In this article, it is aimed to overcome the sociological studies carried out in harmony with the bio-medical model, which is now abandoned in medicine. It is aimed to answer three questions as sub-problems for the main problem of the inadequacy of studies on the body, which is mostly based on naturalistic positivistic sociological quantitative research: a) Can "relational sociology" be the theoretical basis for a more adequate body sociology? b) To what extent is a grounded theory methodology suitable for data collection and analysis in relational sociological work? c) What kind of differences and contributions can be made in body and health sociology studies by applying relational sociology and grounded theory methodology together? In the research, coding was done in accordance with the grounded theory method. Delphi technique was also used in the study. The main feature of the research is the simultaneous data collection and analysis. It has been understood that two similar concepts as “cüsse"(size) and “kalıp” (form) in the dominant traditional Anatolian folk culture in Turkey are used instead of body. Contrary to classical sociology based on duality and essentialism, it has been revealed that the word "şişman" (fat), as a more ambiguous concept, is used instead of obese because of its liminal feature, which includes both health and disease. It has been understood that the word "şişmanlık “(fatness) in Turkish is preferred for obesity. As a result, it has been shown that two words from Anatolian folk culture are used in a reframed way instead of obese and obesity, which are the disease signs of modern medicine. In addition, the distinction between "balık etli” (fish/ full figured) for women and "tosun” (bullock) for men is another interesting and important finding of the study.
Keywords: Grounded Theory Methodology; Obesity; Relational sociology; Sociology of body
Most sociologists working on the body accept that the body is affected by the societal forces in terms of both causes and results . However, in our opinion, it is inevitable to criticize this one-sided social determination from a relational sociological perspective. This determination has not been one-sided, both in the long evolutionary process and in the life time of individual people. Because, reflexively, there is a process in which causes and effects affect each other in a circular manner. As a matter of fact, Antony Giddens and his Reflexive Sociology also accept that structure and agent are in mutual interaction. Self-reflexvity is also used to describe the relationship between the agent and the structure as living and reacting entity.
The sociological study of the body is historically not very old and begins in the 1980s. Therefore, Shilling [2,3] defines sociology's interest in the body as "absent presence", inspired by Derrida. However, according to Netteleton , sociologists become more interested in the body due to many reasons, especially women's initiatives. Undoubtedly, technological innovations, the use of artificial intelligence in health, the increase in life expectancy all over the world and the phenomenon of aging attract sociologists to the body phenomenon .
In addition, ethical issues, the role of pandemics that transcend the borders of the country such as AIDS/HIV and Covid-19 cannot be denied. Multi-layered inequalities that have increased especially during the Covid-19 Pandemic process have drawn the attention of law, economics and political scientists in Turkey . The effects of the pandemic were also discussed from a geographical and feminist perspective. In particular, the legal regulations brought under the pandemic conditions and their effects on social life have been evaluated .
On the other hand, it is impossible not to mention the classical approaches on the body as well as the phenomenological studies that try to build bridges between them. Two well-known classical approaches are Naturalistic and Humanistic sociology. While naturalistic sociology reduces the body to biology, humanists see the body as a human-centred construction. Historically, the first emerging naturalist approach, in addition to being in harmony with the bio-medical body that is abandoned today, accepted the male body as the norm and justified inequalities between men and women. Even in the 18th century, the famous biologist Geddes defined women as anabolic and was marginalized by being seen as less and inadequate than the catabolic men .
It was only with the work of George Engel in the 1970s that a new model, a bio-psychosocial model, inevitably replaced the unchanging, fixed body approach, which reduced human and society to biology . This model is now more preferred because it is patient-centred rather than disease and physician, as well as having a holistic understanding. In fact, under the general umbrella of sociological social constructionism, it is possible to talk about different views, especially discourse, social context and social body . The discourse approach claims that the disease is caused by the effect of doctors' discourse . Others argue that the body has a material basis shaped by social practices and social context . On the other hand, Mary Douglas , points out that the perception of the physical body is realized through the social body. It can be said that she was influenced by the Durkheimian tradition here. Because Durkheim defines sacred and profane and claims that there are discriminations in societies on the basis of these dualities. In other words, the division of societies is tried to be explained by Durkheim by making the dirty-clean, healthy-patient duality .
