Monitoring the ‘diabetes epidemic’: A framing analysis of United Kingdom print news 1993-2013

Autoři: Kristen Foley aff001;  Darlene McNaughton aff001;  Paul Ward aff001
Působiště autorů: Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225794



The view that we are in the midst of a global diabetes epidemic has gained considerable ground in recent years and is often linked to the prior ‘obesity epidemic’. This research explored how the diabetes epidemic was represented in United Kingdom (UK) news over the same time period that the obesity epidemic was widely reported. The research was motivated by a sociological interest in how postmodern ‘epidemics’ synergise with each other amidst broader political, economic, moral and sociocultural discourses.


We analysed three time-bound samples of UK news articles about diabetes: 1993 (n = 19), 2001 (n = 119) and 2013 (n = 324). Until now, UK media has had the least attention regarding portrayal of diabetes. We adopted an empathically neutral approach and used a dual method approach of inductive thematic analysis and deductive framing analysis. The two methods were triangulated to produce the findings.


Framing of diabetes moved from medical in 1993 to behavioural in 2001, then societal in 2013. By 2001 obesity was conceptualised as causal to diabetes, rather than a risk factor. Between 2001 and 2013 portrayals of the modifiable risk factors for diabetes (i.e. diet, exercise and weight) became increasingly technical. Other risk factors like age, family history and genetics faded during 2001 and 2013, while race, ethnicity and culture were positioned as states of ‘high risk’ for diabetes. The notion of an ‘epidemic’ of diabetes ‘powered up’ these concerns from an individual problem to a societal threat in the context of obesity as a well-known health risk.

Discussion and conclusion

Portraying diabetes and the diabetes epidemic as anticipated consequences of obesity enlivens the heightened awareness to future risks in everyday life brought about during the obesity epidemic. The freeform adoption of the ‘epidemic’ term in contemporary health discourse appears to foster individual and societal dependence on biomedicine, giving it political, economic and divisive utility.

Klíčová slova:

Diabetes mellitus – Ethnic epidemiology – Childhood obesity – Medical risk factors – Obesity – Political aspects of health – Public and occupational health – Type 2 diabetes


1. McNaughton D. "Diabesity’ down under: overweight and obesity as cultural signifiers for type 2 diabetes mellitus. Critical Public Health. 2013;23(3):274–88. doi: 10.1080/09581596.2013.766671 23914074

2. Crawford R. A Cultural Account of ‘Health’: Control, Release, and the Social Body. In: Beattie A, Gott M, Jones L, Sidell M, editors. Health and Wellbeing: Macmillan Education UK; 1993. p. 133–43.

3. Crawford R. Health as a meaningful social practice. Health (London, England: 1997). 2006;10(4):401–20. Epub 2006/09/16. doi: 10.1177/1363459306067310 16973678.

4. O'Hara L, Gregg J. Human Rights Casualties from the “War on Obesity”: Why Focusing on Body Weight Is Inconsistent with a Human Rights Approach to Health. Fat Studies. 2012;1(1):32–46. doi: 10.1080/21604851.2012.627790

5. Lupton D. Risk as moral danger: the social and political functions of risk discourse in public health. International journal of health services: planning, administration, evaluation. 1993;23(3):425–35. Epub 1993/01/01. doi: 10.2190/16ay-e2gc-dfld-51x2 8375947.

6. Crawford R. Healthism and the medicalization of everyday life. International Journal of Health Services: Planning, Administration, Evaluation. 1980;10(3):365–88.

7. Bell K, Salmon A, McNaughton D. Alcohol, tobacco, obesity and the new public health. Critical Public Health. 2011;21(1):1–8. doi: 10.1080/09581596.2010.530642

8. Brandt AM, Rozin P. Morality and Health: Psychology Press; 1997 1997. 430 p.

9. Raisborough J. Fat Gets Melodramatic: The Obesity Epidemic and the News. Fat Bodies, Health and the Media: Palgrave Macmillan UK; 2016. p. 51–76.

