Welcome to part two on my series examining health in the context of neoliberalism. Part one critically engaged with the “obesity epidemic” and traced various responses to it. Part two looks at how the fat body is understood and constructed in the neoliberal context and how environment-level interventions are instituted differently depending on class (and though I don’t mention it in this section of the paper, we cannot understand class without understanding the cultural and historical forces that make racialization highly correlated with poverty).
The Fat Body in the Context of the Neoliberal Project
Guthman and DuPuis (2006) argue that the obesity epidemic and the construction of the cultural meanings of the fat body should be understood within the context of neoliberalism. Neoliberalism can be understood as “a multi-faceted project with real institutional and economic restructuring, coupled with reinforcing cultural and ideological processes” (Coulter, 2009, p. 26) that includes a “deliberate push for an emphasis on individualism, and on consumption as a source of identity and a vehicle for social participation” (Coulter, 2009, p. 26). Macdonald (2011) explicitly includes health and lifestyle in his definition of neoliberalism, which, he says, “can be understood as an approach to governing society in such a way as to reconfigure people as productive economic entrepreneurs who are responsible for making sound choices in their education, work, health, and lifestyle” (p. 37). Guthman and DuPuis (2006) trace the twin cultural obsessions of obesity and dieting to the “problem of inelastic demand” wherein demand for food reaches its upper bound because there are natural limitations on how much food a person can eat. In response to the expanded availability of food that has come with globalization, the commodification of dieting can be understood as a facet of the neoliberal trend toward creating “purchasable solutions to the problems it generates” (Guthman & DuPuis, 2006, p. 441). They point out that the dominant dieting paradigms rely on high-margin processed foods being substituted for their higher-calorie counterparts rather than a low-margin, minimally processed diet of whole foods.
The use of supplements and artificial sweeteners in diet foods can also be understood as a neoliberal response to inelastic demand. The use of zero-calorie sweeteners as well as supplements and pharmaceuticals that prevent the full absorption of fat, Guthman and DuPuis (2006) argue, circumvents the body’s natural limits, thus enabling increased consumption—which is to say, more products sold. Thus, they argue, “this double fix of eating and dieting, in other words, is not epiphenomenal; it has become a central piece of the US economy” (Guthman & DuPuis, 2006, p. 144).
Personal Responsibility vs. Obesogenic Environment
The neoliberal paradigm criticizes governmental intervention and instead “returns improvement to the individual” who is considered responsible for their body through the choices they make (Guthman & DuPuis, 2006, p. 443; Colls & Evans, 2009). These choices are supposed to allow the “rational, self-managing citizen” to achieve maximum health and quality of life through voluntary self-governance (Macdonald, 2011). However, there is a growing field of research examining the ways in which physical and social environments are implicated in the obesity issue (Townshend & Lake, 2009). The term “obesogenic environment” was developed to describe “the sum of influences, opportunities, or conditions of life have on promoting obesity in individuals or populations” (Swinburn, Egger, & Raza, 1999, p. 564). Obesogenic environments are considered to be a significant factor in the increased incidence of obesity (Lake & Townshend, 2006). Factors in obesogenic environments include food access, marketing of foods and accepted portion sizes; as well as environments and infrastructure that support or inhibit physical activity such as safe green space (like parks) and walkable neighbourhoods (Townshend & Lake, 2009). Multiple studies have found that neighbourhoods with lower socio-economic status have fewer resources that promote physical activity and that there is a link between neighbourhood SES and sedentary lifestyles (Townshend & Lake, 2009).
Although the shift away from individual responsibility toward obesogenic environments can be understood as a positive move, Colls and Evans (2009) argue that policies addressing obesogenic environments “often construct particular groups or communities as homogenous and compare them against normative models of ideal lifestyles” (p. 1014). Thus, they point out, public health interventions often differ along class lines, with most interventions aimed at poor and working class communities who are “considered unable to avoid obesity due, not to unequal access to resources, but to lack of knowledge about the ‘right’ way to eat and live” whereas obesity among the middle class is “less often attributed to a failure in knowledge or ability to assume responsibility for one’s own health than to “responsible” behavior in other areas of life” such as long work hours, and the shift of many middle class women from homemaker to working outside of the home (Colls & Evans, 2009, p. 1014). Therefore, this paradigmatic shift which was supposed to address the social determinants of health simultaneously re-entrenches problematic stereotypes and beliefs.
Stay tuned for Part Three: The Morality of Health.