Area (2006) 38.

3, 259–267

‘Gluttony or sloth’: critical geographies of bodies

Blackwell Publishing Ltd

and morality in (anti)obesity policy

Bethan Evans
Department of Geography, University of Liverpool, Liverpool L69 7ZT
Email: b.evans@liv.ac.uk

Revised manuscript received 28 February 2006

In many countries, obesity is high on public health policy agendas, and geographical
research has begun to engage with obesity. However, obesity is a highly contested term,
and recent debates about geographers’ engagement with policy, and critical discussions
of the presence of bodies in medical geography, bear great relevance for developing a
critical perspective on dominant ‘obesity discourse’. Through a critical reading of a
recent UK policy document, this paper considers the presence of bodies in (anti)obesity
campaigns, calling for a more critical approach to the medicalization of body size to be
central to future geographical work on obesity.

Key words: United Kingdom, critical geography, obesity, policy, bodies, medical geography

medical geography] on individuals’ complex experi-

Introduction
Health is never simply ‘health’; instead it can easily
become a means of moralising of normalising and of
regulating. (Parr 2002, 373)
In recent years, there has been a move in geographical
research concerning health to take a more ‘critical’
perspective on issues of public health (Cummins
and Milligan 2000; Brown and Duncan 2002; Parr
2002 2003 2004). Driven in part by (feminist) critiques
of the way in which bodies were present (or absent)
from previous work in medical geography, much of
this involves critically evaluating the definition of
‘health’ and ‘illness’ and the use of such terms in
medical discourse (Dorn and Laws 1994; Hall 2000;
Parr 2002 2003 2004). Central to such critiques is
the deconstruction of the dualistic way in which mind
and body are conceptualized in Western medicine
and positivist research – viewing bodies in a
mechanical way as sites or containers which can be
defined as either healthy or unhealthy and through
quantification counted and mapped (Parr 2002).
A more holistic definition of health has allowed for
a consideration of bodies as more than simply ‘healthy’
or ‘unhealthy’, resulting in a ‘new emphasis [within
ences of health and impairment and the associated
politics of identity’ (Hall 2000, 21). Much of this
work has involved exploring medical geography’s
‘productive intersections with social and cultural
geography, as well as with wider social theory and
a critical medical sociology’ (Parr 2002, 241) in
understanding the complex relationships between
biological, social and cultural factors in shaping
people’s embodied experiences of health, illness
and impairment (Hall 2000), and in understanding
bodies as ‘more than dots on maps’ (Parr 2002, 243).
With the current panic surrounding obesity in
many Western countries, (medical) geography is
seeing a burgeoning interest in obesity and ‘healthy
lifestyles’ (Wrigley 2002; Cunningham 2003; Sui
2003). However, obesity is a highly contested term
and it is vitally important to consider critically the
ways in which geography engages with obesity
(Evans 2004), and how particular readings of bodies
(re)produce ideas about (im)morality. The aim of this
paper therefore is to discuss the potential to think
critically and reflexively about what has been termed
the ‘global obesity epidemic’ made possible by recent
debates in geography, thus providing a perspective
on obesity which ‘de-centres’ the medical.

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260 Evans
The quote in the title of this paper, ‘Gluttony or
sloth’, is taken from the most recent House of
Commons Health Select Committee1 Report on Obesity
(HOC 2004, 23). This report is the product of an
enquiry launched in 2003, reported to be the most
comprehensive inquiry undertaken by the health
select committee.2 The scope of the inquiry was to
consider the trends, health implications and possible
solutions of obesity in the UK; to evaluate current
and possible future institutional structures instru-
mental in understanding obesity trends/management
(e.g. the health service, education, food standards
agency, etc.); and to suggest policy strategies at
both local and national3 scales. The report itself,
and related press release and media reports were,
and are, instrumental in shaping discourse, practice
and dominant knowledge(s) about obesity in both
policy and popular media contexts in the UK. This
influence was evident even before publication, the
report itself stating that ‘this inquiry has contributed
to the huge publicity that the subject of obesity has
prompted over the last year or two’ (HOC 2004, 104).
