Overweight and obesity as cultural signifiers for type 2 diabetes mellitus & its consequences

Transcription

1 Overweight and obesity as cultural signifiers for type 2 diabetes mellitus & its consequences Darlene McNaughton Ph.D Anthropologist darlene.mcnaughton@flinders.edu.au

2 Vignette I m not fat, I ve never been fat, how can I have bloody diabetes? Life amongst the entomologists

3 T2DM has a very complex etiology, there are MANY risk factors Ageing, Previous gestational diabetes, Genetics, family history T2DM Poverty, inadequate nutrition etc. The interplay of these is not entirely clear *1 parent with T2DM increases risk 40% *2 parents with T2DM increases risk 70%

4 People from a broad range of weights can get T2DM T2DM: sometimes more prevalent among those considered obese, however, people from a broad range of weights (including those considered healthy ) can & do develop T2DM, for example: Large national Australian study estimated 44% of participants with impaired glucose were obese, 56% were not (Dunstan et al. 2001, 1 AUSDIAB). Weight gain common symptom of the onset of T2DM (increased hunger, as well as thirst & urination)

5 Many reasons why T2DM prevalence appears to be increasing. In Australia prevalence increased from 1.3% to 3.9% (AIHW 2012) Including: ageing pop.(disease of ageing) increased life expectancy rising community awareness improved detection and survival greater surveillance improved access to health care services

6 So where did this idea, that weight drives, causes and is symbolic of type 2 diabetes come from?

7 Our current concern with overweight with obesity and a purported obesity epidemic were first ignited in the mid 1990s (Saguy and Riley) Exponential increase in coverage, fear and concern (LeBesco)

8 Other blazes have been ignited Assertions that we are in the midst of a type 2 diabetes mellitus (T2DM) epidemic AND That this has been generated by the alleged obesity epidemic double or dual epidemics Obesity driven Diabetes epidemic, Diabesity epidemic?

9 Several studies. Examined Media, Health Research, Popular Discourse from years before (WHO Obesity Report 1998) Australia, Canada, UK

10 The rise in diabetes was framed consistently as being driven by the obesity epidemic Framed in terms of fear, identifying the threat, a public health disaster, economic impact. By early 2002 a diabetes epidemic driven by the obesity epidemic was eminent and would rival the HIV-AIDS epidemic (Australian Advertiser, 2002).

11 Since the late 1990s the idea that overweight or obesity are the most important risk factors and/or central causes of T2DM has become increasingly prevalent and naturalised across these mediums in all three countries.

12 Weight & diabetes were consistently, increasingly conflated over time - most obvious idea diabesity. Over time, weight has transitioned from a symptom of T2DM, to a potential risk factor, to a cause, for some the most important cause of T2DM

13 Like OW and OB, diabetes was invariably depicted as self-inflicted, the result of entirely changeable, risky behaviours and unhealthy lifestyles that are irresponsible and antithetical to a long, healthy life. Over emphasis on lifestyle. Often ignoring or rendering invisible other factors, including SDoH, genetics and those beyond individual control.

14 The larger than average body has become a powerful cultural signifier for diabetes, (or the diabetic body to come) (beyond earlier work risky, abject, unhealthy body) turns a symptom (weight gain) into a cause greatly oversimplifies the complexity of the disease and its etiology...overstates gaps in knoweldge

15 Theory Identified a pervasive cultural and medical discourse that conflates obesity and diabetes

16 The aim of this work is to deconstruct and displace the foundations of our knowledge about T2DM in order to expose its assumptions, conflations, moralising tendencies and consequences unintended and intended.

17 How is this framing is being taken up un(?)intended consequences Medical Encounter (C. Smith) Weight as cause of diabetes - conflation Overemphasis weight/loss (LS) Little no mention other factors, WL -> Reverse diabetes Weight Bias PO, good and bad Shame, Failure, Avoidance, Manip. Results Dread, Avoid Insulin (weight gain) Trisha said: I tell people they re lucky to get diabetes as their life will be healthier that it was in the past

18 Bell, K., Salmon, A. & McNaughton, D. (2011) Alcohol, tobacco, obesity and the new public health. Special double thema?c issue of CriCcal Public Health, 21(1,2). References McNaughton, D (2013) Diabesity Down Under: Overweight and obesity as cultural signifiers for Type 2 Diabetes Mellitus, Critical Public Health. 23:3, , DOI: / McNaughton, D (2013) Diabesity and the stigmatizing of lifestyle in Australia. In J. Hardin & M. McCullough (eds), Reconstructing Obesity: The Meaning of Measures and the Measure of Meaning. Berghahn: USA. McNaughton, D and Smith C (2014) Diabesity (Dieobesity?) or the twin epidemics : reflections on the iatrogenic consequences of stigmatising lifestyle to reduce the incidence of diabetes mellitus in Canada, in McPhail, D Mitchinson, W and J Ellison (eds) Obesity in Canada: Historical and Critical Perspectives, University of Toronto Press. Smith, C, McNaughton, D. and S Meyer (2015) Client perceptions of group education in the management of type 2 diabetes in South Australia Australian Journal of Primary Health. McNaughton, D and Quinn E (forthcoming) The conflation of diabetes and weight in the British Media Bell, K., Salmon, A. & McNaughton, D. (2011) Alcohol, tobacco, obesity and the new public health. Special double thematic issue of Critical Public Health, 21(1,2).