Body Mass Index, masculinities and moral worth: men's critical understandings of 'appropriate' weight-for-height

'The Lay Gaze'-Rural Norwegian men's assessment of others' health based on pictures

In this article, we explore lay men's understanding of the relationship between other's bodily appearance and health-'the Lay Gaze'. We applied the theoretical concepts of biopower, medical gaze, bodyism and healthism-the ideology where one feature is that a slim body is equivalent to a healthy body-and interviewed 18 adult and elderly men in rural Norway, representing a heterogeneous group regarding age, ethnicity and education. To explore the interviewees' subjective perception or 'gaze', the interviewees were presented with eight pictures of different people. Our main findings were, first, that the sample of a relatively heterogeneous group of adult and elderly lay men in rural Norway talk similarly about body appearance and health and follow the healthism discourse with an embedded association between body appearance and health assessment. Second, we found some variation regarding how interviewees define other standards for the elderly and black people.

Body mass index is just a number: Conflating riskiness and unhealthiness in discourse on body size

Despite the ubiquity of the body mass index (BMI) in discourse on health, there is ambiguity in its use as a biomarker of current abnormality versus future risk. This distinction is consequential for knowledge of the relationship between body size and health, as well as for individuals deemed to have abnormal and 'unhealthy' bodies. Consequently, the purposes of this review are threefold. The first is to differentiate this 'biomarker' perspective from extant critiques of BMI as a proxy for health behaviours or as the defining characteristic of obesity as a disease. The second is to highlight the shift towards treating BMI as a measure of attained unhealthiness, rather than a probabilistic indicator of risk. Finally, rather than call for the abolition of BMI, this paper argues that its continued use as 'just a number' is in keeping with the push for weight neutrality in research and practice. The review concludes by demonstrating how the riskiness and unhealthiness of body size is conflated in public health messaging on COVID-19. BMI is a marker of risk, but its use as a surrogate for COVID-19 severity equates body size with health, shaping beliefs about vulnerability and personal responsibility amid an ongoing pandemic.

BMI and dissatisfaction with life: contextual factors and socioemotional costs of obesity

Purpose

In this study, we investigate whether individuals’ BMI categories are associated with being dissatisfied with one’s life, how this association is affected by the social comparison that individuals make, and what the role of the overall BMI levels in this process is.

Methods

We use data for 21,577 men and 27,415 women, collected in 2016 by the European Bank for Reconstruction and Development, from 34 countries in Europe, the Middle East, and Central Asia. To understand the moderating effect of contextual environment, we use multilevel mixed effect logistic regression models and data for national, regional, and cohort-specific BMI levels.

Result

We find that the association of BMI and dissatisfaction with life differs by gender, with overweight men being less likely to be dissatisfied with life than men with normal weight and obese women being more likely to be dissatisfied with life compared to women with normal weight. For contextual effects, we find that obese women in regions with low BMI levels are more likely to be dissatisfied with life. The effect of obesity on female life dissatisfaction is not observed in regions with high BMI levels. As for men, regional BMI levels affect the levels of life dissatisfaction but only for underweight men.

Conclusions

Our study adds additional nuance to the quality-of-life research by showing that the association between BMI and decreased life satisfaction is, at least partially, moderated by the contextual environment, and that the character of these effects differs by gender.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02912-3.

Food assessment: a discursive analysis of diet talk in interviews with older men who are obese

Objective: Obesity rates are increasing faster in men than in women, with particular concerns raised regarding older men. However, men are less likely than women to engage in weight-loss activities such as dieting, typically constructed as a feminine practice. Previous research has argued that men's food consumption is notably different and unhealthier than women's. The novel contribution of this article is an analysis of food assessments in order to explore how older men (mostly) undergoing weight management programmes make sense of changes in their nutritional intake. Design: Semi-structured interviews were conducted with 30 men who were obese, 27 of whom were engaged in weight loss programmes. Discursive psychology was employed to analyse the data. Results: In contrast to other research, participants constructed nutritional advice as enlightening. Participants worked up 'ownership' and pleasure assessments to certain food choices which they contrasted with new, less calorific, eating practices. Moreover, new diets were constructed as acceptable. Conclusion: Our study contributes new insights about how nutritional advice impacts upon preconceived (mis)understandings of healthy eating practices. During the interviews, men positioned themselves as educators - health promoters might usefully develop nutritional advice in collaboration with men who have successfully changed their diets for optimum effect.

