‘If you’re serious about losing weight, why are you drinking all those Cokes?’: a critical discourse analysis of interviews on sugar-sweetened beverages amongst residents of a middle to upper class neighborhood in Winnipeg, Manitoba

ABSTRACT

Sugar-sweetened beverages (SSB) have been identified as a health policy target, due to their associations with weight gain. However, fatness or ‘obesity’ is associated with stigma, and for ‘obese’ children, mother blame; thus, SSB policies must be evaluated for their potential to reinforce existing forms of stigma. The purpose of this study was to explore discourses mobilized in discussion of SSB consumption and purchasing amongst residents of a middle-upper class neighborhood in Winnipeg, Canada. We conducted a critical discourse analysis of qualitative interviews from 2019, with English-speaking, adult participants using purposive sampling. Eighteen participants were recruited; fifteen were women, all self-identified as white and spoke about (grand)parenting. Considerations of weight stigmatization informed analysis. Participants utilized a personal responsibility discourse to determine the acceptability of SSB purchasing and consumption. Negative emotions, or judgements, shaped discussion of regular SSB consumption, consumption by higher-weight individuals, or consumption in specific contexts, which were unacceptable. Parental responsibility was a discourse applied to children’s SSB intake and elicited judgmental language, particularly among mothers. The discourses utilized by dominant social groups are stigmatizing, particularly when directed towards higher-weight individuals, leading to maternal blame. Therefore, the impact of SSB policies on stigma, including weight-based stigma, should be carefully considered prior to implementation.

KEYWORDS:

• Sugar-sweetened beverage
• weight stigma
• Canada
• privilege
• critical discourse analysis

Introduction

Sugar-sweetened beverages (SSB) have been identified as a major public health concern (e.g. Dietitians of Canada, 2016) due to their sugar content and association with weight gain (Nguyen et al., 2023) and type two diabetes (Malik et al., 2010). SSB include beverages sweetened with added sugars, such as soft drinks, fruit drinks, sports drinks, and other types of pre-prepared beverages (Dietitians of Canada, 2016).

Sugar-sweetened beverage consumption patterns and policies

In Canada, SSB intake differs across various socio-demographic factors; SSB consumption in 2015 was higher amongst Canadian men (compared to women), children and adolescents aged 9–18, and young adults (Jones et al., 2019). Similarly, adults living in food insecure households reported higher SSB intake compared to those in food secure households (Warren et al., 2022). Additionally, off-reserve Indigenous¹ populations reported the highest volume consumption of SSB compared to all other ethnic or racialized groups, while white populations consumed the most alcohol (Jones et al., 2019). Importantly, when compared to the previous survey (2004), daily consumption of SSB or high-calorie beverages in 2015 had decreased significantly (Jones et al., 2019). It remains unclear among which population groups intake decreased the most. Regardless, the highest consumers of SSB in Canada likely already encounter stigma and discrimination due to colonialism, race, income, class, weight, and/or other socioeconomic factors, which is relevant to the exploration of stigma given in this paper.

SSB targeting policies, commonly in the form of taxes, have been proposed in the Canadian context, and recently implemented in Newfoundland and Labrador (Government of Newfoundland and Labrador, 2021). Additionally, SSB taxes have garnered support from major health organizations as a means to address the prevalence of non-communicable chronic diseases, which most argue also includes ‘obesity’² (As reviewed by Waugh (2022), e.g. Dietitians of Canada, 2016).

Biomedical ‘obesity’ narrative

Common ‘obesity’ narratives are founded on the medicalization of fatness (Jutel, 2006; Lupton, 2018). Sadler et al. (2009, p. 412) describe medicalization as ‘a process by which human problems come to be defined and treated as medical problems’. Body composition, in biomedical language, has long been purported to be a result of lifestyle, whereby bodily fatness is interpreted as the result of caloric imbalance from too much food/too little exercise (Mayes, 2016). Thus, ‘obesity’ is framed as the result of individual failure to manage dietary consumption or compensatory activities (i.e. exercise) (Lupton, 2018), which is a foundational assumption underpinning weight stigma (Puhl & Heuer, 2010). Bodily fatness is subject to stereotyping, including laziness, stupidity, or worthlessness (Teachman et al., 2003) and expressions of disgust in cultures that value self-regulation (Lupton, 2018). Personal responsibility framing is also a common critique of neoliberal public health policy that emphasizes lifestyle interventions over other health-promoting strategies (e.g. Ayo, 2012; Mayes, 2016).

