HEALTH STUDIES
A SIZEABLE PERSONAL TROUBLE, A LARGER PUBLIC ISSUE:
A BIOMEDICAL AND SOCIAL APPROACH TO OBESITY
Westerberg, VM
Date: 28 March 2009
The present work does not represent the author’s views on health and obesity, it is tailored according to the instructions of the paper coordinator
WESTERBERG, V. M.
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A SIZEABLE PERSONAL TROUBLE, A LARGER PUBLIC ISSUE:
A BIOMEDICAL AND SOCIAL APPROACH TO OBESITY
“The “i” in illness is isolation, and the crucial letters in wellness are we.”
Anonymous (as quoted in Guarneri, 2006, p. 1)
Health has been defined as:
A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity. (...). Health is a resource for everyday life, not the object of living. It is
a positive concept emphasizing social and personal resources as well as physical
capabilities. (World Health Organization [WHO], 1998, p.1).
This broad definition of health implies that some pre-requisites must be present in order to
achieve individual and community health like living in an equalitarian society where individuals
have access to good quality food, water, education, housing, jobs, health services, etc. These
assumptions are not considered in the biomedical definition of health, which is simply the
absence of disease. Therefore, someone suffering from obesity would be labelled as “healthy”
until that person develops an objective and usually irreversible disease related or not to a
significantly increased Body Mass Index (BMI), not taking into account the environmental and
socio-political contexts that person lives in and how they can impact health outcomes. This essay
will discuss how the biomedical and the social health models could work together to achieve a
more holistic concept of health and it will suggest that the two models are not self-exclusive,
showing that they can and should co-exist within society. The micro-individual and macro-social
levels of analysis (Mills, 1959), which represent the biomedical and social models of health
respectively, may be linked together to achieve individual wellness through activism as suggested
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by Baum (1998) who compels doctors to take both social and political action to create a healthier
society.
In order to understand how failure to take into account the social perspective of health, i.e.: the
lack of sociopolitical action, has led to increasing rates of obesity, an issue which is reaching
nearly epidemic proportions in developed countries (Hill, Peters and Jortberg, 1998), it is
necessary to briefly explain this condition from a biomedical model standpoint so as to
understand how healthcare professionals see obesity as just a personal trouble affecting a
growing number of people but not as a public issue requiring sociopolitical action and institutional
intervention.
Biomedically, obesity is considered a disease related to an abnormal feeding behaviour (Jordaan,
Roberts & Emsley, 1996) that can be explained on the basis of the presence of either structural
(anatomic) or non-structural (psychiatric) pathology. Anatomical pathology may lie at a central
(hypothalamic or hormonal) or a peripheral (gastric dilatation) level.
Modern, processed foods are more calorically dense and contain lesser nutrients than natural
foods and when eaten for long periods of time or in large amounts they have serious effects in the
organism. (Lisle & Goldhamer, 2006). Obesity, once established, leads to the "obese mind set"
which results in self-perpetuating behaviours - sedentary lifestyle, overeating, social isolation,
fatigue and feelings of being "out of control." (McElroy et al., 2009).
Processed foods are served in so-called “fast, or junk, food restaurants”. These establishments
are widely spread (this means that local administrations readily grant them the license to open),
sell at low prices compared with regular restaurants (attracting people of the lower socioeconomic strata of society), always have promotions (get 2 pay 1, a larger menu for just 1 more
WESTERBERG, V. M.
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dollar) and add flavour and aroma enhancers to their meals (making them addictive). (Taylor,
2010).
From a business-for-profit or consumption perspective, obesity is a good source of income for
fast food restaurants, pharmaceutical companies, institutions and governments. Additionally,
obese people seek frequent and expensive medical and surgical treatments for secondarily
developed pathologies ranging from hypertension, diabetes, hypercholesterolaemia and heart
disease to gastric reduction procedures and plastic surgery to deal with redundant skin and
subcutaneous tissue (Lisle & Goldhamer, 2006). Being and staying overweight appears to be
good for business and the Establishment so, why would those who have the power to do
something about it, like governments and institutions, want to put an end to it?
Power (Mills, 1959) means the capability to influence large scale, macro-level, political decisions
in the global market which would lead to changes in the micro-level situation resulting in
significant benefits for the individual constituents of society. Mills thought it was possible to create
a good society on the basis of knowledge, and that people of knowledge must take responsibility
for its absence.
