Diagnostic Narratives

Abstract

This study explores how Austrian newspapers and magazines report on the obesity epidemic. We show how the media provide a space for formulating situated diagnostic narratives, that is, accounts that develop both a diagnosis of society through the lens of a health phenomenon and a definition of the phenomenon itself. Nourished by globally circulating discourses, these narratives are articulated in a national context and are enmeshed in biopolitical struggles. Linking a diagnosis of society to the biomedical sphere grants authority to diagnostic narratives and creates a space in which otherwise contestable moral calls to return to traditional orders can be articulated.

Keywords

health communication obesity narratives mass media biopolitics

Introduction

Over the past two decades, obesity has assumed a prominent place on health and political agendas worldwide (Gard & Wright, 2005). A widespread public debate has followed, with the mass media as central players representing the issues at stake (Saguy & Almeling, 2008). From the beginning, the media intertwined accounts of health issues with sociocultural developments, for example, by reporting that obesity is unevenly distributed over social groups or is connected to lifestyle choices. In this, the media have also reflected on the political and moral aspects of obesity. Media reports, therefore, should be investigated not as solely conveying the (bio)medical aspects of obesity in a more or less adequate manner but as an arena for negotiating moral and political orders and for biopolitical struggles over appropriate forms of individual and collective life.

In her seminal work, Illness as Metaphor and AIDS and Its Metaphors, Susan Sontag (1988) argued that illnesses are often used as metaphors not only “to propose new critical standards of individual health” but also “to express a sense of dissatisfaction with society as such” (pp. 72-73). According to Sontag, tuberculosis in the 19th century and cancer in the 20th century served as master illnesses, that is, as common metaphors to make sense of societal developments. In contrast to Sontag’s examples, the definition of obesity as an illness appears fragile and still partially contested, and we argue that the mass media continue to play an important role in publicly establishing obesity as a phenomenon that resembles a master illness. The public staging of obesity not only imposes specific meanings of illness and appropriate conduct on individuals (Harwood, 2009; Wright, 2009) but also adopts a form similar to Sontag’s (1988) historical cases: Media reporting on this health issue develops a critical diagnosis of profound changes in societal institutions, the organization of social life, and traditional value structures.

This diagnosis of society gives rise to narratives in which the Austrian nation appears as both the protagonist and the affected subject. We therefore propose to analyze media reporting on obesity as a site where diagnostic narratives on a societal body and its aberrations and developments are formulated. We define diagnostic narratives as media narratives that simultaneously develop a diagnosis of society through the lens of a health phenomenon and a definition of the phenomenon itself by situating it within societal developments. This concept points to how the Austrian media identify the causes and symptoms (both health and societal) of the purported epidemic, reflect on potential mitigations to contain the phenomenon, and construct potential solutions. As we will argue, diagnostic narratives gain their power through linking a diagnosis of society to the biomedical sphere and thus through tying biological and social factors together. Furthermore, diagnostic narratives play an important role in giving a universal phenomenon such as the “global obesity epidemic” a situated meaning. Following a long tradition in science and technology studies, we regard biomedical knowledge and its mediations not as direct representations of an exterior reality but as shaped through and intervening in culturally and historically specific contexts (Jasanoff, 2004; Latour, 2005).

Building on a qualitative sample of 457 print media articles published between 2005 and 2011 in six Austrian newspapers and two weekly news magazines, we analyze how media reports on obesity have become a site for pursuing a specific form of Foucauldian biopolitics. In offering this analysis, our interest is directed toward context-specific reconfigurations of more widely circulating discourses. It is not modern society on an abstract level that is depicted within these narratives but a society that is localized and nationally imagined, with a specific past, present and future—an Austrian society that is situated within a global “Western” world but is attempting to distinguish itself from it. Obesity narratives thus become a way of addressing an “Austrianness” (Felt, 2015) under attack by global developments epitomized by the obesity epidemic. We situate media reports within specific technopolitical cultures, that is, nation-specific ways of addressing the relationship among the scientific, the biomedical, the social, and the political in the widest sense (Felt, Fochler, & Winkler, 2010). This in turn allows us to show how seemingly objective medical issues become arenas for contesting, negotiating, and reinforcing social norms and value hierarchies that tacitly govern contemporary bodies and collectives.

Media Communication of Health Issues

Mediated forms of communication have historically played a privileged role in producing modernity and have “transform[ed] the spatial and temporal organization of social life, creating new forms of action and interaction, and new modes of exercising power” (Thompson, 1995, p. 4). According to Benedict Anderson (2006), print media have been particularly important for assembling the nation as a form of social order and collective identity. Garde-Hansen (2011) has noted the role of media in forming “the first draft of history” (p. 4): that is, in giving shape to collective memories and imaginations of the future. Highlighting the role of narrative conventions in (re-)producing national identities, Mihelj, Bajt, and Pankov (2009) have argued that “contemporary news stories are stories about a particular nation, told to an audience that is seen and addressed in national terms” (p. 57).

Similarly, we are interested in how societal imaginations and collective identities are produced within media discourse in the specific setting of health news. Stehr (2001) has highlighted the increased role of media reporting on science and expertise in the “knowledge society.” In science communication, health reporting plays a pivotal role because “. . . in many countries, the bulk of what passes for science writing is about medicine and health” (Dunwoody, 2008, p. 18). Bauer (1998) has noted “the medicalization of science news,” that is, increased reporting on medical issues and the use of medical metaphors to describe phenomena—a trend embedded in a wider social context in which “health and the qualities of personhood associated with its achievement are key metaphors traversing the moral terrain of contemporary societies” (Crawford, 2006, p. 402).

