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The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem’s concepts of “the normal and the pathological” as a theoretical frame, we examine the gendered assumptions that shape medical understandings of “healthy” and “dysfunctional” exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.

When it comes to food, eating and technologies, convenience is constructed as contradictory: on the one hand as a practice that saves time and effort, and on the other hand, an easy and often “unhe...

Objective: Australian tertiary eating disorder services (EDS) have a divided model of care, where child and adolescent mental health services (CAMHS) support patients until the age of 18 years, and thereafter, adult mental health services (AMHS) provide care. Consumers and carers have criticised this divided model because the age boundary occurs during the peak period of onset and acuity for eating disorders. Most CAMHS patients are lost to specialty follow-up around age 18, increasing the risks of relapse and premature mortality from eating disorders, since young women (aged 15–24) have the highest hospitalisation rates from anorexia nervosa. The current article is a commentary on the transition gap and possible service designs. Conclusions: Eating disorders require access to specialty treatment across the life span. The Australian Federal Government has expanded all-age care through the 2019 Medicare Benefit Schedule (MBS) eating disorder plans. Some new MBS patients require a rapid step-up in care intensity to a tertiary EDS, thereby increasing demand on the public sector. State/Territory Governments should strengthen EDS using the ‘youth reach-down’ model, where AMHS extend EDS to age 12. Vertical service integration from 12 to 64+ facilitates continuity of care for the duration of an eating disorder.

Objective: Young women living in industrialised westernised societies have a higher prevalence of anorexia nervosa, partly due to a cultural emphasis on thinness as a beauty ideal. Sociocultural milieux might promote recovery from anorexia nervosa amongst young women. The current article is a commentary about the social influences on recovery from anorexia nervosa – based on social anthropology, narratives of people with lived experience, and clinical studies. Conclusion: Anorexia nervosa increases social withdrawal, and recovery leads to re-engagement with meaningful relationships. Recovery also empowers women as ‘cultural critics’ who challenge assumptions about the thinness beauty ideal and gender roles. The gradual process of full or partial recovery often occurs during emerging adulthood (aged 20–29). In this life stage, adolescent friendship groups are dissolving as women move from education to work, reducing the danger of weight-based teasing by peers, which is an environmental risk factor for disordered eating. Women recovering from anorexia nervosa may connect with those aspirations of peers and mentors that eschew a focus on weight and shape, but relate to the life-stage tasks of starting careers, beginning new friendships, selecting life partners and family formation – that is, a broader role in larger relationship networks.

This article explores how desire operates in the daily lives of women with disordered eating. Based on qualitative findings from a South Australian study investigating why women with disordered eating are reluctant to seek help, we trace the multiple “tipping points” and triggers that are central to participants’ everyday experiences. Employing anthropological interpretations of desire, we argue that triggers are circulations of productive desire, informed by cultural values and social relations, and embodied in routine daily acts. We examine the cultural-work of desire and the ways in which gendered relationships with food, eating and bodies trigger desires, creating a constant back and forth movement propelling participants in multiple directions. In conclusion, we suggest that a socio-cultural approach to desire in disordered eating has clinical implications, as cultural configurations of desire may help to understand ambivalence towards relapse and recovery.

By foregrounding positive and productive capacities of fat, we explore experiences of expanding, maintaining, or diminishing body sizes to accommodate the different meanings and enactments of fat. Drawing on fieldwork conducted in a South Australian community that has experienced significant socioeconomic disadvantage, we detail how the "problem" of fat in public health discourse is countered in the lived experience of people targeted for obesity intervention. In so doing, we attend to the multiple meanings and practices of fat that differ to the focus within public health interventions on the negative health consequences of overweight and obesity.