School bullying, body size, and gender: an intersectionality approach to understanding US children's bullying victimization

We examine separate and combined effects of children's body size and gender on school bullying victimization in the US. Second-grade data from the 2012-2013 school year from the US Early Childhood Longitudinal Study, Kindergarten Class of 2011 were analyzed, hierarchical generalized logistic modeling was used, and three forms of school bullying were studied. Girls were less likely than boys to be verbally or physically bullied and obese children were more likely to be verbally and relationally bullied than non-obese children. The protective effect of gender extends to obese girls when obesity is not a risk factor (physical bullying). When obesity is a risk factor, gender is not protective (verbal bullying) or is a risk factor (relational bullying) for girls. These findings suggest an intersectional body size-gender lens is crucial to understanding how inequality is produced through school bullying. Future interventions should incorporate an intersectional understanding of school bullying.

Men's experiences of having osteoporosis vertebral fractures: a qualitative study using interpretative phenomenological analyses

Men and women with vertebral fractures due to osteoporosis are treated differently by society and health care professionals. This can lead to inequalities in health care and affects how men with fractures view themselves as people. We need to raise awareness that men get these fractures as well as women.

INTRODUCTION

There is a lack of research exploring the experience of osteoporosis from the male perspective. This study was undertaken to explore and describe the experiences of men with vertebral fractures due to osteoporosis, including their perceptions of diagnosis, treatment and changes in their sense of self.

METHODS

The study consists of in-depth semi-structured interviews with nine male participants of the PROVE (Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture) study. Interviews were digitally audio recorded and fully transcribed. Data were coded in accordance with an interpretative phenomenological analysis approach to analyses.

RESULTS

Three main themes are presented. (i) Osteoporosis is considered an old women's disease. (ii) Men are diagnosed and treated differently than women in the NHS. Health care inequalities exist. (iii) Changes in self can occur in men after vertebral fracture/s due to osteoporosis.

CONCLUSIONS

Greater awareness that men get this condition is needed in both society in general and also by health care professionals who often do not expect osteoporosis to affect men. Approaches to diagnosis and treatment need to be considered and improved to ensure that they become appropriate and effective for men as well as women.

Men living with obesity in New Zealand: What does this mean for health care in general practice?

INTRODUCTION

More men than women live with overweight and obesity in New Zealand, yet we know little about their everyday lives or their weight management experiences in primary care. This study sought to link the weight management experiences of these men in primary care, with their experiences of life in general as big men.

METHODS

Semi-structured interviews with participants selected purposively based on a priori criteria were conducted. Interviews were either face to face or via telephone. Interviews were digitally recorded and transcribed and text coded into a priori codes where established.

RESULTS

Fourteen men were interviewed. Analysis of text data revealed three overarching themes. The first, social experience of life as a big man highlighted the significance of social transitions as times of weight gain. The second theme related to experiences of weight management in primary care, with communication the largest sub-theme. Finally, stigma materialised as a key and widespread issue.

CONCLUSION

Scant attention has been paid to the experiences of overweight and obese men in primary care or the impact of their size on their daily lives. Effective, tailored communication by health professionals in primary care is sorely needed. Times of social transition can be exploited as appropriate instances to offer advice on effective strategies to reduce the risk of weight gain. Men also need to be made aware of their vulnerability for weight gain at these times through effective, gender specific health promotion messages. The widespread nature of stigmatising experiences within personal networks was a concerning finding.

Volition and motivations influence on weight maintenance

Purpose

The purpose of this paper is to explore how the psychological constructs volition and motivation influence successful and unsuccessful weight maintainers’ experiences during the difficult period following an intensive lifestyle intervention.

Design/methodology/approach

Post lifestyle intervention semi-structured interviews with 11 successful and four unsuccessful weight maintainers were conducted.

Findings

The eight themes that emerged and the differences between successful and unsuccessful maintainers were theoretically explained applying the self-determination theory (motivation) and the personal systems interaction (volition).