10. Gard M, Wright J. The Obesity Epidemic: Science, Morality and Ideology: Routledge; 2005 2005/04/28/. 227 p.

11. Boero N. Obesity in the media: social science weighs in. Critical Public Health. 2013;23(3):371–80. doi: 10.1080/09581596.2013.783686

12. Campos PF. The obesity myth: Why America's obsession with weight is hazardous to your health: Penguin; 2004 2004.

13. Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol. 2006;35(1):55–60. doi: 10.1093/ije/dyi254 16339599

14. Lupton D. Risk as moral danger: the social and political functions of risk discourse in public health. International Journal of Health Services: Planning, Administration, Evaluation. 1993;23(3):425–35.

15. Boero N. Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic”. Reprint edition ed: Rutgers University Press; 2013 2013/08/12/. 192 p.

16. McCarthy. The rise and rise of diabetes in Australia 1996: a review of statistics, trends and costs / Daniel J McCarty … [et al.].—Version details. Trove. 1996.

17. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011;40(3):804–18. doi: 10.1093/ije/dyr029 21335614

18. Espelt A, Borrell C, Roskam AJ, Rodríguez-Sanz M, Stirbu I, Dalmau-Bueno A, et al. Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia. 2008;51(11):1971–9. doi: 10.1007/s00125-008-1146-1 18779946

19. Sacerdote C, Ricceri F, Rolandsson O, Baldi I, Chirlaque M-D, Feskens E, et al. Lower educational level is a predictor of incident type 2 diabetes in European countries: the EPIC-InterAct study. Int J Epidemiol. 2012;41(4):1162–73. doi: 10.1093/ije/dys091 22736421

20. Das A. How does race get "under the skin"?: inflammation, weathering, and metabolic problems in late life. Soc Sci Med. 2013;77:75–83. doi: 10.1016/j.socscimed.2012.11.007 23201190

21. Gustafsson PE, Hammarström A. Socioeconomic disadvantage in adolescent women and metabolic syndrome in mid-adulthood: an examination of pathways of embodiment in the Northern Swedish Cohort. Soc Sci Med. 2012;74(10):1630–8. doi: 10.1016/j.socscimed.2012.01.044 22464906

22. O'Neill S, O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015;16(1):1–12. doi: 10.1111/obr.12229 25407540

23. Smalls BL, Gregory CM, Zoller JS, Egede LE. Conceptualizing the Effect of Community and Neighborhood Factors on Type 2 Diabetes Health Outcomes. Environment and Behavior. 2016:0013916516652440. doi: 10.1177/0013916516652440

24. Doria A, Patti M-E, Kahn CR. The emerging genetic architecture of type 2 diabetes. Cell Metab. 2008;8(3):186–200. doi: 10.1016/j.cmet.2008.08.006 18762020

25. Kelly SJ, Ismail M. Stress and Type 2 Diabetes: A Review of How Stress Contributes to the Development of Type 2 Diabetes. Annual Review of Public Health. 2015;36(1):441–62. doi: 10.1146/annurev-publhealth-031914-122921 25581145

26. Ling C, Groop L. Epigenetics: A Molecular Link Between Environmental Factors and Type 2 Diabetes. Diabetes. 2009;58(12):2718–25. doi: 10.2337/db09-1003 19940235

27. Brunetti A, Chiefari E, Foti D. Recent advances in the molecular genetics of type 2 diabetes mellitus. World Journal of Diabetes. 2014;5(2):128–40. doi: 10.4239/wjd.v5.i2.128 24748926

28. Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World Journal of Diabetes. 2015;6(6):850–67. doi: 10.4239/wjd.v6.i6.850 26131326

29. Gollust SE, Lantz PM. Communicating population health: print news media coverage of type 2 diabetes. Soc Sci Med. 2009;69(7):1091–8. doi: 10.1016/j.socscimed.2009.07.009 19666208

30. Rock M. Diabetes portrayals in North American print media: a qualitative and quantitative analysis. Journal of Public Health. 2005;95(10):1832–8.

