The Harm Inflicted by Polite Concern: Language, Fat, and Stigma.

Understanding language as a social action draws attention to the ways in which fat stigmatizing discourses do social harm. Drawing on interviews and experiences situated in Osaka, Japan and north Georgia, US, this paper looks closely at the ways in which fat stigma is expressed across the two sites, both blatantly and through more subtle language use. We identified four key themes in people's narratives around localized ideas about fatness. These themes are: (1) expressed pity or concern for fat people; (2) reported experiences of indirect stigma in public settings; (3) reported experiences of direct stigma in private settings; and (4) robust and repeated associations between fat and other conditions that had locally relevant negative connotations in each site. We further identify the expressed concern and pity articulated in the first theme as a form of cloaked, "dressed up" stigma and as such, we argue that it enacts social harm, especially when it co-occurs with more blatant forms of stigma. Linguistic niceties around caring actually, at least in these contexts, reify symbolic connections between fat bodies and their social failure.

Fat Is All My Fault: Globalized Metathemes of Body Self-blame.

Norms valorizing not-fat bodies appear to have spread around the world, combined with a globalizing belief that thinness is the result of individual management of self and hard work. We examine themes of blame and felt responsibility for weight and "fat" in four distinct geographic and cultural locations: peri-urban Georgia, United States; suburban Osaka, Japan; urban Encarnación, Paraguay; and urban Apia, Samoa. Use of a novel metatheme approach that compares and contrasts these four distinct places characterized by different population-level prevalences of obesity and by specific cultural histories relevant to body norms and ideals provides a flexible toolkit for comparative cross-cultural/multi-sited ethnographic research. We show that self-blame, marked by an articulated sense of individual responsibility for weight and a sense of failing in this responsibility, is present in every field site, but to varying degrees and expressed in different ways. [fat, obesity, metatheme, stigma, self-blame].

Elective surgery to save my life: rethinking the "choice" in bariatric surgery.

AIMS: The aim of this study was to explicate the processes by which a patient's choice to undergo bariatric surgery is made to feel like a medical necessity, to explore the ways widespread societal stigmatization of weight and bariatric surgery shapes patient and provider discourse about surgery and to discuss patient rationalizations of the choice to have surgery. BACKGROUND: Severe obesity is currently highly stigmatized. Bariatric surgery has become an increasingly used option for individuals seeking to lose drastic amounts of weight. The surgery itself, however, remains stigmatized across many diverse settings. DESIGN: This research design is centred on an ethnographic study of bariatric surgery patients who undergo surgery at a particular bariatric clinic in the American Southwest. METHODS: Data collection included repeated ethnographic interviews with 35 individuals enrolled in the bariatric programme over the past 5 years. The interviews were supplemented by extensive participant observation, starting in 2014 to date. Thematic analysis of fieldnotes and transcribed interviews followed. RESULTS: People who have bariatric surgery for weight-loss may trade one type of stigma for another. Thus, individuals who qualify for bariatric surgery based on weight alone may be reluctant to explore the surgery as a viable option. This research also shows that younger women are more likely to face the effects of weight-related stigma, which has an impact on their motivations for undergoing bariatric surgery. CONCLUSION: Stigma - both weight-related and surgery-related - needs to be addressed at a larger level, in terms of policy and in clinical bariatric programmes.

Shame, Blame, and Status Incongruity: Health and Stigma in Rural Brazil and the Urban United Arab Emirates.

Stigma is a powerful determinant of physical and mental health around the world, a perennial public health concern that is particularly resistant to change. This article builds from sociologist Erving Goffman's classic conception of stigma as a unitary social phenomenon to explore the stigma attached to two seemingly dissimilar conditions: food insecurity in rural Brazil, and obesity in the urban United Arab Emirates. Our analyses underscore that both conditions are stigmatized because they represent a departure from a deeply-held social norm, and in both cases, self-stigma plays an important role. Furthermore, in both cases, the stigma associated with food insecurity and obesity is likely at least as harmful to personal wellbeing as are the biological consequences of these conditions. Finally, evidence increasingly links obesity and food insecurity causally. Our analyses suggest that these forms of stigma transcend individuals and are largely structural in their origins, and therefore that they are most likely to be improved through structural change.

Publically Misfitting: Extreme Weight and the Everyday Production and Reinforcement of Felt Stigma.

Living with extreme weight in the United States is associated with discrimination and self-stigma, creating structural exclusions, embodied stress, and undermining health and wellbeing. Here we combine ethnographic interviews and surveys from those with experiences of living with extreme weight to better explain how this vulnerability is created and reinforced by public cues, both physical (e.g., seatbelts) and social (the reactions of strangers). "Misfitting" is a major theme in interviews, as is the need to plan and scan constantly while navigating too-small public spaces. The most distressing events combine physical misfitting with unsympathetic reactions from strangers. Sensitivity to stigmatizing public cues reduces with weight loss, but does not disappear. This study explains one basic mechanism that underlies the creation of felt stigma related to weight even after weight loss: the lack of accommodation for size and the lack of empathy from others that characterize modern urban spaces.

Not 'Taking the Easy Way Out': Reframing Bariatric Surgery from Low-effort Weight Loss to Hard Work.

Cultural notions equating greater morality and virtue with hard work and productive output are deeply embedded in American value systems. This is exemplified in how people understand and execute personal body projects, including efforts to become slim. Bariatric surgery is commonly viewed as a 'low-effort' means of losing weight, and individuals who opt for this surgery are often perceived to be 'cheating.' This extended ethnographic study within one bariatric program in the Southwestern United States shows how patients conscientiously perform this productivity. By prioritizing discourses that focus on their own hard work and the inherent value and necessity of their surgery, patients and practitioners alike contest the dominant public views of surgically-induced weight loss.

