IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v294y2022ics027795362200017x.html
   My bibliography  Save this article

Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity

Author

Listed:
  • Gutin, Iliya

Abstract

Childhood obesity is a challenging diagnosis. Children's body mass index (BMI) is an imprecise diagnostic of health, leading clinicians' interactions with patients and families to focus on the potential of future harm rather than the presence of infirmity or disease. This is complicated by emphasis on certainty in medical care; clinical diagnoses like childhood obesity are intended to help delineate good and bad health among patients. However, healthiness and wellbeing take on many meanings among individual children and families, especially in relation to weight. To better understand different forms of uncertainty and challenges in providing care, this study draws on 28 semi-structured interviews with U.S. health practitioners working with pediatric patients to examine strategies for communicating risk and defining success in the diagnosis and treatment of childhood obesity. Rather than focusing on patients' current BMIs or making the explicit diagnosis of obesity, clinicians turn to more optimistic prognoses emphasizing the gradual development of beliefs and behaviors that promote long-term physical, mental, and social health. This prognostic framework privileges the doctor-patient relationship over medical guidelines and protocols dictated by diagnoses, encouraging greater consideration of non-clinical factors shaping patients' health and weight. Clinicians expand their diagnostic framework and criteria to include information on the totality of patients' present and future lives, allowing for cognitively, emotionally, and socially attuned understanding of health and weight that is not focused on BMI. Critically, clinicians' awareness of the social etiology childhood obesity heightens their sense of futility about addressing it through clinical interventions, demonstrating the need for a diagnostic and treatment model that empowers doctors to look beyond the more proximate, biophysiological determinants of health.

