites are proper biocitizens: they manage their weight and lifestyle in the present as a means of influencing an uncertain future, and this is part of their ethical responsibility to the “health and economic well-being of others in the community and the nation” (Halse 2009, 53). To this end, villagers are repeatedly incited by the VOD experts to take control of their health for themselves, their families, the future, the community, and the nation. According to the VOD narrative, the “choice” to embark on a journey of individual and community transformation is not imposed by outside forces but emanates from the town and its residents. Drawing upon the

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discourse of choice and the promise of transformative salvation that the “right choices” offer, VOD carefully manages the power relations that operate within its script, presenting the villagers as freely consenting and complicit participants who willingly and enthusiastically take up their lifestyle transformation. What remains un-scene, however, is that “proper” biocitizenship circumscribes the ethical conditions of possibility whereby certain behaviours and techniques of the self are deemed “worthy, desirable and necessary virtues” (Halse 2009, 47). This is certainly the case for healthy eating, active living, and weight loss, while other practices and lifestyles are cast as irresponsible and unethical. Here, civic engagement is mobilized around many projects of the self, all of which are designed to control the flesh through diet, exercise, and weight loss. This form of civic engagement, however, is shorn of the sort of collectivist notions that underpin the idyllic notions of community that VOD apparently conjures. Instead, community is re-­imagined in neoliberalist terms, where the managerial, self-surveying subject is putatively “empowered” to make the “right” and “healthy” choices in the name of individual and collective good. The communitarian ethic at play in VOD, therefore, locates transformation and self-improvement as a responsibility of individual biocitizens, as the narrator makes clear when he suggests that “change starts at home” (Fraggalosch 2011b). Such a biopolitical strategy thus positions change within the private (and traditionally feminine) domain as opposed to within public and civic institutions and spaces such as the community centre, the town hall, or the municipal, provincial, and federal levels of government. In constructing Taylor – and, implicitly, the rest of rural Canada – as an idyllic community, VOD can leverage a communitarian ethic where citizens are incited to look after the self in the name of preserving (saving, even) the idyllic quality of their community. This construction, however, runs headlong into a fundamental paradox as VOD simultaneously poaches on the less idyllic aspects of Taylor (e.g., gossip, rumour, fat discrimination) as a means to motivate Taylorites to make the “right choice” (lest they be alienated from the community) and to heighten the program’s drama. Indeed, upon closer examination, representations of Taylor as an idyllic, concordant community were at odds with the fractures, tears, and stresses that were discernible within the town. Such stresses were sometimes represented to viewing audiences, but only within a particularly constraining neoliberal ethos that also silenced alternative, potentially volatile readings that could challenge the dominant obesity discourse. For example, several of the

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villagers complained that their fatness resulted in stigmatization, social ostracism, and bullying – experiences that served to socially isolate them from the community and prevent them from engaging in physical activity. The narrative of Jamie Kenzitt, a twenty-four-year-old villagerdieter, goes some way to dismantling the myth of the tightly knit social fabric of Taylor: “My weight makes me feel like … I’m just a prisoner in my own home. I feel like that if I’m walking down the street, there’s at least five people that are, like, staring at me” (Fraggalosch 2011d). Another telling narrative is that of Jonathan, the thirteen-year-old who left school because he was being bullied by his peers for being “too fat.” Rather than drawing critical attention to and challenging the judging surveillance that Jamie, Jonathan, and others experienced, VOD utilizes the alienation and emotional angst they experienced at the hands of the so-called idyllic community to increase the drama of the show and remind viewers that “difference” is not to be embraced. VOD thus blames the victims and proposes an individualized solution rooted in selftransformation through weight loss. Indeed, social problems such as weight oppression and bullying are re-imagined as individual problems that can and should be conquered through disciplinary regimes of taking control of the flesh. For the VOD script to do otherwise would be to undermine the regulatory and normalizing effects of the communitarian ethic in producing good and productive (i.e., non-obese) biocitizens, the very aim (and premise) of the program.

Scene 3: Weighing In Megan Warin argues that “in reality TV private spaces of bodies are no longer private and become public spectacle and entertainment” (2011, 29). In the case of VOD, the scale was a pivotal instrument of public spectacle and dramatic tension. Each episode ended with the “weekly weigh-in.” The camera followed village dieters into the private spaces of their homes, recording their reactions to the numbers on the scale. These scenes were wrought with angst, tension, frustration, and joy. As one villager noted, “the numbers [on the scale] can be so emotional” (Fraggalosch 2011b). The dramatic tension and emotional spectacle of the weigh-in, replete with tears of jubilation and humiliation, were often attenuated through ominous voice-overs. In one episode, for example, the narrator comments, “the weekly weigh-in is looming and the town is about to find out who the saints and sinners are” (Fraggalosch 2011b). Weigh-ins were not limited to individual households; the show

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also featured several “community weigh-ins” where the whole town – or at least those participating in the challenge – was collectively weighed on a truck scale or on multiple scales at the local community centre. Weighing the community as a whole is a novel concept that was deployed in VOD to determine “just how far off the national [weight] average the town really is” (Fraggalosch 2011c), a determination that formed the crux of the diet challenge. While this might make for good television, the scale functioned as a confessional technology to produce the “truth” about the town and its residents.

Un-Scene: Measuring the Moral Worth of the Citizen Body and the Body of the Citizenry The “truth” about the lifestyle, health, and morality of both individual citizen bodies and the body of the citizenry was gleaned from numbers on a scale. In dramatic fashion, both the individualizing and “massifying” aspects of the private and public weighing sessions were turned into spectacle. Paying homage to Foucault, critical obesity scholars Rail and Lafrance (2009) have discussed the technologies used in extracting the “truth” from individual bodies in terms of the “confessions of the flesh.” In VOD, the “truth” is wrought from the “flesh” through subjecting the body to measurement (i.e., with the scale) and using this truth to calculate a body mass index (BMI). Once the body “confesses” its BMI and once its pathologies are revealed (i.e., the body is obese; the body has a disease), it is then possible for an interwoven network of health professionals – or the “butt-kicking experts” featured on VOD – to intervene in life itself in aiding subjects, “rescu[ing], rehabilitat[ing] and sav[ing]” (Rail and Lafrance 2009, 76) their flesh from eternal damnation. Through rendering the everyday lives of ordinary people as spectacle, reality TV figures prominently in normalizing the tactics of surveillance that are crucial to strategies of governing at a distance (Andrejevic 2004). The blurring of the public/private distinction is particularly evident during the weekly weigh-ins. Although the scale is usually located in the most private room in the household (i.e., the bathroom), within the VOD script it is brought into the more communal space of the kitchen, where family members as well as the viewing public bear witness to village dieters on their journey of self-transformation. This positions dieting and weight loss less as private endeavours of personal toil and struggle than as matters of family, community, and even national interest. In addition, the biopedagogical function of the scale teaches both individual villagers and the Canadian viewing public about what to look for, how to put self

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and others under surveillance, and how to identify “saints and sinners.” Although individual citizens’ confessions of the flesh are standard fodder for makeover reality TV, what is novel about VOD is that such confessions extend to the body of the citizenry as well. Through community weigh-ins, VOD instigated confessions of the community flesh – a dramatic tactic that pulled together and further blurred the distinction between disciplinary and regulatory forms of power. The collective “flesh” of Taylor was inserted into national statistical charts that determined that the town was two thousand pounds overweight. Thus, the “truth” of Taylor was extracted from the community as a whole and then deployed as justification for a multitude of expert interventions into the lives of Taylorites to manage, shape, incite, organize, and in some cases control both the citizen body and the body of the citizenry. Tellingly, the Taylor community centre was transformed into a community weigh-in centre for the final confessions of the collective flesh. The use of the community centre marked the shifting significance of the public sector, democracy, and citizenship within the context of neoliberalism (see Ouellette and Murray 2009; Palmer 2008; Ringrose and Walkerdine 2008). Indeed, “weighing-in” or, perhaps more appropriately, “weighing in(to)” the community – literally checking in, being counted, and becoming a part of – seemed to serve as a passport to (bio) citizenship, a shift associated with the neoliberal turn (Halse 2009). The pedagogical civics on offer in VOD are not the sort of collectivizing we might envision in broad-based social movements, but rather are a collective of disparate individuals who are called upon by a dominant obesity discourse and its regulations. They become subjects of and to such discourse, and (re)construct themselves within it. Consequently, they come to take responsibility for their flesh as an end for the collective good. Situating the scale as an individual and collective technology of confession further serves the biopedagogical function of compelling Canadian citizens more broadly to insert themselves within a web of obesity surveillance, such as that offered in the national Million Pound Challenge that was featured on the CBC website. Such weight-loss incitements ignore the ugly side of a health imperative that links citizenship to body shape and size, thereby dividing the population into, on the one hand, the privileged self-governing neoliberal (and largely white, able-bodied, middle- and upper-class) subjects who have the cultural and material resources to manage their flesh, and on the other hand, those degenerate, burdensome, obese Others. Ultimately, the biopedagogies surrounding obesity and the ethopolitical discursive fabric they forge are profoundly unethical.

362  Moss E. Norman, Geneviève Rail, and Shannon Jette

Conclusion Want a different ethic? Tell a different story. Thomas King (2003, 164)

In closing, we return to the “story” metaphor with which we started this chapter, because Village on a Diet makes it clear that we need to tell different stories about health, bodies, and embodied health practices than those available within the dominant obesity discourse. The visual and discursive stories of obesity that circulate through Village on a Diet are unethical in a number of ways. First, they take irreducibly complex physiological, social, psychological, and structural phenomena such as body weight and reduce them to a simplistic and individualized problem of will power (LeBesco 2011; Warin 2011). In so doing, they actually create or materialize the very “problems” (e.g., “obesity,” the “obesity epidemic”) that they supposedly address (Rail 2012; Rail, Holmes, and Murray 2010) by erasing or rendering “un-scene” the complexity of factors that go into shaping bodies and health. Tellingly, the story of lifestyle transformation on offer in VOD differs from that of other reality TV transformation programs found in the American context (e.g., The Biggest Loser) in that it focuses on “the village” as opposed to the individual, potentially reflecting the sort of differences between the United States’ and Canada’s responses to the “obesity epidemic” that Paradis refers to in this collection. But the collectivist approach on offer in VOD ultimately ends up entrenching – as opposed to destabilizing – neoliberal notions of individual responsibility. Second, the diet-and-exercise model of lifestyle change that the show prescribes is not only unrealistic in promising lifelong weight loss, health, happiness, and vitality, but is also very likely unhealthy. Third, the dieting biopedagogy that circulates through individual bodies as well as the body of the town shifts responsibility for health onto individual bodies and communities, without the provision of necessary resources (e.g., social and economic equality) to take on such responsibility. Fourth, cloaked in a communitarian ideal, the program’s project actually promotes surveillance between community members and turns them against one another as a means of rendering bodies docile and complicit with normative body weight ideals. Finally, it transforms the traditional privacy of the bathroom scale into a public spectacle whereby body weight is a measure of the moral worth of both the citizen body and the body of the citizenry. In this way, civic engagement is re-imagined in

The (Bio)politics of a Canadian Reality Weight Loss Series  363

line with a biocivics where weight can be used to discriminate between good (normal weight) and bad (overweight or obese) citizens. In contrast to the ethic outlined in the storyline of VOD, we need to re-imagine another ethic by telling different stories that present alternatives to the largely dubious claims of dominant obesity science. We need to tell not The story, but stories in their multiplicity and alterity, stories that emerge from the situated, emplaced, and embodied context of individuals. Our call for such stories, therefore, is not a plea to get to the “truth” but rather a yearning for an “insurrection of subjugated [body] knowledges” (Foucault 1980, 81), where a range of voices are heard and a diversity of stories are told, in the hopes that such multiplicity, otherness, and complexity will ultimately prevent one, overarching truth discourse from crystalizing. The new stories that we envision are more ethical ones in which “health,” as a marker of moral worth in the dominant model of “healthism” (Crawford 1980), is not defined by normative body weight ideals. Breaking the assumed connection between health and body weight is a step towards lessening the neoliberal trend of downloading personal responsibility for health to the individual and deciding an individual’s moral worth by his or her body shape/size. Rather than constructing health as a do-it-yourself project, the new stories would appreciate the complexity of health, attending to its multiple social and cultural determinants. In these scenarios, health is a social justice issue (Bryant and Raphael 2010), requiring mindfulness to “social inequality, exclusion, disadvantage, disrespect and suffering” (Mona­ghan, Rich, and Aphramor 2011, 228). Counter to the situation in VOD, being part of a community would not entail coming under the surveillance of one’s neighbours or using narratives of blame and shame as a means of rendering bodies docile and complicit with normative body weight ideals. Instead, being a community member would entitle one to a network of social support and the embodied, positive health effects such support has been shown to produce (Aphramor and Gingras 2011). NOTES 1 The dominant obesity discourse has generated new forms of normalizing practices that have been called “biopedagogies” (see Harwood 2009). Informed by Foucault’s (1978) notion of biopower, we argue that pedagogies of bios (life) form part of an apparatus of governmentality that centres upon regulating life: how to live, how to eat, how to move, how to look.

364  Moss E. Norman, Geneviève Rail, and Shannon Jette







Biopedagogies are focused on controlling bodies to protect them from health “risks.” 2 According to Foucault (2009), a transformation in the exercise of power emerged in the eighteenth century with the birth of liberalism. Foucault associates liberalism with a form of government that attempts to maximize its effects while minimizing its costs, following the industrial model. Liberal thought centres on populations and how to control life to better manage the labour force. But to take charge of life and govern the political and economic body of an industrializing society, power needs new processes. Power must be increasingly a productive power to intervene in o ­ rder to “make live” rather than the power to put to death. Biopower is the term Foucault uses to refer to modern states’ new focus on life through the subjugation of bodies and the control of populations (e.g., the regulation of customs, habits, reproductive practices, family, sexuality, hygiene, well-being, health). 3 Live Right Now, http://www.cbc.ca/liverightnow/about.html (accessed 12 February 2011). 4 Taylor, BC. n.d. “Taylor, British Columbia – Citizenship, Immigrant Status, Minority and Aboriginal Population.” http://www.city-data.com/ canada/Taylor-Districtmunicipality.html (accessed 6 September 2013). 5 For Foucault, modern states’ concern with fostering the life of the population centres on the poles of discipline and regulatory controls. While he saw discipline as an “anatomo-politics” (1990) that mostly applies to individuals, he uses the term biopolitics (2009) to speak of regulatory controls, as they mostly apply to populations. Foucault’s concept of biopolitics is closely related to his concept of biopower and signals the expansion of power beyond the traditional boundaries of the state and the normative modes of domination to touch every aspect of life. Biopolitics thus refers to a style of government that regulates populations through biopower.

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The (Bio)politics of a Canadian Reality Weight Loss Series  371 Ringrose, Jessica, and Valerie Walkerdine. 2008. “Regulating the Abject: The TV Make-over as Site of Neo-liberal Reinvention toward Bourgeois Femininity.” Feminist Media Studies 8 (3): 227–46. http://dx.doi.org/ 10.1080/14680770802217279. Rose, Nikolas. 1996. “Governing in ‘Advanced’ Liberal Democracies.” In Foucault and Political Reason: Liberalism, Neo-liberalism and Rationalities of Government, ed. Andrew Barry, Thomas Osborne, and Nikolas Rose, 37–64. Chicago: University of Chicago Press. – 1999. Powers of Freedom: Reframing Political Thought. Cambridge: Cambridge University Press. – 2007. The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press. Roy, Stephanie, Guy Faulkner, and Sara-Jane Finlay. 2007. “Fit to Print: A Natural History of Obesity Research in the Canadian News Media.” Canadian Journal of Communication 32 (2/3): 575–94. Saguy, Abigail, and Rene Almeling. 2008. “Fat in the Fire? Science, the News Media, and the ‘Obesity Epidemic.’” Sociological Forum 23 (1): 53–83. http:// dx.doi.org/10.1111/j.1600-0838.2004.00399.x-i1. Sender, Kathleen. 2011. “Real Worlds: Migrating Genres, Travelling Participants, Shifting Theories.” In The Politics of Reality Television: Global Perspectives, ed. Marwan Kraidy and Katherine Sender, 1–11. New York: Routledge. Sender, Katherine, and Margaret Sullivan. 2008. “Epidemics of the Will, Failures of Self-Esteem: Responding to Fat Bodies in The Biggest Loser and What Not to Wear.” Continuum: Journal of Media and Cultural Studies 22 (4): 573–84. http://dx.doi.org/10.1080/10304310802190046. Skeggs, Beverley, and Helen Wood. 2012. Reacting to Reality Television: Performance, Audience, and Value. New York: Routledge. Status of Women Canada. 2012. “Strong Women, Strong Canada – Women in Rural, Remote and Northern Communities: Key to Canada’s Economic Prosperity.” http://www.swc-cfc.gc.ca/dates/iwd-jif/index-eng.html#tab7/. Accessed 5 May 2012. Warin, Megan. 2011. “Foucault’s Progeny: Jamie Oliver and the Art of Governing Obesity.” Social Theory & Health 9 (1): 24–40. http://dx.doi.org/ 10.1057/sth.2010.2. Weedon, Chris. 1997. Feminist Practice and Poststructuralist Theory. London: Blackwell. Wood, Helen, and Beverley Skeggs. 2005. “Notes on Ethical Scenarios of Self on British Reality TV.” Feminist Media Studies 4 (2): 203–12. – 2011. Reality Television and Class. London: Palgrave Macmillan.

372  Moss E. Norman, Geneviève Rail, and Shannon Jette World Health Organization (WHO). 2006. “Obesity.” http://www.who.int/ topics/obesity/en/. Wright, Jan. 2004. “Post-structural Methodologies: The Body, Schooling and Health.” In Body Knowledge and Control: Studies in the Sociology of Physical Education and Health, ed. John Evans, Brian Davies, and Jan Wright, 19–32. New York: Routledge. – 2009. “Biopower, Biopedagogies and the Obesity Epidemic.” In Biopolitics and the “Obesity Epidemic,” ed. Wright and Harwood, 1–14. Wright, Jan, and Valerie Harwood. 2009. Biopolitics and the “Obesity Epidemic”: Governing Bodies. New York: Routledge.

14 Fat Authenticity and the Pursuit of Hetero-romantic Love in Vancouver: The Case of Online Dating Jacqueline Sch oe make r H ol me s

Because I study online dating, I am often regaled with people’s “worst” or “best” online dating stories at parties, in the salon, and even in my university department’s lounge. The anecdote that I am going to share comes not from my eight-month ethnographic exploration into the everyday practices of online dating among urban professionals in Vancouver, British Columbia, but rather from a colleague friend of mine who exuberantly told me when I recently saw her, “You have to use this story – it’s so perfect.” The story goes like this. My colleague’s fourteen-year-old niece found out that her father was an active member of an online dating site that caters to men (usually white, North American men) who are seeking to meet and marry women from the Philippines. Curious, the girl created a profile so that she could track her dad’s activities on this site. While her niece was showing her the site, my colleague became aware that her niece, too, could be contacted for dates because of the nature of the profile she had to create in order to view the site freely. When my colleague asked her what she does when approached online by an interested man, my colleague’s niece replied simply, “Oh, they don’t ’cause on my profile I say I’m fat.” What makes this story “perfectly” suited to my research is this young girl’s explicit understanding that “fatness” won’t fly in the world of online dating. In fact, she strategically used that knowledge to “spoil” her otherwise decent, albeit bare-bones and nondescript, profile (presumably the girl also didn’t use her real age). This story exemplifies a key theme that emerged in my own research, that of fat phobia in the online dating practices of the male participants in my study, who made up seventeen of the forty self-identified heterosexual urban professionals I interviewed in Vancouver.

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This chapter explores a phenomenon I call fat authenticity that emerged from examining the online dating pursuits of urban professionals in Vancouver. Fat authenticity, as part of a hetero-romantic project, requires women who date online to construct themselves as “authentically fat” or “authentically thin” in order for potential dates to deem them appropriately embodied enough to date, and ultimately to be seen as realistic and desirable marriageable love partners. This gendered practice is performed exclusively by women but is compelled through a complementary set of practices and requirements that are hetero-romantically situated. In the often mundane work of pursuing love online, individuals are required to make themselves intelligible to others through their presentation of self in highly gendered, sexualized, racialized, and classed (to name but a few) ways. I refer to this manner of identifying oneself as “selfing.” No such embodied requirements exist for men in my study. While I initially understood fat authenticity as a subversive practice, I quickly came to realize that women were as much constrained by as they were resistant to the unspoken requirement to represent their weight “accurately” and “appropriately” so as not to encounter rejection or humiliation upon meeting a date for the first time. What makes this practice so profoundly resistant is women’s tacit acknowledgment not only of the widespread fat phobia prevalent on online dating sites, but also of their own efforts to “spoil” their embodied selves to avoid rejection, humiliation, and ultimately, the “wrong” date, man, and potential partner. The women who identified as fat – who knew their bodies did not fit the implied “ideal” of what one participant called “Yaletown size two” – spoiled their identities in an effort to be authentic.1 Regardless of size, women in the study seemed comfortable in bodies that were “out of bounds” (Braziel and LeBesco 2001) and performed resistant versions of self that spoke back to rampant fat phobia they encountered in online dating scenarios. Fat authenticity is understood here to be a complex combination of identificatory practices (Butler 2006) that constitute some of the gendered “selfing” practices that go into online dating, and subjectification, or what I call authentic askesis – authentic projects of the self (borrowing from Foucault 1992). Fat authenticity is one such form of selfing. This chapter explores selfing in online dating scenarios as a technologically mediated reality using empirical examples from my research in which women explain their practices of fat authenticity. I examine these practices as spoilage and, ultimately, as resistance.

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Methods Informed by my training as both an anthropologist and a sociologist, I sought to understand these practices in an in-depth, experiential way that became an ethnographic project that existed neither entirely online nor “off.” This methodological approach was informed by the early debates about the validity and methodological rigour of conducting “online ethnography” (see Constable 2003; Miller and Slater 2000). The general consensus of this debate was not to approach “cyberspace” as a kind of “self-enclosed cyberian apartness” (Miller and Slater 2000). This recognition of online and offline space as an amalgam, and as co-­constitutive space, served to inform much of the debate about how we understand bodies and selves in engagements with these heavily technologically mediated realities (Campbell 2004). I envisioned a project that allowed for in-depth access into the lives of online daters – and more specifically, the collection of practices that constituted the collective whole called online dating – by situating my work within a city (Vancouver) and a specific demographic (urban professionals between eighteen and sixty-five years of age).2 I also “shadowed” four participants very closely over the course of the research to get an in-depth perspective on what it means to online date. This shadowing involved observing these four participants while they did everything from creating online profiles on different dating sites to keeping an online dating log to chronicle all of the work that goes into online dating. I chose Vancouver as a convenient urban setting that I am familiar with, having lived there for six years. Certain aspects of city life and understanding of what/how Vancouver “is” as a city influence how online dating is understood, recognized, and practised there. Vancouver is a city understood to be beautifully scenic while having an urban scene for the many active Vancouverites who call it home. The official Vancouver tourism site, Tourism Vancouver, which the City of Vancouver website refers visitors to, heralds Vancouver as a “dynamic, multicultural city set in a spectacular natural environment. No matter what time of the year you visit, there are indoor and outdoor activities to please adults, families, couples and friends to no end.”3 Vancouver is heralded as Canada’s “healthiest city”4 and there is a great deal of emphasis, manifesting as healthism5 in many instances, on healthy living, healthy eating, and healthy bodies, which were defined by my male participants as “fit,” “active,” and importantly, “not fat.” Vancouver as a “healthy” city reinforces expectations about

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“proper” embodiment, but as will become clear, this requirement is predominantly for women.6 Given the importance of Vancouver in shaping online dating practices, I wanted to understand these place-specific practices in an indepth way without online dating myself,7 and without hiding in the bushes on participants’ dates. This resulted in an ethnographically inspired methodology that consisted of in-depth interviews with forty urban professionals. Requirements for participation in this study were quite straightforward: participants had to be currently online dating or have dated online in the past year and be presently employed in a profession for which they had been trained. The decision to focus my investigation on professionals was practical, based on the realization that professionals make up a good portion of working people in Vancouver. I stipulated that these professionals were busy (thereby making online dating a “convenient” choice for them), had significant access to and competence with internet8 technologies both at home and in the office, and presumably had the income and leisure time (despite the “busyness” of their schedules) to participate in online dating. My pool of forty participants comprised twenty-three women and seventeen men ranging in ages from twenty-seven to fifty-seven (see Table 2 for participants’ demographics), all of whom identified as heterosexual and as seeking heterosexual partners. Participants came from a broad range of professions including, but not limited to, law, engineering, computer programming and graphic art. The pool also included a business-owning sex worker, two realtors, and a home inspector. All but five identified as white; two were Asian, one woman was Persian/Iranian, one man was Latin American, and one woman identified as mixed-race or “other” on her online dating profile. As is evident in this brief overview of the participants, they do not constitute a homogeneous group. While there are differences in the ways different age groups or divorced-versus-single people date online, there remains a discernable series of events, or tasks, that individuals must accomplish in order to online date. These practices of online dating involve a learning curve for all online daters, and while they may be subtly different for a middle-aged woman and a woman in her thirties, there was still a very defined and recognizable coherence in all participants’ accounts of their online dating practices/experiences. This emphasis on practices is important to establish what is similar or consistent within the context of this diverse group of Vancouverites.

Fat Authenticity: The Case of Online Dating  377 Table 2. Participant Demographics Name (Pseudonym)

Sex

Age

Profession

Marital Status (Single/Never Married [NM]/Divorced/Coupled)

Self-Identified Race/ Ethnicity

Daniel*

M

24

Engineer

Single/NM

White

Leanne

F

29

Teacher

Single NM

White

Lawrence

M

35

CEO

Single NM

White

Linda

F

54

Home inspector

Divorced

White

Liza*

F

44

Researcher

Divorced

Mixed Race: Asian/White

Michela

F

25

Researcher

Single NM

White

Nick

M

37

Contractor

Single NM

White

Nicola

F

25

Smallbusiness owner

Single NM

White

Ollie

M

30

Researcher/ former IT professional

Single NM

Latin American

Olivia

F

31

Administrator

Single NM

Asian

Paula

F

42

Administrator

Divorced

White

Peter

M

57

Contractor

Divorced

White

Roland

M

33

Teacher

Single NM

Asian

Seema

F

26

Realtor

Single NM

Persian/Iranian

Simon

M

30

Manager

Single NM

White

Sue

F

29

Administrator

Single NM

White

Susannah

F

29

Architect

Single NM

White

Tate

M

32

Researcher

Single NM

White

Tom*

M

45

IT salesperson

Single NM

White

Victoria*

F

30

Researcher

Divorced

White

* signifies “shadowed” participants

378  Jacqueline Schoemaker Holmes

The one aspect that was consistent was their self-identified heterosexuality.9 Although this study was not intentionally designed to focus solely on heterosexual online dating practices, this “accident” of recruitment means that the data generated are based on heterosexual (and I argue, heteronormative) practices of online dating in Vancouver. From my larger pool of participants, I recruited what I called “shadowed participants,” two men – Daniel (age twenty-four) and Tom (age forty-five) – and two women – Victoria (age thirty) and Liza (age fortyfour) – whom I interviewed on seven occasions, deepening my understanding of what it means to date online. These four people participated in a set of uniquely designed methods of data generation to explore particular practices. These methods involved researcher-participant surfing and online-dating-activity logs that gave me access to the everydayness of these practices as necessary components or “tasks” that an online dater must complete to make contact, build rapport, set dates, and ultimately, for some, find partners.10 These methods helped me understand the intricacies of online dating and took me beyond interviewing. I used these researcher-participant surfing sessions as an opportunity to observe participants. I immersed myself in the “lifeworlds” of online daters as they pursued the search for online love, whether in their homes or in their local coffee shops. These methods allowed me, as a person who had never dated online, access to the learning curve online daters experience through their engagements with various interfaces, as well as the appropriate codes of conduct that are involved in online dating (which are largely dictated by the online dating interfaces themselves). However, the field was not located in online dating interfaces or websites per se; rather, the field was understood as the city of Vancouver. In order to situate the field and how individuals position themselves within it, I explore how constructions of the self are integral to online dating generally, and fat authenticity specifically. Framing the Self Forty-three-year-old Andrew sat across from me in a local coffee shop where I regularly conducted interviews. He was seated in a relaxed posture, slouched back in his seat, resting one ankle on one knee. Despite his relaxed demeanour, what he was saying made it obvious Andrew was not comfortable. He was fed up with online dating after admittedly having little luck finding the serious relationship he was

Fat Authenticity: The Case of Online Dating  379

looking for. Andrew was annoyed at the technology, thinking it too impersonal, but hoped he didn’t appear to be blaming the internet for his lack of success. He explained that “too much time is spent relating in that medium and that’s what not a relationship is. A relationship isn’t you on a terminal and me on a terminal and we’re communicating with words or photos. I hope it never comes to that and that’s ultimately why internet dating hasn’t worked for me. It’s not real. The communication that’s formed is not real for me.” Andrew’s characterization of two terminals standing in for “real” face-to-face interaction is common, and invoked in discourses of anxiety that seek to construct online dating as just one example of the many ways technologies are threatening the very basis of sociality. The two-terminal image conjures people who can no longer relate to one another, and who cannot identify the “proper” basis for coming together because they are too lost in “cyberspace” to know what – and who – is real. Andrew went on to explain that you’re trying to play God, you’re trying to meddle, you’re trying to control everything. And there’s that aspect where you’re totally trying to manage it and to make it end, to come up with how it’s gonna look. To me the beauty of meeting people and interacting with human beings is that you don’t know who you’re gonna meet, when you’re gonna meet, or how it’s gonna happen. You carry yourself open in the world, you don’t know what’s going to be brought to you when you kind of get out of your own way. For me, it’s kind of hard for me to use that technology and not overmanage because I’m a writer and I like technology and I like to use technology. It’s hard for me not to overmanage and kind of come off too strong instead of just being measured in it because it is so virtual and so intangible. I kind of want something real. I can’t fault the medium – it’s how we use it. It’s like anything – it’s not the flaw of the medium, it’s how we approach and there are so few rules about it. Most of my friends are struggling how to date in person. How do we date in person? How do we meet someone, tell our story, but not give too much away? How do we not get too close, too quickly? How do we not manufacture what we want? How do we see people for who they really are? How do we tell people who we really are?

