Bringing Sociology to the Table:
A Case for a Sociological Approach to the “Obesity Epidemic”
Sarah Bowen (sarah_bowen@ncsu.edu) and Sinikka Elliott (sinikka_elliott@ncsu.edu)
Department of Sociology and Anthropology
North Carolina State University
Paper presented at the Social Science Research Seminar,
Wake Forest University, November 30, 2012
* NOTE: This is a work in progress. Please do not cite without authors’ permission.
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Rates of obesity have risen for all Americans over the past few decades, with the largest
increases among children and minorities (Olchansky et al. 2005). Prevalence rates of childhood
and adolescent obesity have more than doubled since 1980 (Cali and Caprio 2008). Seventeen
percent of children and adolescents between the ages of 2 and 19 are classified as obese (BMI ≥
95th percentile) and 32 percent are considered overweight (95th ≥ BMI ≥ 85th) (Ogden et al.
2010). Referring to trends like these, a 2005 article in the New England Journal of Medicine
concluded: “unless effective population-level interventions to reduce obesity are developed… the
youth of today may, on average, live less healthy and possibly even shorter lives than their
parents” (Olchansky et al. 2005).
Amid claims of an “obesity epidemic,” scholars have increasingly begun to interrogate
how and why Americans eat. Existing research focuses largely on individual eating behaviors or
underscores the role of food environments. These bodies of research imply an either overly
individualistic account of people’s dietary patterns or an overly deterministic one. We know
surprisingly little about how individual food practices and perceptions are situated within the
broader food environment. Moreover, both the individual and environmental perspectives
typically accept at face value that there objectively is an “obesity epidemic” whereas some social
science scholars urge caution in this regard, pointing, for example, to the historical, scientific,
and political construction of obesity as a disease and an epidemic (Biltekoff 2007; Du Puis 2007;
Farrell 2011; Oliver 2006; Saguy and Almeling 2008). In this paper, we first examine the
empirical research (largely coming from fields such as nutrition and public health) on the causes
of obesity, particularly childhood obesity, with a focus on food, highlighting both individual and
environmental approaches. We then review several studies that take a more critical perspective,
interrogating the ground upon which the “obesity epidemic” has been sown. Sociologists have
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been largely absent from the scholarly literature on obesity. We argue that sociology has much
to bring to the field of obesity research and conclude by offering suggestions of specific areas of
research to which sociology is poised to contribute.
Explaining obesity: Existing approaches
Here, we review the existing empirical literature on the causes of obesity and overweight
among individuals, children especially, and of the obesity epidemic more broadly. We focus in
particular on studies that have analyzed food practices and beliefs and food environments. (We
note that there is also a significant body of literature focused on physical activity and in
particular the role of the built environment in fostering or hindering physical activity (see Sallis
2009 and Brownson et al. 2009 for reviews of this literature) that is beyond the scope of this
paper).
Individual approach
Much research on obesity has focused on individual-level (and in some cases familylevel) explanations, broadly comprising people’s food behaviors and knowledge about health and
weight, as well as biological and demographic factors. Childhood obesity researchers who take
an individualistic perspective often focus on mothers’ food knowledge, preferences, and feeding
habits (see, for example, Gibson et al. 1998; Nicklas et al. 2001; Spruijt-Metz et al. 2002),
directly or indirectly suggesting that mothers’ beliefs and practices are driving rising obesity
rates (Baughcum et al. 1998). This work has considered the importance of such factors as
parents’ education and awareness about health and nutrition (McGarvey et al. 2004), amount of
time children spend watching TV (Brown et al. 2010; Dennison et al. 2004; Kumanyika 2008),
portion size (Fisher et al. 2007; Ledikwe et al. 2005), and dietary composition (i.e., fruits and
vegetables consumed, fat content) (Epstein et al. 2001; Godley and McLaren 2010; Kumanyika
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2008). Scholars also point to the influence of biological factors, including genetic variation
(Atkinson 2005; Speliotes et al. 2010), altered hormone levels (Sumithran et al. 2011), and
intestinal microorganisms(Ley et al. 2005), on weight and obesity.
