Managing blame in NHS weight management treatment: Psychologizing weight and ‘obesity’

Abstract

Weight management services in the UK's National Health Service (NHS) are on the increase, partly due to rising rates of patients classified as ‘obese’. Those attending such services are held accountable, on some level, for their weight, although this issue is rarely addressed in clinical research in this area. By contrast, critical social research on ‘obesity’ considers blame a prominent issue though has yet to examine this in situ, in interactions between patients and health professionals. This paper uses discursive psychology to examine how blame is managed in the turn-by-turn interaction in group meetings within NHS weight management treatment. The data corpus comprises of digital audio recordings of 27 discussion-based group meetings between patients and practitioners in a specialist weight-management service in central Scotland. The analysis focuses on those moments in which patients appear to resist the notion that they are responsible for their weight gain. Such moments are typically managed by patients in one of two ways: By denying having performed the blameworthy activity, or locating the blame as outside of individual control. Both strategies, however, rely on an individualistic concept of weight that reifies the medical model, while at the same time, troubling that model and its efficacy. The paper concludes with a consideration of the implications of these discursive practices and their relevance within the field. Copyright © 2009 John Wiley & Sons, Ltd.