Andrew’s concern for having something “real” with a “human being” reflects central concerns about the nature of human engagement and relationship formation both on and offline. In particular, Andrew’s questions about how not to manufacture what is desirable and how to

380  Jacqueline Schoemaker Holmes

see people for who they really are – as well as being able to represent oneself accurately – demonstrate this anxiety about what is “real.” These questions stand as important aspects of selfing in appropriate ways that will be recognizably desirable to a potential date (and soulmate). Andrew constructs a version of offline reality that he privileges over the “terminal-to-terminal” relationship he fears. However, this offline reality is still informed by questions of authenticity. That is, how do we know what/who we want and how do we construct ourselves in a way that attracts what we want? Andrew’s questions ultimately point to how difficult it is to self in authentic ways both online and off. While these questions point to how Andrew understands “real life” as having more spontaneity and more authenticity of engagement, he still questions what that authenticity truly means, how it is constructed, and importantly, how it can be maintained as distinct and more valuable than constructions of self that occur online. Andrew’s anxieties about authenticity in dating, whether online or off, introduce the topic of selfing as it emerges in a medium that users are cautioned and instructed to distrust. Warnings about not sharing personal information flash on the screen while you respond to e-mail, and reports of identity theft and online scams from Nigeria abound online and in the traditional news media. The message is clear: the internet is a place of anonymity that, as Turkle warned many years ago, “may provide some people with an excuse for irresponsibility” (1995, 254). This means that before online daters even begin to date, they must overcome anxieties over the warnings they have received about rampant online deception. This means that they must take pains to accurately and appropriately represent themselves so that they cannot be accused of participating in this kind of anonymous and irresponsible conduct. Online daters, armed with this knowledge about possible deception, largely protect against deception by signing up to one of the mainstream or “legitimate” dating sites. According to participants’ overall rankings, Lavalife is at the top of this list and Craigslist is at the bottom (Plenty of Fish, as a free replica of Lavalife, sits in the middle in terms of popularity).11 These sites, except for Craigslist, require online daters to fill out a profile, which is seen as further protection against inauthentic accounts of self because everyone has to fill in the same information, according to the same categories of physicality and personality. Craigs­ list online daters follow a loose framework for creating a profile that includes “stats” – that is, bodily statistics: height, weight, eye and hair

Fat Authenticity: The Case of Online Dating  381

colour – as well as personal preferences and specifications of what they are looking for in a partner. This provides the first “litmus” test of authenticity once daters reach the first date – does the person reflect the stats they posted or did they fudge the numbers? Thirty-year-old Victoria explained the importance of “stats” to me in one interactive surfing session. These “vital statistics” or very brief descriptors that online daters see as they browse through the profiles of potential dates (the Lavalife interface allows you to browse lists of people who include these stats with pictures so that you can filter people with a quick look at their stats instead of having to navigate to their full profile). These stats can be very basic, such as eye colour, height, weight, occupation, and religious affiliation, and are based on the “self” that the online dater creates upon joining the site by filling in the information required to access the profiles of others. This information is understood to be given honestly, and in such a way that what you see online is what you get in person. Authenticity requires two central components that fall along gendered lines: physical replicability, mainly required by men – that is, does she look exactly like the picture and does she weigh what she said she weighed online? – and replicability in terms of honesty and integrity, which seemed most important for women – is what he told a woman online and in his profile actually true when she meets him in person? However, authenticating the self begins long before the profile is written and is intimately connected to the boundaries of gendered, racialized, classed, and embodied identifactory practices that get transposed online through a series of categories that make the dater intelligible and immediately desirable. Turkle’s (1995) and Stone’s (2001) accounts of the self as mediated by technology fail to take fully into consideration the embodied nature of that engagement and the extent to which selfing – or identifying – is limited by the constraints of regulatory norms, and in particular heteronormative logic. Approaches like these that highlight the malleability of identity construction sometimes fail to fully critically engage with what it means to be recognized as an intelligible subject in a medium fraught with anxieties about anonymity and deception. By contrast, Kendall (2002) discovered that in a “virtual pub” known as Blue Sky, the “multi-user dungeon” (or MUD) she studied (which was originally developed as an online venue to play games such as Dungeons and Dragons, an offline fantasy board game) required men and women to negotiate their gender roles in interesting and familiar ways. In this space, acknowledged as anonymous and even “playful,” Kendall

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observed patterns of gender behaviour that largely reflected offline interactions, statuses, and power relations. Rather than encountering gender play online – that is, strategies of playing with alternatively gendered “selves” – Kendall observed that “cyberspace remains a realm populated mostly by the white and middle class and is still largely dominated by men” (2002, 221). Cyberspace should not, then, be understood as a gender-neutral escape from our contemporary situation. Recognizing how “real-life” power relations and gendered identities get played out online allows us to see how online dating is a gendered phenomenon that does not exist outside relationships of unequal gender power. Online dating ultimately lays bare the regulatory nature of what Judith Butler calls the heterosexual matrix (2006, 208n6) because it requires people to self in an overt way. Online dating requires individuals to self for the other, as we do in everyday life, but it also forces both the dater and the generalized other to lay bare the mechanics of that process of selfhood and thus exposes the gendered and racialized norms that influence its construction. Online dating asks daters to allow themselves to be exposed, judged, and evaluated – all in a particular form, and through particular means. As an online dater, if you are having trouble locating yourself on the grid of intelligibility, that becomes your problem, your personal flaw or inability to attract dates. You quit, or make do with less – less contacts, less dates, less opportunities to meet “Mr or Ms Right.” To further uncover how this matrix operates in online dating, as in everyday life, we look to the ways that cyber-selfing is managed, manipulated, and perfected along highly prescribed lines. Many of these hetero-normative and racialized logics that undergird practices of heterosexual dating in Vancouver can be seen in the practices that privilege the visual – specifically filtering and fat phobia. Filtering Fragmented Selves Online dating differs from more conventional forms of dating primarily because of the wealth of information an individual has access to about their potential date prior to ever meeting face-to-face. As Whitty and Carr report in their 2003/2004 study of an Australian internet dating site, some online dating sites require individuals to conduct a personality test so that individuals can be matched on compatibility. Most sites, however, simply require individuals to provide both general and more in-depth details about themselves (e.g., gender, location, physical

Fat Authenticity: The Case of Online Dating  383

description, interests, and what they are looking for in a partner) to be perused by interested singles (Whitty and Carr 2006, 124). In my study, online daters appreciated the amount of information they received prior to a face-to-face meeting because it helped to “filter out” undesirable people and qualities. As Tom explained, online dating and the process of viewing profiles online expediates12 the filtering. Because you know when you meet somebody – you know the first thing is well, you have to look nice, but let’s find out about you now, right? Well, the internet is sort of the reverse of that unless you have a picture and even that’s not accurate, right? But yeah, the internet allows you to sort of reverse that and go “let’s expediate all of the fluff” and get that out of the way and decide if we even want to meet at that point.

Both women and men repeated this view. Twenty-three-year-old Dana echoes Tom’s sentiments on filtering by stating, “I guess there’s that power of having information about people, like a filter. It’s time-saving as well.” Participants largely experienced this ability to filter as empowering and commonly suggested that they had not had any “bad dates” (i.e., horror stories) because they considered themselves good at this part of the process. However, some participants outlined how this filtering could become problematic, both by heightening their own and others’ pursuit of “ideal dates” and by causing them to more easily reject those who did not fit their criteria for the “perfect date.” Many of the women in my study expressed concerns that they were “too picky” by filtering out potential dates they might have had if they had not had so much information to begin with. Liza’s concerns about the ease of rejection based on filtering or, in her words, “weeding out” best exemplify this trend. She explained, “I mean it was nice to weed through and perhaps that was like the biggest issue for me. It was too easy to weed everybody out and have nothing left.” The anxiety around being too picky was more acute for women, who are cast as the “choosers” in the gendered stratification of labour in online dating practices in Vancouver. Men generally flood women with “smiles” (a free emoticon sent to potential dates as a sign that one is “interested”), e-mails, and instant messages. Men characterized their online dating strategies in terms of “hunting,” “flooding,” and “contacting as many women as possible” because the way online dating plays out among heterosexual daters is sharply divided along gender lines,

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with men contacting widely, while women have the “luxury” of choosing and rejecting from the pool of men that contact them.13 Men therefore have to negotiate a lot of rejection and often expressed frustration over this seemingly unfair “privilege” or advantage women enjoyed as a result of men’s “flooding” practices. But this gendered pattern of “flooding” and “choosing” also results, for women, in a sense of being “picky.” Forty-year-old Carla reflects this anxiety about being “too picky” by saying that online dating is “kind of addictive, you know that’s what I was trying to say, like you know? There’s always someone better out there. You know?” I later discuss the implications this level of choice affords women in a seemingly new form of (re)gendered dating schema, but for now I point to the primacy of the visual for these selection and rejection practices and how they are intimately related to the gendered phenomenon of fat phobia. While women seemingly have the final say about who they will meet, given the large pool they have to choose from, they also experience an implicit and explicit anxiety about being rejected once the process moves “offline.” Women expressed considerable anxiety around being rejected on the basis of their weight, and many agonized over the appropriate way to represent their weight to be as accurate and “authentic” as possible, similar to Liza’s anxieties about being as legitimately “knowable” as possible. Many women routinely scaled their weight up in their profiles so they would not be seen as inauthentic by checking the box for “thin” when a potential date might see them as “average.” This is an interesting understanding of authenticity that demonstrates the extent to which an authentic self is constructed in contingent relation to what the generalized other expects. However, women did this for good reason because the majority of the male participants expressed concern and dismay about the potential for women’s deceptions about weight. Male online daters explicitly stated their desire for women who, in “positive” terms, were described as “fit” or “active,” and in negative terms, for a woman who is simply “not fat.” In our first interview Tom explained to me an online dating deception that he had experienced when he met a woman from out of town for an agreed-upon meeting over a weekend when she planned to visit a friend in Vancouver. When the woman’s friend was called away on business, she asked to stay with Tom at his place. He reluctantly agreed but when he went to pick her up at the bus station, he found that he had been deceived:

Fat Authenticity: The Case of Online Dating  385 My first thought was, “you freaking lied to me. You are a lot fatter than what you are in the picture.” And as mean as that is I don’t do well with fat. So, I just sort of went, “Oh God.” So we ended up going back to my place ’cause it was late and she ended up crashing. We get up in the morning and I phone my buddy Ray and I said, “Ray, phone me back here in fifteen minutes” – she was in the shower – “phone back in fifteen minutes. Pretend you’re my brother and my grandma just died.” He says, “What?” I said, “Just do it” … I could have won an Oscar for my performance.

Here, it is evident that Tom felt deceived and intentionally misled. In response, he deceived this woman through an elaborate lie that would provide him with a basis for his rejection, or at least dismissal, of her as a love candidate. Tom said that she later sent a sympathy card to him expressing her condolences about his grandmother, which in his eyes just made her more “pathetic,” especially since she kept sending him things in the mail. He explained, “So then she started sending me things in the mail. And I ended up getting a parcel and there was all sorts of things in there. But one of the things that she put in there was this little tiny pair of very sexy panties she put perfume on. My first thought was you would never even fit into these things.” This reaction is perhaps an extreme example, but was echoed to greater and lesser extents in the majority of my interviews with male online daters. For women, this requirement to be authentically embodied translates into being burdened with what I call the onus of authenticity, which takes the form of responsibility for being either “authentically fat” or “authentically thin.” Women are responsible for being honest and authentic about their weight representation, from filling out the appropriate box on their profile to posting profile pictures that allow potential dates to attempt to “objectively” measure their body mass index (BMI), which twenty-four-year-old Daniel explained as an important guideline for date selection.14 Daniel also explained that it was helpful to get multiple pictures (sometimes from being added to a potential date’s Facebook account) in order to be able to visually quantify a woman’s measurements to decide if she was an appropriate weight to date. Daniel used his fingers to try to objectively measure the width of women’s hips from the photos they provided. Daniel further articulated that dating a bigger woman would be embarrassing because when he introduced her to friends, he knew that they would be thinking she was fat and wondering why he could not do better.

386  Jacqueline Schoemaker Holmes

Contingent Authenticities and Spoilage Of course, fat phobia is not a new phenomenon in hetero-romantic dating. In their discussion of a slightly different form of fat phobia in offline contexts described as “hogging” by the men who engage in it, Gailey and Prohaska (2006) came to similar conclusions about dating when they found that men did not ultimately want to be in a relationship with “big” women because that would threaten their status as appropriate and desirable males (45).15 Their research demonstrates how online dating reiterates attitudes of male fat phobia in North American dating practices, and has perhaps amplified rejection based on body size now that men have greater access to diversely shaped women and their sometimes inaccurate representations of themselves that are compelled by the desire to be “authentic.” In this way, gendered relations of power are enhanced and further articulated by the ability to have more information prior to a face-to-face meeting. This visual and textual enhancement results in higher rates of rejection based solely on primarily visual and some textual cues (in this case about weight) as well as by and through the reification of women’s presumed appropriate role of “becoming an attractive object as a role obligation” (Shur, qtd. in Gailey and Prohaska 2006, 33). The primacy of embodiment in my study stands in stark contrast to the fluid self that Turkle imagines in online engagements where “the self is not only decentred but multiplied without limit. [The internet provides] an unparalleled opportunity to play with one’s identity and to ‘try out’ new ones” (1996, 356). Rather, the authentic self that emerges in the online dating practices of my participants, especially with regard to a woman’s weight, requires accurate depiction and conscious, authentic, and extensive explication. Nakamura (2002) points to how celebratory notions of the “fluidity of self,” of freeing ourselves from our limiting bodies, “tend to overlook the more disturbing aspects of the fluid, marginalized selves that already exist offline in the form of actual marginalized peoples, which is not nearly so romantic a formulation” (xvi). Nakamura coins the term “cybertypes,” borrowing from the concept of stereotype, to describe the distinctive ways that the internet “propagates and disseminates images of race and racism” (3). She rejects the notion that we are “virtual” in cyberspace on the basis that “machines that offer identity prostheses to redress the burdens of physical ‘handicaps’ such as age, gender, and race produce cybertypes that look remarkably like racial and gender stereotypes” (5). Through her

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concept of the cybertype, Nakamura argues against the notion that the internet is a democratic space capable of freeing us from our embodied selves/identities. Instead, she maintains that these assertions about the fluidity of identities and selves emerge from the privileged invisibility of whiteness and mask the differential access various groups experience in relation to new technologies. Nakamura claims that cybertyping keeps race “real” through the discourse of the virtual (26). Just as Liza was unable to be limited by one “cybertype” – that is, she was unable to easily “reduce” her identity in ways that made her easily intelligible – so too are women gendered negatively by being located in bodies that are cybertyped as lazy, unhealthy, unfit, and, most significantly, unattractive. While this theme of men desiring only “thin” women may not seem entirely surprising or entirely new, it is interesting in light of the work done on technologically mediated transformations of self, and ideas of the mutability of physical characteristics in online environments (e.g., Turkle 1995). Here, this “fat phobia” serves at once to subject women to their bodies even in online environments while requiring them to continuously become or reinvent themselves as “fat subjects” by constantly having to own up to the “reality” of their weight in order to avoid embarrassment, humiliation, and rejection. Foucault’s understanding of the networked relationship of assujetissement complicates this notion – that is, women at once become subject and subjected through practices and care of the self, or askesis. The men in my study almost universally claimed that women in the past had deceived them with false or misleading representations of their weight. Further, when asked, “What are the fundamental char­ acteristics you are looking for in the profile of a potential date?” they again almost universally responded with some variation of “not fat.” Only two women mentioned weight as important in their choice of potential date. Thirty-one-year-old Emma explained that she is not attracted to overweight or out-of-shape men, and another said that she does not look for “really big men,” whether muscular or heavy. More significantly, I began to hear how the stories of both male and female participants complemented each other, how “not fat” was not only a male desire but was also tied to practices of authentically representing the self for women. As Emma explains, “I’m a little bigger than lots of women, right? So my pictures show that.” Another thirty-sixyear-old participant, Francesca, explained that she isn’t a “Yaletown” size two. She wanted to make sure the men she contacted online knew that prior to their meeting. As much as her efforts can be perceived as a

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strategy of authenticity, they can also be understood as a “project of the self” or a technique of the self, insofar as they represent a project that one both subjects one’s self to and is made subject to. As Foucault explains, self-formation as an ethical subject – in this case as an honest, authentic, “real” person – “requires him [sic] to act upon himself, to monitor, to test, improve, and transform himself” (Foucault 1992, 28). Further, he explains that there is “no forming of the ethical subject without ‘modes of subjectification’ and an ‘ascetics’ or ‘practices of the self’ that support them” (28). What genders this particular practice of the self is its disproportionate effect upon how women construct and cultivate themselves in their profiles for potential dates. In this hetero-normative practice of cyber-­ selfing, women are responsible not only for the representational cues they “give,” but also for the subtler cues being “given off” (to use the language of Goffman 1959). Women must construct a version of themselves that meets male standards of beauty and desirability while maintaining an “honest,” true, and “authentic” self-portrayal. In this way, women must consciously and continuously reconstruct themselves as “fat,” and own up to an identity or “self” that they understand the generalized other conceives them as. Women become “subject to” their bodies by accepting an identity, or in the case of Lavalife, by checking a body-size box on their profile that is somewhere above “average” and below “queen-sized” (the final category listed). In this way, women’s bodies define them and accompany them online: there is no transcendence here, only “truth.” In my limited study, women are not entirely disabled by this subjectification, but such moments of subversion can also be understood to destabilize the very ground of the “authentic self.” While my research findings bear out that men overwhelmingly say no to fat women online, that research also revealed that women’s reaction to this labelling or perception was not negative. Rather, it appears that the reaction to a perceived stigma against “fat” has been largely to engage in the “constant reinvention of self,” as Victoria put it. By this, Victoria was referring to the constant performance of self that must occur in the context of online dating. For example, the dater repeatedly tells dates where she works, what she likes to do, and what she looks like. This performance has been variously explained as confusing and messy but always honest and authentic, particularly for women. Most of the women I interviewed embraced their appearance with a kind of “take it or leave it” attitude. They did not dwell on the perceived or real rejection they might encounter based on their physical appearance, regardless of their size.

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As Emily explained, she wants to demonstrate that she is not like other women, but bigger, and attempts to accurately portray that to potential partners. It is here where self-discipline and proper practice of the self fail to conform to normalized techniques of the self. These women recognize what is expected in the world of hetero-normative ideals; that is, to be “fit,” active, and thin women, whether online or off. Nevertheless, while reacting to the power of ascetic truth or authenticity, they reject such normalization. By “telling the truth” and, I argue, by embracing the onus of responsibility around their “fat authenticity,” these women “exceed normalizing goals and expand, rather than reduce, [sic] possibilities for being in the world” (Heyes 2006, 146). When Francesca said that she wants potential dates to know that she is athletic but not “Yaletown skinny,” she is resisting the definitions and rejections of men who would construct her as fat and opening up an enabling space of being that is not restricted by the profiling practices that subject her to her body. Rather, Francesca’s and Emily’s discourses of subtle resistance, coupled with their practices of fat authenticity, offer a dynamic picture of self that is both constrained and enabled by the particular technique of self that compels them into authenticity in a process of cyber-selfing that takes embodiment seriously. In perhaps the most subversive example of fat authenticity, women over-report their weight in an attempt to be as authentic as they believe the generalized other wants them to be. In this way, women not only embrace their embodiment, but also acknowledge the contingency of authentic representations of self as a complex process of regulated and constrained performances. By finding ways around the limited picture of self that the profile holds them to, women subversively rewrite their authenticity in ways that acknowledge the contingencies of self and other. This complex interplay of truthtelling as a project of the self that is both disabling and enabling means, according to Heyes, that we must “understand that we have reason to embrace the increases in capacities it permits without acceding to the intensification of disciplinary power it requires” (2006, 127). Michael Moon (with Eve Sedgwick, 2001) explains that in this society everyone who knows a fat woman feels they know something about her that she doesn’t herself know – namely, that she’s fat. However, I argue that fat authenticity gives fat women the arena to speak – in fact, it forces them to speak their fatness, spoil their identity, and thus manage such spoilage in a different way from it’s simply being seen and understood negatively. Fat women in this study must transform themselves into knowable subjects in the hetero-normative space of online dating. Here the fat woman can’t be understood as ignorant; instead

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she knows, pre-empts, negotiates, and manages by way of accepting this onus of fat authenticity. It is in this knowability that I agree with Murray (2004), who suggests that “speaking one’s fatness” is not ambiguous or deliberative enough to be rightly subversive. However, it is an act of resistance because within the boundaries of intelligibility, some of the women in my study create knowable bodies online to negotiate the fat-phobic hetero-­ normativity they experience in every facet of everyday technologically mediated life. Further, these women call upon what we all know – as women we are all entangled in the tacit understanding of how fat oppression operates, evident in my colleague’s anecdote, and so the contingent and contradictory embodied experiences that these women “speak” online stand as resistance to the hierarchy of thin over fat that Murray (2004) discusses. How then is fat authenticity resistance? Goffman (1968) famously suggested that stigma defines those who have been disqualified from full social acceptance and that stigmata were originally bodily signs to indicate this rejection (including face brands). The contemporary social stigmata of fatness, however, are written all over the body, a fleshy skin brand that cannot be covered over. If we shift what the women in my study accomplish through their fat authenticity from simple subversion to an embracing of a spoiled identity, we can then think of fat authenticity as resistance. A spoiled identifactory practice accepts this stigma – performs this stigma – which is evident in what twenty-nine-year-old Leanne had to say: I was just afraid – I didn’t want anyone to say, “Oooh, you’re fat.” So I was always trying to say, “I work out every single day, but I’m not 120 pounds, five foot eight” – 120, I’m not. If you want the high-maintenance, gorgeous girl that dresses up and blah, blah, blah, that’s not who I am.

And as twenty-four-year-old Carmel explained: “Like, I like to put up realistic pictures … I don’t want to show up and them be like, ‘Cool, you’re a fat cow. I was expecting a size two,’ so that’s my only concern, but I try to be realistic. I’m not overweight but I’m no size two. I am who I am.” Fat authenticity as active spoilage of “properly” gendered femininity is resistance, then, in two ways: it demonstrates the self-signifying knowledge of the fat woman and it demonstrates the management of a spoiled identity out of which Moon and Sedgwick argue experimental identities can be born. She explains that, “at a certain level of human

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creativity, it may be true that the management of spoiled identity simply is where experimental identities, which is to say any consequential ones, come from” (2001, 302). Finally, spoilage as an experimental identity has implications for how we all experience fat in the world. Whether or not it will be rejected by men met online, these woman laid claim to a spoiled identity through practices of fat authenticity. As Allyson Mitchell, founding member of the activist performance group called Pretty Porky and Pissed Off, explains it, her activism grew out of a desire to “live large in the bodies we presently inhabit rather than continue to pretend that we are only temporarily visiting them” (Mitchell 2005, 214). Fat authenticity, as an online identificatory practice, allows women an arena to publicly acknowledge the knowledge of their bodies, their spoiled identities, in resistant, different, more overt ways despite the fat phobia that they know exists in heterosexual dating scenarios. But like Mitchell, who embraces her spoiled identity along with her troupe, the women in my study recognized that even though “you may have the privilege of passing as normal, depending on body size, … there will always be a part of ‘fat’ that stays with you, that informs how you perceive the world and your place in it. Who you are and who you understand yourself to be is shaped by your bodily experiences. We learn how to move around in the world in a fat psyche. We are fat regardless of size” (Mitchell 2005, 215). Conclusion The spoilage that my colleague’s niece engaged in that opens this chapter is a reality for many of the women in my study. I originally thought of women’s acts of weight reportage on online dating sites as subversive because, even in the face of rampant fat phobia in men’s profiles and the rejection and humiliation some of them experienced both online and when meeting men in person, women remained open and as true-to-life as possible about their weight. These women’s practices also reveal the contingency of authenticity – women in the study even over-reported their weight to negotiate fat phobia and protect themselves against meeting men who would reject, embarrass, or humiliate them in person. However, I have recently recategorized these acts as resistant instead of subversive, because women who engage in these practices work within a framework of knowing around their vilified weights but do not entirely subvert them by disengaging, disidentifying, or rearticulating the boundaries of their subjectivities.

392  Jacqueline Schoemaker Holmes

Women in my study “spoiled” their identities online and then managed their spoiled identities through practices of what I call fat authenticity. Fat authenticity emerges as an attempt to speak one’s fatness, as Eve Sedgwick (with Michael Moon) suggests the fat woman must do to emerge from the “closet of size.” Speaking fatness acknowledges the critiques of this kind of speaking (Moon and Sedgewick 2001). Murray (2004) suggests, for example, that speaking yourself as a fat woman or “coming out as fat” does not formulate new modes of embodiment or being-in-the-world because it refuses a kind of ambiguity that allows for contradictions in bodily experience and ultimately re-hierarchizes fat over thin. However, in spoiling their identities by “coming out” or speaking their fat authenticity, women in my study resisted the knowing of others and created a space of knowing for themselves. By acknowledging their spoiled identities, the women speak them to uncover how fat operates in gendered relations of power that seek to normalize and regulate their bodies. Unlike simply speaking your fatness, when you speak from a spoiled identity you are not working within the conditions and limitations others impose on your intelligibility – rather, one acknowledges the vilification of a spoiled identity and speaks back to it knowingly and without compromise. This story isn’t about disidentification, opacity, subversion, or even trying to find a way out of the intelligible bind of identity that’s embodied through what Murray (2004) calls ambiguity. Rather, it is about spoilage – spoiling not only the satisfaction of reiterating hetero-normative rejections of the fat woman but also working within the discourse that says all fat is stigma or shame. Performing fat authenticity allowed the women in my study, regardless of size, to spoil their identities by speaking fat first and, what’s more, resisting the oppressive definitions of others and multiplying the embodied possibilities for livability and love. NOTES 1 Yaletown is an affluent neighbourhood in downtown Vancouver. 2 How did I recruit my participants? After attempting to recruit participants through posters and other “analogue” forms of advertisement (e.g., an ad in the Georgia Straight, a free news and entertainment newspaper published by Vancouver Free Press Publishing Corp.) to no considerable avail, I began recruiting in the volunteers section of the Vancouver page of craigslist.com, an online classifieds page that acts as a community forum for various cities around the world. Craigslist is unique insofar as it is an

Fat Authenticity: The Case of Online Dating  393 interactive form of a newspaper classifieds section that has everything from personal ads to housing to group activity postings and even a ­“volunteers” section, which is heavily used by researchers from both Vancouver universities (the University of British Columbia and Simon Fraser University) who are looking to recruit for their research projects. Individuals interested in volunteering – or who clicked on the “volunteers” link when they were also browsing for potential dates in the “personals” section of Craigslist – contacted me through my university email address included on the posting. This digitally enabled form of recruitment was by far the most successful form, although I did recruit one ­participant from a blogging and social media conference I attended in Vancouver and one participant from the Georgia Straight ad. It stands to reason that those who are online dating in Vancouver would find it much more convenient to make contact and set up interview times over the internet, by email. In a few instances, a form of random sampling occurred (although sample is the wrong word here, as I did not compile a universe of all of Vancouver’s online daters) where individuals I interviewed knew someone who might like to speak with me about their experiences and so passed my information along to them. In another case, I interviewed two couples, where one member of the couple immediately agreed to participate and the other agreed to participate at a later date. My shadowed participants were unique cases and “self-selected” in the sense that they acted as key informants would in an ethnographic setting. These four individuals had both the time and the interest to dedicate to the study. 3 “Why Vancouver?” http://www.tourismvancouver.com/vancouver/ about-vancouver/why-vancouver/ (accessed 6 April 2009). 4 David Ebner, “For Healthy People, Build a Healthy City,” Globe and Mail, 6 September 2012. http://www.theglobeandmail.com/life/health-andfitness/for-healthy-people-build-a-healthy-city/article4201227/?service= mobile (accessed 30 November 2012). 5 Crawford defines healthism as “a particular way of viewing the health problem [that] is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political and, therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized wellbeing” (1980, 365).

394  Jacqueline Schoemaker Holmes 6 A recent opinion piece in the popular public-transit commuter newspaper 24 hrs Vancouver by a Vancouverite, Melissa Carr, responding to an article about weight discrimination in the city, asks, “Does Vancouver discriminate against overweight people, or does our city just place high value on health, well-being and fitness?” She answers her question by claiming that “in Vancouver, we have a culture where people are encouraged to take care of themselves and their bodies. Should Vancouver apologize for this? I say, absolutely not” (“Vancouver Promotes Healthy Lifestyle,” 24 hrs Vancouver, 3 August 2012, http://vancouver.24hrs.ca/Columnists/GuestShot/2012/ 08/02/20060831.html (accessed 30 November 2012). This conflation of “health” with “thinness” was evident in men’s constructions of characteristics they were looking for in a date and a marriageable partner. 7 A choice made at the outset of research. 8 The i in internet is not capitalized throughout this analysis in order to acknowledge recent scholarship that does not view the internet (which is now recognized by some as “internets” or “interwebs”) as one monolithic space or an entity that influences its users through sheer exposure (Baym, Zhang, and Lin 2004, 300), but rather promotes a vision of the internet that privileges its use. Baym, Zhang, and Lin suggest that it is the pursuit of “social and cultural goals” by and through the internet that should provide the “starting point for analysis rather than totalizing measures of all Internet use” (ibid. 301). 9 The only exception here is one female participant, thirty-year-old Ann, who detailed her desire to date a woman using online dating sites. She felt that if she still lived in the city of her birth or was surrounded by the longtime friends of her youth she would be more inclined to explore gay bars. However, while online dating did give her the opportunity to meet a few interested women, she was concerned that she was not ready for a samesex relationship and that her period of “adjustment” to a gay lifestyle would be unfair to impose upon a woman looking for a serious commitment. This meant that Ann ultimately gave up on her desire to “experiment” with women online because, in her words, “I figured it would take me several women to find one who I could behave properly with.” 10 These online dating “tasks” were broken down into four steps. Task 1 is creating a profile, an integral component of the selfing that takes place when online daters have to create and recreate a profile that reflects them “authentically” while attending to the constraints of constructing oneself as an appropriately gendered, attractive, and potentially marriageable heterosexual partner Task 2 is initial contact. Men tend to cast their nets more widely because many women will ignore contact from men they consider undesirable. Women tend to be the initial “choosers” online – men face a

Fat Authenticity: The Case of Online Dating  395 lot of rejection in this arena, but face rejection at task 4 when men “size up” whether they were authentic about their embodiments in person. Task 3, filtering, involves practices of screening out those who might be ­after just sex (for women), those who might not be serious (for both men and women), and those who are considered unsavoury or inappropriate (again for both men and women, but at this stage women are more “in charge” of filtering). Task 4 is the first date: “successful” online daters know that this should take place within two weeks in order to not waste time having an “online romance” that would fizzle if the “e-chemistry” didn’t translate in person. 11 These rankings are based on cost, legitimacy, and overall parameters. For example, Lavalife has a cost associated with it and is therefore seen as ­being more legitimate and having more legitimate daters on it, while Craigslist is freeform where anyone can post. 12 The participant said “expediate” rather than “expedite” – the usage is ­authentic to the interview transcript. 13 This trend changes as women age. Older women have to put more time and energy into searching because older men tend to focus attention on younger women, often ignoring the profiles of women their own age. 14 Body mass index (BMI) is a statistical measure of the weight of a person scaled according to height. 15 “Hogging” is a practice in which men prey on overweight or unattractive women to satisfy their sexual urges (Gailey and Prohaska 2006, 32). Gailey and Prohaka point out that men engaged in processes of neutralization, such as denying the victim and victim-blaming, perceive overweight women as deviants who do not appropriately fulfil their female role ­obligation by being “attractive” and thin (33).

WORKS CITED Baym, N.K., Y.B. Zhang, and M.-C. Lin. 2004. “Social Interactions across Media: Interpersonal Communication on the Internet, Telelphone and Face-to-Face.” New Media & Society 6 (3): 299–318. http://dx.doi. org/10.1177/1461444804041438. Braziel, Jana-Evans, and Kathleen LeBesco, eds. 2001. Bodies Out of Bounds: Fatness and Transgression. Berkeley: University of California Press. Butler, Judith. 2006 [1993]. Bodies That Matter: On the Discursive Limits of “Sex.” New York: Routledge. Campbell, John Edward. 2004. Getting It On Online: Cyberspace, Gay Male Sexuality, and Embodied Identity. New York: Harrington Park.