Underpinning this medicalized frame of reference with respect to bodily fatness is the conflation of weight with health (Harjunen, 2017), an over-statement exposed effectively by Flegal et al. (2019). Biomedical ‘obesity’ framing ignores the multiple factors that may be contributing to lifestyle-related behaviors, weight, and health of an individual, and leads to the promotion of surveillance of bodies (internally or externally) to conform to standards of thinness (Harjunen, 2017). In contrast to the biomedical perspective, there is evidence of potential health benefits to living in a body classified as ‘overweight’ by BMI (Flegal et al., 2007). Alternatives to ‘obesity’ narratives recognize that health can exist within different body sizes, including the Body Positivity movement or Health at Every Size™ (HAES™) (Bacon & Aphramor, 2011; Bombak, 2014; Bombak et al., 2019). Within these frameworks, different bodies are an example of natural variation among people, health is understood as more than physical, and there is acknowledgement that individuals of all sizes can be healthy.

The conflation of weight and health is oversimplified and may contribute to policies further reinforcing this conflation. For example, while SSB intake is associated with weight gain (Nguyen et al., 2023), there is no evidence to our knowledge that abstaining from SSB leads to sustained weight loss. Indeed, research supports the ineffectiveness of sustained weight loss efforts (e.g. Mann et al., 2007). Nevertheless, conflating health and weight reinforces an individuals’ moral failing in achieving a ‘healthy’ weight and controlling their SSB intake, which contributes to weight stigma. In a neoliberal context in which individuals are charged with personal responsibility for their health, the dominant framing of fatness as unhealthy and produced by lifestyle choices can distract from equitable and salutogenic structural reforms, even when public health pays lip service to the social determinants of health (LeBesco, 2011; Medvedyuk et al., 2018).

Children’s consumption and intensive mothering

Childhood ‘obesity’ was provided as a reason for implementation of SSB taxation by some health organizations (e.g. World Health Organization [WHO], 2017), because children and young people (aged 9–18) are high consumers of SSB (Jones et al., 2019). The responsibility to control aspects of children’s health often falls to their mother, and consequently mothers are recipients of blame and shame if their children are fat (Friedman, 2015; Herndon, 2014). When children are perceived as ‘obese’, stereotypes of being permissive or bad parents are often directed towards their parents, and mothers in particular (e.g. Ioannoni, 2017; Jackson et al., 2007; Kokkonen, 2009). These elements of responsibility for children’s weight are reinforced by cultural understandings of mothering; intensive mothering refers to the gendered idealization of resource and labor-intensive child rearing (Hays, 1996), currently promoted in Western countries. According to intensive mothering discourses, being a ‘good mother’ includes a responsibility to feed your child(ren) healthy meals and prevent them from becoming ‘obese’ (Wright et al., 2015). Therefore, examining perceptions of children’s consumption of SSB offers an opportunity to engage with both ‘obesity’ and parental responsibility narratives.

Stigma and policy

Stigma, as defined by Link and Phelan (2001, p. 377), occurs when ‘labeling, stereotyping, separation, status loss and discrimination occur together in a power situation that allows them’. Stigma must be considered in the context of power imbalances and can be explored at individual and structural levels (Link & Phelan, 2001). Stigmatization can be related to identity, behaviors, health conditions, and appearance (Pearl & Puhl, 2018); self-stigma can also occur through internalization of stigma(tizing discourse) (Durso & Latner, 2008), and is associated with negative emotions such as shame and guilt (Burris, 2008). Stigma contributes to both social and health inequities (Stangl et al., 2019).

