Through this important research project, I will explore social work and how it works with obesity in healthcare settings. This work is very important to me personally, as well as to the practice of social work as a whole. Fat oppression is an intersection that is often left out of conversation in social work discussions of anti-oppression responses and social justice.
The remaining chapters will discuss the findings and discuss implications for future research and social work practice. When looking at fatness, social work is assumed to adopt a social perspective in practice, which upholds client dignity and choice (Friedman, 2012).
Literature Review
This study also highlights the importance of assessing self-perception of body esteem without the influence of external factors such as the medical establishment or societal notions, which can be particularly harmful to bodies that "transcend" constructs of body size normality. McCardle (2008) conducted research to explore how weight bias among social workers affects practice with obese clients. Overall, weight bias was found to exist among social workers and can negatively impact practice with obese clients (McCardle, 2008).
Methodology and Research Design
I also examined the experiences of the social workers I interviewed in the context of policies and mandates related to each medical clinic in which I recruited participants. I interviewed three social workers who work in health clinics at health centers and hospitals in downtown Toronto with different practice locations. Through these interviews, I gained an understanding of the way in which social work engages with obesity by resisting and/or accommodating medicalized discourses and practices with obese clients. Institutional ethnography recognizes the authority of the experienced and uses the narratives provided in interviews to undermine the problematic and/or oppressive nature within the system/institution (Smith, 2005).
However, although often not explicitly stated, it is noted that much of the research on fatness uses an autoethnographic methodology. Many of the theorists to date have theorized fat oppression through their own lens, basing it on problematic experiences they have encountered. First, I would remove the experience of the self as this can sometimes be seen as limiting the usefulness of the findings beyond highlighting one person's experience (Creswell, 2013).
Third, since there is a gap in the research with an institutional ethnographic methodology on this topic, I would like to contribute to this literature from this methodology and undermine the problematic nature of the institution of medicine in relation to obesity, specifically in relation to social work practice, which has not been done in this way until now. Interviews were conducive to my method as I was able to capture authentic narratives of the experiences and practices that participants engage in and bear witness to. The interviews took place in person and were audio-recorded with the participants' permission so that I could have the content transcribed after the interview.
This form of data analysis is compatible in an institutional ethnographic study, as it allows for an understanding of the self that is situated in organizational contexts (Paliadelis & Cruickshank, 2008).
Findings
I feel it's important for me to be there to bring views that aren't necessarily brought up many times. Each participant shared their experiences of the role of medical professionals in their specific workplaces, what the doctor-patient relationship looks like, and any challenges or problems they observed with how the medical profession engages with fat-identified clients. More concrete examples of ways in which strategic actions are taken to navigate their practice from an anti-oppressive lens will be discussed in the third section of findings.
A large theme that emerged from the interviews with participants was their frustrations with the way the medical profession engages with fat-identified clients and their own limitations in intervening from a fat-positive lens. Linking these findings to the description of the problem mentioned earlier in the findings, this section focuses on the ways in which the participants identify the power structures operating in their institutions, limiting or constraining their capacities to resist or work on obesity from an anti-oppressive perspective. In addition, participants mentioned standardized assessments as a barrier to gaining a better social understanding of the issues facing the client.
This reflects the hegemonic and subversive power that medicine has within the institution. This leaves much work for social workers to engage in the work of advocating an alternative understanding of the problem. I had several one-on-one conversations with the psychiatrist and most of them he agreed with, and some of the policies were actually changed.
This chapter provided narratives of the experiences of three social workers working in medical clinics in Toronto, Ontario.
Analysis and Discussion
Each participant shared their experiences as social workers engaged in anti-oppressive approaches to practice. Participants shared their knowledge of anti-oppressive practice and what it looks like in practice with fat clients. Participant two discussed her knowledge of anti-oppressive practices as recognizing the barriers fat clients face and using clients' privileges to get them the services and resources they need through advocacy.
Through the use of language, customer focus, learning opportunities, and advocacy, employees strategically navigate the medical system to do the anti-oppressive work they want to do. Participant two discussed ways in which language exchange with clients has been a powerful tool for engaging in discussions from an anti-oppressive social perspective. Participants spoke about having conversations with clients and medical professionals that are consistent with anti-oppressive practice and have had a meaningful impact on clients.
However, this may have created biased responses due to their anti-oppressive philosophies and critical engagement that they are already involved in fat-positive social work practices. The contributions to anti-oppressive practice and social work are very much intertwined in this research study as the data presented findings that are specific to anti-oppressive social work practice. My research question asked, 'how do social workers navigate conversations around fatness with service users in medical settings from a social perspective?'; this question looks specifically at the operation of anti-oppressive practice in medical settings.
Participants' responses revealed that there is a difference between social work and anti-oppressive social work, separating the two. This research also contributes to anti-oppressive practice by opening conversations about fatness, an identity category that is often left out of the conversation about anti-oppressive responses to social work practice. Finally, there are two findings that I believe have emerged from this research: the need for greater numbers of anti-oppressive social work practitioners in clinical spaces, as well as greater support and resources needed for social workers currently occupying these spaces to to continue to do their work. work they do.
Conclusion and Future Directions
It may be interesting to explore the role of social workers in these settings and the resistance and conformity these workers take to working with the medical model. It may also be useful to conduct research that explores the experiences of bariatric patients and their interactions with medical professionals and social workers to see how their experiences with both disciplines are, which may provide meaningful results for clinical practice. social work in these environments. Further, it may be interesting to conduct a study that looks at obesity as an identity rather than a clinical definition.
By opening up the criteria within my study to interviewing a participant who works in the field of eating disorders, which primarily serves clinically “thin” people, it provided insight into what fatness as an identity or social construct looks like and how the medical institution interacts and frames each other. service plans with people who are not clinically fat, but identify as such. This research could provide opportunities to reframe how we view fat as a social construct and identity rather than a numerical value. Furthermore, it may be interesting to see what the role of social work is in these situations with clients who identify as fat but appear clinically thin.
Participants Needed for Research Regarding Social Work Practice with Fat Clients in Medical Settings
The risk of this happening is low/minimal and community resources will be made available at the start of the interview to each participant, which can be utilized if support is needed after the interview. The risk of this happening is low/minimal and participants will be given pseudonyms and information will be stored on a password protected device and destroyed after the study is completed. The risk of this happening is low/minimal and the interview location will be held in a private room secured with aural and visual privacy at either Ryerson University or a location of your choice to maintain confidentiality.
No personal information will be used in the research study and all information will be stored on a password protected device and. The risk of this happening is low/minimal and information will be stored on a password protected device, as well as participants will be assigned pseudonyms to maintain confidentiality. The risk of this happening is low/minimal and participants will be reminded of the obligation to report before the interview.
Everything related to the study will be kept confidential and all transcripts will be stored in a password protected file. You are advised that if you have any questions or concerns, you may contact me, the researcher, at any time. You will be asked to review/edit their interview transcripts to ensure you are satisfied with the information you have provided.
The audio files will be deleted once the transcriptions have been approved by you.
Resisting Medical Discourses in Fat Social Work Practice: An Exploration of Social Work Practice in Medical Settings
Resistance to medical discourses in bold social work: An exploration of social work practice in medical settings. Fat is a social work issue: Fat bodies, moral regulation and the history of social work.