Living With Obesity: Expressions of Longing

Theoretical Framework

Body phenomenology thematizes how humans as subjects exist and experience themselves physically in the world in relation to context and fellow human beings. It is through the body that we live, speak, recognize, and become conscious of ourselves (Merleau-Ponty, 2002).

This study was mainly inspired by Foucauldian theories concerning how human bodies are disciplinated by cultural norms (Foucault, 1977, 1982, 1983, 1988; Foucault & Miskowiec, 1986). In this context, Foucault elaborated the concepts of heterotopic space, normalization, disciplination, self-care, and counter-power, which may be fruitful for interpretation of suffering caused by obesity (Foucault, 1977, 1988; Foucault & Miskowiec, 1986). Foucault claimed that modern society has a similar disciplinary control over our bodies, like the historic panopticon used to monitor prisoners (Foucault, 1977; Jansen & Wehrle, 2018). Those who deviate from the norms in our society are placed in a deviant heterotopia (Foucault & Miskowiec, 1986). Foucault elaborated on the concept of self-care (care of oneself) as an act of resistance against normalizing mechanisms (Foucault, 1982, 1983, 1988). Some quite specific forms of self-care practice lead to greater freedom in life: resistance, reflection, and boldness (Foucault, 1983).

Based on these considerations, the purpose of this article is to gain an in-depth understanding of the experiences of longing by those suffering from obesity. We address the key research question: How does longing unfold in life when people live with obesity?

Setting, Sample, and Data Collection Method

The participants were recruited during 2016 from a 3-week program organized by a specialist health service, which was focused on health promotion, but not specifically weight loss. Our study focused on the individual’s experienced longing in everyday life when suffering from obesity and the interviews were not related to the actual program.

The program leader informed all 30 program participants about the research project by providing written information. The program leader was not involved in direct patient treatment. Those who decided to participate contacted the program leader or the first author and interviews were arranged.

Eighteen participants (15 women and 3 men) with BMI values of 30 to 45 (Table 1) joined the study. These participants represent a convenience sample insofar as they have experienced living with obesity. The inclusion criteria were a BMI ≥ 30 and obvious motivation to participate in an individual in-depth interview.

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Table 1.

Participants (N = 18) Background Information.

Participants	Age	Occupation	Disorder
Female	24	Unemployed	Strain injuries
Female	31	Working	High blood pressure and strain injuries
Female	33	—	Strain injuries
Female	42	On sick leave	High blood pressure and strain injuries
Female	44	Receiver of disability benefit	Low metabolism and strain injuries
Female	45	Working	—
Male	46	Working	Depression and breathing problems
Female	47	Working	Strain injuries
Female	49	Working	Strain injuries
Female	50	On sick leave	Strain injuries
Female	50	On sick leave	Low metabolism and strain injuries
Female	51	Working	Low metabolism
Female	51	Working	Low metabolism and bipolar disorder
Male	57	Receiver of disability benefit	Strain injuries
Female	58	Working	High blood pressure and strain injuries
Female	63	Retired	High blood pressure, strain injuries, and diabetes
Female	64	Retired	High blood pressure and strain injuries
Male	71	Retired	Strain injuries and breathing problems

Confidentiality was guaranteed and the participants signed a written consent form prior to the interview.

We used qualitative in-depth interviews to deepen our insight into the experiences of longing related to living with obesity. Each interview lasted 30 to 90 minutes. As longing is tied to human existence, qualitative in-depth interviews are well suited to providing such insight (K. Dahlberg et al., 2008; Kvale & Brinkmann, 2009).

Each interview began with questions such as Please talk about your experiences of what longing is like? Follow-up questions were aimed at uncovering thoughts and feelings in relation to their longing, such as What is the most important/essential longing for you in the actual situation? The same interview guide was used with each participant. However, it was a semistructured approach, with open questions to search for nuances, follow-up questions, and requests for further elaboration on answers to avoid misunderstanding.

The interviews took place in a conference room at the health promotion center and were recorded and transcribed verbatim by one of the researchers after all interviews were performed.

Data Analysis

The interpretation of text and analyses took place on three levels: self-understanding, common sense, and theoretical interpretation (Table 2; Kvale & Brinkmann, 2009). The process of going from understanding to interpretation occurs as a hermeneutical movement between the particular, the universal, and the whole, wherein the interpreter cannot be fully aware of his or her own prejudices and preunderstanding (Gadamer, 2007). The researchers’ preunderstanding was that longing as an existential phenomenon is important when struggling with health issues.

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Table 2.

Examples of Three Contexts of Interpretations.

