Acceptance and acknowledgement: obesity and the discrimination against obese people analyzed from an interdisciplinary perspective. Merleau-Ponty's phenomenology and Foucault's genealogy as an explanatory framework

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Acceptance and acknowledgement:

obesity and the discrimination against

obese people analyzed from an

interdisciplinary perspective

Merleau-Ponty's phenomenology and Foucault's genealogy as an explanatory

framework

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1

25 August 2015

Master thesis: Political Science, Political Theory Academic Year: 2014-2015

Radboud University Nijmegen Supervisor: Dr. Bart van Leeuwen

Abstract

Despite various governmental measures and health campaigns the prevalence of obesity has been rising. Much focus has been on the medical aspects of obesity; however, little attention has been directed to the aspects of social justice concerning obesity. I will argue that we need an interdisciplinary approach to obesity if we want to evaluate obesity from a social justice perspective. By using both the phenomenology of the body developed by Merleau-Ponty (2002) and the genealogy of power structures developed by Foucault (1977), I examine obesity in a way that goes beyond the medical discourse about obesity. I will argue that obesity has to be understood by the unequal structures in the environment and by the power structures that produce our understanding of obesity. Furthermore, I will argue that we need to acknowledge the discrimination experienced by obese people and accept the obese body. However, we should not accept obesity as such, the government needs to prevent obesity. I will conclude that there will be a tension between on the one hand letting people live the good life and on the other hand caring for the health of the community by preventing obesity.

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Keywords:

Obesity, acknowledgement, phenomenology, Foucault, fat acceptance

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2.3.2.2. Supposed causality...15 2.3.3. Social justice...16 2.3.3.1. Size discrimination...16 2.4. Conclusion...18 3. Merleau-Ponty... 19 3.1. Introduction...19 3.1.1. Dualism...19 3.1.2. Phenomenology...19 3.2. Phenomenology of Perception...20 3.2.1. Empiricism...21 3.2.1.1. ''Genetically obese''...21 3.2.2. Intellectualism...22

3.2.2.1. Changing fat identities...22

3.3. The body...23

3.3.1. Embodied being-in-the-world...23

3.3.1.1. Obese being-in-the-world...23

3.3.1.2. Influenced decisions...24

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3.3.2.1. Eating habits...26

3.4. Agency...26

3.4.1. I can...26

3.4.2. Meaningful decision making...27

3.4.3. Responsibility...27

3.5. Intersubjectivity...28

3.6. Discussion...29

3.6.1. A dualistic or non-dualistic approach?...29

3.6.2. The anonymous body...30

3.6.3. Gender...31

3.6.4. Power structures...31

3.7. Conclusion...32

4. Foucault... 34

4.1.1. The archeological phase...35

4.1.1.1. Episteme and discourse...35

4.1.1.2. Empirical-transcendental doublet...35

4.1.1.3. Phenomenology...36

4.1.2. Genealogical phase...36

4.1.3. The ethical phase...37

4.2. Discipline and punish...37

4.2.1. Disciplinary power...38

4.3. The Body...38

4.3.1. Power and knowledge...39

4.3.2. Bio-Power...39 4.3.3. Docile bodies...40 4.4. Agency...41 4.4.1. Hierarchical observations...42 4.4.1.1. Panopticon...42 4.4.2. Normalizing judgments...43 4.4.3. The examination...43 4.4.4. Producing identities...44

4.4.4.1. The body mass index...44

4.4.4.2. Eating disorders...45

4.4.4.2.1. Anorexia...46

4.5.1. Inhibition and consumption...47

4.5.2. Acknowledgement and acceptance...49

4.6. Discussion...50

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4.6.2. (Inter)subjectivity...52

4.6.3. Medical knowledge...53

5. Freedom versus care... 55

5.1.1. Experience versus discourse...55

5.2. The Body...56

5.2.1. Gender...56

5.2.2. Why not all people are thin?...58

5.2.2.1. False beliefs about weight loss...58

5.2.2.2. Material body...59

5.2.2.3. Inequality...60

5.2.2.4. It is hard to lose weight...60

5.2.2.5. Concluding...61 5.3. Agency...62 5.3.1. Resistance...62 5.3.1.1. Genealogical approach...63 5.3.1.2. Collective action...64 5.3.1.3. Normalization...65

5.3.1.4. Care of the self...66

5.4.1. Social justice...67

5.5. Acknowledging and accepting obesity?...68

5.5.1. Acknowledging prejudice and discrimination...68

5.5.2. Accepting obesity...69

5.5.2.1. Self-realization...70

5.5.2.2. The role of the government...71

5.5.2.2.1. Changing structures...71

5.5.2.2.2. Consumer freedom...72

6. Conclusion... 76

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1. Introduction

Obesity and obesity related diseases are among the greatest threats to public health (Kopelman, 2000). Many health risks such as hypertension, cancer and insulin resistance are associated with overweight and obesity. Factors that play a part in weight gaining are genetic, environmental and psychological factors (Kopelman, 2007). To combat and prevent obesity various measures on both the individual and the population level have already been taken. For example, the weight of kids at school is closely measured and inspected. Simultaneously, governments have tried to ban junk food from school and sport cafeterias (Throsby, 2008, p. 117). People are encouraged to start working out and to start dieting in order to lose weight. However, despite these various (governmental) health campaigns the prevalence of obesity is increasing (Wright, 2009).

In the Netherlands we can observe the same developments. Nowadays, almost half of the Dutch population is considered to be overweight. According to self-reported data around 5% of the Dutch population was considered obese in 1981, while this number increased to 12% in 2004 (Schokker et al, 2006, p. 101). Important to note is that in self-reports people tend to underestimate their weight, we should thus expect the actual figures to be higher (Gezondheidsmonitor, 2013). It is clear that obesity has become a problem for our society and that obesity is not something that is easy to resolve.

1.1. Literature on obesity

There has been a lot of research on obesity and the health risks associated with obesity (Kopelman, 2000; Spiegelman and Flier, 2001; Mokdad et al, 2003; Kramer et al, 2013; Flegal et al, 2005). Generally in scientific literature but also in the mainstream media it is argued that obesity is a threat to (public) health. Besides obesity being detrimental to people's health, obesity has also become to represent an undesirable bodily difference. That is to say, in the Western culture the slender body is considered to be a sign of self-discipline and self-control; these are highly valued personal and moral traits. The obese body, however, has become a sign for laziness and lacking self-control, therefore the obese body lacks moral worth (Groven et al, 2012; Hopkins, 2012; Murray, 2005).