Some scholars argue that a lack of specific training and difficult work conditions¹ lead health and science journalists to rely on external sources like press releases for story ideas more often than other journalists (Nelkin, 1995; Tanner, 2004); nevertheless, all journalists take an active role in embedding “facts” in sense-making narratives. By choosing rhetorical devices and selecting evidence, they construct specific accounts of health issues, unfold moral narratives, and distribute responsibilities (Malone, Boyd, & Bero, 2000). It is thus important not to look at “journalists’ presentations of health and science stories [through the lens] of ‘correctness’ or ‘truth’” but to “consider the choices made in describing, quoting and portraying scientists, scientific evidence and the interpretation of scientific studies” (Malone et al., 2000, p. 715). These choices are tied to media-specific logics and shaped by time constraints or market demands that impinge on how stories are crafted to attract attention (Nelkin, 1995).

Similar to agenda-building theory, we view “media, government, and society [as] reciprocally affect[ing] one another” (Tanner, 2004, p. 353) and understand the media as important participants in building health agendas. Petersen, Heinrichs, and Peters (2010) have argued that we can observe a phenomenon of “medialization,” that is, there is “an institutionalization of attention to mass media coverage and an internalization of media criteria on all levels of the policy making process” (p. 865). Similarly, media coverage feeds back into research and frames researchers’ ideas of how to represent science (Felt & Fochler, 2013).

These considerations relate to arguments within communication studies and science and technology studies that the relationship between science communication and the public cannot be adequately understood in terms of a linear one-way model (e.g., Hilgartner, 1990; Logan, 1991). Researchers have argued against claims that a lack of adequate uptake of scientific information constitutes a deficit on the part of “the public.” How people make sense of scientific information is framed by prior knowledge, personal experiences, and wider contexts (Hilgartner, 1990). More generally, cultural studies scholars such as Stuart Hall (1980) have argued that how media messages are encoded does not determine how they are decoded, thus enabling a variety of interpretations and perceptions. These studies have further highlighted how some readings nevertheless appear as hegemonic in a particular context. Interested in broader biopolitical ramifications, we focus on the encoded hegemonic readings while acknowledging that other readings are always possible.

In our study, we investigate how health communication becomes an arena for narratives about society. Narrative analyses of health issues have been employed to study the formation of both individual and collective experiences (Seale, 2003). Narratives are an essential element of social life and a major mode of communicating, knowing, and making sense of social action (Czarniawska, 2004). Following a broad definition of narratives, we define them as a communicative form that consists of chronologically connected and sequenced events and actions that involve one or more subjects who experience these events and actions (Czarniawska, 2004). Dahlstrom and Ho (2012) have noted, “Narratives actively create implicit rather than explicit meanings” (p. 595), thus “offering benefits of persuasion through their ability to make normative claims without needing to explicitly state or defend them” (p. 603).

While studies on media narratives have primarily focused on human characters as protagonists, we argue that society adopts the role of a central character in media accounts of obesity. Below, we show how health reporting becomes the site for partly implicit yet highly persuasive and normative narrative diagnoses of society, and thus highlight further aspects of the role of narratives in health communication.

Biopolitics, Obesity, and the Media

We regard reporting on obesity as part of “biopolitical governance,” which allows us “to move beyond the issue of weight to pose important questions about discourse, subjectivity and, ultimately, power” (Greenhalgh, 2012, p. 473). The term biopolitics originates with Foucault (1978), who conceptualized it as one of the two poles of biopower that were fully formed during the 19th century: Whereas anatomo-politics aims at disciplining and maximizing the efficiency of individual human bodies in enclosed spaces like schools or factories, biopolitics encompasses all types of interventions that target “vital” characteristics (like fertility and morbidity rates) of the population as a whole (Foucault, 1978). Rabinow and Rose (2006) have identified three elements of biopolitics: “one or more truth discourses about the ‘vital’ character of living human beings,” “strategies for intervention upon collective existence,” and “modes of subjectification through which individuals are brought to work on themselves” (p. 197). Wright (2009) argues that as part of the discourses surrounding the obesity epidemic, “methods to evaluate, monitor and survey the body are encouraged across a range of contemporary cultural practices including popular media” (pp. 1-2). Wright (2009) and Harwood (2009) view these methods as parts of “biopedagogies” dispersed “across a wide range of social and institutional sites” (Wright, 2009, pp. 8-9). In line with this thinking, we argue that media not only report on the obesity epidemic but also form an arena in which knowledge and what is to be regarded as truth about human life and social order are negotiated and governance effects occur.

The biopolitics of the obesity epidemic has sparked a considerable body of scholarly criticism. Critical obesity studies have observed an increasing medicalization of body fat and have related it to moral agendas. Because fatness has been transformed from body shape to pathology, individuals are increasingly made accountable for a disease framed as a consequence of lifestyle choices (Chang & Christakis, 2002). Medical models of obesity thus reinforce stereotypes in which the fat body appears as “a site of moral and physical decay” (Murray, 2005, p. 266). In line with this perspective, Susan Bordo (1993) has argued that the prominence of fatness as a concern is rooted in a patriarchal society that imposes gendered body norms. Guthman and DuPuis (2006) have noted that the urge to attain a slim and disciplined body is tied to political-economic contexts in which the body becomes a project to work on constantly.

