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This essay will look at sociological concepts and concerns that can help in understanding why obesity is a public health problem. I will begin by giving a definition of obesity, and then address the public health concerns of obesity in relation to sociological concepts such as socioeconomic status, ethnicity and stigma. I will make reference to obesity health inequalities throughout this essay. Relevant contemporary literature and policies will be used to support my arguments.
Obesity is defined as excessive fat accumulation that may impair health world Health Organisation (WHO). Body mass index (BMI) is a measure of weight-for-height that is commonly used in classifying obesity in individuals. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). BMI provides the most useful population-level measure of obesity as it is the same for both sexes and for all ages of adults (Doak et al 2002). In actual figures the World Health Organization (WHO) defines "overweight" as a BMI equal to or more than 25, and "obesity" as a BMI equal to or more than 30. These cut-off points provide a benchmark for individual assessment, but there is evidence that risk of chronic disease in the populations' increases progressively from a BMI of 21. Ellaway et al (2005) argues however that (BMI) should be considered as a rough guide because it may not correspond to the same degree in different individuals.
In 2004, the average body mass index (BMI) of men and women in the United Kingdom was 27kg/mÂ², which is outside the World Health Organisation recommended healthy range of 18.5-25kg/m2 (Lobstein & Jackson-Leach 2007).
A greater proportion of men than women (42% compared with 32%) in England were classified as overweight in 2008 (BMI 25 to less than 30kg/m2). Thirty-nine per cent of adults had a raised waist circumference in 2008 compared to 23% in 1993. Women were more likely than men (44% and 34% respectively) to have a raised waist circumference (over 88cm for women and over 102 cm for men) (Department of Health, 2008).
Several government documents have emphasised the fact that obesity is a major public health problem due to its association with serious chronic diseases such as type 2 diabetes, hypertension high levels of fats in the blood that can lead to narrowing and blockages of blood vessels, which are all major risk factors for cardiovascular disease and cardiovascular related mortality in England and Wales
(National Institute for Health and Clinical Excellence (NICE), 2006).
Over weight individuals suffer from a number of problems, such as an increased wear and tear on joints and the psychological and social difficulties caused by altered body image and stigma such as depression which in turn increases the health burden of the National Health Service (NHS) Graham (2004).
The increase in numbers of obese people means that the population is at a higher risk of suffering from co-morbidities as a result of their weight gain. Many writers have made a link between people with high BMI and health for instance, people with high BMI are likely to suffer from hypertension and twice as likely to suffer from type- two diabetes and obesity compared to people without hypertension, and half are insulin-resistant (Lobstein & Jackson-Leach 2007). One can therefore infer that obesity is linked with increased mortality and contributes to a wide range of conditions, including ischaemic heart disease, hypertension, stroke, certain cancers, and gall bladder diseases. Risk of disease grows with increasing BMI and is particularly marked at high BMI (Ellaway et al 1997). Consequently this is a public health concern because in economic terms, a lowering of the rates of CVD, cancer and strokes would result in significant reductions in the amount spent on drugs and social care required to manage these diseases and their effects (Ellaway et al 1997).
Socioeconomic Status and Obesity
Socioeconomic inequality in obesity is defined as differences in the prevalence of obesity between people of higher and lower socioeconomic status (Mackenbach and Kunst 1994). A large body of evidence suggests that socioeconomic differences in obesity exist throughout the world Sobal and Stunkard (1989). These findings suggest that the increase in inequality in income recently observed in many countries including Bulgaria, Poland, Romania and the Russia may be associated with an increase in the burden of obesity. Midtown Manhattan Study was one of the first to highlight socioeconomic differences in obesity; it found that obesity was six times more prevalent among women of lower socioeconomic status than those of higher socioeconomic status (Mackenbach and Kunst 1994). James et al (1997) found that people in high socioeconomic status in the United Kingdom, have a reduced risk of obesity compared to those with low socioeconomic status.
Socioeconomic status and obesity is a public health concern because among children and adults in high-income countries such as the United Kingdom, lower education level and socioeconomic status have been associated with different markers of poor diet potentially associated with obesity, including lower consumption of fresh fruit and vegetables and higher intake of sugar, fat and meat (Northstone and Emmett 2005). Mulvihill (2003) asserts that population groups' dietary choices of are often related to socioeconomic considerations. McKee and Raine (2005) suggest that major factors influencing food choices include affordability, accessibility, availability, attractiveness, appropriateness and practicality. This makes sense to me in that people of low socioeconomic status are likely to be obese because for them they cannot always afford to buy fresh fruits vegetables have gym membership as this is expensive. Some proponents have gone as far as saying that the poor do not eat what they want, or what they know they should eat, but what they can afford (Wardle and Griffith 2001). One could infer that the cost of food is one barrier to adopting healthier diets, especially among low-income households. Studies have suggested that high energy food which are usually nutritionally poor because of high amounts of added sugar and fat are relatively cheaper cost than lean meat, fish, fresh vegetables and fruit (Doak et al 2002).
