Reinsch, Stefan
Dr., Postdoctoral Researcher,
Centre for Health Service Research & Working Group Adipositas / Metabolic Syndrome in an Aging Society, Brandenburg Medical School – Theodor Fontane (Germany)

Gretschel, Lennart
PhD Candidate,
Centre for Health Service Research & Working Group Adipositas / Metabolic Syndrome in an Aging Society, Brandenburg Medical School – Theodor Fontane (Germany)

Wagner, Annika
PhD Candidate,
Centre for Health Service Research & Working Group Adipositas / Metabolic Syndrome in an Aging Society, Brandenburg Medical School – Theodor Fontane (Germany)

Overweight is a chronic condition that affects around third of the German population. As metabolic syndrome it includes cardiovascular problems, diabetes and problems of movement. The condition is clearly visible and conflicts with dominant notions of beauty, leading to stigmatization. While the medical literature discusses people with overweight and obesity primarily as an epidemic threatening the health care system, here we propose to use overweight as a lens to analyse negotiation around access to health care infrastructure, practices of eating and working, and aesthetic notions, and how all these affect belonging to a community, region or nation-state. We use a practice theoretical approach, where practices are understood as a nexus of sayings, doings and a set of teleo-affective structures.

Our study is set in several scarcely populated areas of the state of Brandenburg, a region that is characterized by scarce infrastructure and high unemployment as well as a set of values and practices that are distinct from metropolitan areas such as the capital, and partially rooted in the former worker state from which people ‘emigrated without moving’ into a neoliberal society. We purposefully selected physicians-patient dyads to represent a range of ages, experiences, localities, and specialisations. Based on 30 individual interviews with 15 patients with overweight and their primary physicians, as well as participant observation in selected practices, we compare and contrast patients and their physicians’ experiences, attitudes and practices related to overweight, specifically how these were shaped by living in or moving to the countryside, and by growing up in either eastern or western Germany, either before or after the reunification.

In our analysis we show that rurality is associated with people with overweight feeling the disapproving gaze of others intensely as there is little anonymity. At the same time, longer distance and problems of access in rural areas are a matter of concern for the majority of patients and physicians, and lead to frustrations and a feeling that nobody cares. This is contrasted with practices of working hard rather than taking care of one’s weight, and partaking in barbecues and drinking alcohol together, which are seen as preventing weight loss or leading to weight gains, but that also create identification, a feeling of belonging, and being liked despite one’s weight; and that are reproduced through shared experiences.