Recognizing the power of such texts in constructing
and reproducing understandings of health and illness
(Evans et al. 2003) is therefore of great importance,
and this paper utilizes a discourse analysis approach
to develop a critical reading of the HOC report;
reading for and highlighting the points at which
it draws on and reproduces particular moralities
regarding (fat) bodies; such as the notion of sin
implicated in using the terms ‘Gluttony’ and ‘Sloth’.
This paper therefore is not concerned with directly
questioning the ‘validity’ or ‘reliability’ of claims
about obesity in the HOC report, but focuses on
the way in which obesity knowledge is discussed
with reference to the language used, recognizing
the power of language in the justification of policy
formation (Moon and Brown 2000). My approach is
therefore clearly rooted in poststructuralism, identified
by Longhurst (2005) as one of several theoretical
perspectives with the potential to contribute to
geographical work on fatness, by ‘unravelling’ the
‘discursive production of fat bodies’ (2005, 256).
However Longhurst (2005), drawing on Colls (2002),
warns of the potential for such poststructuralist
approaches to overlook the materiality and lived
experiences of (fat) bodies, and a recognition of this
is central throughout my analysis. My interpretations
of the discourse reproduced in the HOC report are
therefore grounded in thinking about the implications
that the language used, and the policies generated,
may have for individual’s experiences and under-
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standings of their embodied selves as fat, thin,
underweight, overweight, obese or ‘normal’.
The focus of this paper on the HOC report clearly
places it at the intersection between academic
geography and policy, something about which there
has recently been a growing debate within geography
(for example, Martin 2001 and subsequent debate
in Progress in Human Geography 26; Kearns and
Moon 2002; Cummings 2003; Parr 2004; Beaumont
et al. 2005). In medical geography, concerns have
been expressed that a less quantifiable reading of
health, illness and health inequalities may reduce
medical geography’s relevance to policy (Kearns and
Moon 2002). However, a central assertion of this
paper is that critical work which questions and con-
tests the categories used in biomedical science has
a clear and important role to play in medical geo-
graphy’s engagement with policy and debates around
inequalities in health and health care – highlighting
the processes by which some bodies are seen as
more equal than others (for example, the power
relations inherent in explanations of body size based
on generalized assumptions about the relationship
between class, ethnicity and obesity (Jutel 2005)).
There is a growing body of work which questions
dominant assumptions and highlights the complexity
inherent in biomedical knowledge on obesity, in
particular questioning the basis for links drawn
between particular measurements of the body and
physical and/or mental ill-health (for an overview,
see Gard and Wright 2005). Such work highlights the
uncertainties of biomedical knowledge, uncertainties
inherent as ‘while defining obesity is straightforward,
measuring it is not’ (Evans 2003, 89; Monaghan 2005).
These uncertainties are often simplified and lost in
policy and media representations of obesity know-
ledge (Evans 2003); and in addition to questioning
the certainty of ‘scientific’ knowledge on obesity,
understanding the context for the production, repro-
duction and circulation of knowledge about obesity
(and fatness in general) is central to the develop-
ment of such critical approaches. Here there is clear
scope for (medical) geography to contribute to the
‘obesity debate’, through recognizing that ‘bodies are
always situated in multiple psychoanalytic, discur-
sive and material spaces’ (Longhurst 2005, 249–50),
thus highlighting that ‘fat and fatness cannot be
decoupled from history, 4 geography and culture’
(2005, 250). Recognizing this, the present paper draws
on previous geographical work (Dorn and Laws 1994;
Browne and Barrett 2001; Parr 2003 2004) to illustrate
the ways in which obesity knowledge (as presented
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in the HOC report) is rooted in and reproduces
particular moral readings of (fat) bodies. The paper is
structured (in part) with reference to Dorn’s (1999)
work on morality and alcoholism in relation to the
intemperance movement in nineteenth-century America.