Despite the very influential literature on the risks of obesity, there is a growing literature which advocates for a different perspective on obesity. These new perspectives are called ''critical weight studies''. Contrary to the general opinion, these authors argue that obesity is not as harmful for people's health as is often assumed. Together with the so called ''fat acceptance movement'' they advocate for

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the acknowledgement of the discrimination obese people experience. Furthermore, they argue for the acceptance of obesity (e.g. as something that is healthy and as a form of bodily diversity). Nevertheless, their claims for acknowledgement and acceptance have not gained much attention in the mainstream literature or from the general public. Should we acknowledge the discrimination experienced by obese people? And should we accept obesity?

Social justice scholars have elaborated on why questions concerning acknowledgement and acceptance are important questions for social justice. The acknowledgement of diversity is important for the positive self-realization of people and therefore should be of political concern. The literature on recognition has been concerned with acknowledgement and the acceptance of diversity. However, obesity has not received much attention from the perspective of social justice, because they have mostly been considered with the recognition of different ethnicities, sexualities and cultures (see also Fraser and Honneth, 2003; Fraser, 1995; Taylor, 1994). There seems to be a gap in the literature concerning obesity; that is to say, most literature about obesity is concerned with the medical aspects of obesity, while the political and normative aspects have been underexposed. Before we can evaluate the claims for acknowledgement and acceptance we need a better understanding of obesity in the light of these aspects.

1.1.1. Beyond medical knowledge

Why should a political theoretical thesis be concerned with obesity? Obesity is considered to be a social and public problem. People who are obese are discriminated and oppressed (Puhl and Brownell, 2001), which seems to be legitimate in our society. Furthermore, the withholding of acknowledgement and acceptance can be a form of social injustice and therefore should be of political concern. Moreover, the question whether the government should prevent and treat obesity is a political normative question. That is to say, should the government value public health above the freedom of individuals to be obese? All of these considerations make obesity the perfect subject for a political theoretical analysis, which moves beyond medical knowledge about obesity.

A couple of questions need to be answered if we want to understand obesity. Obesity is clearly a problem of the body, yet how should we understand the obese body? Should we understand the obese body by its materiality or should we understand the obese body in terms of power structures? Should we accept the medical knowledge about the obese body? And why are so many people becoming obese? Can we hold people responsible for their obese body? Or do people get obese because of external factors outside of their control? Do people have the free choice to go on a diet or is this a

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decision made by society for them? And how should we understand the obese person in the relation to other people? Can and should we be concerned with the claims made by the fat acceptance movement? Cooper (2010) argues that the experience of the obese body has been underexposed in research. These experiences are important and will remind us how prejudice and discrimination affect the everyday experience of the obese body. To answer the above stated questions we need an approach that focuses on the experiences of the body and the influence of the environment on the (experience of) body. That is to say, if we want to analyze the experience of the obese body, we need to consider an analysis that starts from the first-person perspective. With the phenomenology of Merleau-Ponty we will be able to analyze the first-persons perspective, without having to neglect the influence of the environment on this perspective.

Merleau-Ponty understands human beings as embodied subjects, who are in relation with the world. The obese body has to be understood in relation to the environment. Obese people have embodied (eating) habits that causes them to gain weight, these habits seem almost impossible to change. However, according to Merleau-Ponty people are always capable of acquiring new habits, such as eating healthy and exercising. This gives people the possibility to change their obese body by losing weight. The fact that people can learn new habits gives them possibilities to act and to choose how to act; i.e. people have agency over their actions. When people have agency they can be held responsible for their choices and actions; that is to say, obese people can be held responsible for their obese body. However, also society should be held responsible for the prevalence of obesity, because the structures in society facilitate the prevalence of obesity. Lastly, Merleau-Ponty argues that based on our mutual embodiment we can relate to the other as experiencing subject; hence, we can acknowledge the prejudice and discrimination obese people experience.

In sum, Merleau-Ponty allows us to investigate the obese body in a way that goes beyond the medical analysis, but without necessarily rejecting this knowledge. Despite the comprehensive analysis of the obese body that phenomenology can offer us, we cannot take into account the power structures that have shaped our understanding of obesity and the position of obesity in our society. Power structures prevent the experience of prejudice and discrimination from obese people to be acknowledged by the mainstream public. The same power structures even tend to legitimize the discrimination of obese people. Furthermore, normalization (as a mechanism of power) has defined obesity as something deviant; hereby, preventing obesity from being accepted. The genealogical approach of Foucault can help us investigating these power structures.

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According to Foucault (1977) experience should not be the starting point of analysis; rather, the power structures that constitute this experience should be the starting point of an investigation. If we want to understand obesity, we need to understand how power relations have constructed obesity. Disciplinary power normalizes and regulates bodies; hereby power relations produce possible identities through which people understand and experience themselves. Dieting and exercising could be understood as disciplines to produce passive bodies that only act according to the norms in society. Obesity has become to signify a negative identity, a deviation from the norm of a slender body. With the analysis of power structures we can investigate relations between people because these relations are shaped by discourse. In our discourse the obese body has become to represent laziness, lack of will-power and lack of self-control. This discourse prevents the claims for acknowledgement of discrimination and the acceptance of obesity to be taken seriously.

Most researchers have chosen one way to approach obesity (see also Heyes, 2007; Davis, 1999); however, I will argue that we need both approaches if we want a complete understanding and evaluation of obesity as such. By using medical knowledge, a critical perspective towards mainstream knowledge about obesity, Merleau-Ponty's phenomenology and Foucault's genealogy, this thesis will have a very interdisciplinary approach. Due to the interdisciplinary approach new (theoretical) insights can be provided; hereby my thesis becomes scientifically relevant. Moreover, I will try to build a bridge between Merleau-Ponty and Foucault based on theoretical shortcomings in their theory and I will show how they supplement each other. My research will reveal that these two approaches can and should be used simultaneously in further research. I will argue that instead of focusing on their differences, we should try to learn from their insights and views. Furthermore, my thesis will fill the gap in the literature of social justice concerning obesity. This thesis will provide a basis for further investigation of the discrimination experienced by obese people and the role of the government concerning the prevention of obesity.

1.2. Research question

Merleau-Ponty understands the human being as embodied being-in-the-world. The human being has agency over its actions and can relate to other people as subjects based on their mutual embodiment. Merleau-Ponty's analysis is mainly about the obese body; i.e. the analysis is concerned with the obese bodies. In comparison, Foucault argues that subjectivity is produced by power relations and instead of starting with the subject; we can only understand the human being when we investigate the power structures that have produced the human being. Foucault's analysis is mainly concerned with the social

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construct of obesity; i.e. the analysis is concerned with obesity as such. These approaches seem to contradict one another. However, I will argue that we need both approaches if we want to understand and evaluate obesity. The research question, which will be central in this thesis, will be:

In the light of both Merleau-Ponty's phenomenology and Foucault's genealogy, how can we understand the obese body and how should we evaluate obesity as such?

