Effects of the American Public School Health Class on Self-Image and Mental Health
P600 Ethnography by Sara Schumacher
How does the education on health and food taught in public schools’ affect students’ self-worth and conceptualizations of health? Public school education is the foundation for many individuals’ conceptualizations of health and what healthy bodies/behaviors look like.
From my own experience and the experiences of four other college-aged women (19–22) who attended Indiana public schools for kindergarten through twelfth grade, particular ideologies and practices were encouraged by the curriculum of our health classes. In understanding what we were taught and how it affects us in our current relationships with food and nutrition, we found that clear healthism, nutritional science, and strict interpretations of healthy bodies were present in our classes. These biases can be visually identified in the food pyramid, myplate.gov, and the other depictions of health bodies in public school health curriculum. The discrepancies between these visual representations and the actual food available to individuals reveal the shame and even if they manage to succeed, success becomes a pyrrhic victory.
I chose this topic because over the course of this semester I have been interrogating my K-12 public education and the narratives it taught me about health and food. This life stage in particular seems to be a popular time to disentangle the ideologies we were taught and the beliefs and education we want to gain. Starting off with the theories of western health and nutrition which seemed applicable to my memories of public school health curriculums, I wanted to look at the roles of local biologies, healthism, morality of health, and hegemonic nutrition play in general health education in Indiana. I hope, by approaching a shared educational experience from such an academic heavy perspective, to disentangle what was presented to me as fact and gain a better understanding of what exactly health is, and how to measure it. By separating the ideological framework from factual information and critically evaluating how the facts were presented, it should be possible to avoid further perpetuation of these ideologies, beginning in my own life.
“I hope…to disentangle what was presented to me as fact and gain a better understanding of what exactly health is, and how to measure it”
To get additional perspectives and understand the lastings effects of the education we received, I interviewed four individuals. Each individual is white, female, age 20 to 22, and attended Indiana public schools for their entire k through 12 education. Two of the four identify as queer. One of the participants was diagnosed with ADHD just after our interview, so now two of the four are diagnosed with neurodivergent conditions. Individual one is my twin sister, hereafter referred to as G, with whom I have conducted a few ethnographies before. Individual two is my best friend of seven years, hereafter referred to as C, who attended high school with me. Individual three is my former roommate, hereafter referred to as A, again a student from the same high school. Individual four is the youngest of the group and the person with whom I have been friends with the least amount of time, hereafter referred to as M. M, A and I have ADHD and we have bonded over our experiences as neurodivergent women in higher education. We also infodump together frequently, which would ease the comfort level between us. I chose each of these individuals because of our similar experiences and our familiarity with each other, hopefully allowing for the interviews to become less formal.
Readings about healthism, local biologies, morality of health, and hegemonic nutrition provide the meat of the ideologies I want to interrogate in this study. Discussions about social determinants of health, capitalistic approaches to health, and structural inequality help prompt questions about these ideas and how they are presented in white lower middle class white women (like me). Many of the studies examine the effects of the ideologies on indigenous communities and Black communities, but since I am not a part of any of those communities, I can better explore how these ideologies impact people like me who must contend with gender biases but benefit from white privilege and class privilege. I had difficulty defining the sources and actual platforms taught in Indiana public school health courses I experienced, so hashing it out with women who went through the same thing seemed like a good solution.
The article by Your Fat Friend (2019) about the history of the BMI was the inspiration for this study. As I was reading, I kept asking why we continue to use BMI to measure individual health and wondered if it is because BMI is just what we are taught or for other reasons. Where do we get these very white, western Eurocentric ideals of health and body-type? Additionally, as I was reading Geronimus and Thompson (2004), I kept asking myself where do we learn developmentalism, economism, and American Creed ideologies which so strongly impact determinants of health? I decided that the education system, whether in medical training institutions or starting as early as elementary school, begins this damaging indoctrination of belief systems which benefit so few. Because I cannot speak to the experiences of people in the communities mentioned in these readings, I figured I may be able to examine the beneficiaries of these ideologies and if white lower-middle class midwestern women are included in that group or if they are also affected and how. My experience with the standards I was taught in school, throughout my educational career, showed me how important it is to discuss hegemonic nutrition and other issues without taking them as fact.