In the context of critical obesity studies, numerous studies have investigated reporting on obesity across different media (for detailed reviews, see Atanasova, Koteyko, & Gunter, 2012; Boero, 2013). They have primarily focused on media representations and only to a smaller extent on issues of production or perception, mirroring larger trends in studying health and the media (Seale, 2003). These studies have been situated in different national contexts, among them the United States (Saguy & Gruys, 2010), Australia (Gard & Wright, 2005; Holland et al., 2011), France (Saguy, Gruys, & Gong, 2010; Saguy & Riley, 2006), and the United Kingdom (Inthorn & Boyce, 2010). We found three analytical foci: First, primarily feminist studies have focused on questions of body image and the stigmatization of fat within both mainstream and minority media (Inthorn & Boyce, 2010; Saguy & Gruys, 2010). Second, another recurring theme is the debunking of media reports as unscientific and ideological. These studies have pointed to the numerous political, financial, and professional interests at stake and have been concerned with deconstructing the seeming facts of the obesity epidemic (Campos, 2004; Oliver, 2006). Third, some studies have focused more specifically on the distribution of blame and responsibility within media articles on obesity, highlighting a trend of making individuals responsible and factoring out collective dimensions (Boero, 2007). Complementary to this argument, Gard and Wright (2005) have highlighted how the purported moral decline of “Western” populations is often blamed and how depictions of the obesity epidemic “conform to a familiar story about Western decadence” (p. 2). Shugart (2013) has argued that only in recent years have ideas about “culture” gained traction as an explanatory narrative that combines attributions of responsibility to individuals and collectives. Felt, Felder, Öhler, and Penkler (2014) have highlighted that temporal narratives play a similar role in integrating individual and collective accounts of what constitutes the obesity phenomenon.

Further highlighting how culture and society are depicted in the media, we foreground a biopolitical analysis of diagnostic narratives, that is, media narratives that evaluate society and its development through the lens of a biomedical phenomenon. Acting on individual and collective life strategies, narratives of society and obesity form part of biopolitical governance that constructs and imposes a nationally imagined and reified societal body and draws on biomedical truth claims to qualify and diagnose this body. Coming from the field of science and technology studies, we do not aim to contest the validity of the epidemiological content of media reports but are more interested in the political effects of how facts “never travel alone” (Dumit, 1997, p. 93) as they become staged as truth claims within sense-making narratives of society in the media.

Method

To investigate print stories on obesity, we analyzed a sample of articles published in six Austrian daily newspapers and two weekly news magazines between January 2005 and October 2011. The starting date for our sample is 1 year before the publication of the first Austrian obesity report (Kiefer, 2006), which coincided with an increase in media interest on the topic (Felt et al., 2014). Newspapers and magazines were chosen to represent national and regional papers with differing political leanings and target audiences: Neue Kronen Zeitung (circulation 930,000), the country’s largest tabloid; Kurier (211,000), a nationwide daily in the middle of the political spectrum; the liberal-left Der Standard (109,000) and the conservative Die Presse (103,000), Austria’s two widest-circulated broadsheets; and Oberösterreichische Nachrichten (138,000) and Salzburger Nachrichten (91,000), two regional dailies with nationwide circulation. Two magazines were analyzed: News (222,000), a glossy magazine that in addition to politics and high society covers public health and wellness, and Profil (90,000), a weekly with regular specials on health issues tailored to a readership with higher levels of education.

We searched the electronic database WISO to identify relevant articles, employing the search words “obesity,” “obese,” “weight,” “weight loss,” “fat,” “slim,” “chubby,” “kilo,” “diet,” “nutrition,” and “eating” (in German). We constructed our sample of 457 articles by including articles with more than 180 words that contained at least one of the search words in the title, and we manually excluded articles that used the keywords in a non–content related way. The reason for choosing this number of words was heuristic: We wanted to obtain full-fledged accounts that contained more complex narrative elements, and a first experimental sample showed that these elements were missing in a majority of shorter articles that were bulletins or fact sheets.

Following a grounded theory–based approach, we conducted a first round of open coding, a procedure for categorizing data according to content, with the goal of identifying recurrent themes (Strauss & Corbin, 1998). All three authors took part in the coding procedure. In addition to other major themes, for example, those related to the temporal dimension of the phenomenon (see Felt et al., 2014), several recurring codes that referred to a critical evaluation of society and its values, norms, and development emerged and subsequently became our focus for the purpose of this article. A second phase of axial coding, a grounded theory procedure for interconnecting, relating, and refining categories (Strauss & Corbin, 1998), was conducted up to the point at which we no longer could identify new subthemes, leading to the categories presented in this article. We then conducted a third phase of selective coding, a procedure that aims to integrate and refine the analysis to develop a coherent explanatory concept or theory (Strauss & Corbin, 1998). After reaching a point of theoretical saturation, in which “no new properties, dimensions, or relationships emerge[d]” (Strauss & Corbin, 1998, p. 143), we added another step of analysis: With the help of the coding software ATLAS.ti, we identified 61 articles that contained our central analytical categories most densely in terms of absolute numbers, and conducted a further round of focused coding in group sessions to test and finalize our explanatory framework. Following the suggestion of Adele Clarke (2005), we also produced “situational maps” that depicted the structural conditions and elements of the media discourse as a visual aid in the initial phases of our analysis.

It is important to note the limitations of our study. Due to our focus on the form and content of narratives and their relative stability over time and different media (see Felt et al., 2014), we focused less on the differences between analyzed magazines and newspapers and did not systematically trace changes in narratives on society over our investigation period.

Findings

Staging the Problem: Obesity, Alarmism, and a Common “We”

Although there are multiple ways in which body weight appears in print media, news stories that specifically address obesity tend to approach the topic in similar ways. Following media conventions, they rely on a specific hook that makes them newsworthy. News hooks range from reports of new scientific and epidemiological findings, policy reports, and public health measures to the advent of summer and the related desire for “a bikini body.” While the hooks partly differ, the stories share structural features and present the phenomenon in a similar fashion. Characteristically, articles introduce epidemiological data in the first third of the story as “public proof” (Latour, 2005) of the problem. These data invariantly relate to the percentage of people classified as overweight or obese according to body mass index either within the entire Austrian population or within subgroups (defined by region, gender, or age). Frequently, these figures feature in the title or lead. For example, the March 31, 2005, edition of eastern Austria’s Kurier was titled “Every Seventh Tyrolean Child Is Obese” (Zwerger, 2005, p. 9). The same year, another daily, Kronen Zeitung (Austria’s largest publication), contained the headline “News on Being Overweight From the Land of the Schnitzel,” thus alluding to the transformation of a traditional culinary emblem into an object dangerous for the nation’s health. The story’s lead provided the following explanation: “Obesity, meaning fatness, is already called the ‘global epidemic’ of the 21st century. In Austria, every third person is overweight—more than two million women, men and children!” (“Neues zum Thema Übergewicht,” 2005, p. 2).