1.2.1. Chapter outline

In the second chapter I will elaborate on the medical literature about obesity. I will explain which factors cause and contribute to obesity. Obesity is nowadays considered to be a physical disease. According to the medical perspective obesity is detrimental to people's health and can cause various health problems, like diabetes, cardiovascular diseases and sleep apnea2_{. After this, I will discuss the alternative}

perspective on obesity, called critical weight studies. Critical weight studies have been strongly influenced by the fat acceptance movement, which argues against the so called "anti-obesity" discourse. Critical weight scholars argue for more attention for the external factors that facilitate obesity. Furthermore, they argue that social justice should also be concerned with the obesity.

In the third chapter I will elaborate on the question why we need the phenomenological approach from Merleau-Ponty if we want to understand the obese body. I will provide an outline of his main ideas and argue that we should understand the obese body by the experiences of the body. In addition, I will argue that we should understand obesity by the inequality in the environment that has facilitated obesity. Moreover, I will argue that because people have agency over their actions, they can be held responsible for their obese bodies. Lastly, I will put forward the claim that we can recognize each other based on our mutual embodiment; therefore, we can acknowledge the discrimination experienced by obese people.

In the fourth chapter I will discuss why we need the genealogical analysis from Foucault in order to investigate the power structures that produce the concept of obesity and the experience of the obesity. Moreover, I will outline the main findings from Foucault's genealogy and I will illustrate how this applies to obesity. In the light of the genealogical approach we should understand obesity as a deviance from the norm of a slender body. Obesity has become to represent negative personal characteristics. I will conclude that the power structures prevent claims for acknowledgement and acceptance to be taken seriously.

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In the fifth chapter I will argue why we need both a phenomenological analysis as well as a genealogical analysis in order for us to understand and evaluate obesity. I will argue that both approaches are not incommensurable and that both approaches can and should be used simultaneously. That is to say, all our experiences are produced by discourse; however, only investigating the power structures that produce experience is limiting because we need to understand what the effects of these power structures are. Moreover, I will discuss some of the possible explanations why not all people are capable of acquiring the habits necessary to lose weight. Furthermore, I will argue that there are possibilities for resistance within discourse towards the power relations and whether we should resist the discourse. I will conclude that we should acknowledge the claims of discrimination and that we should accept the obese body as another form of bodily diversity. However, that does not mean that we should accept obesity; that is, the government needs to prevent obesity.

In the sixth chapter I will summarize my main findings and some of the shortcomings of this thesis. I will argue that more research needs to be done concerning the structures that facilitate obesity. Moreover, I will conclude that instead of focusing on slenderness, we should be more concerned with the health of our bodies. Furthermore, I will also reveal that there will always be a tension between on the one hand letting people decide on how they want to live their lives and on the other hand caring for the health of the community by preventing obesity.

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2. Obesity

In this chapter I will elaborate on the scientific debate about obesity. I will start by explaining how obesity is defined. After this I will elaborate on the various ways obesity is thought to be detrimental to people's health. In doing so, I will use several overview articles which evaluate the existing medical evidence3_{. To a great extent I will rely on the report from the World Health Organization (WHO) from}

2000. This report critically overviews many influential scientific articles concerning obesity. Furthermore, I will shortly illustrate how this literature influences governmental policy. In the second part of this chapter I will discuss some alternative perspectives on obesity and why we should consider obesity from a perspective of social justice.

2.1. Introduction

In the Western society body weight has become an important indicator for people's health. Losing weight is equated with becoming healthy and maintaining a low body weight is considered to be healthy (Tischner and Malson, 2010). Despite the fact that people are encouraged to lose weight, the current trend shows that the prevalence of obesity is increasing. The increase in general weight has not been restricted to the Western world. Evidence is suggesting that the prevalence of obesity is increasing at an alarming speed all over the world (WHO, 2000, p. 16). Some scientists even speak about an obesity epidemic. The scientific literature agrees that obesity is detrimental for people's health and that obesity can cause various health problems. Kopelman (2000, p. 637), one of the leading researchers in the field of obesity, argues that obesity is becoming almost a bigger threat to health than malnutrition and infectious diseases. What exactly is obesity and how is it defined? What causes obesity and what are the health problems related to obesity?

2.1.1. Definition

Obesity is defined as an excessive amount of fat in a person's body composition. Kopelman (2000) argues that we should approach obesity as a disease ''in which excess body fat has accumulated such that health may be adversely affected'' (p. 636). In clinical settings the way to determine people's body composition is mostly done by the Body Mass Index (BMI). The BMI is calculated by the weight in kilos divided by the person's length in meters squared by two. In formula: BMI = body weight(kg)/length(m)2_.

3 Due to the fact that I am not medically trained I am not in the position to evaluate the quality of medical articles. This is the main reason why I have decided to use overview articles.

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In table 1 we find the specified quantities which are established by the WHO; these quantities classify people's body weight. Someone fits the classification ''obese'' if the BMI is equal to or between 30,0 and 39,9.

The assumption is that the difference in body weight between people from the same height is due to fat mass. However, there are examples where people have a very high BMI due to muscle tissue and not fat. In other words, the calculation of the BMI does not incorporate different kinds of bodily tissues and therefore allows various body compositions between people without any discrimination. The result is that the BMI does not necessarily tell us anything about fat distribution nor does it give us an account of the actual body composition.

Table 1: BMI defined by the WHO expert committee

BMI Classification <18,5 Underweight 18,5-24,9 'Healthy', 'Normal' weight 25,0-29,9 Overweight 30,0-39,9 Obesity ≥40,0 Morbid obesity Source: Kopelman (2000, p. 636).

Nevertheless, it is an easy formula to apply and it can provide a rough estimate of the body composition. Due to this simplicity it is the most used calculation to determine body composition and diagnose obesity. According to Kopelman (2000) the use of the BMI ''allows [for] meaningful comparisons of weight status within and between populations and the identification of individuals and groups at risk of morbidity and mortality'' (p. 635).

2.1.2. What causes excess fat?

The mainstream explanation why people store fat is based on the hypothesis of the "thrifty gene". This hypothesis relates to several empirical findings, which are supported by evolutionary theory (see also Hales and Barker, 2001). The hypothesis states that people store excess energy as fat, in order to survive periods of famine (Spiegelman and Flier, 2001, p. 531). The body has a predisposition to like fat, sugar en salt food. Eating food with (lots of) sugar, fat and/or salt results in feelings of satisfaction and pleasure (Birch, 1999, p. 57). Due to the fact that these high-energy products used to be scarce the body developed the mechanism to typically like these products and to store the energy of these products as fat.