Research has also explored family-level factors associated with childhood weight such
as: intrafamily disagreement over what constitutes healthy food and weight (Goodell et al. 2008;
Jain et al. 2001; James 2004), work-family spillover and time constraints (Devine et al. 2006;
Glassman et al. 2011), family stress (Chan et al. 2010; Garasky et al. 2009; Kowaleski-Jones and
Christie-Mizell 2010), single motherhood (Gibson et al. 2007; Glassman et al. 2011), nonresident
father involvement (Kaufman and Karpati 2007; Menning and Stewart 2008), and parenting style
(Patrick et al. 2005; Story et al. 2008). For instance, preschool children whose parents adopt an
authoritative feeding style (i.e., high in nurturance and limit setting) eat more dairy and
vegetables relative to parents who adopt an authoritarian feeding style (i.e., high in control with
little to no regard for children’s food preferences) (Patrick et al. 2005). With obesity’s
widespread prevalence, however, Gibson et al. (2007) contend that parenting style is less likely
to be correlated with obesity than when obesity was less common. Moreover, some research
now suggests that maternal feeding practices are not indicative of childhood obesity, but that
maternal obesity (Saelens et al. 2000) and overweight are (Gibson et al. 2007).
Rates of obesity are highest for black and Latino children (Cali and Caprio 2008) as well
as children whose mothers have less education (Baughcum et al. 2001), and much individuallevel research investigates the link between obesity, race/ethnicity, and education level (often a
proxy for income and social class). This literature typically considers race, ethnicity, and class as
characteristics of individuals that either protect against or promote obesity (see Harris et al.
2010; Nicklas et al. 2001; Shafer 2010). For example, research has found that, compared to poor
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and working-class mothers, affluent mothers are more likely to restrict food considered
unhealthy and to state that they do so for health reasons (Hupkens et al. 1998). Other studies
have concluded that mothers who hold a high school degree or less are three times as likely as
those with some college education to misidentify their child’s overweight status (Baughcum et
al. 2000; Rich et al. 2005). Scholars argue that not recognizing when a child is overweight
contributes to childhood obesity given that mothers who do not view their children as overweight
are less likely to proactively change how they feed their children. This perspective is reflected in
Georgia’s controversial anti-obesity campaign, which depicts overweight children with messages
like “Seventy-five percent of Georgia parents with overweight kids don’t recognize the problem.
Stop sugarcoating it, Georgia.” and “Warning: Fat prevention begins at home” (Strong4Life
2011). Media focus on certain “unhealthy” food cultures means that special scrutiny is reserved
for mothers of color (Boero 2007), who are not only thought to feed their children less well but
also to have greater acceptance of plus-sized bodies. Some studies have found that black women
are more accepting of larger body types (Cox et al. 2010; Flynn and Fitzgibbon 1998; RistovskiSlijepcevic et al. 2010) and that Latina mothers view their overweight children as healthy (Rich
et al. 2005, 136). Others, however, have found that race/ethnicity is not a significant predictor in
mothers’ misclassification of obese children as “about the right weight” (Baughcum et al. 2001;
Eckstein 2006; Maynard et al. 2003) and that acculturation into U.S. society predicts numerous
unhealthy behaviors across multiple immigrant and ethnic groups (Neff et al. 2009), suggesting
that American culture may increase an individual’s risk of obesity. Although the individual-level
approach has contributed to an understanding of how biological and behavioral mechanisms
influence food intake, weight, and health (Drewnowski and Rolls 2005), we criticize the
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tendency, in the behavioral literature especially, to blame individuals for their weight status, and
in the case of childhood obesity, to almost exclusively fault mothers.
Environmental approaches
Not all of the existing research on obesity has focused on biological or behavioral
characteristics of individuals. Importantly, largely outside of sociology, in fields like public
health, preventative medicine, community nutrition, and urban and regional planning, an
extensive body of literature has emerged to measure and show how “food environments”
(Drewnowski and Rolls 2005, Story et al. 2008) affect patterns of obesity. Here we review
research on three main aspects of the food environment: community food environments,
consumer food environments, and food policies (see also Story et al. 2008).