Epidemiological data and figures are generally presented to suggest a dangerous rise of obesity. This rise is also traceable in wordings like “already,” “rising,” and “more and more.” Furthermore, we regularly find efforts in the media to update obesity figures, connecting an already dramatic present with a threatening future. These depictions of increasing body weight are morally laden, not only by extrapolating the trajectory into the future but also through the use of alarmist rhetoric. Phrasings like “unbelievable, but true,” “shocking statistics” (Mara & May, 2007, p. 50), “dramatic development” (Zwerger, 2005, p. 9), and “red alert” (Radmayr, 2010, p. 5) are accompanied by accounts of obesity as a “time bomb” (Marits, 2007, p. 4) and of medical doctors “hearing the warning bells ring” (Zwerger, 2005, p. 9). These dramatizing accounts are often linked to claims that obesity constitutes a financial threat and touch on widespread fears about the future feasibility of Austria’s universal, publically funded health care system, widely regarded as a distinctive accomplishment of the Austrian welfare state.

Often, national data are compared with other industrialized countries to determine Austria’s position on a developmental trajectory imagined to take place similarly in many countries (Felt et al., 2014). The United States is usually depicted as the model case and becomes the reference against which other countries are measured:

Severely overweight—meaning a body mass index above thirty—is every third American, every fourth Mexican and every sixth Brit, Slovak, Greek, Australian, and New Zealander. For comparison: In Austria, according to the Organization for Economic Co-operation and Development, every tenth is severely overweight. (Kugler, 2006, p. 4)

These representations depict Austria not only as remaining in a better position than other countries but also as being threatened with losing its status as an “island of bliss” (Richter, 2006, p. 12). This reiterates the widespread trope that even though Austria is a small country, it has the potential to resist the developments that take place in neighboring countries (Felt, 2015).

These repeated comparisons are further emotionalized through colloquial language that makes frequent use of a rhetorical “we.” Titles and subtitles like “We Have Unlearned to Eat” (Buchacher & Fallent, 2007, p. 123) and “We Become Ever Fatter and Lazier” (Radmayr, 2005, p. 3) create immediacy and include the reader and the writer in an imagined collective (Mihelj et al., 2009). A weekend supplement of the Austrian quality newspaper Der Standard reflects on this: “‘Why we are so fat’ is a frequent topic of intellectual debates in the USA. This ‘we’ that is talked about includes slim people—the fat, in this view, embody the aberration of the whole society” (Rebhandl, 2006, p. A3). The term we introduces a shared problem that transcends specific groups, constitutes the (Austrian) nation as a collective subject affected by a global epidemic, and formulates a call to action.

The Austrian media staging of obesity shares many elements and tropes with other national contexts, such as the reliance on facts and figures and the constitution of obesity as a national problem. Nevertheless, the above-referenced quotes show a specific national self-understanding in connection to a seemingly global epidemic. We thus observe how shared and highly mediatized visions of a good life and a healthy body become connected to a nation-specific public health project.

Media articles on obesity thus enact specific narratives about a changing Austrian society, thereby “emplotting” (i.e., assembling into a logically coherent plot; see Czarniawska, 2004, p. 17) a series of narrative elements that are introduced throughout the articles. Often, experts are given a voice to provide meaning to the figures. Not only medical doctors and dieticians but also nonprofessional experts such as celebrities who embody successful weight loss elaborate on the reasons, meanings, and consequences of the epidemic. Articles also often provide the reader with anecdotal evidence in the form of exemplary cases of affected individuals and their struggles. These stories serve as dramaturgical elements, adding emotions to the narratives. For example, the cover story “Land of the Fat” (mimicking the opening lines of the Austrian national anthem, “Land of Mountains, Land on the River”) in the weekly magazine News features “Alina E. from Sankt Pölten [who] has to fight with her constant craving for food.” The story describes how her mother had “to put a lock on the refrigerator,” and Alina is given a voice to describe her suffering: “When nobody is at home, I often eat secretly. Sometimes I only realize afterwards how much I have scarfed down” (Mara & Wobrazek, 2006, p. 51).

Our aim is to understand how, through diverse means of emplotting and giving meaning to the phenomenon, dense narratives on the state and the development of Austrian society take shape. Before we discuss the dominant strands of these narratives in detail, it is important to note the ambivalences in our story. We want to note two forms in which the dominant obesity discourse is contested. Some longer articles, especially in the two weeklies, deliver complementary narratives that intertwine with the narratives on society on which our analysis focuses. Although these articles accept the epidemiological models of weight gain and their purported roots in societal changes, they also stress the dangers of what they recount as an excessive preoccupation with eating and weight. Framing it in terms of “fat frenzy” (Buchacher & Fallent, 2007, p. 123), “sickly health mania” (Hager, Hofer, & Moser, 2005, p. 53), and “health prevention mania” (Ehgartner, 2009, p. 79), they describe this preoccupation as a part of the consumerist “Western” lifestyle that is blamed for the epidemic itself. An arguably stronger form of contestation of the obesity discourse is found in only a few opinion-editorial pieces that explicitly criticize the morals of that discourse. One example is columnist Elfriede Hammerl’s (2009) response to an earlier article of the same magazine (Profil): She denounces the moralistic aspects of the assessment of a German pediatrician that childhood obesity is linked to growing divorce rates.

