Former CLAHRC West Dan Hill Fellow in Health Equity Oli Williams has published a new paper – alongside co-author Ellen Annandale – in Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. The article explores the relationships between social inequality, health and obesity. In particular, it demonstrates how stigma associated with body weight and size gets under the skin and is felt in the flesh.
The article is based on data from a study of three weight-loss groups in one of the most deprived neighbourhoods in England. The account pairs a year of participant observation, documented in extensive field notes, with interviews with regular group members. This allowed data derived from what participants did (practices) to be considered alongside what they said (narratives).
This approach highlighted how obesity stigma confused people’s experience of their bodies. The confusion was most evident on occasions when group members felt heavier after engaging in negatively moralised behaviours associated with weight-gain, such as consuming high calorie foods or alcohol, but this ‘weight’ didn’t register on the weighing scales.
Oli observed this at the weight-loss groups, as members would regularly come and say things such as:
“I know I’ve put on this week, I can feel it. My clothes are tighter and you can see I’m bloated, can’t you?”
But they were proved wrong when they got on the scales, which showed they had either lost weight or stayed the same. These experiences confused the group members because they could really feel the weight that they assumed their behaviour had led to them putting on.
In the paper, this mis-perception of weight is conceptualised as the weight of expectation. The authors’ analysis was that this feeling illustrates how the morality surrounding weight-management in a culture that’s hostile to those who are seen to be overweight or obese, actually gets under the skin and is felt in the flesh.
Similar to how being embarrassed in a social situation is felt physically, obesity stigma was shown to trigger psychosomatic stress. Being made to feel bad about yourself came to be deeply – and quite literally – felt in the bodies of people engaging in weight-loss services, making their bodies less knowable to them.
Another important finding discussed in the paper is what the authors refer to as carnal cues – bodily sensations that offered weight-loss group members a sense of ‘certainty’ to combat the more uncertain experience of attempting to manage weight. Group participants ascribed sensations from physiological responses to exercise with positive moral and social significance. For instance, group members always wanted to ‘get a sweat on’ because they associated sweating as a result of being physically active with energy expenditure and good health. The same was true of aching muscles.
These carnal cues played an important role in their attempts to negotiate obesity stigma, which otherwise encourages us to think of bigger bodies as being the result of greed and laziness. It provided group members with ‘evidence’ for themselves and others of the effort that they are assumed to have shirked. In short, these carnal cues helped them to feel good about themselves and combat the negative effects of obesity stigma.
These findings are important because they deepen understanding of the lived experience of being stigmatised, as well as how and why obesity stigma is an inappropriate and ineffective means of promoting weight-loss and health.
Oli collaborated with award winning illustrator Jade Sarson to translate the article into an evidence-based comic called The Weight of Expectation (WoE). Back in the summer, CLAHRC West hosted the Bristol comic launch and WoE exhibition at Christmas Steps Gallery. Oli has recently received further funding to create a ‘Next Generation’ edition of the comic specifically designed for teachers to use with young people at secondary schools. The Next Generation edition will be launched – and the WoE exhibition restaged – in York early next year.