Weight stigma can be described as ‘societal devaluation and derogation’ on the basis of bodily fatness (Pearl & Puhl, 2018, p. 1141), and informs our analysis. It has been well documented throughout the evolution of the modern, neoliberal world, for example by Amy Farrell (2011), who describes fatness as developing a strongly negative meaning in the US context, comparable to experience in Canada. Weight stigma is also intertwined with a multitude of social factors, including gender, motherhood, and race (Farrell, 2011; Friedman, 2015; Poudrier & Kennedy, 2008; Strings, 2019; Warbrick et al., 2019). Biomedical narratives of ’obesity’ as described above, further contribute to the stigmatization of weight by charging individuals with managing their weight through self-management, including policies and practices that reinforce this neoliberal, individualistic perspective (Harjunen, 2017), rather than institute structural changes to minimize food insecurity, for example, which is associated with SSB intake (Warren et al., 2022). The intersection of multiple forms of stigma, and marginalized social identities, is also linked with adverse health outcomes and behaviors (Turan et al., 2019).

Recognizing and committing to ending weight stigma in public policies is gaining increasing recognition, due to the documented negative effects on health. Currently, there are global calls to end weight stigma in health policy (for example: Arora et al., 2019). Given the increasing implementation of taxation of SSB globally, and now in Canada, exploring the interactions between SSB, ‘obesity’ and weight stigma discourses is urgently needed. A better understanding of these discourses will provide insights into how they interact, including both the ideology informing this policy, and the potential consequences of implementing an SSB tax.

Against this background, the purpose of this study was to explore the discourses around SSB used amongst the dominant group in Canadian society, using weight stigma as a theoretical lens. Specifically, our research questions were: what are key discourses around SSB and their consumption and purchasing amongst residents of River Heights, Winnipeg; and what factors inform the acceptability of SSB consumption and purchasing?

Material and methods

Design and framework

This study was situated in a critical paradigm, focused on exploring power, inequities, and social change (Creswell, 2013). Food practices are considered an expression of class (Beagan et al., 2015; LeBesco, 2004), and therefore in our case, beverages provide an entry point to examine SSB behaviours in the context of power inequalities. We utilized critical discourse analysis (CDA), as described by Wetherell and Potter (1988) to analyze our interview data. In our analysis, we sought to ‘describe the explanatory resources’ (p. 172) (Wetherell & Potter, 1988), or the discourses utilized by participants. To do so, we first identified ‘interpretive repertoires’, the summary units of discourse (metaphors, tropes, figures of speech) (Wetherell & Potter, 1988, p. 172). We also looked for ‘subject positions’, seeing positioning as a ‘discursive process whereby selves are located in conversations as observably and subjectively coherent participants in jointly produced story lines’ (Davies & Harré, 1990, p. 48). Examining discourses served our objectives, as it ultimately enabled us to examine the functions of a discourse in terms of local (interpersonal) and ideological effects, legitimizing certain expressions of power (Wetherell & Potter, 1988), while de-legitimizing others. We also drew inspiration from the critical discourse work of van Dijk (1993). Although his CDA was intended for media analysis, it also intentionally focuses attention on power and dominance. Using these approaches, we sought to explore the socially circulating resources that participants utilized to interpret and communicate about SSB behaviors. Given that policies directed at SSB aim to impact bodily fatness, we explored how both common and resistant discourses are were taken up by participants.

Setting

The study was conducted with residents of River Heights in Winnipeg, Manitoba, Canada. However, work was embedded in a larger project primarily exploring Indigenous perspectives of SSB taxation in Manitoba. River Heights was chosen as the study location based on demographic characteristics (Winnipeg Regional Health Authority [WRHA], 2015) similar to the dominant group in Canadian society: approximately 75% of residents are white, and 64% have a post-secondary certificate, degree, or diploma, both measures above the municipal prevalence (Cui et al., 2019). River Heights residents also prioritize public health; for example, the neighborhood had one of the highest COVID-19 vaccine uptakes in Manitoba (Government of Manitoba, 2022). The neighborhood also has a history of supporting liberal politics at both the provincial and federal levels and has a reputation, within city-wide discourses, for being the home of Winnipeg’s wealthiest residents (Mann, 2017). Therefore, residents of River Heights were selected as offering a good representation of the dominant social group in Canadian society and provide an entry point for an exploration of power and dominance in the context of SSB.

Participants

Participants were recruited based on the following: self-identified residence in River Heights, English speaking, and $\ge$18 years old. Recruitment occurred via posters in community spaces, social media, and to a lesser extent, snowball sampling. We purposively selected mothers, young adults, high SSB consumers, and people who self-identify as being labelled as ‘obese’. Participants were provided with a $50 gift card honorarium for participation.