One of the most consistent themes present throughout each of my interviews was a concept of morality of health through the moralizing of food (McLennan 2020). G, A, and M each brought up examples of foods they regularly consume but are not considered “real food” such as candy, chips and queso, and oreos. A discusses this theme best as she says, “Is candy food? I mean you eat it right? Not like playdough is eatable but like you’re supposed to eat it” (A 2021, 28:37). Under the messaging we received in our health classes in school, we were taught about “empty calories”, or things you consume that don’t provide any necessary vitamins or nutrients required for a functioning body (Mudambi 2021). McLennan argues that this strategy of moralizing foods as valuable or lacking in value is a relic of colonization, “reinforced the strong links between food, eating, and western moral values. As nutritional science has advanced, advice has changed but the deeper values have remained” (McLennan 2020, 261). M echos this evaluation of colonial epistemologies of food,
“There is nothing inherently bad about a cookie. But gym bro and cheat day shit create these morals for food that have nothing to do with the food but with the people choosing to eat the food” (M 2021 34:19).
The lasting effects of the moral values we were taught to place on foods that do not efficiently deliver nutrients can be seen in the health & beauty industry and diet/exercise culture marketed pointedly at young adults. Even in individuals who say they rejected the messages of health class, like G, the effects of those moral values are still visible: “I eat because I need to. I wish I liked it more. I DO like chips and queso, those aren’t real food though” (G 2021 11:28).
Another theme present in many of the interviews was the prevalence of healthism and hegemonic nutrition. Healthism is an epistemology that suggests that health is the responsibility of the individual and ill health or disease is the result of an issue with the individual’s care for themself rather than genetics, social health determinants, or anything else (Kimura et al 2014). Kimura argues that healthism encourages individuals to “… engage[s] in self surveillance to keep his or her behavior in line with a qualified ideal” (Kimura et al 2014, 38). We can see this in A’s guilt over lack of gym workouts during the pandemic, “If I don’t work out all the time I feel like I have to think hard about what I eat … in high school we worked out daily but now I feel like I’m slipping if I don’t” (A 2021, 16:49). Kimura defines hegemonic nutrition as three assumptions: “the food-body relationship can be standardized, …nourishment is universally equivalent, … and can be decontextualized from social determinants of health”(Kimura et al 2014, 39).
An example from hegemonic nutrition in my interviews would be my discussion with G about the differences in health classes for high school athletes and other students at our shared high school. G says, “health class for us [athletes] was different cuz it was all eat to fuel a game or exercise not like to literally stay alive and shit”(G 2021, 26:54).
Food was framed as a task of consumption, meant for a particular purpose rather than something necessary to live, completely removing any emotional or enjoyment connection to food.
M also mentions an example fitting the first assumption of hegemonic nutrition, “they told us about endo and ecto morphs and stuff which didn’t make sense to me because not everybody fits into like four body types” (M 2021, 13:42).
In our shared experiences of health classes in Indiana public schools, several shared visuals came to light: the food pyramid, myplate.gov, got milk? Posters, and presentations of body types in a style that can only be described as corporate clip-art. It was clear from each of my interviewees that they eventually began to ignore these visuals as they failed to complement their realities.
C described who she listened to instead of her health classes in school, “My mom just taught us to eat a variety of food to make sure you get the stuff you need. I completely ignored health class”(C 2021 31:17). M described how not only the visuals failed to meet her reality but the expectations for body development and BMI also failed to include bodies like hers, “Being shamed at 12 as a 5’3” little girl by a grown man for my ‘bigger woman/womanly thighs’ still hurts now, singled out as fat and middle schoolers are so mean” (M 2021, 53:18).
Cuj et al. reported similar reactions to government recommendations that did not match the reality of people’s lives in Guatemala (Cuj et al 2020, 13).In solutions to this dissonance between reality and government/curriculum recommendations, Cuj and authors suggest “… recognizing the cultural frames that shape health policy, policy makers might design policies that better align with people’s lives” (Cuj et al 2020, 13). C, likewise, suggested that instead of failing to meet the suggested requirements under the my plate program she “I started bringing my lunch because the food they [the school] had wasn’t doing it for me” (C 2021, 22:13).
