Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Healthy Bodies In Picture Books & Children’s Talk A thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy (Psychology) At Massey University, Manawatū, New Zealand. Ria A. Pugmire 2023 P a g e | iii Abstract This thesis explores the health and body discourses in children’s picture books, and in their talk. In part one I begin with an overview of the constructions in a broad selection of picture books, before narrowing down on seven key books for a multimodal critical discourse analysis (MMCDA). Overall, the books offered diverse constructions of health, bodies, food and physical activity; in contrast, those key books that focused on health reproduced dominant healthist discourses, where health was constructed in relation to diet and doing deliberate exercise. However, while this kind of ‘healthy living’ was constructed as what you should do, it was simultaneously shown as boring and unpleasant. In terms of bodies, the stories reproduced an ‘or you’ll get fat’ discourse (reminiscent of widespread obesity discourses) where being fat was constructed as the negative consequence of failing to do ‘healthy living’ correctly; and was associated with being greedy, lazy, humorous and unable. While the stories also offer some critique of these assumptions about health and bodies, these messages were often ambiguous or contradicted within and between the stories, and it was unclear how children ‘read’ these. For part two then, I conducted discussion groups with children (aged 6-7 years), to explore how the children made sense of the picture books in this context, as well as the health and body discourses they drew on in their talk. Predominantly, participants interpreted the stories in line with widespread healthist and obesity discourses, displaying their knowledge of what you should and shouldn’t eat, and constructing the fat characters negatively as ‘too fat’, with advice about how to change this. Their responses were mixed in terms of how they engaged with the critical elements of the stories. However, they also drew on a discourse of ‘growing big and strong’ in relation to health, occasionally troubled the simplistic constructions of fatness, and through their talk and body language showed the importance of pleasure in relation to food and movement. This study adds to our understanding of how children negotiate healthy body discourses in their talk, and reinforces the need to continue to explore how to engage with children about health and media literacy in more critical ways, avoiding the pitfalls of fat stigma. P a g e | iv Acknowledgement Thank you so much to my supervisors and family for your patience and belief in me throughout what turned into a long endeavour, alongside kids and life; I couldn’t have made it without you. This project has been reviewed and approved by the Massey University Human Ethics Committee: Southern B, Application 15/27. If you have any concerns about the conduct of this research, please contact Prof Julie Boddy, Chair, Massey University Human Ethics Committee: Southern B, telephone 06 350 5799 x 86055, email humanethicsouthb@massey.ac.nz mailto:humanethicsouthb@massey.ac.nz P a g e | v List of tables and figures Table 1. Guiding questions for Multimodal Critical Discourse Analysis .........................................................33 Table 2. Summary of discussion groups .......................................................................................................37 Figure 1. Isabella’s drawing: “This is for you… it’s you reading the story to me and Ada… and we like the story”. ...............................................................................................................................................41 Figure 2. Illustration from The Very Hungry Caterpillar (2002), showing the wide variety of foods he eats on Saturday; and The Large Family: A Piece of Cake (1989), showing the family of elephants eating dinner. ..............................................................................................................................................48 Figure 3. Illustrations of food and eating from The Yoga Ogre (2012; top); The Tiger Who Came to Tea (1968; middle); and Willy the Wimp (1984; bottom). .........................................................................50 Figure 4. Illustrations from Piggy Poggett (Tulloch, 2009). ..........................................................................51 Figure 5. Illustration from Frog is Frog (1998), of a frog gazing at his reflection in the water. ......................57 Figure 6. Illustration from Blue Gnu (2012), of a single blue gnu amongst a herd of brown ones. ................58 Figure 7. Illustrations from Cinderella’s Bum (2004), showing different shapes and sizes of mouths, noses, and bums. .........................................................................................................................................60 Figure 8. Illustration of the bully from Phoebe & Digger (2013). ..................................................................61 Figure 9. Illustration of the girl and her hippo from Look there’s a HIPPOPOTAMUS in the Playground Eating Cake (2007). ......................................................................................................................................62 Figure 10. A table of the 7 books examined in depth with a MMDA, as well as their cover images. .............65 Figure 11. Page from A Piece of Cake (1989). ..............................................................................................68 Figure 12. Pages from The Yoga Ogre (2012) and Flabby Cat and Slobby Dog (2010) respectively. ...............70 Figure 13. Illustrations from near the end of Flabby Cat and Slobby Dog (2010) of the dog and cat now sleek and trim. ...........................................................................................................................................73 Figure 14. Illustration from Willy the Wimp (1984). .....................................................................................75 Figure 15. Illustrations from different pages of Vegetable Glue (2004). .......................................................77 Figure 16. Illustration from The Yoga Ogre (2012) .......................................................................................79 Figure 17. Chloe’s page divided into ‘healthy’ and ‘not healthy’; her drawing labelled ‘running’; and her drawing of a television. ...................................................................................................................107 Figure 18. Hannah’s drawing of an ogre eating a banana. .........................................................................111 Figure 19. Tayla’s drawing of us inside a ‘love heart’ .................................................................................131 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180979 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180979 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180979 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180980 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180980 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180982 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180983 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180985 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180986 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180986 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180987 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180988 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180989 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180990 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180990 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180991 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180992 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180993 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180994 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180994 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180995 file:///C:/Users/riap/Documents/Study/PhD/0-%20Ria's%20PhD-%20current%20chapter%20drafts/Ria's%20PhD-%20full%20draft5.docx%23_Toc108180996 P a g e | vi Copyright Note Images from the picture books under study have been reproduced under the “fair use” principle to illustrate my arguments, and as unpublished thesis material I derive no commercial gain from them. These have been cited with their original sources, and the publishers contacted via email and/or their online forms to request permission. However, only one reply was received, which is included in Appendix 8. The original sources are listed in the table below. Author Published date Title Publisher Allan, Nicholas 2004 Cinderella’s Bum Penguin Random House Bently, Peter 2012 The Yoga Ogre Simon & Schuster Browne, Anthony 1984 Willy the Wimp Walker Books Chandler, Susan 2007 Vegetable Glue Meadowside Murphy, Jill 1989 The Large Family: A Piece of Cake Walker Books Willis, Jeanne 2010 Flabby Cat and Slobby Dog Andersen Press Carle, Eric 1970 The Very Hungry Caterpillar Penguin Edwards, Hazel 1994 Look, there’s a hippopotamus in the playground eating cake Penguin Kerr, Judith 1968 The Tiger Who Came to Tea Harper Collins Allen, Pamela 2013 Fat Ferdie Penguin Random House Velthuijs, Max 1998 Frog is frog Andersen Press Mewburn, Kyle 2012 Blue Gnu Scholastic Springstubb, Tricia (illustrated by Jeff Newman) 2013 Phoebe & Digger Candlewick Tulloch, Scott 2009 Piggy Poggett Harper Collins Bennett, Elizabeth (illustrated by Jane Chapman) 2014 Big and Small Tiger Tales P a g e | vii Contents Healthy Bodies .............................................................................................................................................. ii Abstract ....................................................................................................................................................... iii Acknowledgement ....................................................................................................................................... iv List of tables and figures ............................................................................................................................... v Copyright Note ............................................................................................................................................ vi Contents ..................................................................................................................................................... vii Introduction ................................................................................................................................................ 2 Healthism, obesity literature and a healthy weight discourse ............................................................... 3 Fat stigma, discrimination and body-based harassment ....................................................................... 6 Body image, self-esteem and body-management ................................................................................. 