Food and Health

Tanja Schneider
University of St. Gallen, Switzerland; University of Oxford, UK
This is a pre-print of a forthcoming entry, to be published in:
The Blackwell Encyclopedia of Sociology (2nd edition), edited by G. Ritzer and C. Rojek.

Abstract

In many parts of the world the relationship between food and health is predominately
defined by a nutritional and medical discourse today. This discourse focuses on food
intake as a core determinant of individual bodily and mental health, prevention of
under or overweight, and of future diseases. Sociologists and other social scientists,
however, have a broader understanding of the relationship between food and health
and emphasize how cultural meanings and beliefs as well as social structures and
institutions such as education, media, law, politics, and economy shape food practices.
The aim of sociological research, reviewed here, is to understand the conditions of
possibility for the emergence and prominence of a medical nutrition discourse on food
and health and what it tells us about contemporary society.

Keywords: biopolitics of health; food; health; healthism; medicalization; nutritionism
In many parts of the world the relationship between food and health is today
predominately defined by a nutritional and medical discourse. This discourse focuses
on food intake as a core determinant of individual bodily and mental health,
prevention of under or overweight, and of future diseases. The prominence and
adoption of this discourse becomes apparent when not merely nutritionists but also
television chefs, advertisers, and eaters routinely talk about food and eating
employing nutritional terminology such as calories, protein, carbohydrates, vitamins,
minerals, or fibre, and remark on the positive health effects of these nutrients as well
as other food ingredients. Sociologists and other social scientists, however, have a
broader understanding of the relationship between food and health and emphasize
how cultural meanings and beliefs as well as social structures and institutions such as
education, media, law, politics, and economy shape food practices (e.g., Carolan,
2016; Lupton, 1996; Mennell, Murcott, and van Otterloo, 1993). Relatedly,
sociologists and many other researchers and practitioners emphasize the role that
access to, availability of, and affordability of food plays.

Over the last decades, many sociologists have made important interventions to
sociohistorically and socioculturally situate the close entanglement of food, nutrition,
and health, have interrogated what is meant by healthy food and/or healthy eating, and
have emphasized the complexity of the relationship between food and health beyond
nutrition. Although many sociologists would certainly not deny that a balanced diet is
important for an individual’s health in general, they emphasize that eating is not
simply an individual act, an issue of personal choice, or a private habit. On the
contrary, many sociologists of food and eating argue that taste is social, by which they
mean that learned and implicitly shared class-based social and cultural values guideindividual eating practices (Bourdieu, 1984 [1979]).

The aim of sociological
contributions, reviewed here, is to understand the conditions of possibility for the
emergence and prominence of a medical nutrition discourse on food and health and
what it tells us about contemporary society.

A number of sociologists assert that we are witnessing an increasing
medicalization of food. Medicalization (Conrad, 1992; Illich, 1975) is a process
whereby human conditions (e.g., body size) or behaviors (e.g., eating) have come to
be defined and treated as medical issues rather than, as they would suggest, social
problems. The process of medicalizing food is closely related to a “new” moralization
of health that sociologist Robert Crawford (1980) describes as “healthism.” Healthism
is an extreme health consciousness, in particular among members of the middle class
for whom health has become a “super value,” that is, health is not only an end in itself
but healthism is a means, a way of life, to continuously work on maintaining and
achieving health. Crawford argues that good health has become a way to signal one’s
capacity for self-control and by extension one’s qualities to resist material temptations
in a consumer society. Pursuing a healthy lifestyle, however, obliges individuals to
acquire a profound understanding of how certain products and practices affect their
health, with eating but also physical activity featuring prominently. At the same time,
producers and providers of food respond to and drive this development, indicating the
healthiness of food products through certification schemes, food labels, and
nutritional claims seeking to provide individuals with information on the basis of
which they can make healthy choices.

Georgy Scrinis (2015) describes this accentuated attention to nutrient content
in the production, marketing, and consumption of food as nutritionism or nutritional
reductionism. Scrinis views the popular acceptance of the “ideology of nutritionism”
as closely connected to the increasing consumption of highly processed foods and to
the nutritional anxieties that these foods provoke. More generally, he problematizes a
strong “focus on the nutrient composition of foods as the means for understanding
their healthfulness, as well as…a reductive interpretation of the role of these nutrients
in bodily health” (Scrinis, 2015: 16). Such a reductionist perspective on food and
eating, stemming from nutrition science but readily taken up by the food industry and
supported by many states in their public health efforts (Nestle, 2013), Scrinis
proposes, complicates other understandings and engagements with food, including
traditional and cultural knowledge of food, or people’s sensual and practical
experiences with food.