396  Jacqueline Schoemaker Holmes Constable, Nicole. 2003. Romance on a Global Stage: Pen Pals, Virtual Ethnography, and “Mail Order” Marriages. Berkeley: University of California Press. Crawford, Robert. 1980. “Healthism and the Medicalization of Everyday Life. International Journal of Health Services.” 10 (3): 365–88. Foucault, Michel. (Original work published 1985) 1992. The Use of Pleasure, Vol. 2. Trans. Robert Hurley. History of Sexuality. New York: Random House. Gailey, Jeannie A., and Ariane Prohaska. 2006. “‘Knocking Off a Fat Girl: An Exploration of Hogging, Male Sexuality, and Neutralizations.” Deviant Behavior 27 (1): 31–49. http://dx.doi.org/10.1080/016396290968353. Goffman, Erving. 1958. The Presentation of Self in Everyday Life. New York: Doubleday. Heyes, Cressida J. 2006. “Foucault Goes to Weight Watchers.” Hypatia 21 (2): 126–49. http://dx.doi.org/10.1111/j.1527-2001.2006.tb01097.x. Kendall, Lori. 2002. Hanging Out in the Virtual Pub: Masculinities and Relationships Online. Berkley: University of California Press. http://dx.doi .org/10.1525/california/9780520230361.001.0001. Miller, Daniel, and Don Slater. 2000. The Internet: An Ethnographic Approach. Oxford: Berg. Mitchell, Allyson. 2005. “Pissed Off.” In Fat: An Anthropology of an Obsession, ed. Don Kulick and Anne Meneley, 211–25. New York: Penguin. Moon, Michael, and Eve Kosofsky Sedgwick. 2001. “Divinity: A Dossier, a Performance Piece, a Little-Understood Emotion.” In Bodies Out of Bounds: Fatness and Transgression, ed. Jana Evans Braziel and Kathleen LeBesco, 292–328. Berkley: University of California Press. Murray, Samantha. 2004. “Locating Aesthetics: Sexing the Fat Woman.” Social Semiotics 14 (3): 237–47. http://dx.doi.org/10.1080/10350330408629678. Nakamura, L. 2002. Cybertypes: Race, Ethnicity and Identity on the Internet. New York: Routledge. Stone, Allucquère Rosanne. 2001 [1995]. The War of Desire and Technology at the Close of the Mechanical Age. Cambridge: MIT Press. Turkle, Sherri. 1995. Life on the Screen: Identity in the Age of the Internet. New York: Simon and Schuster. Whitty, Monica, and Adrian Carr. 2006. Cyberspace Romance: The Psychology of Online Relationships. Houndmills, UK: Palgrave.

PART 4 Inconclusions

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15 “Celebrating Unruly Experiences”: Queering Health at Every Size as a Response to the Politics of Postponement Jenni fer Br a dy an d Jacqui Ging r a s

The Health at Every Size (HAES) movement represents a view of bodies and health that de-emphasizes body weight to inform health-­ promotion efforts that include people of all body shapes and sizes (Burgard 2009, 42). HAES emerged as a response to the prevailing, weight-centred, anti-obesity paradigm of health that has waged a war on “obesity.”1 The HAES movement is dynamic and diverse, and engages the activist, professional, and scholarly communities. The diversity within the movement means that HAES is not a singular entity. Rather, there are a multitude of approaches to and ways of understanding HAES, including perspectives that have emerged through empirical and theoretical inquiry, activism, and clinical practice. However, HAES is tied together as a movement by a set of generally agreed upon core principles: embodied movement – participating in ways of moving one’s body that are enjoyable and self-caring; intuitive eating – eating according to one’s internal cues of hunger and satiety while honouring the desire for the pleasure and conviviality of food; acceptance of one’s body size and shape; and ending weight bias (Burgard 2009). Above all, the HAES community seeks the widespread acceptance of a weightneutral approach to health and an end to weight-based stigmatization. Although HAES coalesced as an identifiable movement within the last decade, action to advance ideas akin to its core principles began as early as the 1960s (Cooper n.d.). The National Association to Aid Fat Americans (later The National Association to Advance Fat Acceptance) and The Fat Underground were two early grassroots, activist organizations that spoke out against widespread weight-based discrimination and weight-centred health ideology (Cooper n.d.). In Canada in the 1970s the widely acclaimed health-promotion campaign called

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ParticipACTION emphasized healthy living for vitality, not for weight loss (Gingras 2006). Throughout the 1980s other health-promotion campaigns and grassroots organizations carried on the work of advancing fat acceptance, and promoting weight-neutral approaches to supporting the health of Canadians (Cooper n.d.). More recently, authors such as Linda Bacon (2010) and Lucy Aphramor (2010), as well as organizations like the Association for Size Diversity and Health (ASDAH), which formed in 2003, have begun to delineate HAES as a more unified and cohesive movement. In 2011 ASDAH trademarked HAES in an attempt to promote consistency within the HAES community and to prevent anyone from capitalizing on the growing popularity of HAES to market diet-related products (ASDAH 2013). Despite recent efforts to codify HAES, ideas about how to best promote its principles and practices vary among members of its community. Recent developments suggest that the weight-centred paradigm may be losing ground to HAES as the dominant view of fatness and health. An increasing pool of literature generated by HAES-affiliated scholars has documented the failure of weight-loss-driven health-promotion and research initiatives to actually result in safe, long-term weight loss (Mann et al. 2007). There is also an increasing body of evidence that weight loss is not positively correlated with improved health outcomes, but that following the principles of HAES has the potential to improve an individual’s health (Aphramor 2010; Bacon and Aphramor 2011). The HAES movement appears to be gaining momentum, as is evident in the expanding body of literature on HAES’s efficacy in supporting people’s health. The core principles of HAES are positioned in stark opposition to the weight-centred view of fatness, which links “excess” body weight and increased morbidity and mortality. In this view, the means of improving one’s health is weight loss via increased exercise and reduced caloric intake. At its most basic, this paradigm focuses on weight-loss and management. In a previous work, we characterized the weight-centred paradigm as a “control discourse” that constitutes individuals’ eating patterns as a series of reasoned, discrete, and quantifiable choices (i.e., weigh, measure, limit, and avoid) in direct contrast to views that eating is determined by emotion, hunger, appetite, and sociality. Instruments of nutrition science (body weight, body mass index, and hip-to-waist circumference ratio as three common examples) are used to define the marginalized Other’s body as too fat or too thin and

Queering Health at Every Size  401 justify its need for nutrition management in the name of individual and public health. (Gingras and Brady 2010, 2)

While control discourse forms the foundation of contemporary dietetic practice, it also holds a treasured place as a guiding precept in the work of many kinds of health professionals, researchers, policy makers, and scholars as well as in popular understandings of fatness (Gingras and Brady, 2010). Despite the differences between HAES and control discourse, some scholars suggest that these two paradigms share an undercurrent of healthism (Crawford 1980). Healthism describes the rising “preoccupation with personal health as a primary – often the primary – focus for the definition and achievement of well-being” (1980, 386, emphasis in original) coupled with the view that not performing certain health behaviours is evidence of “individual moral failing” (380). These days, representing oneself as healthy requires a dogged devotion to working on the body in particular ways (Crawford 2006). Under the guise of the weight-centred paradigm, working to be healthy means dieting and exercising in ways that align with the expert recommendations and that maintain a body weight falling within the narrow “normal” weight range determined by one’s body mass index (BMI). With HAES, being healthy is unrelated to one’s weight, but HAES still assumes that working to be healthy is something people should do. In other words, the principles of HAES still expect people to present themselves as working on their health. Take for example Bacon’s four steps of living a HAES lifestyle: (1) accept your size; (2) trust yourself; (3) adopt health and lifestyle habits; (4) embrace size diversity. While Bacon’s first, second, and fourth steps starkly diverge from the prevailing weight-­ centred discourse, the third step seems to echo the healthist expectation that one perform certain healthy behaviours. Given the priority of place given to positivist understandings of the body and health, HAES scholars have sensibly taken to refuting the evidence base that is said to support the necessity and efficacy of the weight-centred paradigm in advancing health. One way that HAES scholars have done this is by offering systematic critiques of the evidence used to shore up the weight-centred paradigm (Aphramor 2005; Aphramor and Gingras 2008, 2009, 2011a, 2011b; Bacon and Aphramor 2011; Bacon et al. 2002; Campos et al. 2006; Gard and Wright 2005; Gingras and Aphramor 2010; Gingras and Brady 2010; Reel and Stuart 2012; Saguy and Riley 2005). Another way that HAES scholars have

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contested the weight-centred paradigm is by creating an alternative evidence base that supports the necessity and efficacy of HAES. Despite these efforts, the human, financial, and political resources invested in the weight-centred paradigm, and the cultural and social ubiquity of that paradigm, remain steadfast. While we are similarly steadfast in our belief that the weight-centred paradigm is ineffective as a model for enhancing the health of Canadians, it is not our goal here to expand on the already compelling critiques of it. Our concern is with what this oppositional positioning of HAES and the prevailing weight-centred paradigm might mean for the HAES community’s capacity to effect fundamental changes to how fatness, bodies, and health are understood, and to put an end to the oppressive discourse of body size as it intersects with other discourses of race, class, gender, sexuality, and ability. We wonder if the oppositional positioning of HAES against the prevailing views of “obesity” might annex the HAES community’s efforts by leading them to focus their energies on deconstructing the prevailing paradigm rather than on building up and expanding the work begun earlier by fat activists, scholars, and health promoters. We wonder if HAES scholars’ efforts to fight the weight-centred evidence base with a weight-neutral evidence base, although it’s a valid and important approach, serve to buttress the very centrality of the weight-centred paradigm and positivist understandings of health. Might Audre Lorde charge HAES with attempting to dismantle the master’s house using the very tools used to build and maintain it?2 Might continuing with this course of action lead HAES to perpetuate the oppressive view of health at the core of the weight-centred paradigm, namely healthism? We are concerned with how this oppositional positioning of the two paradigms might set up dualisms in how health, bodies, and fatness are understood by the HAES community. What this dualistic approach represents is not a rejection of “obesity” science or a taking over of that science – we are talking about a disavowal of science in favour of morality. Being fat amounts to being amoral and this position is buttressed by anti-obesity science. In other words, we question whether offering HAES as the alternative to the weight-centred paradigm contributes to what Gibson-Graham (2006) calls “the politics of postponement” (ix). That is, envisioning an emancipatory future may only amount to just that – a never-realized emancipatory future. We do not believe that it is time to reject HAES in favour of another iteration of healthist discourse. We are also not suggesting that HAES

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scholars’ previous work to bring to light the methodological, ethical, and epistemological weaknesses of the weight-centred paradigm’s evidence base has not been important in advancing HAES. What we are curious about is whether it might be time for another approach. Rather than focusing efforts on contesting the weight-centred paradigm, the HAES community might be better served by expanding and making more complex its understanding and practice of HAES as a social movement. To us, social justice means more than inclusivity and ensuring that everyone has equal access to health care. Social justice means unconditional respect for everybody and for every body. It also means that health care services are accessible by all, and the means of accessing those services and the services themselves are respectful, ethical, and fundamentally guided by the recognition that, to a very large extent, health is socially determined. This means that health care services must also serve people with empathy and a recognition of the various social, cultural, political, and economic factors that shape the contexts in which people experience their bodies and their health (Paradis, this volume). In our view, bringing about a more socially just, non-healthist understanding of fatness and bodies requires the HAES community to more explicitly politicize the movement and engage in a more open and self-reflexive querying of its central precepts. For example, HAES has tended to present itself as a way of thinking about health, but has mostly overlooked how thinking about health requires that we think about race, class, gender, sexuality, ability, and so on (Rice in this volume). We have elaborated this idea elsewhere in a critical analysis of HAES and its main tenets (Brady, Gingras, and Aphramor 2013). By way of building on this work, this chapter further queries HAES and its potential to effect fundamental change to the intersection of oppressive discourses, of which weight-based stigma is one. We seek to move HAES in a direction that we believe is necessary to its continued growth and future potential to unite with other social justice movements such as feminism, anti-colonialism, anti-homophobia, and anti-racism. Towards this end, we look to the practice of “queering” that emerged from queer theory. Queering has potential for thinking about and practising HAES in ways that advance a more socially just understanding of bodies, health, and fatness. Finally, we offer this exploration in the spirit of collegial dialogue with the intention of contributing to the robustness of HAES, as well as critical, self-reflexive scholarship and practice.

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HAES and the Politics of Postponement Our concern about how HAES has been positioned in opposition to the weight-centred paradigm is related to Gibson-Graham’s (2006) work on capitalism. Gibson-Graham contends that “it is the way capitalism has been ‘thought’ that has made it so difficult for people to imagine its supersession” (5). She notes that although critical theory’s aim is to “understand the world in order to change it,” the various theoretical counter-capitalist discourses actually serve to reinforce capitalist dominance (1). How scholars speak about capitalism buttresses its “powerful and entrenched position” by leaving it mostly “unnamed but nevertheless unmistakable” (253). In other words, “the project of understanding the beast has itself produced a beast, or even a bestiary; and the process of producing knowledge in service to politics has estranged rather than united understanding and action” (1). GibsonGraham explains that the reason counter-capitalist discourses perpetuate capitalist dominance lies in the way that theory is not so much describing reality, but performing it. Successful theory “performs” a world; categories, concepts, theorems, and other technologies of theory are inscribed in worlds they presuppose and help to bring into being. Thus, the ability of theory to describe and predict is not an outcome of accurate observations/calculations, but a measure of the success of its “performation.” (xxi)

Ultimately, counter-capitalist discourses engender what she calls a “politics of postponement” among left-leaning scholars and activists (ix). That is, when envisioned through counter-capitalist discourses, change follows on the either-or positioning of capitalism versus anticapitalism and demands a complete overthrow of the capitalist system. We are therefore left “waiting for the revolution” (251) rather than recognizing and building on the various forms of non-capitalist activity to chip away at oppressive economic structures. However, Gibson-Graham cautions that we can’t just be “opponents of capitalism.” We must explore how to “desire and create non-capitalism” (xvii) to “unleash the creative forces and subjects of economic experimentation” (253). Gibson-Graham’s description of how the politics of postponement work to reify capitalism can clarify how HAES is weakened in its reliance on the anti-obesity paradigm, however defiant.

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Gibson-Graham argues that leftists must harness the performative potential of theory to expand and replicate already established points of resistance to capitalist hegemony to slowly but surely transform capitalism. In her words, “our vision of a noncapitalist future is not predicated on the general eradication of capitalism but simply involves the acknowledged coexistence of capitalist and noncapitalist economic forms. In other words, it is a vision of economic heterogeneity rather than of an alternative (noncapitalist) homogeneity” (179). Rather than systemic change brought about through revolution, Gibson-Graham (2006) advocates for change brought about by the additive effect of numerous moments of resistance. These moments of resistance include such things as non-capitalist forms of economic exchange like bartering, and can occur on a small local scale among neighbours or may be more systematized and occur among members of a bartering network. Moreover, these moments of resistance are not so much anti-capitalist, in that the effort is not made to eradicate capitalism, but non-capitalist, in that they claim space outside of capitalism and thereby contribute to building different economic relationships. Gibson-Graham’s ideas about the politics of postponement and the additive effect of moments of resistance prompt us to consider how the oppositional positioning of HAES as the alternative to the weight-­ centred paradigm (i.e., the anti-weight-centred view) might limit the change that its advocates hope to bring about in several ways. How might the HAES community engender a politics of postponement that buttresses the centrality and dominance of the weight-centred, antiobesity paradigm by offering HAES as a substitute that seeks a total paradigm shift? Might HAES be offering a counter-hegemony, and if so, what might this mean? What alternate view of weight and health does HAES perform? How does HAES fit with fat activism, or fat studies scholarship? These questions are related to other, more fundamental questions about what HAES is, what the goals of its movement are, and what they should be. By establishing HAES as the alternative, HAES activists, allies, and practitioners have reified the centrality of the weight-centred health paradigm. Anti-obesity discourse, like capitalism for Gibson-Graham, becomes the all-encompassing monolith that all efforts aim to thwart. What is perhaps more troubling, however, is the possibility that underlying HAES is the same healthist discourse that underlies the anti-­ obesity paradigm. Recall the example we gave of Bacon’s four steps for

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participating in HAES. The idea that individuals should undergo a sort of lifestyle transformation by eating, exercising, and thinking differently is common to both HAES and the weight-centred paradigm. What is more, this idea is often promoted without sufficient acknowledgment of the contextual factors that can make this more or less difficult for different people. It is partly HAES’s lack of an overt commitment to social justice that has perpetuated the healthist discourse of the dominant weight-centred approach. Added to this is HAES’s neoliberal focus on individual health-behaviour change, rather than on advocacy around the social determinants of health and the social, cultural, economic, and political factors that underlie the most significant factors influencing individuals’ health, like poverty (Norman, Rail, and Jette in this volume). Although HAES seeks to decouple weight and health, scholarship on the link between health behaviours and morality remains untouched. The effort to reduce stigma and increase access to health care for all people is laudable, but in some ways the absent, or perhaps implicit, political commitment to social justice means that HAES has set up a politics of postponement – efforts are directed towards dismantling the weightbased iteration of health for one centred on health behaviours. We seek to re-envision what theoretical elaborations this approach to health might perform. Gibson-Graham (2006) points to queer theory as a potential means of theorizing the anti-capitalist movement and talking differently about capitalism and the potential for change. We also think that queer theory has potential to politicize HAES and imagine different possibilities for what HAES could be, aside from a reaction to anti-obesity discourse. Introducing Queer Theory We are not evoking queer theory as a referent for the “total community of otherly gendered or sexual outlaws such as lesbian, gay, bisexual, transgender and intersexual people” (Graceet al. 2004, 302, emphasis in original). Instead, queer theory can “talk back” to commonly accepted tenets of HAES in order to politicize these understandings and maintain or reassert HAES as a fluid and temporal designation. Halperin (qtd. in Lovaas, Baroudi, and Collins 2002) explains that “queer is by definition whatever is at odds with the normal, the legitimate, the dominant” (62), so we appreciate queer theory’s ability to challenge the dominant articulations of HAES even though the movement specifically denoted (and now trademarked) as HAES is relatively young.

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Initially, queering a topic meant theoretically critiquing it regarding how it was reproducing a heteronormative view. In other words, “queer … symbolizes spectral differences disavowed in the face of dominant power that normalizes, legitimizes, and privileges heterosexuals” (Grace et al. 2004, 302). We should also note that one who applies queer theory is not necessarily queer or, as Britzman (1995) explains, “the Queer and the theory in Queer Theory signify actions, not actors” (153). Grace and colleagues (2004) robustly summarize what queer research should do, which we contend applies to what queer theorizing should do more generally: [Queer theory should] celebrate unruly perspectives and discontinuous experiences; disturb simple notions of life; complicate that which is undemanding; explore the politics of (re)membering; posture that seeing is not believing; and allow people to live in the disarray that constitutes much of human existence. (319)

Contemporary meanings of queer theory have expanded beyond the heternormative critique and now include challenging any dominant position. For example, Probyn (1999) argues that “queer theory needs to relinquish its dependence on sexuality as the sole optic of analysis” (423). Now any construct that has become essentialized or monolithic through dominant discourse is worthy of queering to destabilize and pluralize. We intend queer theory to produce the same effects when applied not only to HAES, but to dietetics and all health practices more broadly. Drawing on our previous work on dietetic practice and education provides examples of how queering can elaborate ways of being in addition to sexuality. As heteronormative aspects of social life are revitalized and “reversioned” through a queer lens, so too does education, and more specifically dietetic education, benefit from a queer analysis. Such an analysis has been offered by Atkins and Brady (forthcoming) who, as critical dietitians, recognize how their professional social­ ization in a largely heteronormative dietetic curriculum did not prepare them to challenge the foundations of dietetic theory and practice premised upon an empiricist (and heternormative) nutritional science. An example of how heteronormativity undergirds dietetic curriculum can be found in the tools that are fundamental to dietetic practice and that students are expected to demonstrate mastery over, namely Canada’s Food Guide to Healthy Eating, the Body Mass Index,

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and the Harris-Benedict Equation. Each of these tools is used to measure and assess the bodies and eating practices of individuals who are comprehensible only within one of two sex categories, male or female. By not learning to question and to queer, we have come to believe that how things (health practices) have always been done are how they should always be done. By maintaining the status quo, we have acted in our own subordination (Gingras 2009, 116). Until now. One means by which we queer HAES here is to refrain from indicating it as a trademarked entity, even though it is. Our refusal brings to light how HAES as a social-justice movement is discordant with commodification and bureaucratization. While the intent of such trademarking was likely protective, it is a fine line between fortification of and control over the movement. We appreciate that trademarking’s original intent was to preserve the tenets of HAES from being co-opted by the billion-dollar diet industry, but the practical reality of trademarking has quite a different effect. For example, efforts to trademark HAES work to de-historicize the movement by claiming that what we now know to be HAES will forever be called HAES while what came before has been made invisible. We would not like to see the efforts of many who came before, namely those who sparked fat activism in the late 1960s (Cooper n.d.), to be “disappeared” in the name of trademarking since their efforts have made possible the current movement called HAES. The trademark may ultimately detract from the continued growth and vitality of the HAES movement. There are suggestions that trademarking HAES can lead to a more inclusive, HAES-positive community due to the educational efforts of ASDAH to inform people on how to bring their inappropriate uses of HAES in line with the real HAES movement. Yet, this is a measure of corrective discipline. Instead, we wish to see HAES as a movement that is open to free engagement – open to being used and misused in an effort to keep it alive and emergent. We want to live with the limitless possibilities of disarray as we did before the matters of what HAES is and who can use the name were even questions. HAES (without a trademark) has healthist undertones, but with a trademark those healthist undertones become concretized, more overt, and less amenable to fluidity and disarray. If, in the future, the billiondollar diet industry does wish to co-opt the language of “HAES,” or the phrase itself, and transform it into a brand slogan, there is very little ASDAH can do about it without spending an inordinate of money to have lawyers seek redress in court. To even engage in a decision to

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trademark or not to trademark locks us in a double bind where HAES becomes a commodity to be owned by a few in the interests of a few (Gingras and Cooper 2013). In this light, can trademarking HAES possibly lead to a more robust, more inclusive movement? We also worry about the reactions of ASDAH members, who dutifully indicate HAES as a trademarked entity, when we seek to question, challenge, or evolve the current iteration of HAES that ASDAH has trademarked. This is not to indicate our mistrust of ASDAH or their intentions, but it seems contradictory to use the trademark, as we are now expected to, when we seek to introduce new ideas (i.e., change) to its core precepts. Will efforts to evolve and enliven HAES be thwarted because of the commodity power that ASDAH has imbued HAES with through trademarking? We did not worry about this when we were working with terms like “non-diet” or “size acceptance” – we just did the good work our hearts desired. Trademarking HAES has shifted the focus of this good work. In effect, our early efforts have already been co-opted by a regime of power and control. We respectfully resist, not by asking that HAES be renamed, but by asking that the trademark be removed in favour of disarray – it’s a queer approach to understanding how we might resist the dominant weight-centred approach. Another feature of HAES that demands to be read through queer (and feminist) theory is its key tenets that indicate health can be achieved by people of every size by making healthy choices – that is, eating until satisfied, being physically active, and accepting one’s body. Although HAES advocates the adoption of healthy behaviours as a means of self-care, rather than as a means of losing weight, the focus is no less on individuals making discrete decisions about their eating and exercise habits. To reiterate, while we don’t disagree with the aims of HAES, we contest the means the HAES community currently recommends for achieving these aims, specifically through healthist ideals that highlight an individual as making choices without addressing the social milieu in which these apparent choices are negotiated. Again, understanding health behaviours in this way contributes to a politics of postponement because it defines HAES in opposition to the weightcentred paradigm, a move that ends up reproducing the decontextualized, individualistic view of health behaviour that characterizes the dominant discourse by using the tools of dominant discourse (i.e., positivist epistemology) against itself. A final aspect of HAES that queer theory can elucidate is the way that its oppositional positioning tends to direct the HAES community’s

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energies towards thwarting the weight-centred paradigm, rather than creating spaces. That is, efforts to advance more socially just ways of understanding bodies and meeting people’s self-defined needs for health support are gripped by efforts to tear down the dominant paradigm, when perhaps our energies could now be spent on building imaginative and theoretical spaces in which we might see fatness in other ways. Charlotte Cooper (2011) provides a useful example that illustrates our point. Cooper describes a performance art project by Scottee, a London-based artist who draws on themes of queer and fat identity in his work. In one performance piece titled “Burger Queen,” Scottee takes on the “good fattie” image that has been promoted by conservative fat activists (and by many in the HAES community). The “good fattie” is the fat person who is accepted for their size with the caveat that they perform the types of health behaviours endorsed by the HAES principles. As a way to challenge this image, Scottee’s “Burger Queen” celebrates the fat body that does not conform to healthist ideology. Cooper sees Scottee’s piece as committing the same type of error that we are trying to bring to light in the HAES movement: For me there is a flimsiness about Burger Queen as a political statement. Revelling in burgers and chips as a refutation of healthism is too neat a mirror-image flip, it maintains a relationship with dominant ideas about “the obese” when it could be going off on a much weirder and wilder tangent that has nothing to do with obesity rhetoric and everything to do with creating autonomous fat culture. So for me it doesn’t quite go far enough. (2011)

Cooper highlights how, when the HAES community and its allies are consumed with tearing down the dominant paradigm, our energies are being sapped from building an emancipatory future right now. This is precisely the politics of postponement that Gibson-Graham says leaves us waiting for the revolution. How Does Queer Theory Move HAES Forward? In queering HAES, we attempt to destabilize binaries that have held HAES together until now (Gard 2013). For example, as a response to weight-centredness, HAES promotes weight-neutrality. It is deceptive to think we can resist and redress the dominant paradigm (weight-­ centredness) since we are always constituted by it. The power that thin

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privilege affords is one example. It is different for someone who benefits from thin privilege to distil and promote HAES than it is for a fat person because the dominant paradigm that insists too much fat is unacceptable bears down on different-shaped bodies differently. The thin body is constituted by authority, whereas the fat body is constituted as deviant. By being against the weight-centred paradigm and focusing on health, HAES is rooted in the same place as the weight-centred paradigm – healthism. What this amounts to is that everything gets defined in terms of weight as a means to improve health. HAES removes the emphasis on weight (the middle “man”), with a direct promotion of improving health. HAES-positive practitioners may feel emancipated from the shackles of the oppressive weight-centred paradigm, but are  they reconstituting another monolithic practice through a well-­ intentioned promotion of health? By contrast, the body ceases to be a weight-and-health project when we challenge the dominant weight paradigm and queer HAES. The body is open to multiple and fluid expressions, undefined by, but at the same time supported by practitioners who are queering HAES. How the body plays a role in guiding one’s HAES practice of intuitive eating and active embodiment presents yet another dualism. In a recent response to a critique by Lee Monaghan, Gard (2013) elaborates one of the most significant dualisms at the heart of the HAES paradigm – the split between the body and the mind: HAES’s supporters, including its leading proponent (Bacon 2010), argue that we all have a “natural” healthy weight and that we should learn to listen to our body’s natural hunger and fullness signals. In passing, given his comments about the indefensibility of Cartesian dualism, I am curious to know how Monaghan manages to overlook the extreme and seemingly unapologetic form of dualism operating in HAES. HAES rhetoric constantly invokes the idea of a “natural” body that will teach us and, as Bacon (2009) herself says, “do the work for us” … And this is to say nothing of the contentious status of HAES’s core empirical claim about the body’s natural set-point weight. (110)

Welsh (2011) describes the anti-obesity, pro-weight-loss approach and the pro-HAES approach as two sides of the same “‘good-health imperative’” coin (34). She notes that these two sides profoundly disagree about the relevance of weight to an individual’s health status, but both

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still rest on the premise that it is “good” for one to work on the self through self-care and that we should each participate in efforts to enhance or preserve our health. However, for those who proclaim themselves as HAES-positive practitioners, these efforts often include improving mental as well as physical health. According to Welsh, The continuity between HAES and the war against obesity is the imperative to do what is healthy. On the side of the war against obesity, it is imperative to monitor weight and reduce the number of overweight and obese persons. On the side of HAES, it is imperative to stop monitoring weight as the marker of good health and to engage in a variety of healthy practices, including self-esteem building exercises … Thus I can either, in the case of the war against obesity, modify my eating and exercise to fit a certain model of health and beauty, or, in the case of fat activism, I can alter my mind to stop seeing my body as loathsome. If the public health outcry tells us to change our bodies, fat activists tell us to change our minds. (2011, 38–40)

Echoing Welsh’s (2011) characterization of HAES as the other side of the healthism coin, Ferguson (2012) contends that the emphasis on intuitive eating and movement (instead of weight) is good, but can sound suspiciously like the healthist admonitions to eat and move in certain ways while ignoring other elements of health such as the spiritual, emotional, relational, and occupational facets. She claims that “if we tacitly accept a concept of health that focuses almost exclusively on physiology, then we may be subtly participating in healthism and supporting the very paradigm that we are seeking to change” (12). In the same vein, by focusing on the physiological aspects of health (eating and movement) we run the risk of reiterating the “lifestylization” of our everyday activities, so that riding your bike to work is about being healthy rather than about using a lower-cost, environmentally responsible way of getting around. Ferguson (2012) argues that by not talking about what we mean when we say “health at every size,” we risk reiterating healthism in two ways. First, the imperative to be fit if you are fat engenders what she says is commonly called “the perfect fattie syndrome.” That is, the existence of fat people, and of HAES itself, is legitimized if fat people can also prove themselves to be fit by participating in a regime of bodymanagement practices (i.e., eating right and exercising) and falling

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within the normal ranges of various measures of metabolic fitness (i.e., blood pressure, fasting blood glucose). This, she says, pits fat people who are fit against those who are not, but who are also under no obligation to be, or to want to be. What is also problematic about the fit-­ and-fat imperative is that it detracts from the possibility of HAES developing a basis predicated on human rights and, by reproducing the stigma currently associated with individuals’ perceived health habits, it does nothing to enhance social justice. Rather, this view reiterates health as a depoliticized, normative supervalue. Our challenge, then, is to reconstitute HAES not as a fixed identity, but as fluid, changing, and historic, and adaptable so that it can change in another direction. This task is not simple given the power of the dominant weight discourse and what is, for us, the emerging dominant health-centred discourse. However, to politicize HAES through queering it, we attempt to defamiliarize ourselves with the anti-obesity messages to see that they are not homogeneous and that they come from different places with different political motivations. Cooper offers another response in her description of “micro-­moments of activism” when she articulates how individuals can act locally to divest themselves of dominant paradigms and not reconstitute those paradigms through the politics of postponement.3 Acting locally in small but significant ways works to dissociate the HAES movement from the larger, more dominant structures that exist around weight, especially in health care practice. In other words, it is important that we acknowledge what Gibson-Graham might call non-capitalist forms that are already functioning. Cooper (qtd. in Smith 2012) describes those moments of resistance in relation to fat activism: In my research I’ve found that most fat activism isn’t of the being in the streets and waving placards variety, although that does happen, and many people in fat activism are invested in speaking upwards to power through legislative and policy change, for example. Instead, most fat activism takes place in micro moments: in conversations; in choosing some things (wearing clothes that do not hide one’s body, eating in public, putting up pictures of excellent fat people on your wall, reaching out to other fat people) and refusing others (dieting, speaking badly of one’s or other’s bodies, etc.), and so on. I love the everyday accessibility of these forms of resistance, they can be very small and unheroic and also amazingly transformative. (19)

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Cooper’s critique of fat activism’s tendency to “speak upwards” underscores how the fat acceptance movement unknowingly perpetuates the politics of postponement when it holds the weight-centred paradigm at the centre of fat activism’s efforts and does nothing to destabilize the power of that view. Rather, “speaking up” reinforces the position of the dominant weight-centred paradigm, and precludes the possibility of change. Conclusion Our primary intention here is to invigorate collegial dialogue regarding the relationship of health to HAES. This dialogue should include the voices of the HAES community, but also critical fat scholars and activists. We are not suggesting that weight should be the primary predictor of health. We have moved on from that old argument to initiate a new, and what we believe is a necessary, debate regarding how health is practised and condoned as the central tenet in HAES. Applying the politics of postponement necessitates a vigorous rethinking of our tenacious hold on health and healthism as a means for practising HAES. We draw from queer theory to destabilize that hold, since to queer HAES is, in our view, to keep it alive: complex and in complete disarray. Anything less is a trap we don’t wish to fall into as unwitting victims or even perpetrators. We demand of ourselves a theoretical rebellion in how HAES is constituted, and with our demands we maintain an emboldened desire to continually strive to strengthen the work that has preceded us. What does our discussion mean to how HAES is thought and practised? First, we wish to challenge ASDAH to remove the trademark that they currently hold on HAES. We also invite the HAES community to collectively replace the legal codification of HAES with an explicit commitment to politicize health and bodies. It is by politicizing HAES that we believe the HAES community might be able to unearth and contend with the healthism that underlies its central precepts. Moreover, by politicizing HAES we can begin to build a body politics that attends not only to size, but also to the marginalizing discourses that racialize, class, (dis)able, and otherwise oppress bodies of all shapes and sizes. Third, we hope the HAES community takes seriously the potential of the micro-moments of resistance to overcome the politics of post­ ponement that has helped to maintain the predominance of the weight-­ centred paradigm. Finally, we see the kind of self-reflexive and collegial

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dialogue that we hope to spark here as central to the continued ethical practice of HAES. We see these conversations as essential to fostering a culture of collective reflexivity within the HAES community, which is vital to our continuing the celebration of unruly experiences (i.e., of marginalized fat bodies) from which HAES originally emerged. NOTES 1 By obesity we mean a medicalized view of body weight that does not represent our understanding of fatness. The quote marks are used deliberately to denote this (see Paradis, this volume, for a full account of the medicalization of fatness). 2 Audre Lorde wrote about this now famous concept of the master’s tools in a speech delivered at New York University in 1979 that later became the essay “The Master’s Tools Will Never Dismantle the Master’s House,” which was published in a collection of Lorde’s work titled Sister Outsider. Although the exact meaning of the concept has been debated, it is widely taken to mean that oppression cannot be ended through means that are a part of upholding inequitable distribution of power. For example, gender oppression will only be perpetuated if patriarchal means (i.e., androcentric, Eurocentric research methods) are used in the resistance efforts. 3 Personal communication, 26 June 2012.

