Sarah Gillborn

Please remember to credit me if you make use of my original content.

Peer reviewed paper reporting the findings related to the Apocalyptic Public Health discourse: Gillborn, S., Rickett, B., Muskett, T., & Woolhouse, M. (2019). Apocalyptic public health: Exploring discourses of fatness in childhood ‘obesity’ policy. Journal of Education Policy. DOI: 10.1080/02680939.2019.1566839

This year I presented the findings from my first study for my PhD at the Weight Stigma conference in Prague, CZ and the International Society for Critical Health Psychology (ISCHP) conference in Loughborough, UK. I won the prize for best student presentation at ISCHP, and having videoed my presentation for my own use, I’ve decided to share it.

This video shows only a short snippet of findings from a research project that took months to complete – not all of my findings have been included in this video, and there will be another phase to my research after this study too.

Abstract for the video presentation:

As part of the UK government’s work on tackling ‘obesity’, the National Child Measurement Programme annually measures the BMI of Reception (aged 4-5 years) and Year 6 (aged 10-11 years) children. This study aimed to explore how discourses (re)produced within the programme construct responsibility, and how they construct gendered, raced, and classed identities. Foucauldian discourse analysis was used to analyse NCMP materials including operational documents and communications to parents. The first discourse, Apocalyptic Public Health, is characterised by constructions of ‘obesity’ as a hidden but deadly disease, spread as a social contagion whilst dangerously difficult to spot by eye, which represents social and economic catastrophe to society as a whole. This discourse serves to justify state intervention and encourages parents to conform to public health messages for the good of their family and of society. Although this ‘obesity’ apocalypse is regarded as harmful to all, those children and families who are marked as classed and racialised will be hurt more due to the arbitrary use of BMI, a White, middle-class concept that has been normalised as homogenous across social groups. The second discourse, Saboteurs and Saviours, constructs the contrasting positions of those causing harm and those who will save us from it, positioning the intervening state as the agents of change, using surveillance and quantification of bodies as the solution to a problem caused by parents who are constructed as ignorant, uneducated, and in denial about their children’s fate. These discourses hold real implications for the treatment of families with children marked as ‘overweight’ or ‘obese’, and may serve to rationalise the implementation of charges for National Health Service treatment of those deemed to have ‘self-inflicted’ illnesses.

As I state in the video, I reject biomedical terms such as ‘overweight” and “obese’. I do not believe it is accurate nor scientific to claim that there is a ‘normal’ weight range that is homogenous across all people, and consequently, there is no homogenous ‘overweight’ either. I also reject the pathologisation that accompanies labels of ‘overweight’ or ‘obese’, as though these are not ‘normal’ – I therefore use the term “fat” as has been reclaimed by fat activists, but as someone who does not experience size discrimination in any form, I am still considering and learning about the language around this topic whilst considering my epistemological position.

To reference conference presentation:

Gillborn, S. (2017, July). Mothering and the NCMP: Intersectional understandings of mothering and childhood body, health and weight management. Paper presented at the International Society for Critical Health Psychology Conference, Loughborough, UK.

Some things to bear in mind in general discussions around “obesity”:

A lot of what you believe to know about “obesity” is false – for example, studies have shown that people in the “overweight” category actually have the longest life expectancy (Flegal, Graubard, Williamson, & Gail, 2005).
While “obesity” is in many studies correlated with illnesses such as heart disease, there is no evidence to suggest or support that heart disease is caused by “obesity”. The results of mainstream “obesity” research are frequently and persistently misinterpreted in the media, even after the authors of the original research have made efforts to correct misreporting (Lyons, 2009).
Much mainstream “obesity” research is completed by people with massive stakes in the diet industry, who often fail to declare their interests in their writings, and have huge money to make by sustaining the idea that fatness is abnormal and unhealthy (Lyons, 2009; Burgard, 2009). It is rare to find researchers who are not paid consultants to the weight loss industry.
The correlation between “obesity” and the illnesses with which it is frequently conflated are not linear nor as simplistic as we are made to believe. As little as 9% of the correlations between “obesity” and these illnesses are directly correlated, meaning 91% of the relationship between the two are not accounted for by the other variable; in other words, 91% of what accounts for a health outcome has nothing to do with BMI (Burgard, 2009). It may well be that one of these extraneous variables is poverty and being poor, as being poor can result in higher body weight and poorer health for a huge number of reasons (including economic and social, such as less opportunities for free outdoor leisure time in more working-class neighbourhoods and families, and increased difficulty in receiving healthcare, again for a variety of reasons including lack of time, money, and stigma experienced from healthcare professionals.)
Weight cycling, the process of constantly changing weight which is the overwhelming result of dieting (with sustained weight loss failure rates remaining at 90-95% according to NIHTACP, 1992), has shown to cause many of the health problems with which “obesity” is associated (Lyons, 2009) – the ‘cures’ in the case of fatness are often more dangerous than the original ‘symptom’.
Health risks associated with “obesity” are lowered by physical activity, social support, good nutrition, access to medical care, etc, regardless of whether or not weight loss occurs; in contrast ineffective weight loss interventions cause physical and psychological damage (Burgard, 2009). “If dieting was a drug to improve health, no doctor would prescribe it given its high failure rate” (Lyons, 2009, p. 77).
Based on the above two bullet points, it is arguable that it is the fight against “obesity” which is causing more harm to people’s health and livelihood, rather than simply allowing people to live at whatever weight they currently are (see Health At Every Size movement).
Advisors to members of UK government have previously said that “it might be helpful if more stigma is attached to obesity so that people made more effort to lose weight” (UK Parliament, 2004) – the NCMP materials themselves victim-blame fat children for their low self-esteem and mental health, and there seems to be an idea that shaming fat people will help them lose weight. Shaming helps no one and does not improve health.
The National Child Measurement Programme was originally intended to be a ‘monitoring’ programme, meaning children would have their BMI monitored but never fed back to them and never with any guidance given to how to “improve” their health. The National Screening Committee (NSC) claimed that if it were to be a screening programme, i.e. measurements taken and results sent to parents complete with related advice, this would have the potential to do far more harm than good. Despite these concerns, the UK government made the NCMP a screening programme anyway, managing to bypass the NSC’s decision by instead passing it through as a part of policy (Evans & Colls, 2009).

The dominant discourses surrounding fatness are negative ones that are not only based on false “truths”, but have real implications for real people – but dominant is exactly what they are. It is one of few topics I am still reluctant to discuss online, as I am often met with “there’s no argument to be had here – it is common sense that obesity kills”, and I understand why people believe that. These false “truths” are reproduced almost weekly in newspapers and online news sources, but we must start challenging them. Fatphobia is rife even within other activist spaces which argue to be progressive, and it is a very real form of discrimination, with fat women being paid on average less than non-fat women (while the same bias does not exist for men; DeBeaumont, 2009), and with the threat of having healthcare removed for fat people likely to hit Black and working-class families the most (discussed in the video). If you are interested in learning more about this topic, I recommend having a read of The Fat Studies Reader (Rothblum & Solovay, Eds., 2009) – it is very eye-opening and extremely important.

To reference blog post:

Gillborn, S. (2017, July 15). Apocalyptic public health and the saboteurs & saviours of the “obesity epidemic”. [Blog post]. Retrieved from https://sarahgillborn.wordpress.com/2017/07/15/apocalyptic-fatness-and-the-saboteurs-saviours-of-the-obesity-epidemic/

To reference conference presentation:

Burgard, D. (2009). What is “health at every size”? In E. Rothblum, & S. Solovay (Eds.), The fat studies reader (pp. 42-53). New York: New York University Press.

DeBeaumont, R. (2009). Occupational differences in the wage penalty for obese women. Journal of Socio-Economics, 38(2), 344-349.

Evans, B., & Colls, R. (2009). Measuring fatness, governing bodies: The spatialities of the body mass index (BMI) in anti-obesity politics. Antipode, 41(5), 1051-1083.

Flegal, K. M., Graubard, B. I., Williamson, D. F., Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15), 1861-1867.

Lyons, P. (2009). Prescription for harm: Diet industry influence, public health policy, and the “obesity epidemic”. In E. Rothblum, & S. Solovay (Eds.), The fat studies reader (pp. 75-87). New York, NY: New York University Press.

National Institutes of Health Technology Assessment Control Panel. (1992). Method for voluntary weight loss and control. Annals of Internal Medicine, 116, 942-949.

UK Parliament (2004) House of Commons Health Committee: Obesity. Third report of session 2003-2004, volume 1.