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It has often been observed that obesity follows a socioeconomic gradient which adversely affects the poor. This paper proposes the outline of a sociological theory of obesity as a consequence of ‘globalisation factors, such as labour market deregulation. Forced to work longer hours – and with lower levels of job-security – workers in low paid jobs have fewer opportunities to burn calories, and are more likely to consume fast-food. This combination has led to higher levels of obesity among the poor in countries that have adopted neo-liberal labour market reforms.
There are some human phenomena, which seem to be the result of individual actions and personal decisions. Yet, these phenomena are often – on closer inspection – as much a result of social factors as of psychological ones.
In 1897, Emile Durkheim (1997) showed that the suicide – perhaps the most personal of all decisions – could be analysed through the conceptual lenses of sociology.
Obesity, much like suicide, is often regarded as a personal problem; result of an inability to control ones desires in front of the fridge. Obesity does have a psychological, and, indeed, a medical, dimension, yet like the suicide, this growing phenomenon also has a social dimension. This paper is an attempt to do the same for obesity as Emile Durkheim did to the study of suicide; to analyse it in the light of the theories of sociology.
Obesity and Social Science
Interest in the social aspects of obesity is nothing new. Jeffrey Sobal has written extensively about the social and psychological consequences of obesity , including the stigmatisation and discrimination of obese and even overweight individuals (Sobal 2004).
Scholars with a more anthropological twist have written about the different social perceptions of obesity, e.g. the positive view of fatness among some
indigenous peoples (Swinburne et al. 1996). In an article entitled, “An anthropological Perspective on Obesity “ (Brown and Konner 1987), the authors found that “cross cultural data about body preferences for women reveal that over 80% of cultures for which shape preference data are available, people prefer a plump shape” (cited in Sobal 2004, 383).
That these ideals are embedded in their respective cultures is perhaps best evidenced by the small statuette Venus of Willendorf, by common archaeological consent the oldest known work of art. Stone age man evidently preferred a big girl complete with multiple love-handles, someone who could both carry and nurture his offspring under the harsh conditions of the Palaeolithic world.
Other examples of the cultural acceptance of large people obese Buddha statues in the Far East and rituals of prenuptial fattening in many cultures, where fatness is seen as sexually attractive (Brink 1989).
That fat has often been a symbol of status is not merely an anthropological observation. In the 19th Century, in Britain, according to Williams and Germov, “a large, curved, body…connoted fertility, wealth and high status. While poor women were occupied with physical work, the voluptuous women of the middle classes were often viewed as objects of art, luxury, status, virtue and beauty” (Williams and Germov 2004, 342). “Fatness”, they go on, “was linked to emotional stability, strength (stored energy), good health, and refinement to leisure” (Ibid).
These observations are worth bearing in mind when we discuss obesity. Obesity is – to a certain extend – a social construct. But obesity is also more than this. As an increasing medical problem, obesity is not merely a condition that can be – or should be – analysed in the light of perception and aesthetics. Obesity is also a product of biological, psychological, and social conditions.
While not ignoring the importance of the former two factors, this paper presents an account of the latter. While correlations between obesity and social and economic background variables have been reported (Flegal et al. 2000), sociological analyses have thus far not addressed the question of the social aetiology of obesity. This paper seeks to present a first step towards remedying this.
The Obesity Debate
‘Why are we so fat?’ asked American magazine The National Geographic in a feature article in the summer of 2004 (National Geographic 2004). The use of the collective noun ‘we’ seemed particularly warranted as recent statistics show that more than 65 percent of us (the British) are overweight. (defined as having a Body-Mass Index of 25 or above). Still more alarming; 20 percent of us are clinically obese (defined as having a Body-Mass Index of 30 or above).(House of Commons Select Committee on Health 2004).
Britain is not alone in this. In America the figure is even higher; 30 per cent of the Americans are obese (US Department of Health and Social Services 2000). According to a recent study of obesity in the USA, diet related illnesses are responsible for four out of the ten leading causes of death. (Bush and Williams 1999, 135).
These figures matter for more than psychological and aesthetic reasons. It is estimated that more than 30.000 deaths per year in the UK are attributed to obesity or obesity related illnesses (House of Commons Select Committee on Health 2004, 6). In the colourful words of one medical expert: “this is an epidemic…the likes of which we have not had before in chronic disease…[obesity is] making HIV look, economically, like a bad case of the flu” (William Dietz quoted in Greitser 2000, 42). Add to this that close to ten percent of the total NHS budget is allocated to obesity and related illnesses, and it is difficult to dispute that obesity is a major health concern as well as a major socio-political problem.
Facts1 such as these more than justify the Chief Medical Officer’s conclusion that obesity is “a health time bomb” that needs diffusion (Chief Medical Officer quoted in HC Select Committee on Health 2004, 8).
But public health is not just about diagnosing and treating conditions, it is also about understanding causes, the identification of which will enable us to take the appropriate prophylactic measures to combat the epidemic.
Yet, there is far from agreement on what these causes are. The explanations for the obesity epidemic cited in the popular press, e.g. in The National Geographic and in Newsweek (2004) were all biological in origin and medical in consequence.
