Fat and (Un)Healthy: A Dramaturgical Analysis of Health, Lifestyle, and Body Size in Healthcare Settings

Abstract

The assumption that a person’s weight has a direct link to their overall health and wellbeing, and that the fat body is (un)made through lifestyle behaviours are pervasive beliefs in Aotearoa New Zealand. Applying a sociological lens to issues of healthcare, particularly the meanings of ‘fat’ and ‘healthy’, illuminate how these beliefs contribute to a stigmatising healthcare environment, in which fat people must navigate presumptions about their health status and lifestyle habits in the process of accessing care (Lee and Pausé, Frontiers in Psychology, 7, 1–15, 2016). Drawing on Goffman’s dramaturgical approach, this chapter uses a sociological analysis to explore the ways that fat people effectively perform ‘health’ in healthcare settings. I begin by articulating the ways in which health is performative: the notion of ‘healthy lifestyles’ sets out a ‘health’ playbook of sorts, by establishing sets of behaviours, language, and dress—or, ways of acting, sounding, and looking healthy—that citizens actively engage in, in order to communicate their status as ‘healthy’. Using Goffman’s approach, explicit references to healthy eating, dieting and exercise habits can be understood as ways in which fat people ‘perform’ health in order to overcome the stigmatising barriers they face in healthcare. Such insights into the experiences of self-identified fat people highlight how a convincing health ‘performance’ can be a fundamental part of accessing treatment, tests, or advocacy, and demonstrate how a novel application of sociological analysis in clinical settings can illuminate the impact of stigma on healthcare delivery and receipt, and thus contribute to changes that lead to more equitable health outcomes.