Avoiding Throwing out the Baby with the Bathwater

Abstract

The recent article by Gurrieri, Previte, and Brace-Govan provides an earnest, existential challenge to both social and macromarketing in the health domain, as well as more generally. Their research deals with such serious issues as obesity, breastfeeding, and exercise. Yet, while the authors draw most impressively on theoretical thinkers and perspectives, they also misconstrue what they find and contend so one-sidedly that much of what is understood as social marketing becomes obviated and consumers are ironically situated in the hands of various food and medical interests. This commentary provides a much different reading of these issues. It critically deconstructs the authors’ view and then offers a quite divergent one that takes a more balanced, if paradoxical perspective regarding health issues. While health issues are complex, and a certain problematizing indeterminacy sometimes enters in when solutions are proposed and tried, the present critique delineates the necessary roles social and macromarketing can and indeed must play in the provision of good health for all.

Keywords

critical macromarketing social marketing obesity breastfeeding post-feminism

“Irony is about contradictions that do not resolve into larger wholes, even dialectically, about the tension of holding incompatible things together because both or all are necessary and true. Irony is about humour and serious play. It is also a rhetorical strategy and a political method, one I would like to see more honoured within socialist-feminism.”

Donna J. Haraway (1990, p. 149), Simians, Cyborgs, and Women: The Reinvention of Nature

The recent article, “Women’s Bodies as Sites of Control: Inadvertent Stigma and Exclusion in Social Marketing,” (herein referred to as “Women’s Bodies”) by Gurrieri, Previte, and Brace-Govan (2013) applying a feminist critique of social marketing targeted to the site of women’s bodies highlights some of the issues involved in taking critical perspectives across various marketing contexts, whether marketing at large, social marketing, or macromarketing (Dholakia 2012). In this commentary, we evaluate a few of these from a deconstructive critical perspective and attempt to show why their particular construction, while useful in some aspects, leaves the reader to fill in her own sense of paradox and irony. Indeed, such a deconstructive and problematizing process might lead one to conclude, as we will show, that the main paradox in this one-sided rhetorical article is that in challenging the social marketing narrative, it “inadvertently” supports the dominant marketplace food and medical narratives, which have their own transgressiveness. Thus, while it is possible that their analyses of the particular ads they interrogate are of value, their overreaching decontextualization of the health and social marketing narrative(s) seriously undermines and subverts their perspective. Like throwing out the baby with the bathwater, one metanarrative or discursive formation displaces another without due consideration. In the end and most ironically in their work, the very purpose of the social marketing project itself is called into question.

Deconstructive Critical Analysis

In our analysis, we draw on deconstruction as advanced by Derrida (1991) and especially as applied in a marketing context by Stern (1996). The critical view taken by “Women’s Bodies” is first and foremost embodied in a rhetorical text that applies particular discourses. This text and its discourses are as much subject to deconstruction as any other text. In our reading, we also expand the notion of text to include not only “Women’s Bodies,” but also some of the work the authors cite, as well as other related work as parts of the text. To comprehend and contextualize “Women’s Bodies,” it is necessary, as we came to see, to view their work as kind of tip of the iceberg with much other work feeding into theirs.

Going even further as Stern (1996) would suggest, while we focus on the text, both specific to “Women’s Bodies” and expanded, we also look at the discursive practices displayed as they reproduce the sociocultural realities in which they are inscribed. In other words while Derrida emphasized the text, Stern suggests that marketing (and macromarketing) phenomena and discourses are historically, institutionally, socially and culturally embedded, thus necessitating their inclusion in deconstructive analysis. In addition, we take into consideration the need to connect where necessary the micro and macro contexts (Askegaard and Linnet 2011; Canniford and Shanker 2012) by citing empirical research where applicable as “Women’s Bodies” also does. In all this we are also informed by the idea of critical postmodern analysis involving the interplay of the intertextuality, hybridization, and dialogism of different discourses (Boje 2006), which helps us expose the fissures and fault lines we can consider in our deconstruction. We would add that many of the gaps in the text of “Women’s Bodies” are born in the misconstruals and/or elisions of much relevant macromarketing phenomena that deconstruction makes apparent (e.g., claiming to be poststructuralist while essentializing women and health). Moreover, many of these gaps are to be seen as erasures (Derrida 1997), which reflect how the interpretations of “Women’s Bodies” serve to decontextualize what is considered. For example, leaving out the countercultural (including feminist and post-feminist) influences of and on the health movement renders an interpretation that is incomplete at best, if not entirely misleading. Thus while they seek to (re-)contextualize social marketing to women, they constrict their discourse and contextualization to what could be read as ironic and perhaps hyperbole at that, though we do not believe the authors intended it as such. In so doing we seek to problematize their text and its conclusions by a close reading that reveals the gaps we see in them.

Following Stern’s (1996) perspective we seek to deconstructively undo the “received” perspective of “Women’s Bodies” and bring a certain reinvigoration to the critical discourse. Such an undoing we find leads to paradoxical conclusions from the text that are implicit, if not explicit in it. In this regard, the authors in fact open the way with their rhetorical use of privileged isms and ists (e.g., healthism, functionalist) that beg for destabilizing and reinterpretation. We draw both on their perspectives as they privilege them and those they either counter argue or overlook altogether. In so doing, we develop a critical stance which we hope diversifies the set of stances taken beyond their ideology. This is not to necessarily disregard their view per se, but rather to provide a reading and an interpretation, which uncovers its inherent limitations. Reflecting Derrida and Stern on the usefulness of many interpretations and polysemy, we also acknowledge from the outset that our interpretation may be one among many. However, that our view is missing in this context drive us to provide it in order not to let the decontextualized interpretation of “Women’s Bodies” stand alone, uncontested, as the “authoritative” word on social marketing and macromarketing.

