‘I’ve put weight on cos I’ve bin inactive, cos I’ve ’ad me knee done’: moral work in the obesity clinic

Abstract

As governments and healthcare systems grow increasingly concerned with the current obesity 'epidemic', sociological interest in the condition has also increased. Despite the emergence of work discussing obesity as a social phenomenon, the sociological dimensions of medical weight-loss treatments for obesity remain underexplored. This paper reports on a conversation analytic (CA) study and describes how moral issues surrounding weight and patienthood become visible when doctors and patients discuss obesity. Consultations in two UK National Health Service clinics were video-recorded and analysed to identify recurring patterns of interaction. This paper describes how patients answer opening questions: questions which begin the consultation, enabling patients to report their medical status. Analysis reveals that when producing their answers, patients typically imply either 'success' or 'lack of success' in their weight-loss progress. Whilst doing so, they construct their personal agency in different ways, crediting themselves for implied successes and resisting responsibility for lack of success. Through interaction the doctor and patient collaboratively construct obesity as a moral issue. The moral obligations invoked share similarities with certain perceived normative dynamics surrounding obesity and the responsibilities of patienthood. These findings have relevance to healthcare practice and add to sociological understanding of the modern obesity 'crisis'.

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

“…But it also derived from students' appraisals of obese patients as blameworthy. Using the exquisite, fine-grain methodology of conversation analysis, Helena Webb has revealed the pervasive nature of moral judgment in an obesity clinic [51]. What was remarkable, moreover, was how the patients themselves described their weight loss progress in moral terms of good and bad and how actively they shaped the conversation to reflect their agency or their lack of blame.…”

Determining counselling communication strategies associated with successful quits in the National Health Service community pharmacy Stop Smoking programme in East London: a focused ethnography using recorded consultations

“…The misalignment between the smoker's reasons for smoking or wanting to quit and the adviser's perceptions of what these were would result in the adviser setting inappropriate goals for the smoker. [72][73][74][75][76][77][78][79][80][81][82] These misalignments may therefore explain why a smoker's sharing of their lifeworld was not always associated with quit success. This interpretation of the data is supported by similar findings in our separate analysis of adviser interviews, with some advisers explicitly stating that they emphasised particular strategies in those smokers they considered would find it harder to quit, to try to help them.…”

Applying discursive approaches to health psychology.

“…Wiggins suggested that whilst patients are drawing upon an individualist concept of weight which reifies the medical model and renders them responsible, their resistance is couched in a way that troubles this model through claims that it does not work even when they adhere to the diet plan. Similarly, a conversation analytic study conducted by Webb (2009) found that patients at an obesity clinic emphasized their own agency by documenting their exercise and improved health when achieving success but minimized their agency with mitigating factors, such as difficulty in exercising or reactions to drugs, when they gained weight.…”

“…As indicated above, drawing upon conversation analysis the analysis is grounded sequentially -people display their understanding of the previous 'turn' of talk (what has just been said) in their subsequent turn (their response and uptake of what was said). Examining such practices in situ allows us to explore the business of talk in settings such as commercial weight management groups (Mycroft, 2008), NHS weight management treatment (Wiggins, 2009), and obesity clinics (Webb, 2009) discussed below.…”