Practical implications

The study validates and coheres with previous findings on the importance of self-regulation and autonomous motivation for weight loss maintenance. Additionally, the study’s findings expand the literature by explaining both empirically and theoretically how the quality of motivation concerning an activity influences the level of volitional intensity needed when wanting to either engage in goal oriented or refrain from goal opposing activities.

Originality/value

Developing effective obesity interventions has become essential, as obesity is a growing health threat in most countries in the world. However, there is a gap in the literature with regards to qualitative psychological studies with a clear theoretical framework informing intervention development.

In BMI We Trust: Reframing the Body Mass Index as a Measure of Health

Recent work in medical sociology has provided critical insights into distinguishing between obesity as a condition with severe individual- and population-level health consequences, and obesity as a socially undesirable, stigmatizing construct opposing thinness as the healthy ideal. Less often considered is the role of Body Mass Index (BMI) as the standard by which obesity and healthy weight are measured and defined. Addressing this issue, I begin by distinguishing between BMI as an empirical, objective measure of health, and BMI as an arbitrary, subjective label for categorizing the population. I further consider how BMI is empowered as a measurable quantity through the lens of medicalization and evidence-based medicine, and introduce the "performativity" of BMI as a superior framework for confronting the measure's conceptual limitations. Emphasizing key parallels between BMI and self-rated health as measures with high predictive validity, yet unspecified mechanisms of action, I propose an epistemological shift away from classifying BMI as a biomarker and toward a more flexible view of the measure as a holistic appraisal of health. In closing, I argue that researchers may continue to leverage BMI's ease of collection and interpretation, provided they are attuned to its definitional ambiguity across diverse research methods and contexts.

The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Background

Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.

Objective

To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service‐user perspective how programmes are experienced, and may be effective, on the ground.

Search strategy

We identified qualitative studies from existing reviews and updated the searches of one review.

Inclusion criteria

We included UK studies capturing the views of adult WMP users.

Data extraction and synthesis

Thematic analysis was used inductively to code and synthesize the evidence.

Main results

Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or “hook” which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity.

Discussion and conclusions

The evidence revealed that service‐users’ understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about “what happens” in complex psychosocial interventions such as WMPs.

Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators

BACKGROUND

Receiving information about one's weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men's reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences.

METHODS

We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis.

RESULTS

Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be 'like them' and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change.

CONCLUSION

Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings.

Obesity, bodily change and health identities: a qualitative study of Canadian women

Medicalised concerns about an obesity crisis persist yet more needs to be learnt about everyday orientations to weight (loss). This article reports and analyses data generated using qualitative methods, including repeated interviews and fieldwork conducted over one year in Canada with women (n = 13) identifying as (formerly) obese. Three ideal types are explored using empirical data: (1) hopeful narratives; (2) disordered eating distress; and (3) weight-cycling or stagnation. Core themes include women's desire to embody a thin(ner) future and the good life, the harms of intentional weight-loss, and resignation to living as a fat woman whilst nonetheless challenging stigma. The article contributes to critical studies of weight/fatness, the sociology of bodily change and the embodiment of health identities. In concluding, we call for reflexive change in bodies of health knowledge, policy and practice.

Understanding the health of lorry drivers in context: A critical discourse analysis

This article moves beyond previous attempts to understand health problems in the lives of professional lorry drivers by placing the study of drivers' health in a wider social and cultural context. A combination of methods including focus groups, interviews and observations were used to collect data from a group of 24 lorry drivers working at a large transport company in the United Kingdom. Employing a critical discourse analysis, we identified the dominant discourses and subject positions shaping the formation of drivers' health and lifestyle choices. This analysis was systematically combined with an exploration of the gendered ways in which an almost exclusively male workforce talked about health. Findings revealed that drivers were constituted within a neoliberal economic discourse, which is reflective of the broader social structure, and which partly restricted drivers' opportunities for healthy living. Concurrently, drivers adopted the subject position of 'average man' as a way of defending their personal and masculine status in regards to health and to justify jettisoning approaches to healthy living that were deemed too extreme or irrational in the face of the constraints of their working lives. Suggestions for driver health promotion include refocusing on the social and cultural - rather than individual - underpinnings of driver health issues and a move away from moralistic approaches to health promotion.

