Controversies over obesity The risks of political agenda building and the thematization obesity By Jean Pierre Poulain

1. SAS Toulouse, janvier 2009
Controversies over obesity
The risks of political agenda building
and the thematization obesity
Jean Pierre Poulain
Socio‐anthropologue
Professeur à l’Université de Toulouse 2
CERTOP‐TAS UMR CNRS 5044
1

2. Sociology and obesity: two approaches
Sociology « in » … Sociologie « of » …
Links between SES and obesity Medical discourse on obesity
Social stigmatization of obese Preventing obesity: practical
people details and what’s at stake
Modern dietary habits and obesity Social controversies
Transformation of social
representations of fat bodies and
of fat Obesity as a social construction
Obesity as a multi-factorial
disease that sociology seeks to
analyze

3. Plan
Controversies
Obesity : Definition and measurement
Obesity: how many deaths?
Obesity and life expectancy
Controversies : a price to pay for agenda setting
Controversies as part of the process of thematization
3

4. The agenda building theory, COBB et ELDER 1972]
Problem stream Window of opportunity
Prevalence : build-up and
exaggeration of the issue
Definition : Epistemological
transformation
Manipulation of the threshold of social
Aligning the 3 streams
acceptance
Solution stream
Proposal of solutions based upon
optimistic evaluations
Entrepreneurs
More rhetorical prevention than Crossed
real problem-solving
Policy stream Experts
Obesity is often used as a tool to
gain political capital
Financing
Publicity
4

5. Agenda building : decision makers and
windows of opportunity
Entrepreneurs
Experts
5

6. Thematization
Theory of Communicative
Action
There are contexts in which knowledge is
unstable (justification of the Thematization
Precautionary principle).
Organizing, forming questions
Scientific rationality cannot account for based upon the social
the social questions involved.
imagination and in relation to
Science does not deal with human other social issues.
problems alone, since decisions are
made through consensus
Value-rationalities are negociated,
discussed, socially constructed
Structure and function of public debate
6

7. Sociology of science
Theoretical framework
Empirical data :
Mertonian sociology
Scientific documents
(peer reviewed articles, Ethos of the researcher
expert statements, Influence of contexts
books) The « strong program » (Bloor, 1976)
Lobbyists’ work (web Science as a large market
sites, publications, ads)
Resource conquest logic
and on
Press articles (analyses Moderate contextualism (Berthelot, 2002 et
2008)
and interviews)
Conceptual
Contextualist
7

8. Plan
Controversies
Obesity : Definition and measurement
Obesity: how many deaths?
Obesity and life expectancy
Controversies : a price to pay for agenda setting
Controversies as part of the process of thematization
8

9. Body Mass Index
Quételet’s formula
Weight / HeightX Height Categories BMI values
En kg en m
Underweight < 16,0
degree 3
Underweight 16,0-16,9
degree 2
Underweight 17,0-18,4
degree 1
Underweight < 18,5
Normal range 18,5-24,9
Overweight >= 25,0
Mild obesity 25,0-29,9
Obesity class 1 30,0-34,9
Obesity class 2 35,0-39,9
Obesity class 3 >= 40

10. How weight became the n°1 problem
of the United States
Depuis 1998 Avant 1998
Femmes et Femmes Hommes
hommes
Obésité >30 >30 >30
Surpoids 25‐30 27,3‐30 27,6‐30
Poids 18,5‐25 20‐25 20‐25
normal
Minceur <18,5 <20 <20
38 % overweight versus 60 %
10

11. How weight became the n°1 problem
of the United States
In one night, not less than « Current interpretations of the revised
35 million Americans guidelines stigmatize too many people as
became overweight. overweight; fail to account for sex,
race/ethnicity, age, and other differences, and
ignore the serious health risks associated with
The change of the limit low weight and efforts to maintain an
between the categories of unrealistically lean body mass.
normal range and This seeming rush to lower the standard for
underweight from 20 to 18, overweight to such a level that 55% of
which effectively American adults find themselves being
standardizes a weight declared overweight or obese raises serious
concerns ».
previously considered
Strawbridge, Wallhagen, Shema, 2000, American
insufficient. Journal of Public Health.
11

12. The French Rugby team, before and after
Before After
1998
Normal weight 17 3
Overweight 7 21
Obesity 6 6
12

13. Justification of the new guidelines
Scientific argument ?
Controversy :
Diabetes
Overweight and longevity
(Flegal et al. )
Or private interests
Lobbying power of
pharmaceutical/drug
companies
Researchers’ own
motives (Kopelman, 2000).
13

14. The definition of obesity : an
epistemological forceful takeover?
« Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health.» The text follows saying
that “Body mass index (BMI) is a simple index of weight-for-height
that is commonly used in classifying overweight and obesity in adult
populations and individuals. It is defined as the weight in kilograms
divided by the square of the height in meters (kg/m2). »
The writer continues « However, it should be considered as a
rough guide because it may not correspond to the same degree of
fatness in different individuals. » (OMS, 2006).
Then a slight shift and the same text states « The World Health
Organization (WHO) defines "overweight" as a BMI equal to or more
than 25, and "obesity" as a BMI equal to or more than 30. » (OMS,
2006).
14

15. The construction of childhood obesity in
France : paternalist manipulation ?

16. Fatten… the numbers, Le monde 20 janvier 2006.

18. Plan
Controversies
Definition and measurement of obesity
Obesity: how many deaths?
Obesity and the life expectancy
Controversies : a price to pay for agenda setting
Controversies as part of the process of thematization
18