Community food environments
Much of the existing research on built environments and obesity has focused on the
distribution of food stores in neighborhoods and communities. Community food environments
refer to the number, type, location, and accessibility of food outlets such as grocery stores,
convenience stores, fast-food restaurants, and full-service restaurants (Glanz 2009). “Food
deserts, often defined by the absence of supermarkets in an area, are an increasingly common
means of understanding and measuring spatial variations in neighborhood food environments.
Studies have shown that residents of poorer neighborhoods and neighborhoods with greater
proportions of people of color are likely to live farther away from a supermarket (Morland et al.
2002, Zenk et al. 2005, Raja et al. 2008). Furthermore, people living in food deserts suffer from
higher food prices, less variety, and lower quality fresh produce and meat compared to residents
in non-food deserts (Hendrickson et al. 2006; Smith et al. 2008; Wright Morton et al. 2005) and
people with better access to supermarkets tend to have healthier diets (Moore et al. 2008;
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Morland et al. 2002). Black Americans’ fruit and vegetable intake increases by 32 percent for
each additional supermarket in their neighborhood; White Americans’ intake increases by 11
percent (Morland et al. 2002). Residents with no supermarkets near their homes are 25-46
percent less likely to have a healthy diet than those with the most stores, controlling for age, sex,
race/ethnicity, and socioeconomic status (Moore et al. 2008). Although the majority of work on
food deserts has focused on urban settings (for example, Bader et al. 2010; Galvez et al. 2007;
Raja et al. 2008, Zenk et al. 2005), some studies have also examined food access problems in
rural areas, where the majority of residents may live 10 miles or more from a supermarket
(Blanchard and Matthews 2007; Schafft et al. 2009; Wright-Morton et al. 2005)1. People in
urban and rural food deserts may experience different problems related to food access and
quality. Hendrickson et al. (2006) found that people living in urban food deserts were more
likely to perceive food quality as a problem, but that rural residents identified greater barriers to
access (many associated with transportation issues).
Other studies have specifically looked at the association between neighborhood food
environments and risk for obesity for children, adolescents, and adults (Liu et al. 2007; Morland
et al. 2006; Powell et al. 2008; Wang et al. 2007). The increased availability of chain
supermarkets is significantly associated with lower adolescent BMI whereas the greater
availability of convenience stores is significantly associated with higher BMI, an association that
is larger for African-American adolescents compared to white or Latino adolescents (Powell et
al. 2008; see also Liu et al. 2007; Morland et al. 2006).
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Because entire counties can be classified as food deserts, rural food deserts may be more democratic than those in
urban areas, which tend to be located in poor neighborhoods and neighborhoods with high proportions of people of
color. However, Blanchard and Matthews (2007) found that rural food deserts were positively associated with
increased poverty rates and lower educational attainment (see also Schafft et al. 2009).
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Overall, the work on community food environments – and particularly the concept of
food deserts – has been very successful at calling attention to spatial inequalities in the
distribution of retail food stores. However, recently, some scholars have criticized this literature
for privileging supermarkets as the definitive measure of food access and failing to pay attention
to the potential role of alternative food stores (e.g., corner stores, small grocery stores, and
specialty markets), which are the primary source of purchased foods in many low-income
neighborhoods, in improving food (Short et al. 2007; Raja et al. 2008; Gittelsohm and Sharma
2009). Furthermore, recent research calls into question the premises upon which this literature is
built. A study of California children and teenagers found no evidence to support the hypothesis
that improved access to supermarkets, or less exposure to fast-food restaurants or convenience
stores, improves youths’ diet quality or reduces BMI of youth (An and Sturn 2012). And another
study found that although children who live in poor and minority neighborhoods are more likely
to have greater access to fast-food outlets and convenience stores, these neighborhoods also have
greater access to supermarkets (Lee 2012).