Ethics

The study protocol was approved by the Joint Faculty Research Ethics Board, Protocol HS24335 (J2020:068), and the larger project by the Health Research Ethics Board HS21878 (H2018:234) at the University of Manitoba. In addition, each participant provided their informed, written consent prior to interview. To maintain confidentiality, participants are cited using a pseudonym.

Data collection

We (NR and KM) conducted primarily one-on-one qualitative semi-structured interviews. Interviews took place between May and June 2019 in a variety of settings including public spaces, NR’s office, as well as in participants’ homes. Interviews were audio recorded. Participants completed a demographic questionnaire, which collected information to characterize the sample. Field notes were written up after each interview.

The interview guide had 10 main questions together with follow-up questions/prompts (Waugh, 2022; see also online supplemental file). The interview guide did not include any main questions about weight. Instead, the guide sought to stimulate discussion about SSB consumption patterns of participants, their families or communities, reactions to purchasing or consuming SSB, and health implications of consuming SSB. We therefore asked, ‘what are your reactions to someone purchasing sugary drinks?’ with prompts about whether the person was ‘overweight’.³ Data collection concluded once 18 interviews had been completed, as recruitment had slowed considerably, and we had reached saturation.

Data analysis

The lead author (AW) transcribed all interviews verbatim and familiarized herself with the data via multiple readings of the transcripts. For the next phase of analysis, CDA methods were employed following methods outlined by Wetherell and Potter (1988) and inspired by van Dijk (1993) work on power. Analysis was aided by the use of NVivo 12 Pro software, with some additional hand coding and analytic writing.

As described by Wetherell and Potter (1988), interpretative repertoires (e.g. metaphors, tropes, and figures of speech) were utilized as analytic units. AW completed two close reads readings of the transcripts to start. The second stage of analysis, coding, involved asking questions of the data, such as is weight stigma, anti-fatness, pro-thinness discourse used by participants? Analytic writing helped move analysis to broader and more abstract concepts, and as a tool to explore ideas and examine connections, which also served to enhance rigor.

The two authors (AW and NR) most closely involved with analysis presented drafts of emerging analytic insights to the others, whose questions deepened the analysis.

Reflexivity

This research study began from the supposition that tax policies targeting SSB may exacerbate weight stigma and have the potential to inequitably affect people who already are experiencing stigma, due to the intersection of many factors (Riediger & Bombak, 2018). The authors were all white, middle-class, cisgender women settlers with various weight-related histories, sexual identities, family compositions, and patterns of SSB intake. We engaged reflexively in designing the study, data collection, and analysis.

Results

A total of 18 individuals volunteered to participate: three men and 15 women, with an average age of 44 years old. Every participant identified as white and reported being food secure. Most had completed a post-secondary program or degree. Each participant also discussed being a parent and/or grandparent during the interviews, although we did not ask participants directly about parental status. Additional demographic characteristics are summarized in Table 1 The interviews averaged 25 minutes.

Table 1. Demographic characteristics of study participants.

Characteristics (n = 18)	n (%)
Gender
Female	15 (83)
Male	3 (17)
Age ranges*
18–40 years old	8 (51.1)
41–50 years old	5 (29.4)
>50 years old	4 (23.5)
Highest Level of Education*
Completed university degree	14 (77.8)
Completed trade/technical school or college diploma, or primary school	5 (27.8)
Current employment status
Not working in the labor force	3 (16.7)
Working full in time in the labor force	11 (61.1)
Retired or Semi-retired, or working part time in labor force	4 (22.3)
Self-rated sugar-sweetened beverage consumption
Never, or less than once per week	7 (38.)
1–3 times per week	5 (27.8)
4–6 times per week	2 (11.1)
At least once per day	4 (22.2)

*Not every participant answered or provided multiple answers.

Most participants assumed that the interviewers would be supportive of a SSB tax, despite the interviewers or consent forms not articulating any support or lack thereof. We attribute this to the interviewers presenting as white, thin and cisgender women, and working in a nutrition department, as identified on the consent form. This presumed support of SSB taxation likely influenced many participants’ discussion of SSB, their acceptability of any proposed taxation, and the relationship building that occurred.

