The Imperatives of Health and Weight in Primary Care Clinics: Current and Envisioned Practices
MetadataShow full item record
AbstractBiopower imperatives about body weight, eating, and exercise are embedded in primary care practice. The dominant discourses about body weight frame the body as notably malleable, a direct reflection of eating and exercise behaviours, to the exclusion of other influences. In this dissertation, I aim to open dialogue on the question of how to care well for patients in a time when talking about weight, eating, and exercise is both expected and potentially stigmatizing and/or contributing to health disparities. I observed primary care appointments in three Alberta clinics, and a Canadian Obesity Network 5As of Obesity Management™ continuing professional development workshop. I interviewed the observed primary care clinicians, and key informants in the Canadian Obesity Network. Using analytic insights from discourse analysis, actor-network theory, and visual studies, I analysed both clinical practice and the workshop through the theoretical lenses of governmentality and Mol's logics of choice and care. In the clinic, weight-related talk elicited face-saving and confessional talk from most patients (that is, across body sizes), an indication of the strength of dominant discourses that assume malleability of bodies and behaviours, interpret fatness as failure, and reinforce individual responsibility for health. Clinicians’ responses to patients’ face-saving talk, and the ways in which clinicians used epidemiological knowledge to guide action varied. In the continuing professional development workshop, the Network’s vision moved obesity management closer to the logic of care, in part translating some obesities into a chronic disease frame through the folding in of a physiological theory to re-interpret epidemiological studies and clinical trials. This dissertation adds to conversations about anti-fat stigma and discrimination in health care, making visible some modes by which patients, clinicians, and knowledge brokers use and/or attempt to disrupt individualistic, blame-oriented discourses about fatness. The dissertation foregrounds a range of potential mediators that may influence translation of less-stigmatizing clinical practices into primary care clinics.
CitationThille, P. (2015). The Imperatives of Health and Weight in Primary Care Clinics: Current and Envisioned Practices (Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/28199
University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.