Similarities between this movement and the current
public health campaigns surrounding obesity in the
UK are important in understanding the ‘production
of deviance through practices (scientific, medical,
legal, etc.) of exclusion and signification, or rather
stigmatization’ (Dorn 1999, 46; emphasis in original).
Before entering into discussion of the HOC report,
it is important to note that the critique offered by
this paper is an attempt to broaden understandings
of, and dialogue about the (re)production of know-
ledge about obesity in geography, highlighting the
dangers in adopting an uncritical approach which
may contribute to and legitimize the stigmatization,
medicalization and labelling as deviant of some (fat)
bodies, spaces and places (Jutel 2005). As Mona-
ghan demonstrates, critiques of medical knowledge
on obesity are often positioned in a dichotomous
manner as oppositional, and as ‘taking sides’ in
‘quarrelsome “science wars”’ (2005, 303) and this is
not the aim of this paper:
It is not my intention here to argue that . . . [obesity]
is inherently dangerous or safe nor that those
positioned on either side of the debate are dupes or
possessors of false consciousness. Rather, my interest
is in the way that the debate itself constructs spaces
and bodies which clearly affect people’s perceptions
. . . [of] themselves. (Sharpe 1999, 94)
In discussing morality and medical knowledge of
obesity, I am therefore not questioning the morals or
intentions of those involved in producing or acting
on medical knowledge, rather, I am questioning how
ideas about ‘right’ and ‘wrong’, and the association
of guilt with some practices, are formed through,
and rooted in, the discourse surrounding medical
interpretations of obesity. Thus, in discussing ‘the
medical’ I am referring to specific (re)presentations
(arguably the most pervasive and widely read
representations) of bio-medical science through
policy documents (the HOC report) and the media
(Evans et al. 2004; Lawrence 2004), rather than
any generalized notion of a homogenous medical
knowledge. The following analysis and discussion of
the HOC report focuses specifically on the ways in
which medical and moral discourses relating to fatness
combine in the HOC report through discussions of
obesity using (often hyperbolic) language which
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‘Gluttony or sloth’ 261
implies certainty and inevitability about the ‘dangers’
of fat. The remainder of this paper is therefore split
into three sections: first considering the influence of
Cartesianism on obesity knowledge as presented in
the HOC report; secondly considering the represen-
tation of fat bodies as deviant, and finally concluding
through considering possible future directions for
critical geographical engagements with obesity.
The medical and the moral: placing
obesity knowledge in context
In 2002, Parr called for geographers to ‘not only
map the biomedical markings of bodies but also
question its [western scientific medicine’s] ability to
construct the body as a pure object of science’ (p.
243). Just as Dorn notes that
American doctors writing medical topographies
saw no need to differentiate their naturalistic medical
topographic observations from their deeply felt
personal visions of what American society should
become. (1999, 50)
reporting of obesity statistics often fail to recognize
the context of their production – in fact the opening
paragraph of the HOC report states that
the proportion of the population that is obese has
grown by almost 400% in the last 25 years. Around
two-thirds of the population are now overweight or
obese. (2004, 7)5
with no source or explanation of the production of
these data given. Beyond critiquing the basis for
individual statistics, central to understanding the
context for obesity knowledge is recognition of the
role of Cartesianism in Western medicine, whereby
‘bodies are nothing more than automatons, machines
acting as containers for the non-spatial mind’
(Patterson and Elliott 2002, 231). Viewing body and
mind as oppositional and separate means obesity,
as a disorder of the body, can be defined and
diagnosed mechanically: defined as an imbalance
between energy inputs and outputs (the HOC report
referring frequently to the ‘energy equation’); and
diagnosed using measurements of the body, most
commonly Body Mass Index (BMI).6 As a means to
easily account for and count bodies, BMI is used
in the majority of policy, media and academic
reporting on obesity despite being widely regarded as
a wholly inadequate measurement for obesity7 (Evans
et al. 2004; Gard and Wright 2005). Thus, any
262 Evans
uncertainties, ambiguities and conflicts of knowledge
inherent in the primary research field [bio-medical
science] are often obfuscated and very difficult to see
in the ‘obesity discourse’ once it enters the public
domain in the form of official reports, academic texts
[and policy]. (Evans 2003, 88)
This is especially apparent in the discussion of
correlations between obesity and morbidity and
mortality, whereby BMI is used not as a diagnostic
tool, but as a direct measure of health, assuming a
linear relationship between weight and health. Weight
therefore becomes a proxy for ill-health, whereby
there are two mutually exclusive possibilities: fat,
unfit and unhealthy or thin, fit and healthy. The
certainty with which such statistics are reported in
the HOC report is further enhanced by the
inevitability and sense of impending doom implied
through the hyperbolic language used in discussing
these data; for example, the HOC states that ‘with
quite astonishing rapidity, an epidemic of obesity
has swept over England’ (2004, 7) and
should the gloomier scenarios relating to obesity turn
out to be true, the sight of amputees will become
much more familiar in the streets of Britain. There
will be many more blind people . . . [and] this will be
the first generation where children die before their
parents as a consequence of childhood obesity.