We found that participants were primarily drew on a discourse of personal responsibility in their discussion of SSB consumption and purchasing (hereafter referred to as SSB behaviors). In fact, perceived responsibility often determined the acceptability of SSB taxation. Parental responsibility was also a facet of personal responsibility that recurred throughout the interviews and was highly valued by participants.

We chose to present results by dividing personal responsibility into two narratives, overt expressions of responsibility with a focus on how responsibility was created, together with examples; and covert expressions of responsibility in the form of how SSB behaviors were framed as (un)acceptable or (ir)responsible.

Overt expression of responsibility

Weight was the most overt avenue of responsibilization. Personal responsibility was seen as demonstrated through negative associations between SSB and weight, including negative emotions, and the need to avoid SSB to lose weight or prevent weight gain. One participant who was asked about their drink preferences said:

I got to find a new drink to drink because I am, and I’ve just noticed, even just because of my age, I’ve never, I’ve always, but the weight I’m putting on, disgusting. (Emily)

Disgust of body fat was an emotion shared by another participant, who was asked about their reaction to someone ‘overweight’ purchasing a sugary drink replied with ‘I’d be a little, disgusted’ (Sheila). Through the negative language, emotions and judgement, weight gain or being at a higher weight was set up as a failure of responsibility, thus a condition that needed to be fixed.

Personal responsibility was also mobilized in conversations of losing weight or managing weight, such as:

Well my wife used to say to me, if you’re serious about losing weight, why are you drinking all those Cokes? (James)

This quote also illustrates the negativity associated with weight, in the need to lose it, as well as a strong link to SSB. Weight was also discussed directly as an individual’s responsibility. Together, these contribute to the overall framing of responsibility and the link between SSB and weight.

For many participants weight and health were inseparable. For example, when one participant was asked about how they might react if they saw an ‘overweight’ person purchasing SSB, they replied:

Participant: They don’t necessarily need that-

Interviewer: And what kind of reaction?

Participant: They cou-should consider their health more (Jennifer)

In this quote, Jennifer utilizes personal responsibility discourse in reference to health (and weight); the moral imperative is made clear with the switch from ‘could’ to ‘should’. Despite an absence of interview questions about weight (except one prompt about reactions to others drinking SSB), participants often answered questions about health by reference to weight, a notable re-interpretation of the question focus. There were some instances of health discussed outside of framing with weight and responsibility (such as diabetes, dental caries, or more general health concerns), as a part of answers to interview questions asking about both the state of the participant’s health, as well as what they knew about SSB and health, demonstrating familiarity with the associations of sugar and weight. Nonetheless, the conflation of health with weight was central to participant discussion.

Another example of the responsibilization of weight and health came from Louise, when asked about her reaction to an ‘overweight’ person purchasing SSB,

I would think, and I do think they they, uh, if they made just a few changes in their lives they would be happier. Because you don’t see too many TV shows where 600 pound people are happy. (Louise)

Again, the simplicity of making a ‘few changes’ implying that they might make a meaningful difference suggests that weight is easily reduced. This reinforces both weight-stigmatizing stereotypes, and the narrative that individuals with larger bodies are failing to take action and are unhealthy. Additionally, the comment implies that people who are perceived to be unhealthy must also be unhappy. The conflation of health and weight aligns with weight-stigmatizing discourse, as well as reinforces the biomedical framing of fatness.

Another way that health and responsibility were linked was through the discussion of the ‘burden of obesity’ on the health care system, such as:

And people need to take more initiative towards their, their health and [quietly] just taxes our health care system more. (Jennifer)

The use of a quieter voice suggests that this participant was aware of the judgement, and potential harm in what they were saying. The ‘burden of obesity’ discussion suggests that ‘obese’ individuals are undeserving of health care, as they have failed to control their weight, and thus, health.

Not all participants utilized weight stigmatizing discourse, and instead offered some understanding, or alternatives to negativity. Some, such as Colleen, exhibited an awareness of stigma. She acknowledged:

Sometimes I think there is a bit of stigma, like you know, overweight, you know like, heavier people set, heavy set.

Another participant drew on discourses such as body positivity, in contrast to negative and responsibilization approaches to weight. A few explicitly mentioned concerns regarding weight stigma and many others also displayed an initial moment of hesitancy to engage with negativity associated with weight. Almost every interview included a variation of:

Interviewer: Um, how do you react to people buying sugary drinks? Or drinking them?