9 Bringing it together: Healthy body messages .......................................................................................15 Children’s media and picture books ....................................................................................................18 Body messages and weight stigma ......................................................................................................19 Health messages .................................................................................................................................21 The Current Study ...............................................................................................................................23 Theoretical and Methodological roots ........................................................................................................24 Social constructionism and a critical discursive approach ....................................................................24 A study of two parts ............................................................................................................................25 Discourses in media and the importance of multimodality ..................................................................27 P a g e | viii Method ......................................................................................................................................................31 Part 1: Book Analysis ...........................................................................................................................31 Book selection.....................................................................................................................................31 Book analysis ......................................................................................................................................32 Part 2: Discussion Group Analysis ........................................................................................................35 Recruitment ........................................................................................................................................35 Participants .........................................................................................................................................35 Prompts ..............................................................................................................................................37 Consent process ..................................................................................................................................38 Procedure ...........................................................................................................................................39 Ethical concerns ..................................................................................................................................41 Researcher ..........................................................................................................................................43 Data ....................................................................................................................................................44 Analysis ...............................................................................................................................................45 Book analysis: Broad ...................................................................................................................................47 Health .................................................................................................................................................47 Food and Eating ..................................................................................................................................48 Exercise and physical activity...............................................................................................................53 Body image and self esteem ................................................................................................................56 Diversity, individuality and social relationships ....................................................................................58 Body size/shape ..................................................................................................................................60 Summary ............................................................................................................................................64 P a g e | ix Healthy living in picture books: A Multimodal Discourse Analysis ................................................................65 Book summaries .................................................................................................................................66 Healthism and a discourse of healthy living .........................................................................................68 Healthy bodies and an ‘or you’ll get fat’ discourse ...............................................................................69 Health vs pleasure? .............................................................................................................................74 Stories to encourage critical thinking? .................................................................................................78 How can these stories be read? ...........................................................................................................81 Discussion group analysis: How did the children make sense of the books? ................................................84 The Large Family: A Piece of Cake........................................................................................................84 The Yoga Ogre .....................................................................................................................................88 Willy the Wimp ...................................................................................................................................96 Cinderella’s Bum ...............................................................................................................................100 Bringing it together: Constructing bodies & healthy living .........................................................................105 A ‘Healthy Living’ Discourse...............................................................................................................105 ‘Or you’ll get fat’ Discourse ...............................................................................................................110 ‘Growing big and strong’ Discourse ...................................................................................................116 Interacting discourses .......................................................................................................................118 Bigness as a point of tension .............................................................................................................118 Gendered constructions ....................................................................................................................120 Interpreting the stories: Ambiguity and contradiction .......................................................................122 Anthropomorphism...........................................................................................................................122 Ambiguous endings ...........................................................................................................................124 P a g e | x Health vs pleasure .............................................................................................................................127 Alternative discourses: Kindness and pleasure ..................................................................................131 Discussion & Implications .........................................................................................................................132 Book analyses ...................................................................................................................................132 How did these play out in children’s talk? .........................................................................................134 Implications of healthy living discourse, and health vs pleasure ........................................................137 What do healthy living discourses exclude? What are the implications for how they make us think/act/feel? ..................................................................................................................................137 Implications of healthy body discourses ............................................................................................140 Returning to the research questions..................................................................................................144 Teaching health: Interventions with children .....................................................................................145 Reflections on the research process ..................................................................................................147 Future Research ................................................................................................................................149 Conclusion ........................................................................................................................................151 References ................................................................................................................................................153 Appendix 1 ...............................................................................................................................................168 Full book list ......................................................................................................................................168 Appendix 2 ...............................................................................................................................................171 School Information Letter .................................................................................................................171 Appendix 3 ...............................................................................................................................................174 Parental Information Sheet ...............................................................................................................174 Appendix 4 ...............................................................................................................................................177 P a g e | xi Parental Consent Form......................................................................................................................177 Appendix 5 ...............................................................................................................................................179 Child Information Sheet ....................................................................................................................179 Appendix 6 ...............................................................................................................................................181 Child Consent Form ...........................................................................................................................181 Appendix 7 ...............................................................................................................................................182 Transcription notation.......................................................................................................................182 Appendix 8 ...............................................................................................................................................183 Image permission requests and responses ........................................................................................183 P a g e | 1 P a g e | 2 Introduction Children learn about health and bodies from a young age. From as young as three years old they seem to be aware of the sociocultural meanings about body shapes, particularly fatness and thinness (Cramer & Steinwert, 1998; Di Pasquale & Celsi, 2017; Harriger et al., 2010; Latner & Stunkard, 2003; Spiel et al., 2012), and from when they start primary school (if not earlier) they are inundated with particular messages