Abstract
The prevalence of obesity and related health problems has increased sharply in recent decades. Dominant medical, economic, psychological, and especially epidemiological accounts conceptualise these trends as outcomes of individuals' lifestyles - whether freely chosen or determined by an array of obesogenic factors. As such, they rest on forms of methodological individualism, causal narratives, and a logic of substitution in which people are encouraged to set currently unhealthy ways of life aside. This article takes a different approach, viewing trends in obesity as consequences of the dynamic organisation of social practices across space and time. By combining theories of practice with emerging accounts of epigenetics, we explain how changing constellations of practices leave their marks on the body. We extend the concept of biohabitus to show how differences in health, well-being, and body shape are passed on as relations between practices are reproduced and transformed over time. In the final section, we take stock of the practical implications of these ideas and conclude by making the case for extended forms of enquiry and policy intervention that put the organisation of practices front and centre.
Highlights
Many scientific papers and official public health documents report that the global prevalence of obesity, usually defined as a body mass index of more than 30, has increased sharply in recent decades
Despite successions of national and international policies to stem this trend (Gracia-Arnaiz, 2017), rates of obesity continue to rise, along with associated risks to health (Adamson et al, 2007; Allender et al, 2006; British Medical Association, 2005; Caballero, 2007; Department of Health, 2011; Department of Health & Department for Children, Schools & Families, 2008; Ells et al, 2015; Mulvihill & Quigley, 2003; Public Health England, 2020; UK Government, 2016). These apparently simple statements disguise the extent to which definitions, trends, and causes are contested within the medical and biological sciences and beyond (Bell et al, 2011; Lupton, 2012; Oliver, 2006). They overlook the politics of the topic and the historically specific, and often highly normative terms in which obesity is represented (Gracia-Arnaiz, 2017; Hofmann, 2016; Lang & Rayner, 2007)
Within the realm of public health obesity is defined as a risk associated with a number of non-communicable diseases, notably coronary heart disease, certain cancers, and type 2 diabetes
Summary
Many scientific papers and official public health documents report that the global prevalence of obesity, usually defined as a body mass index of more than 30, has increased sharply in recent decades. As Kelly and Russo (2018) point out, dominant agendas and methods consistently conceptualise trends in smoking, heart disease, obesity, physical activity, and poor health in later life, or alcohol consumption and liver disease as outcomes of an array of causal factors which can be acted upon, once located This linear (even where complex routes are acknowledged), cause and effect, intervention and outcome, reductionist view is so prevalent, and so taken-for-granted, that alternative ways of seeing the world are marginalised (Kriznik et al, 2018).. This is not surprising: rather, it is a necessary and unavoidable consequence of the theoretical and methodological assumptions on which so much research and policy are based.2 Bringing these points together, we suggest that public health has been unable to make much impression on the problem of obesity because it misconstrues the nature of the beast, concentrating on individual lifestyle and choice and overlooking social and historical trends in the constitution and transformation of social practices that, in combination, shape the social body literally and metaphorically. We make the case for extended versions of research and intervention that are reflexive, sociologically and historically informed, and focused on the potential for intervening within and as part of always shifting complexes of social practices
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