19. Obesity: how many deaths?
Allison, and al., 1999, “Annual deaths Mokdad and al., 2004, Prevalence of Flegal and al. 2005. Excess deaths
attributable to obesity in the United obesity, diabetes, and obesity-related health associated with underweight, overweight,
States”, JAMA, 282, 1530–38. risk factors, JAMA, Vol. 289, n ° 1, 76-79. and obesity. JAMA 293(15): 1861–67.
450000
400000
350000
300000
250000
200000
150000
100000
50000
0
2000 2001 2002 2003 2004 2005 19

20. 300,000 deaths…obesity or ?
Michael Mc Ginnis and William Foege attribute a high mortality rate
in the United States--300, 000 deaths--to sedentary lifestyles and vad
dietary habits, but not weight in itself. (Mc Ginnis et Foege, 1993).
Paradoxically, this study will become a main scientific reference for
defending the idea of a link between mortality and obesity. An analysis of
electronic data bases shows that in the span of 3 years, it is cited over a
thousand times to support the link between mortality and obesity.
Mc Ginnis and Foege are so upset by the misuse of their work that in
1998 they publish a letter in New England Journal of Medicine wherein
they denounce the « misrepresentation » of their study. Regardless, the
debate continues.
20

21. Plan
Controversies
Obesity : Definition and measurement
Obesity: how much deaths?
Obesity and life expectancy
Controversies : a price to pay for agenda setting
Controversies as part of the process of thematization
21

22. « Life expectancy in the United States will diminish as a result of an
obesity epidemic that will creep through all ages like a human
tsunami » Jay Olshansky
Reduction of life expectancy due to obesity,
separated according to race and sex, United
States 2002
S. Jay Olshansky et al., "A Potential Decline in Life Expectancy in the
United States in the 21st Century", New England Journal of Medicine
352, vol. 11: 1138-45.
22

23. « I doubt that obesity will negate the effects of other medical
progress in improving mortality. » Vaupel
« His perspective is that of an advocate
making a case rather than a scientist
evaluating the body of conflicting evidence.“
"There is a small chance -- less than one in
100 -- that Olshansky's prediction of declining
life expectancy might possibly prove correct."
Vaupel, 2005, directeur du Max Plant Institut
Kenneth Thorpe, d'Emory University, « way
much simplistic »
Even Jo Ann Manson, more or less in the
alarmist camp, explains in the Associated
Press, « the calculations that were done aren’t
exactly perfect… ».
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24. 24

25. Plan
Controversies
Definition and measurement of obesity
Obesity: how many deaths?
Obesity and the life expectancy
Controversies : a price to pay for agenda setting
Controversies like component of the process of
thematisation
25

26. Agro-industry and fast-food
Agro-industry plays a triple game.
Via forceful marketing and advertising, they fill the
market with products that encourage people to eat
more and to eat high caloric foods (snacking
between meals, increased portion size),
Supporting intervention in human nutrition by
public authorities and nutritional councils.
To relieve themselves of responsibility, they stress
the individual responsibility of consumers
(Nestle, 2000 et 2007)
26

27. Which interpretations?
Who benefits from the media
attention given to problems tied to
weight and obesity?
On answer is the pharmaceutical
industry
The market of “medicalized” weight-
loss products has developed has the
science that drives their production
(discovery of new molecules)
advances.
27

28. Public policies….
Tim Lang shows the impact of agricultural
policies and of advertising regulation.
Marion Nestle writes about the result of
shareholder pressure on agro-industries. By
demanding higher and higher dividend earnings,
they force companies to increase sales in an
already saturated market. Companies respond
to this pressure by looking for new markets and
new sale opportunities. In order to achieve their
goals, they encourage behaviors that were once
looke down upon, such as snacking between
meals. They also seek to change social norms
that had previously restricted food consumption
to specific contexts. (Nestle, 2007).
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29. Interest of researchers and of research
organizations
June 23, 2004, the director of the CDC orders
an internal review of a study that had evaluated
the number of deaths caused by obesity at
400,000 and assigns the responsibility to the
research team of Dr. Stephen Thacker.
Conclusions :
Error in calculation?
Problems of bias
At her Congressional hearing, Julie Gerberding
had argued for a 6 billion-dollar budget for the
CDC.
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30. 30

31. How to explain the situation?
Game of musical chairs
where each actor passes
the responsibility to the
next person.
Need to share
responsibility for the
situation.
Theoretical framworks
Agenda-building theory
Thematization
31

32. The agenda building theory
Problem stream
Prevalence : build-up and exaggeration of the issue
Definition : Epistemological transformation
Manipulation of the threshold of social acceptance
Solution stream
Proposal of solutions based upon optimistic evaluations
More rhetorical prevention than real problem-solving
Policy stream
Obesity is often used as a political tool
Financing
Publicity
32

33. Thematization of obesity
Concrete evidence of its effects :
Bad eating habits
Food crises
General feeling that we don’t know what
to do
Culpability for the abundance of
food in northern countries
The legitimization of the obsession
with loosing weight
33

34. 34

35. The consequences of thematizing obesity
Scientists’ demands for caution go unheard
People who dramatize the problem dominate the
discourse on obesity
Media saturation
Obesity as a scientific problem with much at stake
socially
35

36. Body image as an axis of prevention
Effects of dramatization ?
Justification of the skinny beauty standard
Development of eating disorders
Dietary socialization of children
36

37. « What causes the most damage is not the actual
weight itself, but the fear of weight ».
Hillel Schwartz, Never statisfied.
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38. Further reading…
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