BACKGROUND Scholarship across the humanities and social and life sciences has documented a wide variety of historical, sociocultural and medical attitudes to large bodies, including both positive and negative associations. Obesity has never been a stable or unified category. OBJECTIVE The aim of this article is to provide an overview of the historical trajectory of obesity as a disease in a Western context. DISCUSSION Discussions about whether obesity should be classified as a disease have been ongoing. Many scholars regard the early Greeks as the first to identify obesity as a disease, and trace changing manifestations of obesity from Classical times through the Middle Ages and Age of Enlightenment to contemporary times. This trajectory of obesity as a disease is contentious, and in light of recent moves to attribute disease status to obesity in Australia, this article outlines the politics and value of classifying obesity as a disease.

Children have been made a priority in Australian government obesity interventions, with programmes tending to focus on promoting behaviour change in food and exercise practices. This paper reports findings from ethnographic research with a group of Australian children aged 10–14 years living in a low socio-economic suburban setting. We propose that central to these children’s experiences of food and eating is the negotiation and management of hunger. Historically, disadvantage has been embodied and inscribed on children’s bodies in very visible ways, and the coexistence of hunger and obesity is part of this continuum. Despite considerable evidence of food insecurity in our research site, issues of hunger were absent in an obesity intervention underway at the time. We examine how hunger was felt in children’s lives, how it was managed and the ways in which messages about eating less, while eating more ‘healthy foods’, were at odds with the children’s experiences of hunger. Moreover, we argue that h...

What are the symbolic meanings of breakfast in the context of one of Australia’s largest childhood obesity intervention programs? Utilizing a range of theoretical insights into the morality of food and eating and the anthropology of food, we trace how breakfast is packaged and promoted to families in an Australian community as a ‘healthy start’ to the day. Through ethnographic and historic investigation, we argue that eating breakfast and certain types of breakfast foods are symbolic of a classed, healthy lifestyle pattern, embodying parental knowledge and bodily regulation to routinely structure daily life. In communities where poverty and unemployment are harsh realities, well-intentioned programs that encourage people to eat a healthy breakfast are encoded with an assemblage of moral values—of knowledge, foods, families, and times and spaces—that are often difficult to reconcile with the wider sociocultural context in which many people live.

This chapter explores the ways in which obesity is put forward as a medical (and moral) discourse, a problem caused by overeating and not enough exercise. Within the epidemiological field, there is clear evidence of the social gradient in obesity, and the relationship between inequality and obesity is key to the book’s analysis. Despite the dominance of medical interpretations of obesity, different people have differing perspectives on fatness, and not everyone agrees that being overweight or fat is unhealthy. Moving beyond the well-developed social constructionist critiques of obesity, this chapter positions the arguments for the book in practice theories (Mol, The body multiple: Ontology in medical practice. Durham: Duke University Press, 2002), discerning coexisting patterns of fatness.

The trifle is used as a device to articulate anthropological approaches to food and eating, acknowledging the multiple versions of trifles and their anthropological analyses. Trifle was a dish that local participants balked at, as the cost of fresh summer berries was out of reach for people living on very limited incomes, and the substitution of delicious foods with low fat and low sugar diminished the pleasures of taste. This chapter thus situates food and eating in the context of a community that has seen good times shift to hard times, with an increase of food banks, welfare, and unemployment. It is in this context that the French franchise of the obesity program (OPAL) was implemented, aiming to reshape the community and their bodies.

Intense concern about obesity in the public imagination and in political, academic and media discourses has catalysed advocacy efforts to implement regulatory measures to reduce the occurrence of obesity in Australia and elsewhere. This article explores public attitudes towards the possible implementation of regulations to address obesity by analysing emotions within popular discourses. Drawing on reader comments attached to obesity-relevant news articles published on Australian news and current affairs websites, we examine how popular anxieties about the 'obesity crisis' and vitriol directed at obese individuals circulate alongside understandings of the appropriate role of government to legitimise regulatory reform to address obesity. Employing Ahmed's theorisation of 'affective economies' and broader literature on emotional cultures, we argue that obesity regulations achieve popular support within affective economies oriented to neoliberal and individualist constructions of obesity. These economies preclude constructions of obesity as a structural problem in popular discourse; instead positioning anti-obesity regulations as a government-endorsed vehicle for discrimination directed at obese people. Findings implicate a new set of ethical challenges for those championing regulatory reform for obesity prevention.

