In this slides presentation, I review the key findings of my dissertation and discuss the different phases in the medical discourse on body fat.

1. Changing Meanings of Fat:
Fat, Obesity, Epidemics, and
America’s Children
Elise Paradis
Ph.D. Candidate, M.A. Sociology
Stanford University School of Education
http://www.stanford.edu/~eparadis
eparadis@stanford.edu

3. “Elise: I hope you realize that a dissertation
defense is not a boxing match.”
- F.O. Ramirez, Informal Conversation, 2009.

4. Obesity today...

5. Obesity today...
Is perceived as a serious health problem;

6. Obesity today...
Is perceived as a serious health problem;
Is discussed as an epidemic;

7. Obesity today...
Is perceived as a serious health problem;
Is discussed as an epidemic;
And is part of the “risk society” discourse:
We are all “at risk” for obesity (Boero, 2007),
and our society runs major risks if obesity
is not addressed.

8. In the Literature

9. In the Literature
There have been, schematically and over-
simplistically, two main perspectives on obesity
(Saguy & Riley, 2005):

10. In the Literature
There have been, schematically and over-
simplistically, two main perspectives on obesity
(Saguy & Riley, 2005):
1. Obesity as a disease, an economic threat, and as
requiring forceful intervention (“the main
paradigm”);

11. In the Literature
There have been, schematically and over-
simplistically, two main perspectives on obesity
(Saguy & Riley, 2005):
1. Obesity as a disease, an economic threat, and as
requiring forceful intervention (“the main
paradigm”);
2. Obesity as a social construction and a moral
panic (“the counter paradigm”).

12. Dissertation Overview

13. Dissertation Overview
Review the two paradigms of obesity and
adjudicate the evidence each presents (Part I);

14. Dissertation Overview
Review the two paradigms of obesity and
adjudicate the evidence each presents (Part I);
Discuss the development of the obesity discourse,
particularly in the medical literature – what I have
called the “medicalization of fat” (Part II);

15. Dissertation Overview
Review the two paradigms of obesity and
adjudicate the evidence each presents (Part I);
Discuss the development of the obesity discourse,
particularly in the medical literature – what I have
called the “medicalization of fat” (Part II);
And discuss the way schools and education have
been mobilized to solve the “obesity problem” in
the United States and in Singapore (Part III).

16. Dissertation Overview
Review the two paradigms of obesity and
adjudicate the evidence each presents (Part I);
Discuss the development of the obesity discourse,
particularly in the medical literature – what I have
called the “medicalization of fat” (Part II);
And discuss the way schools and education have
been mobilized to solve the “obesity problem” in
the United States and in Singapore (Part III).

17. Intellectual Tradition, I

18. Intellectual Tradition, I
Dissertation falls within a tradition of studies
in the social construction of knowledge and
scientific facts (Berger 1966; Collins and Evans 2002;
Fleck 1935; Hacking 1990, 1990; Latour 2004; Latour and
Woolgar 1979; Swidler and Arditi 1994).

19. Intellectual Tradition, I
Dissertation falls within a tradition of studies
in the social construction of knowledge and
scientific facts (Berger 1966; Collins and Evans 2002;
Fleck 1935; Hacking 1990, 1990; Latour 2004; Latour and
Woolgar 1979; Swidler and Arditi 1994).
Here, obesity and the obesity epidemic are
“facts” with a history. They are embedded
in a social, intellectual, and scientific
context.

20. Intellectual Tradition, II

21. Intellectual Tradition, II
Dissertation also inspired by neo-institutionalist
studies of science and of science
education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer
and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan
1978).

22. Intellectual Tradition, II
Dissertation also inspired by neo-institutionalist
studies of science and of science
education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer
and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan
1978).
Science is seen as:

23. Intellectual Tradition, II
Dissertation also inspired by neo-institutionalist
studies of science and of science
education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer
and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan
1978).
Science is seen as:
– A set of assumptions about the world;

24. Intellectual Tradition, II
Dissertation also inspired by neo-institutionalist
studies of science and of science
education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer
and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan
1978).
Science is seen as:
– A set of assumptions about the world;
– A legitimating force for choices, actions, and labeling;

25. Intellectual Tradition, II
Dissertation also inspired by neo-institutionalist
studies of science and of science
education(Drori et al. 2003; Meyer 1977; Meyer 1987; Meyer
and Jepperson 2000; Meyer and Ramirez 2000; Meyer and Rowan
1978).
Science is seen as:
– A set of assumptions about the world;
– A legitimating force for choices, actions, and labeling;
– A cultural authority across domains;

26. Presentation Overview

27. Presentation Overview
Discuss some of the evidence that shows that fat
is, beyond a “medical” phenomenon, a
“medicalized” phenomenon.