Medicalization, healthism, and nutritionism are important analytical concepts
in understanding and analyzing the relationship between food, bodies, and health from
a sociological perspective. Another central perspective for studying these intricate
relationships focuses on the “biopolitics of eating”; an approach taking inspiration
from French philosopher Michel Foucault’s body of work. In particular, John
Coveney (2006) has demonstrated the importance of considering human food habits
from a Foucauldian perspective, stating that “since the time of the early Greeks, there
has been a moral problematization of food and pleasure. What has changed, however,
has been the particular ethics employed to deal with this problem” (p. 90). Coveney
suggests that today’s ethical stance toward eating well is based on a medical and
scientific discourse that situates nutritional principles as fundamental to individuals’
appropriate food choices. The discourse of nutrition, according to Coveney,
encourages individuals to constitute themselves as ethical subjects through aligning
their dietary choices with authoritative recommendations such as, for instance,
nutrition guidelines. Those who fail for various reasons to take on this form of self3
care and responsibility are considered to not act in their own best interest and to pose
a (future) burden for society in terms of potential healthcare costs.

Building on and taking inspiration from Foucault’s later work and Coveney’s
application to nutrition, a number of food researchers have turned to empirically
examining how individuals are invited to “manage themselves” on the basis of
nutritional knowledge. Many of these studies consider how public health campaigns,
food advertising, diet books, and media reportage play in promoting particular foods
and food practices as healthy and how these convey ideas of (gendered, class, and
race-based) ideal body norms. In this body of research, the “healthy food consumer”
(Schneider and Davis, 2010) is analyzed as a contemporary manifestation of the
“enterprising self” (Rose, 1992) – an active self that is expected to live in a healthaware
way and to rigorously avoid health risks. Such a lifestyle involves constant
self-monitoring (nowadays possibly aided by dietary but also other self-tracking
technologies), and can be interpreted as an embodiment of health prevention efforts.
This newly emerging subject category of the “healthy food consumer” or “nutricentric
consumer” (Scrinis, 2013) is in accord with advanced liberal or neoliberal modes of
government, which operate through technologies of governance that “govern at a
distance.” The nutrition discourse plays a pivotal role in guiding consumers’ or eaters’
self-governance as the discourse’s effects of truth is closely linked to its scientific and
institutional basis.

Yet other studies focus on how people navigate nutritional ideals and
responsibilities in everyday life, or discuss the challenges of maintaining a healthy
diet in a consumer society with abundant and cheap food supply. In particular,
ethnographic research has contributed to a nuanced understanding of the lived reality
of healthy eating in communities of lower socioeconomic status, which are frequently
targeted through public health efforts as in need of nutritional education. For instance,
Warin and colleagues (2015), studying the eating practices of families from low
socioeconomic status communities in a South Australian city, emphasize that
“unhealthy” eating needs to be understood in a context of food poverty and hunger in
which messages to “consume less” and of “making the right food choices” exacerbate
individual and thereby “social suffering” (Bourdieu, 2000 [1993]). Another study, by
Stead et al. (2011), shows how the consumption of brand-name processed foods
among working-class youth in the United Kingdom is a way to signal their social
identity and to subvert the stigma of poverty. These findings pose an interesting
paradox, as for these teenagers “eating healthy” (as stipulated by public health
guidelines) is affectively experienced as “unhealthy.” This raises important questions
for public health that are not limited to reconsidering how best speak to different
social constituencies but, more importantly, ask for a problematization and
reconsideration of the categorization of food as healthy or unhealthy without taking
into account the wider social, cultural, economic, and political context.

Despite this growing research into un/healthy eating practices and the issues this moralization of eating poses for socioeconomically disadvantaged groups, women,
or people of color, a key challenge remains: the difficulty of critiquing and
challenging the imperative of “choosing health” (Cairns and Johnston, 2015), as to eat
healthily is perceived to be acting morally responsibly and personally empowering.
Why would sociologists or anyone be against health (Metzl and Kirkland, 2010)? The
reviewed sociological research reveals that an individualization of health, that is, the
view that one’s health depends on one’s personal dietary choices, is problematic for
several reasons.

First, it is a reductionist perspective that focuses primarily, if not
exclusively, on the relationship between food intake and bodily health and thus eschews any attention to the social, economic, and political conditions in which
individuals (have to) make choices. Second, such a perspective often focuses on
educating consumers on how to make “healthy” choices at the detriment of other
measures, which, third, is highly likely to result in blaming individuals for any
illnesses that are perceived as related to their diet, which they did not prevent by
making the “healthy” choices (on the topic of obesity, see, for instance, Guthman,
2011). Fourth, a likely effect of such an understanding of the relationship between
food and health is the increasing attention to and funding of food technology
innovation that can offer individualized dietary solutions (e.g., functional foods,
Soylent, personalized nutrition) at the detriment of public health intervention (e.g.,
iodized salt) or regulatory changes (e.g., salt content of processed food) that affect all
food producers and consumers in a specific society.