In our analysis, we focus mainly on obesity, which “Women’s Bodies” raises as an issue, though we do at a later point tie it to another issue they consider, breastfeeding. Obesity is a huge and complex social problem related to many diseases. It is perhaps best viewed ecologically as multi-level with possible interventions at various micro and macro sites to provide supportive environments for healthy behavior (Sallis et al. 2013; Story et al. 2008). Heart disease, stroke and hypertension are perhaps the most well-known obesity-related diseases, but breast and other cancers, diabetes, kidney disease, dementia, sleep apnea, fatty liver disease, and reduced lifespan are also major consequences of obesity, among others (Blüher 2013; Chang, Pollack, and Colditz 2013; Eichholzer et al. 2013; Lorincz and Sukumar 2006; Morimoto et al. 2002). This research, of which we are only able to cite a small amount herein, makes it all the more important to state the evidence to counter the perspective of “Women’s Bodies” that all the hullabaloo about obesity is somehow “a rhetoric of health” and “an almost alarmist moral panic” (p. 133). But even in the pages of the Journal of Macromarketing, Witkowski (2007) has made a cogent, counter to this “panic” in terms of useful social marketing strategies for developing nations, but which we feel also hold in many respects for developed nations as well.

Indeed, the very same terms of “rhetoric” and “alarmist moral panic” could well be used to describe “Women’s Bodies.” We should add further to make clear our differences with the authors over health and obesity as a health issue are related to justice and morality, especially in terms of allowing for opportunities in life for all (Daniels 1985). In marketing, various perspectives on distributive justice and ethics address the social marketing of health messages, which suggest that people need information, albeit often on a segmented basis, to make healthful decisions (cf. Newton et al. 2013). These perspectives also start with the concept that health is a right regardless of any issue of sociocultural status (Newton et al. 2013). To be sure, there are many faces to the play of morality in which people on all sides might be seen as situating themselves as moral protagonists in terms of their own identity work and world views (cf. Luedicke, Thompson, and Giesler 2010).

Regarding its take on the scientific-medical evidence, “Women’s Bodies” briefly mentions the problems with obesity, including those of depression, but give them short shrift. Yet, both the economic and social costs are enormous. While they focus on obesity from what they take to be a feminist perspective (indeed a particular older wave construction of feminism which we will address and deconstruct later), the issue is much broader than that. First, women suffer greatly from its afflictions. Second, men do too and the separation of the two genders in addressing these issues can be problematic. As Bell and McNaughton (2007, p. 127) caution based on their observation of dominating feminist discourse which has come to “see fat as a peculiarly women’s issue,” “While it is important not to overlook the political dimensions of relations between the sexes, studying men and women in isolation runs the risk of fundamentally misrepresenting their experiences of fatness.”

Thus, while certainly issues of female representation and objectification in social marketing can and should be addressed, the greater danger in our opinion is to marginalize efforts to deal with these enormous afflictions. There are many gazes to consider, not just “the male gaze” on an objectified female model. Thus, people tend to see the world through their own lenses in a myriad of ways and use their life experiences to form subjective interpretations of the various visual materials they encounter (Rose 2011; Sturken and Cartwright 2009). For instance, consider the gaze on oneself in a mirror when one is affected with preventable diseases caused by obesity. Another perspective on gazes is gained through a perusal of social marketing obesity images available through Google where messages for both men and women are all over the map. This suggests that the gaze of “Women’s Bodies” has focused on a few messages (the image in their figure 1 was among the results), which may not be nearly representative of the universe of social marketing messages. The question is what gazes we should consider and whose construction of them should we privilege.

Then too a paradox exists in applying feminism in a poststructural context without explicitly acknowledging or recognizing the irony of doing so. In “Women’s Bodies” we find this is manifested in at least two ways. First, taking a particularly deterministic feminist point of view but claiming it is poststructural as the authors do loads too much into the analysis. It essentializes feminism and women as all (“universally” perhaps) embedded in their scape. Moreover, feminism cannot and should not be so reduced, as there exist many readings of it. So many versions of feminism occur that we would be remiss if we did not at least consider them and problematize the version “Women’s Bodies” seems to be applying though the authors never even consider that they are applying a “version.”

Here we would suggest they are applying some variation of an older wave of feminism, which also runs into the neoliberal aspect of self-responsibility of the construction of one’s own self-identity apart from cultural structuring (Branaman 2012). These perspectives essentialize gender roles that run counter to other views largely rooted in what can be called post-feminism. The latter seek self-determination for women without naïvely assuming that women are irrelevant as a basis for structuring or necessarily privileging male advantage (Branaman 2012). Moreover, women may have any number of reasons for healthy bodywork, such as dieting and exercise quite apart from a disciplinary gaze (Branaman 2012; Purdy 2001). Furthermore, as Purdy suggests, women can use the medical system toward their own ends, not so much by rejecting it as by transforming it. Indeed, in a paradox unexplained by determinist theories, dominant social norms can constrain women’s choices while simultaneously empowering them (Anleu 2006). Scott (2000) makes similar observations regarding marketing and capitalism. She suggests that women can act under a rubric of market feminism, which, among other things, recognizes and deals with the imperfections and paradoxes of contemporary life. If you are claiming something post structural in your ideas, as do Gurrieri, Previte, and Brace-Govan (2013) be sure not to miss the paradoxes and ironies in what you may be inadvertently saying.