Three contexts of interpretations
Self-understanding	Common sense	Theoretical interpretation
I don’t need to be skinny; I just want to be like everybody else, one who doesn’t stand out from the crowd.You feel branded as not smart enough to understand that you should have gone on a diet.	Longing for normality	Longing as movement between different spacesStruggling with finding ones space in life, longing for normality and longing back to what was lost. Longing as self-care and resistance to disciplinating power. Providing room for one’s own longing toward simplicity in life might create self-understanding, self-care, and resistance to disciplination.
I do have a longing to be nicer looking … because I’ve been there! I want to find my way back to the person I once was. I’ve asked myself whether I might have avoided ending up in this situation. I consider it a weakness. If we were strong enough, we wouldn’t be where we are.	Longing for what was lost
My aim is to be happy. I don’t cry, but I may be unmotivated to live. I long to believe in myself; to know who I am, plain and simple. To live a normal life, be happy, and be OK. Just imagine having a normal existence, focusing on feeling how you are.	Longing for simplicity in life

Self-Understanding

The interviewer read all the interview transcripts to derive an intuitive initial holistic understanding and fragments of significance emerged. The coauthors participated in further readings, analysis, and discussions to reach consensus. The first stage of interpretation was to reveal the participants’ self-understanding. Units of meaning were collected and small headings were inserted in parts of the texts. Parts that belonged together were arranged under preliminary headings.

Common Sense

In the next step, the participant’s self-understanding was reformulated and a new level of abstraction emerged. The units were systematized into closely connected topics. A new level of abstraction yielded the following three themes: longing for normality, longing for what was lost, and longing for simplicity in life. All authors were involved in discussion of the preliminary thematized data to enhance the interpretation. The first two levels of interpretation (self-understanding and common sense) are presented in the Results section.

Theoretical Interpretation

The discussion was enriched by references to relevant theories in relation to self-understanding and common sense (Kvale & Brinkmann, 2009). The third level, theoretical interpretation, is based on other research and relevant theories that may deepen understanding of the findings, as presented in the Discussion section.

Ethical Considerations

The project was approved by the Norwegian Ethical Committee (no. 2015/1720) and by the Norwegian Social Science Data Services. The participants were informed that they could withdraw from the study without giving any reason. Steps were taken to disguise the identity of the interviewees. Because the participants were in a specialized health service program, they could receive the support of professionals if needed.

Longing for Normality

In the interviews, the participants were asked what they longed for, and several expressed a profound longing to be of normal weight:

Imagine having a normal weight; how would that feel?{12} I guess one dream is to feel that you’re quite normal when it comes to looks, the longing to be like everybody else.{2}

Common Sense

Some of the participants’ statements are a strong confirmation of their longing for normality, for being like everyone else. Although they are simultaneously subjected to the devaluing voice of mainstream culture, they admit that they also subject overweight people to critical looks. Behind what they express about their own critical view of the body, one senses a yearning to live with greater freedom with themselves and their bodies.

Longing for What Was Lost

Some participants commented that they longed for the body they once had:

I do have a longing to be nicer looking {6} I want to find my way back to the person I once was. {9}

Common Sense

The idea of who they once were is normative throughout participants’ lives. For the person who no longer experiences life within the framework of normality, such a feeling may be demanding. Yearning for who they were is problematic when they simultaneously make themselves responsible for their condition. Behind the strict judgment they direct at themselves, one senses a longing that is allowed no room because it is locked inside an attitude of self-discipline.

Longing for Simplicity in Life

The interview materials suggest a yearning toward knowledge of self, finding room for oneself, experiencing joy, being at ease with oneself, and living a good life:

My aim is to be happy. I don’t cry, but I may be unmotivated to live.{13} I long to believe in myself; to know who I am, plain and simple.{4} To live a normal life, be happy, and be OK.{9} Just imagine having a normal existence, focusing on feeling how you are. From now on, I will put myself first and be a little selfish.{5}

Common Sense

The aforementioned material suggests a longing that transcends the wish for a thinner body. The longing focuses on a consciousness of emotions, such as the lack of joy and self-knowledge. When people face their longings, the relationship with themselves comes to the fore. Their longing in life is to be within the conventional and normal frameworks of human existence. Unlike everyone else, the informants experienced exclusion from their community life, such as mundane actions like going for a walk, spending time with grandchildren, and enjoying the community by sitting around a table of delicious food. A life of struggle against their weight has led to reproach becoming part of their inner conversation. The longing that follows is aimed at letting go of seeing themselves through the voices and gaze of the outside world.

