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Food and Eating De Ervaring van Dikke Vrouwen The experience of fat Dutch women Submitted August 2000 Ava Nepaul Universiteit van Amsterdam AMMA Program Thesis [email protected] TABLE OF CONTENTS TABLE OF TABLES .......................................................................................................................................... iii ACKNOWLEDGMENTS ................................................................................................................................... iv INTRODUCTION ................................................................................................................................................ 5 LITERATURE REVIEW .......................................................................................................................................... 6 Explanations of fatness ................................................................................................................................... 6 Biomedical aspects of fatness ......................................................................................................................... 7 Social aspects of fatness ................................................................................................................................. 8 RESEARCH OBJECTIVES AND METHODS ............................................................................................... 11 FINDINGS AND INTERPRETATION ............................................................................................................ 13 OBESITY RESEARCH IN THE NETHERLANDS ...................................................................................................... 13 STIGMA ............................................................................................................................................................. 15 LIVING LARGE: THE EXPERIENCE OF FAT DUTCH WOMEN ............................................................................... 19 Why I am fat .................................................................................................................................................. 19 Body Image ................................................................................................................................................... 20 The Quest for Weight Loss ............................................................................................................................ 26 Food and Eating ........................................................................................................................................... 31 Social Interaction ......................................................................................................................................... 33 Gezin .......................................................................................................................................................................... 33 Vrienden (Friends) ...................................................................................................................................................... 35 Andere mensen (other people) .................................................................................................................................... 36 Watch out for maar ..................................................................................................................................................... 39 ORGANIZING ..................................................................................................................................................... 40 Nederlandse Obesitas Vereniging ................................................................................................................ 40 Bond van Formaat ........................................................................................................................................ 42 A Uniting Front: Xenical marketing in the Netherlands ............................................................................................. 43 DISCUSSION ...................................................................................................................................................... 46 CONTEXT PLEASE .............................................................................................................................................. 46 THE THIN IDEAL ................................................................................................................................................. 48 COPING .............................................................................................................................................................. 49 IS GEZONHEID BELANGRIJKST? (IS HEALTH MOST IMPORTANT?) ....................................................................... 51 A NOTE ABOUT AMERICANS ............................................................................................................................. 54 CONCLUSION ................................................................................................................................................... 56 RECCOMMENDATIONS ................................................................................................................................. 57 REFERENCES ................................................................................................................................................... 58 ANNEXES ........................................................................................................................................................... 62 ANNEX 1. LIST OF ABBREVIATIONS ................................................................................................................... 62 ANNEX 2. INTERVIEW GUIDE ............................................................................................................................ 63 iii TABLE OF TABLES TABLE 1. BMI BY SEX AND AGE CLASS FOR THE NETHERLANDS, 1996-1998 (CBS 2000) .................................... 14 TABLE 2. OVER-THE-COUNTER WEIGHT LOSS PRODUCTS SOLD IN A SUBURBAN DUTCH APOTHEEK ...................... 27 iv ACKNOWLEDGMENTS This report is the product of conversations with nine women who were very kind in allowing me to document their experiences and insights. I am indebted to each of them for helping me to come to an understanding what it means to be fat in The Netherlands. I hope that they find that I have done something worthwhile with the knowledge they imparted to me. I would like to thank they key informants who found time in their busy schedules to talk with me about aspects of the project. Jannemieke Hanhart gave me leads on informants and even called me at home to tell me when a relevant television program was being aired. Kathy Davis shared with me her “American living abroad” views on Dutch society. I thank her for advising me to pay attention to Dutch proverbs. Jaap Seidell provided a comprehensive summary of the Dutch research on overweight and obesity. Elly Jeurissen briefed me on the perspective of a patient organization on obesity. Marja Visser shared with me her books, experience as a fat activist, and multiple cups of tea. The development of my research proposal was aided by the remarks of Trudie Gerrits, Ria Reis, and Michael Tan. I thank them for helping me to think beyond the initial interview guide. Trudie Gerrits deserves another mention because she helped me to find a document translator. To Els van Dongen, I owe a great deal of thanks for her belief in my abilties and encouragement. Thanks, Els for helping me to remember to step outside from time to time to see the sun. I was only able to make sense of materials in Dutch through the assistance of Minke Veeneklaas. Her summation and translation of newspaper articles, journal articles, and a book allowed me access to a world of information that would otherwise have been lost to me. Minke, thank you for working so quickly and taking the time to elucidate details that would have otherwise escaped me. I thank my fellow AMMA classmates who provided support, lively discussions, newspaper clippings, book referrals, and fun times at Meer en Vart. To the Salehar-Nativ family, I extend my thanks for helping me to remember to enjoy my time Europe and not expend my energy on trying to achieve the impossible (i.e. a 10). Last but not least, I owe an immeasurable amount of thanks to my project sponsor, Jason Siegel. I could not have completed this process without his love, support, honesty, and willingness to help. It is a good thing that I married him. -Amsterdam, August 2000 Ava Nepaul 5 INTRODUCTION Overweight1 and obesity are increasing in prevalence across the globe. This trend is most marked in the industrialized nations of the Western Hemisphere. Increased wealth and food availability in combination with decreased physical activity contribute to this situation (WHO 1999). The prevalence of overweight and obesity in the Netherlands lies in between the high prevalence in the USA and the low prevalence in China (Mathius-Vliegen 1998a). Within the last decade, there has been an increase in the prevalence of fatness in the Netherlands. In 1998, an estimated 40% of Dutch men and 30% of Dutch women were either overweight or obese (Blokstra et al 1998). Overweight and obesity are implicated in the etiology of ischemic heart disease, diabetes mellitus, and breast and cervical cancers. Excess body fat may inhibit respiration and contribute to clinical depression
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