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Kopelman (2000) argues that the global epidemic of obesity has been caused by a combination of different factors. These factors are ''genetic susceptibility4_{, increased availability of high-energy foods}

and decreased requirement for physical activity in modern society'' (Kopelman, 2000, p. 635). Even though it has been established that genes influence body weight, this is not the reason why there has been a global increase in body weight5_{. Spiegelman and Flier (2001, p. 531) point out that the increasing}

availability of (high-energy) food, the increase in (bad) food intake6_{and the lack of exercise in society are}

among the main factors for the increase in the prevalence of obesity. All these factors influence the balance between energy intake and energy expenditure and thus the fat storage in people's bodies.

In sum, if the intake of energy is higher than we expenditure of this energy, our body will store this energy as fat. The amount of calories7_{in the products which we eat and drink represent the energy}

in that specific product. Thus food that contains large amounts of calories contain high-energy levels. We spend energy through physical activity, basal metabolism8_{and adaptive thermogenesis}9_{. Obesity can be}

caused by a minor energy imbalance, which results in weight gain over a long period of time.

2.1.2.1. Physical activity

Researchers have found a strong relation between obesity and low levels of physical activity. As it turns out physical activity is generally responsible for 20% - 50% of our total energy expenditure. Hence, a lack of physical activity contributes to the risk of developing obesity (Warburton et al, 2006, p. 802). Moreover, physical activity is considered to be good for your general health. For example, regular physical activity10_{increases the life expectancy with 1-2 years after the age of 80. Furthermore, routine}

physical activity has a positive effect on psychological wellbeing and on the body composition, i.e. enough physical activity can reduce the intra-abdominal adiposity11_{(Warburton et al, p. 806).}

4 There are some obesity-associated syndromes, which are really rare. Fatness does run in families, but these genes are susceptibility genes. Susceptibility genes only increase the change of developing obesity, but by themselves they are not a sufficient cause of obesity (Kopelman, 2000, p. 637).

5 The population of the developing countries did not all of a sudden get different genes which caused their obesity. 6 The problem with measuring how food/energy intake influences someone's weight is that most self-reports underestimate the actual food intake. Obese individuals underreport their food intake by an average of 30% (Spiegelman and Flier, 2001, p. 531).

7 1 calorie ''is the amount of energy required to raise one gram of water by one degree Celsius'' (Medical News Today, 2014).

8 This refers to the numerous biochemical processes which are necessary to keep us alive. 9 This refers to the expenditure of energy as a result of heating or cooling the body. 10 Burning at least 2000 kcal per week.

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2.1.2.2. Other factors

Culture also has an important influence on the prevalence of obesity. Culture influences the meaning of fat, which influences the extent to which it is thought to be important to lose weight. For example, there is a difference in perception of the obese body between Afro-American women and white women in the United States. Afro-American women, compared to white women, tend to underestimate their obesity due to differences in weight perception, ideal body weight and a knowledge gap about a healthy weight. Together with other factors, this results in a higher prevalence of obesity among Afro-American women compared to white women (Parker et al, 1995). Another example, in traditional societies people tend to be more active and the food supply tends to be more limited. However, the majority of the population has modernized their lifestyle over the past 50-60 years. Due to modernization, more high-energy food has become available. Culture thus affects the food intake and the amount of physical activity, but also the position of the obese body in the society and the desirability to change it (WHO, 2000).

Moreover, studies revealed that high levels of socioeconomic status negatively correlate with obesity in developed countries. In developed countries there is a higher prevalence of obesity among low educated people and people with a low income (Kopelman, 2000, p. 638). The World Health Organization (2000) notes:

In simple terms, obesity is a consequence of an energy imbalance – energy intake exceeds energy expenditure over a considerable period. Many complex and diverse factors can give rise to a positive energy balance, but it is the interaction between a number of these factors, rather than the influence of any single factor, that is thought to be responsible. In contrast to the widely held perception among the public and parts of the scientific and medical communities, it is clear that obesity is not simply a result of over indulgence in highly palatable foods, or of lack of physical activity (p. 101)

Not much attention has been directed to the effects of these factors on the body. Nonetheless, the major contributors to obesity remain the increased proportion of high energy food and the reduction of physical activity.

2.2. Obesity as a problem for health

Obesity has been related to various health problems (WHO, 2000, p. 39). Increases in fat tissue go together with a change in the physiological functioning of the body. Generalized obesity, in which fat is equally distributed among the body, has an influence in the totality of blood volume and cardiac functioning. The intra-abdominal distribution of fat has a major influence on the development of hypertension, but also on the development of insulin resistances and diabetes mellitus. Obesity can also

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cause sleep-breathing problems, due to the excess fat on the chest wall12_{(Kopelman, 2000). Obesity is}

also associated with a disturbance of the endocrine- and metabolic system13_{of the body (WHO, 2000, p.}

51). In The Netherlands around 40% of the new diabetes diagnoses are due to overweight. In addition, overweight is associated with 5% of the prevalence of strokes and one in seven cases of cardiovascular diseases are due to overweight (Visscher et al, 2014). Moreover, obesity is associated with the prevalence of cancer. A major study of 750.000 people that were followed for 12 years showed that the mortality ratios due to cancer where higher among the obese people14_{. However, whether these forms}

of cancer are the caused by obesity or by a bad diet and lack of exercise remains unclear. Nevertheless, these factors often go hand in hand (WHO, 2000, pp. 48-49).

2.2.1. Mortality

Obesity has also been associated with a higher risk of mortality. In The Netherlands average life expectancy of people with obesity is three years lower than people without obesity (Visscher et al, 2014). A meta-analysis of 2.88 million people shows that obesity is related to a higher mortality rate (Kramer et al, 2013, p. 758). Flegal et al (2005) argue that increased mortality is associated with (higher level) obesity, but also with underweight. Even when we take factors like body composition, intra-abdominal adiposity, physical activity, fitness, dietary intake into account there remains a positive relation between body weight and mortality (Kopelman, 2000, p. 636).

2.2.2. Psychological health

Obesity does not only negatively influence the physical health of people; it also negatively influences the psychological health. The psychological problems are not the result of fat, but they are the consequences of the cultural values by which obese people are evaluated. Obesity is an undesirable bodily appearance in the Western culture. Various prejudices towards obese people exist in society. The discrimination that comes along with being obese can eventually lead to depression. For example, teenagers with weight problems also are more likely to experience somber and suicidal thoughts (Visscher et al, 2014). What is more, obese people tend to have a lower experience of their overall health. That is to say, people who are overweight more often report lower experiences of wellbeing15_{(Savelkoul and Harvers, 2014).}

12 For more detailed information see the article from Kopelman (2000) ''Obesity as a medical problem''. 13 The endocrine system regulates the hormones in your body.

14 With a ratio of 1.33 for obese men and 1.55 for obese women.

15 (odds ratios = 1.55, p<0.001). The numbers were corrected by age, gender, education and ethnicity. When the odds ratio is higher than 1, there is a higher chance that someone will experience lower levels of wellbeing (Savelkoul and Harvers, 2014).