Quoting the work of medical geneticist Rudolph Leibel, The National Geographic concluded that obesity was down to genetics. “Our overeating”, the magazine quoted Leibel as saying, “is not the wilful result of deranged upbringing. It is genes talking” (National Geographic 2004, 62).
This biochemical reductionism is not new – though the underlying science has changed. As far back as 1924, the editors of the Journal of the American Medical Association editorialised that ‘obesity’ was purely the result of ‘malfunctions in normal metabolic processes’ (Editorial: The Journal of the American Medical Association 1924, 1003).
Contrary to the impression left by features such as those in Newsweek, the National Geographic and the octogenarian editorial, the picture is a good deal more complex than that. This is increasingly recognised within medicine. A report from the American Institute of Medicine is an example of a critique of the geneticist view: “there has been no real change in the gene pool during this period of increasing obesity. The root problem, therefore must lie in the powerful social and cultural forces that promote an energy-rich diet and a sedentary lifestyle” (Institute of Medicine 1995, 152).
There is evidence to support the veracity of the hypothesis that social and cultural forces play a role (Flegal et al. 2000, 6).
What is striking about the obesity epidemic is the extent to which it reflects social class conditions. To cite but one example; the Health Survey for England has shown that in 2001, 14 percent of women in professional groups were obese, while 28 percent of women from unskilled manual occupations were categorised as such (House of Commons Select Committee on Health 2004, 16).
Similar examples are legion. As a study concluded; “the largest rates of obesity occur among population groups with the highest poverty rates and the least education” (Drewnowski and Specter 2004, 6).
This correlation between poverty and obesity is likely to be the result of underlying social factors. It is not that there is an automatic relationship between poverty and obesity. This relationship is a new phenomenon, which, consequently, needs to be analysed in the light of recent social, political and economic developments.
As Ulrich Beck has observed; ‘the struggle for one’s ‘daily bread’ has lost its urgency as the cardinal problem overshadowing everything else…for many people the problems of ‘overweight’ take the place of hunger’ (Bech 1997, 21). The interesting question from a sociological point of view – as well as from a medical one – is why.
Globalisation and Obesity: Towards a Pattern
It is difficult to dispute that obesity is a social condition, which adversely affects those in low paid/short term jobs. Needless to say, obesity does have a significant biomedical component; what happens inside the body after you have munched your Big Mac obviously requires a physiological/biochemical explanation. However, it is (from a sociological and public health point of view) equally important to determine the factors which lead you to eat the Big Mac in the first place. What we endeavour to answer is the social aetiology of obesity; the social causes, which lead to weight gain.
The aforementioned research findings strongly indicate that weight problems and poverty are highly statistically correlated. As a oft-cited study said: “diet affects the health of socially disadvantaged people from cradle to grave” (James, Nelson, Ralph, and Leather 1999, 1545).
Of course a quote does not establish a fact, nor does a statistical association. The question is what lies behind these correlations?
Some could – with some justification – argue that these class differences merely reflect and reconfirm the existence of serious inequalities in health – as reported in the Black Report in the early 1980s (Working Group on Inequalities in Health 1982).
What has hitherto been missing from the literature on obesity – as well as that on health in general – has been more ambitious theoretical explanations linking medical conditions – in this case obesity – to more general sociological discourses and theoretical trends (such as modernisation and globalisation).
One obvious – yet overlooked – hypothesis is that societal changes from a traditional industrial society to a globalised (deregulated) economy has created new patterns of life and work, which have had adverse effects on food consumption, exercise, and hence has contributed to the increase in the growth of the obesity epidemic.
According to this hypothesis, the advent of a neo-liberal economic regime has had – and continues to have – profound consequences for working patterns – especially for those in low paid/insecure jobs. This hypothesis is, in fact, consistent with observations made by sociologists such as Anthony Giddens who have observed that “one of the ways globalisation has affected family life in Britain is by increasing the amount of time that people spend each week at work” (Giddens 2004, 62).
In addition to working longer hours, individuals are increasingly working in service sector jobs (such as call centres) with provide little opportunity for physical exercise. With ‘flexible’ working hours, individuals are likely to eat later and more likely to consume fast-food (Dalton 2004, 95). The medical consequence of this is that they are unlikely to burn the extra calories they consume.
While no evidence of this has been published using UK figures, data from America confirm this trend; “Americans now spend almost half of their food dollars on food away from home – 47 percent, or $354.4 billion in 1998” (Dalton 2004, 94) .That the hurried life-style brought about by changes in labour market is – in part – responsible for this, is underlined by figures from the fast food chains reporting that ‘drive-thru’ sales now account for more than half of their total sales (Dalton 2004, 95)2.
That this has contributed to the obesity epidemic is underlined by the fact that “away from home” foods contain more total fat and saturated fat on a per-calorie basis than “at home food” (Dalton 2004, 94).
As a further consequence of the changes in working patterns – and the less free time available – individuals are less likely to engage in sport and social leisure activities – factors which have been shown to be negatively correlated with weight gain (Dalton 2004, 95).