WORKS CITED Aphramor, Lucy. 2010. “Validity of Claims Made in Weight Management Research: A Narrative Review of Dietetic Articles.” Nutrition Journal 9 (30): 1–9. – 2005. “Is a Weight-Centred Health Framework Salutogenic? Some Thoughts on Unhinging Certain Dietary Ideologies.” Social Theory & Health 3: 315–40. Aphramor, Lucy, and Jacqui Gingras. 2008. “Sustaining Imbalance: Evidence of Neglect in the Pursuit of Nutritional Health.” In Critical Bodies: Representations, Practices and Identities of Weight and Body Management, ed. S. Riley, M. Burns, H. Frith, S. Wiggins, and P. Markula, 155–74. London: Palgrave. – 2009. “That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice.” In Fat Studies Reader, ed. E.D. Rothblum and S. Solovay, 97–105. New York: New York University Press.

416  Jennifer Brady and Jacqui Gingras – 2011a. “Helping People Change: Promoting Politicised Practice in the Healthcare Professions.” In Debating Obesity: Critical Perspectives, ed. E. Rich, L. Monaghan, and L. Aphramor, 192–218. London: Palgrave. – 2011b. “Reproducing Inequalities: Theories and Ethics in Dietetics.” In Fatness and the Maternal Body: Women’s Experiences of Corporeality and the Shaping of Social Policy, ed. M. Unnithan-Kumar and S. Tremayne, 205–23. Oxford: Berghahn. Association for Size Diversity and Health (ASDAH). 2013. “ASDAH Guidelines for HEALTH AT EVERY SIZE® AND HAES® Usage.” https:// www.sizediversityandhealth.org/content.asp?id=159. Atkins, J., and J.L. Brady. (forthcoming). “Queer Theory and Dietetics Education: Interrupting Heteronormativity.” Journal of Critical Dietetics. Bacon, Linda. 2010. Health at Every Size: The Surprising Truth about Your Weight. Dallas: BenBella. Bacon, Linda, and Lucy Aphramor. 2011. “Weight Science: Evaluating the Evidence for a Paradigm Shift.” Nutrition Journal 10 (9): 1–13. Bacon, L., N.L. Keim, M.D. Van Loan, M. Derricote, B. Gale, A. Kazaks, and J.S. Stern. 2002. “Evaluating a ‘Non-diet’ Wellness Intervention for Improvement of Metabolic Fitness, Psychological Well-Being and Eating and Activity Behaviors.” International Journal of Obesity 26 (6): 854–65. Brady, J., J. Gingras, and L. Aphramor. 2013. “Theorizing Health at Every Size as a Relational-Cultural Endeavour.” Critical Public Health 23 (3): 1–12. http://dx.doi.org/10.1080/09581596.2013.797565. Britzman, D.P. 1995. “Is There a Queer Pedagogy? Or, Stop Reading Straight.” Educational Theory 45 (2): 151–65. http://dx.doi.org/10.1111/j.1741-5446 .1995.00151.x. Burgard, D. 2009. “What Is Health at Every Size?” In The Fat Studies Reader, ed. E. Rothblum and S. Solovay, 41–53. New York: New York University Press. Campos, P., A. Saguy, P. Ernsberger, E. Oliver, and G. Gaesser. 2006. “The Epidemiology of Overweight and Obesity: Public Health Crisis or Moral Panic?” International Journal of Epidemiology 35 (1): 55–60. http://dx.doi. org/10.1093/ije/dyi254. Cooper, Charlotte. 2011. “Queering Fat Activism: Burger Queen.” 9 April. Obesity Timebomb (blog). http://obesitytimebomb.blogspot.ca/2011/04/ queering-fat-activism-burger-queen.html. Cooper, Charlotte. n.d. “A Queer and Fat Activist Timeline.” http://www. charlottecooper.net/downloads/timelinezine/cooper_queertransfat activisttimeline_zine_0411.pdf. Accessed 9 May 2013. Crawford, R. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services 10 (3): 365–88. http://dx.doi.org/ 10.2190/3H2H-3XJN-3KAY-G9NY.

Queering Health at Every Size  417 – 2006. “Health as a Meaningful Social Practice.” Health 10 (4): 401–20. Ferguson, Fall. 2012. “The HAES File: What Do We Mean by Health?” Health at Every Size (blog). http://healthateverysizeblog.org/category/fallferguson/page/10/. Accessed 13 March 2013. Gard, Michael. 2013. “Disagreement, Not Misrecognition: A Reply to Monaghan.” Social Theory & Health 11 (1): 106–15. http://dx.doi.org/10.1057/ sth.2012.20. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. London: Routledge. Gibson-Graham, J.K. 2006. The End of Capitalism as We Know It: A Feminist Critique of Political Economy. Minneapolis: University of Minnesota Press. Gingras, Jacqui. 2006. “Throwing Their Weight Around: Canadians Take on Health at Every Size.” Health at Every Size Journal 19 (4): 195–206. – 2009. Longing for Recognition: The Joys, Complexities, and Contradictions of Practicing Dietetics. York, UK: Raw Nerve Press. Gingras, Jacqui, and Lucy Aphramor. 2010. “Empowerment, Compliance, and the Ethical Subject in Dietetic Work.” In Configuring Health Consumers: Health Work and the Imperative of Personal Responsibility, ed. Roma Harris, Nadine Wathen, and Sally Wyatt, 82–93. New York: Palgrave Macmillan. Gingras, J.R., and J.L. Brady. 2010. “Relational Consequences of Dietitians’ Feeding Bodily Difference.” Radical Psychology 8 (1). http://www. radicalpsychology.org/vol8-1/gingras.html. Gingras, J., and C. Cooper. 2013. “Down the Rabbit Hole: A Critique of the ® in HAES®.” Journal of Critical Dietetics 1 (3): 2–5. Grace, A.P., R.J. Hill, C.W. Johnson, and J.B. Lewis. 2004. “In Other Words: Queer Voices/Dissident Subjectivities Impelling Social Change.” International Journal of Qualitative Studies in Education: QSE 17 (3): 301–24. http://dx.doi.org/10.1080/0951839042000204670. Lovaas, Karen E., Lina Baroudi, and S.M. Collins. 2002. “Transcending Heteronormativity in the Classroom: Using Queer and Critical Pedagogies to Alleviate Trans-Anxieties.” Journal of Lesbian Studies 6 (3–4): 177–89. http://dx.doi.org/10.1300/J155v06n03_15. Mann, T.A., J. Tomiyama, E. Westling, A. Lew, B. Samuels, and J. Chatman. 2007. “Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer.” American Psychologist 62 (3): 220–33. http://dx.doi.org/ 10.1037/0003-066X.62.3.220. Probyn, E. 1999. “An Ethos with a Bite: Queer Appetites from Sex to Food.” Sexualities 2 (4): 421–31. http://dx.doi.org/10.1177/136346099002004003. Reel, J.J, and A.R. Stuart. 2012. “Is the ‘Health at Every Size’ Approach Useful for Addressing Obesity?” Journal of Community Medicine & Health Education 2 (4): e105. http://dx.doi.org/10.4172/jcmhe.1000e105.

418  Jennifer Brady and Jacqui Gingras Saguy, A.C., and K.W. Riley. 2005. “Weighting Both Sides: Morality, Mortality, and Framing Contests over Obesity.” Journal of Health Politics, Policy and Law 30 (5): 869–923. http://dx.doi.org/10.1215/03616878-30-5-869. Smith, C. 2012. “Under the Radar: Fat Activism and the London 2012 Olympics: An Interview with Charlotte Cooper.” 15 May. Games Monitor: Debunking Olympic Myths. http://www.gamesmonitor.org.uk/node/1647. Welsh, Talia. 2011. “Healthism and the Bodies of Women: Pleasure and Discipline in the War against Obesity.” Journal of Feminist Scholarship 1 (Fall): 11. http://www.jfsonline.org/issue1/pdfs/welsh.pdf.

16 Revisioning Fat: From Enforcing Norms to Exploring Possibilities Unique to Different Bodies Ca rla R i c e

I would like to begin this chapter by situating myself. My work comes from my lived experience of fatness. Having moved in my adolescent and adult life both inside and outside the “fat” category, I have intimate knowledge of fat oppression and how it is gendered symbolically and systemically. I also know first-hand about the micro and institutional aggressions experienced by many fat people, especially women. On the flip side, I have experiential knowledge of body privilege, and how the world responds to a “passing-as-normal” woman. The flourishing euphemisms (from ample to zaftig) and fluidity of the category aside, there is something fixed about my memories. My fatness haunts me – an abject that cannot be cast away. Julia Kristeva, a French feminist philosopher, calls the abject the “twisted braid” (1982, 3) of fear and fascination that people feel when we encounter bodily fluids, features, or functions that remind us of the unknowability and uncontainability of our bodies, our vulnerability to disease, and the certainty of our death. For scholar Deborah Covino (2000), abjection is a rich term because it captures undesirable dimensions of embodiment that people want to push away (pain, disease) as well as the scapegoating of groups (fat people, those with illness or disabilities) associated with those experiences. In addition to being a former fat girl, my work grows out of twentyfive years’ experience of advocacy and activism, in and around systems such as schools, hospitals, governments, and industries that send moralizing instructional messages about bodies, eating, and weight to diverse individuals. I have witnessed two successive waves of feminist activism targeting hegemonic body norms and ideals, and an eatingdisorder epidemic; it distresses me that despite these, bodies have become ever-more-important markers of status and value in a context

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where people rationalize and reproduce inequalities under the guise of aesthetics, personal taste, desirability, self-care, health, and choice. I recite this history to show how I have come to care about these issues and debates theoretically, professionally, and personally, and why I feel deeply invested in finding a pathway through them in ways that respect and honour people’s embodied diversity and emotional and social well-being. In this chapter I develop a feminist “body-becoming” theory of fat that interweaves constructivist and new materialist theories with embodied and aesthetic perspectives in order to imagine other possibilities for what fat bodies can be and become. My unique take on issues related to fat embodiment introduces a rich corpus of feminist body theory, including “body-becoming” and new materialist theories as correctives to previous approaches; proposes a new critical theory of bodily becoming that challenges conventional theories of how people come to be fat; calls into question biopedagogicial interventions into “the obesity problem” by centring women’s narratives of fat embodiment, which have something to teach us about rethinking ethical responses to fat; and, finally, engages with feminist art practice and theories of aesthetics to consider how bodies might become differently if they were imagined differently. I begin by sketching mainstream mechanistic models of obesity and the history of feminist body theory before proposing an alternative body-becoming theory of fat. Drawing from my earlier study examining the narratives of twenty-five adult women who recount becoming the “fat girl” in a Canadian context (Rice 2007, 2009, 2014), I then outline how big kids become fat kids in social, relational, and physical spaces, which I argue are productive of “overweight.” Thinking beyond conventional biopedagogical interventions that conflate moral with medical values in teaching what bodies should be, I theorize a body-becoming ethics and pedagogy that moves away from enforcing norms towards more creative ways of envisioning possibilities for what fat could become. In our bean-counting and boundary-setting world, this kind of imagining is not considered within the purview of the social scientist; it is considered the work of the artist. This is why I turn in the final section of my paper to the arts and to aesthetic theory for insight and inspiration in this project. From Mechanistic Models to the New Materialism In North American societies, two competing ideas shape current dialogues on obesity and overweight. The first claims that obesity is an

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epidemic, while the second holds that it’s a myth (Campos 2004; Gard and Wright 2005). Although both frames have a diverse mosaic of members who espouse a range of both socially progressive and conservative arguments (Gard 2011), it is also true that the first frame – the epidemic of obesity – dominates public discourse. Over the past twenty years, experts have fuelled fear of fat by interpreting obesity as an escalating epidemic that threatens the health, fitness, and security of nations (Ontario 2004; World Health Organization 2000, n.d.). Attentiongrabbing hyperbole abounds: obesity is said to pose a greater threat to health than “influenza or the plague,” according to one former director of the Centers for Disease Control.1 Beyond health concerns, serious political and environmental problems are blamed on fat – from global warming (Jacobson and McLay 2006) to state vulnerability to terrorist attack.2 Despite such dire predictions, there is significant debate in obesity science about causes, effects, measures, and treatment of obesity (Jutel 2006, 2009). My purpose here is not to enter the debates but to approach them from the embodied perspectives of those perceived as fat and to look at fat embodiment through a critical lens that raises questions about our mechanistic models of weight. In the past forty years, feminist scholarship has provided alternative conceptions of bodies that challenge conventional medical accounts. During the second wave of anglo western feminism, theorists developed a political understanding of idealized femininity and beauty, which they saw as limiting possibilities for women’s lives and as contributing to sexual inequality (Brownmiller 1984; Greer 1972; for an expanded discussion of feminist body theory, see Rice 2014). Clinicians’ and activists’ concerns mounted throughout the 1980s, when the rise of eating problems led many to focus attention on the profound psychosocial consequences of sexist body standards for girls and young women (Orbach 1979; Schoenfielder, Wieser, and Mayer 1983; Székely 1988). Representation has since been a major concern of feminists, in terms of understanding both the origins and functions of cultural messaging (Bordo 1993; Frost 2001) and how such imagery influences individuals’ bodies and selves (Coleman 2008, 2009; Weiss 1999). When social constructionist theories began to circulate in the 1990s, theorists moved away from probing the constraints placed on female bodies in patriarchy towards exploring how bodily selves are shaped through social discourses (Butler 1990). Within social constructionism, the connection between cultural images and actual bodies varies: either the flesh of bodies is seen as shaped by the social contexts in which these bodies are situated, as many theorists understand it (Bordo 1993; Ussher 1989), or,

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as others argue, bodies are not directly accessible to us without being mediated by culture and language (Butler 1990; Oudshoorn 1994). The first group posits that cultural messaging orients people to modify their bodies by manipulating their desires in socially preferred ways (e.g., to desire thinness). For the second, cultural bias is impossible to eradicate since scientists must translate their observations into words and pictures in order to make meaning. Belief systems inevitably seep in via researchers’ choice of language and metaphor (such as calling obesity an epidemic). According to historian Londa Schiebinger, social constructionist theories of bodies have been critically important to feminism because they seek to “break the stranglehold of arguments from nature” (2000, 2) by showing how the meanings given to sex, race, disability, size, and other differences are socially and historically variable. From the late 1990s onward, social constructionism has been challenged by two theories about bodies and embodiment. These are “bodybecoming theory” (Battersby 1998), an offshoot of feminist philosophy of the body (Coleman 2009; Weiss 1999), and the new materialism, which arose in part from feminist studies of science (Birke 2000; Hird 2003, 2004). Unlike social constructionism, which analyses how bodies are talked about, these theories attend to lived experience and to the biology of bodies. Theorists do not see bodies as bounded, stable entities but as fluid forms that come to be through relations with natural and cultural forces that surround them. Body-becoming philosopher Elizabeth Grosz (1994), for example, uses the Möbius strip to convey how body, mind, and culture can be thought of as continuous. According to Grosz, the body, like the Möbius strip, has no clear distinction between inside and outside – instead, these fold into each other. Through this “infolding,” everything that happens to people – accidents, insults, or pleasures – becomes an ingredient in the history and development of their bodies (1999, 2008). Building on her work, new materialist biologist Anne Fausto-Sterling (2000) uses Russian nesting dolls as a way of visualizing the various layers that make up human beings – from the cellular to the social – to convey the inseparability of biology from culture. Like feminist body-becoming philosophy, the new materialism conceptualizes the physical body as a source of knowledge in itself and understands matter to have agency independent of people’s perceptions or manipulations of it (Barad 2003). This means that all matter – from rocks and birds to blood and fingernails – has agency through the energy it possesses at an atomic level and through the ways it affects,

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and is affected by, the matter that surrounds it. Theorists see the becoming of bodies as a relatively open process, which cannot be predicted or determined in advance, and seek to explain how nature and culture affect and transform each other to jointly construct our world (Alaimo and Hekman 2008; Coole and Frost 2010). Body-becoming and new materialist theories converge in theorizing bodies as emergent systems that materialize as a result of their own agency and other forces acting upon them. Since cultural contexts, physical and social environments, and personal habits shape each person’s physical being, no one can predict with one hundred per cent certainty what any body will become. Thus within these frames, bodies do not come to be before their interactions but emerge through interacting. These theoretical shifts are important to revisioning fatness because they recognize the roles of physicality, process, unpredictability, and creativity in understanding the human body and embodiment. By stressing the body’s open-ended becoming, they enable us to see how biology might influence but not determine what bodies can be. The concept of the body’s open-ended becoming, whether from the philosophy of Grosz or the new materialism of Fausto-Sterling, speaks back to older, more deterministic ways of understanding the body. (Determinist models posit that bodily attributes are mediated either by biological factors, such as behaviour and genetic makeup, or by social ones, such as institutions and built environments.) In contrast to the predictive and mechanistic models of obesity science, a body-becoming approach to fat would posit that neither genetics nor health habits nor social structures alone determine weight; instead, the relation between weight and health would vary depending on how people’s bodily selves are perceived and treated in the world. When size and its properties and capacities (fitness, health, ability) are understood as being produced by multiple interacting elements, the idea that fat is necessarily unhealthy and unfit or caused by bad genes or bad habits can be disputed. Drawing on feminist insights into how bodies come to be, I see size as an emergent attribute materializing at the intersection of biology, psychology, and context. Like gender, ability, and other categories of difference, size emerges through the interplay of broader contexts with peoples’ psyches and the biological agency of their bodies. Bringing a body-becoming reading to women’s stories shows how the unfit fat body is made from interactions of large bodies, cultural messages, social practices, and physical environments that shape “bodies of size.”

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By helping us to see how dominant ways of knowing bodies influence what they can be, this reading enables us to consider how changing our conceptualizations could transform what bodies become. From Bio- to Body-Becoming Pedagogies Over the past ten years, social science research has become increasingly critical of the effects of obesity epidemic discourses on diverse groups, especially children perceived as fat (Ferrari 2012; Larkin and Rice 2005). For example, studies in social psychology have shown that anti-fat attitudes have powerful impacts on fat children, ranging from higher depression and suicidal attempts (Eisenberg, Neumark-Sztainer, and Story 2003) to lower self-esteem and physical competence (NeumarkSztainer et al. 2002; see also Ward, this volume). Health researchers also have critiqued the conventional idea that obesity is a behavioural disease caused by overeating and physical inactivity. Such a framing is problematic because it contributes to size stigma and shifts attention away from other health problems assumed to be caused by fat (e.g., blaming heart disease and type 2 diabetes on overweight rather than looking at multiple causes of these conditions such as stress, hidden sugars in processed foods, etc.) (Brownell and Horgen 2004; Cogan and Ernsberger 1999; see also McNaughton and Smith, this volume). Soci­ ologists Michael Gard and Jan Wright (2005) have argued that the obesity epidemic is a moral panic because misplaced morality and ideological assumptions underlie our “war on fat.” Gard (2011) has since published a follow-up text in which he posits that levelling obesity rates and rising life expectancy in many Western nations combined with mounting resistance to some experts’ alarmism have marked the beginning of “the end of the obesity epidemic.” Taking another theoretical track, critical researchers such as MacNeill and Rail (2010), Rich (2010, 2011; Evans and Rich 2011), and Wright (2009) have theorized obesity-prevention efforts in schools, clinics, and families as examples of “biopedagogies” or “body pedagogies.” These they define as the loose collection of information, advice, and instruction about bodies and health, often moralizing or lecturing in tone, that works to control people by using praise and shame alongside “expert knowledge” to urge their conformity to weight norms. However, the ways in which anti-obesity messaging and biopedagogies might affect people’s eating and exercise remain largely unexplored. Also unexamined are the complex bioethical issues surrounding biopedagogies. Certainly few

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researchers or policy makers take people’s embodied experience of fatness into account in their theorizing and policy making. In response to these conundrums, I draw on the narratives of twentyfive adult Canadian women who recount becoming the “fat girl” to propose a feminist body-becoming theory of fat and to consider how body-becoming frameworks might invite more expansive approaches to “obesity” or “overweight.” The women I interviewed (aged between twenty and forty-five) grew up prior to the moral panic of the obesity epidemic in Canada. Yet their experiences are relevant to current debates about childhood obesity prevention since they confronted earlier state-sponsored biopedagogical campaigns calling for more physical activity to prevent fatness and promote fitness in citizens, especially in children. (For a more in-depth account of this study, including parameters, participant demographics, methods, discussion, and analyses, see Rice 2007, 2014). Although it is commonly claimed that too much food and not enough exercise cause overweight and obesity in children, for those with whom I spoke the opposite was more often true: pervasive weight stereotyping and enforced dieting at home and school led them to avoid physical activity and engage in problem eating, which contributed to their life-long difficulties with food and weight. In light of dire warnings about the obesity epidemic in children, my analysis here focuses on the implications of their accounts for feminist-informed health-promotion/health equity policy and practice. I am interested in thinking about a body-becoming ethics and pedagogy that opens up more embodied ways of approaching the relationship of fatness to fitness and health, by moving away from biopedagogical practices of enforcing norms and towards more creative ways of exploring the abilities and possibilities unique to different bodies.

Biopedagogies: Producing Unfitness and Problem Eating Recent history shows that obesity-epidemic messages have emerged as dominant partly because they dovetailed with earlier state-sponsored body pedagogies designed to improve the health, fitness, and competitiveness of populations. From the late 1960s onwards, many anglo Western governments, including the Canadian government, initiated campaigns advocating greater physical activity to prevent fatness and promote fitness in citizens. One popular public service announcement (PSA) that ran throughout Canadian media in the early 1970s famously and unfavourably compared the fitness levels of a thirty-year-old

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Canadian man with those of a sixty-year-old Swede. (In fact, the comparison was the fictitious creation of an advertising agency).3 This ad was part of a sweeping fitness campaign called ParticipACTION that operated from 1971 until its demise in 2001 (and subsequent resuscitation in 2007 to stem rising obesity rates).4 The representation of the ideal citizen as a fit white man can be interpreted as part of Canada’s nationbuilding enterprise to increase its economic strength and competitiveness on a global stage. Other ParticipACTION ads such as “True North Strong Soft and Free” and “Canada Is An Underdeveloped Country” associated fatness with femininity and unfitness with the Third World other. Signifying the future health and prosperity of nations, children were targeted as a group needing special attention. In the midst of the current obesity crisis, many research organizations in Canada have carried on framing fat as a disease that threatens the health and strength of the nation. This includes the Canadian Obesity Network, which focuses on developing partnerships between academic researchers and private-sector commercial interests and promoting an understanding of health that excludes bodies that are not young, muscular, white, and male (with its now defunct logo featuring the hyper-muscular upper arm and torso of a young, white male weightlifter). In a neoliberal climate that emphasizes taking personal over collective responsibility, public health efforts such as the “Stop Playing Games with Childhood Obesity” campaign launched by the City of Hamilton put the onus on children and families to stop childhood obesity.5 If we follow this neoliberal logic, then the re-launch of ParticipACTION as an explicitly anti-obesity campaign targeting children begins to make sense. In contrast to the messages these campaigns convey (that fatness is caused by overeating and inactivity), women in my research recounted  how they were rendered as “unfit” through the ongoing dialogue of  their social relations (rather than by their bodies or behaviours). This included the symbolic systems, social structures, and face-to-face exchanges that taught them that their big bodies transgressed the culturally normal – feminine, fit, and flawless – body. Memorable biopedagogical messages for many came from state-sponsored public service announcements. For example, in one ParticipACTION PSA entitled “FitFat” that ran throughout major Canadian media in the late 1970s, a lazy and chubby cartoon character represented using the letter a was contrasted with an able, slimmed-down figure symbolized by the letter

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i. This ad, by positioning fat as opposite to fit, conveyed that fatness and fitness could not coincide in the same body.6 While the women in this study could only vaguely recall the content of such public health messages, some recalled their consequences, which included instilling a sense that their bodies were in some way bad or wrong. Many participants told how body standards and stereotypes were communicated everywhere at school, through furniture and uniforms, seating arrangements, and most of all in gym classes. A majority of those interviewed enjoyed physical education. However, many described how continually being framed as unfit fat girls, rather than according to their potential or actual capacities, undermined their physical abilities. When teachers and students rooted assessments of their abilities in stereotypical notions concerning their size – if you’re fat you must be unfit – almost every girl stopped engaging in physical activity. As other researchers have noted, the internalization of emotion, especially shame and disgust, is a key means by which children learn to follow biopedagogical instruction (Evans et al. 2008). It’s not incidental that those interviewed were shamed for embodying the wrong weight. It was instead a form of “emotional bullying,” in which teachers’ and popular peers’ greater authority to abuse big girls was legitimized by the stateendorsed curriculum that “moralized and normalized” how their bodies should appear (Evans et al. 2008, 396). The women’s narratives reveal how anti-fat biopedagogies alienated them from their abilities and from participating in physical activities. Charting body pedagogies’ effects on this generation may be critically important for assessing the implications of obesity-epidemic “solutions” for fat kids today. For many participants, doctors, mothers, and other adults also encouraged and enforced dieting routines, which frequently resulted in life-long struggles with food and eating. Adults sometimes characterized their concern about girls’ bodies as being related to health, but most were more worried about appearance because thinness was (and is) a necessary condition of femininity (McKinley 1999) and increasingly of good character and citizenship (Halse 2009). Since mothers are the adults who are most often held responsible for children’s eating problems, children’s eating habits can become part of a larger motherblaming discourse without critical analyses of the broader context in which mothers are positioned as primary caretakers and given contradictory advice about feeding their children (see Mitchinson, this volume). Some women in my study developed compulsive, binge, and

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secretive eating in childhood as a direct response to adult interventions. Others took up dieting, anorexic, and bulimic practices in adolescence when they faced increased pressure to appear feminine and desirable. For many, the process of becoming identified as fat, which negatively affected their embodiment and eating, began before adolescence, even though puberty is the period that many psychologists and theorists argue is fraught with dangers to girls’ bodies and psyches. But whether they started secretive eating in childhood or later adopted dieting and disordered eating, it is noteworthy that all participants perceived as fat eventually took up problem eating practices in response to biopedagogies (Rice 2009, 2014). According to participants, being a big girl was not the same as being a fat girl. Women’s bigness became fatness within environments that produced their unfitness and led to exercise and eating habits typically associated with fat. Fat became a problem because it emerged out of a disordered relationship between big girls and social relations that refused to see female fitness and health as embodied by anything but a thin, able form (Rice 2007). This does not mean that self-identified fat participants were aware, as children, that becoming a fat girl was a social experience. Instead, those interpolated as fat often looked back with anger and regret on their childhood experiences and felt, in retrospect, that they weren’t really fat or as fat as they remembered when they were first labelled as such.