Translating obesity: navigating the front lines of the "war on fat".

OBJECTIVES: Obesity is treated within medicine, public health, and applied sciences as a biomedical fact with urgent health implications; obesity is also, however, a social fact and one that reveals biomedical concerns can lead to social suffering. Translation of social science-oriented obesity research for broader public good requires navigation of the space between these polemical and seemingly mutually exclusive positions. METHODS: Using examples from our own current programs of biocultural research, we explain the opportunities and ongoing challenges of efforts to bridge the chasm between critique and intervention when the topic under discussion is obesity. The examples range from cross-population analyses of human variation and the implications for how we measure and classify obesity to biocultural research into fat-stigma to translational research conducted as part of a larger collaboration across multiple institutions. RESULTS AND CONCLUSIONS: Translation of social science-oriented obesity research for broader public good requires collaborative work across disciplines and fields, as well as between academics, professionals working in public health and medicine, policy makers, and other key stakeholders. Translation efforts must acknowledge and develop practical programs addressing the "obesity crisis," but also are compelled to question core assumptions upon which obesity-reduction interventions have thus far been based.

Managing menstruation with dignity: Worries, stress and mental health in two water-scarce urban communities in India.

An emerging body of literature examines multiple connections between water insecurity and mental health, with particular focus on women's vulnerabilities. Women can display greatly elevated emotional distress with increased household water insecurity, because it's them who are primarily responsible for managing household water and uniquely interact with wider water environments. Here we test an extension of this proposition, identifying how notions of dignity and other gendered norms related to managing menstruation might complicate and amplify this vulnerability. Our analysis is based on systematic coding for themes in detailed semi-structured interviews conducted with twenty reproductive-age women living in two water insecure communities in New Delhi, India in 2021. The following themes, emerging from our analysis, unfold the pathways through which women's dignity and mental health is implicated by inadequate water: ideals of womanhood and cleanliness; personal dignity during menstruation; hierarchy of needs and menstruation management amidst water scarcity; loss of dignity and the humiliation; expressed stress, frustration and anger. These pathways are amplified by women's expected roles as household water managers. This creates a confluence of gendered negative emotions - frustration and anger - which in turn helps to explain the connection of living with water insecurity to women's relatively worse mental health.

Weight stigma after bariatric surgery: A qualitative study with Brazilian women.

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.

Negotiating weight and body image in the UAE: strategies among young Emirati women.

OBJECTIVES: The goal of this study was to evaluate weight, nutritional status, and attitudes toward weight and health among a cohort of young women drawn from local populations in the United Arab Emirates. METHODS: This sample was composed of 103 female Emiratis, aged 18-30. Eighty of the women were students at Zayed University (ZU) in Dubai and 23 were students at UAE University (UAEU) in Al Ain. Research was divided into two phases. Methods included the collection of weight and height measurements (to analyze BMIs) and body fat percentages; 24-h food and activity recalls; semistructured, structured, and unstructured interviews; and participant observation. RESULTS: The distribution of BMIs in this sample was skewed toward underweight and normal weight in the ZU sample and split evenly between underweight-to-normal and overweight-to-obese in the UAEU sample, a finding that stands in contrast to the high rates of overweight and obesity reported in other age cohorts in local populations. This lower distribution of BMIs was correlated with widely expressed concern over body image, whereas reported interest in nutrition was much lower. Dietary patterns reflected attempts to manage weight. There was a marked trend toward nutritionally poor diets and sedentary living. CONCLUSIONS: Obesity and overweight among young women in the Emirati population do not appear to be as significant a problem as they are in older populations. However, several other health-related causes for concern emerged in this study, including extreme dieting strategies, insufficient micronutrient and protein intake, and widespread inactivity.

Eating in the Panopticon: Surveillance of Food and Weight before and after Bariatric Surgery.

In this article, we explore the processes by which surveillance of eating and weight is coupled with popular and medical ideas about discipline, responsibility, and moral worth for individuals identified as fat/obese. We then follow these individuals through bariatric surgery and weight loss, paying attention to what discourses and practices shift and what remain unchanged. We argue that weight loss does not temper the intensity and constancy of surveillance, because it is at the core of ideas concerning good citizenship and personal responsibility. Accompanying judgments do shift, however, as the perceptions of failure at disciplined "healthy" eating associated with fatness give way to more diverse attitudes post surgery. This analysis also highlights the fact that public and clinical perceptions of "troubled eating" often rely not on eating practices but on the types of bodies that are doing the consuming.

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence.

Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery. Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis. Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance. Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.

Body image, health, and modernity: women's perspectives and experiences in the United Arab Emirates.

The countries of the Arab Gulf have experienced accelerated development and urbanization over the last 50 years. Changes in health have likewise been dramatic: Kuwait, Saudi Arabia, Bahrain, and the UAE now have some of the highest proportions of obese/overweight people in the world, with correspondingly high rates of chronic disease. In the UAE, particularly high rates of obesity/overweight have been reported among middle-aged Emirati women, but other problems relating to health and nutrition are starting to be identified in younger age groups as well. This article describes preliminary data from a project among young Emirati women in the UAE. This study examines how these women cope with the increased availability of fast food, changing work patterns, and evolving ideas about body image, "risk," and health within a larger context of increasing chronic disease and weight gain throughout the UAE.