Respondent: I-usua- don’t react. (Roxanne)

However, most participants did eventually overcome their hesitancy, in addition to sharing their own experiences of judgement.

Similar to weight, SSB, particularly pop (a fizzy drink), was also talked about with negative emotions, including shame and guilt. For example:

I actually feel, like if someone sees me drinking a pop like I actually feel embarrassed. Especially with certain groups of people. (Kristen)

Negative emotions associated with SSB were somewhat dependent on context. Specifically, Emily felt ‘guilty’ about consuming SSB at work. Another participant, Grace, implied discomfort at the prospect of a cashier seeing her purchase SSB:

I would probably feel most comfortable buying them [SSB] at Superstore and using the self checkout. (Grace)

In contrast to participants’ own experiences with SSB behaviors, most participants did not perceive any judgement from external sources. The exception to this was one participant who self-identified as ‘bigger’, and when asked about why she thought people reacted to her buying sugary drinks she said:

Maybe because I’m a bigger woman and maybe I shouldn’t be drinking those kinds of drinks. (Grace)

Akin to the maintained personal responsibility of weight, health and SSB behaviors, parental responsibilities were also a universal thread. Some participants described negative emotions, including judgement and guilt, when discussing the expectations of them as parents and how to feed their child(ren). One participant said, ‘as a parent, you feel guilty all the time, right?’ (Nikki). Another shared, ‘I feel a little bit … judged in even groups of moms too’ (Paige). The language and emotions utilized by participants about their parental responsibilities suggests internalized judgement.

Participants’ discussion established they had high expectations for parents as those responsible for their family’s health, including the overt responsibility to establish healthy eating habits in their children. Furthermore, as health was regularly conflated with weight, parental responsibility discourse was extended to child(ren’s) weight. The direct use of personal responsibility discourse, in terms of weight, health and parenting further demonstrated how pervasive this narrative was to SSB behaviors. Perceived transgression of the ideal elicited judgement, as described by James, a former regular SSB consumer:

I cringe when I see grocery carts with soft drinks in them and kids. ‘Cause it’s, … they’re building a lifelong habit that is unhealthy. (James)

Judgement, although identified by both fathers and mothers in this study, was primarily experienced and internalized by mothers.

Covert expressions of responsibility

Personal responsibility was mobilized covertly to determine the acceptability of SSB behaviors. Unacceptable SSB behavior was primarily described as a regular (i.e. habitual, frequent) consumption. For many participants, regular SSB behaviors were indicated by an ‘obese’ individual. Regular SSB consumption was also signaled by consumption at work, which was also identified as a place a participant might feel least comfortable consuming SSB. Another participant, who did not consume SSB at work but had a colleague who did, spoke about it at length, highlighting the frequency of intake:

Like she always has a bottle of pop in her hand … I feel bad even saying this, but I find it like really off-putting, like, … ‘How can you drink that all the time?’ … it doesn’t sit well with me [Laugh], Yeah. (Kristen)

For the majority of participants, it was unacceptable for children to consume any SSB, which made any parent/adult involved with children who consumed SSB appear complicit and irresponsible. One example of this occurred when a participant described their experience purchasing SSB:

… if I’m there on my own, it’s perceived a little bit better. If I’m there with my kids and then buying lots of sugary drinks, I think people … you are automatically sort of being judged a bit, ‘cause you’ve got little kids in there and you’ve got things that are, (Mumbles) everyone knows are unhealthy. (Grace)

Some participants reported negative consequences of sending their child to school (or daycare) with juice boxes, which were sent home by the school (or daycare). They quickly learned that juice consumption was perceived unacceptable in these settings and exhibited some defensiveness in rationalizing the sending of juice:

There was maybe a couple of times where I put a juice box in her lunch, just … you’re running out of time, and [laughs] you know how it is […] here’s a filler [high voice] and I know sometimes she likes juice, just the odd time, it always comes back, and they’ve never made a rule, and they’ve never said anything in the newsletters like, don’t bring juice, but I’m wondering if they just don’t accept it there. (Nikki)