On the other side of the coin theoretically one can argue that it not only diet and health and affordability of food that makes people obese, for instance for argument sake one could not afford to buy healthy food but can exercise take up a activity to keep themselves fit. The reality however is that people low socioeconomic status are likely to be in low income employment where they are likely to work long hours in overtime and have little time with their families or for leisure activities (Scambler 2008) This is consistent with McKee and Raine (2005) finding that individuals from low socioeconomic status make personal other choices over diet, physical activity and other health promoting action, in practice all actions happen in context disadvantaged individuals face structural, social, organisational, financial and other constraints in making healthy choices. In addition McLaren and Godley (2008) observed that men in sedentary jobs although one would assume that nature of these jobs that drives the larger average body size (due to lack of occupation-based physical activity) existing literature would indicate that they are still more likely than their lower status counterparts to engage in physical activity in their leisure time.
Other sociological concerns regarding socioeconomic status is whether they are any variations in how individuals with different socioeconomic status perceive obesity or overweight. For instance, analyses from the Office of National Statistics (ONS) (1999) survey showed that many respondents with lower socioeconomic status tended to have lower levels of perceived overweight, thus individuals monitor their weight less closely, were less likely to be trying to lose weight and less frequently used restrictive dietary practices than those with higher socioeconomic status, after adjusting for sex, age and BMI. Wardle and Griffith (2001) found that, women living in highly affluent neighbourhoods were more likely to be dissatisfied with their weight than women from deprived neighbourhoods. Women, particularly those in disadvantaged situations, face structural, social, organisational, financial and other constraints in making healthy choices. Secondly poorer neighbourhoods provide fewer opportunity structures for health promoting activities than more affluent areas (Ellaway et al 1997). These findings make it very difficult for professional to decide how to target health promotion activities. Ellaway et al (1997)argues that people who low socioeconomic status focus on the basic issues of survival, whether these be financial including purchasing food at all, let alone healthy sources or social including battling the stigma of poverty and/or overweight and all that is related to it. In my view this suggests that it may be plausible to conclude that where someone lives what socioeconomic status they have and how much they earn can influence his or her opportunities to undertake health promoting activities which in turn may influence body size and shape. Public health policies which aim to reduce the proportion of overweight people in the population should be targeted in deprived local areas, and their facilities and amenities, as well as at individuals (Ellaway et al 1997).
Obesity and ethnicity
A great deal of confusion surrounds the meaning of ethnicity and in some cases this term is still being Inter-changeable with race (Scambler 2007). Ethnicity however embodies one or more of the following, shared origins or social background; shared culture and traditions that are distinctive, maintained between generations, and lead to a sense of identity and group; and a common language or religious tradition (Bhopal 2009).
There is also repeated evidence of social disparities in the prevalence of obesity and overweight. Data from national surveys paint a consistent picture where women, individuals of lower socio-economic position and minority racial/ethnic groups have the highest rates of obesity and overweight (Bhopal 1998). Links have been made why disparities exist in the prevalence of obesity especially among disadvantaged ethnic minority groups. Henderson and Kelly (2005) suggest that these disparities exists because of inequalities in the society they argue that people with more knowledge, money, power, prestige and beneficial social connections are better able to control weight gain, either through the ability to make healthy food choices (by having greater awareness of, access to, and resources to purchase healthy foods), or through greater opportunities for exercise, and safe play. I agree with this, in my view there is numerous evidence to show that ethnic groups are disadvantaged in term of income, socioeconomic status and employment, the point above suggest to me that ethnic minorities are less likely to have money prestige and social connects that (Henderson and Kelly 2005) suggest will lower the risk of obesity. This view is supported by Sniderman et al (2007) who found no disparities in prevalence of obesity among ethnic groups when he factored in adjustments of socioeconomic status and income.
Black ethnic groups have a significantly higher risk of obesity than those in Mixed, Asian, Other and White ethnic groups (Ellaway et al 1997). Children living in deprived areas have a higher risk of obesity than those living in less deprived areas. However, the increased risk associated with deprivation is greatest for White children, whereas it seems to have much less of an effect for black children. For Asian, Other, and Mixed ethnic children deprivation increases the risk of obesity, but not as much as for White children (Ellaway et al 1997). In my opinion however the measuring of BMI to determine and compare obesity between various ethnic groups remains very "sketchy". For example Sniderman et al (2007) asserts that in various sections of the population, the BMI classification is not generally applicable. For instance in when looking at children, the elderly and when comparing ethnic groups.
Seidell and Visscher (2000) found that there were some systematic variations in normal BMI across ethnic groups in some Asian populations a particular BMI equates to a higher percentage of body fat than for the same BMI in a white European population. In these Asian populations, the risks of type II diabetes and cardiovascular disease increase at a BMI below the standard cut-off value of 25 kg/m2. In other populations, such as black populations, the opposite is true and a particular BMI corresponds to a lower percentage of body fat and consequently lower risks of morbidity and mortality than in a white European population. When comparing obesity in different ethnic groups. Seidell and Visscher (2000) suggest that using a more different definition such as waist to hip ratio rather than standard BMI.
