A Growing Risk: Clinical, Epidemiologic, and Subjective Ambiguity in the Relationship between Weight and Health

Abstract

This dissertation examines the complex and often uncertain relationship between body weight and health in a highly weight-conscious society like the United States, using a mixed methods approach to study three key domains in which this ambiguity is evident. The first chapter draws on interviews with clinicians to examine the tension between medical definitions of healthy weight used by practitioners, the metrics of success they seek to promote among patients, and the broader messaging about weight and health in the culture at-large. Notably, practitioners often avoid “diagnosing” childhood obesity and poor health in favor of emphasizing a more optimistic “prognosis” emphasizing children’s and families’ success in developing healthy beliefs and behaviors that engender long-term success. The second chapter questions the assumption of homogeneously poor health among adults with obesity by examining the clustering of body size and other measures of health in a large nationally-representative data set. Medical research often frames “healthy” and “unhealthy” obesity as a function of random biological differences in the population; conversely, my work shows that these phenotypes are socially-patterned on the basis of individuals’ socioeconomic status, helping to explain group differences in mortality. Finally, the third chapter examines the consequences of individuals’ perceptions of their weight over the life course. Social and cultural stereotypes about individuals on the basis of their weight suggest that negative perceptions of one’s weight can be psychosocially damaging, leading to many of the harmful outcomes that we associate with body weight. This study demonstrates that objective and subjective weight status influence each other over time, such that both impact health in adulthood. Critically, these analyses underscore the consequences of weight-related stigma as source of poor health that is attributable to social norms about what constitutes a “healthy” and “normal” body. In sum, this dissertation advances a more comprehensive approach to the study of and messaging about body weight and health, inclusive of a broader and more nuanced set of physiological and psychosocial explanations.Doctor of Philosoph