Obesity, stigma and reflexive embodiment: Feeling the 'weight' of expectation.

The dominant obesity discourse which emphasises individual moral responsibility and lifestyle modification encourages weight-based stigma. Existing research overwhelmingly demonstrates that obesity stigma is an ineffective means by which to reduce the incidence of obesity and that it promotes weight-gain. However, the sensate experiences associated with the subjective experience of obesity stigma as a reflexively embodied phenomenon have been largely unexamined. This article addresses this knowledge gap by providing a phenomenological account. Data are derived from 11 months of ethnographic participant observation and semi-structured interviews with three single-sex weight-loss groups in England. Group members were predominantly overweight/obese and of low-socio-economic status. The analysis triangulates these two data sources to investigate what/how obesity stigma made group members feel. We find that obesity stigma confused participant's objective and subjective experiences of their bodies. This was primarily evident on occasions when group members felt heavier after engaging in behaviours associated with weight-gain but this 'weight' did not register on the weighing scales. We conceptualise this as the weight of expectation which is taken as illustrative of the perpetual uncertainty and morality that characterises weight-management. In addition, we show that respondents ascribed their sensate experiences of physiological responses to exercise with moral and social significance. These carnal cues provided a sense of certainty and played an important role in attempts to negotiate obesity stigma. These findings deepen the understanding of how and why obesity stigma is an inappropriate and ineffective means of promoting weight-loss.

Theorising women's health and health inequalities: shaping processes of the 'gender-biology nexus'.

Since the theoretical frameworks and conceptual tools we employ shape research outcomes by guiding research pathways, it is important that we subject them to ongoing critical reflection. A thoroughgoing analysis of the global production of women's health inequality calls for a comprehensive theorization of how social relations of gender and the biological body mutually interact in local contexts in a nexus with women's health. However, to date, the predominant concern of research has been to identify the biological effects of social relations of gender on the body, to the relative neglect of the co-constitutive role that these biological changes themselves may play in ongoing cycles of gendered health oppressions. Drawing on feminist and gender theoretical approaches, and with the health of women and girls as our focus, we seek to extend our understanding of this recursive process by discussing what we call the 'shaping processes' of the 'gender-biology nexus' which call attention to not only the 'gender-shaping of biology' but also the 'biologic-shaping of gender'. We consider female genital mutilation/cutting as an illustration of this process and conclude by proposing that a framework which attends to both the 'gender-shaping of biology' and the 'biologic-shaping of gender' as interweaving processes provides a fruitful approach to theorising the wider health inequalities experienced by women and girls.

Gender Inequality in the Couple Relationship and Leisure-Based Physical Exercise.

AIMS: To analyse whether gender inequality in the couple relationship was related to leisure-based physical activity, after controlling for earlier physical activity and confounders. METHODS: Data drawn from the Northern Swedish Cohort of all pupils in their final year of compulsory schooling in a town in the North of Sweden. The sample consisted of 772 respondents (n = 381 men, n = 391 women) in the 26-year follow-up (in 2007, aged 42) who were either married or cohabiting. Ordinal regression, for men and women separately, was used to assess the association between gender inequality (measured as self-perceived equality in the couple relationship using dummy variables) and a measure of exercise frequency, controlling for prior exercise frequency, socioeconomic status, the presence of children in the home, and longer than usual hours in paid work. RESULTS: The perception of greater gender equality in the couple relationship was associated with higher levels of physical activity for both men and women. This remained significant when the other variables were controlled for. Amongst men the confidence intervals were high. CONCLUSIONS: The results point to the potential of perceived gender equality in the couple relationship to counteract the general time poverty and household burden that often arises from the combination of paid work and responsibility for children and the home, especially for women. The high confidence intervals among men indicate the need for more research within the field with larger samples.

Central gender theoretical concepts in health research: the state of the art.

Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (i.e., a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

A conceptual muddle: an empirical analysis of the use of 'sex' and 'gender' in 'gender-specific medicine' journals.

BACKGROUND: At the same time as there is increasing awareness in medicine of the risks of exaggerating differences between men and women, there is a growing professional movement of 'gender-specific medicine' which is directed towards analysing 'sex' and 'gender' differences. The aim of this article is to empirically explore how the concepts of 'sex' and 'gender' are used in the new field of 'gender-specific medicine', as reflected in two medical journals which are foundational to this relatively new field. METHOD AND PRINCIPAL FINDINGS: The data consist of all articles from the first issue of each journal in 2004 and an issue published three years later (n = 43). In addition, all editorials over this period were included (n = 61). Quantitative and qualitative content analyses were undertaken by the authors. Less than half of the 104 papers used the concepts of 'sex' and 'gender'. Less than 1 in 10 papers attempted any definition of the concepts. Overall, the given definitions were simple, unspecific and created dualisms between men and women. Almost all papers which used the two concepts did so interchangeably, with any possible interplay between 'sex' and gender' referred to only in six of the papers. CONCLUSION: The use of the concepts of 'sex' and gender' in 'gender-specific medicine' is conceptually muddled. The simple, dualistic and individualised use of these concepts increases the risk of essentialism and reductivist thinking. It therefore highlights the need to clarify the use of the terms 'sex' and 'gender' in medical research and to develop more effective ways of conceptualising the interplay between 'sex' and 'gender' in relation to different diseases.

Constructing the 'gender-specific body': A critical discourse analysis of publications in the field of gender-specific medicine.

Gender-specific medicine, a new and increasingly influential ethos within medical research and practice, has received little critical attention to date. The objective of this article is to critically examine the attributes of gender-specific medicine as imparted by its advocates. Through a critical discourse analysis of its two leading academic journals, we identify five interrelated discourses: of male/female difference; of hegemonic biology; of men's disadvantages; of biological and social reductionism; and of the fragmented body. Together these comprise a master discourse of the 'gender-specific body'. The discourse of the 'gender-specific body' is discussed in relation to the current neoliberal political agenda which frames healthcare as a market good and locates health and illness in individual bodies rather than in the wider social arrangements of society. We argue that the 'gender-specific body' threatens not only to turn back the clock to a vision of the biological body as fixed and determinate, but to extend this ever deeper into the social imagination. Lost in the process is any meaningful sense of the human body as a relatively open system which develops in interaction with its social world. We propose that, as it gains momentum, the 'gender-specific body' is likely progressively to circumscribe our thinking about the health of women and men in potentially problematic ways.

Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups.

BACKGROUND: Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK METHODS: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. RESULTS: Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. DISCUSSION: By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.