Статті в журналах з теми "Facial comparison practitioners"

Confirming the identity of the accused is a critical component of many criminal trials. However, recent evidence suggests this process is highly error prone and leads to unacceptably high rates of wrongful conviction (Innocence Project, 2015). When photographic identification evidence is ambiguous, facial mapping practitioners may be called upon to make comparisons between images of the culprit and the accused. This practice assumes that the techniques employed are reliable and can be used to assist the court in making identity confirmation decisions. However, previous experimental work in this area has established that many of these techniques are unreliable (Kleinberg, Vanezis & Burton, 2007; Strathie, McNeill & White, 2012). We extend these findings by examining another facial mapping technique that uses gridlines, drawn between face-pairs, as a potential face matching aid (Oxlee, 2007). Results show that a simple side-by-side presentation of face-pairs without gridlines produces most accurate responding. Moreover, the application of the grideline technique increases the likelihood that two different face pairs will judged to be the same. These findings suggest that continuing to admit facial mapping evidence in court is likely to increase, rather than decrease, the incidence of wrongful conviction.

Objectives: The aim of this study was to examine the knowledge and attitudes towards orthodontic treatment among non-orthodontic specialists. Methods: A web-based survey was formulated for non-orthodontic dental specialists to respond to statements regarding an orthodontic treatment. It contained 20 multiple-choice questions with three or more possible answers. Two hundred and fifty questionnaires were sent via email, with explanatory letters, to randomly selected non-orthodontic Croatian dental specialists. Data were assessed using IBAM SPSS 23.0. and p < 0.01 was considered significant. Results: The results indicate that the majority of respondents were well informed about principles and practices in orthodontics. All the respondents (100%) were aware that malocclusions can affect a patient’s facial aesthetic and masticatory function. The results also showed statistically significant differences in answers about contraindications for orthodontics therapy among different non-orthodontic specialists (p < 0.01). Private health practitioners were better informed about the ideal time for the first orthodontic appointment (74.2%) and that implants and periodontal problems are not contraindications for orthodontic treatment (over 70%), in comparison with public health practitioners. Conclusion: Non-orthodontic specialists in this sample exhibit encouraging awareness and knowledge of the principals and practices of orthodontic treatment. Additional improving of practitioners’ knowledge and awareness can help patients with malocclusion to decide upon orthodontic treatment at earlier stages and avoid later complications in the future.

Aim:-To compare the opinion regarding usage of bisecting-angle technique and the paralleling techniques among BDS students, post graduate students, private practitioners in and around Bhimavaram town for intra oral imaging in dentistry. Materials and methods: A detailed questionnaire composed of questions regarding technical parameters, exposure parameters, operator and patient comfort and image accuracy in diagnosis. Details of the study were explained to the participants preferred option to be marked according to the question mentioned in the questionnaire. Total 500 individuals participated in the present study, with 100 individuals in each group. Data was collected and entered in Microsoft Excel (2010) and statistically analysed using SPSS 20. Chi-square test was used to evaluate differences in the responses with P-value ≤ 0.05 were considered significant. Results: Results showed that in technical parameters most of the people opted for bisecting angle technique with p value≤ 0.05 and found as significant. In aspect of exposure parameters, results are in favour of paralleling technique and p value is ≤ 0.05. In aspect of the operator and patient comfort there is an equal opinion most of them opted for bisecting angle technique and paralleling technique p value is significant. In aspect of image accuracy p value is significant for paralleling technique. Conclusion: Great work should have to be done to alleviate the quality of radiographs and the understanding and perspective of dental graduates regarding dental and maxillo-facial radiology. The results of present study revealed though there is knowledge about the techniques, but lack of application decreases their ability to get more accurate diagnostic radiograph. Paralleling technique being the most accurate in image accuracy should be emphasized to practice and needed to be modified in conditions where it is not feasible to deal with.

<p class="affiliations"><strong>Abstract— </strong>Computer visions and their applications have become important in contemporary life. Hence, researches on facial and object recognition have become increasingly important both from academicians and practitioners. Smart gadgets such as smartphones are nowadays capable of high processing power, memory capacity, along with high resolutions camera. Furthermore, the connectivity bandwidth and the speed of the interaction have significantly impacted the popularity of mobile object recognition applications. These developments in addition to computer vision’s algorithms advancement have transferred object’s recognitions from desktop environments to the mobile world. The aim of this paper to reveal the efficiency and accuracy of the existing open-source facial recognition algorithms in real-life settings. We use the following popular open-source algorithms for efficiency evaluations: Eigenfaces, Fisherfaces, Local Binary Pattern Histogram, the deep convolutional neural network algorithm, and OpenFace. The evaluations of the test cases indicate that among the compared facial recognition algorithms the OpenFace algorithm has the highest accuracy to identify faces. The findings of this study help the practitioner on their decision of the algorithm selections and the academician on how to improve the accuracy of the current algorithms even further.</p>

Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23 rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. The age ranged between 23 and 77 years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The protein levels in cerebrospinal fluid samples ranged between 40 and 193 mg/dl. None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.

