Discontent with the weight-centred health paradigm: A critical examination of the charge against 'obesity'

Abstract

Since the late 1990s, addressing the global obesity epidemic has been a key public health priority. Despite substantial resources dedicated to its curtailment, the epidemic persists, prompting scholars to re-examine the underlying mechanisms of prevailing anti-obesity efforts. Within this context, the weight-centred health paradigm (WCHP) – the framework for conceptualising health which prioritises maintaining a ‘healthy’ weight – has been criticised for perpetuating, rather than alleviating, health and social justice challenges. Situated within Critical Obesity Studies and Science and Technology Studies, the aim of this thesis is to advance interdisciplinary critiques of the WCHP and contribute to ongoing debates relating to obesity. The thesis offers a distinct perspective by examining discontent with the WCHP as an indicator of its limitations. It explores the anger and discontent of activists, critical scholars, and ‘lay’ communities, alongside the dissonance expressed by obesity experts regarding their own anti-obesity efforts. Chapters One and Two outline the research background, theoretical framework, and methodology. Chapter Three, drawing on 184 academic and grey literature sources, is a literature review that synthesises and narrates existing scholarly and ‘lay’ critiques of the WCHP. It traces the historical, socio-political, and cultural origins of the paradigm, and this history’s enduring influence on contemporary anti-obesity efforts. Subsequent chapters utilise semi-structured interviews with 32 obesity experts, ethnographic observations at an international obesity conference, and autoethnographic reflections based on the author’s time spent immersed within and across the two communities under examination in the thesis. Informed by findings from Chapter Three and by critical theory, these chapters examine three contemporary issues relating to anti-obesity efforts that are sources of dissonance among obesity experts. In Chapter Four, the relationship between weight stigma and obesity is explored. The rise of GLP-1 agonist medications and their impact on how obesity is conceptualised as a public health problem forms the basis of Chapter Five. Chapter Six addresses the persistent exclusion of critical perspectives of the WCHP from health research. Chapter Seven synthesises these findings, revealing the social, political, and cultural contexts in which discontent with the WCHP emerges and is sustained. It discusses the scholarly significance of the research, synthesises recommendations, examines strengths and limitations, and proposes avenues for further research.