Obesity and Stigma
Physical deviance has been conceptualised as a "stigma" by Goffman (1963) defines as any attribute that is deeply discrediting to an individual. In addition to what he calls the abominations of the body or the physical deformities, he lists the "tribal stigmas of race, religion, and social class, and what he calls the blemishes of individual character, such as mental illness, addiction, alcoholism, and homosexuality (DeJong, 1980). Goffman (1963) argues that individuals who possess a spoiled identity as a result of their stigma, the consequences can be severe, regardless of the particular nature of the stigma. Although a bit extreme people with stigmatised conditions are viewed as not quite human and are subject to discrimination and outright rejection or avoidance (DeJong, 1980). As a result, the stigmatised learn to continually monitor their self-presentation and to consciously devise strategies of interaction. In spite of those efforts, however, a stigma can continue to intrude itself into the interaction, and its possessors may come to feel that their identity is strictly defined in terms of it (DeJong, 1980).
On the other hand all the above writers fail to list obesity among the physical stigmata. There is a certain irony in that fact, for some have argued that the obese are subject to a particularly severe degree of ridicule, humiliation, and discrimination. I would argue that perhaps Goffman (1963) and (DeJong, 1980) did not include obesity as in that time being obese held different stature in the society than it does now, for example wealth and physical presents. Secondly I would infer that research into the links of obesity and health were not widely publicised as they do now. Some
Scambler (2008) takes a functionalists view that those who possess certain discredited conditions that result in stigma have acquired their deviant status through the commission of deviant acts. In this day and age obesity is seen by some as a discredited condition, this normally results in ideas that obese people are responsible for their condition, in other words they have put themselves in that condition. DeJong (1980) agrees with this notion that people that possess stigmatising conditions are almost always seen as having responsibility for acquiring and controlling their deviant status. Wright (1960) contrasts this by stressing that individuals with a physical stigma are not usually held personally responsible for their condition. Nonetheless in terms of obesity this works both ways the genetic component that the stigmatised individual has no control or responsibility no matter how much dieting and exercise he or she does, and the self inflicted individual who is seen to stuff themselves with fatty foods. Wright (1960) suggests that most physical attributes of the body are viewed as determined by genetic and environmental forces beyond an individual's personal control.
Quintessentially in the case of obesity observations have frequently been noted to be extremely negative toward the obese, this seems to arise from the belief that obesity is caused by self indulgence, gluttony, or laziness. In short, the obese do seem to be held personally responsible for their physical condition (DeJong, 1980).
Obese individuals are commonly blamed for their excess weight, are socially disliked, and are the targets of pervasive negative stereotypes such as having a lack of self-discipline (Puhl and Brownell 2001). Obese people are highly stigmatised and face different forms of discrimination and prejudice because of their weight (Brownell et al 2005).
Stigma and obesity is a public health concern as Puhl and Brownell (2001) found that health-care professionals (physicians, nurses, psychologists, and medical students) possess negative attitudes toward obese people. They suggest that obese people are not only stigmatised by the society but by the health professional that are meant to deliver help to them. A study of British healthcare professionals found that providers perceived overweight people to have reduced self-esteem, sexual attractiveness, and health. Healthcare professionals believed that physical inactivity, overeating, food addiction, and personality characteristics were the most important causes of overweight (Puhl and Brownell 2001).
Attitudes obese people amongst healthcare professionals is a major public health concern in that it sometimes influences how this group excess health given the fact that they are a high risk population in terms of more prevalence to a number of physical health issues. Puhl and Heuer (2009) found that obese patients who experience stigma in health-care settings may delay or forgo essential preventive care. Mitchell et al (2008) discovered in their study that obese individuals are less likely to undergo screenings for breast, cervical, and colorectal cancer for women with a BMI greater than 55 kg/m2, 68% reported that they delayed seeking health care because of their weight, and 83% reported that their weight was a barrier to getting appropriate health care. When asked about specific reasons for delaying care, women reported disrespectful treatment and negative attitudes from health professionals, embarrassment about being weighed, receiving unsolicited advice to lose weight, and gowns, exam tables, and other equipment being too small to be functional.
Removing the stigma-related barriers to receiving screenings may help to diminish the relationship between excess body weight and mortalities (Mitchell et al 2008).
Puhl and Heuer (2009) argues that and I am convinced by their view that disapproval by the society leaves overweight and obese individuals vulnerable to social injustice, unfair treatment, and impaired quality of life as a result of substantial disadvantages and stigma. Crawley (2004) found in his study that among females, a negative correlation between body weight and wages. He argues the explanation is that obesity lowers wages; for example, by lowering productivity or because of work placed discrimination, secondly is that low wages cause obesity.
Where someone lives what socioeconomic status they have and how much they earn can influence the choices they make about their health. Ethnic disparities in the prevalence of obesity still exist in the United Kingdom. Sociological concepts can assist us in understanding how to deal with obesity given known link between poor diets during pregnancy is a risk factor for low birth weight, which in turn has been associated with abdominal obesity in adulthood Crawley (2004).