Background: Guillain-Barre Syndrome (GBS) is a neurological autoimmune disease that can lead to respiratory failure and death. Whether COVID-19 patients are at high risk of GBS is unknown. Through a systematic review of case reports, we aimed to summarize the main features of patients with GBS and COVID-19. Methods: Without any restrictions, we searched MEDLINE, Embase, Global Health, Scopus, Web of Science and MedXriv (April 23rd, 2020). Two reviewers screened and studied titles, abstracts and reports. We extracted information to characterize sociodemographic variables, clinical presentation, laboratory results, treatments and outcomes. Results: Eight reports (n=12 patients) of GBS and COVID-19 were identified; one was a Miller Fisher case. Overall, the median age was 62.5 (interquartile range (IQR)=54.5-70.5) years, and there were more men (9/102). GBS symptoms started between 5 and 24 days after those of COVID-19. The median protein levels in cerebrospinal fluid samples was 101.5 mg/dl (IQR=51-145). None of the cerebrospinal fluid samples tested positive for COVID-19. Six patients debuted with ascendant weakness and three with facial weakness. Five patients had favourable evolution, four remained with relevant symptoms or required critical care and one died; the Miller Fisher case had successful resolution. Conclusions: GBS is emerging as a disease that may appear in COVID-19 patients. Although limited, preliminary evidence appears to suggest that GBS occurs after COVID-19 onset. Practitioners and investigators should have GBS in mind as they look after COVID-19 patients and conduct research on novel aspects of COVID-19. Comparison with GBS patients in the context of another viral outbreak (Zika), revealed similarities and differences that deserves further scrutiny and epidemiological studies.

Abstract Abstract 1537 Background: Iron deficiency anemia is the most common hematology problem encountered in clinical practice. Oral iron is first line therapy, however successful treatment of iron deficiency often involves the use of parenteral formulations of iron. Before the 1990s, the only available and approved parenteral iron formulation was iron dextran which had a rare but definite association with fatal anaphylactic reactions and was all but abandoned by many practitioners. Since the late 1990s the US Food and Drug Administration has approved 3 new and ‘safer’ iron formulations: iron sucrose, ferric gluconate and most recently ferumoxytol. Besides ferumoxytol, the other formulations are roughly equivalent in cost. Aim: To compare the adverse reaction rates associated with 3 formulations of parental iron (iron dextran, iron sucrose and ferric gluconate) currently in use at our center. Methods: We reviewed the medical records, nursing documentation and pharmacy records of patients who were treated with parenteral iron at our center over a 2 year period (April 2008 – March 2010). A likelihood ratio chi-square test for comparison was calculated using SAS 9.2 statistical software. Results: Between April 2008 and March 2010, 510 patients received intravenous iron at our institution and all 510 patients’ charts were reviewed. 59% (302) of patients received ferric gluconate; 23% (116) received iron dextran and 18% (92) received iron sucrose. The overall reaction rate with iron infusions was 2%; 1.3% with ferric gluconate, 1.7% with iron dextran and 4.4% with iron sucrose. Reactions included facial flushing, chest tightness/pain, circumoral paresthesia, arm redness and swelling (in the absence of infusion infiltration) and lightheadedness. No respiratory compromise or anaphylactic reactions occurred and there were no deaths. Using the likelihood ratio chi-square test, these rates were not statistically different (p = 0.25). Discussion: Based on this single center experience, intravenous iron therapy is safe; iron dextran being just as safe as ferric gluconate and iron sucrose. Though iron sucrose was the least frequently used formulation and had a proportionately higher rate of adverse reactions, the difference was not statistically significant. The use of iron dextran and iron sucrose allows for fewer clinic visits, is more convenient for the patient and results in lower total costs of therapy than ferric gluconate and we encourage their use for this reason. On the other hand, ferric gluconate was particularly well tolerated. Too few events occurred in this analysis to show a difference in the severity of reactions between the therapies. A larger study may show a cluster of more severe reactions to be associated with a specific iron formulation and would further influence decision-making of which iron formulations to use. In the immediate future, we will use our collated data to compare the effectiveness (success of iron repletion achieved) with each parenteral iron formulation to serve as an additional factor in the informed choice of treatment with a parenteral iron formulation. Disclosures: No relevant conflicts of interest to declare.

