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Developmental origins of health and disease (DOHaD) and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health.

In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

Background High rates of alcohol consumption by midlife women, despite the documented risks associated with breast cancer, varies according to social class. However, we know little about how to develop equitable messaging regarding breast cancer prevention that takes into consideration class differences in the receipt and use of such information. Objective To explore the heuristics used by women with different (inequitable) life chances to determine the trustworthiness of information regarding alcohol as a modifiable risk factor for breast cancer risk. Methods and materials Interviews were conducted with 50 midlife (aged 45–64) women living in South Australia, diversified by self-reported alcohol consumption and social class. Women were asked to describe where they sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy. De-identified transcripts were analysed following a three-step progressive method with the aim of identifying how women of varying life chances determine the trustworthiness of alcohol and breast cancer risk information. Three heuristics were used by women: (1) consideration of whose interests are being served; (2) engagement with ‘common sense’; and (3) evaluating the credibility of the message and messenger. Embedded within each heuristic are notable class-based distinctions. Conclusions More equitable provision of cancer prevention messaging might consider how social class shapes the reception and acceptance of risk information. Class should be considered in the development and tailoring of messages as the trustworthiness of organizations behind public health messaging cannot be assumed.

Background: Urgent action is required to identify socially acceptable alcohol reduction options for heavy-drinking midlife Australian women. This study represents innovation in public health research to explore how current trends in popular wellness culture toward ‘sober curiosity’ (i.e., an interest in what reducing alcohol consumption would or could be like) and normalising non-drinking could increase women’s preparedness to reduce alcohol consumption. Methods: Qualitative interviews were undertaken with 27 midlife Australian women (aged 45–64) living in Adelaide, Melbourne and Sydney in different social class groups (working, middle and affluent-class) to explore their perceptions of sober curiosity. Results: Women were unequally distributed across social-classes and accordingly the social-class analysis considered proportionally the volume of data at particular codes. Regardless, social-class patterns in women’s preparedness to reduce alcohol consumption were generated through data analysis. Affluent women’s preparedness to reduce alcohol consumption stemmed from a desire for self-regulation and to retain control; middle-class women’s preparedness to reduce alcohol was part of performing civility and respectability and working-class women’s preparedness to reduce alcohol was highly challenging. Options are provided for alcohol reduction targeting the social contexts of consumption (the things that lead midlife women to feel prepared to reduce drinking) according to levels of disadvantage. Conclusion: Our findings reinstate the importance of recognising social class in public health disease prevention; validating that socially determined factors which shape daily living also shape health outcomes and this results in inequities for women in the lowest class positions to reduce alcohol and related risks.

Summary Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women’s lives. This paper draws on 50 qualitative interviews with midlife women (45–64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or ‘breaking up with’) alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing drinking patterns. If classed differences are not attended to in health promotion efforts, this might mitigate the effectiveness of alcohol risk messaging to women.

The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem’s concepts of “the normal and the pathological” as a theoretical frame, we examine the gendered assumptions that shape medical understandings of “healthy” and “dysfunctional” exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.

This article responds to calls for empirically grounded and critically analytical research on the sociology of happiness. We explore how 35 Australian women in midlife (45–64 years) navigate alcohol use in the context of gendered lifecourses. In response to emerging themes around happiness in and through alcohol consumption during inductive analysis, data were re-analysed using neo-Aristotlean notions of flourishing. This illuminated alcohol consumption for women in midlife vis-á-vis moment-in-time pleasure, lifecourse happiness and management of gendered constraints. Drawing on Ahmed’s concepts of ‘affective economies’ and ‘happiness and unhappiness archives’ we contemporise Aristotle’s notion of flourishing and argue that changing structures of feeling for women in midlife give rise to differing emotions that attach to alcohol use. Understanding the affective reasons for alcohol consumption among this population provides new avenues to think about how alcohol consumption is purposed by women to make and make do with (un)happiness during midlife.

This paper examines the multiple tensions arising in an Australian university and public sector collaboration that aimed to investigate an obesity intervention. A key site of conflict with the exte...