31. Hellyer NE, Haddock-Fraser J. Reporting diet-related health issues through newspapers: portrayal of cardiovascular disease and Type 2 diabetes. Health Educ Res. 2011;26(1):13–25. doi: 10.1093/her/cyq059 20965912

32. McNaughton D. “Diabesity” and the stigmatizing of lifestyle in Australia. Reconstructing Obesity: The Meaning of Measures and the Measure of Meanings: Berghahn Books.

33. McNaughton D, Smith C. Diabesity (Dieobesity?) or the ‘twin epidemics’: Reflections on the iatrogenic consequences of stigmatising lifestyle to reduce the incidence of diabetes mellitus in Canada. Obesity in Canada: Critical Perspectives: University of Toronto Press; 2016.

34. Stefanik-Sidener K. Nature, Nurture, or That Fast Food Hamburger: Media Framing of Diabetes in the New York Times from 2000 to 2010. Health Communication. 2013;28(4):351–8. doi: 10.1080/10410236.2012.688187 22746222

35. Monaghan LF, Bombak AE, Rich E. Obesity, neoliberalism and epidemic psychology: critical commentary and alternative approaches to public health. 2017.

36. Ulijaszek SJ, McLennan AK. Framing obesity in UK policy from the Blair years, 1997–2015: the persistence of individualistic approaches despite overwhelming evidence of societal and economic factors, and the need for collective responsibility. Obesity Reviews. 2016;17(5):397–411. doi: 10.1111/obr.12386 27058997

37. Monaghan LF, Colls R, Evans B. Obesity discourse and fat politics: research, critique and interventions. Critical Public Health. 2013;23(3):249–62. doi: 10.1080/09581596.2013.814312

38. WHO | Obesity: preventing and managing the global epidemic. WHO. 1998.

39. UK D. Diabetes Care in Scotland 2015.

40. Briggs CL, Hallin DC. Making Health Public: Routledge; 2016 2016/05/20/. -1 p.

41. Entman RM. Cascading Activation: Contesting the White House's Frame After 9/11. Political Communication. 2003;20(4):415–32. doi: 10.1080/10584600390244176

42. Clarke AE, Shim JK, Mamo L, Fosket JR, Fishman JR. Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine. American Sociological Review. 2003;68(2):161–94. doi: 10.2307/1519765

43. Klos LA, Greenleaf C, Paly N, Kessler MM, Shoemaker CG, Suchla EA. Losing Weight on Reality TV: A Content Analysis of the Weight Loss Behaviors and Practices Portrayed on The Biggest Loser. Journal of Health Communication. 2015;20(6):639–46. doi: 10.1080/10810730.2014.965371 25909247

44. Henderson J, Wilson A, Meyer SB, Coveney J, Calnan M, McCullum D, et al. The role of the media in construction and presentation of food risks. Health, Risk & Society. 2014;16(7–8):615–30.

45. Couldry N. Theorising media as practice. Social Semiotics. 2004;14(2):115–32. doi: 10.1080/1035033042000238295

46. albionmill.

47. Advertising in newspapers and newsbrands—Newsworks.

48. Executives | News UK.

49. History of the Guardian. The Guardian. 2002 2002/06/06/;Sect. GNM archive.

50. The Associated Press. Associated Press.

51. Smith C, McNaughton DA, Meyer S. Client perceptions of group education in the management of type 2 diabetes mellitus in South Australia. Aust J Prim Health. 2015. doi: 10.1071/PY15008 26351268

52. Rock M. Diabetes Portrayals in North American Print Media: A Qualitative and Quantitative Analysis. Am J Public Health. 2005;95(10):1832–8. doi: 10.2105/AJPH.2004.049866 16131643

53. Patton M. Qualitative Research & Evaluation Methods: SAGE; 2002.

54. Alhojailan MI. Thematic Analysis: A critical review of its process and evaluation. West East Journal of Social Sciences. 2012;1(1):39–47.

55. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa

56. Gamson WA, Modigliani A. Media Discourse and Public Opinion on Nuclear Power: A Constructionist Approach. American Journal of Sociology. 1989;95(1):1–37.

57. Matthes J, Kohring M. The Content Analysis of Media Frames: Toward Improving Reliability and Validity. Journal of Communication. 2008;58(2):258–79. doi: 10.1111/j.1460-2466.2008.00384.x

58. Entman RM. Framing: Toward Clarification of a Fractured Paradigm. Journal of Communication. 1993;43(4):51–8. doi: 10.1111/j.1460-2466.1993.tb01304.x

59. Foley K, Ward P, McNaughton D. Innovating Qualitative Framing Analysis for Purposes of Media Analysis Within Public Health Inquiry:. 2019.

60. Ezzy D. Qualitative Analysis2002.

61. Carter R, Hancock J. GROWING YOUNGER; YOU DONT'T HAVE TO BE OLD BEFORE YOUR TIME. Daily Mail (London). 1993 1993/01/18/Monday.

62. Macnair P. LIVING OFF THE FAT OF THE LAND. The Guardian. 1993 1993/04/12/.

63. Kent A. Stay shapely, stay healthy. The Times. 1993 1993/02/23/.

64. O'Shea S. Dieters' dream pill; 'CURE' FOR DIABETES COULD LET THEM EAT CAKE AND STAY SLIM, SAY SCIENTISTS. Daily Mail (London). 1993 1993/08/09/Monday.

65. Vines G. IS SUGAR THE NEW FAT; All the low-fat foods in the supermarket won't save you from heart disease, because there's something you have overlooked: Syndrome X. One in three of us has it. So could it be you. DAILY MAIL (London). 2001 2001/09/10/.

66. Briffa J. DIABETES How you can protect your family from an epidemic. DAILY MAIL (London). 2001 2001/07/31/.

67. Stuttaford T. How to stop diet cheats—Medical briefing. The Times. 2001 2001/06/07/.

68. Dowden A. Are the celebrity TV chefs killing us with FAT? Daily Mail. 2001 2001/07/17/.

69. Hope J, Chapman J. NHS is warned over soaring diabetes bill; Growing number of victims 'could swallow one fifth of health budget'. Daily Mail. 2001 2001/06/11/.

70. Ingram M. A fat lot of harm—Lifestyle. The Times. 2001 2001/04/05/.

71. Collins J. O—Children's health. The Times. 2001 2001/03/13/.


73. Meikle J. Late diabetes diagnosis `killing thousands early'. The Guardian. 2001 2001/06/11/.

74. Stuttaford T. Why Vaz is at risk—Medical briefing. The Times. 2001 2001/04/05/.

75. Clements R. 20 life saving questions to ask your parents; good helth report. Daily Mail. 2001 2001/11/20/.

76. Estridge B. WILL YOU BE FAT AT FIFTY? Daily Mail. 2001 2001/05/01/.

77. Hope J. How to beat diabetes; Walking 30 minutes a day can slash your risk of developing the disease. DAILY MAIL (London). 2001 2001/08/09/.

78. Stephens A. Childhood time bombs; Good Health: Prevention: How what you do now can give your child health problems later. DAILY MAIL (London). 2001 2001/11/13/.

79. Collins J. New year health resolutions—Health. The Times. 2001 2001/01/02/.

80. Hope J. NOW 1 IN 20 OF US HAS DIABETES. Daily Mail. 2013 2013/03/04/.

81. Thomson A. Taxes will rise if we REJECT the nanny state; We may resent encouragements to stop smoking and improve our health but we all benefit in the end. The Times. 2013 2013/12/11/.

