A recent article that we wrote raises a number of important questions about obesity. Why do policy attempts to control obesity fail? Why do scientists ask the wrong questions about obesity? Why does searching for single causes of the so-called obesity epidemic end in disappointment? Why has the response to the observed association between obesity and mortality from COVID-19 been so feeble?
The answer is that the general public, politicians, governments, NGOs, vested interest of all kinds (including those with diametrically opposed accounts of the issue), public health specialists, and academics, are locked into a way of seeing obesity which is the wrong way round. They inhabit the same epistemic space that sees obesity as determined by either individual behaviour or by an obesogenic environment. Both are causal accounts, which are linear, unidirectional and highly partial. But there is another, sociological, way to see obesity.
People through their actions, or societies through their social forces, do not determine how people live their lives. Humanity and its shape, including its body shape, is relational; it’s about relationships between people – to be human is to relate to other humans and the external physical and social environment in various ways. Human sociation takes place in concert with others; it is only possible along with others, from the simplest dyad, to complex communities and institutions. There are continuous interactions between the things people do, and the world around them. Interaction here is the key. Individuals and society are indivisible. People make society by what they do and society is in them, as they do what they do. The continuous interaction occurs in the here and now, but is a process in which the practices all of human sociation, are the products of their history. Practices are not just what people do now, it’s what people have always done and these practices are transmitted from generation to generation, changing and evolving as they do go. In this view of things, the idea that one single factor is the driving force of one other single factor or outcome – is untenable.
Human biology is not determined by the social world, it interacts with it, as well as the physical environment, in multitudes of ways. Average and individual body shape and size, is a property of these interactions. To imagine something called an obesogenic society exerting its malign influence, as if it were a knowledgeable agent acting on hapless humans, is to deny the very humanity of the species. It is to simplify and reify the issue in way that is as useless in policy terms as are all the admonitions about diet and exercise.
Obesity is a feature of the intersection of multiple practices of governments, politics, power, industry, institutions, and is a product of the history of practices across time – not just today or the last few years. To understand obesity in all its multi-layered complexity, we need to understand these histories. Of course, mostly this is not the way the problem is framed, medically or in policy terms. It is seen as a consequence of what individual people do, how much they eat and drink, how much or how little exercise they do. Or it is seen as an outcome of the social factors which compel or determine these activities in various ways.
Eating and moving around are only two of the historical practices of relevance here. And not necessarily the most important for everybody. Various efforts to manage, control, and reverse obesity, which stick to narrow causal pathways of isolated activities will never deliver for the population as a whole. The two practices, eating and activity, cannot be separated in reality from all the myriad of other interlocking and interacting practices that make up the contemporary world and its history. The array of other practices include, but are not limited to, fashion, style, bodily deportment, military and industrial activity, food production, farming, transport, shopping, distribution chains, work, leisure, education, taxation, trade and commerce, and technologies of movement, communication and knowledge exchange.
The ideas about reversible risk and the consequences of a calorie-rich energy-dense environment are not wrong, but they are only a partial way of seeing the problem. The body, our body, is a product of the interaction between our biography, our biology (including our inherited biology), our social, economic and political history (including such things as imperialism and colonialism), wars, and the lives we live together with other people in communities of activities. Our body, in this sense, is an emergent property of these interactions, many of which are quite beyond the power of the individual or the governments to do anything about. The body is social and bears multiple traces of the world in which we live, and our forebears and generations before us have lived.
Policies, interventions, admonitions to eat less and exercise more, are practices themselves. They intersect and interact with other practices and like these other practices, are changed in that interaction; they evolve. That is why trying to predict accurately the outcome of a specific policy intervention is usually a forlorn hope. The best prediction we can usually make, is that there will be unintended consequences. Policy, if it seriously wants to get to grips with the excess deaths and medical problems which arise from the way people’s bodies are changing in the contemporary era, must stop using heuristics –in this case the idea that there is a simple answer to this complex phenomena. It must stop being the victim of the cognitive bias of thinking there are simple cause and effect deterministic relationships involved and of keep repeating the same old policies and interventions that have failed previously. It must instead embrace the complexity and begin to unravel the nature of the interactions and intersections within the complexity and working out those which are tractable and those which are not.
About the authors: Stanley Blue is a Senior Lecturer in Sociology at the University of Lancashire, with an interest in the temporal organisation of social life matters for contemporary and future ways of living and consuming. He tweets from @stanleybluephd. Professor Mike Kelly is Honorary Senior Fellow in the Department of Public Health and Primary Care at the University of Cambridge, with research interests in the methods and philosophy of evidence-based medicine, prevention of CVD, health inequalities, health-related behaviour change, the causes of non-communicable disease, end of life care, dental public health and the sociology of chronic illness. Elizabeth Shove is a Professor of Sociology at the University of Lancashire, with an interest in practice theory.