Fifth, the increasing emphasis on
the individual’s nutritional self-responsibility for health goes hand in hand with a
potential for decreasing state and public responsibility for providing social, economic,
or public health policies and funding.

Beyond critiquing nutrition and problematizing a reductionist approach to
food and health, some food scholars have called for “doing nutrition differently”
(Hayes-Conroy and Hayes-Conroy, 2013). Jessica and Allison Hayes-Conroy propose
a “project of diverse nutritions,” asking, “how might academics, professionals and
activists begin to perform new nutritional worlds, starting with an ontology of
nutritional difference” (2013: 6, emphasis original)?

For them and others this ranges from envisioning different practices for making nutritional information available and
distributing it, developing new frameworks for thinking about and engaging with food,
to asking how (nutrition) science can be done differently (Hayes-Conroy et al., 2014).
Moreover, they are interested in studying how “everyday people…creatively re-think
and re-enact nutrition” (Hayes-Conroy and Hayes-Conroy, 2013: 6).

This research agenda opens up new and underexplored fields of study for sociologists of food, such
as examining the activities of food hackers, how citizen science might be contributing
to nutrition science, or how dietary self-tracking technologies are reappropriated by
users. These and other practices of “digital food activism” (Schneider et al., 2018)
have the potential to enact new relationships between food and health but require
critical scholarly attention to better understand the power relations embedded in new
(digital) productions of food and health knowledge.

SEE ALSO: Bourdieu, Pierre (1930-2002); Consumer Society; Foucault, Michel
(1926-1984); Food; Habitus/Field; Health; Health and Social Class; Health Lifestyles;

Medicalization
References

Bourdieu, P. (1984 [1979]) Distinction: A Social Critique of the Judgement of Taste,
Harvard University Press, Cambridge, MA.
Bourdieu, P. (2000 [1993]) The Weight of the World: Social Suffering in
Contemporary Society, Stanford University Press, Stanford, CA.
Cairns, K. and Johnston, J. (2015) Choosing health: embodied neoliberalism,
postfeminism, and the “do-diet”. Theory and Society, 44 (2), 153–175.
Carolan, M. (2016) The Sociology of Food and Agriculture, Routledge, London.
5
Conrad, P. (1992) Medicalization and social control. Annual Review of Sociology,
18, 209–232.
Coveney, J (2006) Food, Morals and Meaning. The Pleasure and Anxiety of Eating,
Routledge, London.
Crawford, R. (1980) Healthism and the medicalization of everyday life.
International Journal of Health Services, 10 (3), 365–388.
Guthman, J. (2011) Weighing In: Obesity, Food Justice, and the Limits of Capitalism,
University of California Press, Berkeley, CA.
Hayes-Conroy, A. and Hayes-Conroy, J. (eds) (2013) Doing Nutrition Differently,
Routledge, London.

Hayes-Conroy, J., Hite, A., Klein, K., et al. (2014) Doing nutrition differently.
Gastronomica: The Journal of Critical Food Studies, 14 (3), 56–66.
Illich, I. (1975) Limits to Medicine: Medical Nemesis: The Expropriation of Health,
Marion Boyars, London.
Lupton, D. (1996) Food, the Body and the Self, SAGE, London.
Mennell, S., Murcott, A., and van Otterloo, A.H. (1993) The Sociology of Food:
Eating, Diet, and Culture, SAGE: London.
Metzl, J. and Kirkland, A. (eds) (2010) Against Health: How Health Became the
New Morality, NYU Press, New York.
Nestle, M. (2013) Food Politics: How the Food Industry Influences Nutrition and
Health, Universiy of California Press, Berkeley, CA.
Rose, N. (1992) Governing the enterprising self, in The Values of the Enterprise
Culture (ed. P. Heelas and P. Morris), Routledge, London, pp. 141–164.
Schneider, T. and Davis, T. (2010) Fostering a hunger for health: food and the self
in “The Australian Women’s Weekly”. Health Sociology Review, 19 (3),
285–303.

Schneider, T., Eli, K., Dolan, C., and Ulijaszek, S. (eds) (2018) Digital Food Activism,
Routledge, London.
Scrinis, G. (2013) The nutricentric consumer, in Doing Nutrition Differently:
Critical Approaches to Diet and Dietary Intervention (ed. A. Hayes-Conroy
and J. Hayes-Conroy), Routledge, London, pp. 239–248.
Scrinis, G. (2015) Nutritionism: The Science and Policy of Dietary Advice, Columbia
University Press, New York.
Stead, M., McDermott, L., MacKintosh, A.M., and Adamson, A. (2011) Why healthy
eating is bad for young people’s health: identity, belonging and food.
Social Science & Medicine, 72 (7), 1131–1139.
Warin, M., Zivkovic, T., Moore, V., et al. (2015) Short horizons and obesity
futures: disjunctures between public health interventions and everyday
temporalities. Social Science & Medicine, 128, 309–315.