Consumer food environments and differential pricing
Consumer food environments, closely related to community food environments, focus
less on the physical environment (the types of stores and restaurants that are available in
particular neighborhoods) and more on “what consumers encounter in and around places they
buy food,” including the availability of healthful choices, prices, promotions, and nutritional
information (Glanz 2009, Sallis and Glanz 2006). Early work on consumer food environments
used observational techniques to assess the availability of particular foods. Sallis et al. (1986)
conducted the San Diego Food Availability Survey, which assessed an inventory of 71 “hearthealthy” foods in supermarkets, grocery stores, and convenience stores. Cheadle et al. (1993)
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found a positive and significant correlation between the availability of high fiber and low-fat
food options in stores and the reported healthfulness of individual diets, but follow-up surveys
two years later found little long-term effect. Although few of the early studies on consumer food
environments focused on food prices, newer tools, such as the Nutrition Environment Measure
Survey - Stores (NEMS-S) have been developed to assess and compare the availability of
healthful options, prices, and quality between different types of stores (i.e., between grocery
stores and convenience stores) (Glanz et al. 2007). Researchers have also focused on the high
price of healthy food overall (Drewnowski and Darmon 2005; Drewnowski and Specter 2004).
Adam Drewnowski and colleagues have published a number of articles showing that energydense foods such as fats and oils, sugar, and refined grains are much less expensive on a per
calorie basis than fruits and vegetables; they thus conclude that healthier diets—diets comprised
of fresh fruits and vegetables, lean meats, and whole grains—cost more (Drewnowski and
Darmon 2005; Drewnowski and Specter 2004). Jetter and Cassady (2006) conducted marketbasket surveys and found that the cost of a standard market basket (based on the USDA’s Thrifty
Food Plan) for a two-week period averaged $194, compared to $230 for a market basket with
healthier substitutes. Looking at the cost of fruits and vegetables specifically, Cassady et al.
(2007) used the same market basket survey and found that lower-income households would have
to allocate 70 percent of their average food-at-home budget just to meet the 2005 USDA dietary
guidelines for fruits and vegetables.
Most of the existing research on food access focuses on the physical availability of foods
or their costs; it often fails to investigate variations in food quality across stores (even within the
same supermarket chain) or consumer perceptions of food quality, which have been identified as
potential barriers, particularly to the purchase of fresh produce (Gittelsohn and Sharma 2009,
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Hendrickson et al. 2006). Finally, scholars have also pointed out the importance of looking at
the “cultural appropriateness” of foods as a dimension of food security and food access, and posit
that smaller grocery stores and corner stores may do better at serving the cultural needs of the
population in their neighborhood than do large supermarkets (Short et al. 2007).
Furthermore, although the work mentioned above describes the context of contemporary
food prices in our modern “foodscape” (Winson 2004), relatively little research has examined in
detail the way that food prices actually influence low income families’ decisions about food.
Wendt et al. (2011) found that changing food prices for healthier foods (e.g., lowfat milk and
dark green vegetables) and less healthy foods (e.g., soda, starchy vegetables, and sweet snacks)
were associated with changes in children’s BMI. Lower prices for healthier foods were
associated with decreases in children’s BMI, while lower prices for less healthy foods were
related to increases in children’s BMI, although not all food prices had the same effect (Ibid.; see
also Sturm and Datar 2008). However, there are few studies that examine the linkages between
food prices, food choices, and health outcomes, much less look at the complex patterns that
underlie family food decisions and consumption patterns.