A qualitative evidence synthesis on the management of male obesity

OBJECTIVES

To investigate what weight management interventions work for men, with which men, and under what circumstances.

DESIGN

Realist synthesis of qualitative studies.

DATA SOURCES

Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches.

STUDY SELECTION

Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings.

RESULTS

22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design.

CONCLUSIONS

Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition.

'Fat girls' and 'big guys': gendered meanings of weight loss surgery

Over 80% of weight loss surgery (WLS) patients are women, yet gender is overwhelmingly absent in WLS research. This article discusses the findings of 54 interviews with twenty-one women and six men waiting for WLS in Newfoundland and Labrador, Canada. We critically examine the ways that gender shapes the meaning of WLS in these narratives. We explore gendered meanings in participants' perspectives on their embodied experiences before surgery, social support as they decided to undergo the procedure, and their expectations for their lives after WLS. We draw on feminist theory to explain how these findings counter the dominant gender-neutral medical model of obesity.

Do weight management programmes delivered at professional football clubs attract and engage high risk men? A mixed-methods study

BACKGROUND

The prevalence of obesity in men in the UK is amongst the highest in Europe but men are less likely than women to use existing weight loss programmes. Developing weight management programmes which are appealing and acceptable to men is a public health priority. Football Fans in Training (FFIT), a men-only weight management programme delivered to groups of men at top professional football clubs, encourages men to lose weight by working with, not against, cultural ideals of masculinity. To inform further development of interventions in football club settings, the current study explored who is attracted to FFIT and why overweight/obese men choose to take part.

METHODS

A mixed-methods study analysing baseline data on 747 men aged 35-65 years with BMI ≥ 28 kg/m2 who were participants in a randomised controlled trial of FFIT, and data from 13 focus group discussions with 63 men who had attended the programme.

RESULTS

Objectively-measured mean body mass index was 35.3 kg/m2 (sd 4.9). Overall over 90% of participants were at very high or extremely high risk of future ill-health. Around three-quarters of participants in all age groups were at 'very high' risk of type 2 diabetes, hypertension and cardiovascular disease (72%, 73% and 80% of men aged 35-44, 45-54 and 55-64 years respectively). A further 21%, 16% and 13% were at 'extremely high' risk. Qualitative data revealed that the powerful 'draw' of the football club attracted men otherwise reluctant to attend existing weight management programmes. The location and style of delivery of early FFIT sessions fostered team spirit; men appreciated being with others 'like them' and the opportunity to undertake weight management in circumstances that enhanced physical and symbolic proximity to something they valued highly, the football club.

CONCLUSIONS

The delivery of a weight management intervention via professional football clubs attracted men at high risk of ill-health. The setting enabled men to join a weight management programme in circumstances that felt 'right' rather than threatening to themselves as men. FFIT is an example of how to facilitate health promotion activities in a way that is consistent with, rather than challenging to, common ideals of masculinity.

What do the terms wellness and wellbeing mean in dietary practice: an exploratory qualitative study examining women's perceptions

BACKGROUND

Wellness and wellbeing are terms associated with health within dietetic discourse. More broadly, these terms are found in social discourse as represented in food and nutrition consumer communications. With the increasing requirement for evidence-based healthcare, there is an imperative to understand whether these terms are meaningful to individuals typically targeted for nutrition interventions and whether there are any implications for dietetic education.

METHODS

To explore the understanding of these terms, eight semi-structured focus groups were conducted with 32 female participants (age range 23-79 years) who were actively engaged in managing their health. Overall understanding of the terms, factors that impacted perceptions and any relationships with food behaviour were investigated with the groups. Group discussions were transcribed verbatim and each transcript was examined by two researchers. Inductive analysis linking codes into main thematic categories was conducted using the constant comparison approach across the full data set.

RESULTS

Wellness and wellbeing were identified as meaningful terms associated with health. A theoretical framework of wellness and wellbeing reflecting these meanings was developed linking four dominant thematic areas. These were Desired outcomes (most sought after result); Taking control (self management strategies); Internal influences (various personal inner factors influencing behaviours); and External influences (plethora of peripheral factors influencing behaviours).