When it comes to food, eating and technologies, convenience is constructed as contradictory: on the one hand as a practice that saves time and effort, and on the other hand, an easy and often “unhe...

Objective: Australian tertiary eating disorder services (EDS) have a divided model of care, where child and adolescent mental health services (CAMHS) support patients until the age of 18 years, and thereafter, adult mental health services (AMHS) provide care. Consumers and carers have criticised this divided model because the age boundary occurs during the peak period of onset and acuity for eating disorders. Most CAMHS patients are lost to specialty follow-up around age 18, increasing the risks of relapse and premature mortality from eating disorders, since young women (aged 15–24) have the highest hospitalisation rates from anorexia nervosa. The current article is a commentary on the transition gap and possible service designs. Conclusions: Eating disorders require access to specialty treatment across the life span. The Australian Federal Government has expanded all-age care through the 2019 Medicare Benefit Schedule (MBS) eating disorder plans. Some new MBS patients require a rapid step-up in care intensity to a tertiary EDS, thereby increasing demand on the public sector. State/Territory Governments should strengthen EDS using the ‘youth reach-down’ model, where AMHS extend EDS to age 12. Vertical service integration from 12 to 64+ facilitates continuity of care for the duration of an eating disorder.

Objective: Young women living in industrialised westernised societies have a higher prevalence of anorexia nervosa, partly due to a cultural emphasis on thinness as a beauty ideal. Sociocultural milieux might promote recovery from anorexia nervosa amongst young women. The current article is a commentary about the social influences on recovery from anorexia nervosa – based on social anthropology, narratives of people with lived experience, and clinical studies. Conclusion: Anorexia nervosa increases social withdrawal, and recovery leads to re-engagement with meaningful relationships. Recovery also empowers women as ‘cultural critics’ who challenge assumptions about the thinness beauty ideal and gender roles. The gradual process of full or partial recovery often occurs during emerging adulthood (aged 20–29). In this life stage, adolescent friendship groups are dissolving as women move from education to work, reducing the danger of weight-based teasing by peers, which is an environmental risk factor for disordered eating. Women recovering from anorexia nervosa may connect with those aspirations of peers and mentors that eschew a focus on weight and shape, but relate to the life-stage tasks of starting careers, beginning new friendships, selecting life partners and family formation – that is, a broader role in larger relationship networks.

A history of colonization inflicts psychological, physical, and structural disadvantages that endure across generations. For an increasing number of Indigenous Australians, environmental epigenetics offers an important explanatory framework that links the social past with the biological present, providing a culturally relevant way of understanding the various intergenerational effects of historical trauma. In this paper, we critically examine the strategic uptake of environmental epigenetics by Indigenous researchers and policy advocates. We focus on the relationship between epigenetic processes and Indigenous views of Country and health—views that locate health not in individual bodies but within relational contexts of Indigenous ontologies that embody interconnected environments of kin/animals/matter/bodies across time and space. This drawing together of Indigenous experience and epigenetic knowledge has strengthened calls for action including state-supported calls for financial reparations. We examine the consequences of this reimagining of disease responsibility in the context of “strategic biological essentialism,” a distinct form of biopolitics that, in this case, incorporates environmental determinism. We conclude that the shaping of the right to protection from biosocial injury is potentially empowering but also has the capacity to conceal forms of governance through claimants’ identification as “damaged,” thus furthering State justification of biopolitical intervention in Indigenous lives.