Food policies
Finally, along with journalists like Michael Pollan and Mark Bittman, who have
introduced the Farm Bill into the national lexicon as a topic worthy of debate and discussion,
scholars have discussed the potential contribution of federal policies to rising obesity rates. They
note that US farm policies have led to the overproduction of and artificially low prices for certain
crops (i.e., corn and soybeans), which in turn makes sugars and fats—especially high fructose
corn syrup and hydrogenated vegetable oils—“some of the most inexpensive food substances to
produce” (Neff et al. 2009; Story et al. 2008). Growers of fresh fruits and vegetables, in contrast,
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receive little governmental support. The relatively lower cost of processed foods and the higher
prices for fruits and vegetables are, some scholars contend, caused by shifts in US agricultural
policy over the last 30 years (Story et al. 2008). According to the literature, drastic increases in
consumption of high fructose corn syrup (HFCS)—developed in the 1970s and one of the
primary outlets for abundantly cheap corn—may play a more direct role. Bray et al. (2003) note
that although HFCS represented less than 1 percent of all caloric sweeteners available for
consumption in the US in 1970, this percentage had increased to 42 percent by 2000. The
increase in HFCS consumption just preceded the rapid increase in obesity rates that occurred
starting in the 1980s (Ibid.). A 2010 study suggests that HFCS might affect bodies differently
from other sweeteners: in two experiments, rats with access to HFCS gained significantly more
weight than those with access to table sugar, even when their overall caloric intake was the same
(Bocarsly et al. 2010).
Another line of research, investigating the possibility of a correlation between obesity
and food insecurity, has focused largely on the role that federal food assistance programs may
play (Dinour et al. 2007). This research has found that participation in the food stamp program
positively affects the likelihood of overweight and obesity, at least for adult women (Baum 2007;
Gibson 2003; Meyerhoefer and Pylypchuk 2008), although some studies suggest otherwise (Ver
Ploeg et al. 2007). Some scholars have posited that the feast-famine cycle associated with food
stamps—referring to a 3-week period of overeating when food stamps and money are available,
followed by a 1-week period of involuntary food restriction after resources have been depleted—
could be partially responsible (Dinour et al. 2007). They note that cyclical food restriction is
associated with an increase in body fat and quicker weight gain in response to refeeding (Dietz
1995). Furthermore, “maternal deprivation,” in which mothers sacrifice their intake so that their
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families will be less affected, and federally funded school meal programs, may explain the lack
of a correlation between weight status and food insecurity for men and children (Dinour et al.
2007). Other scholars criticize federal food programs and USDA dietary recommendations for
using “questionable assumptions about the time that low income families will spend in food
preparation” (Kumanyika 2008) and assuming that low-income consumers will be “willing to
adopt unfamiliar eating habits, depart from social norms, and subsist on unpalatable foods”
(Drewnowski and Darmon 2005).
Critical approaches to obesity: Food, weight, and inequality
Although social scientists’ voices are almost wholly absent from the extensive scholarly
debates on the causes of the obesity “epidemic,” an emergent body of social scientific literature
takes a more critical perspective, examining when, how, and why obesity came to be framed as
an epidemic. Here, we review some of these critical perspectives. Largely focused on
discourses and texts around obesity, this research reveals the historical, political, and cultural
construction of obesity as a widespread public and private problem, reminding us that social
issues are never merely matters of fact but rather reflect and produce larger fears, interests, and
inequalities.
In her analysis of American food advice from the nineteenth to the twentieth century,
Melanie Du Puis (2007) makes a compelling case that food is about national belonging—used to
claim a nationality, to exclude different-eating “others,” and to justify inequality. From
America’s industrial beginnings, food was central to what it meant to be American and to claims
about morality and worthiness—but the types of food and food practices that made one a “real”
American shifted over time. In their efforts to build a perfect society, middle-class reformers in
the early nineteenth century—whose nutritional advice was often divinely sent—“claimed that
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world-betterment came through self-betterment” and “sought to impose a new moral order based
on…discipline and self-making” (Du Puis 2007: 37), including diets that incorporated little or no
meat, and, in some cases the avoidance of alcohol, caffeine, tobacco, and other vices associated
with the working class. Moral reformers focused their efforts on working-class and poor
Americans and new immigrants with the goal of building a better society through good eating
habits; however, despite reformers’ efforts, by “the end of the Civil War, consumption, not
denial, became the sign of national belonging” (Du Puis 2007: 39).