Theoretical Interpretation

The aim of this article is to gain an in-depth understanding of the experiences of longing of those suffering from obesity. Our three themes—longing for normality, longing for what was lost, and longing for simplicity in life—are now interpreted and discussed considering earlier research and other theories, but mainly considering Foucault’s theoretical perspectives. Foucault (1988) is relevant because he focused on the influence of culture on self-understanding through a disciplinary power as well as people’s resistance to this power.

The qualitative approach involves linking theoretical concepts to the findings (Malterud, Siersma, & Guassora, 2016). Entering into a dialogue with Foucault’s theoretical thinking, this interpretation goes beyond a common-sense level to search for the deeper meaning of the findings (Kvale & Brinkmann, 2009). Based on this analysis, the three thematic findings are abstracted into two main areas on which the discussion elaborates: longing as movement between different spaces and longing as self-care and resistance to power. First, longing for normality points toward finding one’s space in life when exposed to a disciplinary power. Foucault called this a movement between being trapped in a space of heterotopia of deviation while searching for a space of freedom (Foucault, 1977; Foucault & Miskowiec, 1986). Second, providing room for one’s own longing may create self-understanding and self-recognition and may open a way forward. This is similar to the process that Foucault called self-care and resistance to the disciplination power (counter-power; Foucault, 1988). The overall interpretation also relies on Merleau-Ponty’s philosophy, as he was the first to develop a philosophy of living one’s body as living one’s life.

Longing as Movement Between Different Spaces

The participants expressed their longing to be normal and to return to a thinner body. The findings revealed a longing to be normal and to be like others and be unremarkable in others’ views. Furthermore, we found that being seen as obese makes one feel like an abnormal person. Those living with obesity may be vulnerable and feel less human (Christiansen et al., 2012; Merrill & Grassley, 2008). Merleau-Ponty described how a person’s embodiment may become broken and the prereflexive embodiment as a form of innocence and immediate being in the world can be lost (Fuchs, 2002; Merleau-Ponty, 2002).

Foucault (1977, 1982) problematized the ongoing disciplinary power of culture over human bodies. The gaze of the culture is a moral imperative that becomes moral oppression. We easily exclude people with large bodies as not fitting into society and place them in the marginal space of modernity—the heterotopia of deviation (Foucault & Miskowiec, 1986). Foucault’s (1977) concept of disciplining through a panopticon parallels the feeling of those with large bodies as being constantly scrutinized because their large body cannot be hidden.

In her empirical research, Bahra (2018) claimed that the negative norms and values that suppress a person living with obesity flourish under the gaze of humanism. The panoptic power is akin to constant monitoring, which disciplines bodies (Foucault, 1977). Some argue that we need a paradigm shift in health care from focusing on weight and lifestyle change to compassion-centered health care that encourages a holistic perspective (Bacon & Aphramor, 2011; Tylka et al., 2014).

Our findings reveal a realization by participants that the external stigma of excessive weight has become a self-stigma. Other studies support the view that longing for a normal body seems to be influenced not only by the disciplination of society but also by internal disciplination (Tomiyama et al., 2018). In our view, the consequence of being seen as an improper person by others is that one also becomes improper to oneself. Tylka et al. (2014) show that weight gain is internalized and experienced in the form of body shame and appearance monitoring. According to Merleau-Ponty (2002), people not only become objects to others but also to themselves. When the body is disciplined to follow a universal standard, the obese establish other norms for themselves (Jansen & Wehrle, 2018).

In our study, the participants reported a constant effort to achieve norms, causing self-blame and a sense of fighting against themselves. Longing as expressed in our findings may be a movement between different spaces: utopia and heterotopia (Foucault & Miskowiec, 1986). Utopia may be expressed in the findings as an appeal to an earlier ideal, for a time when one had a thinner body. The dream is a movement, returning to something one has missed. As we see it, participants are in a space where they are not really at home in life, but are placed in a deviant heterotopia in line with that proposed by Foucault and Miskowiec (1986). There is a longing in the dialectical space between the past, the present, and the desired future. In this situation, the body seems to be trapped, as described by Foucault (1977). Thus, a person becomes trapped in a utopian, illusory room (Foucault & Miskowiec, 1986).

Several of the participants often ponder why they have gained weight, attributing it to their own fault, weakness, or lack of willpower. Sadness and bitterness are linked to the reasons why their bodies have become so large. Because of a hostile and unfriendly attitude toward themselves from others, they perceive that they are being scrutinized. Their attitudes toward themselves mean that they have become their own prison guards. Moreover, they do not gain full access to themselves, which implies that something in real life is lost for those who live with obesity (Foucault & Miskowiec, 1986).