Embodied Bioethics and Body-Becoming Pedagogies According to participants, biopedagogies contributed to their problem eating and inactivity. Ironically, others’ instructions and injunctions that framed fat as unfit helped to produce the very behaviours and bodies they were attempting to prevent. With a renewed focus on fatness prevention through fitness promotion, efforts to stem today’s obesity epidemic likewise may be leading a new cohort of large kids to adopt problem eating and exercise, possibly contributing to their struggles with weight. Women’s stories suggest that health policy might more successfully serve kids by shifting its focus from changing bodies to altering aspects of social worlds that impede their options for eating and activity. As a response to participants’ dilemmas as well as those of large kids today, a few years ago equity educator Vanessa Russell and I (2002) proposed a “body equity” approach to health policy in schools that advocated acceptance of diverse bodies, greater

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options for enjoyable activities, and better access to good food choices. Our primary objective was to stop size stigma that contributes to problem eating and inactivity. I continue to believe that an equity approach that incorporates weightism into anti-bullying campaigns is a good start. But I now think our strategy is limited because it does little to challenge our binary thinking about weight, such as our default association of thinness with fitness and attractiveness or of fatness with unfitness and ill health. Poststructuralism teaches us that when we create binaries of norms and differences where one term is privileged over the other – thin/fat, fit/unfit, healthy/unhealthy – we invite “better than” and “lesser than” judgments that inevitably cause harm. Although experts espousing dominant obesity epidemic discourses increasingly shift blame for fat from the individual to the social body (by looking at obesity as an outcome of multiple factors, including “obesogenic” environments [Brownell and Horgen 2004; Raine 2004] and by taking a stand against size stigma), their disease-prevention messages do little to disrupt the cultural devaluation of fat. Instead, fatness remains a powerful signifier of body otherness by conflating size with health. For instance, at the Canadian Obesity Network’s recent summit on weight bias, experts declared that “society must fight obesity, not obese people.”7 While this message commendably attempts to destigmatize the obese, it imposes a certain negative reality on fat bodies by once again fixing them as unhealthy and unfit (see also McNaughton and Smith, this volume). Obesity-prevention biopedagogies with their moralizing undertones create a dichotomy of either/or (you’re either fat and unfit or thin and fit), which precludes the possibility of exploring or learning about the in-between and otherwise. Rather than advising people to adopt imposed norms, how do we create the conditions that will enable them to imagine other possibilities for their bodies? How might we make space for more ethical responses to  size differences? A health promotion/health equity approach informed  by feminist, poststructuralist, and new materialist bioethics would move away from cultural practices of enforcing norms towards more creative endeavours of exploring physical abilities and possibilities unique to different bodies. Poststructuralist philosopher and bioethicist Margrit Shildrick (1997, 2005) argues that the health professions in westernized societies use a mix of consequential ethics (weighing the benefits and harms of various interventions) and deontological ethics (following professional codes) to guide health decision making. While

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she acknowledges that there is a place for conventional ethics to safeguard against medical abuse, she finds that conventional approaches position providers as active decision makers and patients or target populations as passive recipients, so they legitimize power imbalances and deny individuals and communities moral agency in health care. More­ over, because conventional ethics privilege reason over emotion and mind over body, conventional codes cast doubt on the moral agency of certain groups, like women, racialized people, and people with disabilities, who are historically viewed as less rational and more embodied. Emerging as a counterpoint to conventional bioethics, a feminist bioethics eschews universal frameworks in health policy and practice that ­ignore power imbalances and social differences, and investigates social inequalities and the particulars of people’s situations that shape health (Rogers 2006; Scully, Baldwin-Ragaven, and Fitzpatrick 2010). The feminist poststructuralist bioethics advocated by Shildrick (2005) further ­argues for a situated, embodied mode of ethics that values people’s experiential knowledge and recognizes the impossibility of universality and objectivity in health interventions, whether between professionals and patients or policy makers and the public. Shildrick (1997, 2005) uses the term embodied ethics to convey how the health provider’s body and mind are entwined in health care decision making, to capture how we can’t transcend our bodies to make decisions from some detached, objective place. An embodied bioethics further communicates the intermingling of embodied selves in human interactions, capturing the idea that we are interdependent rather than contained, separate selves who affect, influence, and shape each other. Finally, it serves to remind people that the ideal of the healthy, able, in-control body is a temporary state and that the abject will always return whether in aging, disability, disease, fatness, or other “transgressions” of norms. Building on Shildrick’s embodied ethics that acknowledges individuals’ agency, a body-becoming approach to bioethics would further understand all matter to have agency, distinct from subjects’ perceptions or manipulations of it. The body-becoming approach thus challenges the concept of “healthism,” which preaches conformity to narrowly defined notions of the healthy body. (For a critical discussion of healthism, see the introduction and Brady and Gingras in this volume.) Yet unlike biomedical frameworks that predict and prescribe what bodies will and should be, body-becoming theorists ask how physical, psychical, environmental, and cultural forces might expand or limit possibilities for what bodies could become. How a body-becoming pedagogy might

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guide our responses to size differences is an open question, but at the very least it would invite us to think in dynamic, interactional, and systemic ways about weight and the effects of meanings we give to fat. It would also ask us to question mechanistic models and moralistic biopedagogies, to let go of normative notions about able bodies, and consider how our ways of knowing bodies might influence what they can be. It would ask us to consider critically how much physical agency we lose by imposing expectations on bodies and how much creativity and beauty we miss in attempting to regulate bodily diversity. Finally, it would posit that we have to perceive differently if we want bodies to become differently. Revisioning Fat Abilities and Aesthetics On the margins, in countercultures, and in arts communities one can find clues about how to think differently. People like British disabled dancer Dave Toole and the San Francisco–based performance troupe called Sins Invalid use art to reimagine imperfect bodies as aesthetically interesting, exciting, and vital. Sins Invalid, for example, develops cutting-edge performances that challenge medical and cultural paradigms of able, normal, and sexy, “offering instead a vision of beauty and sexuality inclusive of all individuals and communities.”8 Within disability arts organizations and movements, disability is often defined broadly to include people with physical and sensory impairments, cognitive and emotional challenges, and chronic/severe illness, and draws close connections with all those (including fat and trans people) whose bodies do not conform to cultural and medical notions of normal (Hall 2011). Like nuanced imagery of people who embody disability, images of active, aesthetically engaging women who are fat remain on the fringes. From fat-activist Elana Dykewomon’s “naked lady pool parties” (which she proposes to deal with fear of bodily and other differences [2002, 457]) to Julie Wyman’s experimental film Bouyant (2004), which explores the unique properties of fat, many artists and activists who have attempted to resignify fat have often done so by portraying fat women as active and able in water. Examples of attempts to revision fat as agile and strong are found in the film Weightless (2011), about a group of fat women divers, and performances of the fat synchronized-swimming troupe The Padded Lilies. I am also reminded of Percy Adlon’s path-breaking film Zuckerbaby (1985) starring well-known German actress Marianne Sägebrecht, in which

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the fat, depressed protagonist finds sanctuary, hope, and strength in the healing waters of her local swimming pool. While one could argue that these images and narratives re-essentialize old stereotypic associations of fat with fluidity, nature, and femininity (and I think they often do), they can also be read as attempts to valorize the unique properties of fat flesh – its fluidity, buoyancy, and weightlessness in water – and thus to revision fatness as potentially capable and mobile in its own ways and on its own terms. Importantly, each of these interventions into the representational field is distinctly material and experiential in its approach. Compared to activisms that focus on persuading people to think or act differently (see Ellison in this volume), these focus on embodying and materializing change among individuals and groups to challenge social scripts about body, ability, and normality. The vibrant disability arts movement that has developed in recent years as a new genre in Europe and North America gives expression to disability experience and challenges imposed invisibility by reimagining bodily difference. Although (as yet) no parallel self-proclaimed fat arts movement has emerged to revision fat bodies in similar ways, artists like popular American ’zine writer and illustrator Nomy Lamm (also a member of Sins Invalid), British portrait painter Jenny Saville (2005, 2011), and Canadian sculpture and installation artist Allyson Mitchell have, over the past twenty years, worked to resignify the fat female form. In her monumental paintings depicting the intimate surfaces of fleshy bodies, for example, Saville captures the solid yet ephemeral quality of embodiment as well as women’s relationship with their fat flesh in a fat-phobic world. Through her sexy nine-foot-tall Lady Sasquatch crafted out of 1970s fun fur, Mitchell takes a more tongue-incheek approach to fat representation that both exposes and mocks patriarchal fears of fat hairy women. Unlike the films I described that examine the unique capacities and properties of fat bodies, these visual and sculptural works emphasize the aesthetics of fat flesh, and resonate with recent feminist theorizing on beauty. Feminists during the second wave advocated for doing away with harmful beauty standards (Wolf 1992), yet scholars now contend that we cannot eliminate concepts of beauty entirely (for an in-depth discussion see Rice 2014). This is because judgments about what is beautiful may be universally present in societies (Holliday and Sanchez Taylor 2006) and because there is no such thing as a “natural” body to which we can escape from imposed standards (the natural and cultural are

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always shaping and transforming each other) (Scott 2005). Some of these writers wonder what we would lose without beauty – without the visual and tactile, the gesture, smell, and sound, or any sensory pleasure in our lives (Colebrook 2006). To change our limiting, image-­ driven, idealized dominant conception of beauty, they argue instead for creating a feminist aesthetics – an inclusive theory of feminist beauty and sensory pleasure. For example, art historian Joanna Frueh (2001) envisions beauty as an embodied experience based in sensory pleasure and self-love, a feeling that is attitudinal and attends to process rather than being aspirational or predefined. In order to reframe beauty in a way that avoids body shame, refuses to be reduced to the visual, and includes anyone who seeks it, she develops the concept of “monster/ beauty,” a condition emerging “from intimacy with one’s aesthetic/ erotic capacity” (11). Rebecca Coleman and Mónica Moreno Figueroa (2010) are also interested in beauty in a temporal sense, saying that its past and future-orientation (i.e., longing for the body we once had or hope to have in the future) needs to give way to a present orientation to make it less cruel and harmful to women. In their view, beauty could function in women’s lives not as something to aspire to but as an embodied feeling of aliveness or vitality recognized as it is happening in the moment. Drawing on this recent theorizing, we might think about the works of Saville and Mitchell as articulating a feminist aesthetics based not in the body beautiful, but in the horror/beauty of embodiment, the pleasures and afflictions, possibilities and limits, and opacity and uncertainty that is the basis of bodily life. Such theories are promising because they offer ways to rethink beauty and fat aesthetics so that fat women (and all those decreed to be unbeautiful) might begin to reclaim sensory pleasure and bodily self-celebration in their lives. I see the interventions of the feminist, anti-oppressive artists, filmmakers, and performers discussed here as body-becoming pedagogies – as interventions that create alternatives to conventional biopedagogies whose instrumental, outcomes-oriented methods and moralizing overtones enforce physical conformity over diversity and creativity. Rather than being instrumental and outcomes driven, a body-becoming pedagogy is presence and process oriented, interested in body-affirming images and spaces and in expanding possibilities for bodily becoming. In this way, a body-becoming approach aims to refocus energies on improvising the properties and potentialities of big bodies.

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Conclusion How can we translate the body abilities and aesthetics captured in these theories, experiences, and artistic interventions into actual pedagogies that expand options for becoming? Once translated, how can such pedagogies be experimented with in schools, hospitals, and other sites of physical-activity learning? What conditions would enable people to imagine and improvise these and other possibilities for their bodies? How might body-becoming pedagogies invite us to see physical activity as an aesthetics rather than solely as a science of the body? By posing such questions, I hope to make a case for pedagogies that expand openings for physical experimentation, creativity, sensory pleasure, and beauty, and hence for remaking the once-abject into an embodied, even celebrated, identity. NOTES 1 “Americans Experiencing ‘Pandemic of Obesity,’ Says Director of Centers For Disease Control and Prevention in Atlanta,” Terry College of Business, 20 February 2003, http://news.uga.edu/releases/article/030221Pandemic Obesity (accessed 4 September 2013). 2 “Fat Is ‘Terror Within,’ Surgeon General Warns,” Los Angeles Times, 2 March 2006, http://articles.latimes.com/2006/mar/02/nation/na-briefs2.1 (accessed 4 September 2013). 3 ParticipACTION Archive Project. Ads retrieved from http://scaa.sk.ca/ gallery/participaction/english/motivate/theearlyyears.html (accessed 4 September 2013). 4 “$5M to Bring Back ParticipACTION Exercise Program,” CBC News, 19 February 2007, retrieved from http://www.cbc.ca/news/technology/ 5m-to-bring-back-participaction-exercise-program-1.640711 (accessed 4 September 2013). 5 “Stop Playing Games with Childhood Obesity” campaign, 2009, Hamilton Partners for Healthy Weights, http://www.dailythingscount.ca/posters .html (accessed 4 September 2013). 6 ParticipACTION Archive Project. 7 “First Canadian Summit on Weight Bias and Discrimination a Success,” press release, 17 January 2011, Canadian Obesity Network, http://www .obesitynetwork.ca/page.aspx?page=2483&app=182&cat1=457&tp=12&lk =no&menu=37 (accessed 4 September 2013).

Revisioning Fat  435 8 “Our Mission,” Sins Invalid: Unashamed Beauty in the Face of Invisibility, http://www.sinsinvalid.org/mission.html (accessed 22 May 2013).

WORKS CITED Alaimo, Stacy, and Susan Hekman. 2008. “Introduction: Emerging Models of Materiality in Feminist Theory.” In Material Feminisms, ed. Stacy Alaimo and Susan Hekman, 1–19. Bloomington: Indiana University Press. Barad, Karen. 2003. “Posthumanist Performativity: Toward an Understanding of How Matter Comes to Matter.” Signs (Chicago, Ill.) 28 (3): 801–31. http:// dx.doi.org/10.1086/345321. Battersby, Christine. 1998. The Phenomenal Woman: Feminist Metaphysics and the Patterns of Identity. New York: Routledge. Birke, Lynda. 2000. Feminism and the Biological Body. New Brunswick, NJ: Rutgers University Press. Bordo, Susan. 1993. Unbearable Weight: Feminism, Western Culture and the Body. Los Angeles: University of California Press. Brownell, Kelly, and Katherine Horgen. 2004. Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, and What We Can Do about It. Chicago: Contemporary. Brownmiller, Susan. 1984. Femininity. New York: Linden Press/Simon and Schuster. Butler, Judith. 1990. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge. Campos, Paul. 2004. The Obesity Myth: Why America’s Obsession with Weight Is Hazardous to Your Health. New York: Gotham. Cogan, Jeanine, and Paul Ernsberger. 1999. “Dieting, Weight, and Health: Reconceptualizing Research and Policy.” Journal of Social Issues 55 (2): 187–205. http://dx.doi.org/10.1111/0022-4537.00112. Colebrook, Claire. 2006. “Introduction.” In “On Beauty,” special issue, Feminist Theory 7 (2): 131–42. http://dx.doi.org/10.1177/1464700106064404. Coleman, Rebecca. 2008. “The Becoming of Bodies: Girls, Media Effects, and Body Image.” Feminist Media Studies 8 (2): 163–79. http://dx.doi.org/ 10.1080/14680770801980547. – 2009. The Becoming of Bodies: Girls, Images, Experience. Manchester: Manchester University Press. Coleman, Rebecca, and Mónica Moreno Figueroa. 2010. “Past and Future Perfect? Beauty, Affect and Hope.” Journal for Cultural Research 14 (4): 357–73. http://dx.doi.org/10.1080/14797581003765317.

436  Carla Rice Coole, Diana, and Samantha Frost. 2010. “Introducing the New Materialisms.” In New Materialisms: Ontology, Agency and Politics, ed. Diana Coole and Samantha Frost, 1–43. Durham: Duke University Press. http://dx.doi.org/ 10.1215/9780822392996-001. Covino, Deborah. 2000. “Abject Criticism.” Genders Online Journal 32. http:// www.genders.org/g32/g32_covino.html. Dykewomon, Elana. 2002. “The Body Politic – Meditations on Identity.” In The Bridge We Call Home: Radical Visions for Transformation, ed. Gloria Anzaldúa and AnaLouise Keating, 450–8. New York: Routledge. Eisenberg, Marla, Diane Neumark-Sztainer, and Mary Story. 2003. “Associations of Weight-Based Teasing and Emotional Well-Being among Adolescents.” Archives of Pediatrics & Adolescent Medicine 157 (8): 733–8. http://dx.doi.org/10.1001/archpedi.157.8.733. Evans, John, and Emma Rich. 2011. “Body Policies and Body Pedagogies: Every Child Matters in Totally Pedagogised Schools?” Journal of Education Policy 26 (3): 361–79. http://dx.doi.org/10.1080/02680939.2010.500399. Evans, John, Emma Rich, Rachel Allwood, and Brian Davies. 2008. “Body Pedagogies, Policy, Health and Gender.” British Educational Research Journal 34 (3): 387–402. http://dx.doi.org/10.1080/01411920802042812. Fausto-Sterling, Anne. 2000. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic. Ferrari, Manuela. 2012. “Beyond Obesity and Disordered Eating in Youth.” Doctoral diss., University of Toronto. Frost, Liz. 2001. Young Women and the Body: A Feminist Sociology. New York: Palgrave. http://dx.doi.org/10.1057/9780333985410. Frueh, Joanna. 2001. Monster/Beauty: Building the Body of Love. Berkeley: University of California Press. Gard, Michael. 2011. The End of the Obesity Epidemic. New York: Routledge. Gard, Michael, and Jan Wright. 2005. The Obesity Epidemic: Science, Morality and Ideology. New York: Taylor and Francis. Greer, Germaine. 1972. The Female Eunuch. London: Paladin. Grosz, Elizabeth A. 1994. Volatile Bodies: Toward a Corporeal Feminism. Bloomington: Indiana University Press. Grosz, Elizabeth A. 1999. “Becoming … An Introduction.” In Becomings: Explorations in Time, Memory, and Futures, ed. Elizabeth Grosz, 1–11. Ithaca: Cornell University Press. Grosz, Elizabeth A. 2008. “Darwin and Feminism: Preliminary Investigations for a Possible Alliance.” In Material Feminisms, ed. Stacy Alaimo and Susan Hekman, 23–51. Bloomington: Indiana University Press.

Revisioning Fat  437 Hall, Kim. 2011. Feminist Disability Studies. Bloomington: Indiana University Press. Halse, Christine. 2009. “Bio-Citizenship: Virtue Discourses and the Birth of the Bio-citizen.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 45–59. New York: Routledge. Hird, Myra. 2003. “New Feminist Sociological Directions.” Canadian Journal of Sociology 28 (4): 447–62. http://dx.doi.org/10.2307/3341837. – 2004. Sex, Gender and Science. New York: Palgrave Macmillan. Holliday, Ruth, and Jacqueline Sanchez Taylor. 2006. “Aesthetic Surgery as False Beauty.” Feminist Theory 7 (2): 179–95. http://dx.doi.org/10.1177/ 1464700106064418. Jacobson, Sheldon Howard, and Laura A. McLay. 2006. “The Economic Impact of Obesity on Automobile Fuel Consumption.” Engineering Economist 51 (4): 307–23. http://dx.doi.org/10.1080/00137910600987586. Jutel, Annemarie. 2006. “The Emergence of Overweight as a Disease Entity: Measuring Up Normality.” Social Science & Medicine 63 (9): 2268–76. http:// dx.doi.org/10.1016/j.socscimed.2006.05.028. – 2009. “Doctor’s Orders: Diagnosis, Medical Authority and the Exploitation of the Fat Body.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 60–77. New York: Routledge. Larkin, June, and Carla Rice. 2005. “Beyond ‘Healthy Eating’ and ‘Healthy Weights’: Harassment and the Health Curriculum in Middle Schools.” Body Image 2 (3): 219–32. http://dx.doi.org/10.1016/j.bodyim.2005.07.001. MacNeill, Margaret, and Geneviève Rail. 2010. “The Visions, Voices and Moves of Young ‘Canadians’: Exploring Diversity, Subjectivity and Cultural Constructions of Fitness and Health.” In Young People, Physical Activity and the Everyday, ed. Jan Wright and Doune Macdonald, 175–94. London: Routledge. McKinley, Nita. 1999. “Ideal Weight/Ideal Women: Society Constructs the Female.” In Weighty Issues: Fatness and Thinness as Social Problems, ed. Jeffery Sobal and Donna Maurer, 97–105. New York: Aldine De Gruyter. Neumark-Sztainer, Dianne, Mary Story, Peter Hannan, Cheryl Perry, and Lori Irving. 2002. “Weight-Related Concerns and Behaviors among Overweight and Nonoverweight Adolescents: Implications for Preventing WeightRelated Disorders.” Archives of Pediatrics & Adolescent Medicine 156 (2): 171–8. http://dx.doi.org/10.1001/archpedi.156.2.171. Ontario. 2004. 2004 Chief Medical Officer of Health Report: Healthy Weights, Healthy Lives. Toronto: Chief Medical Officer of Health. Orbach, Susie. 1979. Fat Is a Feminist Issue: The Anti-diet Guide to Permanent Weight Loss. New York: Berkley.

438  Carla Rice Oudshoorn, Nelly. 1994. Beyond the Natural Body: An Archaeology of Sex Hormones. London: Routledge. http://dx.doi.org/10.4324/9780203421529. Raine, Kim. 2004. Overweight and Obesity in Canada: A Population Health Perspective. Ottawa: Canadian Institute for Health Information. Rice, Carla. 2007. “Becoming ‘the Fat Girl’: Acquisition of an Unfit Identity.” Women's Studies International Forum 30 (2): 158–74. http://dx.doi.org/ 10.1016/j.wsif.2007.01.001. – 2009. “How Big Girls Become Fat Girls: The Cultural Production of Problem Eating and Physical Inactivity.” In Critical Feminist Approaches to Eating Dis/ orders, ed. Helen Malson and Maree Burns, 97–109. New York: Routledge. – 2014. Becoming Women: The Embodied Self in Image Culture. Toronto: University of Toronto Press. Rice, Carla, and Vanessa Russell. 2002. Embodying Equity: Body Image as an Equity Issue. Toronto: Green Dragon. Rich, Emma. 2010. “Obesity Assemblages and Surveillance in Schools.” International Journal of Qualitative Studies in Education: QSE 23 (7): 803–21. http://dx.doi.org/10.1080/09518398.2010.529474. – 2011. “‘I See Her Being Obesed!’ Public Pedagogy, Reality Media and the Obesity Crisis.” Health 15(1): 3–21. Rogers, Wendy. 2006. “Feminism and Public Health Ethics.” Journal of Medical Ethics 32 (6): 351–4. http://dx.doi.org/10.1136/jme.2005.013466. Saville, Jenny. 2005. Saville. New York: Rizzoli Books. – 2011. Jenny Saville. Palm Beach: Norton Gallery and School of Art. Schiebinger, Londa. 2000. “Introduction.” In Feminism and the Body, ed. Londa Schiebinger, 1–21. New York: Oxford. Schoenfielder, Lisa, Barb Wieser, and Vivian Mayer, eds. 1983. Shadow on a Tightrope: Writings by Women on Fat Oppression. Iowa City: Aunt Lute. Scott, Linda. 2005. Fresh Lipstick: Redressing Fashion and Feminism. New York: Palgrave. Scully, Jackie Leach, Laurel E. Baldwin-Ragaven, and Petya Fitzpatrick, eds. 2010. Feminist Bioethics: At the Center, on the Margins. Baltimore: Johns Hopkins University Press. Shildrick, Margrit. 1997. Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)Ethics. London: Routledge. – 2005. “Beyond the Body of Bioethics: Challenging the Conventions.” In The Ethics of the Body: Postconventional Challenges, ed. Margrit Shildrick and Roxanne Mykitiuk, 1–28. Cambridge, MA: MIT Press. Székely, Eva. 1988. Never Too Thin: Why Women Are at War with Their Bodies. Toronto: Women’s Press. Ussher, Jane M. 1989. The Psychology of the Female Body. London: Routledge.

Revisioning Fat  439 Weiss, Gail. 1999. Body Images: Embodiment as Intercorporeality. New York: Routledge. Wolf, Naomi. 1992. The Beauty Myth: How Images of Beauty Are Used against Women. New York: Anchor. World Health Organization. 2000. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO. – (n.d.). Controlling the Global Obesity Epidemic. http://www.who.int/ nutrition/topics/obesity/en/index.html. Accessed 22 May 2013. Wright, Jan. 2009. “Biopower, Biopedagogies and the Obesity Epidemic.” In Biopolitics and the “Obesity Epidemic”: Governing Bodies, ed. Jan Wright and Valerie Harwood, 1–14. New York: Routledge.

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Contributors

Natalie Beausoleil is associate professor in the Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland. Her research focuses on dominant discourses and people’s experiences of the body and health. Jennifer Brady is a PhD candidate at Queen’s University. Her doctoral work explores the professionalization of feminized professions in Canada through the oral histories of Canadian dietitians. Charlene Elliott is Canada Research Chair in Food Marketing, Policy and Children’s Health and an associate professor of communication at the University of Calgary. Her research focuses on food marketing, promotion, and policy, with a particular emphasis on foods targeted at children. She has provided input and recommendations on federal and international initiatives pertaining to food, labelling, and policy. Jenny Ellison is curator of sport and leisure at the Canadian Museum of History. Her research examines visual and discursive constructions of bodies and health, and the ways that diverse groups have responded to these messages. Michael Gard is an associate professor, School of Human Movement and Nutrition Science, the University of Queensland, Australia. He teaches, researches, and writes about how the human body is and has been used, experienced, educated, and governed. Jacqui Gingras is an associate professor at Ryerson University. Her research engages autoethnographic, narrative, and arts-informed

442 Contributors

methods as a means for understanding dietetic professionalization. Her research appears in the journals Food, Culture & Society, Radical Psychology, Feminist Media Studies, and the Journal of Agricultural and Environmental Ethics. She is the founding editor of the Journal of Critical Dietetics, an online, peer-reviewed, open-access journal at www. criticaldietetics.org. Shannon Jette is an assistant professor in the Department of Kinesiology at the University of Maryland. Her research focuses on sociocultural aspects of health, physical activity, gender, and the body, with a particular interest in health disparities experienced by marginalized communities. Barry Lavallee is a family physician who holds a master’s of clinical sciences degree in family medicine. He is currently director of student affairs at the University of Manitoba’s Centre for Aboriginal Health Education, director of curriculum development in Indigenous Health, and teaches in the university’s medical school. Darlene McNaughton is a cultural anthropologist in public health at Flinders University, Australia. Her research interests and publications focus on subalternity, stigma, and the culture of public health, with particular emphasis on obesity, diabetes, bariatric surgery, and mosquitoborne diseases. Deborah McPhail is an assistant professor in Community Health Sciences, Faculty of Medicine, University of Manitoba. A critical health scholar who has been studying and organizing around fat for fifteen years, Deborah’s interdisciplinary work about “obesity” has been published in such journals as Health and Place and Social Science & Medicine. Deborah obtained a PhD in women’s studies from York University in 2010. Her doctoral dissertation, a feminist history of obesity discourse in twentieth-century Canada, is under review at the University of Toronto Press. Deborah resides in Winnipeg with her girlfriend and their two children. Wendy Mitchinson is a distinguished professor emerita and adjunct professor of history at the University of Waterloo. She has written widely on the medical treatment of women, most recently Giving Birth in Canada, 1900–1950 (2002) and Body Failure: Medical Views of Women 1900– 1950 (2013). She is presently researching the history of obesity in Canada.

Contributors 443

Moss Edward Norman is an assistant professor in the Faculty of Kinesiology and Recreation Management at the University of Manitoba. He uses qualitative methodologies to study young men, embodiment, recreation, rurality, and constructions of health, particularly in relation to fatness and obesity. Elise Paradis is an assistant professor at the University of Toronto, with appointments in the Leslie Dan Faculty of Pharmacy and in the Depart­ ment of Anesthesia. Her research questions the rise of collaboration as a panacea for health care's woes. LeAnne Petherick is an assistant professor in the Faculty of Kinesiology and Recreation Management at the University of Manitoba. Her research examines the social construction and translation of knowledge in health and physical education focusing on the production of ideas about the body, children/youth, and contemporary health culture. Jennifer Poudrier is an associate professor of sociology at the University of Saskatchewan and a research associate with the Indigenous Peoples’ Health Research Centre. Her current academic focus is in the area of community-based participatory research using photovoice methods with First Nations communities in Saskatchewan on the topic of health and wellness. Geneviève Rail is professor and principal of the Simone de Beauvoir Institute at Concordia University. She is interested in women’s discursive constructions and embodied experiences of the body and health. With funding from the Canadian Institutes for Health Research (CIHR), she currently investigates discourses and issues related to fatness, HPV vaccination, and breast and gynaecological cancer care for LBQ women and trans persons. Carla Rice is Canada Research Chair in Care, Gender, and Relationships in the College of Social and Applied Human Sciences at University of Guelph. A leader in the field of body image within Canada, she is a founding member and former director of innovative initiatives such as the National Eating Disorder Information Centre and the Body Image Project at Women’s College Hospital in Toronto. Julie Rochefort works as a primary care community dietitian in Ontario (Noojmowin Teg Health Centre) on Manitoulin Island. She received her

444 Contributors

master’s degree in nutrition communication from Ryerson University in 2011 and was featured on a TEDx talk about the harms from weight stigma. Andrea Senchuk is a registered dietician working with a family health team in Ottawa, Ontario. She holds a bachelor of arts from the University of Ottawa and a bachelor of applied science in nutrition and master of health science in nutrition communication from Ryerson University. Jacqueline Schoemaker Holmes is a sociologist, educator, and advocate who specializes in the study and practice of empowerment. As a critical gender and sexuality scholar, and former front-line worker, Schoemaker Holmes works to foster holistic and inclusive forms of well-being, both in the educational setting and in the community. Cynthia Smith is a doctoral candidate in public health, Flinders University, South Australia. She currently resides in Victoria, British Columbia, and is the dean, School of Health and Human Services, Camosun College, and adjunct professor, School of Public Health, University of Alberta. Pamela Ward is a nurse educator at the Centre for Nursing Studies in St. John’s, Newfoundland. She is also a professional associate with the Faculty of Medicine, Memorial University of Newfoundland. Drawing upon poststructural and feminist perspectives, her research examines people’s embodied experiences in relation to dominant health discourses and care within the health system.