Issue addressed Australian policymakers have acknowledged that implementing obesity prevention regulations is likely to be facilitated or hindered by public opinion. Accordingly, we investigated public views about possible regulations. Methods Cross-sectional survey of 2732 persons, designed to be representative of South Australians aged 15 years and over. Questions examined views about four obesity prevention regulations (mandatory front-of-pack nutrition labelling for packaged foods; zoning restrictions to prohibit fast food outlets near schools; taxes on unhealthy high fat foods; and taxes on sugar-sweetened beverages). Levels of support (Likert scale) for each intervention and reasons for support/opposition were ascertained. Results Views about the regulations were mixed: support was highest for mandatory nutrition labelling (90%) and lowest for taxes (40%-42%). High levels of support for labelling were generally underpinned by a belief that this regulation would educate "Other" people about nutrition. Lower levels of support for zoning restrictions and taxes were associated with concerns about government overreach and the questionable effectiveness of these regulations in changing behaviours. Levels of support for each regulation, and reasons for support or opposition, differed by gender and socio-economic status. Conclusion Socio-demographic differences in support appeared to reflect gendered responsibilities for food provision and concerns about the material constraints of socio-economic deprivation. Engagement with target populations may offer insights to optimise the acceptability of regulations and minimise unintended social consequences. SO WHAT?: Resistance to regulations amongst socio-economically disadvantaged target populations warrants attention from public health advocates. Failure to accommodate concerns identified may further marginalise these groups.

While there is increasing interest in gender and sex issues in the medical field, most research in medicine can still be defined as operating with a binary of sex/gender. Epigenetics presents a mar...

This article explores how desire operates in the daily lives of women with disordered eating. Based on qualitative findings from a South Australian study investigating why women with disordered eating are reluctant to seek help, we trace the multiple “tipping points” and triggers that are central to participants’ everyday experiences. Employing anthropological interpretations of desire, we argue that triggers are circulations of productive desire, informed by cultural values and social relations, and embodied in routine daily acts. We examine the cultural-work of desire and the ways in which gendered relationships with food, eating and bodies trigger desires, creating a constant back and forth movement propelling participants in multiple directions. In conclusion, we suggest that a socio-cultural approach to desire in disordered eating has clinical implications, as cultural configurations of desire may help to understand ambivalence towards relapse and recovery.

By foregrounding positive and productive capacities of fat, we explore experiences of expanding, maintaining, or diminishing body sizes to accommodate the different meanings and enactments of fat. Drawing on fieldwork conducted in a South Australian community that has experienced significant socioeconomic disadvantage, we detail how the "problem" of fat in public health discourse is countered in the lived experience of people targeted for obesity intervention. In so doing, we attend to the multiple meanings and practices of fat that differ to the focus within public health interventions on the negative health consequences of overweight and obesity.

Some Indigenous Australians have embraced developmental origins of health and disease (DOHaD) and epigenetic discourses to highlight the legacies of slow violence in a settler colonial context. Despite important differences between Indigenous and scientific knowledges, some Indigenous scholars are positioning DOHaD and epigenetics as a resource to benefit their communities. This article argues that time plays a crucial role of brokering disparate knowledge spaces in Indigenous discourses of postgenomics, with both Indigenous cosmological frames and DOHaD/epigenetics centring a circular temporal model. Drawing on interview data with scientists who work in Indigenous health, and broader ethnographic work in Indigenous Australian contexts where epigenetics is deployed, this article explores how different circularities of space and time become entangled to co-produce narratives of historical trauma. We use the concept of biocircularity to understand the complex ways that Indigenous and postgenomic temporalities are separated and connected, circling each other to produce a postcolonial articulation of postgenomics as a model of collective embodiment and distributed responsibility.

There is wealth of evidence that points to the pernicious ways in which inequities in food, bodies, and health are disproportionally borne. Equally, there is a wealth of evidence that critiques the role of neoliberal imperatives for individuals to take responsibility for their health, and how this tenet reproduces inequity. However, health interventions and public policy remain immune to addressing social determinants of health and ignore the cultural dynamics of power in food systems, interventions, and policy. Drawing from ethnographic research in an Australian community that has high levels of socioeconomic disadvantage and obesity, and the Australian Government’s response to the ‘obesity epidemic’, this article examines the processes and tactics of depoliticization that are used to elide political and sociocultural phenomenon. I leverage the work of Brown and Povinelli to argue that liberalism’s hold on universalisms, autonomy, and individual liberty in obesity discourses subjugates a comprehension of political relations, positioning liberal principles and culture as mutually antagonistic. It is precisely this acultural positioning of liberalism that makes it possible to remove recognition of the power that produces and contours the ‘metabolic rift’ between food systems, public health, and equity priorities. In conclusion, I consider how obesity policy might be different if we paid attention to this culturalization of politics.