The phenomenological view, which is claimed to build a bridge between naturalistic/positivistic and humanist interactionist sociological approaches, does not seem likely to be accepted because it is essentialist. In fact, the phenomenologist M. Ponty and his idea that all human perception is based on the body is quite impressive at first glance. However, the focus of phenomenology on what the essence of the social world is, by definition, is its biggest handicap. The French philosopher, in his work titled “Phenomenology of Perception” in 1962, argues that all our feelings and perceptions are realized through the body. His concept of embodiment is very important. According to him, all consciousness and perception of human beings are embedded in his/her body. Humans are embodied agents. Moreover, despite all his essentialism, it is admirable that he did not separate the body and the soul. While rejecting his essentialist views, it seems possible to adopt his anti-dualistic attitude towards the soul and body.
When we look at body studies , it is observed that sociologists have made normative and nonnormative body conceptualizations based on the normal-pathology distinction, primarily based on the Durkheimian tradition. Here, "fatness" and "body size" issues come to the fore . Aging and death studies have always attracted the attention of sociologists . Changing the appearance of bodies means getting rid of undesirable body parts. Becoming more attractive and attractive leads to widespread body modifications in both men and women .
Embodied sociology [2,17,18] has become quite popular in recent years. Here, movements such as the domination of the state to people through their bodies, bio-politics , bodies as labour in working life, various applications of medicine as an institution, the circulation of information about the body in general, and the current anti-vaccine movement attract the attention of sociologists.
Problem and objectives
In addition to many issues such as health inequalities, determinants of health, health professions and organizations, artificial intelligence and the transformation of health care, which are handled with different approaches in health sociology, body studies, which have gained importance in recent years, have reached the status / position of becoming an independent field under the title of body sociology. There is an increase in the size of the body and especially in obesity studies among the studies to be carried out in this field. However, studies are mostly carried out with main stream naturalist or phenomenological essentialist approaches and are insufficient or even incomplete. The problem of this study is that body sociology studies are inefficient, especially in empirical body sociology studies, due to the selection of theoretical and methodological approaches appropriately.
In this context, the following questions were tried to be answered in this study?
- a) Could the theoretical basis for a more adequate sociology of the body be relational sociology?
- b) Is grounded theory appropriate in collecting and analysing data in relational sociological study?
- c) What differences and contributions can be made to body and health studies by applying relational sociology and grounded theory methodology together?
Significance and limitations
This article will contribute to the relevant literature as such a study has not been done before. However, the findings cannot be generalized to other societies and cultures, as they are described only with qualitative data and concepts specific to the culture in which the research was conducted. Therefore, it is appropriate to develop research as cross-cultural and mixed design. In addition, within the limits of this short article, the consensuses are justified without including the indexical expressions of the interviewees.
This study may be useful for sociologists and medical staff working in the field of health and body. It is clear that it provides useful information in understanding the challenges and barriers, if any, arising from cultural values, especially in the development of health policies.
Revealing the epistemological harmony of relational sociology with grounded theory and providing data on societies and cultures from outside the West come first. The theoretical/rational foundations and empirical data on which it is epistemologically based are also innovative aspects of the study. It is also very unique that it is based on a qualitative research with a policy oriented feature.
This research was conducted as relational sociological , within the framework of the following basic principles [21-23].
- a) Rejecting dualities b) Rejecting essentialism and accepting ambiguities c) Dealing with time and space together d) Not making a macro and micro distinction e) Examining everyday life f) Process-based work g) Identifying turning points h) Being reflexive i) Problem-oriented pragmatism has been adopted in principle.
The findings section of the research was formed from the discussions made on the basis of these principles.
This study was tried to be carried out in accordance with the grounded theory methodology , included in the five basic traditions by Creswell . In this study, grounded theory methodology was chosen because it is suitable for the approach of relational sociology, which is based on process analysis and rejects essentialism .