(2004, 9)
This link between weight and health is justified with
reference to risk – the risk associated with higher
BMIs of developing diseases such as diabetes and
heart disease. Problems relating to both the use of
population-based correlations to imply individual
risk, and in using BMI to define obesity, make these
assumptions about links between weight and health
inherently problematic (Evans et al. 2004; Gard and
Wright 2005), not least because of the lack of
proven causality and the possibility that obesity may
be a symptom rather than a cause of these diseases8
(see, for example, Campos 2004; Gard and Wright
2005). Furthermore, a result of assuming that
obesity causes ‘associated’ diseases, combined with
the belief that obesity is a behavioural and hence
avoidable disease, may be to ‘blame the victim’
(Evans 2003) and the use of terms such as ‘normal’
and ‘overweight’ in classifying people’s bodies acts
to label fat people as deviant and hence stigmatizes
fat bodies. In fact the possibility that overweight
people may sometime no longer be considered
‘abnormal’ is presented by the HOC as a dangerous
consequence of rising obesity rates:
Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006
So rapid has been the rise in obesity that there is a
danger it will overtake the population to the extent
that what used to be considered ‘overweight’ starts to
become ‘normal’. (2004, 8)
The context for the acceptance of these oversim-
plifications is rooted in Cartesian readings of bodies
which allow the positioning of obese bodies ‘as
corrupt and flawed, requiring the liberatory interven-
tion of rationality acting through science and
technology’ (Patterson and Elliott 2002, 231). The
separation of mind and body in Cartesianism leads
to bodies being conceptualized as unruly, dangerous
and in need of control, an understanding of which
has been central in challenging the othering of
those not conforming to white, male, heterosexual,
able-bodied norms (see, for example, Rose 1993).
This is also central to challenging fat prejudice,
as placing importance on distancing oneself from
bodily functions and controlling bodily urges (Shilling
1993; Elias 2000) allows for fat or obese bodies to
be considered uncivilized. Public health’s increasing
focus on non-communicable diseases means
individuals’ control of, and responsibility for, their
bodies has increased in salience – health risks no
longer located outside the body (contamination
by germs) but located within the self (lack of self
control) (Armstrong 1995; Brown and Duncan 2002).
Ill-health therefore represents the inability to ‘correctly’
control and manage the body to the standards required
to ensure ‘good’ health; obesity the ultimate in failed
‘body projects’ (Shilling 1993) can therefore be read
as ‘the biomedical gloss for the moral failings of
gluttony and sloth’ (Ritenbaugh 1982, 352, cited in
Evans et al. 2002).
