Obesity As a Social DiagnosisThursday, June 30, 2011
As blogged before, obesity has long been defined by the World Health Organisation and other bodies as a chronic disease and even bears its own diagnostic code in the International Classification of Diseases (ICD-9: 278.00, ICD-10: E65).
Nevertheless, the notion of obesity as a ‘disease’ continues to be contested with proponents of the medical model being accused of ‘medicalising’ obesity while many would prefer to see it as simply a ‘norm variant’ of body shape distribution in the population.
Such disparities in defining ‘obesity’ reflect the complexity of the sociology of ‘diagnosis’ – a topic that is extensively discussed in a fascinating paper by Phil Brown and colleagues from Brown University, Providence, Rhode Island, published in Social Science & Medicine.
As the authors note:
“The process of diagnosis is carried out by multiple social actors, including medical professionals, researchers, government agencies, private corporations, social movements, and legal institutions.“
In addition, the affected individuals themselves have an important say in what they consider to be their own ‘diagnosis’ (or not).
“Diagnosis is simultaneously a site of compromise and contestation because it is a relational process. When there is a disconnect between the patient and the medical explanatory model, the individual may be unsatisfied with treatment goals, and collectively work to politicize the illness through social movements. This would be the case especially if people were not given a diagnosis for something which they expected to, or when they received a psychiatric diagnosis for something they believe is physical. The greater the symptom severity or the disconnect between lay and professional perspectives on diagnosis, the greater the likelihood of contestation.”
“In contesting diseases and conditions, people often seek to reshape or overturn a shared set of entrenched beliefs and practices about diagnosis, causation, and treatment that is embedded within a network of institutions, including medicine, law, science, government, health charities/voluntaries, and the media. This network is the “dominant epidemiological paradigm” for a given disease.”
In a medical setting, the term ‘diagnosis’ means labeling a condition, which in turn leads to the exploration of causation, pathology and prognosis, ultimately aimed at ‘scientifically based’ prevention and treatment strategies.
In contrast, from a social perspective, ‘diagnoses’ play a very different role in the context of belief systems, ideologies, culture and other factors that go well beyond conventional medical considerations.
In the case of diabetes for e.g.:
“…medicalized approach to diabetes individualizes and depoliticizes the problem. Alternatively, a political ecology framework emphasizes social, economic, and political institutions of human environments where diabetes is emerging.”
Thus, while in a medical context, the diagnosis ‘diabetes’ is associate with a clear pathology and pathophysiology that prompts specific diagnostic and therapeutic measures, in a social context, diabetes can be seen as a ‘social phenomenon’ that results from ecological changes operating well beyond the individual level that have little to do with the specific genetic, hormonal, or organ manifestations of this problem at the individual level.
What applies to diabetes, is perhaps even more applicable to discussions about obesity – especially given the emotionally charged environment that focusses on ‘shame and blame’ strategies and views obesity largely as consequence of personal choice and responsibility.
“In this paper, we have sought to understand the unique context in which social diagnoses are formed—a sociology of social diagnosis. To reiterate, social diagnosis is social in that it considers both larger social structures, as well as the various social actors which contribute to the diagnosis. In other words, a broad range of social factors goes into the making of a diagnosis, which is carried out by a myriad of social actors. The diagnosing of individuals can allow for the broader diagnosis of a group of illness sufferers, and an even broader diagnosing of communities.”
“If medical sociologists work with clinicians and public health practitioners, they may be able to jointly develop effective ways to use social diagnosis for both treatment and prevention.”
Clearly, this issue will continue to be passionately debated as we strive to find the balance between helping individuals (as we do in medical practice) and helping societies (as we do in population health approaches).
Hopefully, this will not be a debate about right OR wrong or even about doing one OR the other – in the end, we have to do both.
Brown P, Lyson M, & Jenkins T (2011). From diagnosis to social diagnosis. Social science & medicine (1982) PMID: 21705128