Women’s Ways of Knowing and Obesity
In Women’s Ways of Knowing, Belenky, Clinchy, Goldberger and Tarule (1986) explore how women know and learn. The study is an extension and critique of the work of William Perry, who studied and reported on the learning experiences of men. Belenky et al. studied 135 women of diverse age, ethnicity, class, and educational backgrounds. Women were chosen from formal academic institutions and adult education programs in family agencies.
Their conclusions supported the novel view that women’s experiences of knowing and learning are different from the male experience. In the study Belenky et al. (1986) identified five types of knowledge, as summarized by Goldberger, Tarule, Clinchy, and Belenky (1996):
(1) Silence is a position of not knowing in which the person feels voiceless, powerless, and mindless. It marks a beginning point for the development of knowledge and is a classification in itself.
(2) Received knowing is a position at which knowledge and authority are construed as outside the self and invested in powerful knowing others from whom one is expected to learn.
(3) Subjective knowing is knowing which is personal, private, and based on intuition and/or feeling states rather than on thought and articulated ideas that are defended with evidence.
(4) Procedural knowing is the position at which techniques and procedures for acquiring, validating, and evaluating knowledge claims are developed and honored. This includes separate knowing (a reasoning against) and connected knowing (a reasoning with).
(5) Constructed knowing is the position at which truth is understood to be contextual; knowledge is recognized as tentative, not absolute; and it is understood that the knower is part of . . . the known, (pp. 4-6)
These definitions are critical to the research on women’s development, and to understanding women’s experiences of giving up dieting as discussed by Casper (1994) later in this section. Here, however, I focus on the components of the teacher-student relationship recognized by Belenky et al. (1986), because I believe they are of great significance to the researcher-subject and the provider-patient relationships in obesity research and treatment:
In considering how to design an education appropriate for women, suppose we were to begin by simply asking: What does a woman know? Traditional courses do not begin there. They begin not with the student’s knowledge but with the teacher’s knowledge, (p. 198)
This is a particularly relevant insight for both the research and treatment of eating disorders and obesity. Both researchers and health care givers are inclined to study and treat people from their own knowledge base and to discount the knowledge with which co-researchers and patients enter the relationship (Lopez, 1995).
In developing a research or treatment methodology, I suggest that a key component of the design must be identification, validation, and eventual incorporation of the knowledge of the participant. This not only gives credibility to the voice of the participant, but it may also afford other women the opportunity for a more personal learning experience through direct communication with the knowledgeable participant (as might be the case in a group discussion or mentoring program). Belenky et al. (1986) support this idea: “Most of the women we interviewed were drawn to the sort of knowledge that emerges from first hand observation” (p. 200) or learning in context. Additionally, they report, “The women we interviewed nearly always name out-of-school experiences as their most powerful learning experiences” (p. 200). These observations are highly applicable to the kind of learning I believe is most necessary and helpful for successful life changes required for healing of obesity.
Belenky et al. (1986) also address the notion of “connected teaching” (teaching in concert with the student’s viewpoint) and the process of digesting the material for learning. They suggest that the teacher himself takes few risks.. . . he composes his thoughts in private. The students are permitted to see the product of his thinking, but the process is hidden from view. The lecture appears as if by magic. The teacher asks his students to take risks he is unwilling . . . to take himself. (p. 215)
This concept is fundamentally related to women’s experience of weight loss in the following ways. Most researchers and health care professionals essentially aim to teach people how to be with food and their bodies in new ways. Such changes as giving up types and quantities of food are frequently perceived as stressful or risky to the participant. By maintaining the posture of an expert distributing distilled knowledge, the professional takes little risk, since the distillation of knowledge process is hidden from view. Also, insight into the process of successfully managing the necessary risks associated with the attainment of new behavior is absent in unconnected teaching.