28. Presentation Overview
Discuss some of the evidence that shows that fat
is, beyond a “medical” phenomenon, a
“medicalized” phenomenon.
Present the different steps of the process whereby
fat became medicalized, as seen in major
scientific events and in the medical literature over
time (proxy: PubMed database).

29. “The Medical”: Definition

30. “The Medical”: Definition
The biopsychosocial model of health includes the
biological / physiological factors that cause ill
health and disease, and the psychological and
sociological factors that influence or complicate
them.

31. “The Medical”: Definition
The biopsychosocial model of health includes the
biological / physiological factors that cause ill
health and disease, and the psychological and
sociological factors that influence or complicate
them.
e.g., Cancer: The result of uncontrolled growth in a group of cells.
Its risk increases with smoking, physical inactivity, and exposure
to certain chemicals. It affects a time-varying percentage of the
population, and is a stigmatizing condition (Jain 2010; Sontag 1990).

32. “The Medicalized”: Definition

33. “The Medicalized”: Definition
Medicalization (Conrad 1992; Zola 1983) is the process
whereby previously non-medical conditions
come under medical purview. It is the
consequence of the expansion of the medical
profession, and seen in the multiplication of
publications, loci of intervention, and claims to
authority (Starr 1982).

34. “The Medicalized”: Definition
Medicalization (Conrad 1992; Zola 1983) is the process
whereby previously non-medical conditions
come under medical purview. It is the
consequence of the expansion of the medical
profession, and seen in the multiplication of
publications, loci of intervention, and claims to
authority (Starr 1982).
e.g., Mental illnesses are often discussed as medicalized conditions
(e.g., Brumberg 1990; Metzl and Kirkland 2010). Other conditions include
baldness (Powell et al. 2005) and erectile dysfunction (Conrad 2005),
which were not always seen as medical problems.

35. Fat as medical condition.

36. Fat as medical condition.
After reviewing the medical literature, I concluded:

37. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;

38. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;

39. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:

40. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:
• Weight Cycling (–)

41. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:
• Weight Cycling (–)
• Cardiovascular Fitness (+)

42. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:
• Weight Cycling (–)
• Cardiovascular Fitness (+)
• Stress Levels (–)

43. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:
• Weight Cycling (–)
• Cardiovascular Fitness (+)
• Stress Levels (–)
• Insurance Coverage (+)

44. Fat as medical condition.
After reviewing the medical literature, I concluded:
– That obesity rates have been increasing;
– That obesity correlates with illness;
– The data on mortality and morbidity often fails to
control for factors proven to be major determinants
of health, such as:
• Weight Cycling (–)
• Cardiovascular Fitness (+)
• Stress Levels (–)
• Insurance Coverage (+)
– Weight loss is not a sustainable, safe, or proven
strategy for improving health outcomes.

45. Fat as medicalized condition.

46. Fat as medicalized condition.
The legitimating force of science has turned fat
into a medical problem, in contrast with fat as
merely an esthetic concern.

47. Fat as medicalized condition.
The legitimating force of science has turned fat
into a medical problem, in contrast with fat as
merely an esthetic concern.
The medicalization of fat has taken on proportions
that exceed the proven medical problem with fat.

48. Fat as medicalized condition.
The legitimating force of science has turned fat
into a medical problem, in contrast with fat as
merely an esthetic concern.
The medicalization of fat has taken on proportions
that exceed the proven medical problem with fat.
I argue that the medicalization of fat went through
three major discursive shifts: from fat to obesity,
to epidemics, and finally to concern with
America’s children.