First of all, after the open and axial coding, the core concept was tried to be reached [22,26]. In this process, Delphi technique was also applied and discussions were held with an expert group consisting of folklorists, anthropologists, lawyers, psychologists and many sociologists. It has been tried to interpret which concepts about the body are preferred in our culture and why . Then, existing concepts that have been "reframed"  for both body and obesity have been reported with metaphors from the traditional folk culture of Turkey with wise and expert people. With a holistic view, it has been accepted that health, disease and culture are in constant interaction .
Findings and Discussion
Rejection of dualities: As it is known, Aristotelian logic provides the basis for Cartesian dualities by assuming the law of identity, non-contradiction and the impossibility of the third option. According to this formal logic, a person is either healthy or sick. In terms of our subject, it is only appropriate to say that overweight people are sick within the framework of Aristotelian logic. However, thin people can be sick, and healthy people can be fat. Therefore, relational sociology rejects dualities that are developed within modernity, but purely for the purpose of "othering". In addition, the relational sociological view does not find it appropriate to treat overweight people as patients with formal logic.
Denial of essentialism: The rejection of dualities and the rejection of essentialism are interrelated. While the dualities are mutually exclusive, the rejection of essentialism also means finding ambiguities important. More precisely, most of the time, facts and features contain each other. We can have both mental and emotional, healthy and sick, good/beautiful and bad/ugly traits together. Here are conflicting feelings about the two desirable situations, ambivalence in psychology  and being on the threshold in sociology, namely liminality  are concepts that are used very commonly. In particular, uncertainties in values and social relations are the basis of relational sociology [32-34]. As a matter of fact, in Turkey, fatness is more valuable than thinness. Thin persons are criticized more.
Process-based analysis: In terms of our subject, people's diets and lifestyles are different from each other. Although there are genetic predispositions, the signs of discomfort in the body show themselves over time. Some may have faster or slower weight loss or gain than others. Starting from infancy, it is inevitable that different diets and lifestyles lead to changes in the body. Most people have a different capacity to gain and lose weight over time. While some people cannot get results from diets, others can regain their old form immediately. Therefore, changes in the body should be observed in the process. Being overweight or underweight may not always be permanent in the body, which is in an incomplete formation .
Changes in time and space: In process-based studies, it is necessary to examine changes together in both time and space, just as Elias , mentioned in the Civilization Process. While nutritional habits are more organic and natural in traditional rural areas, they are faster and unhealthy in cities. Our whole lifestyle can be different at home, at school, at work or while traveling. Therefore, instead of just the time-based analysis of the past and the present, we need to examine the space factor together. Likewise, in terms of our subject, the definition of thin or fat, healthy or diseased varies according to the culture. At least social interactionist sociologists support this view.
Turning points: While Michel Foucault explains that those who hold power over the body with bio-politics dominate by doing archaeology, he mostly describes the times when the discourse changed as a “break down point”. The relational sociologist Harrison White , (2008) focuses more on "turning points". According to him, identities try to control ambiguities. They look for safe environments for this, and the times they reach or lose it are now a turning point. In terms of our subject, if weight is gained after birth or a significant illness, these traumatic situations are a turning point. It may be necessary to struggle by identifying these turning points in the process, for example, to start the diet again.
Studying everyday life: There are sociologists who point to the importance of examining everyday life, notably Lefebre  and de Certeau [37,38]. Production and consumption activities that people do to make a living as well as to eat, drink, travel and have fun in daily life have priority over the political, military and administrative events of life. For example, a woman's kitchen work in Turkey is more than just an "montage” as the French say, it is an "embroidery work" (de Certeau). Having the economic resources necessary for the health, education and nutrition of children, as well as gastronomy, can often come before democracy or political rights for ordinary people. In this context, when the incomes are not enough for the healthy nutrition of the body, the price of the food comes to the fore, not the quality. For example, retired and low-income citizens who suffer from economic difficulties in street interviews are not interested in the general welfare indicators of the country in daily life. They complain more about the fire in their kitchen expenses, which is the most basic expense area in their daily lives. Regarding our subject, consuming more carbohydrates, especially bread, instead of a healthy protein-based diet, can cause the body to become heavier. Therefore, the examination of daily life is the most productive area in observing the health-disease and body relations.