CONCLUSIONS

Wellness and wellbeing are terms that are relevant and aspirational for individuals typically targeted for nutrition intervention. A theoretical framework of dominant areas of influence on notions of wellness and wellbeing was identified. This theoretical framework is worthy of further research to determine usefulness and effectiveness in dietetic practice settings.

Big fat inequalities, thin privilege: An intersectional perspective on ‘body size’

This article aims to claim ‘body size’ as an increasingly important axis of signification. It draws on research from various disciplines to present an exploratory overview of the different ways in which body size categorizations – being (considered) fat or slender – intersect with other axes, such as gender, race, sexuality, social class and age. The article argues that an intersectional perspective on body size adds to our understanding of the layeredness and complexity of power differentials, normativities and identity formations that co-produce inequalities. Furthermore, it attempts to show how processes of exclusion and marginalization based on body size categorizations are similar to racist, ableist and misogynist logics and practices. Hereby the article intends to demonstrate the vast (negative) impact of body size categorizations, specifically but not exclusively on the lives of those who occupy the marked position in relation to this axis: the ‘fat’. It argues that an intersectional perspective helps us to see body size discrimination more clearly and can help disrupt dominant discourses about the body in order to create a truly ‘healthy’ environment in which bodies of all sizes, shapes, colours and abilities can be celebrated.

Differences by degree: Fatness, contagion and pre-emption

Drawing on evidence from the Framingham Heart Study, Christakis and Fowler in their 2007 article published in the New England Journal of Medicine make the claim that obesity spreads in social networks. Whether they are correct in this assertion is neither the concern nor focus of this article. Rather, what is of interest is the subsequent mobilisation of ‘contagion’ to describe this spread and to account for the emergence of an ‘obesity epidemic’ in contemporary society. Contrary to the argument that there is less stigma attached to obesity, the reporting of the Christakis and Fowler article suggests that being ‘fat’ remains a signifier of moral and physical decay; if we add to this the suggestion that obesity is spread within social networks, it is possible that the stigma associated with body size will begin to mirror that which is attached to other infectious bodies. In order to consider the potential implications of this, the article develops in three directions: it explores the application of contagion as a metaphor for understanding the spread of obesity; it sets this understanding within the context of scholarship on contagion and it draws on critical obesity studies literature to call for a more cautionary approach to be taken when deploying a term that when combined with pre-emptive public health discourse would add significantly to the pathologising of the corpulent, fat or obese body.

Multidisciplinary lifestyle intervention in the obese: its impact on patients' perception of the disease, food and physical exercise

BACKGROUND AND AIMS

To be successful, lifestyle intervention in obesity must take into account patients' views. The aim of the present study, conducted using a narrative-autobiographical approach, was to report on the perception of disease, food and physical exercise in a group of 80 obese patients during a structured multidisciplinary lifestyle intervention.

METHODS AND RESULTS

Patients underwent lifestyle intervention, of three months' duration, structured in the following steps: 1) an initial medical examination; 2) an interview by a psychologist; 3) an assessment by a dietician, 4) a physical examination by a specialist in sports medicine; 5) an individualized program consisting of 24 sessions (two per week) of structured indoor exercise 6) eight sessions of group therapeutic education; 7) Nordic walking activity combined with walking excursions during weekends. All the narrative autobiographic texts obtained during the lifestyle intervention were submitted for content analysis; data were analysed according to the ''grounded theory'' method. According to patients' descriptions at the end of the intervention, lifestyle intervention resulted in enhanced self-efficacy and a reduction in their dependency on food and people; their fear of change was also diminished because, by undergoing intervention, they had experienced change.

CONCLUSION

The findings made in the present qualitative analysis suggest that whenever multidisciplinary lifestyle intervention is planned for patients with obesity, it is of the utmost importance to tailor the approach while taking the following key aspects into account: motivation, barriers and/or facilitators in lifestyle change, patients' perceptions of obesity and relationship with food, diet and exercise.