BACKGROUND Scholarship across the humanities and social and life sciences has documented a wide variety of historical, sociocultural and medical attitudes to large bodies, including both positive and negative associations. Obesity has never been a stable or unified category. OBJECTIVE The aim of this article is to provide an overview of the historical trajectory of obesity as a disease in a Western context. DISCUSSION Discussions about whether obesity should be classified as a disease have been ongoing. Many scholars regard the early Greeks as the first to identify obesity as a disease, and trace changing manifestations of obesity from Classical times through the Middle Ages and Age of Enlightenment to contemporary times. This trajectory of obesity as a disease is contentious, and in light of recent moves to attribute disease status to obesity in Australia, this article outlines the politics and value of classifying obesity as a disease.

Children have been made a priority in Australian government obesity interventions, with programmes tending to focus on promoting behaviour change in food and exercise practices. This paper reports findings from ethnographic research with a group of Australian children aged 10–14 years living in a low socio-economic suburban setting. We propose that central to these children’s experiences of food and eating is the negotiation and management of hunger. Historically, disadvantage has been embodied and inscribed on children’s bodies in very visible ways, and the coexistence of hunger and obesity is part of this continuum. Despite considerable evidence of food insecurity in our research site, issues of hunger were absent in an obesity intervention underway at the time. We examine how hunger was felt in children’s lives, how it was managed and the ways in which messages about eating less, while eating more ‘healthy foods’, were at odds with the children’s experiences of hunger. Moreover, we argue that h...

With the rise of ‘globesity’, fat activism and Fat Studies have become political players in countering negative stereotypes and the devaluation of fat bodies. Both groups are diverse, yet share a common goal to celebrate and/or accept fatness, and challenge practices and discourses that reinforce ‘normal’ bodies (such as diets, ‘fat talk’ and medicalisation). In this article, we reflect on our engagement with a Fat Studies conference, and critically interrogate the assumptions that underlie this particular space. It is not surprising that fat activists and Fat Studies scholars bring different ideologies to the table, yet the differences between them have not been adequately scrutinised or theorised. Drawing upon Linda Alcoff’s feminist philosophy, we examine how identity politics and intersectional perspectives are both used in fat activism, yet have the effect of creating unresolved tensions between singular and multiple embodied identities. We argue that an identity politics approach (exemplified through embodied visibility and declarations of ‘thin privilege’) has the potential to create boundaries for policing and exclusion, and is thus at odds with the much broader axes identified by intersectorial approaches. Rather than dismiss the power of identity politics, we argue for a careful reframing of the relationship between identity politics and intersectionality in fat activism and Fat Studies. We suggest that unexamined contradictions that arise from this mismatch may be counterproductive to the important subversive aims of the movement.

What are the symbolic meanings of breakfast in the context of one of Australia’s largest childhood obesity intervention programs? Utilizing a range of theoretical insights into the morality of food and eating and the anthropology of food, we trace how breakfast is packaged and promoted to families in an Australian community as a ‘healthy start’ to the day. Through ethnographic and historic investigation, we argue that eating breakfast and certain types of breakfast foods are symbolic of a classed, healthy lifestyle pattern, embodying parental knowledge and bodily regulation to routinely structure daily life. In communities where poverty and unemployment are harsh realities, well-intentioned programs that encourage people to eat a healthy breakfast are encoded with an assemblage of moral values—of knowledge, foods, families, and times and spaces—that are often difficult to reconcile with the wider sociocultural context in which many people live.

Bourdieu suggested that the habitus contains the ‘genetic information’ which both allows and disposes successive generations to reproduce the world they inherit from their parents’ generation. While his writings on habitus are concerned with embodied dispositions, biological processes are not a feature of the practical reason of habitus. Recent critiques of the separate worlds of biology and culture, and the rise in epigenetics, provide new opportunities for expanding theoretical concepts like habitus. Using obesity science as a case study we attempt to conceptualise the enfolding of biological and social processes (via a Deleuzian metaphor) to develop a concept of biohabitus – reconfiguring how social and biological environments interact across the life course, and may be transmitted and transformed intergenerationally. In conclusion we suggest that the enfolding and reproduction of social life that Bourdieu articulated as habitus is a useful theoretical frame that can be enhanced to critically develop epigenetic understandings of obesity, and vice versa.