Aim: A pilot study was conducted with the aim of developing a system to protect the eyes, nose, and mouth from the aerosol generated from a high-speed dental handpiece during the COVID-19 pandemic. Background: The SARS-CoV-2 virus is known to be present in the saliva of an infected individual during the contagious viral shedding phase of the disease. The use of rotary dental instruments places oral health practitioners at risk of contracting COVID-19 from infected individuals. In particular, it is very difficult to protect the mucous membranes of the face against the extremely fine aerosol produced from a high-speed dental handpiece. Objectives: This study aimed to develop and test a novel PPE system for use during the COVID-19 pandemic. An air-fed spray-painting mask was used under a plastic hood to protect against the aerosol from a high-speed dental handpiece. This was found to be superior compared to hospital-issued N-95 masks and eye protection in our test model. Methods: Subjects donned various forms of PPE whilst using a high-speed dental handpiece in a confined cubicle. The efficacy of each form of PPE was evaluated by adding fluorescein to the water coolant supply line of a high-speed dental handpiece before checking for facial contamination with an ophthalmology slit lamp. Results: Under our test conditions, the N-95 mask did not prevent nasal and mouth contaminations, but the combination of an air-fed mask with a sealed hood prevented these contaminations. Although goggles worn tightly did prevent contamination, the air-fed mask system was far more comfortable and did not fog up. Discussion: Under the rigorous test conditions of our model, we found hospital-issued PPE ineffective. We also found the single strategy of using positive airflow into a face mask ineffective, even with extremely high levels of airflow. Complete protection was only achieved reliably by the combination of physically sealing off the face from the surrounding airspace and using the air-fed system to provide an external source of air to breathe. We effectively made the clinical equivalent of a dive bell helmet. The air-fed mask is supplied by a standard dental air compressor and is simple to install for someone familiar with the technical aspects of compressors. The compressor does not rely on a filter and proves effective with cheap and easily accessible disposable items. Conclusion: Under rigorous testing conditions, the developed air-fed mask system with a sealed hood on low flow performed better than hospital-issued PPE against high-speed dental aerosol protection. The developed system protects the operators from the air of the room contaminated with aerosol and brings in safe air from the outside for them to breathe.

Objective: To review and summarize topical oxymetazoline’s pharmacology, pharmacokinetics, efficacy, safety, cost, and place in therapy for persistent redness associated with erythematotelangiectatic rosacea. Data Sources: Literature searches of MEDLINE (1975 to September 2017), International Pharmaceutical Abstracts (1975 to September 2017), and Cochrane Database (publications through September 2017) using the terms rosacea, persistent redness, α -agonist, and oxymetazoline. Study Selection and Data Extraction: Results were limited to studies of human subjects, English-language publications, and topical use of oxymetazoline. Relevant materials from government sources, industry, and reviews were also included. Data Synthesis: Data support the efficacy of oxymetazoline for persistent facial redness. Little study beyond clinical trials cited in the drug approval process has been conducted. Current data suggest that oxymetazoline is similar in safety and efficacy to brimonidine. Head-to-head comparisons of topical α-agonists for erythema caused by rosacea are needed. Conclusion: The topical α-agonist, oxymetazoline, is safe and effective for reducing persistent facial redness associated with erythematotelangiectatic subtype of rosacea. Health care practitioners selecting among treatments should consider not only the subtype of rosacea but also individual patient response, preference, and cost.

AbstractDiabetes mellitus has been an increasing concern owing to its high morbidity, and the average age of individual affected by of individual affected by this disease has now decreased to mid-twenties. Given the high prevalence, it is necessary to address with this problem effectively. Many researchers and doctors have now developed detection techniques based on artificial intelligence to better approach problems that are missed due to human errors. Data mining techniques with algorithms such as - density-based spatial clustering of applications with noise and ordering points to identify the cluster structure, the use of machine vision systems to learn data on facial images, gain better features for model training, and diagnosis via presentation of iridocyclitis for detection of the disease through iris patterns have been deployed by various practitioners. Machine learning classifiers such as support vector machines, logistic regression, and decision trees, have been comparative discussed various authors. Deep learning models such as artificial neural networks and recurrent neural networks have been considered, with primary focus on long short-term memory and convolutional neural network architectures in comparison with other machine learning models. Various parameters such as the root-mean-square error, mean absolute errors, area under curves, and graphs with varying criteria are commonly used. In this study, challenges pertaining to data inadequacy and model deployment are discussed. The future scope of such methods has also been discussed, and new methods are expected to enhance the performance of existing models, allowing them to attain greater insight into the conditions on which the prevalence of the disease depends.

