removing the need for physical exertion. The first explanation leads to
blaming overweight people for their own condition. The second offers
opportunities for disciplining the food industry, which following the
anti-tobacco movement is labeled “big food.” Especially with regard to
individual citizens the conclusion seems warranted that medicalizing
fatness adds opportunities for stigmatization and discrimination beyond
those offered by conceptions of beauty and fitness. This causes a double
bind for governments that want to fight both obesity and stigmatization.
Keywords:Stigmatization; discrimination; medicalization; lifestyle;
obesity; fatINTRODUCTION
Social scientistsespecially social constructivistsconcerned with social
problems typically hold that medicalization tends to relieve “patients” from
personal responsibility for their “disease.” According to Best for instance,
“we think of (...) diseases as striking vulnerable individuals who should not
be considered responsible for getting sick” ( 2008 ,p. 35). In this contribu-
tion I want to challenge this notion by proposing that in the case of welfare
diseases it is less likely that “patients” are seen as innocent and vulnerable
with regard to their “disease.”
Welfare diseases have been constructed by public health experts from
the1960s and 1970s. With communicable diseases declining as a source of
illness and death increasingly people suffered from non-communicable dis-
eases (NCDs) such as cancer or cardiovascular disease. By labeling such
“new” diseases “welfare disease” their “cause” was located in the social
conditions of the welfare states of the 1970s. In many cases the social con-
ditions that “cause” these diseases have to do with general patters in every-
day behavior. This is why “welfare diseases” are often also labeled
“lifestyle diseases.” So it is the modern habitat with its common lifestyles
that lie at the root of the non-communicable “welfare diseases.”^1
In this contribution I shall focus on “obesity” which is also often
referred to as “overweight.” Especially the common usage of “obesity”
signifies that “being too fat” has been medicalized. Since the mid-1980s
obesity is officially considered to be a welfare and lifestyle disease in its
own right. Before that time it was considered a “risk factor” for such dis-
eases. Discussing the rise of obesity to its present global prominence I shall
refer to the World health Organization (WHO). However I shall mainly
118 ROEL PIETERMAN