UCSF UC San Francisco Electronic Theses and Dissertations Title Body Size, Gender & Health: A Multi-Method Sociological Exploration Permalink https://escholarship.org/uc/item/9k26f4h9 Author Ingraham, Natalie Publication Date 2016 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California Acknowledgements I would like to acknowledge the women who participated in my WHAM interviews for one part of this dissertation and the colleagues (both academic and activist) that shared documents and stories with me as part of my ethnographic fieldwork. I would also like to thank the members of my dissertation committee for the support and guidance throughout this process, including Dr. Tracy Weitz who, while no longer an official member of my committee, continues to be an amazing mentor. I also want to thank Dr. Adele Clarke for her guidance on the HAES paper and situational analysis project and Dr. Janet Shim for her theoretical and dissertation writing guidance. I want to especially thank Dr. Shari Dworkin for her guidance throughout my doctoral program as both my advisor and dissertation chair. My doctoral education was generously funded by the UCSF Dean’s Health Sciences Fellowship and this dissertation was funded by the Graduate Division Student Research Award. This dissertation would not have been completed without the intellectual and emotional support of my graduate colleagues and amazing scholars in my own cohort and beyond: Kate Darling, Michael Levesque, Karen Lloyd, Jarmin Yeh, Sean Arayasirikul, Jen James, Sonia Rab Alam and Chris Hanssmann. I was also lucky to have mentorship from (and friendship with) several SBS alums including Krista Sigurdson, Yvette Cuca, Leslie Dubbin, Jamie Chang, and Oliver Rollins. I would also like to thank my friends and family for their love and support during this process, especially my amazing parents (and parents in law) and my spouse, Rory Morris, who was there for me every day ii Abstract Social science researchers have tackled the social “problem” of fatness across several disciplines, perhaps most directly in sociology. Sociologists analyze the ways that fatness and fat bodies intersect with social locations like race, class, gender, and health status in ways that create meaning. Fatness has also been explored by public health under the “obesity epidemic” umbrella as a medical problem in need of treatment and as a social problem in need of control. At the intersection of critical obesity studies at fat studies, this dissertation asks about the social construction of fatness and health. Using three distinct data sets, I examine how the social construction of fat bodies plays out in three levels of analysis: the media spectacle, the health movement, and the lived experience. Each of the papers explores a different set of embodied, constructed meanings placed onto fat bodies. In the first study, I examine how contestants on the reality television show The Biggest Loser (TBL) construct narrative arcs related to fatness, fitness and health using Foucault’s confessional framework of sin and redemption. In the second study, I use situational analysis to show how the Health at Every Size movement (a weight neutral perspective on health) acts as a reform movement from within public health. Finally, I take up intersections of body size, sexuality, gender and aging in an examination of the lived experiences of lesbian and bisexual women over age 40. The dominance of the public health perspective of fatness as the great moral and physical health concern of our time exists in all three papers. The HAES paper and the WHAM paper show how both professionals and individuals have tried to push beyond the notion of fatness as the great health evil of our time, but are restrained by the iii dominant public health/medical ideology of fatness. TBL contestants aligned directly with public health by seeking moral redemption as family members, and parents specifically through weight loss. This media spectacle, the health social movement and the lived experiences of fat women all reinforce the notion that public health understandings of fatness continue to dominate our cultural narrative. iv Table of Contents Table of Contents I. Introduction. .................................................................................................................. 1 Statement of the Problem .......................................................................................................... 1 Theoretical Frameworks .................................................................................................. 3 Between Critical Obesity & Fat Studies .................................................................................. 4 Symbolic Interactionism & Social Constructionism ............................................................... 8 Foucault & Biopolitics .......................................................................................................... 10 Identity Politics: Sexual Orientation, Gender & Body Size .................................................. 15 Methodological Approaches / Three Papers Overview ............................................... 17 References ............................................................................................................................. 21 II. Paper 1: Health at Every Size (HAES™) as a Reform (Social) Movement within Public Health: A Situational Analysis ........................................................................... 25 Introduction .............................................................................................................................. 25 Background .............................................................................................................................. 26 Framing Fatness (and Obesity) .............................................................................................. 26 Reform Movements within Public Health ............................................................................. 28 HAES History as Reform Movement in Public Health ......................................................... 30 Theory/Methods Package: Social Worlds/Arenas & Situational Analysis ......................... 33 Mapping HAES Today: Situational Map ..................................................................... 36 Table 1: HAES Situational Map (Organized) ....................................................................... 36 The Social World(s) of HAES ............................................................................................... 37 HAES: Public Health Segment .............................................................................................. 40 HAES: Fat Politics Segment ................................................................................................. 42 HAES: Internal Segments & Critiques .................................................................................. 45 HAES as a Reform Movement in Public Health: Publishing as Strategies ........................ 47 HAES Publishing .................................................................................................................. 48 Healthy Weight to HAES ...................................................................................................... 49 Conclusions ............................................................................................................................... 56 References ................................................................................................................................. 62 III. Paper 2: Mend this Fractured Family”: Sin, Redemption, and Familial Citizenship on NBC’s The Biggest Loser ...................................................................... 69 Introduction .............................................................................................................................. 69 Background .............................................................................................................................. 71 Foucault & Bodily Surveillance ............................................................................................ 71 The Confessional ...................................................................................................................... 74 Fatness as Embodied Sin Requiring Confession ................................................................... 75 Methods ..................................................................................................................................... 78 Findings ..................................................................................................................................... 80 Discussion ................................................................................................................................. 99 Limitations ........................................................................................................................... 103 Conclusion .............................................................................................................................. 104 v References ............................................................................................................................... 105 IV. Paper 3: Out of Touch, Out of Time: Older Queer Women’s Engagement with Fat Acceptance Movements ........................................................................................