Introduction: This study was performed to provide a comprehensive review of the breadth and depth of fellowship training provided by the American Academy of Cosmetic Surgery (AACS), with direct comparison with other current aesthetic surgery training programs available in the United States. We hypothesized that this subspecialty training provides essential experience and confidence to perform aesthetic procedures, which are likely not adequately imparted during traditional residency training. We also address the notion that Cosmetic Surgery is not under the sole ownership of one specialty, but rather a subspecialty that flourishes by collaboration between multidisciplinary surgical backgrounds. Materials and Methods: We performed a cross-sectional study of survey data from 2 distinct groups—current fellows in a 1-year AACS program and surgeons who completed an AACS fellowship between July 2008 and June 2017, who have been in active cosmetic surgery practice ranging from 6 months to over 6 years. A survey was administered via email and distributed by the AACS central office. The responses were compared with data published in the Annals of Plastic Surgery concerning Recent Trends in Resident Career Choices after Plastic Surgery Training. Results: The Accreditation Council for Graduate Medical Education (ACGME) requirements for aesthetic surgical cases in a 6-year Plastic Surgery program are 150 cases, but 50% of graduating seniors feel inadequately prepared to transition straight into aesthetic surgery practice, whereas among AACS graduating fellows, 100% feel very prepared to go on the aesthetic surgery practice, having completed an average of 687 cases within the yearlong training program. We note that the survey response rate was 81% among current fellows versus 35% among practicing surgeons. Discussion: We believe that focused subspecialty training in cosmetic surgery after completion of a primary surgical residency in a form of a structured fellowship through AACS, American Society of Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, Commission on Dental Accreditation, and American Society of Ophthalmic Plastic and Reconstructive Surgery (Oculoplastic) is the ideal preparation for the future. As we learn from each other through fellowship training, academic conferences, and research, this will further advance the subspecialty and ultimately improve patient care and outcomes. There is no evidence that these training programs provide less adequate preparation, although they are not accredited by the ACGME. To the contrary, the additional experience and knowledge gained during these fellowship training programs result in better outcomes and more competent practitioners. Conclusions: The development of subspecialty training and board certification for surgeons committed to cosmetic surgery yields the highest level of qualified providers. The diverse backgrounds of these providers continue to allow us to expand and innovate in this field. This study is aimed at moving this conversation forward in a positive direction.

Abstract Background Facioscapulohumeral muscular dystrophy (FSHD) is among the most prevalent muscular dystrophies and currently has no treatment. Clinical and genetic heterogeneity are the main challenges to a full comprehension of the physiopathological mechanism. Improving our knowledge of FSHD is crucial to the development of future therapeutic trials and standards of care. National FSHD registries have been set up to this end. The French National Registry of FSHD combines a clinical evaluation form (CEF) and a self-report questionnaire (SRQ), filled out by a physician with expertise in neuromuscular dystrophies and by the patient, respectively. Aside from favoring recruitment, our strategy was devised to improve data quality. Indeed, the pairwise comparison of data from 281 patients for 39 items allowed for evaluating data accuracy. Kappa or intra-class coefficient (ICC) values were calculated to determine the correlation between answers provided in both the CEF and SRQ. Results Patients and physicians agreed on a majority of questions common to the SRQ and CEF (24 out of 39). Demographic, diagnosis- and care-related questions were generally answered consistently by the patient and the medical practitioner (kappa or ICC values of most items in these groups were greater than 0.8). Muscle function-related items, i.e. FSHD-specific signs, showed an overall medium to poor correlation between data provided in the two forms; the distribution of agreements in this section was markedly spread out and ranged from poor to good. In particular, there was very little agreement regarding the assessment of facial motricity and the presence of a winged scapula. However, patients and physicians agreed very well on the Vignos and Brooke scores. The report of symptoms not specific to FSHD showed general poor consistency. Conclusions Patient and physician answers are largely concordant when addressing quantitative and objective items. Consequently, we updated collection forms by relying more on patient-reported data where appropriate. We hope the revised forms will reduce data collection time while ensuring the same quality standard. With the advent of artificial intelligence and automated decision-making, high-quality and reliable data are critical to develop top-performing algorithms to improve diagnosis, care, and evaluate the efficiency of upcoming treatments.