49. Medicalized Fat > Medical Fat

50. Medicalized Fat > Medical Fat
16,000
A
14,000
Obesity
12,000 Childhood Obesity
Obesity Epidemic
Childhood Obesity Epidemic
10,000 Total PubMed
Adult Obesity %
Child Obesity % (6-11)
8,000
6,000
4,000
2,000
0
1985-9 1990-4 1995-9 2000-4 2005-9

51. Medicalized Fat > Medical Fat
16,000 1,000
A B
900
14,000
Obesity 800
12,000 Childhood Obesity
Obesity Epidemic
700
Childhood Obesity Epidemic
10,000 Total PubMed
600
Adult Obesity %
Child Obesity % (6-11)
8,000 500
400
6,000
300
4,000
200
2,000
100
0 0
1985-9 1990-4 1995-9 2000-4 2005-9 1985-9 1990-4 1995-9 2000-4 2005-9

52. The Changing Meanings of Fat

53. Before there was obesity, there was...

54. Before there was obesity, there was...
FAT.

55. Before there was obesity, there was...
FAT.
Then, through medicalization, fat
became

56. Before there was obesity, there was...
FAT.
Then, through medicalization, fat
became
Obesity.

57. The medical community mobilizes.
The Medicalization of Fat USDHHS Childhood Obesity
Surgeon General Vision
Obesity in International
NIH: Consensus Statement Classification of Diseases
on Weight-Loss Surgery White House Let's Move!
WHO Global Epidemic
NIH: Obesity in America
IoM Guidelines for Obesity
Surgeon General: Shape Up
Association for the Study of America
Obesity
Surgeon General Call
NIH Use of BMI WHO Use of BMI
Bypass Surgery
1950 1960 1970 1980 1990 2000 2010

59. Associated growth in publications.
40,000
Obesity in Titles and Abstracts
Ratio Obesity to PubMed (x 1M)
30,000
20,000
10,000
0
1950 2010

60. Associated growth in publications.
40,000
Raw growth, 1950-2009: 14,569%
Obesity in Titles and Abstracts
Ratio Obesity to PubMed (x 1M)
30,000
20,000
10,000
0
1950 2010

61. Associated growth in publications.
40,000
Raw growth, 1950-2009: 14,569%
Obesity in Titles and Abstracts
Ratio Obesity to PubMed (x 1M)
30,000
20,000
Normalized growth, 1950-2009: 1,327%
10,000
0
1950 2010

62. Associated growth in publications.
40,000
Obesity in Titles and Abstracts
Ratio Obesity to PubMed (x 1M)
30,000
USDHHS Childhood Obesity
Surgeon General Vision
Obesity in International
NIH: Consensus Statement Classification of Diseases
20,000 on Weight-Loss Surgery White House Let's Move!
WHO Global Epidemic
NIH: Obesity in America
IoM Guidelines for Obesity
Surgeon General: Shape Up
10,000 Association for the Study of America
Obesity
Surgeon General Call
NIH Use of BMI WHO Use of BMI
Bypass Surgery
0
1950 1960 1970 1980 1990 2000 2010

64. An epidemic (of epidemics).

65. An epidemic (of epidemics).
Year First Instance of
1954 Epidemic AND Diabetes
1960 Epidemic AND CVD
1976 Epidemic AND Obesity
1993 "obesity epidemic" OR "epidemic obesity"
1994 "childhood obesity" AND epidemic

66. An epidemic (of epidemics).
0.0006
Obesity AND Epidemic
0.0005 Diabetes AND Epidemic
Cardiovascular Diseases AND Epidemic
Obesity AND Epidemic AND Childhood
0.0004
Year First Instance of
1954 Epidemic AND Diabetes
1960 Epidemic AND CVD
0.0003 1976 Epidemic AND Obesity
1993 "obesity epidemic" OR "epidemic obesity"
1994 "childhood obesity" AND epidemic
0.0002
0.0001
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

67. An epidemic (of epidemics).
0.0006
Obesity AND Epidemic
0.0005 Diabetes AND Epidemic
Cardiovascular Diseases AND Epidemic
Obesity AND Epidemic AND Childhood
0.0004
Year First Instance of
1954 Epidemic AND Diabetes
1960 Epidemic AND CVD
0.0003 1976 Epidemic AND Obesity
1993 "obesity epidemic" OR "epidemic obesity"
1994 "childhood obesity" AND epidemic
0.0002
0.0001
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