While some articles acknowledge the stigmatization inherent to the obesity discourse, a direct critique of the very veracity of the obesity epidemic was almost never formulated. This lack might be partly attributed to the circumstance that Austria has no vocal social movement related to body weight. In particular, fat activist and size acceptance positions are rather marginalized and largely go unheard in the public discourse.

In our outline of dominant narratives on society, we start by highlighting two aspects contained in a story of loss that is presented as formative of the ongoing crisis: One aspect is about Austrian society losing its former ability to accommodate naturally given bodily needs, and the other aspect concerns the loss of social structures and traditions that once shaped collective and individual life. These aspects in turn are contrasted with depictions of contemporary life as chaotic, stressful, and technology dependent. We will argue that, consequently, the Austrian nation emerges as a suffering “patient” in these narratives, giving rise to attributions of blame and responsibility.

Loss of Natural Order

To frame obesity as a recent development, different pasts are invoked. One method of constructing obesity narratives is to project their starting points into the far past. Some articles explicitly refer to the Stone Age, contrasting it with present living conditions. A cover story in the weekly Profil provides the following account:

For the first time in human history, the daily energy needed is lower than the “natural appetite” anchored in the genes. While a Stone Age man burned 50 calories per day per kilogram of bodyweight, it is only 32 today. . . Unlike our ancestors, we do not hunt or walk for miles to find food. Everyday life usually consists of sedentary activities. (Regitnik-Tillian, 2007b, p. 86)

In stories like this, the human genetic makeup is narrated as having remained unchanged over thousands of years, while the environment has undergone dramatic transformations. Especially changes in exercise and dieting habits are repeatedly highlighted, as, for example, in this quote: “Nobody is—biologically speaking—made for our modern akinetic and sugary and fat-laden way of life” (Kotasek-Rissel, 2011, p. G14).

Many articles present this mismatch as a consequence of modern Austrians’ estrangement from their rural and alpine roots, which leads to a loss of linkage between modern, urbanized Austrians and their biological bodies. As part of another cover story, Profil conducted an interview with a nutritionist who insists that the body, in its natural state, “tells” us what it needs. He explains,

We have unlearned eating consciously. Studies have shown that children who eat alone are more overweight than children who eat with their families and that children who incessantly watch TV gain weight because they do not listen to the inner voice that says: Actually, I’ve had enough. (Buchacher & Fallent, 2007, p. 123)

The nutritionist further implies that this “inner voice” is silenced by a modernized environment detached from supposedly traditional Austrian ways of living that evoke nostalgic images of stay-at-home mothers that are in line with dominant conservative and catholic imaginations of family order. The expert blames a dense provision of ready-made and technically altered foodstuffs, seductive advertisements, and importantly, educational failures by parents who emotionally neglect their children.

Although some longer articles explicitly spell out these stories, more often, short references to biohistorical narratives (Lipphardt & Niewöhner, 2007) are alluded to through the use of terms like “unnatural Western lifestyle” or “faulty” genes or in accounts of how people have “unlearned” natural skills. The reference to an unproblematic and natural past serves thus to diagnose modern life as denaturalized. Although this story partly provides a universal account of how humanity used to live, it also takes on a specific local form.

Loss of Social Order

Frequently, media articles refer to a not-so-distant time when lifestyles and natural needs were not yet adverse. This past is rarely explicitly dated but narrated as part of the collective memory of living Austrian generations. The cover story “Truly Fat” in Profil, which focuses on problematic nutritional habits, describes the changes in Austrian society by quoting a famous comedian. Formerly, “Austrianness” could be captured by three central questions that every Austrian asks “himself” (sic) in life: “Where are we from? Where are we going? And what is for lunch?” (Regitnik-Tillian, 2007a, p. 116). This statement is used not only to describe how specific eating habits characterize Austrian culture, in which the collective enjoyment of food plays an important role, but also to voice concerns about its gradual loss. The story continues by bemoaning that it is only in Austria’s westernmost province that “hungry men still traditionally rush home for lunch. In the rest of Austria, eating increasingly happens somewhere in between.” The article goes on to cite the first author of the Austrian obesity report (Ingrid Kiefer): “We all have become snackers.” The disintegration of the iconic family gathering stands as a representative for a wider loss of Austrian traditions that become endangered by modernization. This leaves the modern individual without guidance; a trope alluded to in the picture of the child who is left alone with snacks in front of the television. A famous dietician who has had her own reality television show on weight loss also draws on this highly emotional and moralizing rhetorical figure in a longer article in the weekly News: “Many families do not even own a dinner table anymore, but gobble some stuff in front of the TV” (Siebert, 2008, p. 88).

The loss of collective rituals is connected to a lack of traditional knowledge about food. “The knowledge of how to prepare fresh vegetables is increasingly lost” (“So macht Grünzeug essen Spaß,” 2005, p. 50), states one article, and others voice concerns—employing again the rhetorical “we”—that “we have completely unlearned to cook” or even “unlearned to eat” (Siebert, 2008, p. 88). In supposedly traditional Austrian ways, knowledge of how to prepare and eat food has been passed from one generation to the other. In these accounts, the crumbling of institutions like families and schools becomes directly linked to the current obesity crisis.

The construction of this specific version of recent Austrian history also problematizes the present by comparing it to an idealized past. Within this narrative, tradition is implicitly or explicitly valued as natural, healthy, and well ordered, thereby also constituting an equivalency among these categorizations. Through this comparison, the present, in turn, is devalued as the opposite of previously healthy and well-ordered lifestyles that are implicitly and explicitly depicted as characterizing the Austrian nation.