These moral failings therefore allow the obese
to be seen as posing a risk to society in general,
demonstrated in policy and media reporting through
frequent reference to the amount obesity costs in
health care and lost time from work, etc. This is
particularly salient in a UK context as the state-
funded National Health Service (NHS) means these
are not individual costs: obese bodies cost the NHS
and therefore the tax payer.9 Thus, obesity is not
only seen as a ‘modern day disease . . . [but also] a
social and moral “sin”’ (Evans 2003, 92), reinforcing
a ‘blame the victim’ approach, no more so apparent
in the HOC report than in discussion of the psycho-
logical impacts of stigma associated with obesity,
where the cause of the problem is implied to be the
individuals’ body size rather than the stigma (the
logical solution therefore weight loss). For example,
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in discussing the bullying of obese children, the
report recommends that ‘teachers should receive
training in children’s diets, physical activity levels
[presumably to aid the child’s weight loss] and
how to help obese children combat bullying’ (HOC
2004, 75) rather than recommending that teachers
should discourage the bullying itself and challenge
fat prejudice.
This problematic and simplistic discussion of the
psycho-social impacts of obesity can again be
understood with reference to the influence of Carte-
sianism on Western medicine regarding the division
of mind and body, and psychological and physio-
logical health services. The focus on obesity as an
energy balance, diagnosed by body size, means the
emotional and social aspects of eating, exercising,
body size and health recognized in relation to ‘psy-
chological eating disorders’ such as anorexia ner-
vosa are overlooked when discussing ‘physiological’
disorders such as obesity (Evans et al. 2002; Cam-
pos 2004; Evans 2004; Gard and Wright 2005).
When these emotional and social factors are consid-
ered, it is through problematizing eating and emo-
tions (the HOC report somewhat ironically listing
shame and guilt as two reasons why people might
overeat) as the focus on illness or abnormality, pre-
cludes the pleasurable aspects of eating, exercising,
living as a certain size/body (thus, someone who
has a BMI of over 30, feels fit, healthy and is happy
with their body size must be considered irresponsi-
ble for not wanting to reduce her/his weight). Alter-
natively, psychological aspects of obesity are
discussed as consequences of a high BMI. Thus the
psychological effects of obesity are presented as
further evidence of the burden of obesity on health
services:
Psychological damage caused by overweight and
obesity is a huge health burden . . . rates of anxiety
and depression are three to four times higher among
obese individuals [and] obese women are around
37% more likely to commit suicide . . . Excess weight
is also likely to lead to prejudice in the workplace,
lower self-esteem and reduced job opportunities . . .
a recent study has demonstrated that teachers
underestimate the IQ of overweight children. (HOC
2004, 20–1)
The wording of these statements therefore suggests
that these psychological and social problems are
caused by the ‘excess weight’ itself, not the stigma
associated with fatness, implying that discrimination
against fat people is not inherently problematic
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‘Gluttony or sloth’ 263
and that the solution, again, is weight loss. Indeed,
whilst (thankfully) this was not adopted as a
suggestion, it is mentioned in the HOC report that
a witness to the report ‘argued that it might be
helpful if more stigma [were] attached to obesity so
that people made more effort to lose excess
weight’ (HOC 2004, 104). Reading documents
such as the HOC report, one is therefore left with
little doubt that fat bodies disrupt the social order,
threatening to take up too much space and too
many resources, the HOC going so far as to
suggest that obesity ‘will bring levels of sickness
. . . making a publicly funded health service
unsustainable’ (2004, 7).
