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I UNIVERSITY of CALIFORNIA SAN DIEGO the Weight of Medical UNIVERSITY OF CALIFORNIA SAN DIEGO The Weight of Medical Authority: The Making and Unmaking of Knowledge in the Obesity Epidemic A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Sociology (Science Studies) by Julia Rogers Committee in charge: Professor Martha Lampland, Chair Professor Cathy Gere Professor Isaac Martin Professor David Serlin Professor Charles Thorpe 2018 i Copyright Julia Ellen Rogers, 2018 All Rights Reserved ii The Dissertation of Julia Ellen Rogers is approved, and it is acceptable in quality and form for publication on microfilm and electronically: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Chair University of California San Diego 2018 iii DEDICATION For Eric and Anderson iv TABLE OF CONTENTS Signature Page………………………………………………………………………………iii Dedication ............................................................................................................................... iv Table of Contents ..................................................................................................................... v List of Figures and Tables ....................................................................................................... xi Vita ........................................................................................................................................ xiv Abstract of the Dissertation .................................................................................................... xv Introduction .............................................................................................................................. 1 Networks, Social Worlds, and Expertise in Making Scientific Knowledge ........................ 5 Scientific Controversies ....................................................................................................... 8 Fatness, health, and stigma ................................................................................................. 11 Methods .............................................................................................................................. 12 Plan of the Dissertation ...................................................................................................... 18 Chapter 1: Obesity .................................................................................................................. 24 Biomedicalization of Obesity ............................................................................................. 24 The obesity epidemic ......................................................................................................... 28 The obesity epidemic bandwagon. ..................................................................................... 30 An evolving definition of obesity. ...................................................................................... 37 v Webs of causation. ............................................................................................................. 44 Part 1: The Hidden Civil War in Obesity Research ............................................................... 50 Controversies in Obesity Research..................................................................................... 56 Chapter 2: The Crisis of Evidence in weight-loss maintenance ............................................. 60 Responding to the Crisis in Evidence About Weight-Maintenance ................................... 70 Lowering the Threshold of Weight-Loss Success .............................................................. 71 The move to prioritize health Improvement. .................................................................. 72 Harm from weight-cycling? ........................................................................................... 78 Maybe Diets Do Work? ...................................................................................................... 80 Explaining the Diet Failure Rate .................................................................................... 85 Changes in Metabolic Rate (Set-point Theory) .............................................................. 86 Chapter 3: The Obesity Paradox ............................................................................................ 91 A Paradox of Paradoxes ..................................................................................................... 93 Categorizing the paradoxes. ............................................................................................. 100 Obesity Mortality Paradoxes ............................................................................................ 101 The Mokdad, Marks, Stroup, and Gerberding “actual causes of death” 2004 paper. ...... 102 The 2005 Flegal, Graufard, Williamson, and Gail CDC “excess deaths” paper. ............. 104 Reactions. ......................................................................................................................... 106 The Harvard 2005 Symposium. ....................................................................................... 111 vi The Flegal 2013 meta-analysis. ........................................................................................ 115 Responses from the scientific community. ...................................................................... 117 The Harvard 2013 Response ............................................................................................ 121 Further Studies ................................................................................................................. 126 How to settle the debate? ................................................................................................. 132 We shouldn’t study this at all ........................................................................................... 135 Chapter 4: Healthy Obesity and Health At Every Size ........................................................ 140 Emergence of Health at Every Size .................................................................................. 144 History of the ‘Health at Every Size’ movement. ........................................................ 147 Principles of the Health at Every Size Movement. ...................................................... 152 The influence of eating disorder research. ................................................................... 160 HAES as a Competing Theory/Methods Package ............................................................ 161 HAES changes to the assessment of risk. .................................................................... 162 Naturalized bodily diversity. ........................................................................................ 172 Opening the “black box” and redefining obesity. ........................................................ 175 Strategies and Struggles for the HAES Movement .......................................................... 176 Attacks on HAES credibility ........................................................................................ 178 Use of Evidence-Based Medicine language. ................................................................ 183 HAES use of media appearances. ................................................................................ 186 vii Emergence of the “Healthy Obesity” Paradox ................................................................. 187 What is “metabolically healthy obesity” (MHO). ........................................................ 188 What is the Metabolically Obese Normal Weight (MONW) phenotype? ................... 192 What is the “fat but fit” paradox? ................................................................................. 192 Reactions from the weight-dependent camp. ............................................................... 194 The future of research design? ..................................................................................... 198 Putting behavior before body size ................................................................................ 203 Conclusion ........................................................................................................................ 206 PART 2: Fat bodies .............................................................................................................. 208 Obesity, Biomedical Individualism, and Biopower ......................................................... 215 Chapter 5: Fat Stigma, Anti-fat Discrimination, and Equal Protection ............................... 230 Bias, Stigma, and Discrimination in Society .................................................................... 232 Is fatness a choice? ....................................................................................................... 232 Social Consensus .......................................................................................................... 234 Disgust .......................................................................................................................... 236 The Impact of Anti-fat Attitudes ...................................................................................... 236 Workplace and Education Discrimination
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