about the importance of being healthy (Burrows et al., 2018; Burrows & Wright, 2007; Leahy & Wright, 2016; Wright et al., 2012). These come from a variety of sources, including family, media of all kinds, and school. While our Aotearoa/New Zealand health and physical education curriculum has been praised for its incorporation of more holistic concepts of well-being, including the Māori concept of hauora (incorporating taha tinana, taha wairua, taha hinengaro, and taha whānau – or physical, spiritual, mental and social aspects of health); what this looks like in practice, within the broader social and political context, is less clear cut (Fitzpatrick & Burrows, 2017). Rather, in New Zealand schools (and wider society) an aspect of ‘health’ given particular attention is the production of a healthy body through individual lifestyle (eating and exercise) behaviours (Burrows & Wright, 2007). This focus echoes a neoliberal focus on ‘healthism’ (Crawford, 2006) - that is, a focus on doing health through enacting healthy lifestyle choices as an individual moral responsibility. Since the early 2000s, obesity has been seen as a health ‘crisis’ (Campos et al., 2005; Gard & Wright, 2005), and received a significant amount of attention in New Zealand and elsewhere, seemingly overshadowing other aspects of well-being. This concern remains high on the public agenda (with releases from the government such as: Food Industry Asked to Step up Fight against Obesity, 2019; Work Continues to Reduce Childhood Obesity, 2016), despite critical commentators arguing that this phenomenon of increasing population body weights has already come to an end (Gard, 2011). Within this on-going ‘crisis’, children are seen as a key site for intervention, considered both particularly ‘at risk’ and an effective site for making change and creating healthy futures (Beausoleil, 2008; Burrows et al., 2009, 2018; Burrows & Wright, 2007; Wright et al., 2012). This focus on combatting obesity has therefore encouraged a particular approach to P a g e | 3 health education; one characterised by simplistic messages about ‘good’ and ‘bad’ food, the importance of vigorous physical exercise for fitness, and which (with varying degrees of intentionality) relegates larger bodies as the unhealthy ‘other’ (Burrows & Wright, 2007; Wright et al., 2012) . While often treated separately in practice (within the education context) and in the literature, alongside obesity are other concerns about children’s bodies, including firstly body image and (dis)satisfaction (and in turn its relationship with self-esteem and body management practices such as disordered eating) (Griffiths et al., 2010, 2010; Markula et al., 2008), and secondly body-related stigmatisation (including what has been variously called ‘weight bias’ and ‘fat stigma’) (e.g. Ata & Thompson, 2010; Puhl & Heuer, 2010; Puhl & Latner, 2007). While the challenge of obesity has increased attention on children’s bodies and behaviours, it has generally remained separated from these other concerns, with health promotion programmes aimed at one aspect (e.g. obesity) or another (e.g. body image), but rarely combined (Bray et al., 2018). However, in doing this we run the risk of sending contradictory messages to children. As Neumark-Sztainer and colleagues (Bucchianeri & Neumark-Sztainer, 2014; Neumark-Sztainer, 2005, 2012; Neumark-Sztainer et al., 2006) have argued, the approaches generally taken to these issues can at times appear to be in direct conflict with each other. When we emphasise a negative approach to body weight in terms of health, highlighting fatness as ‘a problem’, we risk undermining any positive body acceptance messages. With such confusing and contradictory goals we run the risk of causing harm, despite our best intentions (O’Dea, 2005). Below I explore each of these areas in the literature in more detail, before considering how they fit together in the current research to make up my focus on ‘healthy bodies’. Healthism, obesity literature and a healthy weight discourse Crawford (1980, 2006) outlined a shift in understandings of health from the mid 1970s, using the term ‘healthism’ to describe how health had come to be increasingly understood in relation to personal responsibility, part of being a responsible citizen, and to be reified in such a way as to become a major marker of agency and identity. Here then, health becomes a moral imperative, a “duty to stay well” (Turrini, 2015, p. 22). Beyond simply avoiding disease, this extends to wellness promotion and optimisation, P a g e | 4 and a focus on lifestyle, including self- and body- control, expanding the boundaries beyond what would traditionally have been associated with ‘health’ at all (Cheek, 2008; Turrini, 2015). Through the 2000s and beyond we have seen a continuation of this social construct, evolving and refracting alongside new technologies and social developments, and within different (micro)cultures (See for example: Brown, 2017; Cheek, 2008; Clark, 2018; J. Evans, Rich, et al., 2008; Johnson et al., 2013; Lee & Macdonald, 2010; Riley & Evans, 2018; Robson et al., 2022; Shea & Beausoleil, 2012; Wright et al., 2006; Wright & Burrows, 2004), and the on-going “consolidation of health as one of the guiding mantras of both governments and individuals, paradoxically and simultaneously both a collective and individual responsibility and desire” (Cheek, 2008, p. 974). In line with this trend, a focus on body work and a preoccupation with body size/weight has become normalised and taken-for-granted in how we understand ‘health’ (Cheek, 2008; Gard & Wright, 2005; Markula et al., 2008; Riley & Evans, 2018; Wright & Harwood, 2009). Dominant understandings of health have become intertwined with looking – at bodies and behaviours (Burrows, 2008; Harwood, 2012; Jutel & Buetow, 2007), and with widespread concerns about obesity there is often a particular focus on health behaviours to avoid fatness, to the point that ‘healthy weight’ becomes the primary goal and success measure of health promotion and interventions. In doing so it subsumes other possible measures of ‘health’, whether these be physical (such as more direct measurement of metabolic activity) or more holistic (including social, emotional, or spiritual as well as physical outcomes). These messages are often characterised by simplicity, for example around certain foods as ‘good’/’bad’ or ‘healthy’/’unhealthy’, as well as energy in/energy out equations: a simplicity that children are picking up, as evidenced by a range of qualitative research with children of a variety of ages (Burrows & Wright, 2007; D. Powell & Fitzpatrick, 2013; Welch et al., 2012). Even when some of the health messages being promoted at a policy level offer a more complex picture of health, these complexities are often lost in translation, from how they are interpreted by individual teachers, to the limits and challenges of an overstretched curriculum (Fitzpatrick & Burrows, 2017). Additionally, recent authors have highlighted a tendency for “lifestyle drift”, where even when interventions and social marketing strategies may initially acknowledge wider social P a g e | 5 factors, they seem to inevitably return to a focus on individual behaviour change (Powell et al., 2017; Warin, 2021). Recent studies in New Zealand and elsewhere have highlighted how, within the context of on-going concern about obesity, children have become a target for neoliberal messages about becoming healthy, focused on eating ‘good’ foods and being physically active, that tend to incorporate particular notions of the healthy body (Burrows & Wright, 2007; Evans & Rich, 2011; Wright et al., 2012). Such a focus in schools is driven by a deep concern about ‘obesity’, and particularly what childhood obesity might mean for the future of this young generation. However, critical commentators from a variety of fields have drawn attention to a number of problematic aspects of this sort of dominant ‘obesity discourse’ and how it is being taken up, including both a critique of the scientific claims being made about obesity and the social, psychological and health effects of obesity discourse (e.g. Bacon & Aphramor, 2011; Campos, Saguy, Ernsberger, Oliver, & Gaesser, 2005; Evans, Rich, Davies, & Allwood, 2008; Gard & Wright, 2005; Tischner, 2013). In comparison to the certainty with which obesity is often talked about, the literature is characterised by complexity and uncertainty, including for example around the meaning of the epidemiological data (e.g. the notion that obesity is escalating at ‘epidemic’ proportions), the causes and consequences of fatness (including its association with various non-communicable diseases such as diabetes, heart disease, and even cancer), as well as whether it is possible to make people thin and whether or not this improves their health. Despite the taken-for-granted assumptions about fatness in our culture, few interventions show reliable, long-term success at getting rid of people’s body fat, nor much evidence that doing so would reduce any associated health risks (Campos, 2004; Gard & Wright, 2005). In contrast, a body of research suggests that it is possible to be fat, fit and healthy, and that lifestyle changes (healthy eating and physical activity) as long as they are not taken to extremes, are beneficial for people’s health irrespective of whether or how much weight is lost. In contrast, many body management practices aimed at combatting fatness or obesity P a g e | 6 such as ‘yo yo dieting’ (that is, the cycles of weight loss and weight gain common for those who attempt to lose weight by dieting), may lead to overall weight gain and worse health outcomes (for outlines of some of these critiques see for example Campos, 2004; Campos, Saguy, Ernsberger, Oliver, & Gaesser, 2005; Gard & Wright, 2005; Monaghan, 2005; Rich, Monaghan, & Aphramor, 2010). It has also been suggested that just as concern about the ‘obesity epidemic’ was ramping up, the phenomena itself was dying down (Gard, 2011). Alongside the debate around the causes and consequences of obesity, there is also concern about the social and psychological effects of obesity discourse and a weight-focused approach. A variety of critical scholars from around the world have highlighted the moral and political aspects of this kind of ‘fat panic’, as well as its dangers (Beausoleil, 2008; J. Evans, Rich, et al., 2008; Gard & Wright, 2001; Monaghan et al., 2013; Rich & Evans, 2005; Tischner & Malson, 2011). Of particular relevance here, we run the risk of individualising complex social-structural issues, as well as contributing to harmful mental health outcomes, encouraging unhealthful body management practices, and increasing body-based stigmatisation. In light of this critique then, it is important to consider our response to obesity as an issue not just in relation to health education around lifestyle choices, but also in relation to the literature on both weight- related stigmatisation, and body image issues. That is, how does the way we understand and talk about weight/fat and health (as well as and in relation to morality, food, fitness and gender) affect people’s lives, activities, relationships and identities? Fat stigma, discrimination and body-based harassment To begin with, by focusing on body weights and shapes, there is a risk of increasing the stigmatisation of ‘fat’ with enormous potential for harm. Bodies are important aspects of our selves, shaped by a complex intermixing of biology, personhood and the social and physical environments within which they exist. They are also the most visible part of what we present to the world, and as such are ‘read’ by the people around us to infer characteristics and identities, who we ‘are’. Body weight or fatness, then, becomes a very visible marker of cultural undesirability, reinforced by healthist notions of obesity, including its causes and