In pursuit of leanness: The management of appearance, affect and masculinities within a men’s weight loss forum

In a somatic society which promotes visible, idealized forms of embodiment, men are increasingly being interpellated as image-conscious body-subjects. Some research suggests that men negotiate appearance issues in complex and varied ways, partly because image concerns are conventionally feminized. However, little research has considered how overweight men construct body projects in the context of weight loss, or how men talk to each other about weight management efforts. Since sources of information and support for overweight men are now provided online, including dedicated weight loss discussion forums, our analysis focuses on one such forum, linked to a popular male-targeted magazine. We conducted a thematic analysis of selected extracts from seven threads on the forum. Our analysis suggests a widespread focus on appearance, as well as the use of emotion categories when describing difficult bodily experiences. Invariably, however, such talk was carefully constructed and constrained by hegemonic masculinities founded on discipline, work-orientation, pragmatism and self-reliance. The findings are discussed in relation to magazine masculinities and aesthetics, as well as literature on male embodiment.

Gendered perceptions of own and partner weight-level

This study investigates gender differences in perceptions of body weight. Previous research has found significant gender differences in perceived weight-level, but less is known about weight perceptions of the opposite gender. Based on Danish survey data (859 women and 160 men), the discrepancy between BMI weight-level and self-perceived weight-level is estimated as well as the perception of one's partner's weight-level. Two main empirical conclusions emerge. First, there are significant gender differences in weight assessment. Whereas women assess weight according to the standardized BMI weight-levels for both genders, men assess weight according to gender. The weight-level of men is often underestimated by men themselves, but both men and women tend to overestimate the weight-level of women in the lower BMI deciles compared to standardized BMI weight-levels. Second, there is greater underestimation of weight-levels for individuals in the higher BMI--especially regarding weight perceptions of the opposite gender. These findings are discussed within a framework of socio-cultural theory of body image and gendered relations.

Words matter: a qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals

Background

Health professionals have an important role to play in the management of obesity, but may be unsure how to raise weight issues with patients. The societal stigma associated with excess weight means that weight status terms may be misunderstood, cause offence and risk upsetting patient-professional relationships. This study investigated the views of people who were overweight or obese on the acceptability of weight status terms and their potential to motivate weight loss when used by health professionals.

Methods

A qualitative study comprising 34 semi-structured interviews with men and women in their mid-to-late 30s and 50s who were overweight or obese and had recently been informed of their weight status. Thematic framework analysis was conducted to allow the systematic comparison of views by age, gender and apparent motivation to lose weight.

Results

Although many people favoured 'Overweight' to describe their weight status, there were doubts about its effectiveness to motivate weight loss. Terms including 'BMI' ('Body Mass Index') or referring to the unhealthy nature of their weight were generally considered acceptable and motivational, although a number of men questioned the validity of BMI as an indicator of excess weight. Participants, particularly women, felt that health professionals should avoid using 'Fat'. Whilst response to 'Obese' was largely negative, people recognised that it could be appropriate in a health consultation. Some younger people, particularly those who appeared motivated to lose weight, felt 'Obese' could encourage weight loss, but it was also clear the term could provoke negative emotions if used insensitively.

Conclusions

Although most people who are overweight or obese accept that it is appropriate for health professionals to discuss weight issues with patients, there is great variation in response to the terms commonly used to describe excess weight. There is no one-size-fits-all approach to discussing weight status: some men and younger people may appreciate a direct approach, whilst others need to be treated more sensitively. It is therefore important that health professionals use their knowledge and understanding to select the terms that are most likely to be acceptable, but at the same time have most potential to motivate each individual patient.

The views of young children in the UK about obesity, body size, shape and weight: a systematic review

BACKGROUND

There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues.

METHODS

We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings.

RESULTS

We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth.

CONCLUSIONS

Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.