IntroductionTransformation, claims McCracken, is the expression of consumer agency and individual freedom in which consumers, as “co-creators of culture,” are empowered to creatively construct new improved selves (xvi). No longer an “extraordinary event for extraordinary creatures,” transformation today is routine and accessible (McCracken xxi). Contemporary consumer culture encourages individuals to enact these transformations by turning to the market to purchase the resources they require to achieve their desired identity (Ellis et al. 179). This market model of transformation embraces the concept of the marketplace exchange where the one party satisfies the needs of the other in a mutually beneficial exchange relationship. For consumers, the market enables transformation through the purchase and consumption of the desired products and services which support identity building.Critics, however, argue that markets have less positive effects. While it is too simplistic to claim that markets manipulate consumers, marketing exchanges constitute an enduring shaping force on individuals and society (Laczniak and Murphy). Markets shape consumer identities by homogenising them and suppressing their self-expressive capabilities (Kozinets 22). As producers become more powerful, “the market is transformed from a consumer-driven mechanism to a sphere where the producers assimilate consumers’ needs to their own through commercial activity” (Sassatelli 76) (my italics). Marketing and promotion have a persuasive influence and their role in the transformation process is a crucial element in understanding the consumer’s impetus to transform. Consumer identity is of course neither fully a “liberatory act” nor “wholly dictated by the market” (Ellis et al. 182), but there is a relationship between consumer autonomy and the dictates of the market which can be explored through focusing on the transformation of identity through the consumption of cosmetic surgery. Cosmetic surgery is an important site of enquiry as a social practice which “merges the attention given to the body by an individual person with the values and priorities of the consumer society” (Martinez Lirola and Chovanec 490). The body, as Kathy Davis highlighted, has long been seen as a commodity which can be endlessly transformed (Davis, Reshaping the Female Body), and the market for cosmetic surgery is at the forefront of this commodification process (Aizura 305). What is new, however, is the increasing marketisation and commercialisation of the cosmetic surgery industry combined with rising consumerism in which surgical transformation can be purchased simply as a “lifestyle choice alongside fashion, fitness and therapy” (Elliott 7). In the cosmetic surgery market, “patients” are consumers. Rather than choosing cosmetic surgery in order to feel whole or normal, contemporary consumers see surgery as a grooming practice which is part of a body maintenance routine (Jones).As the cosmetic surgery market becomes progressively more competitive, it relies more and more on marketing and promotion for its survival. The intense rivalry between providers drives them, in some cases, to aggressive and often unethical promotional practices. In the related field of pharmaceuticals for example, marketers have been charged with explicitly manipulating social understanding of disease in order to increase profits (Brennan, Eagle, and Rice 17). Unlike TV make-over shows whose primary purpose is to entertain, or celebrity culture which influences indirectly through example, cosmetic surgery promotion sets out with intent to persuade consumers to choose surgical transformation. Cosmetic surgery is presented to consumers “through the neoliberal prism of choice,” encouraging women (mostly) to choose surgery as a self-improvement practice in order to “feel good or pamper herself” (Gurrieri, Brace-Govan, and Previte 534). In a promotional culture which valorises external values and ‘the new’ (Fatah 1), the cost, risk, and pain of surgery are downplayed as an increasing array of self-transformative possibilities are presented as consumption choices. This scenario sees the impetus to transform as driven as much by marketing imperatives as by consumers’ free choice. Indeed in mobilising the rhetoric of choice, the “autonomous” consumer, it seems, plays into the hands of the cosmetic surgery industry.This paper explores consumer transformation through cosmetic surgery by focusing on the tension between the rhetoric of consumer autonomy, freedom, and choice and that of the industry’s marketing and promotional practices in the United Kingdom (UK). I argue that while the consumer is an active player, expressing their freedom and agency in choosing self-transformation through surgery, that autonomy is influenced and constrained by the marketing and promotional practices of the industry. I focus on the inherent paradox in the discourse of transformation in consumer culture which advocates individual consumer freedom and creativity yet limits these freedoms to “acceptable” bodily forms constructed as the norm by promotional images of the cosmetic surgery industry. To paraphrase Susan Bordo, those promotions which espouse consumer choice and self-determination simultaneously eradicate individual difference and circumscribe choice (Unbearable Weight 250). Here I explore how ideals of autonomy, freedom, and choice are utilised to support consumer surgical transformation. Drawing on market research, professional publications, blogs and industry webpages used by UK consumers as they search for information, I demonstrate how marketing and promotion adopt these ideals to provide a visual reference and a language for consumer transformation, which has the effect of shaping and limiting consumer freedom and creativity. Consumer Transformation as Expression of Freedom Contemporary consumers need not be content just to admire the appearance of celebrities and film stars, but can actively engage in the creative construction of new improved selves through surgical transformation (McCracken). This transformation is often expressed by consumers as a liberatory act, as is illustrated by the women surveyed for a UK Department of Health report. As one respondent explains, “I think it’s just the fact that they can . . . and I think over the years, women have a battle with their bodies, as they change, different ages, they do, they struggle with trying to accept it over different years and the fact that you can, it’s like ‘wow, so what, it’s a bit of money, let’s just change ourselves’” (UK Department of Health 32). Even young consumers see cosmetic surgery as an easily available transformative option, such as this 16-year-old female research respondent