A few examples of lack of action that promote obesity are: the location of fast food restaurants
near schools, the location of ticket collection booths at the pop-corn counter, healthy food not
being readily available or being expensive, not having enough gyms, bicycle lanes or safe jogging
areas, not banning publicity of fast food restaurants sponsoring sporting events, lack of health
promotion campaigns on TV, educational centres and communities, and there not being
awareness that sociopolitical level actions from governments are a right people are entitled to and
that it is the result of those large-scale actions that could bring about a healthier society with
healthier individuals.
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Conscious that the predominant model of health in developed countries is the biomedical model,
Baum (1998) encourages healthcare professionals to additionally implement and promote the
social model of health claiming that a shift away from the predominance of the former towards the
latter is the sensible way to achieve sustainable and long lasting health improvement. Baum
(1998) appeals to healthcare professionals who wish to create communities which optimize health
for people. Underlying this change is political activity in a context of globalization that emphasizes
social, economic and environmental change over lifestyle changes (Baum, 1998).
A potential threat to Baum´s proposed actions to create a link between models of health, is
modern societies´ tendency to “medicalization”. In the past, natural occurrences like giving birth
and dying were managed without the intervention of professional assistance. Today, these
situations have been “made medical”. Likewise, a condition like obesity is currently considered a
disease that only doctors can diagnose and treat, seeing individuals, now labelled as “patients”,
as entities that stand alone, disregarding the social context in which they live and that may have
driven them to that situation of risk.
Given the developed world tendency in terms of health and contrary to Baum´s efforts to find a
common ground between health models, Illich (1976) clearly positions himself in favour of the
social model of health saying that "the medical establishment is a major threat to health" (p. 11) in
view of the detrimental effects healthcare professionals and their procedures can have on the
health of individuals, a situation known as iatrogenic pathology. An example of this is the
development of obesity in patients with asthma, allergic reactions, arthritis, hepatitis, organ
transplants and adrenal insufficiency due to the administration of corticosteroids (Braunbald,
2008).
WESTERBERG, V. M.
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Governments design institutional healthcare training in such a way that it produces professionals
who focus exclusively on science, objectivity and rationality neglecting the social dimensions of
health and illness (Lyons & Chamberlain, 2006) and these professionals are possibly intentionally
not made aware of the social aspect of health during their studies, a worrying issue which could
be solved with the introduction of a compulsory paper on social health awareness in medical,
nursing and midwifery schools. Another possible way to achieve social awareness in this group of
professionals would be to include social health as part of their compulsory continuing medical
education through, for example, in-hospital conferences.
Malaise can come with the creation of modern societies (Mills, 1959) and the increasing growth of
obesity illustrates that Mills´ concern about negligent institutions creating individuals in need of
assistance is a fact, knowing that those who are the most dependent are people of lower socioeconomic levels, people with no power, knowledge or means to claim their right to health, health
not just understood as absence of disease after medical treatment, but as absence of risk factors
after social and political action. When conditions like obesity are regarded as a personal trouble
and not as a public issue, that day, an equalitarian society will have been created, one with a
more holistic model of health that managed to integrate the best of the biomedical model in the
social model of health.
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Reference list:
Baum, F. (1998). The new public health: an Australian perspective. Melbourne: Oxford
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Braunwald, E., Fauci, A.S., Hauser, S.L., Jameson, J.L., Kasper, D.L., Longo, D.L., et al.
(2008). Harrison's Principles of Internal Medicine (17th ed.). Columbus, OH: McGrawHill.
Guarnieri, M. (2006). The Heart Speaks: A Cardiologist Reveals the Secret Language of
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Hill J., Peters J.C., & Jortberg, B.T. (1998). The step diet book: Count steps, not calories to lose
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Illich, I. (1976). Medical nemesis: The expropriation of health (1st ed). New York, NY: Pantheon
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Jordaan G.P., Roberts, M.C., & Emsley R.A. (1996). Serotoninergic agents in the treatment of
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Lisle, J. D., & Goldhamer, A. (2006). The pleasure trap: Mastering the hidden force that
undermines health and happiness. Summertown, TN: Book Publishing Company.
Lyons A.C., & Chamberlain, K. (2006). Health Psychology: A critical introduction. Cambridge:
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McElroy S.L., Guerdjikov A.I., Winstanley E.L., O'Melia A.M., Mori N., Keck P.E., Hudson J.I.
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