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2.2.3. Policy

What does the general medical community advices governments concerning obesity? Various researches (Kopelman, 2000; Mokdad et al, 2003; Warburton et al, 2006) argue that healthy eating and an increase in physical activity should be promoted if we want to prevent and treat obesity. Overall weight loss has been associated with positive effects on health, such as a better lung capacity, less sleep apnea, improved condition of hypertensive patients and improved cholesterol levels. Moreover, weight loss has also been associated with improved psychological well-being (WHO, 2000, pp. 69-74). In addition, it can be beneficial for the government to reduce the prevalence of obesity. Conservative estimates show that around 2 -7% of the total health costs in developed countries are due to obesity (Kopelman, 2000, p. 636; WHO, 2000, pp. 78-79).

Governments are considered to be responsible for the protection of the health of the community by ensuring access to food, good nutrition and by facilitating places for physical activity. The government can have a positive or negative effect on the societal and environmental factors that influence the prevalence of obesity (WHO, 2000, p. 127). However, what should the role of the government be? Should the government prevent and treat obesity? If obesity does not affect other people, why should the government try to prevent people from becoming obese? Is public health more important than the individual freedom to be obese? These question need to be addressed from a political perspective.

2.2.3.1. The Dutch government

The Dutch government tries to support people to become more active and to eat healthier. The aim of is to reduce the prevalence of overweight and obesity. For example, the government supports programs which try to activating people. Moreover, the Dutch government supports the Voedingscentrum (=nutrition center); this center provides people with information about health and food (Rijksoverheid, n.d.).

The main Dutch governmental program to prevent and treat obesity and overweight is called

Alles is Gezondheid (= Everything is Health). This program works as a platform for various institutions to

find each other and work together in order to stimulate people to become more active, to help people eat healthier and in general to increase health in society (Alles is Gezondheid, n.d.). The Dutch government tries to educate and inform people about (the dangers of) overweight and obesity. The Dutch governmental policy is mostly directed towards the individual and his/her responsibility for his/her body and not so much towards the external factors that contribute to prevalence of obesity.

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2.3. Critical weight studies

Cooper (2010) argues that the mainstream obesity literature has made a critical perspective necessary. The critical perspective that emerged is often referred to as ''fat studies'' or ''critical weight studies''. Critical weight studies argue against what they call the ''anti-obesity'' discourse. This ''anti-obesity'' discourse includes the scientific literature which advocates that obesity is detrimental for people's health; it also includes the mainstream media, literature and the government who teach us that excess fat is something we have to get rid of in order to take care of our health (Cooper, 2010, pp. 1020-1021). Moreover, the ''anti-obesity'' discourse includes fat shaming and the expression of negative attitudes towards obese people.

Critical weight studies argue for a broader perspective on obesity, by stressing the importance of the environment and how it influences the health of individuals. For example, Rich et al, (2010) argue that the environment and the life course events are more related to obesity-related health problems than eating and exercising. They argue that it the influence of society on our health is often underestimated. That is to say, critical weight studies argue for more attention for the connection between health and the social and cultural structures that have shaped our understanding of health. Lastly, critical weight studies argue for the acknowledgement of discrimination towards obese people and the acceptance of the obese body.

2.3.1. Fat acceptance movement

Critical weight studies have been influenced by both fat activist researchers and by the fat acceptance movement, such as the National Association to Advance Fat Acceptance (NAAFA) (Wright, 2009, p. 6). The fat acceptance movement is a social movement that advocates for the acceptance of fat (obesity) and fights against the ''fat bias'' in society. One of the main initiatives of the fat acceptance movement is the Health At Every Size (HEAS) community, which argues for the recognition that you can be healthy no matter what your body size is16_{. There are also parts of the fat acceptance movement that focus on the}

appreciation of the obese body. For example, there are many blogs which post pictures and positive stories about fat and obese people17_.

2.3.2. Perspectives

Even though critical weight studies remains a niche in the scientific literature, the amount of literature is growing. Cooper (2010) argues that are three perspectives (or debates) which can be identified in this

16 For more information on the Health At Every Size community see: http://www.haescommunity.org/. 17 See also http://ilovefat.tumblr.com/; https://www.tumblr.com/tagged/fat-acceptance;

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literature. The first perspective is focused on the social construction of fat. The authors in this debate argue that ''anti-obesity'' political concerns are ideologically (by for example patriarchy) driven perspectives. Orbach (1978), Bartky (1990) and Bordo (1993) are among these critics. Nevertheless, the basic assumption remains that obesity is something that should be treated and prevented.

The second perspective is concerned with the commercial aspect connected to obesity. From this perspective it is argued that knowledge about the obesity epidemic is produced by a market strategy from multinational weight loss corporations, which influence governments. One of the leading authors of this perspective is Eric Oliver. He argues that our understanding of the obesity epidemic is driven by the weight loss industries and the pharmacy which want to make profit. Oliver argues that researchers and public health officials are being sponsored by government funding and other funding agencies to proclaim the (dangers of) the obesity epidemic (Raphael, 2007, p. 1207).

The third perspective is concerned with the rhetoric from the mainstream obesity literature. This rhetoric concerns the way the claims made by medical scientists support the (negative) moral attitude towards obesity. From this perspective it is argued that obesity is not as detrimental to people's health as is argued by the medical scientists. Some would even argue that the moral panic about obesity is supported by badly conducted scientific research. I will now discuss some of the points raised by critical weight studies.

2.3.2.1. Mortality and obesity

Campos (2010) argues that the panic about fat has nothing or little to do with actual science. Campos argues, for example, that the higher mortality rates, which are associated with people who are underweight and people who are obese, only slightly differ from the general mortality risk. The underweight category even has a higher mortality rate, even when controlled for reverse causation due to smoking and co-morbidity (Campos, 2010, pp. 39-40). However, the high prevalence of mortality in the underweight category is due to the fact that sick people often lose substantial amounts of weight before they die, hereby significantly influence the mortality rate in this category. Moreover, a substantive amount of evidence shows that, when properly controlled for various factors, a higher weight is associated with a higher mortality rate. Whether the curve is linear or has a U shape does not really matter, because it remains a fact that the lowest mortality risk is associated with a BMI between 18 and 25 (WHO, 2000, p. 46). Furthermore, even if the difference in mortality rate is small, it remains an indication that obesity can increase the risk of mortality.

Even if we do not accept the mainstream evidence, the argument Campos makes is faulted. The fact that the underweight category has a higher mortality rate is no argument against the claim that

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excess weight is associated with a higher mortality risk. An analogy might be useful here. For example, I am a smoker (obese person) and I argue that smoking (being obese) is not so bad for your health, because doing drugs (being underweight) is worse for your health than smoking (being obese). The fact that something else (being underweight) is worse for your health, does not mean that the thing you are doing, like smoking, (or the fact that you are obese) becomes less dangerous for your health. Thus, based on the comparison with the underweight category, we cannot conclude that being obese is not so bad for people's health after all.