This missing articulation of process can be illustrated by the popular example set by Oprah Winfrey (1997). Oprah has been very vocal about the mechanisms that have helped her to lose weight and maintain that loss – low fat cooking and the importance of exercise. These treatments are not a revelation to any woman who has sought weight loss. What is absent or de-emphasized is Oprah’s process—the lived experience—that has enabled her to create the kind of changes she has made in her relationship with her body. In my opinion, this is a common weakness of many treatments for weight loss that focus on content and rules rather than the processes and experiences that accompany significant change in body size.
Like Belenky et al. (1986), I recommend that researchers and health care providers utilize a midwife approach to addressing obesity. The midwife-teacher assumes that participants are containers of knowledge rather than empty receptacles, and works to draw out their knowledge. Additionally, those in authoritative roles can serve as connected teachers by validating participants’ knowledge, encouraging them to expand their thinking, and explicating the processes when feasible. Belenky et al. assert that “educators can help women develop their own authentic voices” (p. 229) by listening, respecting, and trusting their students. It is my contention that researchers and health care providers have the same opportunity with obese and eating disordered women.
Casper (1994), in her study based in part on the research of Belenky et al. (1986), explores the phenomenological experience of giving up dieting, suggesting that it is an important step towards health and reclamation of self in the life of an eating disordered woman. She suggests that dieting causes a person to begin eating in response to cognitive factors rather than internal cues. Instead of following a natural pattern of listening internally for body signals of hunger, foods hungered for, and satiation, long-time dieters make eating choices based on mental decisions and accumulated knowledge about what they should and should not eat in terms of types, timing, and quantities of food. This circumvents—for some people completely—the necessary reference to the body’s state of hunger and desire for food. Casper’s conclusions are supported by a variety of researchers who suggest that a non-dieting approach is a more effective way to address disordered eating.
In addition, Casper (1994) cites many examples of “blaming the victim” by treatment providers in the weight loss industry. Her literature review is novel and informative, and includes infrequently mentioned research suggesting that heavier people are healthier and live longer than those living at the weight chart ideals.
Casper (1994) concludes that giving up dieting “involves three interactive phases: (a) revising one’s thoughts and beliefs about dieting, (b) relying on self-knowledge and becoming one’s own internal authority, and (c) experiencing freedom” (p. 154). Of particular interest here is the second conclusion regarding self-knowledge and authority. Casper discusses this conclusion with respect to the five types of feminine knowing identified by Belenky et al. (1986). She offers a thought-provoking, yet incomplete synopsis of the five ways of knowing from the perspectives of women giving up dieting and includes quotations from the women’s interviews. She found that none of the thirteen women in her study experienced silence as a dominant way of knowing and that the four remaining areas were well represented in her sample. Her data analysis exposed the fact that in the process of giving up dieting the women’s ways of knowing changed. “Participants who once relied heavily on diet authorities for truth now relied on their own subjective voices and knowledge” (p. 162).
Casper (1994) concludes that “dieting is rarely effective in eliminating conflicts with food and fat. Practically speaking, adopting a more holistic and anti-fat-oppressive perspective of compulsive eating may aid therapists in helping their clients” (p. 169). She stresses the importance of the role of the professional in helping women in treatment find their voices, and thus empower women with disordered eating. The truth expressed by women in treatment for weight loss can change the face of the weight loss industry if professionals are willing to integrate the stories of female participants such as those in this study.
Lopez (1995) describes the lived experiences of six women in three different treatment programs for weight loss. She identifies the fact that research relating women’s experiences as weight loss participants is nonexistent: “Although there is beginning scholarship on women’s personal experiences with the pursuit of thinness, there has been no identified research that examines the nature of women’s personal experiences with weight treatment programs” (p. 3).
Lopez’ (1995) study delineates how women implemented their weight treatment regimens in the context oftheir daily lives, and the meanings they attached to their experiences. She suggests that the results would lead to an increased understanding of how women utilize weight treatment programs and offer prescriptions for improvement in program development, as well as insight for helping professionals working in the programs. A doctoral nursing student, Lopez addresses the lack of client understanding prevalent among health care workers in weight reduction programs. She cites the necessity to give nurses an “adequate knowledge base” (p. 4) of how women actually perceive and use weight treatment programs.