Deviant bodies
Fat, unlike muscle, is not solid or still; it moves,
wobbling and spilling out over belts and other
clothing – apparent in illustrations accompanying
media reports on obesity which frequently show
fat spilling over a waistband. No face is shown to
preserve anonymity in order to avoid the shame
inherent in being identified as fat in ‘a fat-phobic
culture’ (Longhurst 2005, 248) and because this would
imply a self, where what is at issue is the body. We
therefore need to recognize that the (re)production
of obesity knowledge is situated in wider social and
cultural contexts which position thin as good and fat
as bad (Bordo 1993; Shilling 1993; Campos 2004). The
HOC report mentions this context, but underplays
the potential influence of this by implying that social
pressures do not result in adequate concern or
remorse to encourage the ‘necessary’ weight loss:
we have observed an odd tension in society. The
world of popular culture . . . is usually dominated by
fit and slim people . . . Yet the average person is
remorselessly getting heavier and moving further and
further away from the ideal. (2004, 104, emphasis
added)
Through failing to recognize the extent to which such
social pressures can result in anxiety and poor self-
esteem, such reports may actually act to legitimize
social pressures to be thin, with (anti)obesity policy
presented as
an ameliorative, ‘corrective’ or intervention agency, a
potential ‘cure’ to disorder, rather than as a set of
processes which may, themselves, have a problematic,
damaging and ‘disordering’ effect on . . . people’s
lives. (Evans et al. 2002, 199)
264 Evans
In addition to this, referring to obesity as a result of
remorseless weight gain implies that a fat, ‘out of
control’ or deviant body is the result of inaction
or complacency rather than action.10 Not taking
control of one’s body is the cause of ill-health, and
hence all bodies are potentially at risk of this.
This notion of risk is important, as if everyone is
potentially at risk, then complacency is dangerous.
In discussing women’s experiences of child birth,
Sharpe (1999) discusses the ‘cascade effect’ in relation
to pain relief in child birth – i.e. the assumption that
there is a slippery slope down which the use of
nitrous oxide will inevitably lead to an epidural.
Thus, an individual’s experience is fitted into a ‘pre-
given’ schema. In considering obesity, this is seen in
the inclusion of those who are ‘overweight’ in the
reporting of obesity statistics as it is assumed that
people are constantly and inevitably moving ‘up’
the BMI scale: ‘society is getting fatter not just those
who are already fat’ (HOC 2004, 13). Likewise, Dorn
(1999) discusses how the consumption of alcohol in
any form may be seen as a sign of moral intem-
perance and in obesity discourse this is evident in
the classification of certain foods as inherently good,
bad, healthy or unhealthy (Evans 2004; Evans et al.
2002). Any consumption of bad or unhealthy foods
marks a step along the slippery slope to obesity,
thereby justifying the banning of ‘bad’ foods and the
targeting of children in anti-obesity campaigns to
prevent children taking the first step along the slippery
slope to obesity (see Evans 2002). Likewise the
notion of inevitability is inherent in the positioning
of the UK in international obesity ‘league tables’ as
following closely behind the worst offender, the USA:
‘It is often said that Britain lags behind America by a
few years in cultural patterns. Trends in obesity in
Britain do indeed follow, albeit with a delay of a
few years’ (HOC 2004, 8).
A complex range of strategies are suggested in the
HOC report to halt the ‘obesity epidemic’ (through
enabling and encouraging weight loss), utilizing
regulation of food availability, content and marketing;
health promotion in order to educate people as to
the ‘right’ way in which to control their bodies; and
surveillance to monitor this. Thus we are faced with
a new public health dream of surveillance in which
everyone is brought into the vision of the benevolent
eye of medicine through the medicalisation of
everyday life. (Armstrong 1995, 399)
This expansion of ‘an unspecific medical gaze casting
its eye over the whole social realm’ (Philo 2000,
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17), a Foucauldian means of medicalizing through
measurement-based monitoring of all bodies, is
clearly demonstrated in the HOC report in sugges-
tions that every child’s BMI should be measured
annually in school and reported on school report cards,
pathologizing all children’s bodies as potentially
diseased, since
not only would this system identify children who are
already overweight or obese, but it could target those
at the top end of the ‘normal’ range of BMI to prevent
further weight gain. (2004, 95)
This medicalization of all (potentially obese) bodies
is further exacerbated through the use of disease
terminology when discussing obesity: frequent
references to an epidemic of obesity, implying it is
contagious; the search for a genetic cause of obesity;
and the classification of obesity as a ‘disease’ (Gard
and Wright 2005) further implies a BMI of over 30
means inevitable ill-health – it means the body is
diseased – and a BMI of over 40 (morbid obesity)
must presumably mean inevitable death. Some
may argue that this focus on obesity as a ‘disease’
or ‘genetic condition’ will reduce stigma and detract
from the moral implications of an understanding of
obesity as being caused by (irresponsible) behaviour.