Suggested Citation

  • Gutin, Iliya, 2022. "Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity," Social Science & Medicine, Elsevier, vol. 294(C).
    • Handle: RePEc:eee:socmed:v:294:y:2022:i:c:s027795362200017x
    DOI: 10.1016/j.socscimed.2022.114714
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795362200017X
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.114714?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Timmermans, Stefan & Stivers, Tanya, 2018. "Clinical forecasting: Towards a sociology of prognosis," Social Science & Medicine, Elsevier, vol. 218(C), pages 13-20.
    2. Looman, Willemijn & Struckmann, Verena & Köppen, Julia & Baltaxe, Erik & Czypionka, Thomas & Huic, Mirjana & Pitter, Janos & Ruths, Sabine & Stokes, Jonathan & Bal, Roland & Rutten-van Mölken, Maureen, 2021. "Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries," Social Science & Medicine, Elsevier, vol. 277(C).
    3. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    4. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    5. Brown, Eliza, 2020. "Projected diagnosis, anticipatory medicine, and uncertainty: How medical providers ‘rule out’ potential pregnancy in contraceptive counseling," Social Science & Medicine, Elsevier, vol. 258(C).
    6. Nettleton, Sarah & Kitzinger, Jenny & Kitzinger, Celia, 2014. "A diagnostic illusory? The case of distinguishing between “vegetative” and “minimally conscious” states," Social Science & Medicine, Elsevier, vol. 116(C), pages 134-141.
    7. Brown, Phil & Lyson, Mercedes & Jenkins, Tania, 2011. "From diagnosis to social diagnosis," Social Science & Medicine, Elsevier, vol. 73(6), pages 939-943, September.
    8. Mead, Nicola & Bower, Peter, 2000. "Patient-centredness: a conceptual framework and review of the empirical literature," Social Science & Medicine, Elsevier, vol. 51(7), pages 1087-1110, October.
    9. Jutel, Annemarie, 2006. "The emergence of overweight as a disease entity: Measuring up normality," Social Science & Medicine, Elsevier, vol. 63(9), pages 2268-2276, November.
    10. Schubert, Cornelius, 2011. "Making sure. A comparative micro-analysis of diagnostic instruments in medical practice," Social Science & Medicine, Elsevier, vol. 73(6), pages 851-857, September.
    11. Cambrosio, Alberto & Keating, Peter & Schlich, Thomas & Weisz, George, 2006. "Regulatory objectivity and the generation and management of evidence in medicine," Social Science & Medicine, Elsevier, vol. 63(1), pages 189-199, July.
    12. Nettleton, Sarah, 2006. "'I just want permission to be ill': Towards a sociology of medically unexplained symptoms," Social Science & Medicine, Elsevier, vol. 62(5), pages 1167-1178, March.
    13. Armstrong, Natalie & Hilton, Paul, 2014. "Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility," Social Science & Medicine, Elsevier, vol. 120(C), pages 208-214.
    14. Lambert, Helen, 2006. "Accounting for EBM: Notions of evidence in medicine," Social Science & Medicine, Elsevier, vol. 62(11), pages 2633-2645, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Armstrong, Natalie & Hilton, Paul, 2014. "Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility," Social Science & Medicine, Elsevier, vol. 120(C), pages 208-214.
    2. Rathert, Cheryl & Mittler, Jessica N. & Vogus, Timothy J. & Lee, Yuna S.H., 2023. "Better outcomes through patient – Provider therapeutic connections? An exploratory study of proposed mediating variables," Social Science & Medicine, Elsevier, vol. 338(C).
    3. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    4. Taipale, Jaakko & Hautamäki, Lotta, 2021. "Clinical practice guidelines in courts’ representation of medical evidence and testimony," Social Science & Medicine, Elsevier, vol. 275(C).
    5. Gaspar, Mark & Rosenes, Ron & Burchell, Ann N. & Grennan, Troy & Salit, Irving & Grace, Daniel, 2020. "Diagnosing uncertainty: The challenges of implementing medical screening programs for minority sub-populations in Canada," Social Science & Medicine, Elsevier, vol. 244(C).
    6. Timmermans, Stefan & Tietbohl, Caroline, 2018. "Fifty years of sociological leadership at Social Science and Medicine," Social Science & Medicine, Elsevier, vol. 196(C), pages 209-215.
    7. Sandra Ziegler & Camilla Michaëlis & Janne Sørensen, 2022. "Diversity Competence in Healthcare: Experts’ Views on the Most Important Skills in Caring for Migrant and Minority Patients," Societies, MDPI, vol. 12(2), pages 1-23, March.
    8. Koekkoek, B. & Hutschemaekers, G. & van Meijel, B. & Schene, A., 2011. "How do patients come to be seen as 'difficult'?: A mixed-methods study in community mental health care," Social Science & Medicine, Elsevier, vol. 72(4), pages 504-512, February.
    9. Diamond-Brown, Lauren, 2018. "“It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making," Social Science & Medicine, Elsevier, vol. 205(C), pages 48-54.
    10. Tyskbo, Daniel & Sergeeva, Anastasia, 2022. "Brains exposed: How new imaging technology reconfigures expertise coordination in neurosurgery," Social Science & Medicine, Elsevier, vol. 292(C).
    11. Brown, Eliza, 2020. "Projected diagnosis, anticipatory medicine, and uncertainty: How medical providers ‘rule out’ potential pregnancy in contraceptive counseling," Social Science & Medicine, Elsevier, vol. 258(C).
    12. Perrotta, Manuela & Geampana, Alina, 2020. "The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care," Social Science & Medicine, Elsevier, vol. 258(C).
    13. Hyojung Tak & Gregory Ruhnke & Ya-Chen Shih, 2015. "The Association between Patient-Centered Attributes of Care and Patient Satisfaction," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 8(2), pages 187-197, April.
    14. France Légaré & Annette M. O'Connor & Ian D. Graham & Georges A. Wells & Stéphane Tremblay, 2006. "Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict," Medical Decision Making, , vol. 26(4), pages 373-390, July.
    15. Timmermans, Stefan & Almeling, Rene, 2009. "Objectification, standardization, and commodification in health care: A conceptual readjustment," Social Science & Medicine, Elsevier, vol. 69(1), pages 21-27, July.
    16. Mitchell, Ellen M.H. & Kwizera, Amata & Usta, Momade & Gebreselassie, Hailemichael, 2010. "Choosing early pregnancy termination methods in Urban Mozambique," Social Science & Medicine, Elsevier, vol. 71(1), pages 62-70, July.
    17. Jovanovic, Maja, 2014. "Creating the ‘dis-ease’ of high cholesterol: A sociology of diagnosis reception analysis," Social Science & Medicine, Elsevier, vol. 101(C), pages 120-128.
    18. Montenegro, Roberto E. & Dori-Hacohen, Gonen, 2020. "Morality in sugar talk: Presenting blood glucose levels in routine diabetes medical visits," Social Science & Medicine, Elsevier, vol. 253(C).
    19. Hutson, David J., 2013. "“Your body is your business card”: Bodily capital and health authority in the fitness industry," Social Science & Medicine, Elsevier, vol. 90(C), pages 63-71.
    20. Warren Kealy-Bateman & Georgina M. Gorman & Adam P. Carroll, 2021. "Patient/Consumer Codesign and Coproduction of Medical Curricula: A Possible Path Toward Improved Cultural Competence and Reduced Health Disparity," SAGE Open, , vol. 11(2), pages 21582440211, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:294:y:2022:i:c:s027795362200017x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.