Second, reading Foucault as the basis for the various arguments about surveillance, neoliberalism, healthism and the like and then relating them to feminism besides is fraught with its own ironies. As Fox (1998) discusses, for instance, there are many Foucaults such that his views of the self, reflexivity, autonomy and related roots of governmentality changed over time. This might not be such an important issue if thinkers made clear which Foucault they were following and carefully crafted their arguments in that context. Instead, many people including the authors of “Women’s Bodies” reify Foucault and his theoretical descendants in their own archaeologies and constructions. The context of Foucault’s oeuvre is important because it lays open the paradoxes of basing an argument on a decontextualization and mythologizing of his work. In fact, Foucault can be adapted by anyone to justify many contradicting views.

Deconstructing and Recontextualizing the Discourse and Constructions in “Women’s Bodies”

As Derrida (1997) might suggest, liberty to do whatever one wants, such as that afforded by the bodily constructions rendered in “Women’s Bodies,” can match up with various unhealthy conditions. Similarly, the power-based construction of the body as Foucault, cited by the authors, trenchantly explores is fully inscribed just as much in their formulation as it is in the ones they seek to “dismantle” (their term). Is it possible that at least some women may feel or would feel stigmatized or at least disconcerted by constructions of bodily concepts which challenge their own perceptions of healthy? Certainly. At the same time, is it equally possible that other women or even paradoxically some of these same disconcerted women might respond to these constructs as aspirational, if not entirely desirable or realistic models for themselves? Consumers as denizens of the postmodern (albeit postmodernism is problematized in so many ways (Boje 2006)) can play with images and appropriate them in any fashion they see fit. While it is undesirable to stigmatize, it is also undesirable to patronize, not to mention unethical by not providing the information women need. Part of the issue may concern how that information is communicated.

Given our deconstructive perspective, the next step is to apply it to the text of “Women’s Bodies.” We find that the authors apply a discourse with well-worn terms whose meanings may have little bearing on the situation or may be quite pejorative and misleading. In linguistic terms, they are like empty signifiers which have no bearing on the signifieds they aim to capture. Furthermore, “Women’s Bodies” conflates the medical model and the health model. Even Crawford (2006, p. 411) whom the authors draw on in their healthism perspective, distinguishes the former from the latter (holism refers to holistic health), “holism radically expanded the quest for health far beyond medical priorities.” We go further than that in pointing out that the medical system/culture (pharmaceuticals; surgery, hospitals) and the health system/culture (avoiding the medical system through good health) stand as opponents in an ongoing cultural war. We also ask when speaking of the lived experiences of consumers as Gurrieri, Previte, and Brace-Govan (2013) do, how can we neglect the lived experiences of people seeking health? Indeed, their misconsturals of models allows them to invoke and misapply the otherwise useful mobius strip metaphor of Grosz (1994). We would agree for the most part that the medicalized model does privilege a mechanistic, Cartesian separation of body and mind. However, even that model and certainly the ‘health’ model which especially embraces Eastern and Western approaches, such as yoga, Pilates, meditation, mindfulness, etc. are not reducible to such separation. Counter to their use of embodiment theory, consider the relationship-conceptualization of the body and mind versus the medicalized Cartesian separation of body and mind. Have the authors considered or mastered the mindfulness? Are women pursuing health and fitness through yoga, Pilates and the like, caught in a vise of reductionist neoliberal dualism, of medicalization? Would that social marketing and government policy were more influenced by these empowering embodiment perspectives, not less.

The Neoliberal Argument

For good measure, “Women’s Bodies” speaks of “Neoliberalism” as a kind of ally of “healthism” through compelling people to take self-responsibility for their health, self-responsibility being a major tenet of neoliberalism. But if by that term the authors refer to dealing with economic costs of unhealthiness and the possible self-responsibility, these are certainly issues in this era of exploding healthcare budgets. Another related gap in the analysis of “Women’s Bodies” is that we can question the environmental sustainability and greenness of poor health brought on by poor social marketing. The medical (and food production) system have environmental costs. Then when people fall ill and enter the medical system, this necessarily entails the product of all sorts of medical waste and degradation.

In any case, neoliberalism as the authors deploy it is really a blinkered term. First, the more transgressive neoliberalism emerges in and from the deregulation and free rein of the medical-industrial complex, which includes the medical profession, the pharmaceutical and related industries, and interconnected government agencies. Food industries are concomitant handmaidens which serve to accentuate the problems. Consumers are largely left to their own devices with respect to these industries – this is neoliberalism in all its glory.