Lopez (1995) acknowledges the potential misuse of power by nurses when they are ignorant about the true experiences of women:
Most of the existing body of research on the topic of weight reduction assumes that a desire for weight loss is inherently healthy and that the chief problem to address is developing a method that will ensure long term outcomes. Therefore, nurses counseling women who are dissatisfied with their weight may be inadvertently imposing cultural biases on their clients, (p. 4)
Using both feminist and nursing theories to investigate and interpret the phenomenon of women’s experience in weight loss programs, Lopez (1995) cites many authors in support of the need for women’s voices in research, both to elicit the values and experiences of women and to validate women’s own feelings and perceptions. The latter, she affirms, have been culturally relegated to a subordinate position in favor of the advice of experts.
Lopez concludes her extensive review of the literature on women and weight loss with this justification of her research:
The issue of women’s concerns with body size and their problems with weight reduction programs might be productively explored through an examination of how they use weight treatment on a daily basis, how weight treatment fits into their expectations of themselves as members of their culture, how weight treatment organizes their activities, and the circumstances that cause them to enter and drop out of treatment. This information can be gained from qualitative research that allows women to describe their experiences with weight treatment in their own words. (Lopez, 1995, p. 37)
The methodology used in this study was comprised of two parts: (a) a phenomenological method to develop a description of the lived experiences of the women in the study; and (b) a critical hermeneutic approach to logically analyze and interpret the findings related to women’s well-being.
The sample of six women was chosen in accord with the practice of maximum variation sampling in an effort to promote findings of the widest audience possible. To assess two aspects of the experience of weight treatment programs, Lopez chose one woman who succeeded and one who dropped out of each program. The three programs consisted of: (a) a medically supervised modified fasting program, (b) a commercial program offering prepared foods, and (c) a twelve-step self-help program.
Lopez (1995) utilized three interviews made up of open-ended questions for each subject for data collection. The stories that resulted from the analysis of data were compelling and informative. The author integrated the stories with established perspectives on disordered eating, and reached the following conclusions:
(a) Current treatment models do not facilitate women’s autonomy and self- direction in implementing weight-loss strategies within the context of their value systems and lifestyle priorities, (b) ambiguity between health and attractiveness as reasons to pursue weight loss contributes to the nonresolution of the value conflict experienced by women in treatment, and (c) cultural standards for female attractiveness negatively impact women’s quality of life by holding them accountable for a body weight that few can realistically attain. (Lopez, 1995, p. 108)
In conjunction with the second finding, Lopez remarked that commitment to the program was greatly enhanced when the subject perceived the program to be truly beneficial to her health and well-being.
This study is remarkable in the fact that it is the only research to date which not only explores the lived experiences of women and weight loss but also validates many of the insights suggested by feminist authors, including Orbach (1988), Chemin (1981), and Roth (1982, 1984). Lopez does not, however, discuss the ways in which her findings might inform those who develop and work in weight loss treatment programs, which was one of her original research questions. Despite the omission of practical applications for her research, the Lopez study is groundbreaking because it sets a precedent in the literature on obesity – namely, that the stories of the female participants themselves are a valuable, if not imperative, source of knowledge for the treatment of obesity. Emphasizing the need to listen to women themselves for insights into the prevention and treatment of disordered eating, Jordan, Kaplan, Miller, Stiver and Surrey (1991) “urge that women continue to build research and action programs that are informed by their life experience and by further analysis of larger societal forces at work.” (p. 249). This study is a response to the call from Jordan et al. (1991), Lopez (1995) and Casper (1994) for continuing inquiry into— and reporting on— women’s self-knowledge, lived experience, and well-being with regard to their bodies.