who describes surgery as “Things that you don’t really need but you just feel you want to have them” (UK Department of Health 33). As these women attest, cosmetic surgery is seen as an increasingly normal and everyday practice. By rhetorically constructing the possibility of transformation as an expression of individual consumer empowerment (“wow, so what, it’s a bit of money, let’s just change ourselves”), they distance the practice “from negative associations with vanity” and oppression (Tait 131). This postmodern consumer is no dupe or victim but a “conscious subject who modifies their body as a project of identity” (Gibson 51) and for whom cosmetic surgery transformation is “the route to happiness and personal empowerment” (Tait 119). Surgical transformation is not a way to strive narcissistically after “an elusive beauty ideal” (Heyes 93). Instead, it is expressed as something they choose to do just for themselves—which Bordo calls the “for me” argument (“Braveheart, Babe, and the Contemporary Body”). In an increasingly visual culture, the accessibility and affordability of cosmetic surgery enable consumers, who are already accustomed to digitally editing their photographical images, to “edit” their physical bodies. This is candidly expressed by Singaporean blogger Ang Chiew Ting who writes, "When I learnt how to use Photoshop, the things that I edited about myself, those have now all been done in real life through plastic surgery. Whatever I wanted to change about my face, I have done." Yet, as I illustrate later, the emphasis on transformation as empowerment through exercising choice (“Whatever I wanted to change about my face, I have done"), plays into the hands of the industry as it “reproduces the logic of surgical industries” (Tait 121). In the politics of consumption, driven by neo-liberal ideologies, consumer choice is sovereign (Sassatelli 184), and it is in the ability to exercise choice, choosing surgery and taking responsibility for that choice, that agency and empowerment are expressed (Leve, Rubin, and Pusic). Blogger Stella Lee explains her decision as “I don't want to say I encourage plastic surgery, this is just my personal choice. It is like saying if I dye my hair purple then I want everyone to have purple hair too. It is simply just for me only. If you wish to do so, go ahead. If you're satisfied with what you have, go ahead.” This consumer is a “discerning and knowledgeable consumer” who researches information about potential surgical procedures and practitioners (Gimlin, “Imagining” 58) and embraces the ideology of self-determinism (Heyes). Consumers considering surgery may visit recommended doctors, research doctors online, and peruse beauty magazines (Leve, Rubin, and Pusic). Tatler magazine, for example, publishes an annual Beauty and Cosmetic Surgery Guide which celebrates “the newest, niftiest ways to reclaim your face and your figure” (Tatler nd). In taking responsibility for themselves, the contemporary consumer reflects the neoliberal agenda “that promotes empowerment through consumer choice and responsibility for self-care” (Leve, Rubin, and Pusic 131). Yet, consumer information on the suitability of surgery and alternative providers is often partial. As one research respondent recalled, “I just typed it into Google and then worked through whatever came up; you're trying to go for the names of companies that are a bit more reputable” (UK Department of Health 28). Internet searches most frequently identify promotional information from the surgery providers themselves including customer stories and testimonials, which seem informative in nature but which have persuasive intent to influence choice. Therefore although seemingly exerting agency by undertaking a process of search in order to make an informed choice, that choice is made within a promotional context that the consumer may not be fully aware exists.Consumer Transformation as Marketing ImperativeThe aim of marketing and promotion, as medicine meets consumerism, is to secure clients for cosmetic surgery (Mirivel). As a consequence, the discourse of cosmetic surgery is highly persuasive and commercially motivated, promoting the need for surgery by mobilising the existing ideological link between identity and physical appearance for commercial ends (Martinez Lirola and Chovanec 489). Promotional strategies include drawing attention to possible deficiencies in appearance, creating opportunities for surgery by problematising normal bodily states, promising intangible benefits, and normalising surgery by positioning it within a consumerist vision of success. Consumer transformation can be driven by perceived lack, inadequacy, or deficit, where a part of the body or face does not stand up to scrutiny when compared to media images. Marketing and promotion draw attention to this lack and imply that any deficiency in appearance can be remedied by consumption practices such as the purchase of hair dye, make-up, or, more drastically, cosmetic surgery. As one research respondent considering surgery explains, “I think people want to look their best and media portrays ‘perfect’ looking people or they portray a certain image and then because it’s what you see all the time, it almost feels like if you don't look like that, then it’s wrong” (UK Department of Health 18). The influence of media on the impetus to transform is explored elsewhere (see Wegenstein), so is not addressed further here. However, the insecurity which results from such media images is further exploited by the marketing and promotional strategies adopted by cosmetic surgery providers in an increasingly competitive marketplace. This does not go unnoticed by consumers: as one research respondent noted, “They pick out your insecurities as a tactic for making you purchase stuff . . . it was supposed to be a free consultation but they definitely do pressure you into having stuff” (UK Department of Health 19). In this deficiency model of transformation, the cosmetic surgery consumer is insecure, lacking in power and volition, and convinced of her inadequacy. This