While there are no doubt neoliberal tendencies focusing on “regulating the subject” and which appropriate or coopt many aspects of various health movements, the idea of reducing health practices as aspects of that singular notion is a reductio ad absurdum. It is derisive to those of us who have engaged in lifelong resistance to marginalization of health rights and lifestyles. Thus, many practices such as those in alternative/complementary medicine for instance exist and have continuously developed in reaction to the hegemonic governmental medical establishment, not at its behest. If anything, we should conceive of a healthscape including a wide variety of subscapes, some of which “Women’s Bodies” might well capture, but others that are well beyond their constricting perspective.

In this regard, we consider the hot versus cold system trope. Gould and Sussan (2007) suggest that obesity is caught up in social forces involving what they call the hot and cool systems. The hot system involves marketplace forces that promote taste, pleasure, and desire fulfilled through food. The cool system involves other marketplace forces, including social marketers and nutrition-oriented marketers who have a more prevention and nutrition focus. We provide this system conceptualization to apply a much broader cultural dynamic than the neoliberal, “healthiest” formation described in “Women’s Bodies,” and to develop the paradox of their project. While both the hot and cool systems may have some objectifying aspects, an irony that the authors do not acknowledge is that the hot system may show attractive men and women engaging in unhealthy eating and lifestyles with an implicit if not explicit subtext that it will not affect them. “You can eat all you want and not get obese. And you can be with it.” Social marketers, whose public service advertising is generally supposed to be less dramatic (Wells 1989), are at a disadvantage and thus sometimes try to use the communications tools that hot system marketers employ. In some respects too, social marketers may be likened to marketers who in general are caught/hybridized between culture and economy (Slater 2011). Social marketers are caught between various marketplace systems or discursive formations.

Self-surveillance

Drawing on the hot versus cool system trope, we can see how self-surveillance is a complex phenomenon that extends to a variety of norms and conformity with them. Surveillance in general is a phenomenon where what many people do is scrutinized and watched by a relatively few people. As a form of control it itself is paradoxical and ironic (Sewell and Barker 2001, 2006). Surveillance is also an ironic paradoxical intertextualizing aspect of self-surveillance as well. It does not work because people tend to continue as “delinquents” anyway and do not change, according to Sewell and Barker (2001). Moreover, surveillance may be constituted in different discursive formations (Foucault 1972). Sewell and Barker (2006), for example, consider those of coercion and care. Coercion means the power to dominate others and is what “Women’s Bodies” refers to when speaking of self-surveillance in neo-liberal enforced terms. On the other hand, surveillance has a caring side, which seeks to be helpful though we think the authors might characterize this as patriarchal or hegemonic.

We frame self-surveillance as reflexive with these two formations such that consumers are embedded in them and reflect them in their own discursive practices. A related notion concerns self-stigmatization which has been characterized as a paradoxical phenomenon in which some people react with righteous anger and are energized to take corrective actions with respect to their problems while others do indeed experience lower self-esteem (Corrigan and Watson 2002; Major and O’Brien 2005). Still others may be indifferent to stigmatization and do not self-stigmatize. Thus, in interacting with the larger social discourses, consumers may take different stances, including holding more to one or the other or some mix of the two. There may be those who feel more coerced in the sense “Women’s Bodies” portrays or they may feel more comfortable with self-surveillance as a matter of course, more protected, for instance. And as implied by the very concept of discursive formations they may also construct it differently largely following the lines of coercive versus comforting formations. These will mix with other formations such as those about health and medicine (Levin and Solomon 1990), about fashion (Scaraboto and Fischer 2013) and feminism-gender (Scott 2000), among others. This is inscribed in and inscribed by lived experience.

Indeed, many people would rather be left to their own devices than have these medical and industrial establishments lord over them. From our perspective, this as much captures the biopolitics and governmentality of Foucault as anything. While Gurrieri, Previte, and Brace-Govan (2013) and those they cite use this framing to attack health movement(s), they conflate so many things including different approaches to self-surveillance, gender, race, and class with them. These things indeed present a conundrum, which is why the authors and we both have a point, and yet are at loggerheads. Whose vulnerability are we speaking of? Indeed as Shultz and Holbrook (2009) suggest, everyone is vulnerable in some situations. While many people are both economically and knowledge deprived, others are middle class people who may be said to be culturally vulnerable in that they eat “excessive helpings of junk food” (Shultz and Holbrook 2009, p. 125). Thus, the huge social problems preventing some people from achieving the lives they might desire does not or at least should not diminish in any way the quest for better health for all. Targeted solutions regarding various types of vulnerability may be called for.

Furthermore, it should be noted that the health movement as such is rooted in several key historical and countercultural movements, including the Women’s Movement itself, Gay Aids movement, and the alternative/complementary health movement. Thus to say that is somehow applying neoliberal or any other pejorative and misleading term is patronizing and dismissive of the historical and continuing saga of countercultural resistance to mainstream culture. That some aspects have been appropriated or coopted (neoliberalized perhaps?) is certainly important but that does not change the ambiance of ever-present resistance to mainstream marketing, government agencies and the medical establishment. Many of us who engage in healthy behavior do so in spite of the many institutional and marketplace forces arrayed against us in doing so. Indeed these are not the ones driving us to do so, if in fact, any are. This is the type of counter discourse of which “Women’s Bodies” speaks. Indeed, we would further argue that these movements broaden, not limit consumer health responses, as the authors would propose. Moreover, as Thompson (2005) has suggested, we live in an era of reflexive doubt in which all expertise is challenged. That “Women’s Bodies” overlooks this major gap in contextualization can perhaps be explained again by Derrida (1991) who formulated the idea of the trace. Originary ideas and textual developments may appear lost in later readings or texts. Readers and writers may be employing thoughts and ideas that are buried seemingly unrecognizable in their creations. But there is a trace that can be found especially if one is grounded in the socio-cultural context. Ironically, though this is not just a trace, but there are living breathing people who embody these ideas even if erased in the construction of “Women’s Bodies.”