Nutritional health, subjectivity and resistance: Women’s accounts of dietary practices

Food is related to health, both directly and symbolically, in complex ways. Also, social practices around food are highly gendered, and, in the context of family life, fall largely to mothers. This study examines mothers’ talk about nutritional health, and food, health and dietary practices in the context of everyday life, using a discursive analysis of the talk from focus group discussions. Findings show that discourses surrounding nutritional health offer women a variety of conflictual subjectivities. If they do not engage in ‘correct’ dietary practices, women are positioned as immoral, both as individuals and as mothers. Further, their ability to determine which foods are ‘healthy’ or ‘unhealthy’ is undermined through a distrust of ‘facts’ and scientific evidence, and they are rendered susceptible to exploitation through claims made for food as health promoting. Together, these areas of conflict perpetuate subjectivities of anxiety around dietary practices.The women seek to re-position themselves and overcome these contradictions by offering a variety of legitimations for their dietary practices. In doing so, they resist nutritional health messages and reveal how such messages can have unintended effects.

Adiposity and quality of life: a case study from an urban center in Nigeria

OBJECTIVE

To determine relationship between adiposity indices and quality of life (QOL) of residents of a housing estate in Lagos, Nigeria.

DESIGN

Cross-sectional survey employing multistep random sampling method.

SETTING

Urban residential estate.

PARTICIPANTS

This study involved 900 randomly selected residents of Abesan Housing Estate, Lagos, Nigeria.

MAIN OUTCOME MEASURES

Body mass index (BMI); waist circumference (WC); waist-to-hip ratio (WHR); triceps skin-fold thickness (TSFT); and abdominal skin-fold thickness (ASFT) were measured using International Standard of Anthropometric Assessment methods. QOL was assessed using Short Form-20.

ANALYSIS

Data were analyzed using the Pearson product moment correlation coefficient and multiple regression analysis.

RESULT

The mean age of participants was 37.7 +/- 14.3 years, with a range of 20 to 80 years. The mean values of adiposity indices were 24.1 +/- 4.3 kg/m(2) (BMI), 11.5 +/- 5.3 mm (TSFT), 18.5 +/- 6.2 mm (ASFT), 81.8 +/- 11.2 cm (WC), and 0.89 +/- 0.1 (WHR). Although the overall mean QOL score was 72.02 +/- 11.9, women had significantly (P < .05) lower scores (70.1 +/- 5.2) than men (73.5 +/- 11.3). There was inverse correlation between QOL and each of the age and adiposity indices.

CONCLUSION AND IMPLICATIONS

Quality of life of the urban-dweller Nigerians decreased with increasing body adiposity and age. This finding suggests the need to further educate the Nigerian public on the association between high body fat and poor health.

"Obesity" and "Clinical Obesity" Men's understandings of obesity and its relation to the risk of diabetes: a qualitative study

Background

The 2007 Wanless report highlights the ever increasing problem of obesity and the consequent health problems. Obesity is a significant cause of diabetes. An increasing evidence base suggests that in terms of reducing diabetes and CVD risk, it is better to be "fit and fat" than unfit and of normal weight. There has been very little previous research into the understandings that men in the general population hold about the issues of weight, exercise and health; we therefore undertook this study in order to inform the process of health promotion and diabetes prevention in this group.

Methods

A qualitative study in North East England General Practice using a purposive sample of men aged 25 and 45 years (selection process designed to include 'normal', 'overweight' and 'obese' men). One to one audio-recorded semi structured interviews focused on: overweight and obesity, diet, physical activity and diabetes. Transcripts were initially analysed using framework analysis. Emerging themes interlinked.

Results

The men in this study (n = 17) understand the word obesity differently from the clinical definition; "obesity" was used as a description of those with fat in a central distribution, and understandings of the term commonly take into account fitness as well as weight. Men in their late 30s and early 40s described becoming more aware of health issues. Knowledge of what constitutes a 'healthy lifestyle' was generally good, but men described difficulty acting upon this knowledge for various reasons e.g. increasing responsibilities at home and at work. Knowledge of diabetes and the link between obesity and diabetes was poor.

Conclusion

Men in this study had a complex understanding of the interlinked importance of weight and fitness in relation to health. Obesity is understood as a description of people with centrally distributed fat, in association with low fitness levels. There is a need to increase understanding of the causes and consequences of diabetes. Discussion of increased health awareness by men round the age of 40 may indicate a window of opportunity to intervene at this time.