is exacerbated by the promotional images of models featured on cosmetic surgery websites against which consumers evaluate their own looks in a process of social comparisons (Markey and Markey 210). This reflects Bernadette Wegenstein’s notion of the cosmetic gaze, a circular process whereby “the act of looking at our bodies and those of others is informed by the techniques, expectations, and strategies of bodily modification” (2). In comparing themselves with the transformed images on surgery websites, consumers are drawn into a process of comparison that tells them how they should look. At the same time as convincing consumers of their inadequacies, providers also tell consumers that they are in control and can act autonomously to transform themselves. For example, a TV advert for The Hospital Group which shows three smiling “transformed” customers claims “If you’re unhappy with your appearance you could change it. If it affects your confidence you could overcome it. If it makes you feel self-conscious, you could take control with cosmetic surgery or dentistry from The Hospital Group” (my italics). In this way marketers marshal the neo-liberal rhetoric of consumer empowerment to encourage the consumption of cosmetic surgery and normalise the practice through the emphasis on choice. Marketing and promotional messages contribute further to these perceived deficits by problematising “normal” bodily conditions resulting from “normal” life experiences such as ageing and pregnancy. Surgeon Ran Rubinstein, for example, draws attention in his blog to thinning lips as an opportunity for lip augmentation: “Lip augmentation might seem like a trend among the younger crowd, but it’s something that people of any age can benefit from getting. As you get older, some areas of your body thin out while some thicken. You might find that you’re gaining weight around your stomach, while your lips and face are getting thin.” Problematising frames a real or perceived physical state as “as a medical problem that requires a medical solution,” subtly implying that cosmetic surgery is “an unavoidable necessity” which is medically justified (Martinez Lirola and Chovanec 503). For example, Jules’s testimonial for facial fillers frames natural, and even positive, features such as smile lines as problematic: “I smile a lot and noticed some smile lines coming through.” Indeed as medicine has historically defined the female body as “deficient and in need of repair,” cosmetic surgery can be legitimately proposed as a solution for “women’s problems with their appearance” (Davis, “A Dubious Equality” 55). Promotional messages emphasise the intrinsic benefits of external transformation, encouraging consumers to opt for surgery in order to align their external appearance with how they feel inside. Much of this discourse calls on consumers’ perceptions of a disparity between how they feel inside and their external body image (Gibson 54). For example, a testimonial from “Carole Anne 69” claims that facial fillers “make me feel like I’m the best version of myself.” (Note that Carole Anne, like all the women providing testimonials for this website, including Carol 50, Jules 38, or Pamela 59, is defined by her looks and by her age.) Although Gimlin’s research suggests that the notions of the “body reflecting the ‘true’ self or re-creating one’s ‘genuine’ appearance” have become less important (“Too Good” 930), they continue to dominate in customer testimonials on surgery websites. For example, Transform breast enlargement client Rebecca exclaims, “I’m still me, but it has completely transformed how I feel about myself on the inside, how I hold and present myself on the outside.” A typical promotional strategy is to emphasise the intangible benefits of cosmetic surgery, such as happiness or confidence. This is encapsulated in a 2011 print advert for Transform Cosmetic Surgery Group which shows a smiling young girl in a bikini holding a placard which reads, “I’ve just had my breasts done, but the biggest change you’ll see is on my face.” In promising happiness or self-confidence, intangible effects which are impossible to measure, marketers avoid the reality of surgery—where a cut is made, what is added or removed, how many stitches are required. Consumers know the world through shopping (Elliott 43), and marketers draw on this behaviour to associate surgery with any other purchase in the life of a successful consumer. Consumers are encouraged to choose from a gallery of looks, to “Browse through our Before and After Gallery for inspiration,” and the purchase is rendered more accessible through the use of discounts, offers, and incentives, which consumers are accustomed to seeing in familiar shopping contexts. Sales intent can be blatant, such as this appeal to disposable income on Realself.com: “Now that your 2015 taxes are (hopefully) filed and behind you, were you fortunate enough to get a refund? If it just so happens that the government will be returning some of your hard-earned cash, what will you be using it for? Electronic gadgets, an island vacation, a shopping spree . . . or plastic surgery?” Providers reduce perceived risk by implying that interventions such as facial fillers are considered normal practice for others, claiming that “Millions of women choose facial fillers, so that they can age exactly the way they want to” and by providing online interactive tools which consumers can use to manipulate facial features to see the potential effect of surgery (This-is-me.com).ConclusionThe aim of this article was to explore the tension between two different views of transformation, one which emphasised consumer autonomy, freedom, and market choice and the other which claims a more restrictive and manipulative influence of the market and its promotional practices. I argue that McCracken’s explanation of transformation as “the expression of consumer agency and individual freedom” (xvi) offers an overly optimistic view of consumer transformation. In the cosmetic surgery market, the expression of consumer autonomy and freedom rests on the discourse