The increased prevalence of childhood obesity in the U.S. has been recognized as a complex and multi-factorial issue that requires a comprehensive and multi-pronged approach to deal with it. Obesity is generally considered a problem of errant lifestyle behaviors around eating and exercise. Current approaches address adolescent obesity by aiming to change lifestyle behaviors at the individual level, in the school, and in the larger community. The objective of this study was to understand the experience of overweight adolescent girls who are at the center of these changes.
This interpretive phenomenological study was conducted over a 2-year period. It included participant observation in a San Francisco pediatric obesity clinic, in-depth interviews with 15 obese adolescent girls, home visits and in-depth interviews with 3 mothers of girls in the study, a review of adolescent participants’ medical records, a review of San Francisco Unified School District’s (SFUSD) board meeting and committee meeting minutes since 2001, and participant observation in the SFUSD student nutrition and physical activity committee.
The findings have been grouped under three main themes that were present in the data: the adolescent world, how food is understood, and uncovering “the Look.” Within each theme the girl’s own closest domestic environment and the public we-world intersect in the experience of the adolescent who is faced with changing her eating behaviors.
In being identified as the nexus of the problem of obesity, teenage girls adopt different stances, appropriate to their way of being, to respond to those who want to help them control their weight. “Stance” is the stand a person takes on herself. It is not a conscious, mental or emotional stance, rather it is a non-deliberate, non-contemplated effortless way of being. Stance influences every interaction a person has, including those with the clinic, with school, with peers, and with family. Four prominent stances emerged from the data, and are highlighted for comparison and contrast: oppositional, resistant/bargaining, resigned or accepting, and engaged.
Understanding the stance a girl takes may play an important role in the ability to modify her lifestyle behaviors. This is significant for clinicians, who may need to tailor their practice to the stance of their obese patient in order to be effective. This is relevant for policy-makers, as the implication is that social messages, and legislating toward change, must appeal to every stance if they are to be successful in stemming the epidemic of childhood obesity.