Disordered Everyday Life

Against the background of these understandings of the past, modern everyday life appears as characterized by the simultaneous change of temporal (see Felt et al., 2014) and technical infrastructures. “Not finding time for eating during daily work stress is a problem for many people,” says an article that sums up the consequences of these changes, continuing as follows: “One eats, one eats more than needed and over time this sums up around the waist” (Regitnik-Tillian, 2007a, p. 121). Before or during the communication of statistical data on obesity, many articles provide glances into stereotypical versions of Austrian everyday life as lazy or stressed. The Kronen Zeitung introduces the article as follows: “A life in XXL: Many Austrians treat themselves after work with loads of food, putting their feet up in front of the TV. . . There remains (seemingly) no time for exercise” (Kotasek-Rissel, 2010, p. G22). These accounts often portray a picture of everyday life in which Austrians are overwhelmed by work and in which food becomes compensation. As consequence, healthy eating and exercising do not receive the priority that they ideally deserve. An article in Profil illustrates these supposedly new eating habits by not only providing large photographs of greasy fast foods but also opening with a quote from a woman described as a typical Viennese:

“In a rush, I grab a kebab,” says Viennese office worker Heidelinde W., 48. . . . “In theory,” W. thinks highly of eating healthy. But her favorite dish, vegetable stew, is reserved for weekends only, when there is finally time to cook for herself. Just like W., many Austrians like to talk about good and healthy eating but have no time for it in stressful everyday life. (Regitnik-Tillian, 2007a, p. 116)

This and similar accounts build heavily on a pictorial language of unhealthy foods and construct a narrative in which tightening time structures are accompanied by an abundance of easily available and high-calorie foods. This is depicted as a challenge to Austrian understandings of “good and healthy eating,” which are closely connected to a strong organic farming movement that stresses food’s local, Austrian origins. In contrast, fast foods from ethnic communities like the Turkish doner kebab and the archetypal American burger iconically represent a tempting and unhealthy food environment that is alien to “Austrian food culture.” Not only convenience foods but also modern transportation is narrated as a further component of a technologically supported environment: “an affluent society” (“Wunderdiät,” 2010, p. 23) that is adapted to quick and thoughtless consumption.

The Austrian Nation as a Patient

We have so far outlined the development of a narrative trajectory that leads to the loss of order and how this loss plays out in everyday life. Metaphorically, this is often framed as the course of a disease in which the Austrian nation appears as the patient. This is in part implied through the German language, which draws on a variety of corporal metaphors when speaking of states. In the print media, obesity is frequently named a “volkskrankheit,” which is sometimes translated as a “widespread disease” but literally means a “disease of the people.” The German “volk,” in contrast to the English “people,” is a singular entity and carries the double meaning of “people” and “nation.” By applying this notion and others, along with the aforementioned rhetorical “we,” articles not only describe individuals in the Austrian population as gaining weight but also draw a picture of Austria as a collective societal body that is ailing. Many articles explicitly describe this metaphorical societal body as being fat: One article is titled “Austria Is Too Fat” (Kocina, 2010, p. 37), and another one states in his lead: “Fat Austria” (“Die Burschen werden immer dicker,” 2010, p. 14). This is not a neutral picture but instead has clear connections to the previously described criticism of a loss of traditional values, as is evident in many articles’ preference for morally laden terms like fat or even fettsucht² (literally “fat addiction”) over terms like overweight or obesity.

Fewer articles convey this idea of a collective infliction by directly employing a medical language, as for example: “We are developing a sick society” (“Jedes zweite Kind zu dick,” 2010, p. 9). That these accounts are no less normative becomes apparent in an article that describes “a lack of fitness” as “the underlying sickness of modern civilization” (Regitnik-Tillian, 2007b, p. 86). In these articles, obesity narratives reiterate earlier uses of other diseases as metaphors for “what is felt to be socially or morally wrong” (Sontag, 1988, p. 61).

The collective ailing body of Austrian society is also projected into the future. The ever-present trope of children plays a crucial role in describing and dramatizing the threat to the nation’s future. Here, titles like “For the First Time, a Generation of Children Might Die Before Their Parents” (Feiertag, 2007, p. 20) not only fit into an alarmist discourse but also draw a highly moralized picture of an endangered Austrian society.

While Austrian society gets portrayed as the afflicted patient, the roots of the epidemic are described as “Western” and “global” and appear as alien and coming from the outside. This is apparent in the following quote: “Two-thirds of Americans these days are overweight or obese, but the increase is rampant wherever a Western lifestyle takes hold” (Kramar & Langenbach, 2007, p. 1). This construction doubles back to calls to protect Austrian ways of living from global developments and shows how Austria is something depicted as struggling with its own position in the “West.”

Within the emplotment of obesity narratives on society within media articles, obesity becomes an entity that affects Austria as a whole. Because the roots of the phenomenon are tied to a loss of natural and social orders, obesity in effect signifies a threat to the stability of the Austrian nation.

Blame and Responsibility Between the Individual and Collective

Given the moralistic rhetoric of imminent danger, it is not surprising that attributions of responsibility and blame form a recurrent theme in media articles. At first glance, responsibility is distributed widely but nevertheless is attributed to individual actors and not to structural factors. One expert cited in an article on the rise of childhood obesity says, “No one wants to be guilty. . . But everybody—parents, teachers, politicians—has to reconsider and move away from a fast food culture” (Marits, 2007, p. 4). Notwithstanding these general statements, media accounts ascribe different influences to different actors. The responsibility of institutional and political actors is rarely addressed and is often downplayed, as in the following quote in which the image of an organic societal body is invoked: “Even Stöger [Federal Minister for Health] knows that a small minister alone cannot achieve anything: ‘Austria as a whole has to contribute’” (John, 2011, p. 10). Although descriptions of possible policy measures often remain programmatic and vague, there are far more discussions about moral orders like the lack of family values. Here is the continuation of the above quote about how nobody wishes to take responsibility: “Children lack orientation about how much they actually eat. It is problematic that many parents leave it up to their children to eat what they want” (Marits, 2007, p. 4).