Reflexivity: Being reflexive as a definition, it is used to explain that causes and effects affect each other in a circular way, against classical one-way determinism. In addition, the agent affects the structure not only as an individual, but also as a company, a family or a tribe. The structure is also transformed by being influenced by the agents [39,40]. Our subject here is women, men, the elderly, young people or workers and employers, as well as a technology producing company or a religious subculture reference group as much as gender or ethnicity can be influential on the structure. For example, women in Turkey can be seen as agents that will transform the structure. All over the world, the biggest reactions to the bio-medical model came from the women's movement. In addition, interpreting modernity by focusing on the female body is already a classic of Eurocentric thought. In fact, women's headscarves are semiotically considered the most important indicator of non-Westernism [41,42].
Pragmatism: Relational sociology and grounded theory both epistemologically accept pragmatism as the source of knowledge. This actually means working with a problem focus rather than a pejorative meaning like opportunism. Because it is necessary not only to do science for science, but also to focus on social problems and to find solutions. Since our subject is health and body, it is also important to be problem-oriented.
Leaving aside all dualities, especially structure-agent, and inspired by Bourdieu , with a holistic view, when we include traditional Anatolian culture in the analysis, the expression that helps us to understand and explain many things about the body is this: "One dirham covers a thousand shame". The succinct interpretation of this is that "being thin is not a skill; it is better to be overweight, and the weight we have can hide some of our flaws".
Obviously, being overweight is not a flaw in Turkey, except for urban youth and modern employers . Even in Turkey, there is the expression "to be in fish meat" among the people. This phrase is an emphasis on beauty. On the other hand, thin women or men are called "like skinny". Weakness is not a preferred condition. Weight is an indicator of prosperity and wealth, while being thin is an indicator of illness and poverty. In fact, it would not be wrong to say that the woman in Leonardo da Vinci's famous Monalisa painting is also full figured. However, in modern times, bodies that are under the control of the capitalist market with bio-politics are suggested to be thin in order to be fit. In fact, the Twiggy fashion that emerged in the 1960s became an epidemic, and the bodies were tortured to lose weight.
In this study, the most important conclusion reached from the data collected in accordance with the grounded theory, many steps of which are followed, is that the people most prefer the two concepts called "cüsse" and "kalıp" instead of body. For example, “Shame on your kalıp/form”; “to do or not to do what is necessary”; "what is my kalıp/ form" are frequently encountered expressions and the core concepts of this study emerged as “cüsse” and “kalıp”. On the other hand, it has been understood that people use the words “şişman” and “şismanlık” instead of obese and obesity as a foreign word as in all diseases universally.
As a result, it would not be wrong to say that a meaning that is often not seen as related to the disease is attributed to people over weight and that it describes a non-essentialist liminal situation. The important thing is that the relational sociological dichotomy of health and illness does not find much response when the body is studied in daily life. According to grounded theory, the researcher is usually expected to write a story at the end of the report. While trying to explain the liminal meaning of the fat body in Turkey, which includes both health and illness, the metaphor of “tosun" /bullock” for men, "with fish meat"/full figured for women, and even "fatness and sultanate", which is valid for both men and women, has been reached. Because in the Ottoman Empire, instead of king and quin, it was called sultan in a way that included both genders.
These metaphors, which are used for weak and frail people, like skeletons, ribs being counted, like an atlas of anatomy, like a live funeral, reflect the world of daily life of large masses of people. For this reason, it is vital that classical biomedical naturalist obesity studies, which ignore the structure-agent and culture interaction, immediately listen to what the relational sociological researches say.
Rejection of dualities/dichotomies
Rejection of normal-fat dichotomy
Rejection of Essentialism
Uncertainties and liminalities/ambivalence /unity of opposites
Eating, sleeping, working habits ,routine behaviours
Following important events, turning points / pregnancy, quitting smoking, alcohol
Time and space together
Home and work / yesterday/ today and tomorrow
Developing new concepts /re-framings
Finding metaphors from native culture
Circular cause-effect relationship /dieting and quitting
Problem oriented studies/ risk reduction/maintain of health
Table 1: Summary of Relational sociological analysis of embodiment.
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