Due to the pervasiveness of personal responsibility discourse, acceptable SSB behaviors were limited to behaviors that were seen as infrequent. Non-regular SSB behaviors included consumption at special occasions such as a community barbeque event:

last night at a bar-community barbeque I had pop … so in the summer, it’s probably more like once a week. But in the winter, not at-hardly ever. (Kristen)

Acceptable SSB behavior also included consumption for the sake of wellness, such as drinking ginger ale or sports drinks for gastro-intestinal issues. Finally, acceptable consumption also included choosing SSB when other options could be perceived as irresponsible. For example, drinking SSB when pregnant was the responsible choice compared to consuming an alcoholic beverage. Choosing SSB over alcoholic beverages was also perceived as responsible in other contexts:

so with my brother, … . he doesn’t drink alcohol, so, he sort of substitutes pop for alcohol. (Kristen)

SSB mixed with alcohol was also discussed as an acceptable beverage, when consumed in moderation on weekends or social celebrations, again, signaling infrequency of consumption as permissible. Interestingly, once mixed with alcohol, SSB were not usually identified as such by participants or mentioned unless prompted.

you know what I am mainly a beer drinker but uh I do, when I do drink liquor it’s always mixed with pop for the most part. I guess that is one part I didn’t really think about, about pop intake. (Thomas)

Acceptable consumption of SSB by children was described as being more restricted, less influenced by context, and yet still resulted in heightened feelings of judgement and guilt. Acceptability of SSB consumption for children was limited to special occasions (e.g. birthdays) or as a rare ‘treat’. Often the only sugar-containing beverage considered acceptable in these situations was fruit juice, which if 100% fruit juice, was not considered a SSB. Juice was also considered more acceptable if diluted with water.

And my toddler would have, maybe, every couple of days, would have a juice, like a diluted juice in the morning. (Grace)

The very limited acceptability of children’s SSB or juice consumption frames parents as responsible for their children’s intake, with good parents invariably packing ‘healthy’ lunches and serving children only ‘healthy’ beverages. The limited acceptability of all SSB behaviors, but particularly those involving children, highlights how ingrained personal responsibility discourses were.

Discussion

Throughout this study, participants’ discussion of SSB was framed largely in terms of personal responsibility, a discourse highlighted by as well as in wider critiques of neoliberal public health (For example: Ayo, 2012; Mayes, 2016). This suggests that weight stigma is deeply tied to perceptions of SSB and the pervasiveness of weight stigma as central to the ideology of white, educated, liberal culture in Canada, and Canadian public health. When utilizing weight stigmatizing discourse, participants in this study were more likely to make judgements about SSB behavior directed at higher weight individuals, similar to the forms of surveillance described by Harjunen (2017). Personal responsibility also figured prominently in participants’ perceived acceptability of SSB behaviors; seemingly responsible SSB behaviors were considered acceptable, but behaviors assumed to indicate regular consumption of SSB were not. Other weight stigmatizing discourses utilized by participants conflated weight with health (Harjunen, 2017). However, alternative discourses to weight stigma were also present; for example, some participants showed empathy toward SSB drinkers in situations where alcohol use was contraindicated.

Few studies to date have explored attitudes and ideologies pertaining to SSB in a Canadian context. Previous research however supports strong discursive links between negative emotions, responsibility for weight, and SSB consumption. A similar study, connected to the larger project but situated in rural Michigan (USA) reported judgement of higher weight individuals when consuming SSB, and judgement of parents when their children were SSB consumers (Bombak et al., 2021). Consequently, Bombak et al. (2021) caution against policies directed at SSB due to their potential for weight stigmatization. However, in Canada, the highest SSB consumers in Canada tend to be Indigenous people, those with lower levels of education, and those who report food insecurity (Jones et al., 2019; Warren et al., 2022). As high SSB consumers, Indigenous populations may be especially prone to judgement by the stigmatizing discourses identified, the effects of which may be further magnified for those individuals who experience multiple intersecting, marginalized identities (Turan et al., 2019).

In addition to personal responsibility, we found that parental responsibility was a present discourse for participants, which led to judgement of self and others. For example, Dorothy described sugary drinks as her family ‘pitfall’, and James ‘cringed’ at families buying SSB together. Most notably, one participant also described as a parent feeling ‘guilty all the time’ (Nikki). Participants who were mothers, such as Nikki and Dorothy, spoke of internalized judgement; whereas James, a father, described judgement directed at other parents, not himself. This suggests a pattern of mothers feeling the weight of caregiving expectations, of which feeding their child(ren) is one essential aspect – signaling links between SSB consumption and intensive mothering ideology (Hays, 1996).