It seems very clear who should ultimately be blamed for a child’s weight. Disintegrating families and broken homes appear as the fostering grounds of problematic eating habits, as spelled out in Profil: “Children of divorce: Children stay slim if their parents stay together” (Ehgartner, 2009, p. 83). A lack of parental guidance is morally strongly tied to a loss of social cohesion and stability. In particular, working mothers are frequently blamed and depicted as abandoning their traditional role of nurturing children.

Whereas children are narrated as victims and parents are blamed for their weight, adults are held personally responsible. Having lost stable references that are supposed to have once guided his or her behavior, it is nevertheless the individual’s role and duty to compensate for this loss. Overweight individuals are described as having failed at disciplining themselves and are sometimes explicitly blamed: “Every individual has to contribute through a lifestyle change regarding his or her eating or exercising behavior. . . In the end it is the attitude that counts” (Krestel & Linhart, 2007, p. 128).

While Austria as a collective appears as the subject of concern, it is individual Austrians who are seen as the primary agents capable of action. In this sense, they appear as responsible not only for their own health but also for the greater good of the Austrian nation.

Discussion: Diagnosing the State of Austrian Society

Media reports on obesity are full of accounts not only of how Austrian society was, is, and will be but also of how it normatively should be. Overweight and obesity are staged as symptoms of a deep malfunctioning of the societal body and as a threat to the nation. Our study concurs with and further explicates Gard and Wright’s (2005) analysis that articles on obesity in British, Australian and American newspapers often sketch a story of “moral and physical decline” and formulate a “nostalgia” for the past (p. 28). Although this view does not seem to hold true for all national contexts—Holmes (2009) could not find a similar focus in Canadian newspapers—these accounts are very prominent in Austria.

We have proposed the concept of diagnostic narratives to describe these broader narratives on society formulated through the lens of a biomedical concern that simultaneously further define the phenomenon of obesity itself by embedding it within societal developments. Linking social narratives to the biomedical sphere, the diagnosis of society presented in the media articles metaphorically takes a form similar to that of a biomedical diagnosis: It contains accounts of an afflicted subject, symptoms, an underlying condition, and a prognosis (see Foucault, 1975). Fleshing out obesity as a symptom caused by a larger global condition, a narrative emerges that situates Austrian society within this development while formulating a specifically Austrian version of a loss of social and natural orders that are imagined to threaten the nation’s core and stability as a collective subject. Media accounts on obesity narrate the epidemic as the effect of a modernist enterprise gone awry and formulate a (quite classical) critique of modernization (Law, 1994). More specifically, this critique implies a theory of the relationship between technology and humanity and articulates a critical stance toward technological progress.

Focusing on Austrian media, we cannot offer a systematic comparison of how the Austrian case relates to others. However, based on our literature review, Austrian media reporting appears to be quite similar to that in other national contexts but takes a form that is specific and localized. Stories about how national key values are threatened by the obesity epidemic are widespread, although images of what needs to be protected in the name of the nation differ (Gard & Wright, 2005; Holmes, 2009). Gard and Wright (2005) have noted how the obesity epidemic is linked within the British media to images of England’s jeopardized status as a leading sports nation. In the Australian context, the “valued archetype of the Australian body as fit, lean, healthy and physically active” (Lupton, 2004, p. 193) that epitomizes the nation appears at risk (Holland et al., 2011; Lupton, 2004). Susan Sontag (1988) has noted how epidemics historically have often been depicted as “alien” threats that “come from somewhere else” (p. 135). In France, this approach fosters ideas about a culturally more refined French lifestyle threatened by “American” ways of living (Saguy et al., 2010).

In the Austrian context, “American” ways of life are portrayed as threats to national core values of traditionality and naturalness, as opposed to endangering cultural refinement or athleticism. Although we cannot make any claims about the uniqueness of the Austrian context, we argue that Austrian media reporting draws on and (re-)produces visions of the nation and its characteristics and describes the obesity epidemic as taking a specifically Austrian form. What defines Austria becomes clear when looking at what is nostalgically described as threatened: traditional values and orders that are narrated as being “organic” and in tune with nature, a pace of living less stressed and hectic than in other places, and the ability—at least in principle—to live in a self-sufficient manner.

The form of Austrian diagnostic narratives might be explained with reference to an Austrian technopolitical culture (Felt et al., 2010). Throughout the history of Austria’s Second Republic, since its declaration of independence in 1955, the print media have played an important role in propagating a myth that it is better for Austria to keep outside influences “out of the national territory” (Felt, 2015). Two prominent examples are the popular movements against atomic energy and genetically modified foods (Felt, 2015). Closely related to this phenomenon, the strong and long-established Austrian organic food movement has constituted itself as specifically national by advertising pictures of pristine alpine nature and farms often labeled as “free from” intruding technological developments such as genetically modified organisms. As we have shown, this “sociotechnical imaginary” (Jasanoff & Kim, 2013), which is found across a number of technological and medical issues (Felt, 2015, p. 104), is strongly evoked in media reporting on obesity.

