‘I’ve Put Weight on Cos I've Bin Inactive, Cos I've 'ad me Knee Done': Moral Work in the Obesity Clinic

Webb, Helena

doi:10.1002/9781444324020.ch5

Cited by 13 publications

(19 citation statements)

References 26 publications

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“…These findings offer some support to earlier observational work in obesity clinics which showed how stigmatised attitudes towards extreme overweight (on the part of both patients and doctors) shape clinical interactions and accentuate the power imbalance in the consultation . Nevertheless, it is notable that most clinicians in this study took a compassionate approach in consultations, and it is questionable how far the dominant behaviourist approach would have been pursued if resource availability had been more generous.…”

Section: Discussionsupporting

confidence: 79%

Self‐responsibility, rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic

Owen-Smith

Coast

Donovan

2018

Health Expectations

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BackgroundAddressing the prevalence of severe obesity and its concomitant morbidities is widely acknowledged as one of the most pressing global health priorities. Nevertheless, a paucity of effective interventions and universal pressure on health‐care budgets means that access to obesity treatments is often limited. Although health‐care rationing can be conceived as a socially constructed process, little is known about how decisions emerge within the context of face‐to‐face doctor–patient interactions.MethodsIn this study, we used in‐depth interviews and clinic observations to investigate clinicians’ (n = 11) and patients’ (n = 22) experiences of the rationing of obesity surgery and to examine how broader cultural assumptions around personal responsibility for health emerged in the context of clinical interactions.ResultsPatients and clinicians worked within similar frameworks when it came to self‐responsibility for health and the appropriateness of providing publicly‐funded weight loss surgery. Issues around personal accountability dominated consultations, and patients were expected to provide narratives of the development of their obesity and to account for the failure of previous interventions. Clinicians faced the added pressure of having to prioritise a limited number of patients for surgery, which was predominantly managed through mandating pre‐referral weight loss targets.DiscussionAlthough clinicians sought to maintain an empathic attitude towards individual patients, in practice they were conflicted by their responsibility to ration health‐care resources and tended to rely on entrenched models of behaviour change to allocate treatment. As a result, the content of consultations was mostly focused on issues of personal responsibility, reflecting wider stigmatized attitudes towards extreme obesity.

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Section: Discussionsupporting

confidence: 79%

Self‐responsibility, rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic

Owen-Smith

Coast

Donovan

2018

Health Expectations

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“…Simultaneously, participants wished to avoid being seen as ‘stupid’ or incompetent people who did not know how to live properly, exemplified by statements demonstrating their knowledge about health maintenance. Being overweight is a moral issue, fraught with the possibility of being judged for being irresponsible (Monaghan, ; Webb, ). Sociologists contend that paying attention to how people merge ‘public’ and ‘private’ accounts of illness and illness onset so as to avoid judgement as abnormal or being blamed is important (Radley and Billig, ).…”

Section: Discussionmentioning

confidence: 99%

“…It may be that participants were worried about being judged by the researcher and consequently offer accounts which positioned them as blameless for the initial weight gain. Concurrently, they arguably put forward accounts of being knowledgeable, responsible people in order to manage moral standing in relation to reward or blame for weight loss and gain (Webb, ). This is not to say that people were not telling the truth and had not tried to lose weight; rather, the issue is about how discussions are framed and for what purpose.…”

Section: Discussionmentioning

confidence: 99%

‘…I've Found Once the Weight Had Gone Off, I've Had a Few Twinges, But Nothing Like Before’. Exploring Weight and Self‐Management of Knee Pain

Morden

Jinks

Ong

2013

Musculoskelet. Care

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ObjectivesBeing overweight or obese is a key risk factor for the onset and exacerbation of knee pain. Policy and clinical guidelines encourage lifestyle changes as part of prevention or supported self-management. The present study explores how people who have not consulted for knee pain understand weight in relation to joint pain, if and how they self-manage and potential barriers to doing so.MethodsA qualitative investigation was undertaken using repeat in-depth semi-structured interviews and diary study. Thirteen participants who self-reported moderate to severe pain and had not recently consulted their general practitioner for knee pain were recruited to the study. Thematic analysis of data was conducted.ResultsParticipants did not recognize the association between being overweight and the onset of joint pain. The findings illuminate understandings of the effect of weight on joint pain, rationales and strategies for losing weight, and how participants’ position responsibility for weight gain and loss.DiscussionThe present study suggests that clinicians need to account for existing understandings and actions of individuals in relation to weight and joint pain. Supported self-management and public health interventions need to be individually tailored accordingly. © 2013 The Authors. Musculoskeletal Care published by John Wiley & Sons, Ltd.

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“…Though spoken lightheartedly, it constitutes inadequacies as possibly uncontrollable or beyond individual control: naming the self-destructive action of unhealthy eating in addictive terms -as a kind of medical problem -functions rhetorically to remove some of the personal responsibility associated with the 'bad' behaviour and perhaps justifies succumbing, at least occasionally, to unhealthy 'temptations'. This framing recalls Webb's (2009) finding that patients diminish the potential for moral censure by blaming external factors for their lack of success in achieving weight loss. It also suggests the ambiguity of the line between claiming personal responsibility and blaming external causes, or scapegoating, for a state of pollution.…”

Section: Pollution or Sources Of Guiltmentioning

confidence: 92%

The moralization of healthy living: Burke’s rhetoric of rebirth and older adults’ accounts of healthy eating

2012

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This article develops a rhetorical analysis of how older adults in Canada and the UK engage with civic-moral imperatives of healthy living. The analysis draws on Burke's concepts of 'symbolic hierarchies' and the 'rhetoric of rebirth' to explore how participants discursively negotiate the moralizing framework of self-regulation and self-improvement central to healthy eating discourse, in particular. Working from the premise that healthy eating is a 'principle of perfection' that citizens are encouraged to strive to achieve, the article traces the vocabularies and logical distinctions of 'guilt', 'purification' and 'redemption' in participants' accounts of what healthy eating means to them. This analysis reveals some of the complex, situated and often strategic ways in which they rearticulate and reconfigure the normative imperatives of healthy eating in ways suited to their lived experience and their priorities for health and well-being in older age.

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‘I’ve Put Weight on Cos I've Bin Inactive, Cos I've 'ad me Knee Done': Moral Work in the Obesity Clinic

Cited by 13 publications

References 26 publications

Self‐responsibility, rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic

Self‐responsibility, rationing and treatment decision making – managing moral narratives alongside fiscal reality in the obesity surgery clinic

‘…I've Found Once the Weight Had Gone Off, I've Had a Few Twinges, But Nothing Like Before’. Exploring Weight and Self‐Management of Knee Pain

The moralization of healthy living: Burke’s rhetoric of rebirth and older adults’ accounts of healthy eating

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