Intensive mothering is also related to weight stigma, which could explain participants’ experiences and negative emotions surrounding their child(ren)’s consumption of SSB. While intensive mothering differs by social class, the pressure to be a ‘good mother’ (a subject position) affects mothers of all classes (Villabos, 2014). As Elliot et al. (2015) outlined in their research with low-income, Black mothers, there is a similar pressure to be a ‘good mother’ for low-income mothers, which can lead to self-blame for not living up to societal expectations set by mothers in another social class. Intensive mothering and its interaction with SSB, may have far-reaching implications for marginalized mothers in Canada. Given the sociodemographic factors associated with SSB intake, such as food insecurity, stigma is likely to be magnified for individuals experiencing intersecting forms of oppression, including racism.

Our use of CDA (Wetherell & Potter, 1988) facilitated the identification of ‘repertoires’, subject positions and discourses drawn on by participants who are members of a dominant social class. Personal and parental responsibility both connect to weight stigma, intensive mothering, and therefore to neoliberalism. Our findings further suggest that food (and beverages) and fatness are important identifiers of class (Beagan et al., 2015; LeBesco, 2004). Therefore, the framing of SSB consumption in terms of responsibility indicates that associated policies to address intake are likely informed by and reinforce the neoliberal ideologies, power relations, and interests of dominant social groups. In practice, this means the implementation of SSB taxes may serve to reinforce existing stigma (weight) and parental (maternal) blame, both of which have harmful health effects.

Limitations

Our study has some limitations; participants included few men compared to women, and thus transferability is limited, but is perhaps greater for white, female, educated, and liberal populations in contexts in which weight stigma is well established. Additionally, participants reported primarily heterosexual relationships, which are not inclusive of all relationships and parenting circumstances. Finally, these interviews took place in a pre-COVID-19 context, and parenting patterns, as well as the societal relationship to public health may have changed as a result of the COVID-19 pandemic.

Conclusion

In conclusion, white River Heights residents utilized personal responsibility discourses throughout their discussion of SSB, reinforcing existing stigmatization of weight, as well as judgements of parenting. Acceptability of SSB consumption or purchasing was also informed by perceived responsibility of individual circumstances. The utilization of these discourses by members of the dominant societal group may serve to promote the implementation of SSB taxation policies and thus reinforce these discourses. To answer global calls to end weight stigma (eg. Arora et al., 2019) and address health inequities, policies and practices directed at SSB behaviours should be considered potential drivers of structural stigma, with concomitant impacts on individuals who are already stigmatized, or those with multi-faceted marginalized identities.

Acknowledgements

We thank study participants for their time and perspectives, as well as members of the larger research team and participants in other arms of the study whose collective advice and perspectives helped shaped the analysis reported here.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09581596.2023.2265045.

Additional information

Funding

The study was funded by a Canadian Institutes of Health Research grant to NR [grant #156260]. NR is also funded by a CIHR Early Career Investigator Award [grant #155435]. AW was the recipient of a CIHR Canada Graduate Scholarship-Masters, as well as a Graduate Enhancement of Tri-Agency Stipend, and a ‘Top-up’ Award from the University of Manitoba, Faculty of Graduate Studies. The funders had no role in the study design, collection, analysis, or interpretation of the data.

Notes

1. Indigenous People in Canada are comprised of First Nations, Métis and Inuit people, as defined in Section 35 of the Canadian Constitution of 1982.

2. ‘Obesity’ is referred to using quotation marks to acknowledge the normativity and stigmatization inherent with the use of the term (Meadows & Daníelsdóttir, 2016). The term ‘Obesity’ is also a category within the Body Mass Index (BMI) measure of height over-weight, which includes other categories of underweight, normal weight, ‘overweight’, and is a foundational element of biomedical ‘obesity’ narratives.

3. ‘Overweight’ was the term used by the interviewer, and for the sake of continuity we use this term throughout this manuscript, however we acknowledge that this term is also a part of biomedical ‘obesity’ narratives.