2.3.2.2. Supposed causality

Campos (2010, p. 42) also argues that there has not been one causal relation established between body weight and health risks. Nevertheless, correlations found between weight and health risks are presented as causal relations with no actual evidence to support these claim. Nonetheless, Kopelman (2000) clearly summarizes that there is convincing evidence that especially excess fat around the abdomen is very bad for your health. We do know how obesity causes an increase in the chance of getting type 2 diabetes, how obesity influences the cardiovascular functioning and how obesity causes sleep-breathing abnormalities.

Moreover, Kramer et al (2013) argue that even people who are obese and are metabolically healthy are at increased risk of all-cause mortality and cardiovascular events. Obesity is always related to long term negative effects on health, regardless whether that person seems healthy at the moment. The results of the meta-review from Kramer et al (2013) reveal that there is no way of being both obese and healthy in the long term. ''[…] considering a worldwide prevalence of approximately 200 million people with metabolically healthy obesity [..], the absolute risk increase of a 0.7% over 10 to 11 years associated with this condition [..] translates to 1.4 million incident deaths of CV [cardiovascular] events over this time'' (Kramer et al, 2013, p. 767).

2.3.3. Social justice

Next to the focus on the medical knowledge, critical weight studies argue for more attention for obesity from the perspective of social justice. If we commit ourselves to social justice, we have to be aware of cases of exclusion, inequality and disrespect which obese people experience. Monaghan et al (2010) argue that the structural oppression of obese people is legitimized by a victim-blaming ideology. That is to say, obese people are completely responsible for their own health and body size. This process has been referred to as ''civilized oppression''. This civilized oppression might damage the embodied identities, bus also the opportunities obese people have in life. The stigmatization, discrimination and

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marginalization of different body sizes result in inequality, injustice and exclusion of people who are considered obese; this should be a serious consideration for policy makers (Hopkins, 2012, p. 1242).

The specific stigmatization of the obese person is called fat shaming. Fat shaming is a practice which can be specifically found on the Internet. The goal of fat shaming is to make people care for their obese bodies instead of letting obese people victimize themselves as if they are a discriminated ethnic group. Moreover, fat shaming can also be the act of making people feel lazy, worthless and disgusting due to their overweight. Fat shaming and other prejudices in society about obesity can eventually lead to discrimination.

2.3.3.1. Size discrimination

Critical weight studies argue for more attention for the discrimination that obese people experience. Studies reveal that obese people are perceived as unattractive and undesirable. Furthermore, obese people are considered to be lazy, lacking will-power and incompetent (Carr and Friedman, 2005, p. 245). These negative attitudes and prejudices about obese people eventually lead to discrimination of obese people. The NAAFA (n.d.) argues that the discrimination based on size reduces the opportunities in workplace, education and health care for obese people.

The analysis from Carr and Friedman (2005) conclude that the prejudice towards obese people eventually lead to discrimination. Based on an extensive analysis of a survey, conducted among 3.000 adults in the United States, they conclude that ''very obese persons (i.e., with a BMI greater than 35) are more likely than normal weight persons to report major discrimination, interpersonal discrimination, and work-related discrimination'' (p. 253). Carr and Friedman (2005) also found that the experience of discrimination due to obesity is similar across gender, ethnicity, and age. They conclude that obesity has a ''master status'' meaning that is exceeds other characteristics of personal identity. Also Puhl and Brownell (2001, p. 789) argue that there is clear evidence that discrimination of overweight and obese people in various aspects of society.

First of all, Carr and Friedman (2005) conclude that in workplaces obese people experience discrimination. Puhl and Brownell (2001) also argue that studies have shown that there is a hiring bias towards overweight and obese people. That is, people report that they are more likely to hire a thin person than an overweight people with the same qualifications. Moreover, Roehling (1999) argues that overweight employers are assumed to be less competent, lazy, less skilled and to have less emotional skills; this results in discrimination of obese people in employment settings. Moreover, some obese people report that they were fired because of their obesity (Puhl and Brownell, 2001, p. 790).

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Next to discrimination in employment settings, there is also discrimination in educational settings experienced by obese people. Studies show that the negative attitude towards obese children has been increasing in the past 40 years (Puhl and Brownell, 2001, p. 795). For example, there have been reports from students who were dismissed from college due to their weight (Puhl and Brownell, 2001, 797). Furthermore, teachers tend to have lower expectations from obese children (NAAFA, n.d.). Also, overweight children and adolescents are more likely to be bullied and teased than their peers. Both verbally as physically forms of teasing has been directed to obese children by their peers (Puhl et al, 2011, p. 702).

These negatives attitudes have also influenced the opinions from health care professionals as the study by Teachman and Brownell (2001) reveals. They argue that there is a strong implicit bias towards obese people among health care professionals. These negative attitudes can influence the treatment of obese people. Furthermore, they conclude that these negative attitudes are directed to obese people rather than being limited to obesity as such. Schwartz et al (2003) even conclude that researches who specialize in obesity have very strong prejudices towards obese people. That is, they associated obese people (in both implicit and explicit ways) with lazy, stupid and even worthless people18_{. These}

prejudices can deter obese people from looking for medical care when needed; this could prevent early detection and treatment of medical problems and obesity. With the result that the health care costs eventually only increase.

Carr and Friedman (2005, p. 254) conclude that instead of only focusing at the obese individual to combat obesity, policy should also be concerned with the people who are ''doing the discriminating'', because the discrimination can be harmful. Discrimination could deter people from seeking medical help for their problems, or it can discourage people to lose weight. Moreover, prejudice and discrimination result in negative self-perceptions of obese people and lower self-esteem. Likewise, weight discrimination tends to increase people's food intake and decrease people's physical activities; hereby increasing the prevalence of obesity (Sutin and Terracciano, 2013, p. 3).

2.4. Conclusion

The mainstream literature is unanimous about the fact that obesity is detrimental to people's health. If people want to lose weight they should change their diet and start exercising. Moreover, a healthy diet and enough exercise are beneficial for the overall health of people. If we want to prevent and treat obesity governmental policy should promote a healthy diet and physical activity. We can see that the

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Dutch government has an extensive health program to help people reduce weight and to promote people to become more physically active. Nevertheless, these policy programs do not take into account the influence which the environment has on the prevalence of obesity. In the next chapter I will argue that we should be more concerned with the structures in society that facilitate obesity.

In light of this mainstream literature there has emerged a critical perspective, called critical weight studies. The critical perspective argues against the ''anti-obesity'' discourse. However, some of the medical claims made by the critical weight studies are based on logical fallacies. Moreover, the majority of evidence directs to the detrimental effects of obesity to people's health. Therefore, I will not accept the alternative view which argues obesity is not detrimental to people's health. Nevertheless, critical studies have rightly argued for more attention for obesity from the perspective of social justice.

