In light of the increasing prevalence of obesity in the UK, health professionals working within general practice are urged to initiate discussion about weight with overweight and obese patients. Despite such appeals, evidence suggests that only a minority of health professionals routinely talk to patients about weight loss. To understand more about the barriers to raising the topic of weight in general practice, three empirical studies guided by qualitative research design were carried out. The first two studies draw on psychological theory to identify barriers to raising the topic of weight. Semi-structured interviews were conducted with 17 GPs and 17 primary care nurses. The third study conducted with 20 GPs is underpinned by discourse analysis and uses trigger film interviews to capture and critically analyse the discursive production of, and macro-discourses shaping, barriers. In study 1 and 2, three main themes summarise barriers identified from GP and primary care nurse perspectives: limited understanding about obesity care, concern about negative consequences and limited time to raise a sensitive topic. In study 3, four discursive frameworks were identified as underpinning constructions about the barriers to broaching discussion about obesity: medical-reductionist, medical-holistic, moral and ethical. Findings extend understanding about the ways in which obesity is constructed as both a medical and non-medical issue. The findings have implications for health professional education, policy and research including the need to expose and challenge dominant understandings of obesity as a behavioural problem, to address barriers operating at the socio-cultural as well as the individual-level, and to enhance understanding about the socially embedded and pernicious effects of obesity stigma in the consultation and beyond.

This thesis stems from a large, international research project funded in the UK by the Economic and Social Research Council (ESRC) (RES-000-22-2003) and led by Dr. Emma Rich and Professor John Evans at Loughborough University between 2007 and 2009. The study investigated how new health imperatives and associated curriculum initiatives were operationalized within and across eight schools located in a county in the Midlands region of England. The schools were chosen to reflect a variety of socio-cultural settings in the UK, and specifically those that were typical of the Midlands county in which the study took place. The research findings formed part of a three-way international collaboration with parallel studies conducted in Australia (led by Professor Jan Wright) and New Zealand (led by Associate Professor Lisette Burrows) and revealed, among other significant findings, that whilst some young people are deeply troubled by obesity discourse, others are emboldened by it. In pursuit of this key finding, this PhD study departs from the aforementioned project through detailed case study exploration of the emplacement , enactment and embodiment of health policy in three of the eight UK schools from the ESRC-funded study, focusing specifically on the class and cultural mediations of health imperatives in each setting and the various ways these can affect a young person s developing sense of self (particularly the relationships they develop with their own weight/size). Young people are considered to be body subjects (Blackman, 2012) whose embodiments are assembled, performed and enacted in situ. I therefore speak of troubled , insouciant and emboldened bodies as categories which reflect the fundamentally agentic, contingent, relational and fluid nature of young people s embodiment in time, place and space. Hence, whilst highlighting the deleterious and indeed ubiquitous effects of some health education programmes on some young people s relationships with their weight/size, key findings presented in this thesis offer nuance and complexity to the notion of the neoliberal body (Heywood, 2007; Rizvi and Lingard, 2010; Rose, 1999) through exploration of the ways in which contemporary health imperatives also have potential to privilege and empower some young people. The thesis concludes with a discussion of the implications of these findings for policy makers, educators and researchers whose work concerns young people s health and well-being.

Health curriculum traditionally (re)produces obesity discourse, a fusion of biomedical and moral perspectives of weight and fat. This weight-centered approach to bodies may perpetuate weight stigmatization, indirectly supports a culture of thinness, and contradicts other health messages concerning bodies. A Health At Every Size® (HAES®) approach is an alternative, multidimensional health-centered approach that can reconcile the incongruent messages in obesity and eating disorder discourses and may reduce weight stigmatization. The purpose of this study was to develop and evaluate a college personal health curriculum module to promote healthy bodies of all sizes. Discourse positions of teaching assistants were explored through interviews and provided an understanding of their values and teaching methods regarding weight and health. A HAES®-based curriculum module was developed for college personal health classes at a Midwestern university. Quasi-experimental design was used to compare attitudes toward HAES® principles among students who received the alternative, HAES®-based curriculum module versus those receiving a traditional weight management curriculum. Pre- and posttest attitudes of students and teaching assistants were assessed using the Health and Weight Attitudes Scale developed for this study. Teaching assistants provided evaluation of the HAES® module in a focus group. While teaching assistants' discourse positions varied, most used obesity discourse to talk and teach about bodies and weight. Alternative discourses were most common when teaching assistants discussed eating disorders or body image. Students' attitudes at pre-test were slightly positive and did not differ significantly between comparison and intervention groups. Intervention group students' attitudes were significantly more positive than comparison group students' attitudes at posttest. Intervention group teaching assistants reported primarily positive experiences with the module. Teaching assistants rely primarily on obesity discourse to teach about weight and bodies but are receptive and positive when offered an alternative method. A HAES® curriculum module can increase positive attitudes of students and teaching assistants toward promotion of size acceptance and multidimensional health for people of all sizes.

This thesis examines the effects of anti-obesity discourses on parenting practices. While academics have paid attention to the political dimensions of anti-obesity policy and related discourses (for example Colls and Evans, 2009, Evans, 2006, 2010, McPhail, 2009, Rawlins, 2009), and others have considered the experiences of feeding and caring for families (for example Curtis and Fisher, 2007, DeVault, 1991 Warin et al, 2008, Valentine, 1999), the way in which anti-obesity policies become enrolled in, and possibly contested through, parenting practices remains largely uncovered. In response to this, the thesis explores the ways in which these anti-obesity policies and discourses are brought into family life, lived, experienced, and made meaningful, contributing to critical obesity geographies and broader literature on bodies, parenting, care, and consumption. The thesis draws on research interviews and focus groups with parents, in which accounts of parenting practices and understandings around body size were explored in light of contemporary UK anti-obesity discourse. Using this research to explore the everyday enaction of parenting knowledges around body size, these parenting enactions are investigated alongside the governance of body size and parenting, developing an account of the ways in which we can see the aims of the state enacted in everyday practices of care (Dyck et al, 2007). By paying attention to everyday practices, this thesis argues that anti-obesity discourse emerges not only through top-down practices of governance, but through mundane and personal relationships of care and engagement with bodies, food, and fat. However, caring practices are demonstrated as existing in multiplicity and the excesses of everyday life in relation to parenting and body size are given space in the thesis to challenge narrow accounts of what it means to be a ‘good’ parent or have a ‘good’ body size; it is argued that we need to take seriously the situated lay knowledges that are developed through everyday practices of care. The thesis contends that such notions of ‘good’ parenting, bodies, and size are enacted through anti-obesity discourse as a particular classed discourse of parenting knowledge and body size, which furthermore, reinforce gendered versions of bodies, parenting, and everyday life.