consequences. Framed within neoliberal understandings of personal responsibility, fatness is seen as visible P a g e | 7 proof of failure, blamed on fat people’s own choices and actions (Pausé, 2017). These dominant constructions of fat align it with un-healthiness, laziness, gluttony, immorality, and unattractiveness; in contrast, in Western societies, thin bodies (particularly for women) are read as a sign of healthfulness, beauty, success and control. These characteristics become automatic assumptions in the way we interpret bodies as fat or non-fat. As Murray (2005) argues, “we exist in a culture of a negative collective ‘knowingness’ about fatness…. we have a learned negative response to fat bodies, and their aesthetic transgressions” (p.154). While negative social understandings of fat may be old, this ‘knowingness’ is given particular power by the ‘obesity epidemic’ and the larger context of neo-liberalism and ‘healthism’. Fat bodies then are ‘read’ as signs of ‘failure’ to make the ‘simple’ and ‘correct’ choices advocated in obesity discourse, and seen as an economic risk/burden to society (Gard & Wright, 2005). This conflation of issues around weight, health, beauty and morality has a number of detrimental effects, including the stigmatisation and marginalisation of fat individuals across the world, at all ages, and over a wide variety of domains (Pausé, 2017). Such ‘knowingness’ has a huge effect on the lives of fat people. This includes both blatant and subtle stigmatisation, as well as structural inequalities. Further for fat people it can encourage complex relationships with their own bodies. As Pausé (2017) argues, it is not just non-fat people that hold stigmatising attitudes towards fatness; rather “everyone grows up internalizing the fat hating attitudes that are pervasive across the globe” (p. 511). Qualitative studies with ‘large’ women have highlighted how fatness can become a hyper-visible and dominating identity, “a major marker of place and power” (Rice, 2007, p. 167), combining with other lines of difference to increase feelings of ‘otherness’ and shame, and obscuring other positive identities, characteristics, abilities and aspirations. Similarly, Tischner and Malson (2008) found ‘large’ women reported feeling a constant surveillance, under which large bodies are “constructed as better hidden/not to be seen” (p.265), as well as not fitting normative rules or even the physical environment (such as seats on buses or planes). As various authors note (J. Evans, 2003; Gard & Wright, 2001), unlike many other types of stigma and group stereotyping (such as racism and sexism) which have become ‘politically incorrect’, anti-fat sentiments are still largely seen as acceptable and even P a g e | 8 sometimes encouraged. The construction of fat as modifiable and a direct cause of death and disease gives permission, and even demands, surveillance and ‘policing’ of fat bodies, seen as ‘encouragement’ to help people start making the steps for change. Even public health campaigns often make use of stigmatising portrayals of fatness, despite the dubious ethics of doing so (O’Dea, 2005; Pausé, 2017; Puhl & Heuer, 2010). Weight bias, fat stigma and weight based discrimination has been extensively researched in a variety of ways, and translates into inequities across many aspects of people’s lives, including in employment, health- care, and educational settings, as well as interpersonal relationships and the media (Pausé, 2017; Puhl & Heuer, 2009). That is, for fat people it is a part of all their relationships, from friends and family, to colleagues, to social opportunities and income; and increases with size so that “the fatter you are the more stigma you experience” (Pausé, 2017, p. 511). Weight bias is similarly prevalent for children, including from peers, parents and teachers (Pont et al., 2017; Puhl & Latner, 2007), and has been found internationally to be the most common reason for bullying among youth (Puhl et al., 2016). In a classic study, Richardson and colleagues (Richardson et al., 1961) got children to rank six pictures, including images of children with various disabilities (e.g. being in a wheelchair, having an amputated hand, or facial disfigurement) as well as a ‘normal’ weight and ‘overweight’ child. The overweight child was ranked last and rated as least likable. Repetitions of this and similar studies suggest that these kinds of anti-fat attitudes may have become stronger over the last fifty years (Andreyeva et al., 2008; Latner & Stunkard, 2003); are present for both girls and boys from a young age (Spiel et al., 2012), and apply to both human and non-human figures (Marx et al., 2019). Likewise, utilising an attitudinal rating scale with young adults in the US, Ambwani et al. (2014) found that over 90% endorsed at least one negative attitude; while a third agreed that “one of the worst things that could happen to a person would be for him to become obese” (p. 368). While determining specific prevalence rates is difficult due to the diverse types of bias and how it has been measured, research overseas suggests that weight bias is a common experience for overweight youths (Puhl et al., 2016; Puhl & Latner, 2007). Similarly, a survey with children and adolescents across four New Zealand primary and secondary schools suggested that a large number of children experience types of weight bias, P a g e | 9 for example reporting that they have been told by somebody that they were fat or overweight (25-62% varying by age group) or have been bullied about their weight (34- 50% depending on age group) (Burrows, 2008, p. 32). Such weight stigmatisation has a number of damaging effects, including on both mental and physical health. The effects of stress, stigma and discrimination on marginalised groups are well researched, and apply to fat people also, affecting metabolic health (such as blood pressure and cortisol levels), as well as psychosocial outcomes (Pausé, 2017). For example research suggests that higher weight children and teens are more likely to suffer from social isolation, lower self-esteem and body image, depression, anxiety, to be bullied and to be bullies, as well as being at higher risk of suicide (Griffiths et al., 2006; Lumeng et al., 2010; Pont et al., 2017; Puhl & Latner, 2007; Whetstone et al., 2007). Indeed, Puhl and Latner further argue that in terms of overall quality of life, "[a]n alarming finding of this research was that obese children had QOL [quality of life] scores comparable with those of children with cancer" (Puhl & Latner, 2007, p. 567). Further, weight-based discrimination may even negatively impact fat individuals’ cardiovascular health, even when weight (BMI) is controlled for (Muennig, 2008; Puhl & Latner, 2007). Alongside these effects, individuals may also attempt to manage weight bias and fat stigma in ways that are less than healthful, including avoiding situations where this is more likely to occur (such as fitness and healthcare settings), as well as extreme body management behaviours, as I discuss below. Body based harassment then is a serious concern for our youth, and one that needs to be considered in the way we promote health to children from a young age. Body image, self-esteem and body-management In an understanding of obesity as a looming individual and social health crisis, governed by a simple energy equation, a range of behaviours are encouraged: from watching our waist circumference and frequent use of bathroom scales to monitor our weight, to taking offensive steps such as dieting (limiting food intake or abstaining from particular kinds of foods), ‘calorie counting’, use of various pharmaceutical or ‘fitness’ products, ‘buffing up’ and ‘working out’ at the gym, and even weight loss surgery (from liposuction to P a g e | 10 gastric bypass surgery). These pressures are clearly gendered, putting different pressures on women and men. Feminist critiques of the body work required of women are long standing (e.g. Bartky, 1988; Bordo, 1993; Bordo & Heywood, 2004; Duncan, 1994; Lupton, 1996; Markula, 1995; Tischner & Malson, 2011). The slender feminine ideal has evolved over time to a more complex one; yet being (appropriately) skinny (that is neither fat nor extremely thin) remains a strong imperative in Westernised societies, and one with a host of social ramifications, a marker of a range of achievements from health and beauty, to success and control (Markula et al., 2008). As Markula (1995) argued, the feminine ideal has become one of contradictions: “firm but shapely, fit but sexy, strong but thin” (p. 424). Additionally, healthism interacts with a ‘postfeminist sensibility’ in contradictory ways: simultaneously making use of feminist critiques while refuting feminism, where body work practices such as dieting and food restriction for example are rebranded into empowerment and pleasure in managing the self and engaging in ‘healthy’ practices (Riley & Evans, 2018). At the same time as Western culture has become increasingly concerned with an ‘obesity epidemic’, “so-called eating disorders, body image concerns and extreme dieting and body management practices are apparently increasing” (Markula et al., 2008, p. 3). While some level of these practices may be healthful, for example ‘eating well’ and ‘being active’ are widely considered positive practices, it becomes clear that that there is a discursive continuity between health promotion messages driven by obesity discourse, and practices that are far from healthy. For example, in relation to eating, whether the focus is on nutrition or on fat-avoidance becomes ambiguous when driven by obesity discourse. Here the line between ‘healthy eating’ and ‘dieting’, with associated restriction and weight-loss goals, becomes blurred. At their extremes, unhealthful eating practices can turn into eating disorders such as Bulimia and Anorexia Nervosa. While it would certainly be imprudent to over-simplify the aetiology of eating disorders solely to social factors such as obesity discourse and the thin ideal, neither is an explanation of individual dysfunction sufficient. Further it is important to recognise that a continuity of logic can be found between such practices and public health messages driven by obesity discourse, where an imperative for a slender body encourages careful regulation of energy input and output. For example, in their examination of bulimia, Burns and Gavey (2004, 2008) noted a sometimes paradoxical adherence to P a g e | 11 obesity discourse where being slim was seen as a sign of health, in spite of the ‘disordered’ body management practices that were used to achieve it. That is, the ‘look’ of health (i.e. a slender, athletic and attractive body) appeared to be more important than ‘being healthy’, with outwardly ‘unhealthy’ behaviours, such as smoking and purging, justified as ‘compensatory’ practices necessary to eradicate unwanted calories and therefore stave off fat. Further, as Riley and Evans (2018) argue, within healthism and a postfeminist sensibility, transformative bodywork comes to be portrayed and understood through discourses of empowerment, pleasure and fun, masking the work and unpleasantness that may be involved. Likewise, while being active is considered good for the body, peoples’ engagement with exercise, when enmeshed within obesity discourse, can also become problematic in a number of ways. Within obesity discourse, not only is thinness conflated with being healthy but with being fit and athletic. In contrast fat is seen as indicative of being unfit and lazy (Evans, 2003; Gard & Wright, 2005; Rice, 2007). By positioning ‘fitness’ and ‘fatness’ in opposition, an important understanding of the benefits of physical activity irrespective of weight may be lost. Within such a construction fat individuals are positioned as unable before they even start to engage in exercise, suffer stigmatization