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Social Implications of Weight Bias Internalisation: Parents' Ultimate Responsibility as Consent, Social Division and Resistance.

ABSTRACT: Responsibility is a moral quality of caring that is central to child health policies. In contemporary United Kingdom these policies are based on behavioural psychology and underpinned by individualism, an ideology central to neoliberal governance. Amid the complexities of "obesity" and inequalities, there is a multi-layered stigmatisation of parents as moral associates. Few studies consider the lived realities of food policy processes from the standpoint of class. This critical qualitative research draws on theorists who explain processes of power and class: Foucault, Gramsci, Bourdieu, and Marx. Its objectives are: (a) to understand the lived experience of parents as they interact with food policy; (b) to explore how parents resist stigmatisation; and (c) to reflect on implications for policy and practice. Methods:Using purposive sampling, 31 ethnographically informed interviews were carried out in a London borough, with policy actors: policymakers, implementers, and parents as policy recipients, including 12 working-class mothers. Results:A core theme of "responsibilities" emerged with four interconnecting sub-processes that provide insight into how stigmatisation and resistance evolve through policy. Discussion:As have others, this study reveals the idea of responsibility as fundamental to the processes of soft power. Child health is a priority for participants and a "ruling idea." The diffusion of responsibility throughout policy leads to confusion about where it lies. New subjectivities are formed in line with ideas of governmentality. Parents engage with policy at multiple sites that elicit symbolic violence, and stigma sows social divisions. Against this background, working-class parents are left in a state of cognitive dissonance between being made responsible (responsibilisation), and feeling responsible (self-blaming) for their children's weight while lacking the material resources to provide an optimal nutritious diet. Resistance is interwoven and is essentially found in parents' policy alternatives that diverge from United Kingdom government policy. Conclusion:Critical qualitative research using multiple theorists is valuable in understanding how parents interact with policy in a complex social world. With United Kingdom policy failing, useful insights are provided into how involving parents in policymaking might determine a meaningful collective responsibility, with a political ethic of care and unity between parents that would advance health equity.

SUBMITTER: Noonan-Gunning S

PROVIDER: S-EPMC6881380 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Social Implications of Weight Bias Internalisation: Parents' Ultimate Responsibility as Consent, Social Division and Resistance.

Noonan-Gunning Sharon S

Frontiers in psychology 20191121

Responsibility is a moral quality of caring that is central to child health policies. In contemporary United Kingdom these policies are based on behavioural psychology and underpinned by individualism, an ideology central to neoliberal governance. Amid the complexities of "obesity" and inequalities, there is a multi-layered stigmatisation of parents as moral associates. Few studies consider the lived realities of food policy processes from the standpoint of class. This critical qualitative resea ...[more]

PMID: 31824361

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Project description:BackgroundWhilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample.MethodsParticipants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation.ResultsUsing regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R2 = 13%) were gender (β = -0.24, p < .001), and personal exposure in terms of normalisation beliefs that thinner body types are more attractive (β = -0.13, p = .001). The strongest predictors of WBI (adj R2 = 6%) were attractiveness normalisation (β = -0.23, p < 0.001) and participants' perceived body shape (β = -0.27, p < 0.001). Population exposure did not predict either weight bias or WBI.ConclusionsPersonal exposure is more important than population exposure in predicting both weight bias and WBI. Findings hold implications for improving the wellbeing and lived experiences of those living with overweight and obesity.

Project description:Clinical trials are the hallmark of evidence-based medicine, but recruitment is often challenging, especially in stroke trials investigating patients not being able to give informed consent. In some nations, ethics committees will not approve of inclusion in a clinical study via consent of a legal representative. The ethical dilemma of including or excluding those patients has not been properly addressed, as there is little data on the effect of stroke characteristics on the ability to give informed consent.To examine differences between patients able and unable to consent at inclusion to an acute stroke trial, we conducted a post-hoc analysis of monitoring records from a multicentric interventional trial. These records listed patients who gave informed consent by themselves and those who needed a legal representative to do so. This exemplary STRAWINSKI trial aimed at improving stroke outcome by biomarker-guided antibiotic treatment of stroke associated pneumonia and included patients within 40 h after stroke onset, suffering from MCA infarctions with an NIHSS score?>?9 at admission. Standard descriptive and associative statistics were calculated to compare baseline characteristics and outcome measures between patients who were able to consent and those who were not.We identified the person giving consent in 228 out of 229 subjects. Patients with inability to consent were older (p?<?0.01), suffered from more left-hemispheric (p?<?0.01) and more severe strokes (NIHSS, p?<?0.01), were more likely to die during hospitalisation (p?<?0.01) or have unfavourable outcome at discharge (mRS, p?<?0.01), to develop fever (p?<?0.01) and tended to be more susceptible to infections (p?=?0.06) during the acute course of the disorder.Demographics, stroke characteristics and outcomes significantly affect stroke patients in their ability to consent. Where selection criteria and primary outcome measures of a trial are significantly affected by ability to consent, excluding patients unable to consent might be unethical.URL http://www.clinicaltrials.gov . Unique identifier: NCT01264549 .

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Social Implications of Weight Bias Internalisation: Parents' Ultimate Responsibility as Consent, Social Division and Resistance.

Publications

Social Implications of Weight Bias Internalisation: Parents' Ultimate Responsibility as Consent, Social Division and Resistance.

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