Public health in the making: Dietary innovators and their on-the-job sociology. (July 2022)

• Record Type: Journal Article
• Authors: Cupit, Caroline
• Is Part Of: Social science & medicine. Volume 305(2022)
• Publication Date: 2022-07
• Subjects: Public health -- Obesity -- Obesity epidemic -- Materialist sociology -- Institutional ethnography -- Social organisation -- Nutrition -- Diet -- Innovation -- On-the-job sociology -- Fat activism -- Health promotion -- Food industry -- Pharmaceutical industry -- Blame/shame -- Knowledge landscape -- Institutional discourse; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2022.115001
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Diet is understood to be one of the most important influences on public health and chronic disease, and is particularly implicated in the so-called 'obesity epidemic'. Yet interventions aiming to improve the population's dietary habits have failed to translate into widespread health improvements. Simultaneously, the knowledge landscape has become increasingly contentious, with fat activism challenging dominant approaches to how obesity is framed and addressed. This paper is based on 24 ethnographic interviews, and explores the work of health practitioners promoting therapeutic carbohydrate restriction ('low-carb' diets) for people with metabolic health conditions. Drawing on Michel Callon's study of technological innovation, I show practitioners engaging in 'on-the-job sociology'—situated sociological work to justify, and forge a space for, innovative dietary intervention. These innovators employ physiological explanations of hormones, satiety (or hunger), and pleasure (or shame), supported with personal experience, to emphasise material connections between particular eating habits and the sustainability of dietary improvement in everyday life. They resist fat activist influence on healthcare practice (that has resulted in practitioners avoiding conversations about diet, fatness and health), as well as the more extensively critiqued practices of health promotion. Deflecting blame/shame from individuals, innovators spotlight the role of the food industry in undermining public understandings of food and physiology, and dietary improvement that is achievable and sustainable. Through on-the-job sociology, innovators forge a space to engage patients in collaborative dietary experimentation and improvement. This study highlights the importance of on-the-job sociology in the contemporary knowledge landscape, providing new insights about public health in the making. Highlights: Supporting sustainable dietary change has proved difficult in healthcare practice. Innovator practitioners promote low-carb dietary technology for metabolic conditions. Innovators use 'on-the-job sociology' to link physiology and dietary sustainability. On-the-job sociology resists health promotion, fat activist and industry regimes. On-the-job sociology creates space for collaborative dietary work with patients.