New gastropolitics emerged at the end of the nineteenth century, as the Chinese diet was
touted by newly minted nutrition professionals as superior to the calorie-laden American diet and
sold to industrialists as a way to wring the most out of their laborers for the least expense. White
workers in turn deployed racist, nativist, and gendered rhetoric in defending the right to eat meat:
a report by the American Federation of Labor supporting the Chinese Exclusion Act of 1882 was
titled “Meat vs. Rice: American Manhood Against Asiatic Coolieism, Which Will Survive?” In
the early 20th century, as a result of World War I and the nation’s perceived need for a strong,
aggressive military, national leaders touted the milk- and meat-based diet of white Americans as
superior while portraying non-meat eaters as conquered people, easily vanquished through
inadequate nutrition. Social workers began encouraging new immigrants to adopt an
Americanized diet, including plenty of milk, based on the belief that “a uniform diet eaten by a
nutritionally informed public would lead to sound bodies and healthy, well-adjusted children
who would grow up to be excellent citizens, more productive workers, and better soldiers” (Du
Puis 2007: 41). Du Puis (2007: 43) concludes her brief history of food advice in America with
an impassioned call to stop “think[ing] the creation of better bodies will solve our political
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problems [and instead] think about the ways in which this type of politics simply justifies current
inequalities.”
In a similar vein, Charlotte Biltekoff (2007) analyzes the discursive links at the beginning
of the twenty-first century between the war on terror and the war on obesity. From early on
these two “wars” were intricately linked: No more than a few months after 9/11, the Secretary of
Health and Human Services “urged all Americans to lose ten pounds ‘as a patriotic gesture’”
(Biltekoff 2007: 29), implying that America’s fatness had made it vulnerable to a terror attack
and giving Americans “a meaningful way…to participate in a national struggle against a moral
threat” (34). The media participated in this discursive terrain by describing dieters as “foot
soldiers” in the war on obesity and emphasizing the security threat an overweight military posed.
(In January 2002, as Bush delivered his state of the union address portraying Iraq as an “axis of
evil,” the Department of Defense reported that half of the U.S. military was overweight. Given
that today’s voluntary military is disproportionately comprised of black and Latino poor and
working-class Americans, this announcement provided a rationale, Biltekoff (2007: 41) asserts,
“for regulating minority bodies in the national interest.”) At the same time, the rhetoric around
the war on obesity consistently associated thin Americans with health, strength, and morality
while characterizing overweight and obesity as a moral failing and a sign of unhealth—evidence
of sloth, gluttony, and sickness. While these linkages may seem axiomatic for those of us who
have been immersed in these discourses over the past decade, Biltekoff skillfully shows how
they were constructed and, most crucially, the interests they served and continue to serve.
Reflecting neoliberal ideologies like individualism, personal responsibility, and a focus on small
government, public health officials and nutrition professionals began instructing Americans that
the war on obesity could be won by making good choices, exercising personal restraint, and
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rejecting traditional cuisine and cultural acceptance of larger body sizes. Biltekoff (2007, 44)
resoundingly concludes, “in the context of diminishing funding for social welfare
programs….[the war on obesity] contributes to a politics of fear that helps to justify
infringements on civil liberties and legitimate new forms of surveillance and control over the
population,….draws on existing prejudices,…and obscures the tragic consequences the war on
terror is having on minority communities by suggesting that the healthy future of the nation can
be secured by simple acts of the will.”
Julie Guthman and Anna Kirkland, in two pieces that were published almost
simultaneously (Guthman 2011; Kirkland 2011), use similar arguments to criticize the food
environment perspective and related food justice movement, which aims to “bring good food to
others” through initiatives like community gardens and Farm to School programs. Guthman and
Kirkland argue that although the environmental perspective on obesity seems structural, it
ultimately focuses more on food consumption than food production, relying on elite norms about
what constitutes good food and ultimately concluding that obesity could be prevented with
improved education and access to the “right” kinds of food (i.e., local, organic, fresh). Instead,
they call for more attention to the broader injustices upon which trends related to health, obesity,
food, and nutrition rest—issues related to labor, trade, immigration, financial policy, and
ultimately capitalism. Guthman also reminds us that “the implicit linking of good foods, good
bodies, and political activism allows those who are already privileged to achieve even higher
status by virtue of their bodies and food-purchasing habits.”
