Ideology, obesity and the social determinants of health: a critical analysis of the obesity and health relationship

Abstract

Based on a critical review of the obesity and health literature we provide five models of how the hypothesized obesity and health relationship is conceptualized. We then apply these models to make sense of how recent Canadian public health reports and clinical practice guidelines conceptualize the issue of obesity, its causes and health effects, and appropriate responses. We show how conformity to dominant models of the obesity and health relationship by health sciences researchers, public health workers, and the media lead to activities that rather than promoting health, actually threaten it. These dominant models – and the activities derived from them – do so by diverting attention from the far more important issues of the quality and distribution of the social determinants of health. These approaches also stigmatize heavy individuals, doing little to promote their health. For these reasons, we call for an end to seeing obesity as a significant health issue.

Keywords:

• Obesity
• social determinants of health
• health policy

Notes

1. Boero (2012, 2013) expands on the analysis of media coverage of obesity to show how moral entrepreneurs influence media in the ‘production and dissemination of scientific knowledge’ (p. 373) often using studies and information that sound more alarming and news worthy. ‘Indeed, media attention to a particular issue not only informs policy but it also can result in more funding becoming available to develop solutions to these problems.’ (p. 376).

2. The negative physiological and psychological health effects of stigma have been researched for more than five decades (Puhl & Heuer, 2009, 2010); however stigmatization of fat still strongly persists in everyday and is mirrored in obesity perspectives and models of health which drive research and practice (Lupton, 2013, 2015).

3. Critical social scientists use the term social location to describe these individuals occupying positions of differing power and influence (Anderson, 2011). These concepts are not part of the conceptual repertoire of adherents of Models 1 and 2 and therefore not used by these adherents.

4. The word frequency analysis was based on first designating key words through qualitative content analysis, specifically thematic analysis done through coding of Obesity in Canada (Corscadden et al., 2011) and Addressing obesity in children and youth: Evidence to guide action (Public Health Ontario, 2013) completed by Medvedyuk (2015). A hand count was then conducted to identify frequency of mentions.