Agency

Building on the foregoing discussion, we further find that dismissing agency out of hand as done in “Women’s Bodies” can be quite misleading. A more “nuanced” (a word the authors themselves use) view would suggest that there are occasions when consumer agency is in fact agentic, while there are others when that is not the case. Regarding obesity as a case in point, some weight-lowering practices will work for many but not all people. Sometimes therefore individuals can take personal action and sometimes changes need to be made in the available choices on a public/social level (Hu 2013; Sallis et al. 2013. Maybe all of us, Gurrieri, Previte, and Brace-Govan (2013) and ourselves included, might ask as an existential question reflecting indeterminacy: when are people agentic or can they be and when should they be (cf. Borgerson 2005; Murray 2002; Thompson and Haytko 1997)? In “Women’s Bodies”, the authors seem to rely too much on the ideas of commodification and marketization, which have been stretched even more into ideas of self-care, self-therapy, and the like as products of the marketing system. Undeniably, such has happened as marketers and social marketers respond to and coopt or appropriate health issues and concerns. Certainly marketing academics will frame arguments this way as well, that is privileging the central role of marketing and the marketplace system.

Another irony in “Women’s Bodies” interrogation involves the issue of agency versus oppressiveness. The authors rely on arguments, to be sure sound and applicable in some circumstances, growing out of the work of Foucault and others which seem to deny agency to people. The work of Thompson and Hayko (1997) and Murray (2002) lurches toward some way station dénouement if not a solution to this issue. Here, we see a paradox: if one always is in the marketplace (cannot escape it) and this oppressively structures one’s choices how can agentic resistance manifest? So if one practices good health and advocates through various means for this including, social marketing, is one a mere puppet of the system? If the system appropriates one’s discourses and practices, is this all bad? Of course the answer to that depends on many factors, including what forms the appropriations take. Some may be helpful to our life courses by facilitating various practices and discourses (e.g., healthier and greener environments) and some not (discursively labeling the medical system the healthcare system).

At the same time, we are as concerned that the vehemence of “Women’s Bodies” is emblematic of misconstruals of agency such that deferral to the feelings of oppression paralyzes those who fight for and welcome choices. If choice is really not choice and we are inescapably victims of cowering before the transgressive marketplace and state, then activity and resistance are futile. In this regard, we find the views of “Women’s Bodies” transgressive in two aspects. First, the authors render agency entirely and quite ironically as a repressive product of the neoliberal idea of self-responsibility, rather than something emanating from the lived experience of individuals, thus denying and ideologizing them into vulnerable states and into becoming hapless victims. As we might distill from reading “Women’s Bodies”: “You are only fooling yourself if you have agentic pretensions.” Second and not entirely separate, the authors create another layer of oppressiveness, which adds their own narrowing perspective as another ring of surveillance. So now as advocates for good health, we feel we are being watched from what to us is this overweening panopticon (Foucault 1975) that stigmatizes and denormalizes what we regard as the everyday, if we don’t necessarily want to use the word ‘normal’ in this indeterminant, undecidable environment. As we say elsewhere, the irony is that this constricting plays right into the hands of the neoliberal state and marketplace that Gurrieri, Previte, and Brace-Govan (2013) and we too find so disconcerting, at least when the marketplace serves powerful interests which run counter to our own. In fact, it is the authors, not us who serve as handmaidens to these interests, even if inadvertently (we assume).

Moral hazard is a related concept unfortunately ignored in “Women’s Bodies.” Here, we adapt the idea to suggest that if social marketing does not address obesity and breastfeeding in meaningful ways, we create a moral medical hazard. If people do not feel responsible in any way for their health practices and, furthermore, feel they will be bailed out by the medical system if anything happens, then we are creating a moral hazard. Insurance and in particular health insurance are designed to deal with life’s emergencies. Certainly there are many things that happen to people, described in the discourse of insurance as “acts of nature.” But medical conditions may be controllable or avoidable if individuals take the appropriate actions. Thus, for example, it has been reported that even obese women who have had breast cancer had greater survival in following more healthy pursuits, i.e. eating fruits and vegetables and engaging in physical activity (Pierce et al. 2007). Where the line is drawn between what one can be responsible for or not is necessarily contested. But unless one believes in no self-responsibility at all and writes it off as part of healthist, neoliberal domination, there must be some degree of self-responsibility somewhere.

