Just one more cookie: an ethnographic study of subversion in weight-related health promotion in a Dutch fishing community

Abstract

Background: Weight-related health promotion can be heavily contested. This

qualitative study attends to protesting responses in WRHP in the context of Katwijk, a

former fishing town in the Netherlands.

Methods: Building on interviews with families and health professionals, and four years of participant observation in family-focused health promotion activities for children and their parents, this study examines commonplace expressions of subversion and analyzes why WRHP is protested against in this particular context. The interviews and notes were analyzed for themes and patterns using qualitative content analyses. Further, leveraging an arts-informed approach, cases of protesting responses in WRHP are scripted into theatre dialogues, which were analyzed for social dynamics and conflicts. Findings: Joking, anger, mocking, and polite responses were identified as commonplace expressions of subversion. Against the background of historical and contemporary unequal power relations between the public and government in Katwijk, subversive responses are likely underpinned by a protest against institutional indifference toward adverse social circumstances and a protest against the power of health institutes as a result of the perceived threat to social cohesion and continuity. Conclusion: This study demonstrates that strained socio-historical relations between the general population and government institutes need to be considered when introducing public health interventions in historically deprived communities. A contextualized analysis of subversive responses in health promotion can shed new light on behaviors often framed as non-compliance, resistance, and avoidance. Such an analysis might provide the information necessary to sensitize and tailor communication strategies in public health programs targeting childhood obesity.