The potential for regulatory measures to address escalating rates of obesity is widely acknowledged in public health circles. Many advocates support regulations for their potential to reduce health inequalities, in light of the well-documented social gradient in obesity. This paper examines how different social groups understand the role of regulations and other public health interventions in addressing obesity. Drawing upon focus group data from a metropolitan city in southern Australia, we argue that implementing obesity regulations without attention to the ways in which disadvantaged communities problematise obesity may lead to further stigmatisation of this key target population. Tuana's work on the politics of ignorance, and broader literature on classed asymmetries of power, provides a theoretical framework to demonstrate how middle class understandings of obesity align with dominant 'obesity epidemic' discourses. These position obese people as lacking knowledge; underpinning support for food labelling and mandatory nutrition education for welfare recipients as well as food taxes. In contrast, disadvantaged groups emphasised the potential for a different set of interventions to improve material circumstances that constrain their ability to act upon existing health promotion messages, while also describing priorities of everyday living that are not oriented to improving health status. Findings demonstrate how ignorance is produced as an explanation for obesity, widely replicated in political settings and mainstream public health agendas. This politics of ignorance and its logical reparation serve to reproduce power relations in which particular groups are constructed as lacking capacity to act on knowledge, whilst maintaining others in privileged positions of knowing.

This chapter explores the ways in which obesity is put forward as a medical (and moral) discourse, a problem caused by overeating and not enough exercise. Within the epidemiological field, there is clear evidence of the social gradient in obesity, and the relationship between inequality and obesity is key to the book’s analysis. Despite the dominance of medical interpretations of obesity, different people have differing perspectives on fatness, and not everyone agrees that being overweight or fat is unhealthy. Moving beyond the well-developed social constructionist critiques of obesity, this chapter positions the arguments for the book in practice theories (Mol, The body multiple: Ontology in medical practice. Durham: Duke University Press, 2002), discerning coexisting patterns of fatness.

This chapter examines the ideological underpinnings of the OPAL program, focusing on how the deficit model of knowledge (not-knowing) was at the heart of the social marketing and delivery of education, particularly around nutrition. Drawing from the anthropology of ignorance (Sanabria, Cultural Anthropology 31(1), 131–158, 2016), “nutritional black boxing” (Yates-Doerr, The weight of obesity: Hunger and global health in postwar Guatemala. Oakland: University of California Press, 2015), and the construction of obesity as a form of romantic complexity (Kwa, Romantic and baroque conceptions of complex wholes in the sciences. In J. Law & A. Mol (Eds.), Complexities: Social studies of knowledge practices (pp. 23–52). Durham: Duke University Press, 2002; Ulijaszek, BioSocieties 10(2), 213–228, 2015), this chapter demonstrates how interventions rely on established idioms and ways of thinking and drift back to individual behaviors.

In the OPAL program sugar was an item that had to be reduced in everyday consumption, as it damaged bodies and was “empty calories.” For many participants, however, sugar was a small pleasure, a “pick-me-up” and a way of demonstrating care for oneself and for others. Families reclaimed the meanings of sugar beyond a nutritionist discourse of dietary sugar, using sweetness and sugar as a practice of care. When food is one of the few pleasures that people have, being told not to eat it resulted in forms of resistance and resentment. Sugar, Warin and Zivkovic argue, may be empty calories, but it is not an empty category.

Many cross-cultural and historical studies point to the value of fat bodies, where size is associated with status and capacity to be a productive member of society. In Western contexts, fatness is a negative term, and its excess is constructed as lack of care, laziness, and poor choices. This chapter examines the socio-materiality of bodies and practices, how people experienced, enacted, and embodied fat as positive, productive, and disabling in their day-to-day lives.