This chapter has revealed that obese people experience discrimination on a daily basis. In the following chapters I will discuss whether we should acknowledge the experiences of discrimination and on what ground we should acknowledge those experiences. Moreover, I will investigate how the power structures in society shape these experiences. Furthermore, I will investigate, from the perspective of social justice, whether we should accept obesity. By answering these questions more can also be said about the position the government should take towards obesity.

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3. Merleau-Ponty

In this chapter I will discuss the mind-body problem and how phenomenology has tried to give an answer to this problem. I will use the phenomenology of Merleau-Ponty to analyze the obese body, because this way of analyzing provides us with tools to investigate the body; this is something many philosophical theories do not offer. Furthermore, I will discuss the notion of the anonymous body and how our mutual embodiment enables us to recognize each other as subjects. After this I will discuss some points of criticism that have been directed towards Merleau-Ponty's phenomenology. Lastly, I will argue that the discrimination of obese people can be acknowledged as a moral injury on the basis of our mutual embodiment.

3.1. Introduction

In western philosophy the body has often been considered something alien. The focus of most philosophers has been on cutting the body loose from the soul. Plato (427 BC- 348 BC) already spoke about the body as the dungeon for the soul. For Plato the soul is what you are and the body is what you have. Throughout the Christian tradition the body remained an obstacle that needed to be overcome (Slatman, 2008).

3.1.1. Dualism

During the Enlightenment René Descartes (1596-1650) developed a new philosophy which was based on what Descartes thought to be the only thing we can know for certain: "cogito ergo sum''. Descartes argued that I can doubt almost everything; however, the only thing that cannot be doubted was the fact that I am experiencing my experiences (Lewis and Staehler, 2010, p. 7). The mind was considered to be the rational thinking substance and the body material substance which was subjected to natural laws (Price and Schildrick, 1999, p. 2). The notion that people consisted of a mind and a body was picked up by philosophers as the mind-body problem; i.e. in the case where both mind and body are completely different substances, how can it be possible for them to interact? Nevertheless, the mind-body distinction remained a highly discussed problem in philosophy for a long time.

3.1.2. Phenomenology

In the beginning of the 20th century Husserl tried to move beyond the dualistic understanding of human beings with his phenomenology (Taylor, 1999, p. 208). Phenomenology studies the phenomena that appear in our consciousness. Edmund Husserl, Martin Heidegger, Jean-Paul Sartre, Maurice

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Merleau-Ponty and Simone de Beauvoir made significant contributions to the phenomenological tradition (Lewis and Staehler, 2010).

For the analysis of obesity I will use the phenomenology of Merleau-Ponty, but why should we use his phenomenology? Firstly, Merleau-Ponty's phenomenology allows us to consider actual experiences of the material body and how these experiences shape our identity. Secondly, because Merleau-Ponty argues that people should always be understood in relation with the world; that is, his analysis also focuses on the (social) environment in which subjects find themselves. This allows us to investigate in what sense the environment influences bodies and experiences. Thirdly, Merleau-Ponty argues that human beings are intentional beings which can carry out projects towards the world. Human beings have agency over their interaction with the world and with other people. We need to have some notion of agency in order to understand why people are motivated to lose weight or why people would resist certain norms in society. Fourthly, the phenomenological account of embodiment provides us with an analysis in which matter and meaning are intertwined. Both the material and the meaning which the material has for us can be investigated. This will also help us understand how the material of the body and the structures that shape the body give our decisions meaning.

For my analysis I will use Merleau-Ponty's book Phenomenology of Perception (1945/2002). In this book Merleau-Ponty fully develops his concept of embodied subjectivism19_{. I will support my}

interpretation of Merleau-Ponty's work with the Routledge Guidebook Merleau-Ponty and

Phenomenology of Perception (2011) written by Komarine Romdenh-Romluc. She explains

Merleau-Ponty in clear terms and with relevant examples20_.

3.2. Phenomenology of Perception

In this part I will discuss Merleau-Ponty's book Phenomenology of Perception (2002). I will firstly summarize some of the points of critique that Merleau-Ponty had on empiricism and intellectualism. These points of critique are important because they show us how scientists and philosophers have approached the body. Moreover, this analysis will shed light on the ways we should not approach the obese body, according to Merleau-Ponty. After this I will discuss the role of the body in Merleau-Ponty's

19 Levin (2008) explains that in The Structure of Behavior (1942) Merleau-Ponty starts developing a non-dualistic account of embodied subjectivism. However, in that book he had not yet completely developed his notion of embodied subjectivism. Levin (2008) argues that Merleau-Ponty's later work The Visible and the Invisible (published posthumously in 1964) is more concerned with the ontology of embodied subjectivism. However, I am mostly concerned with the experience and not so much with the ontology of embodied subjectivism.

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phenomenology. From then on I will argue that the embodied subject has agency. Lastly, I will discuss the position of other subjects and the notion of the anonymous body as the basis for intersubjectivity.

3.2.1. Empiricism

Merleau-Ponty argues that empiricists (amongst them many scientists) objectify bodies in order to understand human beings. Empiricists theorize that the body is consists of compartments that work together in causal relations; i.e. human beings can be completely understood by their physiological properties (Romdenh-Romluc, 2011). Merleau-Ponty (2002, pp. 60-63) argues that the lived body cannot escape the implications made by empiricists; i.e. experience is brought back to mere chemical processes. The relation between the body and the world is reduced to physiological and psychological mechanisms. Also within the cognitive sciences, psychiatry and philosophy of mind, there is a growing tendency towards neuroreductionism, i.e. holding the view that everything, including feelings, beliefs, desires, thought, emotion, and so forth are in fact ''nothing more'' than just to neurophysiological processes and are fully reducible to it as such.

Merleau-Ponty argues that the experience of the cultural world cannot be explained by the conceptual framework of empiricism (Merleau-Ponty, 2002, pp. 27-28). For empiricists only objective properties are under investigation, they thereby neglect the disapproval which I might feel when I see an obese person. Merleau-Ponty (2002) concludes that empiricism does not do justice to the way we understand the world and ourselves. We do not understand ourselves as pure material objects in which chemical processes take place. Moreover, we do not understand ourselves in neuroreductionistic terms.

3.2.1.1. ''Genetically obese''

Some people, including obese people, use these kind of reductions or ''objective interpretations'' of the body as an excuse to escape moral responsibility. It is often argued by obese people that it is not their fault that they are obese. That is to say, they argue that they have certain genetic predispositions or some other kind of underlying (perhaps unexplained) medical condition that cause obesity. They argue that all kind of biological properties (e.g. genetics, neurophysiology and metabolism) fully determine what they look like and what size their body has. They state that it is beyond their control that they are obese because they cannot influence these properties.