When interviewing M, I was reminded of the Geronimus &Thompson article on developmentalism and economism, and American Creed ideologies. She suggested that the impacts of these ideologies are seen best in the health & beauty and diet industries as well as what she calls “gym bro culture”. The best quote from our discussion that best encapsulates her feelings on these industries is: “Why is it the fault of a 50 year old for not being able to do a diet built for 20 year olds and not a failure of the product by the diet company?” (M 62:59).
Questions like the one M poses here help prompt reconsideration of the ideologies which are behind the structures which impact our daily lives (Geronimus & Thompson 2004, 253). In the interviews with M and A, discussions on how health classes impacted them as women in particular which reminded me of Counihan’s chapter on food, culture, and gender (Counihan 1999). Counihan argues that “race, class, and gender distinctions are manifested through rules about eating and the ability to impose rules on others” (Counihan 1999, 9). G mentions an example of one of these imposed rules Counihan mentions, “I don’t know why. They just told us you shouldn’t cuz it [drinking calories] is bad” (G 2021, 18:02). Again, we can see moralization of food come into play in what is and is not correct consumption. Fischler argues that “food is central to our sense of self identity” (Fischler 275).
If we characterize foods as good and bad, then how does that reflect what we see in ourselves?
Those who cannot or don’t want to consume in accordance with the rules we’ve been taught, under the moralism of food and health, would be considered failures. If you do not have access to the food you need to comply with the rules of moralization, how can you succeed? What does that do to children who are told repeatedly that they have failed to properly take care of themselves, taking on the shame and blame from noncompliance. After years of that shame, surely the mental health of those children would be impacted. Jamal argues that changing the school environment and curriculum can impact the mental health of the students. So if we changed the rules and how we place responsibility, can we do less harm to our children's mental health?
Social determinants of health are outside factors that impact an individual or a group’s health (Levin & Browner 2005, 747).. These can range from racism to access to a refrigerator. In my interview with A, she recounted the effects health and gym class discussions of BMI could have had on her mental health:“I missed BMI day THANK FUCK or I’d be really sad” (A 2021 42:16). She then went on to make clear that numerous social determinants went into her conceptualization of a healthy body and if BMI was added onto that, at an adolescent age, it would have hurt her substantially. C suggested in her interview that given her circumstances at home,
“honestly, if I tried to follow those rules and eat those lunches, I’d be set up to fail”( C 2021 56:09).
M also experienced strong influences from her public education as a factor in how she achieved health in a college context. She brought to light the stress and odd role college students experience in burgeoning adulthood, to be defined as successful and adult like, students must comply with outside expectations for health and consumption. M sums up these outside expectations as: “I think college cultivates this starving artist mentality and encourages early stages ED [disordered eating] habits” (M 2021 67:03). If students struggle with disordered eating or food security issues, Henry’s study of college students in 2017 suggests that it may be more difficult to attain help. Unfortunately, college kids face greater rates of food insecurity and of shame/ stigma around food insecurity than the national average. Along the lines of M’s thoughts, Henry finds that struggle and discontent were normalized as part of figuring out how to successfully obtain food and asking for help was considered to be a sign of surrender or failure (Henry 2017).
The things we learned in school were healthism, moralization of food and health, hegemonic nutrition, and feelings of personal failings. Although I can’t say exactly how responsible these ideologies were for the mental health issues each of my interviewees face, I can say that the blame and shame based system does not lend itself to positive impacts on mental health. Hearing from women who went through the same classes I did, having them bring up the experiences that were important to them really helped highlight shared themes. Most of my interviewees were happy to discuss the topic but struggled to articulate how the memories made them feel and impacted them long term. The interviews I conducted helped me pull at the common threads of each of our experiences and discuss these commonalities to isolate the themes focused on here. I asked each interviewee to draw something as a follow up to the interview, a visual representation of their idea of health. From these drawings, it is clear that despite experiencing similar curriculums and teachings, each individual has a particularly unique understanding of health.
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