68. An epidemic (of epidemics).
0.0006
Obesity AND Epidemic
0.0005 Diabetes AND Epidemic
Cardiovascular Diseases AND Epidemic
Obesity AND Epidemic AND Childhood
0.0004
Year First Instance of
1954 Epidemic AND Diabetes
1960 Epidemic AND CVD
0.0003 1976 Epidemic AND Obesity
1993 "obesity epidemic" OR "epidemic obesity"
1994 "childhood obesity" AND epidemic
0.0002
0.0001
Fat wins.
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

69. 800
700
600
500
400
Childhood Obesity
300
200
Let’s Move!
100
0
1980 1985 1990 1995 2000 2005

70. Concern with obesity then turned to children.
800
700
600
500
400
Childhood Obesity
300
200
Let’s Move!
100
0
1980 1985 1990 1995 2000 2005

71. Concern with obesity then turned to children.
800
700
Raw growth, 1980-2009: 3,700%
600
500
400
Childhood Obesity
300
200
Let’s Move!
100
0
1980 1985 1990 1995 2000 2005

73. And schools and education were mobilized.
500
Education
400 School
Childhood and Education
Childhood and School
Epidemic, Childhood and Education
Epidemic, Childhood, and Schools
300
200
100
0
1980 1985 1990 1995 2000 2005

74. And schools and education were mobilized.
500
Education
400 School
Childhood and Education
Childhood and School
Epidemic, Childhood and Education
Epidemic, Childhood, and Schools
300
Surgeon General Call
200
100
0
1980 1985 1990 1995 2000 2005

75. Medical vs. Medicalized Fat

76. Medical vs. Medicalized Fat
In sum, my research has shown that fat is not
merely a medical phenomenon; it is a medicalized
one.

77. Medical vs. Medicalized Fat
In sum, my research has shown that fat is not
merely a medical phenomenon; it is a medicalized
one.
- The medical bases to call fat a disease, and to entice people to
lose weight, are still shaky;

78. Medical vs. Medicalized Fat
In sum, my research has shown that fat is not
merely a medical phenomenon; it is a medicalized
one.
- The medical bases to call fat a disease, and to entice people to
lose weight, are still shaky;
- Immense scientific mobilization to define obesity as a disease,
in the U.S. and beyond;

79. Medical vs. Medicalized Fat
In sum, my research has shown that fat is not
merely a medical phenomenon; it is a medicalized
one.
- The medical bases to call fat a disease, and to entice people to
lose weight, are still shaky;
- Immense scientific mobilization to define obesity as a disease,
in the U.S. and beyond;
- Dramatic expansion of medical publications on the topic.

80. Medical vs. Medicalized Fat
In sum, my research has shown that fat is not
merely a medical phenomenon; it is a medicalized
one.
- The medical bases to call fat a disease, and to entice people to
lose weight, are still shaky;
- Immense scientific mobilization to define obesity as a disease,
in the U.S. and beyond;
- Dramatic expansion of medical publications on the topic.
Fat is a social construction.

81. Steps in the medicalization of fat.

82. Steps in the medicalization of fat.
First, there were fat people.

83. Steps in the medicalization of fat.
First, there were fat people.
By 1970, they were obese. By 1985, they were
defined by a BMI above 30. In 1990, obesity
officially became a disease.

84. Steps in the medicalization of fat.
First, there were fat people.
By 1970, they were obese. By 1985, they were
defined by a BMI above 30. In 1990, obesity
officially became a disease.
Early 1990s: Obesity emerges as an epidemic. By
1999, trumps other epidemics of non-contagious
diseases.

85. Steps in the medicalization of fat.
First, there were fat people.
By 1970, they were obese. By 1985, they were
defined by a BMI above 30. In 1990, obesity
officially became a disease.
Early 1990s: Obesity emerges as an epidemic. By
1999, trumps other epidemics of non-contagious
diseases.
At the turn of the century, concern with children
explodes. Governmental action targets them -
and their parents - specifically.

86. Thank You!