in exercise contexts that can make it difficult or unappealing, may give up due to perceived ‘failure’ if exercise doesn’t appear to result in the desired body changes, or may push themselves to unhealthy extremes. Similarly, ‘thin’ individuals may be encouraged to engage in exercise in ways that can be obsessive and unhealthy, or to eschew exercise as unnecessary as society already views them as ‘slim and healthy’ (Mansfield, 2010; Markula, 1995; Markula et al., 2008; Mutrie & Choi, 2000). It is important to note that, like with eating, ‘working out’ for the purposes of body management involves different requirements to those necessary for health. Further, while exercise has been shown to have numerous positive effects for the body, this too can be taken to unhealthy extremes. For example, Zanker and Gard (2008) explain using the ethnographic study of ‘Lindsay’ (a long distance runner with symptoms of anorexia nervosa as well as ‘over-exercising’) how exercise and fitness can come to constitute a significant P a g e | 12 part of someone’s life and identity in ways that while sometimes nurturing can also be harmful, an “ever- vigilant taskmaster” (p. 56). As with the eating disorders described above, it is the continuity with imperatives of obesity discourse in health and physical education (and wider public health messages) that Zanker and Gard argue is particularly striking and dangerous. In Lindsay’s stories, the firm belief that fitness equals moral superiority as well as health is clear, used as a defence against repeated illness and bodily- breakdown, as well as the views of those around her that her engagement with sport and exercise is extreme and damaging. Body dissatisfaction is not just a concern for overweight children, although they may be particularly vulnerable; rather a focus on bodily appearance, a fear of fat, and narrow delineations of what is considered ‘healthy’ and ‘normal’ mean that children (like adults) of many shapes and sizes are susceptible to body dissatisfaction and potentially turning to body management practices that can be far from healthful. For example, research also suggests that there is a group of ‘thin’ or ‘normal’ weight girls who are also particularly vulnerable to body dissatisfaction even from a young age (see for example Tremblay, Lovsin, Zecevic, & Larivière, 2011). Working with older youths, Evans et al. (2008) bring together scholarship on obesity discourse, body image, eating disorders and educational practices in their research with young women with anorexia nervosa or bulimia. It becomes clear in their research that the implications they are exploring go beyond those with eating disorders; rather they note that “the actions and views of these young people who have taken ‘disordered eating’ to an extreme throw into sharp relief aspects of schooling, culture and society that are problematic for many other children and young people, not just ‘the vulnerable few’” (Evans et al., 2008, pp. 3–4). A related issue then is the concern in the literature that body dissatisfaction and body management behaviours have become more common (Bucchianeri et al., 2013; Dion et al., 2016; Irving & Neumark- Sztainer, 2002), and in younger children than previously thought (Damiano et al., 2015; Ricciardelli & McCabe, 2001); yet have remained relatively understudied in the public health arena (Bucchianeri & Neumark-Sztainer, 2014). For example, in their review of the literature on children 6-11 years old Ricciadelli P a g e | 13 and McCabe argue that between 28-55% of girls, and 17-30% of boys desire to be thinner; while on the opposite end 4-18% of girls, and 13-48% boys desire a larger/broader body size. In terms of body management behaviours, estimates range from 20- 55.6% for dieting to lose weight, approximately 43% report exercising to lose weight, and fewer (6.5% of girls and 14.2% of boys) report binge eating or self- induced vomiting (1.8% of girls and 0.7% of boys) (Maloney et al., 1989, as cited in Ricciadelli & McCabe, 2001). Likewise, the responses to questions about weight and body (dis)satisfaction reported by Burrows (2008) from their survey of New Zealand children and adolescents suggests quite a high percentage of young people, even at primary school, report some body and weight concerns; for example 44% of the primary school students, and 67% of the secondary students responded that they only ‘sometimes’ or ‘rarely’ felt good about their bodies, with marked gender differences. Further, of the primary school cohort 38% of boys and 42% of girls, and of the secondary cohort 30% of boys and 62% of girls, responded that they had at some time thought they needed to be thinner. Research has explored a variety of inter-related elements to the development of body dissatisfaction and body management behaviours, including larger body size, perfectionism, internalisation of appearance ideals, exposure to media, parental and peer influences (Dohnt & Tiggemann, 2006; Evans et al., 2013; McCabe & Ricciardelli, 2005; Paxton et al., 2006; Tatangelo et al., 2018). Body dissatisfaction trajectories over the lifespan are not well understood, but have been found to increase over adolescence and early adulthood (Bucchianeri et al., 2013), and to remain relatively stable (Tiggemann, 2004; Wang et al., 2019). While there is some evidence of weight concerns and body dissatisfaction even for pre-schoolers, the early school years seem to be a key time. For example, around six or seven years old seems to be when associations between sociocultural influences and body dissatisfaction begin to strengthen for young girls (Dohnt & Tiggemann, 2006; Hayes & Tantleff-Dunn, 2010; Heron et al., 2013). Longitudinal research has suggested that girls’ body dissatisfaction and weight concerns at younger ages are predictive of body dissatisfaction and weight concerns in late childhood, as well as increased dietary restraint and maladaptive eating attitudes (Davison, Markey & Birch, 2003), paralleling studies with older adolescents that have found links between recurrent body dissatisfaction during P a g e | 14 adolescence and elevated symptoms of depression and disordered eating in late adolescence and early adulthood (Ohring et al., 2002). Likewise, qualitative research has drawn attention to similar concerns. Rice (2007) for example explores the consequences of messages around fitness and fatness received in childhood in the life stories of Canadian women, and in particular how these affected their emerging social identities, including their acquisition of gender identities, as well as their on-going engagement with eating and exercise. It is important to note that while research on body image and dissatisfaction has tended to focus on women and girls, research suggests that men and boys too are subject to particular concerns and pressures about the body. Within the context of the ‘obesity epidemic’ fat is constructed as a danger to ‘everyone everywhere’ (Gard & Wright, 2005); and fear of fat has become increasingly important for men also, both aesthetically and as part of the moral health imperatives that require one to ‘look after’ one’s health (and not be a ‘burden’ on society) to be a ‘good’ citizen. While the pressures this puts on men and boys are qualitatively different, researchers have highlighted the need to explore what this means for how masculinities are negotiated in relation to body size and body management behaviours (Gill, 2007; Monaghan, 2007; Monaghan & Malson, 2013). Unsurprisingly then, studies have found body dissatisfaction in a noteworthy number of boys and men, including the very young (Muise et al., 2003), although specific concerns may vary across the lifespan (McCabe & Ricciardelli, 2004). The presence of disordered eating and exercise behaviours was found to be more apparent when less stringent criteria (than the DSM-IV classifications) are used (Muise et al., 2003) and when body concerns relating specifically to dominant constructions of masculinity are also examined. For example Neumark-Sztainer et al. (2006) argue that when notions of ‘disordered’ eating and exercise are extended to those aimed at achieving a large (non-fat) muscular body (masculine ideal), as well as a small thin one (feminine ideal), similar levels are apparent in boys to those of body image and eating disorders in girls. Likewise, others have found young boys to be particularly invested in muscularity, strength and athleticism, as well as non-fatness (McLean et al., 2018; P a g e | 15 Tatangelo et al., 2018). Body image, size and weight concerns for boys and men are also likely to be accompanied by body management behaviours, including following rigid rules about eating and exercise, binge-eating, vomiting, substance (ab)use, ‘over-exercising’ and extreme use of dietary supplements and drugs to ‘bulk up’ (Hillgrove, 2014; O’Dea & Abraham, 2002; Tatangelo et al., 2018). Such body work to achieve the desired body for men may derive from similar social pressures of bodily surveillance and control to those affecting women, although more research needs to be conducted to explore these gendered pathways (Gill, 2007; McCabe & Ricciardelli, 2004). Finally, certain populations may be particularly ‘at risk’, for example boys with a higher BMI and those who identify as homosexual or bisexual (Muise et al., 2003), highlighting the importance of intersectionality. Bringing it together: Healthy body messages Concerns about the ‘thin ideal’ and body image issues, particularly for girls and women, are longstanding. However, these concerns seem to have taken a backseat to (or fail to be integrated with) policies combatting the apparent looming threat of obesity. There has been a tendency for the fields of body image and eating disorder prevention to remain separate, despite the potential for cross-over, as well as danger of unintended effects. Indeed, while there is sympathy for the stigmatisation of overweight children, the power of obesity discourse means there is also a tendency to question whether stigma might actually be acceptable or even helpful in motivating weight loss. However, there is no evidence that this is the case (Puhl & Latner, 2007), nor as Puhl and Latner contend, would this make it acceptable. As O’Dea (2005) has argued, it is important for health interventions to take a step back and consider the primary objective to first, ‘do no harm’. Yet anti-obesity interventions often involve the potential for a number of unintended consequences, from further stigmatization, prejudice and discrimination of fat individuals; increasing marginalisation of already vulnerable groups; victim-blaming; misinformation; increasing body dissatisfaction; encouraging avoidance of important services such as healthcare; to inadvertently encouraging unhealthful body management practices such as dieting and other weight-loss techniques. While some of these arguments are almost twenty years old, they remain important and an on-going P a g e | 16 challenge. More recently, for example, Warin and others have highlighted the on-going “’gentle invisible’ violence of obesity prevention” programmes in Australia, which despite “position[ing] themselves as well intentioned can reproduce forms of slow and symbolic violence through pedagogic care” (Warin, 2020, p. 663). This includes continuing to push a ‘one-size-fits-all’ approach that ignores the social gradient in obesity statistics (Warin et al., 2019), and the complexities of families’ lives and socio-economic contexts (Graham et al., 2018; Throsby, 2018; Warin, 2021; Warin et al., 2019). Lauded as ahead of its time, the New Zealand HPE curriculum is centred around a notion of ‘well-being’ that foregrounds holistic understandings of health, including ‘hauora’ (a Māori perspective that highlights mental and emotional, social and spiritual, as well as physical dimensions as pillars of health), as well as teaching