82. Campbell D, Malik S. Front: 'The fat man of Europe': Britain's doctors say obesity crisis becoming 'unresolvable': Report calls for 20% tax on fizzy drinks and takeaway curb: Over half of all adults will be seriously overweight by 2050. The Guardian. 2013 2013/02/18/.

83. Campbell D. Sugar blamed for global surge in type 2 diabetes cases. The Guardian (London)—Final Edition. 2013 2013/02/28/.

84. Boycott R. WE'RE ALL SUGAR JUNKIES NOW! MAIL ON SUNDAY (London). 2013 2013/09/15/.

85. Drainey N. Scotland 'in the grip of diabetes epidemic'; As many as 350,000 could have disease by 2025 Diabetes epidemic in Scotland. The Times. 2013 2013/06/25/.

86. Barrow M. Simple checks that could save the NHS billions and 7,000 diabetics their feet. The Times. 2013 2013/01/26/.

87. McMahon B. The power foods for your brain: what to eat at every age; Do you walk into rooms and forget why? Are you always losing your car keys? Changing your diet will improve your brain function, says Dr Neal Barnard. He explains why to Barbara McMahon. The Times. 2013 2013/08/24/.


89. Whipple T. The districts where 1 in 10 has diabetes. The Times (London). 2013 2013/09/30/.

90. Smyth C. Fast-food generation is stumbling into sickly era, health expert says. The Times (London). 2013 2013/07/03/Wednesday.

91. Men's exercise needs vary with ethnicity, study finds. The Times (London). 2013 2013/12/12/Thursday.

92. Crane H. Society: Public Services Awards: Joint working keeps community hubs open: Financial excellence winner: Ealing, Harrow and Brent borough councils: Helen Crane reports how three councils have pooled their resources to win better contracts. The Guardian (London)—Final Edition. 2013 2013/11/13/.

93. Nicholas S. RISE OF THE IRON LADIES. The Mail on Sunday. 2013 2013/10/20/.

94. Borland S. AREAS WHERE ONE IN TEN SUFFER DIABETES. Daily Mail. 2013 2013/09/30/.

95. IGNORANCE OF DIABETES 'A DISASTER IN WAITING'. Daily Mail. 2013 2013/09/23/.

96. Smyth C. Walking for two and a half hours a week is 'wonder drug' that could save 37,000 lives DAVID LEES / GETTY; Chris Smyth Health Correspondent. The Times (London). 2013 2013/10/07/.

97. Hope J. STROKES IN UNDER 64S SOAR BY 25% IN 20 YEARS. Daily Mail. 2013 2013/10/24/.

98. Simpson J. Health crisis 'is looming' for 2030. The Times. 2013 2013/08/21/.

99. Patterson C. Comment: Bad habits that kill: Where parents refuse to take responsibility for a child's diet and exercise, schools need to step in. The Guardian (London)—Final Edition. 2013 2013/08/28/.

100. Cavendish C. Fat and sugar are just as deadly as cigarettes; Britain is second only to America for obesity. Relying on education alone has failed—now we must ban trans fats. The Times (London). 2013 2013/01/03/Thursday.

101. Charter D. Men in South live 10 years longer than Glaswegians. The Times. 2001 2001/02/23/.

102. Lawrence F. Comment & Debate: What's so special about a 'special offer' burger?: You think you are getting a bargain—the same food, but cheaper. But cut-price deals are not what they seem. The Guardian. 2013 2013/01/25/.

103. Hodgetts D, Chamberlain K, Scammell M, Karapu R, Nikora LW. Constructing health news: possibilities for a civic-oriented journalism. Health:. 2008;12(1):43–66. doi: 10.1177/1363459307083697 18073246


105. Hacking I. Making Up People.

106. Colls R, Evans B. Making space for fat bodies?: A critical account of ‘the obesogenic environment’. Progress in human geography. 2014;38(6):733–53.