Index

abjection, 419, 430 Abonyi, Sylvia, 110 Aboriginal peoples: colonialism and, 18, 112–13, 182; concept of health, 99; deficit thinking and, 177, 178; diabesity and, 129; and diabetes, 98, 113; epidemiological discourse and, 92; food traditions, 326–7; genetics and, 104, 110, 111; “going to bush,” 182–3; health care providers and, 184; health discourse and, 92–3; healthy-at-every-size approach and, 181–2; malnutrition among, 201; micro-aggressions ­regarding obesity and, 180; and neoliberalism, 20; and obesity, 180, 184; obesity as stereotype and, 20; as problem population, 175; racism and, 18, 182; as separate vs. homogenous, 100; stereotypes regarding, 177; structural influences on, 182; surveillance of, 92, 110; thrifty gene theory and, 18, 90, 91, 111; and traditional foods, 336n1; travelling/nomadism of, 103; universal health care system

and, 183–4; VOD and, 356–7; and “walking” vs. obesity, 184. See also indigenous peoples; Sandy Lake Oji-Cree Abraham Carolyn, “How the Diabetes-Linked ‘Thrifty Gene’ Triumphed with Prejudice over Proof,” 112 Act to Encourage Physical Fitness and Sport (1961), 9 Adams, Stephen, “Television Creates Perfect Storm of Childhood Obesity,” 227 Addition-Elle, 305 Adlon, Percy, Zuckerbaby, 431–2 advertising: to children, 276–81; and children’s ages, 278, 282–3; and consumer’s ideal vs. actual self, 284; nutrition, 196–7. See also food advertising/marketing Advertising Standards Canada (ASC), 277 aesthetics: body-becoming theory and, 420; feminist, 433 affective biopolitics: and affects of tradition, 323; as failed biopolitics,

446 Index 334; of healthy eating, 329, 334; of obesity panic, 323, 335; potential for failure in, 325 affect(s): aliens, 323, 325, 329, 333; in critical obesity scholarship, 323–4; embodiments and, 324; emotions vs., 324; health policy and, 324; and obesity rhetoric, 324; of tradition, 323, 325–8 agency: of children, 189, 193, 201, 202–3, 224–5, 231, 281–2, 286; of matter, 422–3, 430; moral, of marginalized groups, 430; of teens, 189, 202–3 aging: and diabetes, 130; and increase in incidence of diabetes, 126, 127; and weight gain, 4 Ahmed, Sara, 255, 323, 325 L’Aide aux personnes obeses handicapées du Quebec, 313–14n2 Aldebaran (Vivian Mayer), 293, 295, 296 Alexander, Stephanie A.C., 231 Almeling, Rene, 73, 276 Alvaro, C., 128 Amazones d’hier (LG5), 300, 301f Andrew, Shannon, 307 Angel, A., 194 Aphramor, Lucy, 170, 400 appearance: body image and, 255–6; and femininity, 427; of teachers’ bodies, 255–6 askesis, 387 assimilation: Aboriginal peoples and, 20, 93, 105, 110; biomedicine and, 93, 110; cultural, 20, 93; in fat activism, 296, 297 Association for Size Diversity and Health (ASDAH), 400, 408, 409, 414

Atkins, J., 407 Attorney General of Québec v. Irwin Toy Ltd., 277–8 Australia: body weight statistics in, 49; diabetes and indigenous vs. non-indigenous Australians, 114; rise in T2DM incidence, 138–9n2 authenticity: authentic asks, 374; gender and, 387–8; on- vs. offline, 380; in online dating, 380, 386; of profiles, 381; replicability and, 381; in selfing, 380; of women’s embodiment, 385; in women’s self-representation, 387–8; women’s subversion of, 389–90; of women’s weight, 384–5, 386. See also fat authenticity autoethnography, 18–19, 150–8, 170 Bacon, Linda, 170, 400, 401, 405–6, 411 Baker, J.L., 44–5 Baldwin, James, 167 Baranowski, Tom, 228 bariatric surgery, 59, 65, 70, 139n5, 354 Barker, D.J.P., 99 Barnett, Anthony, 228 Baym, N.K., 394n8 Beagan, Brenda L., 236 Beausoleil, Natalie, 19, 125, 160, 190, 236 beauty: changing standards of, 303–4; as embodied feeling, 433; feminism and, 432–3; idealized, 421; monster/, 433; slenderness and, 6 The Beauty Myth (Wolf), 300, 304 Beck, Ulrich, 222 “Becoming the ‘Fat Girl’” (Rice), 135

Index 447 behaviour(s): essentialism of notions regarding, 16; gender and on- vs. offline, 381–2; ideas and, 57; of men in online dating, 383–4; and obesity as behavioural disease, 424; and obesity as problem, 8; obesity science and monitoring of, 7; risk (see risk(s)); sedentary, 231; stereotypes, 16 Bélanger-Ducharme, F., 42, 48 Bell, Kirsten, 75, 124, 134, 137–8 Berger, Peter L., 57 Betteridge, D.J., Diabetes: Current Perspectives, 98 Beynon, C., 44 Beyond Dieting (Ciliska), 302 “Big Can Be Beautiful” (Canadian Living), 305, 306f, 307 The Biggest Loser (TV show), 346, 347, 362 binaries: and body equity approach, 429; and fat “other,” 228; fat/thin, 228; geographically situated, 357; HAES and, 22, 411; harm caused by norms/differences, 429; and large children as “other,” 222; mind/body, 22, 411; primitive/ civilized, and individual responsibility for health, 109; thrifty gene and, 90; Trickster and, 91; between white and Aboriginal groupings, 105–6 biocitizenship: healthism and, 252; neoliberalism and, 361; spread of goodness/healthiness ideas and, 251; teachers and, 249, 261, 264, 265, 266; in VOD, 357, 358 biocivics, 20, 362–3 bioethics: biopedagogies and, 424; embodied, 430; and experiential

knowledge, 430; feminist bioethics vs., 430; and size differences, 429–30 biomedicine: and assimilation, 93, 110; colonialism and, 93; and dietetics, 156–7, 159; energy balance model, 157, 345; feminist scholarship and, 421; and healthrelated stories, 353; and increases in overweight/obesity rates, 128; indigenous knowledge vs., 115 biopedagogies: about, 424; bioethical issues, 424; biopower and, 352; body-becoming pedagogies vs., 433; body-becoming theory vs., 420, 425; and childhood obesity, 425; defined, 224; dichotomy creation in, 429; and eating disorders, 428; and fatness-fitness relationship, 426–7; of government health-promotion messages, 426–7; harm of, 345–6; and inactivity, 428; of measurement, 360–1; normalization and, 363–4n1; and obesity epidemic, 425; in schools, 224, 231; surveillance and, 361; in virtual realm, 231–2; in VOD, 20, 347, 350, 352, 360–1, 362 biopolitics: affective, 324, 334–5; and biocitizenship, 357; defined, 364n5; failed, 334; of obesity panic, 335; resistance to, 334–5; in VOD, 20, 358 biopower: biopedagogies and, 352; biopolitics and, 324, 364n5; defined, 224, 364n2; Foucault and, 224, 363n1 biosociality, 92 Birmingham, C., 128 Blackman, Lisa, 345

448 Index blame/blaming: problem populations, 17; of self for diabetes, 123, 136; victim, 177, 359, 395n15; and youth, 20. See also mother blaming; individual responsibility Blue Sky, 381 “Body Builders and Reducers” (Chatelaine), 200 body equity approach, 428–9 body image: and appearance, 255–6; children and, 154, 199–200; cultural perceptions, 189; dietitians and, 153–4; importance of positive, 60; mothers and, 200–1; nutrition vs., 202; school resources on, 246–7; teens and, 199, 200–1, 202; weights and, 12. See also teachers’ bodies Body Image Network, Healthy Bodies Come in Different Shapes and Sizes, 246–7, 265–6 body mass index (BMI): about/usefulness of, 51n1; on continuum, 12; cut-offs, 44; defined, 395n14; and evaluation as obese, 135; and fatness, 157; and health, 154; in medical literature, 68–9, 70f, 77; and medicalization of fat, 78; obese children as conscious of, 229, 230, 231; and obesity epidemic, 3; in online dating, 385; prevalence/statistics, 39–40; ranges, and obesity/overweight, 150; standards for children, 68–9; and surveillance, 231; in VOD, 360; volatility in data, 39–40; weightcentred paradigm and, 401; in Wii Fit gaming system, 229, 230, 231 body norms/ideals: fat activism and, 312; feminism and, 419; ideal weights, 363; patriarchy and, 300;

and teachers’ bodies, 251; as temporary state, 430; thinness as, 250, 302; weights, 363 body size(s): as abnormal, 223; acceptance of diversity in, 237; body-becoming theory and, 423; as emergent attribute, 423; and healthiness, 248; as individual responsibility, 220–1; and marginalization, 307; as personal vs. patriarchal issue, 300; range of healthy, 11 body weight. See weight body-becoming theory/approach: about, 22, 420; advantages of, 430–1; and aesthetics, 420; and agency of all matter, 430; to bioethics, 430; biopedagogies vs., 420, 425, 433; and bodybecoming through interactions, 423; determinism vs., 423; and fatness-fitness relationship, 425; healthism vs., 430; new materialism and, 423; as open process, 423; and relation between weight and health, 423; and size, 423; social constructionism vs., 422–3; and unfit fat body, 423 body/-ies: “citizen,” 357; cultural messages about, 421–2; as fluid vs. bounded, 422; particular size/ shape as healthy/good, 248; rational asceticism and, 163–4; as source of knowledge, 422–3 Boero, Natalie, 74–5 The Bolster (LAL), 305, 307 Booth, G.L., 128 Boschman, Lorna, “Fat Liberation: A Wages for Housework Perspective,” 297

Index 449 Boston Area Fat Liberation, 296, 303 Bouyant (Wyman), 431 Brady, Jennifer, 18–19, 21–2, 152–3, 161, 166, 196, 407 Bramley, D., 48 Breaking the Diet Habit (Polivy; Herman), 302 Britzman, D.P., 407 Brown, Alan, The Normal Child, 197 Brown, P., 57 Bruch, Hilde, 8, 74, 195 Brumberg, Joan Jacobs, 57 Brumberg, Steven, 57 Bryans, A.M., 204 Budd, G.M., 136, 137 Burger King, 278 “Burger Queen” (Scottee), 410 Burrows, Lisette, 223–4 Butler, Judith, 159, 160, 310, 382; Gender Trouble, 220 Byrne, C., 113 CAI (Children’s Food and Beverage Advertising Initiative), 276–7, 278–9, 280–1, 282, 283 Cambridge Women’s Centre, 296 “Canada Diabetes Epidemic Predicts Worse for World” (Shaw), 129 Canada Fitness Survey, 43–4 Canada Fitness Test, 9 Canada Health Surveys, 11 CANADA Wyde, 298 Canada’s Food Guide, 198, 327, 330, 407 Canadian Association for Size Acceptance (CASA), 298 Canadian Broadcasting Corporation (CBC), 352–4; The Nature of Things, “The Weight of the World,” 90; Village on a Diet (VOD), 343, 347

Canadian Chronic Disease Surveillance System (CCDSS), 126 Canadian Community Health Survey (CCHS), 45, 48, 126 Canadian Community Health Survey (CCHS), 123 Canadian Council on Nutrition, Dietary Standard for Canada, 198 Canadian Diabetes Association, An Economic Tsunami, 128 Canadian Guidelines for Healthy Weights (Health and Welfare Canada), 10–12, 60 Canadian Health Measures Survey (CHMS), 45, 49, 126, 187 Canadian Home Journal, 200 Canadian Journal of Public Health, 193 Canadian Living, “Big Can Be Beautiful,” 305, 306f, 307 Canadian Obesity Network (CON), 15, 60, 134, 351, 426, 429 Canadian Public Health Association, 190 “The Canadian Weight-Height Survey” (Pett; Ogilvie), 35, 36 capitalism, politics of postponement and, 404–5 Cappon, Daniel, Eating, Loving and Dying, 202 cardiovascular health, 226–7 The Care of the Child (Goldbloom), 198 Carr, Adrian, 382–3 Carr, Melissa, 394n6 Carroll, M.D., 46 Causes of Diabetes (Leslie), 98 Cavender, Gray, 357 Center for Science in the Public Interest, 276 Centers for Disease Control (CDC), 43, 421

450 Index Cerin, Ester, 228 Chang, V.W., 73 Chapman, Gwen E., 236 Charland, Michèle, 300 Chatelaine, 193, 196, 200; “Body Builders and Reducers,” 200; “Miss C Diet Book,” 194 Chaufan, Claudia, 98–9 Chernin, Kim, Obsession: Reflections on the Tyranny of Slenderness, 300 Child Welfare, Division of, 7 Child Welfare Council, 190 childhood obesity: biopedagogies and, 425; causation, 194, 195, 204–5; collective/social responsibility for, 275–6; definitions of, 43, 44; dieting and, 427–8; discourse of war on, 236–7; and diseases, 279; embodied experiences, 219, 237; epidemic, 187, 221, 425; family history/heredity and, 194; food industry and, 274, 275, 278–9, 280; food intake and, 194; gender and, 43–4; health discourses and, 237; historiography, 189; importance of, 218–19; incidence of, 187, 194; institutional spaces and, 19; and interventions, 275; as lagging behind adult, 74; and life expectancy, 219, 279; and lifestyle choices, 283; in medical literature, 68–9, 70f, 74, 78; medicalization of, 74–5; mothers and, 19, 74–5, 194, 204, 205–6, 282; in Nike “Jogger” commercial, 272–3, 275, 284–5; in Norway, 47; overeating and, 194, 425; parents and, 187, 204; physical activity and, 425; prevalence of, 43–4; prevention of, 219; rates of, 274;

responsibility for, 20; responsibility for adult obesity vs., 275; risk and, 279; schools and, 245, 246, 247, 427; sedentary activities and, 229; as social problem, 273, 275; treatment, 195–6, 205, 219, 221; in US, 47; weight stereotyping and, 425. See also obese children children: advertising to, 276–81, 277, 283, 285–6; age/gender and bodily changes, 263–4; agency of, 189, 193, 201, 202–3, 224–5, 231, 281–2, 286; at-risk, 74, 224; BMI standards for, 68–9; and body image, 154, 199–200; body-based harassment among, 264; and choice making, 248, 281; and construction of childhood, 223–4; constructions of health, 220; decisions about nutrition/health, 277, 281; and dietary components, 197–8; eating habits/disorders, 201, 202–3, 425, 427–8; of fat/ obese parents, 15; fitness testing of, 34; and free play, 231; and greatness, 283–4, 285; height of, 36; and individual responsibility, 19, 285–6; living conditions, 248; measurement of, 33–4; in medical literature, 75, 76f; and milk, 190, 198; mothers as gatekeepers to, 192; in Nike “Jogger” commercial, 272–3; normalization of, 224; nutrition, 34–5, 36–7, 197–8, 201; protection of, 276, 283–4, 286; resistance to unhealthy identities, 19; risk and, 19, 189, 279; school interactions regarding body attitudes, 260–1; as social responsibility, 275–6; surveillance of, 189,

Index 451 197; underweight, 189, 190, 193–4, 199, 205; unfitting normative body standards, 237; weighing of, 197; weight management, 19; weight of, 36–7; weights in Canadian provinces, 47. See also overweight children; parents; schools; teacherstudent relationship Chovancek, Jonathan, 350 Christakis, N.A., 73 chronic illnesses/diseases: deficit theory and, 178; lifestyles and, 130–1; obesity epidemic and, 3; publicization of risk factors, 130–1; stigma and access to care, 136 Ciliska, Donna, 61; Beyond Dieting, 302 Clarke, S., 327–8 classes, social. See social classes “Clinical Utility of HNF1A Geno­ typing for Diabetes in Aboriginal Canadians” (Hegele), 107 Cloutier, Michael, 127 “Cod Tongues and Corpulence” (McPhail), 322 Cohen, S., 124 Coleman, Rebecca, 433 colonialism: and Aboriginal peoples, 18, 182; and biomedicine, 93; and cause of diabetes, 129–30; colonized body and fat, 14; and diabetes, 178; effects on bodies, 182; and health, 114; and normal/ abnormal embodiments, 5; and social/health problems among First Nations communities, 112–13. See also decolonization Community Health Survey (Statistics Canada), 320 CON. See Canadian Obesity Network (CON)

consciousness-raising groups, 296, 307 Consumer Protection Act (Quebec), 276–9, 280, 281, 282, 283 “The Continuing Epidemics of Obesity and Diabetes in the United States” (Mokdad), 128 Cook, Daniel, 281–2 Cookie Monster, 276, 285 Cooper, Charlotte, 298, 410, 413–14; Fat and Proud, 295; The Fat Studies Reader, 294 corpulence: Dancel on, 5–6; decline in use of term, 65; in medical literature, 66, 76 Coveney, John, 234 Covino, Deborah, 419 Craigslist, 380–1, 395n11 Crawford, Robert, 132, 247–8, 249, 393n5 critical medical education, 175 critical obesity scholarship/studies: about, 7; affect theory in, 323–4; and alternative narratives to obesity discourses, 345, 358–9; and conspiracy theory, 345; and construction of obesity, 3–4, 50; in dietetic education, 156, 157–8, 170; and fat phobia, 14; and individual experiences, 219; and obesity ­science, 7, 17, 50; and obesity statistics, 50; and policy, 50–1; and use of word “obesity,” 22–3n1 Crohn’s disease, 152–3 Cross, Glen, 355 Cross-National Diabetes Attitudes, Wishes and Needs (DAWN), 136 “Cultural Expectations of Thinness in Women” (Garner), 302 cultures: and body image, 189; family, 203–4; and family foods, 203–4;

452 Index and food, 203–4; and weight, 189. See also traditional foods Cutler, D.M., 31 cyberspace. See internet Dal Santo, Joan, 307 Dancel, Francois, Obesity or Excessive Corpulence, 5–6, 7 Daniels, Adelaide, 195 Davis, Clara, 193 Davis, Kathy, 298, 299 decolonization: indigenous world views and, 94–5, 96–7; of methodologies, 96–7; of science, 94–5, 96–7, 106; and thrifty gene theory, 90, 106–7, 111–12; and value neutrality, 97. See also colonialism deficit theory, 177, 178, 179 Department of National Defence, XBX and 5BX programs, 9 Depression, 190, 192, 194, 203 DeVault, M., 159, 165, 166, 169 diabesity: about, 18, 129; epidemic, 128; and First Nations peoples, 129; and indigenous peoples, 129; risk behaviours and, 133; and weight/obesity as cause of diabetes, 129–30 diabetes: Aboriginal/indigenous peoples and, 89, 98, 112, 113, 114, 115; access to health care services, 126; aging and, 126, 127, 130; antipsychotics and, 122; colonization and, 178; deficit theory and, 177, 178; diabesity and weight/ obesity as cause of, 129–30; as dual epidemic with obesity, 128; environmental factors, 112, 113, 122; as epidemic, 127, 128, 129; etiology of, 89–90; family history/

heredity and, 122, 130; fetal nutrition and, 99; genetics and, 89–90, 93, 98, 99–100, 102–3, 108–9, 111, 113–14, 122; identification of highrisk subjects, 107–9; incidence of, 123; individual responsibility for, 132; and insulin, 122, 130; among Keratin Inuit, 101; life expectancy and increase in incidence of, 126, 127; lifestyle and, 98–100, 107, 112, 113, 128, 130–2; malnutrition and, 99; marginalization and, 108; Mexican indigenous groups and, 115; modifiable vs. non-modifiable factors/causes, 131–2, 138; obesity epidemic and, 127; obesity stigma and, 136–7; obesity/overweight and, 18, 108, 123, 129, 130, 131, 133, 134, 137 (see also diabesity); and Pima Indians, 98; race and, 94; risk factors, 113; among Sandy Lake Oji-Cree, 90, 100; and selfblaming/self-inflicted, 123, 136; social determinants of, 108, 113, 114, 129–30, 138; symptoms vs. causes, 138; about T2DM, 122; thrifty gene theory and, 89, 90, 97, 98, 111, 112; trauma and, 115; weight and, 18, 123–4, 127–8, 134, 138 Diabetes: Current Perspectives (Betteridge), 98 Diagnostic and Statistical Manual of Mental Disorders (DSM), 8 die-obesity, 130 Dietary Standard for Canada (Canadian Council on Nutrition), 198 diet/dieting: binge, 304; body weight vs., 36; and childhood obesity,

Index 453 427–8; components of children’s, 197–8; controlling, 163; crash, 10, 11, 302; epidemic of, 70; FU and industry, 293; HAES and industry, 408; history of, 58; industry, 354; and malnutrition, 7, 190; in medical literature, 71–2, 77; as medical solution, 72; medically supervised, 70; non-, 154; problems with, 10; programs, 302–3; teachers and, 256–8; yo-yo, 10, 11, 302. See also eating; food; nutrition dietetic education: about, 18–19; biomedicine in, 156–7; critical fat studies in, 170; critical obesity scholarship/studies in, 156, 157–8, 170; and critical thinking, 155; and fat phobia in students, 162; fatness in, 156, 157–8; helping/caring concepts in, 162; internship, 153– 4, 156, 158; lack of critical view in, 162; political nature, 166; professional socialization in, 165–6; and professionalization, 159; rational ascetic/individualistic tendencies in, 163–4; science in, 151, 152; as weight biased, 155, 156 dietetics: anti-fat attitude within, 149; biomedicine and, 159; and critical fat studies/dietetics, 164– 5; critical race theory and power within, 166–7, 168; discourses of, 169–70; and evidence-based practice, 149; and fat/ness, 151, 152; and feminism, 151; gender in, 168–70; and healthy weights, 159–60; home economics and, 168; and horizontal violence, 169; melancholia in, 159, 160; naming/ colonizing Other in, 152; nutrition

control discourse in, 401; and paradox of natality, 159, 166; as performance, 159; power relations within, 149, 167; within professional medical hierarchy, 169; professionalism in, 159, 165, 169; and rational asceticism, 163; reflexivity in, 159, 160; and weight control, 152–3; weight-centred paradigm in, 149–50; white guilt and, 167. See also nutrition dietitians: anti-fat attitudes/ discourse, 161–2, 165; beliefs regarding obesity and morbidity/ mortality, 163; and body image, 153–4; and body weight, 153–4, 160, 163; cost of accessing, 183–4; and fat activism, 154–5; fat vs. thin, 160; HAES, 167, 168; helping/ caring obligation, 162–4; and nutrition, 158–9, 160–1; and obesity epidemic, 148, 165; oppression among, 167–8; power relations among, 167–8; process of becoming, 155 (see also dietetic education); professional thinness, 160–2; professionalism of, 158; and war on fat, 149; and war on obesity, 148; as weight management experts, 153, 159, 161 Dietitians of Canada, 161 directly measured data: meaning of, 32–3; self-reported data vs., 33, 39, 42 disability: arts movement, 432; defined, 431 disease(s)/illness: childhood overweight/obesity and, 279; construction of, 57; degenerative, 36–7; fat as, 15, 163, 426; fat as

454 Index reserve to fight off, 200; fatalism regarding, 108–9; genes and personal identity, 108–9; obesity as, 57, 344, 424; obesity as risk factor for, 223; preventative measures against, 108, 110; risk, and prevention of, 162; social construction of, 57–8; structural forces and, 138; structural racism and, 177 Division of Child Welfare, 7, 190 drugs, in medical literature, 77, 78 Drury, C.A., 137 Dukepoo, F., 104, 110 Dungeons and Dragons, 381 Durkheim, Émile, 57 Duster, Troy, 92, 106 Dykewomon, Elana, 431; Lesbian Herstories and Cultures, 294 Earnshaw, V., 136 eating: constant, 274; emotional, 254–5; health promotion and, 254–5; intuitive, 399; Pett on, 34–5; in VOD, 350; weight-centred paradigm and patterns of, 400. See also diet/dieting; food; healthy eating Eating, Loving and Dying (Cappon), 202 eating disorders: biopedagogies and, 428; children and, 425, 427–8; compulsive/binge/secretive eating, 427–8; fat oppression and, 304; fatness-fitness relationship and, 428; F.E.D. and, 303; feminist activism and, 419; incidence of, 304; media and, 304; sexist body standards and, 421; stigma and, 429; women and, 12 An Economic Tsunami (Canadian Diabetes Association), 128

Edmonton Obesity Staging System, 4 Elliott, Charlene, 19–20, 196, 197, 202, 224–5, 264 Ellison, Jenny, 14, 21, 58, 133 Enke, Anne, 305 epidemic, as term in medical literature, 66, 67, 69f, 77 Epidemiologic Methods (McMahon; Pugh; Ipsen), 37 epidemiology: discourse and Aboriginal peoples, 92; methodologies of, 93; obesity and, 32–7; rise of, 66; weight-height statistics and, 37 Equal Rights Amendment (ERA), 295 ethnicity: and diabetes genes, 93–4; in genetics, 92; race as articulated through, 106; thrifty gene theory and, 111; and traditional foods, 326–7. See also Aboriginal peoples; indigenous peoples; race/racism ethnography: auto-, 18–19, 150–8, 170; online, 375 Evans, Bethan, 325; “Anticipating Fatness,” 323–4 Evans, John, 233 Everett, Holly, 327, 328 Everett, M., 114–15 “Every Girl Her Own Girdle,” 200 Fabrey, William J., 295 families: and child nutrition, 203–4. See also parents fashion, 297, 305, 306f, 307, 310 fat acceptance: diverse array of activisms, 296–7; fat activism and, 14; groups, 12–14; LAL and, 294; personal, 294; and politics of postponement, 414

Index 455 fat activism: assimilationism vs. radicalism in, 296, 297; and body norms, 312; in Canada, 297–9; core principles, 313; dietitians and, 154–5; diverse/multiple issues targeted by, 296–7, 312, 313; and fat acceptance, 14; and fat authenticity, 391; and fat liberation, 293, 296–7; and feminine culture, 312; and feminism, 21, 299–300, 302; and gender norms, 299; genealogy of, 21; and “good fattie,” 410; and government-funded health care initiatives, 302; groups, 12–14; and identity, 309; identity politics and, 299, 313; lack of ideological focus, 296–7; literature on, 293–4; loose connections/informal networks in, 298–9; micro-moments of, 413, 414; as movement, 298–9; and personal experiences, 299, 313; queer theory compared to, 309; and race, 308–9; resilience of, 313; self-reflexivity and, 312–13; shared experiences within, 298–9; speaking upwards to power, 413–14; in US, 294–7 Fat and Proud (Cooper), 295 fat authenticity: about, 21, 374; as combination of identificatory practices, 374; as constraint vs. resistance, 374; fat phobia vs., 391; as gendered, 374; and normalization, 389; in online dating, 387–8; and over-reporting of weight, 389, 391; as public acknowledgment of knowledge of bodies, 391; resistance and, 389, 390–1; selfing and, 374; and spoilage/spoiled identities, 374, 389–91, 392. See also authenticity

fat cells, overeating and, 194 Fat Chance (National Film Board), 314n2 fat children. See overweight children Fat Femme Mafia, 14 Fat Is a Feminist Issue (Orbach), 297, 300 “Fat Liberation: A Wages for House­ work Perspective” (Boschman), 297 “Fat Liberation Manifesto” (FU), 293, 297 fat oppression: critiques of, 297; diversity of experience of, 312; and eating disorders, 304; feminine norms and, 293; FU and, 295; healthism and, 15; LAL and, 294; as lesbian feminist issue, 296; LG5 on, 297–8, 300, 301f; NAAFA and, 295; refocusing of attention on, 310; as social reality, 296; and weight preoccupation, 304; and women, 390 fat people: children of, 15; civil rights, 295; equal rights for, 293; financial marginalization of, 309; health insurance and, 15; and health system, 133; NAAFA social networks/activities for, 295; othering in obesity discourse, 228; pathologizing of, 344; representations of, 133–4; stereotypes of, 236; stigmatization of, 295; structural discrimination and, 15 fat phobia: construction of online knowable bodies vs., 390; critical obesity scholarship and, 14; and dietetics students, 162; fat authenticity vs, 391; fat studies and, 14; feminine need for body

456 Index fat and, 14; HAES movement and, 21; healthism and, 15; men and, 386; online dating and, 373, 374, 384, 387; as othering, 14; and overreporting of weight, 391; reasons for, 14; teacher-student relationship and, 251 The Fat Studies Reader (Cooper), 294 Fat Underground (FU), 13 fat women: in artistic representations, 431–2; beauty/fat aesthetics rethinking and, 433; diet industry and bodies of, 293; girls, 428; in online dating, 385, 388; social sites/services for, 13–14; and speaking one’s fatness, 392; ­stereotypes, 309–10 fat/fatness: as abjection, 419; African American people and, 14; alternative understandings of, 344–5; of babies, 199; BMI and, 157; as “bodily trespass,” 124; as body otherness, 429; causes of, 423; colonized body and, 14; as construct, 310; critical studies, 7, 22–3n1, 155; and diabesity, 133; dietetics and, 151, 152, 156, 157–8; dietitians and, 151, 154; as disease, 426; euphemisms for, 419; fat-liberation movement, 13, 293, 296–7; in France, 59; gender and, 13, 134, 310, 313, 392; and health, 157; and heterosexual system, 297; Hispanic people and, 14; historically, in children, 199–200; identification beginning in childhood, 428; as identity category, 308; and ill health, 15, 163; indigenous people in Canada and, 14; in medical literature, 66; models of,

58–9; modernity and, 14; nutrition and, 151; obesity vs., 6–7, 61, 150; obsession, 300; online dating and, 373; overweight vs., 7, 150; owning of meaning of, 79; patriarchy and, 14; and physical fitness, 425, 426–7, 428; in political terms, 295; and political/environmental problems, 421; racialization of, 14; as reserve to fight off disease, 200; social context in shaping attitudes toward, 59; sociocultural/economic factors behind, 61; speaking one’s, 390, 392; stigmatization of, 135, 307, 359, 390; terminology of, 6–7; as threat to global health, 124; as unhealthy, 12–13, 163; in US, 59. See also medicalization of fat/fatness; obesity; overweight fathers: in medical literature, 75, 76f. See also parents Fausto-Sterling, Anne, 422, 423 F.E.D. (Freedom from Eating Disorders), 303 Federal Trade Commission (FTC; US), 278 Fee, Margery, 16, 94, 130 femininity/feminine culture: acceptance vs. liberation from norms of, 294; appearance of girls’ bodies and, 427; fat activism and, 312; fat authenticity as spoilage of, 390–1; feminism vs., 305; among girl students, 263–4; idealized, 421; norms and oppression of fat women, 293; PP&P and, 310; thinness norms, 293; women’s world view and, 312 feminism: and beauty, 432–3; bioethics vs. feminist bioethics, 430; and

Index 457 biomedicine, 421; black feminists and, 308; and body norms/ideals, 419; and body-becoming theory, 420; cultural, 299; and dietetics, 151; and eating disorders, 419; and emotional eating, 255; and fat activism, 21, 299–300, 302; and fat liberation movement, 296; feminist aesthetics, 433; fragmentation of, 299; FU and, 295; and government health-care programs/ policies, 302; and health, 300, 302; LAL and, 307; lesbianism and, 295–6, 300; loose connections/ informal networks in, 298; and overweight children, 275–6; participation in feminine culture vs., 305; post-structural research and discourses privileging identities, 220–1; productive nature of, 305, 310; and professionalization, 165; and race, 308, 309; radical, 295; and representation, 421; and social constructionism, 421–2; theory, and HAES, 409; and weight, 12–13 Ferguson, Fall, 412–13 Ferraro, K.F., 135 Fiddler, Albert, 97 Fiddler, Flora, 97, 99–100, 103 Fireweed, 310 First Nations. See Aboriginal peoples fitness. See physical fitness Fleck, Ludwik, 57 Flegal, K.M., 4 food: complexity of choices, 335; cultural meanings of, 203–4; emotional eating, 254–5; mothers and family, 192, 205–6; new categories of, 274; nutritional value of, 190; processed, 274–5; in schools, 246;

take-out/fast, 234–6; teachers and, 256–8; in VOD, 350; women and, 258, 282, 323. See also diet/dieting; eating; traditional foods food access: and healthy eating, 336; and indigenous communities, 183; and obesity, 183 food advertising/marketing: and ages of children, 281, 285–6; “better for you” products, 277, 280, 281, 285; and childhood obesity, 275; to children, 277, 278–81, 283, 285–6; individual vs. food industry, 285; legislation, 276, 277–81, 282, 283, 287n4; and overweight children, 276; restrictions on, 276; and risk to children, 279, 280. See also CAI (Children’s Food and Beverage Advertising Initiative) food industry: and childhood obesity, 274, 275, 278–9, 280. See also CAI (Children’s Food and Beverage Advertising Initiative) “The Forgotten Woman: For Fat Women Only” (workshop), 13 Foucault, Michel: and assujetissement, 387; on biopolitics, 364n5; and biopower, 224, 352, 363n1, 364n2; and body, 360, 363; and governmentality, 220; and indigenous knowledge/peoples, 94; on language, 348; on liberalism, 364n2; and medical-genetic gaze, 110; and othering, 94; on project of self, 225; on self-formation, 388 Fraggalosch, Grant, 348–9, 350, 355, 358, 359–60 France: attitudes toward dieting/ weight in, 59; body weight statistics in, 49

458 Index Fraser, Laura, 58 Fraser, Suzanne, 255 Freedman, Estelle, 12 Freespirit, Judy, 293 Frohlich, Katherine L., 231 Frueh, Joanna, 433 FU (Fat Underground): about, 399; Boston Area Fat Liberation and, 296; disbandment, 295; “Fat Liberation Manifesto,” 293, 297; and fat oppression as lesbian issue, 295–6; and feminism, 295; formation of, 293; LAL and, 294; Partridge and, 294; schism with NAAFA, 295 Fullertone, S.M., 114 Fusco, Caroline, 231 Gailey, Jeannie A., 386, 395n15 Gard, Michael, 17; on body/mind split in HAES, 411; on children’s life expectancy, 279; on neoliberalism and obesity alarmism, 345; on obesity epidemic as moral panic, 424; on obesity epidemic rhetoric,­ 127; and obesity statistics, 188; and population-level data in Canada, 59–60, 79; on television watching and overweight, 227 Garner, David, 10, 302, 303, 315n20 Garner, David, “Cultural Expectations of Thinness in Women,” 302 Garriguet, D., 48 gender: and authentic self-­ representation, 387–8; and body weight/socioeconomic status, 46; and childhood obesity, 43–4; and combined obesity/overweight, 48; in dietetics, 168–70; fat activism

and norms of, 299; and fat authenticity, 374; and fatness, 13, 134, 310, 313; interventions and, 9; and obesity/overweight rates/prevalence, 41–2, 43, 59; and on- vs. offline behaviour, 381–2; in online dating, 382, 383–4, 388; of patients, health professionals and, 135; patriarchy and roles, 21; and physical fitness, 9; and power relations, 386, 392; replicability and, 381; and students’ bodily changes, 263–4; in Taylor (BC), 356; in teenage body image, 200. See also men; women Gender Trouble (Butler), 220 General Mills, 278, 280 Genetic Nature/Culture (Goodman; Heath; Lindee), 92 genetics: and Aboriginal peoples, 104, 110, 111; bioethnic conscription and, 94; and determinism, 110–11; and diabetes, 89–90, 93, 99–100, 102–3, 108–9, 111, 113–14, 122; ethnicity in, 92; geneticization defined, 92; homogeneity, 102–5; and indigenous peoples, 16, 93–4, 104, 112; and individual responsibility, 109; and Mexican Americans, 94; and obesity, 16, 111; race/racism in, 92, 113; risk and preventative action, 110; and risk populations, 106; Sandy Lake Oji-Cree and, 100–1, 102–3, 107; stereotypes and, 104–5; and surveillance, 110; and thrifty gene theory, 93. See also thrifty gene theory Germov, John, 70 Gibson-Graham, J.K., 402, 404–5, 406, 410, 413