children to be critical health consumers who can reflect on, integrate, and take action from health information (Burrows & Wright, 2004, 2007; Fitzpatrick & Burrows, 2017). However, the avowedly holistic and critical nature of the NZ HPE curriculum sits in tension with other influences, including the wider context of obesity concerns, government agendas and the tendency of public health messages to focus on simplicity (Fitzpatrick & Burrows, 2017), as well as their interpretation by particular teachers in individual school contexts (Burrows & McCormack, 2012). Likewise, as Burrows and Wright (2007) argued: in the context of the obesity epidemic, much of the potential this curriculum yields in terms of regarding children as social actors is diluted… despite an avowedly more ‘holistic’ notion of what health entails, in an ‘obesity’ laden environment, much of the focus in schooling remains on practices that impact on physical health–specifically on eating and physical exercise. (Burrows & Wright, 2007, p. 88) I have argued here that imperatives to ‘eat well’ and ‘exercise’ enmeshed in obesity discourse are not necessarily simple or healthy in the way they are taken up in the everyday lives of individuals. Rather, at its extremes, obesity discourse encourages embodied relationships characterised by guilt and anxiety as well as obsessive and potentially damaging ‘control’ of diet and exercise. In relation to the ongoing pressure of these messages in children’s lives, both at home and at school, then, such messages seem to set children P a g e | 17 up to have unrealistic and potentially damaging expectations about bodies and health with harmful effects for how they might engage with food, physical activity and their own and others' bodies (Burrows, 2010b; Burrows et al., 2002). As Burrows and Wright argued: The sheer volume and scope of resources being applied to schools provides children with a wealth of information and knowledge about their own and others’ health, yet the nature of that information is such that it tends to close down rather than open up possibilities for young children to think critically and weigh up options for themselves relevant to their particular life circumstances. (Burrows & Wright, 2007, p. 94) A range of strategies have been mobilised in schools including banning particular foods and drinks from school cafeterias, parental education attempts, introducing ‘fitness’ activities, making use of a variety of (often commercially sponsored) nutrition resources, and surveillance of children’s lunchboxes (Maher et al., 2020; Pluim et al., 2018; D. Powell & Fitzpatrick, 2013; D. Powell & Pluim, 2020; Wright et al., 2012). Attempts to mobilise children as health advocates or ‘agents of change’ within the family, through information about healthy eating at schools, put increasing pressure on children and families (Burrows, 2017, 2021). However, despite this focus, recent projects that focused on talking to families in NZ and Australia have found that families experience relatively little of this information making it home; rather children see their family as primary sources of expertise on health and food (Burrows, 2021; Maher et al., 2020). School messages about health and bodies are often experienced by children and their families as contradictory, and even sometimes hypocritical, as well as failing to align with the more relational nature of family food practices (Burrows, 2017; Lindsay et al., 2021; Maher et al., 2020). For example Maher et al argue that while school messages are often instrumental and compartmentalised, with specific items labelled as healthy or unhealthy, this is often overshadowed for children by rules and regulations about where and when eating occurs, what foods are ‘allowed’, and prohibitions against sharing food; as well as in stark contrast to other school policies, for example around fundraising (Maher et al., 2020). In contrast, families tend to make decisions about food in context, balancing “pragmatism, pleasure and health, where relationships and care are at the centre” (Maher et al., 2020, p. 87). Likewise, Burrows talks about how families weave together knowledge from different sources, alongside practicalities such as the cost and availability of foods, children’s allergies, likes and dislikes, commitments to sustainability, as well as familial P a g e | 18 rituals and traditions, cultural and religious practices; food knowledge then “assembled in ways that made sense for each family’s life” (Burrows, 2021, p. 240). Research talking to children and families about these clashes between school and home, has found a range of reactions from viewing school rules and policies as minor annoyances, to a source of a variety of unintended negative emotional consequences for children and their families (Burrows, 2021; Maher et al., 2020; Tanner et al., 2019). For example, Tanner et al (2019) show how narrow Anglo-Western ideas of what constitutes ‘healthy food’, rigidity around what and how food is consumed at school, and how it can be presented (e.g. ‘nude food’) “can produce feelings of frustration, concern, worry, upset and anger for families, and feelings of worry, embarrassment, fear and shame for children” (p.21), including further marginalising those from diverse cultural backgrounds. Children’s media and picture books Given the young age that anti-fat attitudes and body dissatisfaction appear to develop, as well as the consistent and simplistic ways that even young children are engaging with obesity discourse, further exploration of what messages are being directed at very young children and how they are engaging with these messages seems crucial. While concern about (and study of) health and body representations in popular visual media such as television, movies and magazines are widespread (e.g. Dohnt & Tiggemann, 2006; Greenberg, Eastin, Hofschire, Lachlan, & Brownell, 2003; Hargreaves & Tiggemann, 2004; Himes & Thompson, 2007; McGladrey, 2013; Northup & Liebler, 2010; Veldhuis, Konijn, & Seidell, 2014), these messages in picture books have been relatively understudied. Yet stories generally and picture books in particular are an important and useful window into social norms and expectations; a way that children learn what is expected and valued in society from a young age; and so form part of the mosaic of understanding that contributes to children’s formation of self-image and identity as well as understanding of the world more broadly. A wide variety of research has examined the representations of gender in picture books, for P a g e | 19 example, and potential effects of this (see for example Ashton, 1983; Davies, 1989; Diekman & Murnen, 2004; Hamilton, Anderson, Broaddus, & Young, 2006; McCabe, Fairchild, Grauerholz, Pescosolido, & Tope, 2011; Parsons, 2004; Weitzman, Eifler, Hokada, & Ross, 1972). In arguing that such inequitable representations matter, Hamilton et al (2006) note that experimental research aligns with the ‘common- sense’ understandings of parents (and others), strongly suggesting that gender bias in picture books reinforces and strengthens children’s own gender biases, with measurable effects on subsequent attitudes, toy and activity choices, and occupational interests. Similar research has been conducted in relation to other social groups, including along the lines of age (Crawford & Bhattacharya, 2014; Hollis-Sawyer & Cuevas, 2013), ethnicity (Mendoza & Reese, 2001), sexuality (Flanagan, 2008; Kelly, 2012; Sunderland & McGlashan, 2013), and characteristics such as deafness (Golos & Moses, 2013) and disability (Matthews, 2009). While little research has been conducted to date on representations of body shape/size in picture books, I argue this too could be usefully subjected to a similar examination. Like all of these groups, representations of body diversity are political, and are an issue of social justice, given (as discussed above) the harms being caused by weight bias, stigma, and discrimination and the prevalence of body dissatisfaction. Body messages and weight stigma Appearance messages are common in a wide variety of media, including the “what is beautiful is good” phenomenon (Dion, Berscheid & Walster, 1972, as cited by Herbozo et al, 2004, p.23). That is, there is a tendency for ‘good guys’ to be represented as physically attractive, while ‘bad guys’ are often unattractive and otherwise physically ‘deviant’ from currently accepted social ‘ideals’, their moral deviance represented through their physical appearance- their bodies. One of the ways this manifests is through weight stigma. This includes larger bodies being under-represented, as well as portrayed in negative and stereotypical ways. While body weight and attractiveness are long-standing points of focus in media, the widespread attention given to concerns about the ‘obesity epidemic’, particularly in the 1990s and 2000s, provoked a proliferation of particular representations of fat bodies in popular media, “as grotesque, uncontained, P a g e | 20 destined for ill-health and an early death, and a burden on the public purse” (Lupton, 2017, p. 120). For example, fat people are widely stigmatised in news content, including the types of shots and angles used as well as the activities engaged in (Puhl et al., 2013). ‘Obesity’ is regularly symbolised by images of what Charlotte Cooper coined “headless fatties” (Cooper, 2007), eating takeout or pictured in otherwise unflattering and inactive ways. Likewise, research on popular media representations of body size have found relationships with a variety of aspects, from characters’ gender, age, height and ethnicity, to their representation as attractive or unattractive, to the kinds of behaviours they engage in and the kinds of storylines they are involved in. There is also a tendency to under-represent body sizes/shapes that do not fit into (gendered) body ‘ideals’: not unlike what in relation to gender has been termed the “symbolic annihilation” of women in media. These kind of issues with the representation of larger body sizes have been found across a range of media, from magazines (Malkin et al., 1999; Tiggemann, 2003), to music videos (Borzekowski et al., 2000), to films and television (Eisenberg et al., 2015; Fouts & Burggraf, 1999; Fouts & Vaughan, 2002; Greenberg et al., 2003; Himes & Thompson, 2007; Robinson et al., 2008), to newer media forms such as YouTube and Twitter (Hussin et al., 2011; Lydecker et al., 2016; Yoo & Kim, 2012); and has been found to be true for media aimed at children as well as adults (Ata & Thompson, 2010; Klein & Shiffman, 2005; Northup & Liebler, 2010). In their review of fat stigma in children’s media, Ata and Thompson (2010) note that movies and animated cartoons were particularly likely to have fewer fat or overweight characters, and for these to be portrayed in negative ways; while children’s books and situational comedies demonstrated these trends to a lesser extent (though with high variance between individual examples of these media). In Klein and Shiffman (2005)’s analysis of children’s animated cartoons, they note that over the past several decades, ‘underweight’ characters have become more common, while ‘overweight’ characters have reduced in frequency. Consistent with the ‘what is beautiful is good’ stereotype, overweight characters were more likely to be represented as unattractive as well as in a range of other negative ways: with below average P a g e | 21 physiques, to have below average intelligence, and to be less happy, energetic and loving. There was also a gendered effect, where female characters were more than four times as likely to be ‘underweight’, while males were nearly twice as likely to be ‘overweight’. Explorations of the effects of media exposure on fat stereotyping by children suggest some relationship (Latner et al., 2007), alongside factors such as parental beliefs, and self-image, including