Longing as Self-Care and Resistance to Power

The findings tell us about peoples’ inner workings, that is, their thoughts, and feelings in relation to longing. When the participants reflect on their innermost longings, they highlight possibilities more than they do their restrictions. This longing is evident. Despite having a large body, they focus on such desires as greater happiness, peace, self-knowledge, and love. This longing focused on the simple everyday life is similar to what Foucault referred to as resisting the existing ideals of the body (Foucault, 1988; Walseth & Tidslevold, 2019). People living with obesity have an interest in improving their own bodies; the question is how free they are in this work with themselves (Jansen & Wehrle, 2018). As we see it, providing a space for one’s innermost longings may create self-care and resistance against the power of society. However, when longing is directed toward normality, it is likely to be impossible to achieve.

The findings reveal that longing is not always free. The interviewees longed for the body that society has set as a standard. The disciplinary pressure from society has consequences for the obese. As such, we need a deeper understanding of the freely lived life-world position (Bahra, 2018; Foucault & Miskowiec, 1986; Fritsch, 2015; Merleau-Ponty, 2002). Longing may address the desire for an ordinary life and appears to resist both external disciplination and self-disciplination. The longing points toward being true to one’s deepest desires in life as well as allowing space for future-oriented longing.

Bahra (2018) asked whether it is true that you can only be happy if you’re thin. If only the fixed sizeist/normative idealized body is celebrated, it seems difficult to be happy outside the norm. Some studies (Bacon & Aphramor, 2011; Logel et al., 2015) highlighted self-care and self-compassionate, nonjudgmental perspectives toward oneself as being essential in achieving health.

Our findings indicate that the participants long to create their own lives on their own terms. Foucault (1982, 1983, 1988) pointed out that exposure to power and disciplination will always trigger resistance. People living with obesity cannot escape the cultural context, but must find a way to master the influence of culture. In our findings, such self-care and counter-power are expressed as a striving for self-understanding. Fuchs (2002) claimed that taking a meta-perspective on how one understands oneself helps to cope with self-devaluation. Furthermore, “the capability of adopting a meta-perspective depends on an open interpersonal space which allows for freedom of self-distance” (Fuchs, 2002, pp. 240). According to Merleau-Ponty (2002), the only way to really live one’s life fully is to achieve an inner fullness in life. It is to let the lived body take over and melt together with the “drama” of life that pervades the lived body. In our view, one can achieve a greater inner fullness by listening to the heart’s longing. When “the inner fullness” is weak, it will be a challenge to completely own one’s place, and further inner fullness is required if people are to meet the world confidently (H. Dahlberg, 2011).

The findings reveal vulnerability in longing for a past that can neither be reached nor repeated. Self-understanding is related to who we are and who we want to be, and it will always imply a process of personal vulnerability (Batchelor, 2006). Self-care is characterized by an internal transformation of the individual; it presupposes freedom and a form of self-determination. Such self-care might establish a relationship with oneself that can be a source of pleasure (Jansen & Wehrle, 2018). Bahra (2018) argued for incorporating the obese body as different in itself by opening up the many possibilities and potentials for our embodiment. One possible option is to change the perspective on one’s fatness, through applying a “heterotopic imagination.” This means to broaden an approach to look at our bodies in an alternative way, and thereby trying to create a space in which we can experience and affirm our embodiment (Bahra, 2018; Fritsch, 2015). Such an approach has been confirmed by other research emphasizing the importance of being grounded in self-care (Bacon & Aphramor, 2011; Logel et al., 2015). When we care for ourselves, we can select the norms we want to reflect and choose the principles under which we subjugate ourselves (Jansen & Wehrle, 2018).

Methodological Considerations

This study is based on information from a convenience sample of 18 participants. Although the use of a convenient sample entails a risk of limited specificity, we are also aware that the power to inform (information power) in our study appears strong, given that this sample held adequate information to develop new knowledge based on the study aim, establish theory, provide high-quality dialogue, and allow strategic analyses (Malterud et al., 2016).

The data material consisted of rich and detailed descriptions. Trustworthiness deals with establishing arguments for the most probable interpretation. Although there is no single correct interpretation, our research group is made up of several authors who analyzed and discussed alternative interpretations, and described the analysis process details, demonstrating trustworthiness. Trustworthiness also includes the question of transferability. Our results can be transferred to similar group of patients who are living with challenging health issues.

We found that Foucault’s theoretical perspective regarding deviation into heterotopic space and counter-power are of great value for examining the phenomenon of longing. This theoretical perspective serves to synthesize existing knowledge as well as extend the sources of knowledge beyond the empirical interview data.