Lifestyle as a choice of necessity: Young women, health and obesity

Original Article Lifestyle as a choice of necessity: Young women, health and obesity Alex Dumasa,*, Jeanne Robitaillea and Shannon L. Jetteb a School of Human Kinetics, University of Ottawa, 125 University, Ottawa, ON, K1N 6N5, Canada. E-mail: adumas@uottawa b Department of Kinesiology, University of Maryland, 2351 SPH Building, College Park, MD 20742, USA. *Corresponding author. Abstract Sociologists of health have regularly called into question strictly knowledge-based health promotion approaches that focus on individual lifestyle change, claiming preference for collective actions on social determinants of health. These critiques have more recently been directed towards the issue of obesity. Although there is a growing body of work that shows the connection between poverty, obesity and ill health, few studies have focused on the concerns for health and lifestyle of vulnerable populations. In this qualitative study, 15 in-depth interviews were conducted with young underprivileged women in order to capture their dispositions towards health practices by outlining sociocultural factors that do (or do not) incline them to pursue a health regimen and weight control strategies. By drawing on Pierre Bourdieu’s concepts of habitus, practical sense and ‘choice of the necessary’, the results suggest that inclinations to follow normative health guidelines are strongly influenced by family and financial responsibilities and by pressing health concerns rather than a calculation of how the prescribed risk avoidance behaviours will improve personal health and/or prevent illness for one’s own sake. In conclusion, this study highlights the limits of prescribed ‘solutions’ to health improvement that have little to no consideration of embodied social knowledge and lived experiences. Social Theory & Health (2014) 12, 138–158. doi:10.1057/sth.2013.25; published online 20 November 2013 Keywords: Bourdieu; health; obesity; lifestyle; women; poverty Introduction Most current health promotion initiatives linked to obesity encourage people to take up a healthy lifestyle in order to decrease the risk of developing a range of chronic diseases (for example, diabetes, high blood pressure) thought to be associated with obesity (WHO, 2013). At the basis of such initiatives is the © 2014 Macmillan Publishers Ltd. 1477-8211 Social Theory & Health www.palgrave-journals.com/sth/ Vol. 12, 2, 138–158 Lifestyle as a choice of necessity intention to educate and vest responsibility over one’s health (Brownell et al, 2010). The sociology of health inequalities has provided many criticisms of this approach for its over-simplistic understanding of people’s health and lifestyles, notably for its neglect of social structure and social inequalities as important determinants of health. It has also called into question strict knowledge-based or behavioural approaches to lifestyle in health policy, instead calling for more inclusive strategies that embrace collective action on various social determinants of health (Frohlich and Poland, 2007). Although individual-based and structure-based approaches stem from separate research foci that have been associated to the biomedical and the social models of health respectively (Germov, 2005), a neat separation between them misrepresents the complexity of efforts to promote healthy lifestyles. Even if it is clearly not flawed to accept individual-centred strategies to improve health by changing lifestyle, as Cockerham reminds us (2013, p. 150), ‘it seems very rare that agency ever truly frees itself from structure’. Hence the importance of investigating the interactions between these two positions. Although there is a growing body of work demonstrating the connection between poverty, obesity and ill health (Levine, 2011), few studies have focused on the concerns for health and lifestyle of socio-economically deprived populations by using an elaborate theory of practice. In this qualitative study, 15 indepth interviews were conducted with young underprivileged women in order to capture their dispositions towards health practices by outlining sociocultural factors that do (or do not) incline them to pursue a health regimen and weight control strategies. By drawing on Pierre Bourdieu’s concepts of habitus, practical sense and ‘choice of the necessary’, results show the manner in which the participants’ health and weight management practices were influenced by their immediate needs and responsibilities, as well as their embodied social knowledge for how to cope with stress and responsibilities – despite their awareness of normative health guidelines. Such conclusions promise to contribute by informing policy makers of the hierarchy of priorities of young underprivileged women. Women, Lifestyle and Obesity. A Critical Approach The Public Health Agency of Canada (2011), in collaboration with the Canadian Institute for Health Information, has recently published a document stressing the various facets of the ‘obesity epidemic’ including its prevalence, determinants, contributing factors, as well as its health and economic implications. The publication and distribution of this report was quickly followed by a series of newspaper editorials and health bulletins across Canada that restated the health risks associated with obesity and issued warnings about the repercussions of © 2014 Macmillan Publishers Ltd. 1477-8211 Social Theory & Health Vol. 12, 2, 138–158 139 Dumas et al neglecting generic health guidelines (see Doctors of Weight Loss, 2011). These forums regularly present mortality and morbidity notes associated with the social and economic impacts of obesity on Canadian society. These publications, public health bulletins and accompanying newspaper editorials are part of an array of obesity-related messages so vast that any adult female living in North America would be hard-pressed to miss the alarm about the obesity epidemic or the common health prescription for women at ‘risk’ of overweight or obesity: weight loss through lifestyle change (diet and exercise). However, a growing number of scholars and activists question the claims of mainstream obesity science as well as the related anti-obesity health promotion discourses. There is a diversity of perspectives within this group (see Gard, 2011), with some challenging the validity of mainstream obesity science (namely the idea that obesity and overweight cause ill health) (Gaesser, 2002; Campos, 2004; Oliver, 2006), and others urging fat acceptance (see Rothblum and Solovay, 2009). Most relevant to our analysis are those scholars who criticize the so-called neo-liberalization of obesity-related health promotion and the manner in which various organizations have uncritically positioned individuals as solely responsible for changing their lifestyles to ensure an appropriate (and ‘healthy’) body weight (Burrows, 2009; Fullagar, 2009). The imperative to take responsibility for one’s health that is advocated by medical inst (...truncated)