The ruling of weight: An institutional ethnography investigating young people's body weight surveillance work

Rationale: Dominant framing of childhood obesity as a public health burden has increased weight stigma towards young people in larger bodies. However, weight stigma literature is generally limited by its focus on individuals' attitudes and beliefs, overlooking the broader social conditions shaping stigma. Further, few weight stigma studies have been conducted from young people's standpoint; little is known about how they navigate stigmatizing environments while growing up. Objective: This study aimed to examine the social organization of young people's everyday work of growing up in a larger body, interpreting work generously as any activity requiring thought and intention. Methods: Using institutional ethnography, we conducted individual interviews in Alberta, Canada with 16 informants aged 15-21 who grew up in larger bodies. Five, repeated group interviews were then held with a subset (n = 5) of these informants. Results: Weight surveillance work (e.g., self-weighing on scales, social comparison) was informants' most common form of weight-related work while growing up. Surveillance results instructed them on next steps, whether that be working to fit in (literally and figuratively) or resisting social conformity altogether. Informants' bodies were monitored by nearly everyone around them: family, peers, educators, and healthcare providers. Informants learned how and why to do the work expected of them through social relations. Despite their (mostly) good intentions, surveillance by respected adults conveyed to informants that their self-worth depended on their weight. Biomedical, individuated health and weight discourses guided the enactment of institutional policies and practices in healthcare and education, such as those related to the Body Mass Index. These ruling discourses objectified bodies as normal or abnormal, healthy or unhealthy, good or bad. Conclusion: Overall, study findings show how young people's experiences of growing up in their bodies were predictably organized by dominant weight and health discourses, identifying possible levers for public health intervention.

Automated summary

The study highlights how young people growing up in larger bodies are often monitored by family, peers, educators, and healthcare providers, shaping their self-worth and social adaptation. Surveillance work was the most common weight-related activity among informants, influencing their next steps and responses to social conformity.