107. Coveney J. The government of girth. Health Sociology Review. 2008;17(2):199–213. doi: 10.5172/hesr.451.17.2.199

108. Armstrong D. Chronic illness: a revisionist account. Sociology of health & illness. 2014;36(1):15–27.

109. Petersen A. Governmentality, Critical Scholarship, and the Medical Humanities. Journal of Medical Humanities. 24(3–4):187–201. doi: 10.1023/A:1026002202396

110. Fee M. Racializing narratives: obesity, diabetes and the "Aboriginal" thrifty genotype. Soc Sci Med. 2006;62(12):2988–97. doi: 10.1016/j.socscimed.2005.11.062 16426714

111. Knight C. "Most people are simply not designed to eat pasta": evolutionary explanations for obesity in the low-carbohydrate diet movement. Public Underst Sci. 2011;20(5):706–19. doi: 10.1177/0963662510391733 22164708

112. Keval H. Risky cultures to risky genes: The racialised discursive construction of south Asian genetic diabetes risk. New Genetics and Society. 2015;34(3):274–93. doi: 10.1080/14636778.2015.1036155

113. Tillin T, Sattar N, Godsland IF, Hughes AD, Chaturvedi N, Forouhi NG. Ethnicity-specific obesity cut-points in the development of Type 2 diabetes—a prospective study including three ethnic groups in the United Kingdom. Diabetic Medicine. 2015;32(2):226–34. doi: 10.1111/dme.12576 25186015

114. Armstrong D. Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century. Cambridge Cambridgeshire; New York: Cambridge University Press; 1983 1983/03/31/. 160 p.

115. Armstrong D. The rise of surveillance medicine. Sociology of Health & Illness. 1995;17(3):393–404. doi: 10.1111/1467-9566.ep10933329

116. Bell K, Salmon A, McNaughton D. Alcohol, Tobacco and Obesity: Morality, mortality and the new public health: Routledge; 2012 2012/03/29/. 234 p.

117. epidemic—definition of epidemic in English | Oxford Dictionaries. Oxford Dictionaries | English.

118. Bell K, McNaughton D, Salmon A. Medicine, morality and mothering: public health discourses on foetal alcohol exposure, smoking around children and childhood overnutrition. Critical Public Health. 2009;19(2):155–70. doi: 10.1080/09581590802385664

119. Cohen S. Folk devils and moral panics. London: Routledge; 1972 1972.

120. Cohen S. Folk Devils and Moral Panics: The Creation of the Mods and Rockers: Psychology Press; 2002 2002. 276 p.

121. McNaughton D. From the womb to the tomb: obesity and maternal responsibility. Critical Public Health. 2011;21(2):179–90. doi: 10.1080/09581596.2010.523680

122. Keval H. Constructing the Risk: Faulty Lifestyles, Faulty Genes. Health, Ethnicity and Diabetes: Palgrave Macmillan UK; 2016. p. 61–86.

123. Aphramor L, Gingras J. Helping People Change: Promoting Politicised Practice in the Health Care Professions. In: Rich E, Monaghan LF, Aphramor L, editors. Debating Obesity: Palgrave Macmillan UK; 2011. p. 192–218.

124. Gard M. The End of the Obesity Epidemic: Routledge; 2010 2010/11/05/. 206 p.

125. LeBesco K. Neoliberalism, public health, and the moral perils of fatness. Critical Public Health. 2011;21(2):153–64. doi: 10.1080/09581596.2010.529422

126. Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res. 1998;8(3):341–51. Epub 1999/11/11. doi: 10.1177/104973239800800305 10558335.

127. Finerman R, Bennett LA. Overview: Guilt, blame and shame in sickness. Social Science & Medicine. 1995;40(1):1–3. doi: 10.1016/0277-9536(94)00121-9

128. Coreil J, Levin JS. A Critique of the Life Style Concept in Public Health Education. International Quarterly of Community Health Education. 1984;5(2):103–14. doi: 10.2190/FYTG-A92T-4P5X-U9XW 20841133

Článek vyšel v časopise


2020 Číslo 1