In this regard, what critics such as Gurrieri, Previte, and Brace-Govan (2013) load on contemporary health consciousness and practices is likely to be more harmful than helpful, especially if allowed to fester unchallenged. While it is necessary to unpack their agenda, it is more important to state the “seemingly” obvious: many if not most consumers seek to have good health for whatever reasons. For many it is even a spiritual activity that Crawford (2006) seems to abhor. And why this is necessarily anti-social is certainly beyond our ken. For example, health social movements are seen to challenge the authority of medical, governmental and corporate institutions (Brown and Zavestoski 2004). Of course the archeology gets complicated. Of course there are levels and cross-currents of social activity. But reducing these to healthism is creating a metanarrative, while fortunately not fully embraced in broader society, nonetheless poses a social control danger of its own. There are at least two types of comfort possible in this regard: being comfortable with no messages aimed at so-called normalization, versus comfort in avoiding illness and feeling good. Moreover, rest assured, following the arguments of Gurrieri, Previte, and Brace-Govan (2013) and some of these others, more medicalizing will occur as people suffer the consequences of not being in the health system. This may be inadvertent (or not) as the authors claim about the social marketing communications they challenge, but it is at once ironic and pernicious.

The Issue of Breastfeeding

Though we focus mainly on the obesity issue in this paper, we also consider breastfeeding which is not altogether separate from the obesity issue and which is perhaps most disturbing in “Women’s Bodies.” The general concern here for the body projects of women and “morally infused disciplinary discourses” (p. 136) runs into ethically charged issues never considered. First, let us stipulate that marginalizing women who cannot breastfeed is certainly something to be avoided where possible. On the other hand, marginalizing/disparaging the medical literature, as done in “Women’s Bodies,” serves no purpose. And in fact, that literature goes well beyond the one they cite (Arenz et al. 2004) and one unhealthy state (childhood obesity they reference). Indeed, a key point we would make links the issue of breastfeeding with obesity. In addition, it has been found that there is a relationship between maternal and children’s obesity in terms of what is called overnutrition during pregnancy (Muhlhausler et al. 2013). Most importantly for the discussion here, research has shown babies’ tastes for foods can be determined by what the mother eats during gestation and breastfeeding periods (Forestell and Mennella 2007). This research is also noteworthy in that the genetic argument concerning obesity is problematized by the very process of nurturing.

Thus, we would consider it unethical not to promote breastfeeding. This is not a neoliberal imperative or healthist one or somesuch though it is well within the scope of a feminist one. So while it is well to consider women’s bodies and feelings, it is also important to consider their children. For example, recent research found that breastfeeding duration had a significantly positive effect on various measures of a child’s intelligence scores as the child developed (Belfort et al. 2013). Of course, much more support for breastfeeding should be provided throughout society including in the workplace, something we think Gurrieri, Previte, and Brace-Govan (2013) would support. However, it should be emphasized and made clear here we are speaking of living and vulnerable children who are not represented in “Women’s Bodies.” What of their fate?

“Women’s Bodies” chooses one social marketing ad regarding breastfeeding (figure 3) to critique. Assuming we even agreed with their critique, it still remains that an examination of social marketing ads on Google shows many that do in fact show breastfeeding – something the authors point out that their sample ad does not. So while the sample ad may not even be representative, “Women’s Bodies” considers it to be so and so we too will ponder this message. The authors lob virtually everything at this ad including another ism, face-ism, as well as male gaze, the celebrity effect, and the aforementioned idea of not even showing breastfeeding. In the end we do not know how effective this ad was, nor whether it was perceived as offensive or not. But we can say that some women may have reacted as “Women’s Bodies” suggests, that is they are made uncomfortable or marginalized by the ad. We would argue though that even a very different ad merely showing breastfeeding with a less than “glamorous” or “average” woman might still make some women uncomfortable if they are unable or unwilling to engage in breastfeeding. On the other hand, many women who respond to hot cultural stimuli may have reacted more positively and aspirationally, such as by thinking, “If she can do it, I can too.” Celebrity appeals often work this way in general in that consumers where a fit is appropriate to them identify with them in terms of similarities and also aspirational qualities (Escalas and Bettman in press; Hirschman and Thompson 1997; McCracken 1989). And/or given advertising conventions, they may have taken this as a bit of puffery (playful irony) which nonetheless they were comfortable with and made them more receptive to the message. We honestly do not know about the reactions and we do suspect a polysemy, which is unavoidable given different segments and voices. But we can say that if anyone responded favorably in terms of being reinforced and engaging in the act of breastfeeding itself, this speaks to the whole purpose of the social marketing campaign to begin with.

Ironic Relationships with Commercial Interests

While “Women’s Bodies” largely ignores commercial interests in the discussion of women and social marketing, this leaves a gap that becomes apparent as a deconstructive element, as well as cultural contextual one. Thus, while the authors deploy neoliberalism as a rhetorical weapon against advocacy for dealing with obesity and other issues, it is these very commercial interests they are inadvertently supporting and who really benefit from the neoliberal policies of deregulation. Here, we interrogate this gap by considering two sets of such interests: (1) food and related industries and (2) health industries. We are acutely aware of the ironic overlap and commingling of these two at times but for the moment, we disentangle them to show the ironic effects of each in relation to women and social marketing.

The Paradox of the Giving Cover to the Food and Related Industries

When “Women’s Bodies” speaks to issues of the government, healthism and especially normalization, the authors may be surprised to learn that they are in cahoots with defenders of the food, tobacco, and other industries that go to great lengths to attack health advocates. When we speak of the hot system marketplace, it is just these marketers and their defenders whom we most have in mind, at least in the context here. They use every tool they can to appeal to consumers and to make them accepting of products which may not be very healthy at all. Moreover, while health advocates do have their voices in government, it would be hard to deny the sheer power of these “unhealthy” advocates and lobbyists arrayed against them. They may seem to be anti-stigmatization, but they are patronizing and indulging in ways that can be just as or even more damaging and stereotyping to women and other consumers. So in this marketplace war, guess who is winning. Thus social marketing is a gnat compared to these corporate forces. “Women’s Bodies” problematizes the former in ways that might weaken it further.