Abigail Saguy and Kjerstin Gruys (2010) also highlight the production of stigma and
blame around obesity and how this reproduces inequality. In an analysis comparing news
coverage of overweight/obesity and eating disorders from 1995 to 2005, they demonstrate that
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during this period the news media routinely associated overweight and obese status with bad
individual choices while casting bulimics and anorexics as victims of “a host of complex and
interrelated factors, thus mitigating individual blame” (Saguy and Gruys 2010: 239).
Furthermore, news articles mentioning blacks and Latinos were more likely to blame cultural
attitudes about food and body size for overweight and obesity. (Yet, ironically, the media
portrayed these same attitudes as protective in discussions of thinness-oriented eating disorders.)
The proposed solutions to obesity/overweight versus thinness-related eating disorders also reveal
stark contrasts: whereas articles tended to frame the fix for overweight/obesity in terms of
personal responsibility—indicting parents, and, especially mothers, for woeful irresponsibility,
even negligence, in rates of childhood obesity—press reports on eating disorders consistently
advocated medical interventions as the solution. As Saguy and Gruys (2010: 247: emphasis in
original) note, “in the contemporary U.S. society where thinness is highly prized, news articles
are less likely to blame individuals for being (or trying to be) too thin than they are to blame
them for being too fat.” Given that the media emphasized middle-class white girls’ and women’s
susceptibility to anorexia and bulimia, these articles framed the blameless victim as white,
female, and middle class while framing the irresponsible “other” as black, Latino, and poor.
Overall, these findings convincingly reveal how the national media both promote stigma around
obesity and reproduce race, class, and gender inequalities.
Discussion: The case for a sociological approach to obesity
Americans are more likely today than in the past to be diagnosed as obese; incidences of
diet-related illness such as diabetes have increased over time. Our relationship to the foods we
consume is increasingly complex and profoundly shaped by larger social inequalities. Much of
the existing work on the causes and consequences of the “obesity epidemic” focuses narrowly on
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the attitudes and behaviors of individuals or, conversely, on structural-level factors that promote
obesity, such as food environments and policies. These studies ignore the interaction of the
individual with the structural. They also take for granted that an obesity epidemic exists and that
it will be solved by changing how Americans eat. A burgeoning social scientific literature, in
contrast, highlights the sociohistorical construction of dominant ideas about food and weight,
including the “obesity epidemic.” Yet this body of literature focuses almost exclusively on texts
and discourses, neglecting the arena of people’s everyday food identities, beliefs, and practices
(for an exception conducted in the UK context, see Monaghan 2008). Very few scholars have
asked the communities that their research purports to serve—typically low-income and minority
populations—about their experiences feeding their families or their visions for a more just food
system, which may be very different from the white, middle-class vision reflected in much of the
literature (Guthman 2011; Kirkland 2011).
We argue that sociologists need to step in and contribute meaningfully to this
conversation. At the most fundamental level, a sociological perspective on obesity would
examine how practices and perceptions are situated within broader structural contexts.
Sociologists have the opportunity to show how taken-for-granted assumptions, identities, and
preferences around food are shaped but not determined by food policies, discourses, and local
environments as well as larger inequalities of race, class, gender, and size. This kind of
perspective could show how individuals navigate, understand, and alter their food environments.
In doing so, it would conceptualize food environments not as deterministic, but instead look at
individuals and their environments as co-creative, examining how they have the power to shape
each other (Dixon and Broom 2007). A review of the “state of the science” on food
environments, published in the American Journal of Preventive Medicine, acknowledges the
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need for this kind of research, concluding that we must “put the individual back into the
equation” in order to better understand what influences the choices people make within their
food environments and the differential effects of physical and social environments on
individuals’ food choices across populations and communities (Lytle 2009: S142).