perceived body size (Holub, 2008; Holub et al., 2011; Spiel et al., 2012). While issues around physical attractiveness, body size, and body image have been extensively studied, very few studies have examined body size in relation to children’s literature or picture books specifically. Interestingly, two studies that did look at picture books found relatively few negative messages about food, eating or body size (Byrne & Nitzke, 2000; Herbozo, Tantleff-Dunn, Gokee-Larose, & Thompson, 2004). Indeed Herbozo et al (2004) found that under 10% of the books in their sample (compared with around 70% of the films) included specific body related messages according to their coding framework. Messages about obesity were a bit more common, occurring in about 20% of the books. While additional research is needed, this initial exploration suggests that picture books may offer a different insight into the range of messages about healthy bodies available to children, and particularly those that offer more (body) positive understandings. Health messages Predominantly research that has been done in relation to representations of health in children’s media has focused on specific health messages, including nutrition (Bellows, Spaeth, Lee, & Anderson, 2013; Byrne & Nitzke, 2000; Byrne & Nitzke, 2002; Goldberg, 1992), and physical activity (Jarvis et al., 2014; Knowles et al., 2014; Svendsen, 2012; Taveras et al., 2004). These have generally focused on their use as a tool for encouraging children and/or their parents to get active, eat a balanced diet, and also to try new foods. Additionally, research has tended to involve quantitative methodologies such as content analysis to give broad trends in the kind of messages apparent in children’s books and other media. For example, Turner (2006) conducted a content analysis of a convenience sample of 119 children’s picture books involving health, illness and injury related topics, to aid parents and health professionals who want to select and P a g e | 22 provide health related reading materials. This study focused predominantly on messages such as coping with illness and injury; books more generally about health, healthy bodies or healthy lifestyles were relatively few, although this may have been related to the sampling framework used. Overall there is a dearth of research exploring the nuances of health and body portrayals in media for young children, and especially in picture books. P a g e | 23 The Current Study In the current study, I aim to explore the messages young primary school aged (5-6 years old) children are receiving about ‘healthy bodies’ in New Zealand, and how they are making sense of these messages through their talk. Here notions of body size/shape/weight and health education around healthy lifestyle choices are placed alongside the related issues of body image and body-based stigmatisation: together forming the focus on ‘healthy bodies’. Taking a social constructionist stance, I argue we need to explore the multitude of (often contradictory) messages children are receiving from all around them. Bodies are central to the way we interact with the world, and the meanings we attribute to them are everywhere. Further, even young children are not passive consumers, but actively engaged with their worlds; it is also important, therefore, to explore how children engage with these messages. Here then, I examine the ‘healthy body’ discourses available to children, via a focus on picture books. While, as I have argued, research has often concentrated on newer visual media, such as children’s TV, movies and music videos, I focus here on picture books as a relatively understudied media form, which children engage with from a young age and in both school and home contexts; and potentially one that more often highlights diverse and critical messages about health and bodies. Additionally, by using key picture books identified in this initial analysis in small focus group discussions with young children, this research aims to go deeper into the nuances of meanings in these texts, in interaction with their audience and how they are ‘read’ by children. Key questions guiding the research include: 1. How are healthy bodies constructed in children’s picture books, and in particular what messages about shape/size, eating, exercise, diversity, body image and gender do they offer in relation to this? 2. How do children read, understand and engage with these messages? 3. What discourses available to children allow them to engage with the complexities of health in ways that encourage critical thinking, self-esteem and are (body) positive? P a g e | 24 Theoretical and Methodological roots Broadly, my research fits within a social constructionist epistemology, taking a critical discursive approach to examine the complexities of how ‘healthy bodies’ are being constructed in both children’s media and in their talk. My research has two main parts: 1. An analysis of the messages about ‘healthy bodies’ in picture books for children. 2. Interviews and small group discussions with 5-6 year old children (in groups of 2-3), using a subset of the books analysed in stage one, as well as an unstructured drawing activity, as a focus for discussing health & bodies. In this chapter, I explore the theoretical underpinnings of the research, before describing the methods used to collect and analyse the data. Social constructionism and a critical discursive approach In this research, at an epistemological level I take a social constructionist stance, where truth and meaning are seen as contextual and contested, coming into being through social interaction. Constructionism questions the idea that we can know or observe ‘reality’ directly. Rather, the world is seen as given meaning through how it is negotiated between individuals, mediated and even constructed through language (Gergen, 1985; Willig, 2013). Here, language is seen as more than just a passive and neutral means for transmitting information. Rather, language is acknowledged to be an important social practice. Language is never neutral, but rather does things; and has real world effects. Particular constructions of health, for example, have implications for how we understand and ‘do’ health (Crawford, 2006). Likewise, our understandings of healthy bodies, and of ourselves as healthy or not, arise from social interaction, within particular social and cultural worlds, and have follow on effects for how we engage with the world (Lyons & Chamberlain, 2006). In this sense, the ways in which we understand the world are “social P a g e | 25 artifacts” (Gergen, 1985, p. 267), which are socially and culturally situated, and actively contested in interactions; “Knowledge… is something people do together” (Gergen, 1985, p. 270). In line with this stance, Potter and Wetherell (1995) and Parker (1990, 2005) pioneered a discursive approach in psychology, which focuses on exploring the ways language is used in interactions to construct particular versions of the world. Here the focus is on ‘discourses’, coherent sets of meanings, which construct people and objects in particular ways (Parker, 1990). Based on the works of these writers, two different schools of Discourse Analysis (DA) in psychology are often differentiated, namely Discursive Psychology, and Foucauldian or Critical Discourse Analysis. Discursive Psychology, based on the work of Potter and Wetherell (1995), tends to focus more at a micro level, exploring how a speaker or writer uses discourse within a particular context to fulfil certain social actions. In contrast, a Critical Discourse Analysis approach focuses more on the broader social functioning of discourses, and on the ways in which language functions in relation to power (Parker, 1990; Parker, 2005). Here, Parker is influenced by the work of post- structuralist writers such as Foucault (1972, 1980 as cited in Parker, 1990). However, while these two versions of discourse analysis tend to focus on different aspects of discourse, a combination may be particularly valuable (Potter & Wetherell, 1995; Willig, 2013). In the current study I primarily take a Critical Discourse Analysis approach, though utilising more of a mixed approach for the second part of the research in which I explore children’s talk in a discussion group context, as I outline below. A study of two parts My analysis consists of two parts: an analysis of picture books, and then exploring children’s talk within group discussions. For the first part of my analysis, I primarily take a critical discourse analytic approach to explore the health and body discourses available to children through the medium of picture books. In line with this approach, my focus in this research is primarily on the interacting discourses available to children, as well as their effects. How are bodies being constructed in relation to health and well-being, and what are the implications? In the second part of my analysis, exploring health and body discourses in children’s talk, I employ more of a mixed approach, considering both how children use different discourses to fulfil P a g e | 26 particular social functions within our interaction, as well as stepping back to consider the broader implications of how these discourses construct health and bodies. That is, how might the repetition of certain representations of what constitutes healthy bodies construct children’s understandings, opening up certain possibilities for ways of being and doing, while closing down others? Here then ‘discourses’ are sets of meanings that construct the world in a particular way, which people draw on in talk and text (and also other systems of meaning-making). While a speaker or writer must make active decisions within specific social interactions in the way they draw upon different discourses, these also do things that can be somewhat outside of the speaker or writer’s control. That is the interlinked meanings can go beyond what an individual speaker intends, drawing on social meaning systems. Discourses construct objects and articulate relationships, as well as creating subject positions, addressing us in a particular way and inviting us into a particular understanding of the world- with implications for how we engage with the world. A discourse analysis then focuses on how discourses position people and objects in certain ways, with effects for what can be thought, felt and done. Discourses are not static, but located in time, evolving and interacting with each other. Importantly for this approach then are notions of ‘multivoicedness’ and contradiction, the contested nature of discourses, and how they may contradict with one another or work together. In this way, discourses function ideologically within a particular historical moment; particular ways of understanding and talking about the world are implicated in relationships of power, either supporting or challenging the status quo (Parker, 1990; Parker, 2005). In taking a discursive approach, I follow in the footsteps of others who have come before me in the critical health literature. An acknowledgement of the need to position children as participants in (rather than objects of) research, and to value children’s voices, has led to burgeoning qualitative work to explore children’s experiences of diverse aspects of health and bodies (e.g. Burrows, 2008; Burrows et al., 2002; Curtis, 2008; Drummond et al., 2009; Powell & Fitzpatrick, 2013; Wills et al., 2006; Wright et al., 2012). This literature highlights the importance of making research accessible to and respectful of diverse young people; as well as the challenges inherent in research with children, and the value of diverse qualitative P a g e | 27 methods (Curtin, 2001; Drummond et al., 2009; Kirk, 2007; Supski & Maher, 2021). For example, utilising visual research techniques such as photo-voice has proved a valuable way to engage with children about