Consumers may seek to conform to the dictates of the hot system and if there is no escaping the marketplace then there seems to be no escaping self-surveillance either. One may self-surveil with respect to the cool health system or one may self-surveil with respect to the prevailing hot social and marketplace norms to eat, drink, and be merry. Stigma may carry over in all forms of norms where a self-surveilled conformity occurs. Conflicted self-surveillance seems in order then. Focusing on only one form of self-surveillance decontextualizes and gives a misleading view of what many consumers may be experiencing.

A number of commentators have noted that public issues such as obesity attract strange bedfellows (Bell 2013; Gard 2011). In the case of obesity in particular, we would note that the arguments of “Women’s Bodies” find resonance with the libertarian Cato institute, something we do not think they intend at all. For example, the Cato Institute and its allies have pieces about the public health establishment’s denormalizing of “fat people” (Basham and Luik 2009) and its paternalism in this regard (Marlow and Abdukadirov 2012). They also denounce measures such as taxes on sodas and other fatty foods (Basham and Luik 2010), thus defending positions taken by the industries (e.g., Bauerlein and McKay 2010). This suggests that “Women’s Bodies,” albeit probably not on purpose, is giving cover to industries associated with obesity.

Health Commercial Interests

Commercial interests, themselves, are various in their own right and there are also those for whom health is a primary focus. Moreover, social marketing is perhaps a step child of such health commercial interests or health marketers. We view this broadly to include people marketing natural, organic or otherwise healthy food, supplements, health services of all sorts, cosmetic products that make one look healthy, and even green products which are also healthy. The irony here is that no matter what one may say about social marketing, health marketers do not share the same constraints. They can if they deem appropriate use any hot marketplace system tool they find useful. They may or may not intentionally stigmatize women by showing thin bodies or attractive women as healthy but that may be the effect that occurs for some but not all women.

Overlapping and Conflicting Cultural Codes of Glamor-beauty and Health

“Most people know that obesity can result in serious health problems, yet many of us continue to focus on its cosmetic consequences rather than its risks to health” Brody (2013). Indeed, people often conflate beauty and health (Purdy 2001) and thus bodywork to meet unrealistic attractiveness standards as posed in “Women’s Bodies,” is not an issue to take lightly. However, nor is the bodywork when one becomes sick. The article virtually ignores this while valorizing an almost illness-free perspective. Denigrating healthy bodywork as the authors do does not help very much at all. It is perhaps a matter of picking your poison, bodywork now or medical bodywork later. Certainly, entering into the medical system and its surveillance of oneself can be seen as forfeiture to the medical gaze. If there is a choice one might ask, would individuals on the whole rather be subject to this medical gaze or one that while perhaps disturbing in some aspects, may help keep one out of the medical system or at least reduces one’s time in it? There are all sorts of gazes and vulnerabilities. Indeed, bodywork for ameliorating the problems associated with unhealthy body types can entail not just medical issues but issues in daily living (e.g., working on the job with chronic arthritis). Sources of suffering and pain in this life may be unavoidable, but perhaps one can influence what they are.

“Women’s Bodies” cites research that emphasizes the complexity of and possible resistance and reactance to public health messages regarding issues such as obesity (Lewis et al. 2010) and suggests the need for empirical research documenting various aspects of social marketing. Certainly we agree with the need for more research. But much has already been done and other evidence does not support the authors’ findings. For instance, social marketing relying on the use of a social norms approach has been shown to be effective across a wide variety of behavioral settings (Burchell, Rettie, and Patel 2013; Gordon et al. 2006). Social norms regarding healthy behavior have been found to encourage just such behavior while unhealthy norms have the opposite effect (Burger et al. 2010; Schultz et al. 2007). In this regard, research on the effects of stereotype activation shows that exposure to a stereotyped cue (e.g., a photograph of an obese person) activates stereotypic characteristics (Blair and Banaji 1996; Kawakami, Dion, and Dovidio 1998) and also influences behavior resulting in an increase in stereotype consistent behavior even when it is perceived as negative (e.g., eating more; see Dijksterhuis and Bargh 2001; Wheeler and Petty 2001). Campbell and Mohr (2011) based on their series of studies of images of women of different weights suggest that the inclusion of stereotypic overweight women in the media may lead to the unintended consequences of women eating more indulgently, not less.

Moreover, stigmatizing should not be conflated with inspiring. Hirschman and Thompson (1997) argue that non-advertising forms of mass media, such as television and magazines, are an essential aspect of the perceived meanings consumers derive from advertisements. Through routine exposure to advertising, television programming, and cinema, consumers are continuously immersed in a conceptual system that provides prototypic expectations about, among many other things, dress, food preferences, and appearance (Bordo 1990; Bourdieu 1984; Fiske and Hartley 1978; Hirschman 1988; Scott 1993). Consumers allow mass media to become relevant to their everyday lives by creating consumer-media relationships where a media image is interpreted as representing an ideal self to which the consumer can aspire. The unobtainability of the ideal is experienced not as a source of frustration, but rather is read as a goal toward which one can increasingly strive to accomplish. Thus, the consumer suspends many sources of disbelief and opts to trust that these media images are genuine making it possible for the consumer to aspire to look like these ideal images (Hirschman and Thompson 1997). This perceived attainability of these ideal attributes leads viewers of such idealized thin images to engage in assimilative self-evaluations (Lockwood and Kunda 1997). Women may not experience lower appearance self-esteem or self-evaluations when exposed to thin-idealized images, especially when disclosures are made about these idealized images (Semaan, Gould, and Kocher 2012). Viewed in this way social norms and social marketing may be seen as providing social support for healthy behavior.