Furthermore, we call for sociologists who study how Americans access, prepare, and
consume food to locate their research with larger contested and unequal social environments,
including the construction of obesity as a social problem (Saguy, Gruys, and Gong 2010) and the
privileging of certain kinds of foods and food practices as not just healthier, but morally better
(Biltekoff 2007; Du Puis 2007; Guthman 2011; Saguy and Gruys 2010). Fatness has not always
been a cause for panic in the United States and, indeed, was once considered a sign of health and
wealth. Importantly, the stigmatization of fatness preceded any health concerns about obesity
and was instead related to “prevailing ideas about race, civilization, and evolution” (Farrell
2011). Sociologists are positioned to ask: Whose interests are served by the construction of
obesity as an epidemic and an individual moral failing? How do everyday people make sense of
their food practices and preferences within stigmatizing and blaming size-ist contexts? How
does the negative characterization of obese and overweight Americans give the middle and upper
classes a new language of morality to justify their status and privilege in a context of increased
inequality and class conflict? How do shame and stigma around obesity provide insight not only
into contemporary attitudes toward health and weight, but also how inequality is experienced and
perpetuated and modern, neoliberal definitions of what it means to be a “good” (i.e., productive)
citizen? This perspective would examine how decisions and discourses about food are inscribed
in broader sets of power relations—related to contested definitions of what constitutes “good”
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food, elite norms about the foods that do and do not connote privilege, and sociopolitical
negotiations about nutrition, food, weight, and health.
Sociologists are also positioned to ask important questions linking food and health to the
economy, public policy, and the institution of family. How and what we eat are embedded in
broader political economic processes, including stagnating wages, the increased expectations that
all adult members of a household will work, and dwindling public support for families, including
parental leave and affordable, high-quality childcare. Moreover, feminist scholars have shown
that white, upper-middle class women’s entrance into the labor force has been facilitated by the
transfer of much of their care work to other women who are often poor, immigrants, and women
of color (Allen and Sachs 2007, Duffy 2005) and who earn very little for this work; this is true
for food (and food work) as well. How are patterns related to eating and health linked to shifts
in how work is organized, economic restructuring, and public policy? Regardless of culture,
class, or race/ethnicity, “the majority of women cook and serve food for their families” (Allen
and Sachs 2007; De Vault 1991; Little et al. 2009), and “food is directly linked to what it is to be
a mother” (Warin et al. 2008). Women may hold a certain degree of power as “gatekeepers” who
control the flow of food into their households, as first suggested by Lewin in 1943, yet how
much power do women really gain from their role as food providers? Family food provisioning,
preparation, and consumption likely involve intricate negotiations in which food, love, care,
discipline, and concern are intertwined. How do negotiations over food reflect power dynamics
within households, such as relationships between women and their intimate partners and
relationships between parents and children? This approach to obesity would be attuned to how
privilege and oppression intersect and inform people’s everyday perceptions and ways of
navigating their social environments (Collins 2000, 2005; Few 2007).
19
Conclusion
For over a decade now, researchers have claimed that America is experiencing an
“obesity epidemic.” What is less clear is how Americans are making sense of food, weight, and
health within this context. Scholars critical of the sociopolitical construction of obesity as an
epidemic rarely explore the food practices and meanings of everyday people; those who
interrogate the causes of obesity rarely adopt a critical perspective. Moreover, individual-level
approaches to obesity frequently blame individuals for rates of obesity whereas work examining
the structural causes of obesity tends to position individuals as dupes of the system or, akin to the
individual perspective, as rational actors who would eat “better” if better food was available.
Although some scholars and activists have begun to use “food justice” as a framework for
problematizing the influence of race and class on the production, distribution, and consumption
of food (see Alkon and Agyeman 2011), much of this work focuses on “bringing good food to
others” while failing to address other injustices in the food system (Guthman 2011). Few studies
have asked poor and working class people how they experience and feel about their food
systems, what changes they would like to see (if any) in their neighborhoods, or what justice
means to them. By asking people about their food practices and the meanings food holds for
them, while being attuned to social inequality and the social construction of the “obesity
epidemic,” sociologists are positioned to bridge the gap between individual- and structural-level
approaches to obesity and bring new insight and humanity to research on food, weight, and
health.
20
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