Again American figures illustrate the trend. In 1991, 46 percent of high school students and 57 percent of middle school students were enrolled in sport activities (Sallis 1993, 403). By 1999, those figures had dropped to 29 percent of high-school students and 35 percent of middle school students. On average there is a 3 percent decrease in the number of kids who take part in sporting activities on a daily basis (CDC 2000).
Viewed in this light is perhaps not surprising that the countries in the forefront of ‘globalisation’ (especially labour market deregulation) are also the countries with the highest incidence of obesity (See table One). Conversely, countries with less globalised economies, have had lower – sometimes much lower – levels of obesity.
A few examples will suffice. In Sweden – a country that has not followed the neo-liberal reform agenda – the number of overweight people is 39 per cent (the same figure as France – another country that has resisted neo-liberal reforms). The figure for Norway another affluent society in the same category is even lower; 25 percent (www.iotf.org).
That labour market dergeulation goes hand in hand with obesity, seems to be confirmed when we contrast the obesity figures from ‘globalised’ countries with similar figures from less globalised economies (as measured by the Heritage Foundation Index of Economic Freedom). The Pearson’s Correlation Coefficient between this measure of globalisation (admittedly a gross proxy!) and obesity rate is a Pearson’s R of -.71. In other words, the less globalised the economy, the lower the number of obese people. While this correlation is not all conclusive – and only significant at 0.37 (two-tailed), it does suggest the existence of a causal link between obesity and globalisation.
Table One: Index of Economic Freedom and Obesity Rates
CountryIndex of Economic Freedom %Obese
Sources: The Heritage Foundation and www.iuns.com (accessed 14 August 2004)
While governments of the most globalised economies – such as Australia, the UK and the USA – have gone to great lengths in their efforts to deregulate the economies and give ‘the market’ a stronger role, other countries – especially those with strong corporatist traditions (See Lijphart 1999) –have adopted a different approach to globalisation.
In the Netherlands the government, trade unions, and employers associations have negotiated responses to globalisation, which have prevented the growing inequalities and levels of job-insecurity associated with globalisation in Australia (Bessant and Watts 2002, 306)., Britain and the USA (Giddens 2001, 69).
Consequently, the Dutch workers are not under the same pressures as their British and American counterparts in having to seek low paid/short term employment, with all the consequent negative implications on food consumption and lack of time for physical exercise (Freedman 2000).
The difference between these two ‘pure types’ of welfare capitalism is not merely of importance for the reasons identified above (food intake with little opportunity to burn calories). There is also evidence to suggest that the ‘Dutch model’ is more conducive to the formation of ‘social capital’, which in turn is negatively correlated with levels of obesity (Putnam 2000, 264).
Further globalisation is more than just labour market deregulation. Global liberalisation of trade under the WTO and liberalisation of the market for broadcasting are other factors to be taken into account. Globalisation is a mix of contingent factors which – when combined – create social developments.
One of the consequences of globalisation is a society, in which consumers both ‘enjoy’ the benefits of cheap food from around the globe, while at the same time, are being subjected to advertisements from multinational food and beverage producers, such as McDonalds, Pepsi, Burger King, Coca Cola, and others.
The level of this influence can hardly be exaggerated; in one year McDonald spent in excess of 1 billion US-dollars on advertising for kids (Brownell and Horgen 2003, 60).
Globalisation has profoundly affected capitalist democracies, yet not all countries have responded by deregulating labour markets and unleashing market forces. In some cases, countries have (successfully) attempted to regulate the forces of globalisation, e.g. through restrictions on media advertising (especially on TV). In the Netherlands the public broadcasters are not allowed to interrupt programmes aimed at the Under-12 year olds with advertisements. Similar restrictions have been introduced in Sweden and Norway (www.childrensprogrammes.org).
That such restrictions have been introduced in small countries with relatively open economies is an indication – perhaps even a proof – that the effects of globalisation are not inevitable; that political intervention has not been rendered impossible by globalisation
“There is no question that the rates of obesity and Type 2 Diabetes …follow a socioeconomic gradient, such that the burden of disease falls disproportionally on people with limited resources, racial-ethnic minorities, and the poor”. Thus wrote two dieticians recently (Drewnowski and Specter 2004, 6). Previously, scholarly studies in the social aetiology of obesity have stopped short of developing these statistically based conclusions into a more general theoretical sociological framework.
In this paper a case has been made for the view that obesity is – at least in part – a consequence of the recent political and economic developments commonly known as ‘globalisation’.
Globalisation has led some governments (e.g. in the USA, Britain and Australia) to enact and implement labour market reforms (flexible job-markets with less job-security). One of the consequences of this development has been pressures on families and individuals in low paid/temporary jobs. Through this ‘globalisation’ has created conditions, which are conducive to over-consumption of high-energy foods.
Forced to work longer hours, individuals have less time to prepare meals opting instead for pre-prepared fast food with a high fat content.
In addition to this development, the availability of cheap food from around the globe coupled with advertising from multinationals – has resulted in new pressures which have led to a growth in the consumption of energy-rich food among the poor.
Thus a combination of social factors have contributed to the fast growing epidemic of obesity which is eroding our health budgets, lowering self-esteem and creating premature deaths.
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