Conclusion: The Undoing of Social Marketing?

In reading “Women’s Bodies” and writing this commentary, we explored the multifaceted discernments of critically-informed macromarketing, which problematizes the roles both marketing and social marketing play at the very nexus of health, medicine, lifestyle and society, among other meaning sites. In this analysis, we find the author’s interpretation of social marketing to be a one-sided indictment, which in its construction of macromarketing, ignores the broader social and marketplace system implications we believe macromarketing embodies. These domains involve persuasion and discourses that may be handled in a too ideologically driven, rhetorical manner to reflect the lived experiences of consumers that “Women’s Bodies” explores. Thus, a logical conclusion of reading this article is that social marketing cannot really say anything because some consumers will be made to feel “bad” in some way. For instance, the mere mention of breastfeeding, even if handled in the most delicate or innocuous possible fashion the authors could suggest, might make someone feel guilty or ashamed. The very idea of breastfeeding, weight loss and physical activity are necessarily culturally charged. Thus, applying all the rhetorical isms and ists that “Women’s Bodies” does could be seen to undo social marketing completely. It is indeed an existential question whether some people (privileged perhaps at that) should intervene in others’ lives at all. For instance, the very idea the authors provide of social marketing being entangled in neoliberalism suggests that encouraging anyone to do anything at all even if it is in their best interests is problematic. As things stand, a close reading of their ideas leads to this conclusion.

Indeed, it is not clear if Gurrieri, Previte, and Brace-Govan (2013) and like thinkers assume there is an obesity problem or not. For example, they speak of the issue as “moral panic.” Other times they seem to say there is an issue and there is a role for social marketing. Assuming there is a problem, which we do, then what is the role for individual responsibility if any? The authors and like-minded thinkers want to abnegate self-responsibility, seemingly altogether. However as we pointed out in our discussion linking obesity and a mother’s diet during gestation and breastfeeding, the genetic argument is problematized to a large degree by her nurturing. Indeed, let’s assume that all the socialized medical care possible was available from cradle to grave for all. Would there then be any role for self-responsibility? Assuming as we do that people can be responsible for many aspects of their own health, then even with all the medical care available, they can still and necessarily must choose within certain limits to engage in healthy or unhealthy behaviors. We also need to think about self-responsibility theoretically and deconstructively in terms of free will, social norms and discursive practices, etc. a project that goes well beyond what we can say in this paper. All the rhetoric of labeling, if not mislabeling, people in terms of healthism and neoliberalism, as is done in “Women’s Bodies” should not be allowed to obscure this perspective.

Indeed, a more trenchant analysis would suggest that social marketing efforts fail because they do not make strong enough health versus medicalization links, not ones that we need to tamp down. There can be too much linkage, too little or perhaps the right amount, assuming one accepts any at all. Still, the links between obesity and poor nutrition during gestation and breastfeeding, for instance, suggest that better and perhaps more social marketing messages are needed. Unfortunately, in keeping with our theme of the dominance of the pharmaceutical, food industrial complex whatever social marketing and its relative public health try to do they are seriously out funded and outgunned by that complex (Harris et al. 2009; Upshur 2013).

The construction of health that “Women’s Bodies” discusses is the authors, and certainly not ours. Frankly, this perspective (and its vehemence) astounds us and we could only wish for more focus on such things as world hunger, a greener environment, and healthier living. We cannot help but feel that if left uncontested the ideas within “Women’s Bodies” move us further from those goals, not closer. For example, providing good quality food to all (Daniels 1985) is a much more desirable goal to us than helping sustain unhealthy practices and unhealthy industries, even if inadvertently. For us, justice and equity would relate to everyone having equal access to health information and practices. While there may be unintended consequences which we would hope could be ameliorated, the unintended consequences of not dealing with the major health issues we are embedded in could be catastrophic. Thus, the unintended consequences “Women’s Bodies” finds regarding social marketing, while provocative and therefore useful in raising important issues, must be viewed against the unintentional consequences of protecting if not altogether promoting unhealthy behavior. Is “Women’s Bodies” moving toward reducing vulnerability, which the authors claim as the domain in which they are operating? Or are they moving toward increasing it by rendering possible degrees of agency as not possible and thus leaving women and others even more vulnerable? There are ethical tradeoffs to be sure that in some ways embody Derridean undecideability and indeterminacy. Yet, choices must be made. Thus, if based on the view we have expressed here, one child is aided developmentally by breast-feeding who might not otherwise have received it (Arenz et al. 2004; Belfort et al. 2013; Christakis 2013), or one woman based on this view avoids debilitating breast cancer which is positively related to weight (Eichholzer et al. 2013; Morimoto et al. 2002), then we will have achieved our goal, both in this commentary and in general.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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