FUNCTIONAL FOODS AND WOMEN'S HIGH CHOLESTEROL i Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology FUNCTIONAL FOODS AND THE RISE OF HIGH CHOLESTEROL AS-DISEASE IN WOMEN'S HEALTH By MAJA JOVANOVIC, (BA) Hons., M.A. [email protected] A Thesis Submitted to the School of Graduate Studies in Partial Fulfilment of the Requirements for the Degree of Doctoral of Sociology McMaster University© Copyright by Maja Jovanovic, September 2013 ii Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology DOCTORATE OF PHILOSOPHY (2013) McMaster University Sociology Hamilton, Ontario Title: Functional Foods and the rise of high cholesterol as-disease in women's health Author: Maja Jovanovic, M.A. (McMaster University). Supervisor: Professor N. McLaughlin NUMBER OF PAGES: xii, 254 iii Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology Abstract Food and the various aspects surrounding what we eat, what we should eat, and concerns about how to remain healthy and ward off disease and illness is escalating while our choices are endless. In this competitive food market a new type has emerged: the functional food. Functional foods are those that have an added health benefit beyond the basic nutritional content and display physiological benefits in reducing chronic diseases. A popular category of functional foods are those that purport to lower one's cholesterol. In particular, high cholesterol is marketed as a "disease" rather than a risk factor for various cardiovascular diseases, such as heart disease. Little is known about the sociological diagnosis of high cholesterol and the marketing of functional foods, in particular with women. This dissertation address this gap by asking: (1) How is high cholesterol identified and marketed as a disease rather than a risk factor for cardio vascular diseases in functional food advertising - specifically addressing the Becel® pro.activ® margarine campaign? (2) How do women understand the issue and causes of high cholesterol; and (3) What do women understand the solution to high cholesterol to be and how do they view Becel's® high cholesterol solution? This sandwich thesis is organized into an introductory chapter where I introduce the main research questions and give an overview of the research problem and need for the study. Chapter 2 is the literature review. Chapter 3 contains the research design, data collection and analysis. A content analysis of the functional food campaign of Becel® pro.activ® margarine and semi- structured in-depth interviews with 49 women over the age of forty who were concerned with high cholesterol took place. Chapter 4 contains article 1 and provides the background for the empirical research by examining the functional food landscape and high cholesterol directed at women. It is based on a content analysis of the narratives behind the Becel® pro.activ® margarine health campaign which consisted of 6 key advertisements in 2 Canadian magazines. Chapter 5 contains article 2 and examines what the participants think are the causes of high cholesterol, how it is understood by women, whether they classify it as a disease and how blame and responsibility for high cholesterol is attributed. I discuss how these findings vary by class. Chapter 6 contains article 3 and examines what women understand the solution to high cholesterol to be and the strategies involved. I also examine Becel's® corporate marketing solution to high cholesterol and see how they differ from lay perspectives. In the conclusion (chapter 7) I discuss the key findings and contributions to the literature, the strengths and limitations of the research and future work. This interdisciplinary research draws on sociology, in particular the sociology of diagnosis and the sociology of health, illness and medicine, nutrition studies, women's health, cultural studies, and health promotion. This research is a key contribution to knowledge about the social creation of disease and the reproduction of health along class lines. iv Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology Acknowledgments This dissertation would not have been possible without the expert advice, guidance and unwavering support of Neil McLaughlin. He is a mentor and a friend, who gave his time so generously to me over the years. His valuable suggestions and enthusiastic encouragement is deeply valued. Neil has taught me the value of always looking at the bigger picture and to plan my dissertation, my research and my life's ambitions with one eye to the future. I would also like to thank Josee Johnston who provided a much needed critical food sociologists' perspective. Josee, thank you for reading so many drafts, for your thoroughness, sound judgment and constructive feedback which strengthened this dissertation and made me a better sociologist. I would like to thank my thesis committee of Tina Moffat and James Gillett for providing timely and useful feedback through our committee meetings and over the years when reading the many versions of these articles. To Sandra Colavecchia, who although is not on my committee, she has served as a mentor and true friend over the years and has supported and guided me with sage advice and gentle but probing reminders to publish, publish, publish! To Weizhen Dong (my M.A. supervisor from the University of Waterloo), who continues to be a source of unflagging support and a mentor to me since we first met over 6 years ago. She guided me through one graduate degree, then another, and continues to provide encouragement and uncannily accurate professional advice. I would like to thank the 49 women who participated in this research, without whom much of qualitative work would cease to exist. I thank you for your honest and detailed responses and hope that I have remained true to your voices in the selection of quotes. v Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology I would also like to honor the memory of a fellow sociologist, my colleague Zac Walker (1989-2013), whose untimely death shocked and saddened us all. Zac died before graduating from his M.A., and I know that he would have been proud and delighted for those of us who completed our graduate journey and who stand now where he once wanted to be. Lastly, I would like to thank the reviewers and editors of Food, Culture & Society, and Social Science & Medicine, that have published my first two dissertation articles, and Sociology of Health and Illness, where I am currently revising and resubmitting. Their helpful comments and feedback has strengthened my work. vi Ph.D. thesis - Maja Jovanovic; McMaster University - Sociology TABLE OF CONTENTS LIST OF TABLES........................................................................................................................ix LIST OF ABBREVIATIONS & KEY TERMS..........................................................................x PREFACE....................................................................................................................................xii CHAPTER 1: INTRODUCTION Introduction to this Chapter.................................................................................................1 Overview of Research Problem: Why study functional foods and high cholesterol?.........1 The Need for this Study? Women's high cholesterol and functional foods in the literature...................................................................................................................3 Main Research Questions....................................................................................................7 Introduction to Journal Articles/Dissertation Chapters.......................................................8 References for introduction................................................................................................14 CHAPTER 2: LITERATURE REVIEW Functional Foods..............................................................................................................20 History of functional foods................................................................................................20 Consumer acceptance of functional foods.........................................................................24 Criticisms of functional foods............................................................................................27 Food Discourses................................................................................................................31 Healthism...........................................................................................................................31 Health promotion...............................................................................................................33 Neoliberalism and the role of the healthy lifestyle discourse............................................35 Food corporations and food advertising............................................................................38 Gender and Food.............................................................................................................42 Gender and carework.........................................................................................................43 Women and healthy eating.................................................................................................45 Women and advertising.....................................................................................................49 References for literature review.........................................................................................52