Index 459 Gillingham, Ruth, 298 Gingras, Jacqui, 18–19, 21–2; on dietetic culture, 165; on dietetics career, 152–5, 159; and dominant dietary discourse, 196; “Health at Every Size,” 61; on learning curve for dietetics students, 163; politicization of, 166 Gleason, Mona, 275 Global Strategy on Diet, Physical Activity and Health (WHO), 336n1 globalization: and obesity, 336n1; and overweight prevalence in poorer vs. Western countries, 46 Goffman, Erving, 132, 227, 388, 390 Goldbloom, Alton, The Care of the Child, 198 Gong, S., 59 Goodman, A., Genetic Nature/Culture, 92 governing at a distance: neoliberalism and, 351; surveillance and, 360; of VOD, 347 governmentality: meaning of, 225; normalizing practices and, 363–4n1; and obesity discourse, 220, 363–4n1; power relations and, 225 Grace, A.P., 407 Gracey, M., 114 Great Depression. See Depression greatness: children and, 283–4, 285; individual responsibility and, 284 “La grosseur: Obsession? OPPRESSION!” (LG5), 300, 301f Grosz, Elizabeth, 228, 422, 423 Groupe de travail provincial sur la problématique du poids, 60 Gruys, K., 59

HAES (Health at Every Size): about, 399–400; and Aboriginal peoples, 181–2; diet industry and, 408; dietitians and, 152, 167, 168; diversity of, 399; and fat phobia, 21; feminist theory and, 409; and fit-and-fat imperative, 412–13; as fluid vs. fixed identity, 413; four steps of living lifestyle of, 401; and health, 400, 414; and healthism, 21, 401, 402, 405–6, 408, 409, 411, 412, 414; and healthy behaviours, 401, 409, 410, 411–12; and human rights basis, 413; and individual vs. social choices, 409; and lifestyle activities/changes, 406, 412; mandate, 399; and marginalizing discourses, 414; marketing of diet-related products, 400; meaning of, 412– 13; and mental health, 412; and micro-moments of activism, 413, 414; and mind/body binaries, 21, 411; and neoliberal individual responsibility vs. advocacy, 406; as open to free engagement, 408; politicization of, 403, 414; and politics of postponement, 402, 404–6, 409, 414; principles/tenets of, 399, 400, 409; queer theory/ queering and, 21–2, 403, 406, 408, 409–15; reflexivity and, 414–15; scholarship, 400, 401–2, 403, 406; and social justice, 406, 413; as social movement, 403; thin privilege and, 411; trademarking of, 408–9, 414; and war on obesity, 412; and weight neutrality, 399, 402, 410–11; and weight-centred paradigm, 399, 400–5, 409–11, 414

460 Index Haig, G.T., “Suppose Tommy Won’t Eat,” 193 Hainsworth, Brad E., 280 Hales, C.N., 99 Halse, Christine, 249, 357, 358 Hanley, F.W., “A Nutrition Survey among School Children in British Columbia and Saskatchewan,” 34–5 Hann, Alison, 233 Happy Meals (McDonalds), 276, 285 Haraway, Donna, 91 Harris-Benedict Equation, 408 Harry, Debra, 104, 110 He, M., 44 health: Aboriginal concept, 99; biomedical vs. social determinants of, 72–3; BMI and, 154; body size/ shape and, 248, 250; children’s constructions of, 220; children’s decisions about, 277; as choice, vs. inequities in living conditions, 248; colonization and, 114; construction of, 57; and denial of pleasure, 233, 234–6; excess weight and, 11; fat/fatness and, 12–13, 15, 157, 163; HAES and, 400, 414; history of children’s, 190–2; individual vs. social/ political/cultural determinants of, 163; insurance and fat people, 15; knowledge and transmission in schools, 245, 246; lifestyle and, 247; media use and, 228; neoliberalism of governmentalities, 20; as preoccuption, 218; risk behaviours/­factors, 4, 133, 137–8; slenderness/thinness and, 6, 250, 330; social determinants of, 72–3, 77, 114, 163, 262–3, 356, 403, 406,

430; as social justice issue, 363; social regulation of, 190; stigmatization and, 15–16; structural racism and, 177; of Vancouver, 375–6; weight and, 4, 154, 177, 237, 259, 363, 400, 402; of young, 190. See also public health Health, 193 Health and Welfare Canada: Canadian Guidelines for Healthy Weights, 10–12, 60; Fitness and Amateur Sport, 302; Promoting Healthy Weights, 302–3 “Health at Every Size” (Gingras), 61 health behaviours: HAES and, 409, 410, 411–12; non-performance as moral failure, 401; surveillance of teachers’, 251. See also lifestyle(s) Health Canada: 2003 guidelines, 12; creation of Department of Health, 7, 190; Healthy Canadians 2008 Federal Report, 60; and obesity as risk factor for diabetes, 131; weight reports, 225 health care professionals/­providers: and Aboriginal communities, 175–84; and consequential/­ deontological ethics, 429–30; control discourse in, 401; and overweight, 135–7; patient gender, and attitudes toward overweight, 135; power relations with patients, 156. See also dietitians health care services/system: access to, and increase in incidence of diabetes, 126; affects and, 324; costs, and health promotion, 9–10; costs of access, 183–4; diabetes epidemic and, 127; fat people and, 133; and individual blaming, 178;

Index 461 obesity demands on, 4; obesity epidemic and, 3; social justice and, 403; stigma and avoidance/ delay in, 137; universal, 79, 183–4, 190. See also public health health discourses: and Aboriginal peoples, 92–3; and childhood obesity, 236–7; individual responsibility in, 218; individual risk in, 218; in schools, 246; teachers and, 264; and teachers’ bodies, 256. See also healthism health programs/policies: and affects, 324; body weight statistics and, 49; dieting and healthy weights, 302–3; feminism and, 302; and National Dialogue on Healthy Weights (NDHW), 342–3; physical activity campaigns, 425–7. See also Health and Welfare Canada; Health Canada; ParticipACTION; public policy health promotion: Aboriginal peoples and physical activity, 181; and emotional eating, 254–5; and free play, 231; Lalonde Report and, 9–10; and media use, 254–5; neoliberalism and, 180–1; in Newfoundland and Labrador, 328; and obesity rates, 321; and pleasure, 233; public-private partnerships and, 354; risk in, 223; in schools, 246; and sedentary lifestyle, 254; weight-loss-driven, 400 healthism: about, 247–8; and biocitizenry, 249, 252; body-becoming approach to bioethics vs., 430; definition of, 393n5, 401; and fat oppression/phobia, 15; “good fattie” vs., 410; HAES and, 21,

401, 402, 405–6, 408, 409, 411, 412, 414; and individual responsibility, 15, 286; and malnutrition, 192; medicalization and, 393n5; neoliberalism and, 15, 223; and obese children, 232–4; risk within, 222; teachers and, 248, 250; and teachers’ bodies, 253; teacher-student relationship and, 248; and weight gain/loss, 258. See also health discourses; individual responsibility “Healthsharing” (journal/collective), 302 Healthy Bodies Come in Different Shapes and Sizes (Body Image Network), 246–7, 265–6 Healthy Canadians 2008 Federal Report (Health Canada), 60 healthy eating: affective biopolitics­ and, 329, 334; and cultural identity, 336; food access and, 336; knowledge in Newfoundland and Labrador, 320–1, 328, 329–30, 335, 336; and lower weight/ weight loss, 330; and negotiation with obesity discourses, 21; Newfoundlanders and, 21; social class and, 328; traditional foods and, 321, 330–1, 335. See also eating Healthy Weights for Healthy Kids (House of Commons Standing Committee on Health), 279 Heart and Stroke Foundation of Canada, 351, 354 Heart Health Surveys, 32, 42 Heath, D., Genetic Nature/Culture, 92 Hee, M., 114 Hegele, R.A., 90, 100–1, 103, 105, 107, 108–9, 112; “Clinical Utility of

462 Index HNF1A Genotyping for Diabetes in Aboriginal Canadians,” 107 height/weight data. See under weight statistics/data heredity/family history: and childhood/teenage obesity, 194; and diabetes, 122, 130. See also genetics Herman, Peter, 10; Breaking the Diet Habit, 302 Hermiston, Alana, 196–7 Herndon, April Michelle, 188–9, 197 Herrick, Clare, 354 Hersize: about, 312; difference from other groups, 303–4; disbandment, 308; and fat oppression, 307–8; F.E.D. and, 303; formation of, 10, 303; and magazines, 303; and weight preoccupation, 303, 307–8; and women of colour, 308–9 Heuer, C.A., 135–6, 162 Heyes, Cressida J., 389 Hill Collins, Patricia, 167, 168 hogging, 386, 395n15 Holland, K.B., 135 Holmes, B.J., 61 House of Commons Standing Committee on Health, Healthy Weights for Healthy Kids, 279 “How the Diabetes-Linked ‘Thrifty Gene’ Triumphed with Prejudice over Proof” (Abraham), 112 Human Genome Diversity Project, 96 Hunt, Alan, 279, 281 Hunt, John, 10 Hux, Jan, 127, 128; “Picture of an Epidemic,” 127 hysteria, meaning of, 23n2

Iacovetta, Franca, 8 identity: fat activism and, 299, 309, 313; fat as category of, 308; fat authenticity and, 374; healthy eating and cultural, 336; queer theory and, 309; traditional foods and, 321–2 Ikeda, Joanne, 153 illness. See disease(s)/illness immigration, 8 indigenous peoples: classism/racism and, 177; diabesity and, 129; and diabetes, 89, 93–4, 112; and fatness, 14; food access and, 183; life expectancy, 48; obesity in, 48, 176; othering of, 94; and overweight, 48, 177; social determinants of health in, 356; stereotypes regarding, 104–5, 180; world views, and Western science, 94–5, 96–7, 109. See also Aboriginal peoples individual responsibility: adult vs. childhood obesity and, 275; blaming and, 17; childhood obesity and, 220, 229–30, 237; childhood obesity and age of, 285–6; children and, 285–6; civic engagement vs., 358; collective solutions vs., in medicalization of fat, 78; for diabetes, 132; in dietetics, 163–4; for food consumption habits and body size, 286; and geneticbased disease, 109; and greatness, 284; for health decisions, 163; in health discourses, 218; healthism and, 286; for obesity, 176–7, 218; obesity epidemic and, 352; for risk factors/management, 109, 137–8; social-determinants model vs., 73, 79, 163, 353, 406; teens and,

Index 463 202; in VOD, 359; for weight loss, 20. See also healthism; neoliberal individual responsibility infants: fat babies, 199; fatness in, 199; mortality rates, 7, 190; nutrition and, 7. See also children International Classification of Diseases, 57 internet: and cybertypes, 386–7; and deception, 380; embodiment vs. fluidity of self in/on, 386–7; face-to-face vs. communication via, 379; as self-enclosed cyberian apartness, 375; trust in, 380. See also media use; online dating Inuit: lifestyle, 101; malnutrition among, 201; Sandy Lake Oji-Cree compared, 101, 105; seal hunt and, 182 Ipsen, J., Epidemiologic Methods, 37 Irwin Toy, 277–8 Jasper, Karin, 315n20 Jennings, Laura, 60–1 Jenny Craig, 15 Jette, Shannon, 20, 163, 258, 282 Jiggs dinner, 326, 331, 332–3 Joanisse, L., 135 “Jogger” commercial (Nike), 272–3, 274, 275, 282–3, 284–5 Jutel, A., 49, 60 Kaizer, Nancy, 305, 307 Karpf, Anne, 280 Katz, David, 272 Katzmarzyk, P.T., 38–9, 41, 42, 47, 60 Kautiainen, Susanna, 228 Kendall, Lori, 381–2 Kenzitt, Jamie, 359 Keratin Inuit. See Inuit

Kilbourne, Jeanne: Killing Us Softly, 303–4; Still Killing Us Softly, 304 King, M., 114 King, R., 327–8 Kipnis, Laura, 309 Kline, Steven, 275 Krieger, N., 37 Kristeva, Julia, 419 Kruks, Sonia, 299 Lady Sasquatch (Mitchell), 432 Lafrance, Melisse, 360 Lalonde Report, 9 Lamm, Nomy, 432 Lamont, Michèle, 236 Large as Life (LAL): about, 13–14, 312; aims of, 294, 304–5; The Bolster, 305, 307; and community of fat women, 307; and fashion, 305, 306f, 307; and feminine culture, 305; and feminism, 305, 307; formation of, 294, 304–5; and personal acceptance vs. liberation from feminine norms, 294 Laski, Bernard, 193–4 Latour, Bruno, 57 Lauer, Matt, 285 Lavalife, 380, 381, 388, 395n11 Lavallee, Barry: about, 20, 175; on colonization, 182–3; and critical medical education, 175, 176; on deficit thinking, 177–9; on food access, 183; on individual responsibility/blaming, 176, 178, 179; on lifestyle, 182–3; on microaggressions, 179–80; on obesity as moral failure, 176; on physical activity/movement promotion, 181; and problem-population designation, 175; on stereotypes

464 Index of Aboriginal community, 177, 180; on structural racism and death/disease, 177–8; on universal health care system, 183–4; on weight and health, 177, 180–2 Leader, Audrey, 92–3, 110 Leahy, Deanna, 251, 261 LeBesco, Kathleen, 133, 227, 232, 275 LeBlanc, Gilles, 313n2 lesbian feminism: FU and, 295–6; and LG5, 300; loose connections/ informal networks in, 298 Lesbian Herstories and Cultures (Dykewomon), 294 lesbians/lesbianism: and fat vs. thin women, 297–8; feminism vs., 300 Leslie, Ann, 305 Leslie, R.D.G., Causes of Diabetes, 98 Levinson, N., 159, 166 LG5 (Lesbiennes grosses cinq): about, 13, 312; Amazones d’hier, 300, 301f; and fat oppression, 297–8, 307–8; formation of, 300; “La grosseur: Obsession? OPPRESSION!,” 300, 301f; lesbian feminism and, 300; and NAAFA Canada, 298; on patriarchy, 300; on politics, 300; and weight preoccupation, 307–8 life expectancy: childhood overweight/­obesity and, 219, 279; and increase in incidence of diabetes, 126, 127; indigenous Canadians and, 48; obesity and, 31; physical fitness and, 4; as rising, 424. See also mortality rates lifestyle(s): Aboriginal peoples and, 101, 182–3; childhood obesity and, 283; and chronic diseases, 130–1; and diabetes, 98–100, 107, 112,

113, 128, 130–2; diseases, 40–1, 124, 131–2; HAES and, 406, 412; and health, 247; identification of high-risk subjects and, 107–8; modifiable vs. non-modifiable factors in, 131, 138; and obesity rates, 321; preventative measures against disease and, 108, 110; risk and, 110, 137–8; in VOD, 349, 350, 356, 358, 362; weight-centred paradigm and, 406. See also sedentary lifestyle Lin, M.-C., 394n8 Lindee, S.M., Genetic Nature/Culture, 92 Lindsay, Lionel M., 193, 194, 205 Lippmann, Abby, 92 Liquori, T., 168–9 Live Right Now, 350–1, 353–4 Loblaw’s, 351 longevity. See life expectancy Lorde, Audre, 402; “The Master’s Tools Will Never Dismantle the Master’s House,” 415n2 Louderback, Llewellyn, “More People Should Be Fat,” 295 Louis, M., 137 Luckmann, Thomas, 57 Lupton, Deborah, 7, 162 Lyon, D., 104 MacNeill, Margaret, 424 Mahera, Jane Marie, 255 makeover reality television. See reality television malnutrition: Depression and, 192; and diabetes, 99; diet and, 7, 190; healthism and, 192; height/ weight charts and, 190; history of, 7; mother blaming for, 192–3,

Index 465 194; overweight children and, 189, 193–4, 205; products addressing, 191–2; and public health interventions, 7; reasons for, 192; underweight children and, 189, 190, 193–4, 205; working mothers and, 193. See also eating disorders; nutrition Manitoba Centre for Health Policy, 4 Mannheim, K., 57 marginalization: body size and, 307; and diabetes, 108; financial, 309; HAES and discourses of, 414; moral agency of groups, 430; nutrition science and othering, 400–1; power relations within groups, 168 Marks, J., 104 Marx, Karl, 57 “The Master’s Tools Will Never Dismantle the Master’s House” (Lorde), 415n2 Mayer, Vivian. See Aldebaran (Vivian Mayer) McCarthy, D.J., 126 McCullough, J.W.S., 197 McDermott, L., 73–4 McDermott, Robyn, 93 McDonald’s, 234–6, 276, 280 McHenry, E.W., 198, 202 McLaren, L., 46 McMahon, B., Epidemiologic Methods, 37 McNaughton, Darlene, 18, 75, 123, 124, 126, 127–8, 134, 137–8 McNeal, James, On Becoming a Con­ sumer, 281 McPhail, Deborah, 20–1, 203, 236, 255, 263; “Cod Tongues and Corpulence,” 322

measurement(s): biopedagogies of, 360–1; of children, 33–4; and communitarian ethic, 360–1; impulse to collect population-scale data, 33–4; and solutions to obesity epidemic, 48; standardization, obesity discourse and, 41; surveillance of, 225–6; in VOD, 359–61, 362–3. See also statistics media: corporate control over, 353; and diabetes epidemic, 129; and eating disorders, 304; images, and race, 308; images of women, 303–4; on larger children, 227; and obesity epidemic, 61, 349; and weight preoccuption, 304 media use: and health, 227, 228; health promotion and, 254–5; video games, 227, 228, 229, 232 medical education: critical, 175; health problems in, 176; hidden curricula in, 176 medicalization: about/defined, 57–8; of childhood obesity, 74–5; dominance over medical in literature, 75–6; and entrepreneurialism, 38; and evolution of medical language, 67; health-industrial complex and, 70–1; and healthism, 393n5; of mothers, 78; and power relations, 58; and social control, 57–8; in terms overweight/­ obesity, 157 medicalization of fat/fatness: about/extent of, 78; aspects in literature, 64–75; BMI and, 78; and dieting, 72; individual vs. collective responsibility/solutions, 73, 78, 79; medical language in, 65–8, 76–7, 78; in medical literature, 66;

466 Index medical solutions in, 69–72, 73, 78; and moral panic, 78; previous perspectives on, 58–61; psychiatry and, 71; publication trends in, 62–3; universal health care and, 79; in U.S. compared to Canada, 78–9 men: and body weight/socioeconomic status, 46; and fat phobia, 386; hogging by, 386; overestimation of height, 39–40; overweight/ obesity prevalence, 41–2; and women’s weight, 384–5, 387. See also gender Mendelson, R., 46–7 mental health: HAES and, 412; in medical literature, 71–2, 77; medicalization of fatness and, 71; obesity as issue, 8; stigmatization and, 15 Merton, Robert K., 57 Mexican Americans, genetic epidemiology and, 94 Mexican indigenous groups, and diabetes, 115 Meyer, John, 61 Michigan Womyn’s Music Festival, 296, 297 micro-aggression, 179–80 Mikkonen, Juka, 248 Miller, Peter, 280 Million Pound Challenge, 350, 361 mind/body binaries, 21, 22, 411 Mindlin, Jan, 305 “Miss C Diet Book” (Chatelaine), 194 Mitchell, Allyson, 391, 432, 433; Lady Sasquatch, 432 Mitchell, R., 136 Mitchinson, Wendy, 7, 19, 223, 262, 282

Mokdad, A.H., “The Continuing Epidemics of Obesity and Diabetes in the United States,” 128 Monaghan, Lee, 134, 345, 411 Monagle, J.E., 198 Monroe, Marilyn, 303 Montoya, Michael J., 94, 114 Moon, Michael, 389–90, 390–1, 392 moral failure: non-performance of health behaviours as, 401; obesity and, 11, 176, 275 moral panic: medicalization of fat and, 78; obesity discourse as, 56; obesity epidemic as, 18, 124, 344, 424, 425 morbid obesity: as degree of overweight, 68; and health, 4 morbidity, 148–9, 163, 400 “More People Should Be Fat” (Louderback), 295 Moreno Figueroa, Mónica, 433 mortality rates: excess body weight and, 400; infants, 7, 190; obesity and, 31, 163; overweight and, 31, 149. See also life expectancy Mosby, I., 35 mother blaming: for childhood obesity, 194, 195–6, 205–6, 282, 427; for children’s eating habits, 195; for children’s weight management, 19; Depression and, 192; history of nutrition and, 190; for malnutrition, 192–3, 194; nostalgia for past and, 188–9; in obesity discourse, 188; for overeating/ obesity, 8; parent blaming vs., 187; reasons for, 187; surveillance of children/risk protection and, 189 mothers: and body image, 200–1; and body weight, 200–1; and

Index 467 calories, 197–8; and childhood obesity, 19, 74–5; and children’s eating, 202–3, 427; family dynamics and, 203–4; and family food/ meals, 187, 192, 205–6; as gatekeepers to children/teens, 192; in medical literature, 75, 76f, 77–8; medicalization of, 78; and nutrition, 189, 193, 196–7, 198–9; and obesity epidemic, 75; responsibility for children’s physical/social body, 262; and responsibility for obesity, 345; role of, 19; surveillance of children by, 195–6; and teenaged girls, 202; and weighing of children, 197; working, 193 Murphy, Peter, 163 Murray, Samantha, 223, 284, 390, 392 NAAFA (National Association to Advance Fat Acceptance): about, 13, 293, 399; as assimilationist social movement, 296; formation of, 295; and gender/health, 296; radical/feminist branches, 296; schism with FU, 295; shift of mandate, 295; and weight-centred health ideology, 399 NAAFA Canada, 298; and LG5, 298 NAAFA-Canada, 13 Nakamura, L., 386–7 National Center for Biotechnical Information (NCBI), 62 National Dialogue on Healthy Weights (NDHW), 342–3, 351, 352 National Eating Disorder Information Centre, 12 National Film Board, Fat Chance, 314n2

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 98 National Institutes of Health, 60; on BMI, 68 National Longitudinal Survey of Children and Youth, 43 National Physical Fitness Act (1943), 9 National Population Health Survey, 126 Neel, James V., 89, 97–8, 102 neo-institutionalism, 56 neoliberal individual responsibility: and Aboriginal peoples, 20; advocacy vs., 406; body size as, 220–1; and childhood obesity, 426; children and, 19, 233, 237; and colonialism, 20; defined/meaning of, 351–2; and dominant obesity discourse, 345; HAES and, 406; healthism and, 15; social structure in obesity epidemic discourse vs., 17; in VOD, 362 neoliberalism: Aboriginal communities and, 20; and biocitizenship, 361; and body weight, 259; and children as incomplete subjects, 224; defined/meaning of, 351–2; and education/health promotion, 180–1; and governing at a distance, 351; of health governmentalities, 20; and healthism, 223; and public-private partnerships, 353–4; and reality makeover television, 347; and responsibilization, 280; and risk, 162, 237; and schools/pedagogical practices, 247, 248; in VOD, 352, 358–9 Nestle, Marion, 276

468 Index new materialism, 422–3 New Zealand, obesity as obstacle to seeking support in, 136–7 Newfoundland and Labrador: construction as problem population, 263; fatness in, 219; fisheries closure in, 321; health promotion in, 328; knowledge about healthy eating in, 21, 320–1, 328, 329–30, 335, 336; obesity rates, 20–1, 320, 322, 327, 328, 330–1; poverty in, 321, 328; public policy in, 328; rural areas of, 335–6; school resources on body image, 246–7; social classes in, 321, 323, 328, 335; socioeconomic status in, 320, 321, 328, 335; stereotypes regarding, 21, 320–1, 327–8, 329–30, 335; traditional foods in, 321–2, 326, 327, 335 NIDDM (non-insulin-dependent diabetes mellitus). See diabetes Nike, “Jogger” commercial, 272–3, 274, 275, 282–3, 284–5 Nkongolo, K.K., 113 The Normal Child (Brown), 197 normalization/normativity: and biocitizenry, 251; and biopedagogies, 363–4n1; biopolitics and, 364n5; of body size, and “abnormal,” 223; body-becoming theory and, 431; of children and construction of obesity, 224; children outside, 237; curricula and, 427; and defining obesity, 344; fat authenticity and, 389; gendered/ racialized norms and online dating, 382; and governmentality, 363–4n1; and healthism, 250, 258, 363; hetero-, 378, 381, 382, 388, 389–90, 392, 407; of ideal body

weights, 363; and ideal of healthy bodies, 251; makeover television and, 346; norm binaries, 429; of obesity discourse, 4, 324, 344; and power, 96; resistance to, 260, 265, 266; in science, 96; and selfing, 381; spoiled identities and, 392; and surveillance, 360, 363; teachers and body, 251; and teachers’ bodies, 252–3; and universalization of women, 307–8, 309; in VOD, 359; of women in online dating context, 389 Norman, Moss, 20, 163, 258, 282 Norway, childhood obesity in, 47 nutrition: advertisements, 196–7; advice regarding, 196, 198–9; body image vs., 202; children and, 34–5; children’s decisions about, 277, 281; dietitians and, 158–9, 160–1; education in schools, 202; and fat/fatness, 151; history of, 7–8, 190–3; and infants, 7; magazines and, 196; and marginalized Other, 400–1; and meal plans, 205; mothers and, 189, 193, 196, 198–9; and obesity, 7–8, 148, 155, 190–3; over-, 35 (see also overeating); in public health, 35; in public policy, 35; in schools, 199; teenagers’ sense of, 194; and weight of children, 36–7. See also dietetics; malnutrition Nutrition Canada, 198 Nutrition Canada Survey (NCS), 191, 201 Nutrition Services Division, 7, 34 “A Nutrition Survey among School Children in British Columbia and Saskatchewan” (Pett; Hanley), 34–5

Index 469 obese children: and BMI, 229, 230, 231; as consumers, 273, 275; denial of pleasure, 233–6; embodied experiences, 219, 237; and healthist labels, 232–4; and individual responsibility, 20, 220, 229–30, 237, 285–6, 426; meanings of social experiences, 221; and media use/ video gaming, 227, 228, 229–32; negotiation/resistance of dominant discourses, 221; normalization, and construction of, 224; and obesity discourse, 230, 237; physical activity, 226, 227, 232–3; and risk discourse, 237; sedentary activities, 227, 228, 232–3; self-representations, 232–4; and self-responsibility, 220; surveillance of, 229, 231; and take-out/ fast food, 234–6; taking responsibility for size, 285; as “ultimate at-risk” children, 224, 237; weight, and identity of, 230; and weight discourses, 229. See also childhood obesity; overweight children obesity: awareness, 188; as behavioural problem/disease, 8, 424; BMI and, 135, 150; causes behind, 60; contemporary issues in Canada, 14–17; cost of, 3; definition of, 35; as degree of overweight, 68; development of fatness into, 61; epidemiology and, 32–7; fatness vs., 6–7, 150; globalization and, 336n1; and health consequences/outcomes, 76, 125; historical perspectives, 5–14; history of nutrition and, 7–8; meanings of, 22–3n1; in medical literature, 66, 67f, 76–7;

medicalization of, 38; moral character of, 11, 176, 275; morbid, 4, 68; multidisciplinary perspectives on, 3–4; as obstacle to seeking support, 136–7; popularization of term, 65; prevention of, 218; psychological causes, 195; reductionism and, 176; representations of, 20; as state of ill health vs. bodily state, 126; structures/ influences underlying, 176–7; terminology of, 6–7; as threat to global/national­ health, 125. See also diabesity; overweight obesity discourse(s): and Aboriginal peoples as problem populations, 175; affect and, 324; alternative narratives to, 345, 358–9, 363; and at-risk bodies, 344; and biopower, 324; children’s living conditions and, 263; construction-of-reality framework, 56; and definitions of overweight/obese, 41; fat identity within, 227–8; and fat other, 228; as global news story, 38; governmentality and, 220, 363–4n1; and healthist labels, 234; and individual vs. social/political/cultural determinants of health, 163; as moral panic, 56; mother blaming­ in, 188; and negotiation with healthy eating, 21; obese children and, 230, 237; as obesity truths, 344, 345, 348; and online dating, 21; and power relations, 348; and precision in monitoring body weights, 41; problem populations and, 20–1; rational asceticism and, 163–4; and risk discourse, 224; and sedentary activities, 227; and

470 Index social norms, 324; and surveillance, 250–1; teachers and, 250–1, 252–3, 263; and traditional foods, 322; and VOD, 349; and weight categories, 230; and Wii Fit gaming system, 229; and youth, 20 obesity epidemic: biopedagogies and, 425; BMI and, 3; childhood obesity and, 187, 221, 425; classism and, 328; construction of, 50; and consumer’s ideal vs. actual self in advertising, 284; critical studies and, 170; and diabetes, 127; dietitians and, 148, 165; diet/ weight-loss industries and, 354; end of, 424; and fat children, 424; as global, 65, 124–5, 342; individual responsibility for, 352; measurement, and solutions to, 48; media and, 61, 349; mothers and, 75; ­obesity myth vs., 420–1; obesity statistics and, 18, 51; problem populations and, 16–17; promiscuity of, 31–2; public health discourse and, 342; public policy and, 276; and reality makeover television, 346; and response to risks, 125–6; as rhetorical virus, 79; and rise in prevalence of overweight/obesity, 42–3; risk vocabulary within, 225; spread of predictions regarding, 31–2; story metaphor, 343–6; and teenage obesity, 187; threat to health posed by, 421; as weight management experts, 148; weight preoccupation vs., 23n4 Obesity in Canada (Public Health Agency of Canada), 336n1 Obesity or Excessive Corpulence (Dancel), 5–6, 7

obesity panic/crisis: affective biopolitics and, 329, 335; and embodied affects of hunger/ taste, 323; evidentiary basis vs. urgency regarding, 325; as moral, 18, 124, 344, 424, 425; nostalgia for idealized past and, 325–6; optimal health and, 218; and precision in monitoring body weights, 41; public health and, 56; traditional foods and, 335. See also war on obesity Obesity: Preventing and Managing the Global Epidemic (WHO), 59–60, 65, 124, 125 obesity rates/prevalence, 56; education and, 321; in First Nations people, 180; gender and, 59; health promotion and, 321; increase vs. plateauing in, 125; increases in, 40f, 41–3, 126–7, 128; lifestyle and, 321; medical publications on obesity vs., 344; in Newfoundland and Labrador, 320, 322, 327, 328, 330–1; obesity epidemic and rise in, 42–3; plateauing/levelling of, 125, 424; plateauing/reversing of, 46, 48; research community response to, 76; sedentary lifestyle and, 342; self-reported data and, 42, 45–6; socioeconomic factors and, 60, 335; traditional foods and, 327 obesity research: attitudes toward obesity statistics in, 48–9; directly measured data in, 32–3; generalizing of findings regardless of context, 32; and policy, 60; response to obesity rates, 76 obesity science: alternative stories to, 363; and anti-fat discourse, 164;

Index 471 and behaviour monitoring, 7; critical dietetics vs., 170; critical scholarship and, 17, 50; development of, 35–6; LAL and, 294; and public policy, 7; school culture and, 19 obesity statistics: about, 17; as artefacts, 49; attitudes in obesity research, 48–9; changes from year to year, 48; critical obesity scholarship and, 50; divergence in, 45; geographic ranges in Canadian, 48; and obesity epidemic, 18, 51; overweight statistics combined with, 40f, 41–3; precision of, 48–9; self-reported data in, 33 obesogenic environments, 16, 17, 224, 261, 285, 429 O’Brien, K., 135 Obsession: Reflections on the Tyranny of Slenderness (Chernin), 300 O’Dea, Jennifer, 261 Ogden, C.L., 46 Ogilvie, G.F., “The Canadian Weight-Height Survey,” 35, 36 Oji-Cree of Sandy Lake. See Sandy Lake Oji-Cree Oliver, J. Eric, 70–1 Olshansky, S.J., 31 On Becoming a Consumer (McNeal), 281 O’Neil, John, 92–3, 110 online dating: authenticity in, 380, 386; conventional forms of dating vs., 382–3; deception in, 384–5; fat authenticity in, 387–8; fat phobia and, 373, 374, 384, 387; fat women in, 385, 388; fatness and, 373; gender and, 382, 388; gendered stratification of labour in, 383–4; gendered/racialized norms in,