A Review of Men's Health and Masculinity

Men's health is a new and evolving area of specialty that goes beyond men's cancers and sexual activities. Men's health in the 21st century incorporates a broader conceptualization of health, health behaviors, and lifestyle choices. This new focus results from the fact that men continue to lag behind women in life expectancy and in health care use, a situation that is worse for minority men. Understanding how gender socialization and masculine ideology affects men's health is an important step toward providing effective care for men. In this article, the authors review these areas and then discuss each of the top actual causes of death for men: tobacco use, poor diet, alcohol use, and physical inactivity. They then discuss the important issue of steroid use among men. Throughout the review, the authors highlight racial and ethnic differences in health behaviors. Furthermore, they provide empirically supported clinical implications to assist clinicians who see men with health concerns in their practices. Finally, they offer suggestions for creating ways to include men in the health care system in hopes of improving their use.

The experiences of young people with obesity in secondary school: some implications for the healthy school agenda

In 1995, the World Health Organisation launched a Global School Health Initiative to reduce health risks among young people. In the UK, the National Healthy School Programme (HSP) developed as part of a wider government commitment to promoting social inclusion. One of the key issues to be tackled by the programme is childhood obesity, for obesity is widely argued to be a public health problem for which a solution needs to be found. However, the assumption that obesity is necessarily problematic and that a higher body weight leads to health problems and social exclusion, is not without challenge. Critics of anti-obesity campaigns question the significance of weight per se and highlight the potential implications of discrediting not only fatness, but also the people who are seen as fat. This paper therefore explores the experiences of young people with obesity within the secondary school environment in relation to areas of concern prioritised by the HSP. The paper draws upon data from a qualitative research study involving 18 children and young people, between the ages of 10 and 17. Data were generated in focus group discussions and individual interview with participants of a community-based obesity intervention programme in South Yorkshire, UK. Data collection took place in 2005, and thematic analysis of the data was undertaken. Findings suggest that the issues prioritised in the HSP, particularly physical exercise and healthy eating, present challenges to young people with obesity and can reinforce their vulnerability to bullying in schools and contribute to their social exclusion. It concludes that social exclusion is a process experienced by, and pertinent to, children and young people, which has meaning for their experiences of, and during, childhood and youth. The whole-school approach of the HSP may fail to adequately address the experiences of marginalised and vulnerable groups of young people within schools, challenging and undermining the social inclusion agenda in which the programme is grounded and contributing to the construction of undesirable, fat, young bodies.

Bodies, mothers and identities: rethinking obesity and the BMI

Despite the intense level of attention directed towards obesity, there has been limited success in addressing the rising rates of this public health phenomenon. This paper argues that current approaches to obesity fail to consider concepts of embodiment, and in particular, that gendered and class-based experiences of embodiment are ignored in health promotion practices and policies. Drawing on Bourdieu's concept of habitus, this ethnographic study sought to locate obesity within the biographies and everyday experiences of two groups of women from differing socio-economic settings. Rather than identify with the clinical category of obesity, these women constructed identities that were refracted through a gendered and classed habitus, and in particular, through their role as mothers. Food provision and practices were central to constructs of mothering, and these relational identities were at odds with the promotion of individual behavioural changes. Moreover, these women's daily lives were shaped by different class-based aspects of habitus, such as employment. In demonstrating the ways in which obesity is enmeshed in participants' taken-for-granted, everyday practices, we problematise the universality of health-promotion messages and highlight the integral role that the critical theory of habitus has in understanding the embodiment of obesity.

“How could you let yourself get like that?”: Stories of the origins of obesity in accounts of weight loss surgery

In the context of the contemporary rhetoric of the "obesity epidemic", the fat body is easily labelled as lazy, self-indulgent and lacking in discipline. Those who become fat often find themselves needing to account for their size in order to refute the suggestion of moral failure that attaches itself easily to the fat body. Drawing on a series of interviews with 35 weight loss surgery patients in England and Scotland, this paper explores the discursive resources and strategies available to those who are, or who have been, very overweight in accounting for their size. The paper argues that the participants drew on three core discourses in order to resist the construction of their fatness as an individual moral failure: (1) the fat-prone body; (2) childhood weight gain; and (3) life events disrupting weight management efforts.