Apocalyptic public health: exploring discourses of fatness in childhood ‘obesity’ policy

Abstract

Recent 'obesity' preventions focus heavily on children, widely regarded as the future of society. The National Child Measurement Programme (NCMP) is a flagship government programme in England that annually measures the Body Mass Index (BMI) of children in Reception (aged 4-5) and Year 6 (aged 10-11) in order to identify 'at risk' children and offer advice to parents. Using Foucauldian discourse analysis this study explores how discourses within the programme construct fatness. The NCMP materials contain three key interrelated themes (concerning the hidden threat of 'obesity', the burden of 'obesity', and bodies that pose a greater risk) that combine to construct a 'grotesque discourse' of apocalyptic public health. 'Obesity' is constructed as a social and economic catastrophe where certain bodies pose a greater threat than others. We argue that this discourse has the potential to change health service policy in markedly regressive ways that will disproportionately impact working-class, Black, Asian, and mixed race families. Introduction: children, BMI, and biopower Recent decades have seen globally increasing media and medical concern over a socalled 'obesity epidemic', particularly among children (Hilton et al., 2012; Ogden et al.,

A Feminist Relational Discourse Analysis of mothers’ voiced accounts of the “duty to protect” children from fatness and fatphobia

“…These extracts echo discourses of fatness (re)produced through policy that position successful weight loss as a preventative measure to avoid bullying or low self-esteem (Gillborn et al, 2020). To this end, avoiding fatphobia by successfully conforming to normalised standards of health is necessary and can be achieved via weight-monitoring, while fatphobia is a reasonable and expected response to abnormal bodies.…”

“…Critical scholars have highlighted these damaging contradictions, calling attention to patriarchal cultural norms that construct idealised bodies (Woolhouse & Day, 2015) and position women's and girls' bodies as in constant need of improvement in ways that harm mothers and daughters alike (Walsh & Rinaldi, 2018). Dominant discourses responsibilising mothers for the harm caused by constructed body ideals shift responsibility to individual mothers (Parker & Pausé, 2019), obscuring the role of government and policy in legitimising fatphobia as a response to "regimes of truth" about "obesity" (Gillborn et al, 2020).…”

“…Research with children has demonstrated how the NCMP reproduces a fear of fatness as an abnormality (Evans & Colls, 2009). Mothers are "incorporated as … actual or potential all[ies] into pedagogic programmes" (Rose, 1999, p. 182), and policy documents related to implementing this programme construct active engagement and cooperation as the moral duty of parents (Gillborn et al, 2020). Research has elucidated parents' opinions of the NCMP, such their rejection of the programme's pathologisation of their children (Gainsbury & Dowling, 2018).…”

A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the ‘Childhood Obesity: a plan for action’ (2016, 2018, 2019)

“…A narrow definition of obesity is also reflected in the key measure highlighted in the policy documents being the National Child Measurement Programme (NCMP) which is based on BMI (body mass index). Measures which rely on BMI (designed for use in adults), and the NCMP in particular [ 41 – 43 ], have been criticised for simplicity and for generalising a relationship between weight and health (see for example [ 44 , 45 ]). Such a measure implies a definition of obesity which is not about the presence of illness or health problems, instead categorising individuals as overweight or obese based simply on height and weight [ 41 , 44 ].…”

“…Measures which rely on BMI (designed for use in adults), and the NCMP in particular [ 41 – 43 ], have been criticised for simplicity and for generalising a relationship between weight and health (see for example [ 44 , 45 ]). Such a measure implies a definition of obesity which is not about the presence of illness or health problems, instead categorising individuals as overweight or obese based simply on height and weight [ 41 , 44 ]. BMI is not a measure of overall health and thus the limitations of BMI (and any such screening method) and its complex association with health needs to be acknowledged.…”