diverse aspects of health, food and physical activity, at school and home (Lindsay et al., 2021; O’Connell, 2013; D. Powell & Fitzpatrick, 2013; Supski & Maher, 2021). Likewise, utilising activities involving pictures and stories within interviews or focus groups may help with engaging children, making the research process more fun, and allowing children to express themselves in diverse ways; however, care needs to be taken in assuming particular activities such as drawing will be ‘fun’ and accessible for all children (Kirk, 2007). Likewise, Curtin (2001) talks about the importance of bridging different styles of communication in working with young children, as well as reducing the inequality inherent in adult-child relationships, by engaging in curious and responsive, rather than authoritarian or judgemental, ways. However, this involves a delicate balance, which I reflect on further below. Discourses in media and the importance of multimodality Lyons (2000) has highlighted the importance to health psychology of critically analysing media representations of health and illness. She argues that such representations can influence individuals’ beliefs and understandings about health and illness, their attitudes towards themselves or others, and even mediate their lived experiences of health and illness. While her examples primarily focus on news media, popular media are likewise a useful window into cultural norms and understandings and a valuable ‘text’ to subject to discursive analysis. As Machin (2013) has argued: “Discourses are communicated not only through political speeches and news items but through entertainment media such as computer games and movies, in the social and material culture of everyday life such as fashion, toys, music, architecture, and town planning and in the very ways that we engage our bodies and interact. Discourses are communicated through different kinds of semiotic resources, different modes, and realised through different genres. And it is at this level that many people most frequently experience these discourses as fun, as style, and simply as part of the taken for granted everyday world, even if on other more or less tangible levels they feel their power over them. All these different levels of communicative activity are infused by and shaped by, power relations and ideologies.” (Machin, 2013, p. 347) P a g e | 28 Likewise, picture books for children are not apolitical but rather are embedded in a particular sociocultural context, and will draw on discourses in their constructions of the world generally, and healthy bodies particularly. Discursive work in psychology has typically focused primarily on talk and text, perhaps due to the difficulties inherent in working with different modes, and a simultaneous perception of visual data as lesser or more simplistic, as well as more ambiguous (Reavey, 2012; Reavey & Johnson, 2008). However, talk and text are not the only systems of meaning making by which people construct the world; indeed constructionists have long argued the need to look beyond just written and spoken language, or to conceptualise ‘language’ more broadly (Misra, 1993), despite the challenges inherent in doing so. Likewise, Parker (1990) explicitly talks about identifying the variety of ‘texts’ in which discourses function in a much broader sense than just a piece of speech or writing. As Reavey argues, “multi-modality is a complex interplay between a number of meaning-making resources that are part of our experience and can be part of the way we communicate” (p. xxviii). Indeed, as Kress (and others) have argued, all communication, all meaning-making, is inevitably multimodal (Kress, 2005; Lemke, 2012), presented for example in visual as well as textual ways, whether with gesture, the embodiment of the person speaking, or the way the words are presented on the page. Images, and other aspects of multimodal communication, are an essential part of our social worlds, including the negotiation of complex notions of identity and subjectivity, and of what is seen as normal and desirable (Reavey, 2012). This is only becoming more so with the advent of new digital technologies. Psychology has been slower than other disciplines to embrace multiple modalities, including the visual; however, there is a growing recognition of their importance in the richness of experience and in the production of meaning (Frith et al., 2005; Reavey, 2012). For my research, multimodality is particularly important in an analysis of picture books, where (most obviously) the story is constructed through both written words and illustrations (see Agosto, 1999; Guijarro, 2013; Martinez & Harmon, 2012; Shuxuan Wu1, 2014; Sunderland & Mcglashan, 2013). In this medium, words and images complement each other in such a way that neither alone can provide a P a g e | 29 complete picture. Additionally, the stories in picture books often utilise text size and font, as well as layout on the page; likewise, the story is not only written on the page but generally read aloud and this too may be important in the production of meaning. My method of analysing the books in particular then borrows from Critical Multimodal Discourse Analysis (A. F. Gibson et al., 2015; Machin, 2013; Machin & Mayr, 2012). Here I expect discourses about healthy bodies to be constructed through multiple modalities, including both textual and visual choices in children’s picture books. Further that these choices will be embedded in social power relations (A. F. Gibson et al., 2015; Machin, 2013). That is, I don’t view picture books as ‘innocent’ in their constructions but rather as inevitably embedded in their sociocultural context, actively working to (re)produce particular versions of the world, including elements of ideology, social institutions and social hierarchies. How the objects of interest (health, bodies, eating and exercise) are represented through the different modes within the picture books will create different affects, and will involve prioritisation of some bodies and behaviours over others, reproducing certain understandings of what is normal and desirable, and invoking powerful concepts such as identity, morality, family, and medical institutions. Key in looking at picture books through this lens, meanings around health and bodies are portrayed not just by the words, but by the construction of the illustrations, by the relationships between image and text, and by narrative and tone. Key features included repetition, size and spatial orientation, symbolism, affect and humour. Additionally, being designed for reading aloud, the text has aural elements, playfully utilising rhythm and rhyme. Each mode offers different affordances; that is, they enable and constrain the production of meaning in particular ways, and will draw on different social conventions in the way they produce meaning (Machin, 2013). For example, while the written text may describe what a character is doing, thinking or saying, it can do so without making commitments about what they look like, their body shape, or spatial relationships. Images on the other hand must make these elements of a character specific. Likewise, other objects of interest (such as food and exercise), must be represented in specific ways through the images, and how this is done changes the meanings offered, engaging particular emotional P a g e | 30 responses and inviting children into particular ways of seeing the world. Of interest then is how these modes are ‘mutually enhancing’ (Sunderland & McGlashan, 2013), how they interact to make different meanings available as well as to influence and refine how each other may be interpreted (Jewitt, 2008; Sunderland & McGlashan, 2013; Unsworth & Cléirigh, 2011), and how they can be used to avoid certain commitments, working to naturalise particular taken-for-granted understandings (Machin, 2013). I am interested in how discourses about health and bodies are drawn on in picture books, what assumptions they make about doing health and being healthy, and how these are ‘read’ by children. P a g e | 31 Method Part 1: Book Analysis Book selection I wanted to include a broad selection of picture books that reflected the diversity of meanings around ‘healthy bodies’ available to young children locally. To achieve this, I developed an initial list through a variety of different methods, including: 1. The Whitcoulls Top 50 Kids books list – a list of popular children’s books voted for each year by the New Zealand public 2. Recommendations from a local school librarian of books available in the school library that came to mind for her as possibly relevant to the topic 3. A list of the top 35 most commonly borrowed children’s picture books from the local public library 4. Themed picture books from the local public library that came up in keyword and subject heading searches that had been borrowed 6 or more times in the last 12 months1. Through these methods I selected books directly related to my topics of interest, as well as simply the most popular books. These diverse methods allowed me to include not just obviously ‘themed’ books, but also popular books that may have more subtle or oblique messages around healthy bodies in the initial selection. It also meant the selection included both new books and older ‘classics’ that have remained popular over time, as well as books published in a variety of places (the UK, NZ, USA and Australia). This allowed a broad snapshot that is likely to more accurately reflect the diversity of what local children are reading, than if a single method (for example, utilising recent literary award winners) had been used. 1 Keyword and subject headings including: Health; Obesity; Fat; Body size; Body image; Self-esteem; Social acceptance; Bullying; Food; Eating; Exercise; Physical activity. P a g e | 32 I then went through this list and narrowed it down to a manageable number for analysis, ensuring that only books classified as ‘children’s picture books’, and only one book from each author, were included, as well as excluding books where I could see no material for analysis relating to the research focus on ‘healthy bodies’ (including anything related to shape/size, eating, exercise, diversity, or body image). This meant excluding most of the simpler stories for younger readers (for example based around counting, listing, rhyming); as well as stories about machines or (non-personified) animals, unless something about the words or illustrations seemed potentially relevant. Book analysis I then conducted a broad descriptive thematic analysis (TA) of the remaining books (42 books; See Appendix 1). Here TA provided a flexible tool to begin to organise and describe the rich detail of the data (Braun & Clarke, 2006) in this wider selection of books. In particular, this involved working through how each of the key focus areas identified in my first research question (health; food/eating; physical activity/exercise; body size; body image; self-esteem; diversity/individuality) were referenced in the picture books, and beginning to map out these different constructions. The focus here was on describing the variety of meanings across the books, so the criteria for including ‘themes’ was left open, allowing space to include any patterns of meaning relating to my research questions later on. While multimodality formed a background influence here, at this stage I didn’t delve deeply into the interplay of different modes in constructing these ideas. However, for the next step of analysis I wanted to look at some of the books in more depth, exploring how healthy bodies were constructed multimodally across the illustrations and texts of the stories. In order to get to a more manageable number of books that could be subject to a more in-dpeth, thorough analysis, I excluded books that were out of print, and ones that were only tangentially related to health and bodies,