However, these claims are obviously flawed since there are no actual epistemological grounds that could possibly support these claims. For example, people have no way of knowing their genetics because they do not have access to their genetics. Moreover, these claims are generalizations of certain empirical propositions and therefore cannot be used as an explanation of people's obesity. An analogy

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might be useful here. A majority of people suffering from depression respond well to a group of psychopharmaca who increase the serotonins levels. Due to this some people suffering from depression argue that it is caused by some kind of neurochemical imbalance which they cannot influence. The logical fallacy is striking if we apply the same kind of ''reasoning'' to introvert personalities. Most people that are considered introvert become extravert by consuming alcohol, thus introvert personalities are caused by a chronic lack of alcohol in the bloodstream (see Dehue 2010). We only know that there are certain similarities in the genetic structuring between obese people, however that gives us no reason to argue obesity is caused genetically. We cannot conclude that obesity is caused by genetics. In conclusion, there is no logical nor epistemological ground for us to assume genetics caused certain people to become obese, thus we have no ground to assume that these people cannot help themselves being obese nor do we have ground to argue that they are not responsible for their body.

3.2.2. Intellectualism

Contrary to empiricists, intellectualists argue that consciousness should not be understood as an object among other objects. All things in the world are causally determined; consciousness cannot be a thing in the world, because it is not causally determined (Romdenh-Romluc, 2011, p. 54). Intellectualists locate people's identity (consciousness) outside of the body, i.e. they separate the body from the mind. Merleau-Ponty argues that when I try to think this dualism and see my body from a third person perspective it does not make any sense. I can only think of seeing and moving when I experience my body. The experience of our body cannot be disconnected from the body; i.e. our identity is an embodied identity (Merleau-Ponty, 1997, pp. 246-247).

3.2.2.1. Changing fat identities

Within the fat acceptance movement there is also a tendency to disconnect identity from the body. Marilyn Wann, the leader of the Fat Acceptance movement called ''Fat?So!'', tries to change people's experience of their obese body by arguing that people should rationally change their experience of their obese body. In other words, Wann argues that obese people should be proud of their fat (and obese body). Obese people should celebrate fat as (part of) their identity instead of feeling shame towards this fat. She argues that people should consider their fat as a positive and valuable aspect of their identity.

However, I would argue just like Murray (2005), that Wann hereby completely neglects that people have embodied identities. Wann argues for rational control over our identity, but we cannot disconnect our identity from our body. That is to say, if we experience our body as an obstacle or "offensive'' we cannot rationally change that experience by just thinking positively about the body

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(Murray, 2005)."Because I AM my body, and this understanding is always informed by cultural imaginings about bodies. My body and fat and my self are inextricably bound up in producing and reproducing my identity, which is always already corporeal" (Murray, 2005, p. 276). In sum, both empiricism and intellectualism do not offer us a correct understanding of the human being. Human subjectivity is not objective, neither is it outside of the world. We can only understand human beings as embodied subjects in relation to the world.

3.3. The body

The body plays a central role in the phenomenology from Merleau-Ponty. The body is not something that I identify with because I recognize the body as the bearer of my sensations. The fact that I attribute my sensations to the body presupposes identification with the body. I already identify myself with my body before I experience my body, i.e. I am my body. Therefore, Merleau-Ponty argues that we can never completely objectify our body. When my left hand touches my right hand I am touching and being touched at the same time, therefore my own body cannot be just an object for me. Moreover, I cannot observe my body the same way I observe external objects, because to do that I would need a second body (Merleau-Ponty, 2002, pp. 105-107).

3.3.1. Embodied being-in-the-world

Merleau-Ponty (2002) argues that the body perceives the world and through our body we are in the world. The body is constantly directed towards and in communication with the world. The objects that surround the embodied subject are not just objects with certain qualities. These are objects that ''invite'' the embodied subject to act. For example, something looks eatable or kickable and thus invites the subject to act in those ways (Romdenh-Romluc, 2011, pp. 74-76).

3.3.1.1. Obese being-in-the-world

In what way the immediate context is inviting the embodied subject is, according to Toombs (2002), closely linked to someone's own physique. Whether something looks kickable or touchable depends on the capacity of the body. For example, when someone is severely obese the ball might not look kickable, because the person cannot stand on his/her legs. The interaction with the environment can vary due to the materiality of the body.

The environment also generates different experiences of the body. Hopkins (2012) investigates how experience of body size is negotiated through different spaces and at different times. For example, going shopping, eating out for lunch or talking to other people, all influence the experience of the body.

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Places like restaurants influence the experiences of the body size, i.e. causing uncomfortable feelings and making people very conscious of their body. Some obese people even avoid such situations where others would closely watch what they are eating. Shopping causes the most bodily-awareness for obese people. Especially clothes sizes and not being able to fit clothes can cause negative feelings about the body. These experiences however, are not per se generalisable experiences. Hopkins (2012) concludes that the emotional reactions of obese people to these situations varied intensely. Some experiencing a sense of exclusion on a regular basis while others felt extremely anxious. Nevertheless, there is a tendency for negative experiences of the obese body.

3.3.1.2. Influenced decisions

Embodied being-in-the-world also means that the environment in which we live influences our decision and choices. Merleau-Ponty (2002) argues that the choices we make in our lives are always dependent on what is already given. My environment, my character and my past all influence the choices that I make. The culture in which people live has a great influence in the food choices people make. Cultural history shapes dietary habits, cooking style and attitude towards food. For example, the cultural history of African Americans has influenced their diet in such a way that it now contains a relative high fat intake, high calorie intake, high amounts of salt and low amounts of vegetables, fibers and grains (James, 2004). Also education influences the food choices people make. In The Netherlands the prevalence of obesity is the highest among lower educated people. In the past 20 years there has been an increase in overweight in all the educational classes. However, the percentage of overweight people remains the highest among the lower educated group (see also Savelkoul and Uiters, 2014 and Wardle et al, 2002).

Furthermore, the influences of the social structures the chance of becoming obese is also influenced by the actual environment people find themselves in. Booth et al (2005) and Popkin et al (2005) argue that the specific built environment21_{in which people live has a major influence on the available options}

for physical activity and healthy food. For example, mostly low socioeconomic areas have a larger number of fast food restaurants which promote unhealthy food choices. Furthermore, in the lower socioeconomic areas less healthy food shops and options for physical activity are available than in the higher socioeconomic neighborhoods. This could partly explain why the prevalence of obesity (in Western countries) is higher among lower socioeconomic regions. In sum, the (social) environment thus has a significant influence on the possibilities people have in their lives. However, that does not

Acceptance and acknowledgement: obesity and the discrimination against obese people analyzed from an interdisciplinary perspective. Merleau-Ponty's phenomenology and Foucault's genealogy as an explanatory framework