Between blame and care: women's 'needs talk' about obesity interventions in prenatal care.

Pregnant women's weight is no longer a private life situation, but a public health issue. In western prenatal care policies, pregnant women with a high body mass index (BMI) are targeted as a high-risk group in need of extra prenatal care to prevent pregnancy complications and childhood obesity. Recent studies argue that such targeting leads to a number of unintended negative consequences for women such as stigmatisation and mother blame. While targeting based on BMI increases the surveillance of women's weight and behaviour in pregnancy, it might also provide extra care and services for women. This article draws on Nancy Fraser's concept of 'needs talk' to investigate how women interpret Danish prenatal care services provided to meet the 'obese' pregnant women's needs. The analysis shows that women engage ambivalently with claims about their needs and who they 'are' as these are formulated by health authorities. Some claims and assumptions about the 'obese' pregnant woman are accepted. Others are rejected or redefined. The article concludes by discussing maternal ambivalence about the obesity discourse in relation to the 'obese' pregnant woman as a category that positions women between being blamed and receiving extra prenatal care.

Being targeted as a "severely overweight pregnant woman" -A qualitative interview study.

BACKGROUND: Pregnant women with a body mass index (BMI) ≥ 30 kg/m2 have been targeted in health-care systems in many western countries as a high-risk group. However, we have limited knowledge of the long-term significance of this prenatal care policy. OBJECTIVE: To investigate accounts women give of their experiences of being targeted as severely overweight during pregnancy when they look back at the intervention 4-5 years later. DESIGN: Interpretive analysis based on 21 semi-structured interviews conducted 4-5 years after the pregnancy with Danish mothers categorized as having a pre-pregnancy BMI ≥ 30. FINDINGS: In the women's retrospective accounts three phases were identified and separated: (i) Being identified as a "severely overweight pregnant woman." The women differed over whether they accepted this categorization, but all believed that an approach based on weight was acceptable. (ii) Encounters with health-care professionals. The women differed here: some reported no negative experiences; others reported experiences of prejudice and silence. (iii) Reflections on long-term outcomes. Most women reported that the interventions during their pregnancies did not lead to any lasting lifestyle change. The women disagreed over whether, in principle, pregnancy was a suitable time to be targeted. DISCUSSION AND CONCLUSION: Our study illustrates the importance of critically considering whether pregnancy is a suitable window of opportunity for obesity prevention, and shows that women's experiences should be examined in relation to each phase of intervention. More interdisciplinary studies are needed to map potential benefits and other consequences over the short- and long-term.

Changes in the social context and conduct of eating in four Nordic countries between 1997 and 2012.

How have eating patterns changed in modern life? In public and academic debate concern has been expressed that the social function of eating may be challenged by de-structuration and the dissolution of traditions. We analyzed changes in the social context and conduct of eating in four Nordic countries over the period 1997-2012. We focused on three interlinked processes often claimed to be distinctive of modern eating: delocalization of eating from private households to commercial settings, individualization in the form of more eating alone, and informalization, implying more casual codes of conduct. We based the analysis on data from two surveys conducted in Denmark, Finland, Norway and Sweden in 1997 and 2012. The surveys reported in detail one day of eating in representative samples of adult populations in the four countries (N = 4823 and N = 8242). We compared data regarding where, with whom, and for how long people ate, and whether parallel activities took place while eating. While Nordic people's primary location for eating remained the home and the workplace, the practices of eating in haste, and while watching television increased and using tablets, computers and smartphones while eating was frequent in 2012. Propensity to eat alone increased slightly in Denmark and Norway, and decreased slightly in Sweden. While such practices vary with socio-economic background, regression analysis showed several changes were common across the Nordic populations. However, the new practice of using tablets, computers, and smartphones while eating was strongly associated with young age. Further, each of the practices appeared to be related to different types of meal. We conclude that while the changes in the social organization of eating were not dramatic, signs of individualization and informalization could be detected.