Conclusions: The Biopolitics of Diagnostic Narratives

What can we learn beyond the specific Austrian case? To conclude, we wish to argue that our study can contribute to an understanding of the appeal and power of dominant media narratives on obesity. In Illness as Metaphor and AIDS and Its Metaphors, Sontag (1988) argued that “it is diseases thought to be multi-determined (that is, mysterious) that have the widest possibilities as metaphors for what is felt to be socially or morally wrong” (p. 61). Sontag’s assertion is connected to Natalie Boero’s (2007) more recent argument that rising obesity rates resemble what she calls a “‘post-modern epidemic,’ one in which unevenly medicalized phenomena lacking a clear pathological basis get cast in the language and moral panic of more ‘traditional’ epidemics” (Boero, 2007, p. 42). In our view, it is this polyvalence, multiplicity, and vagueness of etiological accounts of obesity and the wide range of different forms of expert and commonsense knowledge invoked by it that make it especially salient to moral and political claims in the media. While we concur with Boero (2007) that this makes obesity apt to “offer individual explanations for social problems at a time of growing inequality” (p. 58), we argue that its biopolitical effects go beyond the biopedagogical disciplining of individuals and smaller social units like the family (see Wright, 2009): Media reporting on obesity evokes a biopolitical discourse about greater collectives, social orders, and the good life, which (re-)produces an idealized organic imaginary of a healthy nation at risk.

The purportedly more objective terrain of a health-related issue enables the formulation of a multilayered diagnosis that involves a range of different aspects, such as a locally specific critique of modernity, consumerism, and moral decline. This diagnosis tends to be socially conservative and might not be easily advanced in other contexts. Austria’s national socialist and fascist pasts have delegitimized ideas of a societal body and ideological appeals to naturalness and purity. Similarly, several decades of the women’s rights movement have problematized calls for women to stay at home, cook, and care for children. To explain why otherwise contested demands become possible in the case of obesity, it is necessary to take into account the specificities of the subject matter.

We can further explain the persuasive power of dominant obesity narratives by connecting different arguments: First, as health increasingly becomes a hegemonic value and a preferred sense-making device in late modern capitalist societies (Crawford, 2006), health media reporting gains additional authority in making moral claims. Second, Susan Sontag (1988) has suggested that master illnesses offer different metaphorical possibilities. Obesity taps into century-old moralizations of overindulgence and metaphors of being out of control (Saguy & Gruys, 2010) and is thus especially suited to convey pictures of social and moral decline. Third, because health journalism tends to rely more than other media areas on input from expert sources for its stories (Tanner, 2004), it seems to locate its expertise not in assessing what gets constructed as facts but in spelling out the social, moral, and political aspects of issues and using them to fabricate larger narratives about society. Fourth, as Dahlstrom and Ho (2012) have suggested, the implicit nature of the narrative as a communicative form might make it especially persuasive. These arguments suggest that because health reporting implicitly co-constructs narratives of society, it is particularly effective in (re-)producing hegemonic images of the social body. These considerations might also explain how the issue of obesity has gained momentum in a relatively short period of time: precisely because it enables broader truth claims about social orders.

Media coverage on obesity thus takes place within wider biopolitical struggles, which might explain why articles strikingly similar in content and structure recurrently appear throughout the years even though no fundamental changes about the epidemic are reported. Hence, the appeal in the recurrent reporting of ever-new obesity facts and figures lies not solely in their newsworthiness but also in the moral stories that they rehearse. Similarly, this might explain why media reporting on obesity appears as similar across a variety of national contexts.

In this article, we have argued that reporting on obesity becomes a vehicle for articulating powerful narratives on society and for (re-)producing normative visions of a nationally imagined social body. The media, as privileged sites of meaning making in contemporary societies, play an important role in biopolitical struggles over the desired and appropriate forms of collective life. In our case, health communication assumes this role by creating a space in which otherwise politically contestable moral calls for a return to traditional social orders can be articulated. Viewing media reports through the lens of diagnostic narratives allows us to highlight how collective orders and values are enacted in the biopolitics of obesity beyond its individual disciplining effects.

Footnotes

Acknowledgements

We would like to thank the editors and three anonymous reviewers for their generous comments that have helped significantly in improving the article. We acknowledge Theresa Öhler for her participation in the research project that has led to this publication. Finally, we would like to thank the language editors from American Journal Experts for the careful editing of the manuscript.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication is based on data from the research project “Perceptions and Imaginations of Obesity as a Socio-Scientific Problem in the Austrian Context” (PI: Ulrike Felt), which has been funded by the Austrian Ministry of Science and Research and the FFG in the framework of the “GEN-AU: Genome Research in Austria” initiative and which was an ELSA subproject of the larger “GOLD 3—Genomics of Lipid Associated Disorders” consortium. We further thank the Vienna Science and Technology Fund for having allowed us to continue our reflections on obesity and society in the framework of the research project “From Lab to Intervention and Back: Doing and Undoing Diversity in Obesity Research, Treatment and Prevention.”

Notes

Author Biographies

Michael Penkler is a science, technology, and society scholar with a focus on biomedicine, public health and the body, and a lecturer and researcher at the Department of Science and Technology Studies at the University of Vienna. His current research centers on questions of body weight, subjectivity, and embodiment and on how human diversity is done and undone in health care.

Kay Felder is a scholar of science, technology, and society with a focus on biomedicine and public health and a lecturer and researcher in the Department of Science and Technology Studies at the University of Vienna. Her current research centers on questions of temporal sense-making in public understandings of science and medicine and on how human diversity becomes a matter of concern in biomedical and public health contexts.

Ulrike Felt is a professor of Science and Technology Studies and Dean of the Faculty of Social Sciences at the University of Vienna. Her research interests gravitate around issues of governance and public participation in technosciences, science communication, and changing knowledge politics and research cultures. Her work is often comparative between national contexts and technological or scientific fields (especially life sciences, biomedicine, and nanotechnologies). Between 2002 and 2007, she was editor in chief of the international peer-reviewed journal Science, Technology, & Human Values.

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