they were under or at a medically acceptable weight. For example, Sian comments:
Sian (16 years): Yeh, ‘cos before I knew I had diabetes, I was actually happy ‘cos I lost a lot of weight. And I always wanted to be skinny. And then I found out that I was
actually sick, and I had to eat more. And then I put on weight again and I wasn’t happy.
Sian’s preference for being “skinny” reflects not only the western ideal for an attractive slim body, but that a body type that young people view as attractive and slim may actually be thin. This is congruent with the findings of a qualitative study of attitudes toward the “thin ideal” that whilst young women disparaged the “ultrathinness” (p. 73) of leading fashion models, their view of a “normal” attractive weight was of a sample with a Body Mass Index of 20, which is at the lower end of the normal weight range (Ahern et al., 2011). Burns and Gavey (2004) concur, arguing that cultural representations of what is aesthetically pleasing render the majority of female bodies as “overweight.”
Healthy weight. The “thin ideal” public narrative is congruent with the “self- responsibility” and “healthy weight” public narratives. As Burrows, Wright and Jungersen- Smith (2002) acknowledge, “a slim toned body has come to signify self-regulation and worth, the sign of moral standing” (p. 41). Lupton (1996) concurs, referring to a “food/health/body triplex,” in which outward appearance embodies the “inner worthiness” (p. 137) of its owner. It has been argued that the body dissatisfaction culminating from young women comparing their bodies to a “thin ideal” can be a contributing factor to disordered eating, but Burns and Gavey (2004) also argue that a discourse of a healthy weight “provides the cultural conditions that support, rationalise, and to some extent normalise, practices that are considered bulimic” (p. 561). They argue that whilst they accept that there are health benefits to good nutrition and fitness and that there can be health risks related to obesity, absolutely linking weight status to health can have a damaging effect. The stories of the health professionals suggest that they recommend that the young women maintain a healthy weight:
HP1 (Paediatrician): Of course if you put on weight that increases insulin resistance, so that makes controlling diabetes harder. So you don’t want people to pack on the
130
diabetes control. But it’s probably a lesser problem for me than girls focusing on their weight and unfortunately diabetes sets you up to have to focus on your eating,
detailing what you eat, so it makes it extra hard. I mean, I almost don’t want to weigh the girls every time. I mean girls who are very conscious about their weight, will obsess about it “oh I have put on an extra kg” when it’s probably the kilt that she’s wearing, or she hasn’t emptied her bladder or something like that.
……….
HP5: We address it if it’s relevant to their needs. Because often we try and focus on their long term health. So, if they are significantly overweight, then that becomes is a part of it. But if they are just a little bit chubby or something like that, then that is not a major for their physical health. It might be for their mental health. So I tend to shy away from it, because I just worry too much that there is a focus on that than what matters more for their long term health. I mean if it is a question, then let’s see what you do weigh to get a starting point and adjust our diet. Then I would refer them to the dietician, and we might weigh them to get a starting point to get some objectivity to it.
Their stories suggest that whilst they would recommend maintaining a healthy weight, they are mindful of the potential problems associated with a focus on weight. Their stories suggest that they might not introduce weight gain as an issue unless the young person’s weight had exceeded what they would consider a healthy range.
The medical public narrative of a “healthy weight” has shaped societal attitudes to equate being overweight with being unhealthy. For example, headlines in a Norwegian newspaper read “Norwegians fear fat more than anything else,” reporting on a public survey that identified obesity as the leading health problem, ahead of care for the elderly, cancer, psychiatry, and cardiovascular disease (Malterud & Ulriksen, 2010). Burns and Gavey (2004) refer to this as the “pathologization of the non-slender body” (p. 550). However, Danesky, Higgs and Morgan (2010) argue that the linkage between disease and obesity rests on a weak evidence base. Burns and Gavey concur, contending that public health messages construct obesity as a health problem of epidemic proportions and cite the literature that suggests that the relationship between obesity and ill health is putative. Therefore, the congruence between the “thin ideal,” the “healthy weight” and the “self responsibility” public narratives may reflect a conflation between health and thinness. For example, Lupton (1995, cited in Burns & Gavey, 2004, p. 551) states that “a biomedical construction of fatness as unhealthy therefore feeds into existing cultural