This article explores the complex sensorial encounters that people with eating disorders have in response to their mouths, food, eating, and embodiment. We argue that relationships to food, perceived primarily in clinical and psychological terms of control and discipline, ignore sensorial and generative dimensions of embodiment and the associated affective agency of hungers, pleasures, and disgust. Through analysis of the filmed performance of Untitled (The Party), we examine how the mouth for people with eating disorders embodies a metaphorical space of disgust, but also pleasure. As a soft, moist bodily opening, the mouth presents a symbolic space that can be filled with sensorial engagements of touch, disgust, pleasure, and taste. It is through the materiality of cream as used in the performance, and Irigaray's morphological mediation of bodily dimensions and language via the mucous touch, that we present new sensorial engagements with eating disorders.

Background This paper explores the differing perspectives of recovery and care of people with disordered eating. We consider the views of those who have not sought help for their disordered eating, or who have been given a diagnosis but have not engaged with health care services. Our aim is to demonstrate the importance of the cultural context of care and how this might shape people’s perspectives of recovery and openness to receiving professional care. Method This study utilised a mixed methods approach of ethnographic fieldwork and psychological evaluation with 28 women from Adelaide, South Australia. Semi-structured interviews, observations, field notes and the Eating Disorder Examination were the primary forms of data collection. Data was analysed using thematic analysis. Results & Discussion Participants in our study described how their disordered eating afforded them safety and were consistent with cultural values concerning healthy eating and gendered bodies. Disordered eating was viewed as a form of self-care, in which people protect and ‘take care’ of themselves. These subjectively experienced understandings of care underlie eating disorder behaviours and provide an obstacle in seeking any form of treatment that might lead to recovery. Conclusion A shared understanding between patients and health professionals about the function of the eating disorder may avoid conflict and provide a pathway to treatment. These results suggest the construction of care by patients should not be taken for granted in therapeutic guidelines. A discussion considering how disordered eating practices are embedded in a matrix of care, health, eating and body practices may enhance the therapeutic relationship.

Mothers are expected to monitor their children’s dietary intakes and physical activities and are blamed for over feeding their children if they are obese. Women are also urged to manage their own weight in preparation for conception and during pregnancy in order to reduce complications associated with maternal obesity at childbirth. Through a theoretical lens of maternal blame, we argue that Australian media representations of scientific studies of the fetal overnutrition hypothesis extend behavioural maternal blame to the interiority of women’s bodies. Women’s intrauterine environments are positioned in the media as central to the intergenerational transmission of obesity, with women portrayed as responsible for passing obesity on to their children (and grandchildren) via biology and ill-informed ‘lifestyle choices’. Linking in with historical and contemporary discourses of maternal bodies and individual responsibility, the implications of the ‘double damage’ caused by women entails a concerning return to essentialism in which women’s bodies are being largely blamed for producing and reproducing obesity across generations.

This paper traces the genealogy of the Barker hypothesis and its intersections with popular representations of scientific discourses about pregnancy and maternal obesity.Drawing on Foucault's genealogical method, this study examines the historical 'descent' of the developmental origins of adult disease and its initial grounding in structural factors of gender inequality and low socioeconomic status.In the more recent reproductive medicine literature, Barker's hypothesis has been used to understand the causes and consequences of foetal over-nutrition and has shifted its focus from social determinants to individual, gendered bodies. The print media has gainfully employed this conceptualization of obesity and, in doing so, placed women, and mothers in particular, as causal agents in the reproduction of obesity across generations. Such a 'common sense' understanding of obesity production and reproduction means that both the scientific literature and the public understanding of science has inadvertently assisted in putting women forward as the transmitters of obesity across generations.This powerful telescoping of the origins of obesity to women's bodies and their appetites is in stark contrast to earlier foci on gender inequalities and changing women's circumstances.