However, this is a further medicalization of body
size which contributes to the understanding of fat
as inherently unhealthy, undesirable, ill and deviant
(whatever its cause). When considered in context,
genetic explanations may encourage a further focus
on the ‘abnormality’ of fat bodies, with medical
knowledge legitimizing social pressures positioning
thin as ideal and fat as deviant:
Once isolated as a medical species, the alcoholics [or
the obese], it was believed, would be freed the
potential stigma of moral failure. Yet . . . rather than
the medical cancelling out the moral, it may be
observed that these two discourses merely fed off one
another. (Dorn 1999, 28)
Conclusions: moving forward – obesity,
morality and engagement with policy
As I stated at the outset, this paper is based on a
particular (re)presentation of obesity knowledge
through one specific policy document and may
appear overly critical of such reporting which aims
to improve individuals’ health. Whilst I have no
criticism of policy which aims to help people to
feel healthier, there are problems when this is then
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directly related to body size, since by relating health
to body size, bodies are medicalized in a way
which allows for only two alternatives: fat, unfit and
unhealthy; and thin, fit and healthy (Evans 2004).
One potential danger in engaging with medical
policy is the perceived need to unquestioningly
begin with the medical (in terms of methodologies
and definitions) to contextualize and legitimize
our research as ‘adopting diagnostic criteria and
imagery from the disabling professions is one
means by which academics establish their own
professional credibility’ (Dorn 1999, 63). Focusing
on the medical in this way sets medical knowledge
as the ‘essential’ truth, reducing the body to ‘a pure
object of science’ (Parr 2002, 243). This is
especially evident when discussing fat or obese
bodies as, by centring the medical here, we limit
our conceptualizations of these bodies to seeing
them as (potentially) ill, at risk, diseased, dangerous
and deviant – readings firmly rooted in the social
and moral contexts within which this ‘science’ is
(re)produced. This is not to say that there is not
space for a medical reading of bodies:
geographers of health do not need to ‘do away with’
the medical, but can engage with it, albeit in a more
critical capacity than has been the case previously in
the subdiscipline. (Parr 2002, 241)
Likewise, it does not mean that critical approaches
cannot speak to the medical, or are ‘only of insular
importance within geography’ (Kearns and Moon
2002, 617). Through engagement with bio-medical
science, both in critically considering its construc-
tion of bodies in our own work, and through
involvement in interdisciplinary working groups,
geographers have a clear role to play in providing
alternative ways of thinking about obese bodies
(Longhurst 2005).
There is a small, but growing body of work in
social and cultural geography on issues of ‘fatness’
which does not medicalize fat bodies in this way,
providing an understanding of the materiality and
lived experiences of being ‘fat’, which extends
beyond a medical/clinical definition (Colls 2002
2003; Longhurst 2005). In addition, there has also
been a recent growth in geography’s engagement
with emotions (Davidson 2000; Davidson and Milli-
gan 2004), which allows for an alternative, non-
medical reading of obese or fat bodies where being
healthy is about feeling healthy, not any specific
definition or measurement of health evaluated by
the medical profession. Likewise, fat need not be a
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‘Gluttony or sloth’ 265
measurement of body size, but ‘emotional size’ – an
individual’s perception and feelings about her/his
body (Colls 2002; Longhurst 2005). By thinking
about both obesity and health in this way, an indi-
vidual’s embodied knowledge is given value and
status, allowing for a more fluid understanding of
bodies which can change over time and in different
spaces. This has clear possibilities for engagement
with health professionals and debates in health
science around an alternative ‘health at every size’
approach to obesity ‘treatment’, where the goal is
feeling healthy rather than weight loss (Robinson
2005).