382; and heterosexual matrix, 382; and ideal/perfect date, 383; impersonality of technology, 378–9; knowability of subjects in, 389–90; learning curve for, 376, 378; men’s behaviour in, 383–4; obesity discourses and, 21; older vs. younger women in, 395n13; performance of self in, 388; personality tests, 382; power relations in, 382, 386; profile completion, 380–1, 382–3; reality in, 379–80; replicability in, 381; same-sex relationships, 394n9; selfing/self-making in, 21, 374; sites, 380–1; tasks of, 394–5n10; vital statistics in, 381; weight deception in, 384–5; women’s vs. men’s weight in, 387 online ethnography, 375 Orbach, Susie, Fat Is a Feminist Issue, 300 Ostry, A.S., 35 The Other Woman, 297 othering: in dietetics, 152; fat phobia as, 14; of fatness, 429; of indigenous peoples, 94; of large children, 222; in obesity discourse, 228 Our Bodies, Ourselves, 298 overeating: and childhood obesity, 425; and childhood/teenage obesity, 194; and fat cells, 194; history of, 7–8; and public health interventions, 7–8. See also eating overweight: and acceptability of bodies, 284; BMI ranges and, 150; in Canadian provinces, 47; and cervical cancer screening rates, 136; classism and, 177; concern with weight vs., 60; conflation with obesity, 130; definition of, 35;

472 Index as degree of overweight, 68; and diabetes, 130, 134, 137; as disease, 295; fat/fatness vs., 7, 150; health consequences, 125; health professionals/health care providers and, 135–7, 295; and healthiness, 4, 11; indigenous peoples and, 177; and lifestyle diseases, 124; in medical literature, 66, 67f, 76–7; and medicalization of body, 157; and morbidity, 148–9, 400; and mortality, 31, 149; obesity discourse and definition of, 41; racism and, 177; as risk factor, 131, 132; scientific footing of, 35–6; as state of ill health vs. bodily state, 126; stereotypes of, 137; stigmatization of, 247; as threat to global/national health, 125; three degrees of, 68. See also fat/fatness; obesity overweight children: anti-fat attitudes and, 424; definitions, 44; feminism and, 275–6; gender of, 43–4; historical fatness and, 199–200; informal school interactions, 260–1; and life expectancy, 279; and malnutrition, 189, 193–4, 205; media on, 227; mother-child psychological relationship and, 195; obesity epidemic discourse and, 424; as other, 222; prevalences of, 43–4, 274; protection from food advertising/marketing, 276; rates of, 274; and social ostracism, 194. See also obese children overweight rates/prevalence, 56; of children, 43–4, 274; divergence in statistics, 45; gender and, 41–2, 43; increases in, 38, 41–3, 128; obesity statistics combined with, 40f,

41–3; plateauing/reversing of, 46, 48; self-reported data, 42, 45–6 Ozanne, S.E., 99 The Padded Lilies, 431 Paradies, Y.C., 114 Paradis, Elise, 18, 344, 362 parents: and food marketing to children, 286; Healthy Bodies Come in Different Shapes and Sizes and, 247; mother blaming vs. blaming of both, 187; responsibility for feeding/­activity of children, 261–2. See also fathers; mother blaming; mothers ParticipACTION, 9, 17, 190, 351, 354, 400, 426–7 Partridge, Kate, 294, 305, 306f, 308 Patel, Raj, 274 patriarchy: and body ideals, 300; and constraints on female bodies, 421; and fat, 14; and feminine beauty, 19; and gender roles, 21; LG5 and, 300; and weight-centred paradigm, 149; and women’s subordination, 295 Peckham, Stephen, 233 Percival, Lloyd, “Sports College,” 9 Periactin, 191–2 Petherick, LeAnne, 19, 160, 190 Pett, Lionel Bradley, 34–7, 38, 40, 45, 50, 199; “The Canadian Weight-Height Survey,” 35, 36; “A Nutrition Survey among School Children in British Columbia and Saskatchewan,” 34–5 pharmaceutical industry, 70–1, 78 Phipps, S.A., 43, 44, 47 physical activity: biopedagogies and, 428; and childhood obesity,

Index 473 425; government campaigns, 425–7; parents’ responsibilities for children’s, 262; in schools, 246, 427; teachers and, 259; in VOD, 349–50 physical fitness: and exercise science, 33–4; fat/fatness and, 425, 426–7, 428; gender and, 9; and longevity, 4; and perfect fattie syndrome, 412–13; slenderness/thinness and, 10, 429; testing of children, 34; and weight, 9 “Picture of an Epidemic” (Hux), 127 Pima Indians, and diabetes, 98 Plenty of Fish, 380 Poland, Blake, 283 policy. See health programs/policies; public policy politics of postponement: and capitalism, 404–5; fat acceptance and, 414; and HAES, 402, 404–6, 409, 414; micro-moments of activism vs., 413, 414 Polivy, Janet, 10, 61, 302; Breaking the Diet Habit, 302 Poudrier, Jennifer, 16, 18, 175 power/power relations: and affects of obesity, 324; bioethics and, 430; dietetics and, 149, 167; among dietitians, 167–8; and fat/fatness, 392; and formation of subjectivities, 222; gender and, 386, 392; and governmentality, 225; health care professionals and, 156; liberalism and, 364n2; in makeover reality television, 353; within marginalized groups, 168; medicalization and, 58; in medicine, and personal choice, 176–7; normativity and, 96; obesity discourse and, 348; on- vs.

offline, 382; in online dating, 382, 383, 386; between professors and students, 156; scientific knowledge and, 109; and speaking upwards to power, 413–14; thin privilege and, 168, 410–11; thrifty gene theory and, 111; in VOD, 358, 361 Pretty Porky and Pissed Off (PP&P), 14, 309–10, 311f, 312, 391 problem eating. See eating disorders “Problem of Obesity Said Frustrating to Doctor and Patient”(Canadian Medical Association Journal), 205 problem populations: Aboriginal peoples as, 175; blaming of, 17; components of, 16; epidemiological discourse and, 92; Newfoundland constructed as, 263; and obesity discourse, 20–1; obesity epidemic and, 16–17; risk and, 16; stereotypes of, 16–17. Seealso risk populations Probyn, E., 407 Prohaska, Ariane, 386, 395n15 Promoting Healthy Weights (Health and Welfare Canada), 10–12, 303 psychiatry: and medicalization of fatness, 71; and obesity, 74. See also mental health public health: body weight changes as emergency in, 38; context of body weight surveys, 39–40; discourse, 275, 342; and food environment, 274; and individual self-monitoring/regulation, 275; malnutrition and, 7; nutrition in, 35; and obesity epidemic, 56, 65, 342; overnutrition and, 7–8; social determinants of health approach

474 Index and rise of, 77; statistics and identification of those in need of services, 37; and surveillance, 197. See also health care services/ system Public Health Agency of Canada, 3; and obesity as risk factor for diabetes, 131; Obesity in Canada, 336n1 public policy: childhood obesity and, 275; critical obesity scholarship and, 50–1; and food advertising to children, 285–6; in Newfoundland and Labrador, 328; nutrition in, 35; and obesity epidemic, 276; obesity research and, 60; obesity science and, 7; rise in prevalence of overweight/ obesity and, 43; and thinness, 237. See also health programs/policies public-private partnerships, 353–4 PubMed database, 59, 62, 74 Pugh, T.F., Epidemiologic Methods, 37 Puhl, R.M., 135–6, 162 Quebec: Consumer Protection Act, 276–9, 280, 281, 282, 283; and sociocultural/economic factors behind fatness, 60–1 queer theory/queering: about, 309; and anti-capitalist movement, 406; definitions, 406, 407; and HAES, 21–2, 403, 406, 408, 409–15; and identity, 309; meaning of, 407 Quinn, D., 136 Rabinow, Paul, 92 race/racism: and Aboriginal peoples, 18, 182; as articulated through ethnicity, 106; as biological

phenomenon, 102; critical race theory and power within dietetics, 166–7, 168; cybertypes and, 386–7; and deficit thinking, 177; and diabetes, 94, 129–30; fat activism and, 308–9; feminism and, 308; in genetics, 92, 113; Hersize and, 308–9; and ill health, 177; media images and, 308; as methodological variable, 93; and obesity, 345; and overweight, 177; racialization of fat, 14; and thrifty gene theory, 94, 106, 114–15; and traditional foods, 326–7; and women of colour and obesity, 309; women’s movement and, 309. See also ethnicity Rail, Geneviève, 20, 133, 163, 234, 258, 282, 360, 424 Ramírez, Francisco, 61 Raphael, Dennis, 17, 248, 353 Rasmussen, N., 71–2 rational asceticism, 163–4 Raven Steals the Light (Reid), 91 Raven trickster. See Trickster Razack, Sherene, 177 Reading, Jeff, 92–3, 110 reality television: class antagonism here in, 346; cultural contexts of, 353; idyllic communities in, 357; neoliberalism and, 347; normalization of surveillance in, 360; private bodily spaces becoming public spectacle/entertainment in, 359; and self-transformation, 346, 352; social norms in, 346; VOD differences from, 362; weight-loss, 346–7 Recreation and Sport Canada, 9 Reid, Bill, Raven Steals the Light, 91

Index 475 resistance: to biopolitics, 334–5; to capitalism, 405; of children to unhealthy identities, 19; fat authenticity and, 374, 389, 390–1; to normalization/normativity, 260, 265, 266; of obese children to dominant discourses, 221; in selfing, 21; spoilage as, 390–1 responsibility/responsibilization: for adult vs. childhood obesity, 275; childhood obesity and, 20, 285; and choice making, 280–1; in food marketing to children, 278–81; neoliberalism and, 280; women/ mothers and, 345. See also individual responsibility Rice, Carla, 22, 58, 149, 303; “Becoming the ‘Fat Girl,’” 135 Rich, Emma, 230 Riley, Kevin W., 59, 65 risk discourse: children and, 226–9; growth of, 59; neoliberalism and, 237; obese children and, 237; obesity discourse and, 224; prominence of, 66 risk factors: associated with obesity, 11; behaviours and health, 4, 133; for diabetes, 113, 131–2, 137–8; to health, 137–8; individual responsibility and, 137–8; lifestyle, 131–2, 137–8; modifiable vs. unmodifiable, 138; obesity as, 131, 132, 223; overweight as, 131, 132; preventability of, 137–8; publicization of, 130–1; race, in diabetes, 113; sedentary behaviour as, 231; video games as, 227 risk populations: children in, 19, 74, 224, 237, 279; genetics and, 106; identification of high-risk subjects,

107–8; and problem populations, 16; societies, 66, 73, 222. See also problem populations risk(s): anxiety and, 279; and cardiovascular health, 226–7; and changes in lifestyle, 110; and childhood obesity, 279; consciousness, 223; construction of, 223; defined, 162; food marketing and, 280; in health discourses, 218; health promotion and, 223; in healthism, 222; individual responsibility for management of, 109; in medical literature, 66, 67, 69f, 77, 78; in monitoring/ surveillance of fat body, 223; neoliberal health agenda and, 162; obesity epidemic and response to, 125–6; of obesity stigma, 11; and pleasure, 234; processed foods and, 274; as regulation, 222–3; statistics and identification of, 37; surveillance of children for protection against, 189; vocabulary within obesity epidemic, 225 Ritchie, John, 349 Robertson, Elizabeth Chant, 194 Rochefort, Julie E., 18–19, 155–7, 164, 166, 196 Rochman, Bonnie, 273, 274 Rokholm, B., 44–5 Rose, Nikolas, 249, 280, 351, 352 Rosella, L.C., 128 Rosen, A.B., 31 Rubens, Peter Paul, 303 Russell, Vanessa, 428–9 Rutherford, Paul, 9 Ryan, J.M., 167 Sägebrecht, Marianne, 431–2 Saguy, Abigail C., 59, 65, 73, 276

476 Index Said, Edward, 94 Salmon, Amy, 75, 124, 137–8 Sandy Lake Oji-Cree: ancestral background, 103, 104; comparative groups and, 101, 105; and diabetes, 90, 100; genetics and, 100–1, 102–5, 107; isolation of, 103; thrifty gene theory and, 100, 102 Saputo, 278 Saville, Jenny, 432, 433 Schiebinger, Londa, 422 Schoemaker Holmes, Jacqueline, 21 school teachers. See teachers schools: body attitudes in, 260–1; body equity approach in, 428–9; body standards/stereotypes in, 427; and childhood obesity, 245, 246, 247, 427; critical health studies and knowledge in, 245–6; culture and obesity science, 19; food/nutrition in, 199, 202, 246; health discourses in, 246; health knowledge transmission by, 245; health promotion in, 246; neoliberalism and, 248; physical activity in, 246, 427; stigmatization in, 247; surveillance of children in, 190–1. See also children; teenagers/youth Schwartz, Hillel, 6, 58 science: binary classification in, 106; construction/production of knowledge, 109; decolonization of, 94–5, 96–7, 106; and dietetic education, 151, 152; indigenous peoples and, 94–5, 109; pure/applied distinction in, 96, 109; and value bifurcation, 96, 109; and value neutrality, 95–6, 109 Scottee, “Burger Queen,” 410

Secretary of State’s Women’s Program, 302 sedentary lifestyle: and childhood obesity, 229; children and, 227, 228; health promotion and, 254; obese children and, 232–3; obesity discourse and, 227; and obesity rates, 342; and risk, 231; traditional foods and, 331; and weight gain, 9, 254; and work, 8, 9 Sedgwick, Eve, 389–90, 390–1, 392 Seed, Barbara, 153 selfing: authenticity in, 380; deception in, 380; defined, 374; fat authenticity and, 374; norms and, 381; in online dating, 374; for other, 382; and profiles, 380–1; reality in, 380; resistance in, 21; and vital statistics, 381 self-reported data: about, 33; and Aboriginal-white binary classification, 105; combined overweight/ obesity, 45–6; directly measured data vs., 33, 39, 42; and healthy vs. unhealthy body weights, 123; andincrease in diabetes rates, 126 Senchuk, Andrea, 18–19, 157–8, 160, 161, 166, 196 Sender, Katherine, 353 set-point theory, 10 Shadow on a Tightrope, 296, 297, 313 Sharma, Arya, 4, 134 Shaw, J.E., “Canada Diabetes Epidemic Predicts Worse for World,” 129 Shea, Jennifer M., 236 Shelton, B.L., 104 Shields, M., 46 Shildrick, Margrit, 429–30 Simmons, D., 136–7

Index 477 Sins Invalid, 431, 432 Skolbekken, J.A., 61 slenderness: and beauty, 6; and eating disorders, 304; and health, 6; mothers and, 200; and oppression, 297–8, 310; and physical fitness, 10; societal obsession with, 23n4; teenaged girls and, 191, 200, 202. See also thinness Smith, Cynthia, 18 Smith, D.E., 168 Smith, Karen, 282 Smith, Linda Tuhwai, 92, 94–5 Sobal, Jeffery, 38, 58–9, 64, 65, 69–70 social classes: and healthy eating, 328; in Newfoundland and Labrador, 321, 323, 328, 335; obesity and, 46–8; and obesity epidemic, 328; on- vs. offline, 382; and overweight, 177; in reality makeover television, 346; in VOD, 350 social constructionism, 421–3 social determinants of health: biomedical vs., 72–3; diabetes, 108, 113, 114, 129–30, 138; of diabetes, 138; epidemiology and, 77; feminist bioethics and, 430; health entertainment vs., 354; and indigenous peoples, 356; individual change vs., 406; individual vs., 73, 79, 163, 353; medical solutions, 72f, 73; obesity discourse and individual vs., 163; and public health approach, 77; and social justice, 403 social justice: and access to health care services, 403; HAES and, 406, 413; health as, 363; meaning of, 403

social norms. See normalization/ normativity socioeconomic factors/status: and diabetes, 108, 113, 114; and fatness, 61; in Newfoundland and Labrador, 320, 321, 328, 335; for obese women, 309; and obesity, 60, 335, 345; and poor health, 114; stereotypes and, 321, 327–8; Taylor (BC), 355–6. See also social classes Sørensen, T.I.A., 44–5 Sorrell, Nathan, 273, 275, 282–3, 284–5 Spock, Benjamin, 8 spoilage/spoiled identities: fat authenticity and, 374, 389–90, 392; normalization/regulation of bodies and, 392; in online profiles, 373; as resistance, 390–1; speaking fatness vs., 392 “Sports College” (Percival), 9 Spring, Helena, 13, 298 Spurgeon, David, 90 Stanford School of neo-­ institutionalism, 56, 61 Starky, S., 60 statistics: faith in population-level, 34, 37; vital, in online dating, 381. See also measurement(s); obesity statistics; weight statistics/data Statistics Canada: body weight data, 44–5; Community Health Survey, 320; and obesity rates within health reports, 60; weight reports, 225 Stearns, P.N., 59 Stein, Judith, 296, 308 stereotypes: of Aboriginal/indigenous peoples, 104–5, 177, 180;

478 Index behaviour, 16; and eugenics, 16; of fat people, 236; of fat women, 309–10; and fatness-fitness relationship, 427; and genetics, 104–5; hidden curricula and, 176; and micro-aggression, 180; of Newfoundland and Labrador, 21, 320–1, 327–8, 329–30, 335; obesity as, 20; of overweight/obese people, 137, 232; of problem populations, 16–17; in schools, 427; and socioeconomic status, 321, 327–8; and thrifty gene theory, 100 Stewart, S.T., 31 stigma/stigmatization: and acceptance of stereotypes, 232; and access to care in chronic illnesses, 136; and avoidance/delay in health care, 137; body weight, 133–4; and diabetes management, 137; diabetes science and, 18; emotional eating and, 255; of fatness, 135, 295, 307, 359 (see also fat oppression); of girls in schools, 264; in medical literature, 77; and mental health, 15, 71; and micro-aggression, 179–80; in Nike “Jogger” commercial, 272–3; of overweight bodies, 247; and physical health, 15–16; and problem eating/inactivity, 429; risks of, 11; in schools, 247; and stigmata, 390; structural discrimination and, 15–16; of teachers’ bodies, 251 Still Killing Us Softly (Kilbourne), 304 Stone, Allucquère Rosanne, 381 Strong, P.M., 73 students, school. See children; teacher-­ student relationship; teenagers/ youth

sugar, 191, 194 Sui, Xuemei, 4 “Suppose Tommy Won’t Eat” (Haig), 193 Supreme Court of Canada, and advertising to children, 277–8 surgery, in medical literature, 71–2, 77, 78 surveillance: of Aboriginal peoples, 92, 110; of anthropometric measurements, 225–6; and biopedagogies, 361; of BMI, 231; and child risk protection, 189; of children, 197; of children by mothers, 195–6; genetics and, 110; and governing at a distance, 360; of obese children, 229, 231; obesity discourse and, 250–1; in public health, 197; risk and, 189, 223; risk of disease and, 92, 110; of school children, 190–1; self-, in Wii Fit game, 229; among teachers, 250–1, 257–8, 259–60; in VOD, 359, 360, 362, 363; of weight gain/loss, 258–9 Synnott, A., 135 Tamaki, Mariko, 310 Tarasuk, V., 46–7 Taylor (BC): about, 354–5; biocitizenship in, 357; characteristics of, 355–6; communitarian ethic in, 357, 358; community weigh-ins at, 361; food environment in, 350; as free-floating pedagogy, 357; as idyllic community, 357, 358–9; socioeconomic factors in, 355–6; stresses within, 358–9; in VOD, 348–50. See also Village on a Diet (TV show)

Index 479 teachers: about, 248–9; and biocitizenry, 249, 261, 264, 265, 266; and curricula, 246; and dieting, 256–8; and emotional health, 253; on femininity among girl students, 263–4; and food, 256–8; and healthism, 248, 250; as modelling rational approaches to health/ good citizenship, 249; and obese body/obesity-related comments, 250; and obesity discourse, 250–1, 252–3; and obesity science, 19; and physical activity/education, 250, 259; role in health/risk conditions for children, 245; surveillance among, 250–1, 259–60; and war on obesity, 252 teachers’ bodies: appearance of, 255–6; body-image concerns, 19; dissatisfactions with, as separate from student relationship, 264; as embodying healthy practices, 260; emotional connections to, 259; health discourses and, 256; healthism and, 253; and negotiation of ideas about students’ bodies/health, 252–3; relationships with own, 246, 251; stigmatization of, 251; as teaching tools, 251; weight gain/loss, 253–4, 256, 258–9 teacher-student relationship: and “big”/overweight students, 261–2; “do no harm” within, 261, 264; and emotional connections related to bodily knowledge, 260; ethics of care, 249–50; fat phobia and, 251; and food-deprived children, 263; healthism and, 248; role modelling in, 249; and

shaping of students’ health practices, 249–50; and student age/ gender and bodily changes, 263–4; and students’ informal interactions regarding fat bodies, 260–1; and students’ talk about bodyrelated issues, 250; teachers as role models in, 251, 260; teachers’ body dissatisfactions as separate from, 264; teachers’ negotiation of ideas about students’ bodies/ health within, 252–3; transmission of health knowledge/messages within, 250, 260 teenagers/youth: agency of, 189, 202–3; and body image, 199, 200–1, 202; and fast food, 236; fat girls, 428; girls, and slenderness, 191, 200, 202; girls and femininity, 263–4, 427; girls’ eating habits/ nutrition, 202; health, 190; and individual responsibility, 202; and malnutrition, 190; and milk, 198; mothers and girls, 202; mothers as gatekeepers to, 192; obesity, 187, 189, 194, 195–6; obesity discourse and, 20; overeating and obesity, 194; rejection as war recruits, 190; and responsibility, 20; sense of nutrition, 194; treatment of obesity, 195–6, 205; underweight, 190 Teixeira, M.E., 136, 137 “Television Creates Perfect Storm of Childhood Obesity” (Adams), 227 Thatcher, Richard, 60 thinness: authenticity and, 385; dietitians and, 160–2; evolution towards, as ideal for women, 302; and fatness binary, 228; feminine norms and, 293; and femininity,

480 Index 427; and fitness, 429; and health, 6, 250, 330, 394n6; healthiness of, 4; as ideal healthy bodies, 250; lesbians/lesbianism and, 297–8; online dating and, 384, 385, 387, 389; and privilege/power, 168, 410–11; public health policy and, 237; societal preoccupation with, 222; underweight children, 189, 190, 193–4, 199, 205. See also slenderness Thobani, Sunera, 8 thrifty gene theory: about, 18, 89, 97– 100; and Aboriginal peoples, 18, 90, 91; construction of, 100–2; context around, 111; decolonization of, 90, 111–12; and diabetes, 89, 90, 97, 111; and diabetes among Aboriginal peoples/First Nations, 98, 112, 113; and ethnicity, 111; and existence of thrifty genes, 98–9, 100, 106–7, 112; genetic epidemiology and, 93; as hypothesis, 90; and indigenous peoples globally, 89; Neel and, 102; and obesity, 89; race and, 94, 106, 114–15; among Sandy Lake Oji-Cree, 100, 102; scientific evidence undermining, 98; stereotypes and, 100; as story, 106–7, 111–12; thrifty phenotype hypothesis vs., 99; and Trickster, 90–1, 99, 111. See also genetics Tidmarsh, F.W., 201 Toole, Dave, 431 TOPS (Take Off Pounds Sensibly), 15 traditional foods: Aboriginal peoples and, 326–7, 336n1; and affective disjuncture, 329; affective negotiation with, 335; changes in acquisition/preparation/consumption, 326; dislike of, 333; embodied

affects of, 335; ethnicity/race and, 326–7; frequency of consumption, 332–3; generational trends, 333–4; healthiness vs. unhealthiness of, 322, 327; and healthy eating, 321, 330–1, 335; and identity, 321–2; modern vs., and obesity, 336n1; in Newfoundland and Labrador, 321–2, 326, 327, 335; nitrate content of, 327; nostalgia regarding, 326, 335; and obesity, 321, 322, 327, 334, 335; and sedentary lifestyle, 331; technological change and, 326; and weight, 331–2 Tremblay, A., 42, 48 Tremblay, Mark S., 43–4, 47 Trethewey, A., 161 Trickster, 90–1, 97, 99, 111 Turcotte, Louise, 297, 300 Turkle, Sherri, 380, 381, 386 United States: attitudes toward dieting/weight in, 59; body weight statistics in, 49; childhood obesity in, 47; ERA in, 295; fat activism in, 294–7; medicalization of fat in, 78; overweight prevalence in, 46 universal health care/medicare: and Aboriginal people, 183–4; development of, 190; and medicalization of fat, 79 US Centers for Disease Control, 4 value bifurcation, in science, 96, 109 value neutrality, in science, 95–6, 97, 109 Vanasse, A., 45, 48 Vancouver, 375–6 Vassy, J.L., 122 Veinot, Mike, 349

Index 481 victim blaming, 177, 359, 395n15 Village on a Diet (TV show): about, 20; and Aboriginal people, 356–7; biocitizenship in, 357, 358; biocivics in, 20, 362–3; biopedagogies of, 20, 347, 350, 352, 360–1, 362; biopolitics in, 358; collectivist vs. individual responsibility in, 362; community physical activity challenges, 349–50; eating in, 350; food in, 350; governing at a distance and, 347; individual responsibility in, 359, 362; lifestyle changes in, 349, 350, 356, 358, 362; neoliberalism and, 352, 358–9; normalization in, 359; obesity discourse and, 349; obesity stories as unethical, 362–3; power relations in, 358, 361; premise of, 348–50; public measurement in, 359–61; re-imagining of rural Canada, 356–7; scene vs. un-scene in, 347; social classes in, 350; social problems as individual problems in, 359; socially transformative function, 349; surveillance in, 359, 360, 362, 363; victim blaming in, 359; weigh-ins, 359–61, 362–3; as weight-loss reality show, 346. See also Taylor (BC) Village on a Diet (VOD; CBC), 343 Virol, 191 vital statistics, 381 vitamins, 190 Wages for Housework, 297 Waldram, J., 93, 110 Wann, M., 149 war on obesity: dietitians and, 148; HAES and, 399, 412; media and,

349; nutrition and, 148; teachers and, 252. See also obesity panic/ crisis Ward, H., 46–7 Ward, Pamela, 19, 125, 162, 190, 262 Warin, Megan, 359 Watson, J.M., 132 Weber, Max, 57 Weedon, Chris, 252 Weight Bias Summit, 134 weight gain: aging and, 4; and diabetes, 18; healthism and, 258; as physiological, 10; sedentary lifestyle and, 254; surveillance of, 258–9; teachers’ bodies and, 253–4 weight loss: bariatric surgery and, 59; body as project, 258–60; Dancel on, 6; disadvantages of programs, 302; and good citizenship, 20; and health, 259, 400; and health promotion, 400; healthism and, 258; individual responsibility for, 20; industry, 49, 354; medication, 59; and reality makeover television, 346–7; surveillance of, 258–9; teachers and, 253–4, 256, 258–9; women and, 11 “The Weight of the World” (CBC, The Nature of Things), 90 weight statistics/data: in Australia, 49; and epidemiology, 37; in France, 49; generalizations from, 32; and health policy, 49; Heart Health Surveys and, 32; heightweight, 36, 37, 38–40, 62, 190; Katzmarzyk on, 38–9; and malnutrition, 190; Pett and, 34, 36, 37, 38–9; and public health context, 39–40; self-reported vs. measured, 62; in US, 49

482 Index Weight Watchers, 195, 302 weight-centred paradigm/discourses: as control discourse, 400–1; in dietetics, 149–50; HAES and, 399, 400–5, 409–11, 414; and health, 402; and lifestyle changes, 406; obese children and, 229 Weightless (film), 431 weight(s): alternative stories about, 354; authenticity and, 384–5, 386; binaries of norms/differences, 429; changes as public health emergency, 38; childhood management of, 19; of children, 36–7; concern with, vs. overweight, 60; cultural perceptions, 189; and diabetes, 123–4, 127–8, 134, 138; diet vs., 36; dietetics/dietitians and, 148, 152–4, 159–60, 161, 163; among embodied norms, 8; feminism and healthy initiatives, 12–13; government reports on, 225; guidelines, 10–12; and health, 4, 154, 177, 237; healthy eating and, 330; individual agency/ strength and control over, 61; and lifestyle diseases, 40–1; mechanistic models of, 421; in medical literature, 66; mothers and, 200–1; neoliberalism and, 259; neutrality, HAES and, 399, 410–11; normal, 148; normative ideals, and health, 363; obesity discourse and categories of, 230; in online dating, 384–5, 389, 391; physical fitness and, 9; and positive body image, 12; preoccupation, 11, 23n4, 302–3, 304; range of acceptable/healthy, 11, 60, 123, 125, 154; scholarly/popular comment

about, 37–8; set-point theory and, 10; socio-cultural dimensions of, 302; traditional foods and, 331–2; trends in, vs. publication trends, 64, 65f; variations in, 12; visibility, and discrimination, 135; weighing of children and concern regarding, 197; and will power, 362 Welch, Rosie, 254, 256, 263 Welsh, Talia, 411–12 Weston Food Group, 353 Wharton, C., 162 Whitt, Laurie Anne, 92, 94, 95–6, 106, 109 Whitty, Monica, 382–3 Wii Fit gaming system, 229–32 Williams, Lauren, 70 Willms, J., 47 Winstrol, 191 Wittig, Monique, 297 Wolf, Naomi, The Beauty Myth, 300, 304 women: and authentic embodiment, 384–5, 386; and authenticity of self-representation, 387–8; and body fat, 14; and body weight/ socioeconomic status, 46; Dancel on, 5–6; as defined by bodies online, 388; in dietetics, 168–70; and eating disorders, 12; emotional eating and stigmatization of, 255; essentialist notions of capacities, 8; fat oppression and, 390; as food provisioners, 282; and food work, 323; health activism and government-funded health care initiatives, 302; and hysteria, 23n2; magazine images of, 303; on men’s weight, 387; nutritional problems, 201; obesity prevalence rates, 41,

Index 483 42; and online dating, 383, 384–5, 386, 387, 388, 389, 391; overnutrition and, 7–8; over-reporting of weight, 389, 391; patriarchal society and, 295; responsibility for healthy food, 258; and responsibility for obesity, 345; subversion of authenticity, 389–90; in Taylor (BC), 356; underestimation of weight, 39–40; universalization of, 307–8, 309; and weight authenticity, 384–5; and weight loss, 11; in workforce, 8; world view, 312. See also fat women; gender; mothers Women’s Health Clinic (Winnipeg), 12 women’s movement. See feminism Womyn’s Music Festival, 13 Woolgar, Steve, 57 World Health Organization (WHO): on BMI, 68; on global obesity

epidemic, 342; Global Strategy on Diet, Physical Activity and Health, 336n1; on limitations on foods for children, 276; Obesity: Preventing and Managing the Global Epidemic, 59–60, 65, 124, 125 Wright, Jan, 127, 223–4, 227, 254, 255, 256, 263, 424 Wylie-Gillingham, Ruth, 13 Wyman, Julie, Bouyant, 431 XBX and 5BX programs (Department of National Defence), 9 Youngblood Jackson, Alecia, 252 youth. See teenagers/youth Zentner, Alissa, 129, 355 Zhang, Y.B., 394n8 Zimmet, Paul, 129, 130 Zuckerbaby (Adlon), 431–2