This paper investigates the ways in which ‘the child’ is positioned in obesity debates and, in doing so, examines the discursive relations between childhood obesity, mothering and child neglect. Using legal cases of parental neglect and an analysis of representations of obesity in Australian print media, we argue that a particular constellation of ‘child politics’ in which children are represented as innocent victims of poor parenting is at play. Parenting, however, is a code for mothers and it is their gendered responsibility for food and families for which they are now being held legally culpable in cases of neglect. The relationship between children and mothers has become the focus of moral discourses around childhood obesity, containing contradictory elements of innocence and risk, responsibility and danger. The intersection of child politics, mothering and individualized responsibility not only illuminates the ways in which gender is absent yet centrally implicated in obesity debates and policy, but also highlights how models of neoliberal governance encompass both State and decentralized forms of power in their attempt to regulate excess bodies.

The evaluation of complex systems-wide public health interventions requires evaluation research that is underpinned by theory. This article presents and discusses the trans-disciplinary evaluation research framework developed to support the evaluation of a South Australian program called OPAL (Obesity Prevention and Lifestyle). The aim is to provide insights into the research design, methods and implementation of the evaluation and contribute to the debate on how to evaluate community-based interventions with complicated and complex aspects. In an attempt to capture the complexity of childhood obesity and the intervention, the OPAL evaluation research employs post positivist, interpretive and critical epistemologies, valuing epistemological pluralism. Each component of the multi-phase mixed methods evaluation captures different yet complementary information concerning the context, process, cost effectiveness and outcomes providing a more complete understanding of the impacts of the complex program. Evaluation research is not without challenges. Some of the tensions and challenges that arose in the establishment, planning and conduct of the OPAL program and evaluation are discussed. Refereed/Peer-reviewed

This paper examines how contemporary understandings of health and care are engaged with by women with disordered eating. Based on findings from an Australian Research Council grant study, we explore the ways in which people align themselves with ‘healthy eating’ principles to legitimize their practices. Rather than always seeing their practices as a problem in need of intervention, many participants actively pursued and ‘tinkered with’ (Mol et al., 2010) their disordered eating as a form of self-care. We investigate how participants use the new food regime of orthorexia, as well as food choices and intolerances, as a normalised cover for restrictive diets. We argue that orthorexic practices entailing natural, medical and ethical concerns were successfully incorporated into participants' eating disorder repertoires. Participant's commentary on orthorexia reveals the vulnerability of people with disordered eating to the panoply of health and fitness advice circulating in contemporary society in which the pursuit of health and healthy lifestyles are at the centre of moral virtue, personhood and citizenship (Crawford, 1980). We demonstrate how these eating and body practices relate to an ethics of care that promotes moral virtues of hard work, purity and deprivation – all of which can ultimately lead to dangerous restrictive practices. Understanding how categories of health and care are understood and transformed by people with disordered eating has important implications for identifying people at all stages of help seeking.

This paper explores how young women with disordered eating rationalise their behaviour as 'healthy'. Based on preliminary findings from an Australian Research Council grant that is investigating why people with eating disorders are reluctant to engage with treatment services, we demonstrate how young women use normative discourses of body surveillance, 'healthy eating' and self-discipline to maintain and support eating disorder practices. Healthy lifestyles are supported by a range of public health initiatives that promote 'watching one's weight', taking regular exercise and eating foods that are low in fat. Such culturally sanctioned discourses are readily available for people with eating disorders to position themselves within, providing a normative space to practice body surveillance, and also a legitimate and moral claim to looking after oneself. Investigating the parameters in which people rationalise excessive dietary restriction, and over-exercising as a healthy lifestyle is important for early detection of eating disorders, and to the development of strategies that challenge the ease in which eating disorders can be hidden in everyday health practices. This abstract was presented in the Understanding and Treating Eating Pathology stream of the 2013 ANZAED Conference.