‘I’ve put weight on cos I’ve bin inactive, cos I’ve ’ad me knee done’: moral work in the obesity clinic

Abstract

As governments and healthcare systems grow increasingly concerned with the current obesity 'epidemic', sociological interest in the condition has also increased. Despite the emergence of work discussing obesity as a social phenomenon, the sociological dimensions of medical weight-loss treatments for obesity remain underexplored. This paper reports on a conversation analytic (CA) study and describes how moral issues surrounding weight and patienthood become visible when doctors and patients discuss obesity. Consultations in two UK National Health Service clinics were video-recorded and analysed to identify recurring patterns of interaction. This paper describes how patients answer opening questions: questions which begin the consultation, enabling patients to report their medical status. Analysis reveals that when producing their answers, patients typically imply either 'success' or 'lack of success' in their weight-loss progress. Whilst doing so, they construct their personal agency in different ways, crediting themselves for implied successes and resisting responsibility for lack of success. Through interaction the doctor and patient collaboratively construct obesity as a moral issue. The moral obligations invoked share similarities with certain perceived normative dynamics surrounding obesity and the responsibilities of patienthood. These findings have relevance to healthcare practice and add to sociological understanding of the modern obesity 'crisis'.