Facing the Challenges of Female Obesity During Midlife: Social Inequality, Weight Control, and Stigma in Clinically Overweight and Obese Women

Abstract

The increasing burden of chronic disease in ageing populations has shifted focus towards illness prevention and the self-management of health. Middle-aged and menopausal women’s transitioning bodies, specifically with respect to weight gain and changes in body fat composition, have received much attention by public health officials during the alleged obesity epidemic. In addition to these transformations, socioeconomic status has been shown to interact with obesity by decreasing the psychosocial health of vulnerable women. Although public health actions have targeted the health practices of clinically obese women throughout the menopausal transition, their effectiveness is limited because of existing socioeconomic inequalities, narrow focus on body weight interventions, and the psychosocial impact of an obesity stigma. Drawing on Bourdieu’s sociocultural theory of practice, and namely his concepts of body habitus and symbolic violence, this study aims: (a) to identify the norms and values of clinically overweight and obese postmenopausal women from contrasting socioeconomic backgrounds with regard to the ways they treat and care for their body, and (b) to outline the socio-cultural processes which incline them (or not) to pursue weight-loss strategies. Forty semi-structured interviews were conducted with clinically overweight and obese postmenopausal women from underprivileged (n=20) and middle class (n=20) milieus in the city of Sherbrooke, Québec. An intersectional (gender, age, socioeconomic status) thematic analysis was employed in order to analyze the data and identify emergent themes within and between both socioeconomic groups. This thesis is composed of two distinct studies. The first identifies the diverse contexts of occurrence of obesity stigma and weight shaming, as well as the contrasting responses between the two socioeconomic groups. Although all participants experienced obesity stigma, participants from lower social positions were more vulnerable to the psychosocial impact of dominant obesity discourses. In contrast, a higher access to social, economic, and educational resources provided middle-class women with more protection from weight shaming and discrimination. In the second article, from a public health perspective, the analysis of hierarchies of priorities, perception of control, as well as barriers and facilitators show that weight management needs to be understood as the outcome of a social process in which living conditions, material and psychosocial, offer a number of conditions of possibilities. Globally speaking, middle-class conditions privileged the adherence to public health recommendations, while socially deprived conditions inclined women to adopt unsustainable and risk-oriented weight-loss practices.