This paper has considered obese bodies in dis-
course rather than individuals’ experiences, and
there is a clear need to
focus on the materiality and meaning of the body and
its messy processes . . . [and through de-centring
medical definitions of obesity to] debate more
rigorously how body spaces are socially constructed
and experienced as well as (and not just) biologically
determined. (Parr 2002, 247)
The use of BMI and weight to classify people as
fat or obese reduces the body to a simple
measurement, when in reality ‘it is difficult (if not
impossible) to talk about fat bodies without talking
fleshy materiality – folds of skin, rolls of fat’
(Longhurst 2005, 251). There is clear scope for
medical geography to contribute to this through
considering the lived experiences and materialities
of obese bodies – the experiences of being or
feeling fat or obese in ‘health spaces’, where bodies
are educated, monitored, prodded, measured, stapled,
etc. To do so, it is necessary to avoid the repetition
of medical definitions of obesity based on problematic
measurements of the body such as BMI, which
‘legitimate the ordering of a diversity of . . . experiences
in equivalent terms for the purpose of measuring,
prediction and control’ (Sharpe 1999, 92), instead
recognizing the social and cultural context within
which such definitions are rooted, and the unequal
power relations they may (re)produce.
Acknowledgements
I would like to thank Katie Willis, Richard Phillips, John
Evans and three anonymous referees for their comments on
earlier drafts of this article. Thanks also to those who com-
mented on the paper following presentation at the 11th
International Medical Geography Symposium, 2005 and to
the British Academy for part-funding my attendance.
266 Evans
Notes
1 One of a series of investigative committees broadly mirror-
ing government departments (e.g. Health; Education
and Skills, etc.) which are constituted by and report to
the House of Commons, and comprise members from all
political parties. Their broad remit is to scrutinize the
expenditure and policy of government departments, and
in this case inform policy decisions. The reports produced
are then used to inform and justify policy decisions,
debated in the House of Commons, and are publicly
available. For more information, see http://www.parliament.
uk/parliamentary_committees/health_committee.cfm
(Accessed 10 February 2006).
2 The report is 146 pages long and the inquiry involved
collecting oral and written evidence from a vast number
of ‘witnesses’ – representatives from academia, government
departments, regulatory bodies, food industry representa-
tives, and physical activity and health professionals.
3 Whilst centred on the UK, the process of evidence collec-
tion involved visits to the USA, Brussels, Finland and
Denmark in order to establish international examples
of best (and worst) practice and to contextualize current
(and proposed future) UK trends in obesity.
4 ‘Acceptable’ body size (and with it the meanings associ-
ated with fatness) is not fixed and has varied historically
and in different cultural contexts. However, public health
policy surrounding obesity relies on a notion of a fixed
‘healthy’ body weight. In this paper I focus specifically on
the current UK context as there is not the space here to
enter into discussion of historical changes in ideal body
size – for this see Jutel (2005).
5 These statistics also ‘open’ the press release, and were
central to many subsequent media reports.
6 BMI = (weight(kg)/height(m))2, whereby underweight
(<20), normal (20–24), overweight (25–29), obese (29–
39) and morbidly obese (>40). The HOC report includes
a BMI table to allow readers to establish whether they are
under, over, normal weight or obese.
7 BMI has been criticized for many reasons too numerous
to enter into here, including: a failure to distinguish between
muscle mass and fat, or differentiate by age, gender,
ethnicity, frame or distribution of fat; and because the
thresholds for normal, overweight, obese, etc. are
arbitrary (developed by insurance companies) and have
changed (getting lower) in response to changing societal
ideals.
8 As Evans (2003) points out, this is especially concerning
when considering the attribution of cause for depression
and other mental illnesses to obesity – implying that mental
ill-health can be cured by weight loss.
9 There are numerous problems in calculating such figures,
not least because as mentioned previously, the direction
of causality in correlations between obesity and certain
diseases is unknown (Jutel 2005).
10 This makes the discourse surrounding obesity different
from that surrounding smoking to which it is often compared.
Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006
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