of choice. This same discourse is adopted by surgery providers in their persuasive strategies to secure new clients so that the market’s promotional language (e.g. a whole new you) becomes part of the consumer’s understanding of and articulation of cosmetic surgery transformation. I argue that marketing and promotion work to progress consumers along the path to surgery, by giving them reasons to do so. This is achieved by reflecting existing consumer anxieties as deficiencies, by creating new reasons for surgery by problematising normal conditions, by promising intangible benefits, and by normalising the purchase. These promotional practices also regulate and restrict consumers by presenting visual images of transformation which influence how others understand “the perfect you.” The gallery of looks on surgery websites constrains choice by signifying which looks are desirable, and “before and after” rhetoric emphasises the pivotal role of cosmetic surgery in achieving this transformation. ReferencesAizura, Aren. “Where Health and Beauty Meet: Femininity and Racialisation in Thai Cosmetic Surgery Clinics.” Asian Studies Review 33.3 (2009): 303–17.Bordo, Susan. “Braveheart, Babe, and the Contemporary Body.” 3 June 2016 <www.public.iastate.edu/~jwcwolf/Papers/Bordo>.———. Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley: U of California P, 1993.Brennan, Ross, Lynn Eagle, and David Rice. “Medicalization and Marketing.” Journal of Macromarketing 30.1 (2010): 8–22.Davis, Kathy. “‘A Dubious Equality’: Men, Women and Cosmetic Surgery.” Body & Society 8.1 (2002): 49–65.———. Reshaping the Female Body. New York: Routledge, 1995.Elliott, Anthony. Making the Cut: How Cosmetic Surgery is Transforming our Lives. London: Reaktion Books, 2008.Ellis, Nick, James Fitchett, Matthew Higgins, Gavin Jack, Ming Lim, Michael Saren, and Mark Tadajewski. Marketing: A Critical Textbook. London: Sage, 2011. Fatah, Fazel. “Should All Advertising of Cosmetic Surgery Be Banned? Yes.” British Medical Journal 345 (7 Nov. 2012).Gibson, Margaret. “Bodies without Histories: Cosmetic Surgery and the Undoing of Time.” Australian Feminist Studies 21.41 (2006): 51–63.Gimlin, Debra. “‘Too Good to Be Real’: The Obviously Augmented Breast in Women’s Narratives of Cosmetic Surgery.” Gender & Society 27.6 (2013): 913–34.———. “Imagining the Other in Cosmetic Surgery.” Body & Society 16.4 (2010): 57–76.Gurrieri, Lauren, Jan Brace-Govan, and Josephine Previte. “Neoliberalism and Managed Health: Fallacies, Facades and Inadvertent Effects.” Journal of Macromarketing 34.4 (2014): 532–38.Heyes, Cressida. Self-Transformations: Foucault, Ethics, and Normalized Bodies. Oxford: Oxford UP, 2007.Jones, Meredith. “Clinics of Oblivion: Makeover Culture and Cosmetic Surgery Tourism.” PORTAL Journal of Multidisciplinary International Studies 8.2 (2011).Kozinets, Robert. “Can Consumers Escape the Market? Emancipatory Illuminations from Burning Man.” Journal of Consumer Research 29 (2002): 20–38. Laczniak, Eugene, and Patrick Murphy. “Normative Perspectives for Ethically and Socially Responsible Marketing.” Journal of Macromarketing 26 (2006): 154–77.Leve, Michelle, Lisa Rubin, and Andrea Pusic. “Cosmetic Surgery and Neoliberalisms: Managing Risk and Responsibility.” Feminism & Psychology 22. 1 (2011): 122–41.Markey, Charlotte, and Patrick Markey. “Emerging Adults’ Responses to a Media Presentation of Idealized Female Beauty: An Examination of Cosmetic Surgery in Reality Television.” Psychology of Popular Media Culture 1.4 (2012): 209–19.Martinez Lirola, Maria, and Jan Chovanec. “The Dream of a Perfect Body Come True: Multimodality in Cosmetic Surgery Advertising.” Discourse & Society 23.5 (2012): 487–507. McCracken, Grant. Transformations: Identity Construction in Contemporary Culture. Bloomington and Indianapolis: Indiana UP, 2008.Mirivel, Julien. “The Physical Examination in Cosmetic Surgery: Communication Strategies to Promote the Desirability of Surgery.” Health Communication 23.2 (2008): 153–70.Sassatelli, Roberta. Consumer Culture: History, Theory and Politics. London: Sage, 2007.Tait, Sue. “Television and the Domestication of Cosmetic Surgery.” Feminist Media Studies 7.2 (2007): 119–35. Tatler Magazine. “Beauty & Cosmetic Surgery Guide 2016.” Tatler 2016. 3 June 2016 <http://www.tatler.com/guides/beauty--cosmetic-surgery-guide/2016>.UK Department of Health Research. “Regulation of Cosmetic Interventions: Research among the General Public and Practitioners.” 28 Mar. 2013. Version 3. 22 Apr. 2016 <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/192029/Regulation_of_Cosmetic_Interventions_Research_Report.pdf>.Wegenstein, Bernadette. The Cosmetic Gaze: Body Modification and the Construction of Beauty. 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BackgroundIn the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change. Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.). Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).Social Marketing CampaignsIn 2006 the Australian, State and Territory Governments funded the Measure Up social marketing campaign (Australian Government Department of Health and Ageing "Measure Up"). As the name suggests Measure Up focuses on the measurement of health through body weight and waist circumference. Campaign resources include brochures, posters, a tape measure, a 12 week planner, a community guide and a television advertisement. Campaign slogans are ‘The more you gain, the more you have to lose’ and ‘How do you measure up?’Tomorrow People is the component of Measure Up designed for Indigenous Australians (Australian Government Department of Health and Ageing "Tomorrow People"). Tomorrow People resources focus on healthy eating and physical activity and include a microsite on the Measure Up website, booklet, posters, print and radio advertisements. The campaign slogan is ‘Tomorrow People starts today. Do it for our kids. Do it for our culture.’ In 2011, phase two of the Measure Up campaign was launched (Australian Government Department of Health and Ageing "Swap It, Don't Stop It"). The central premise of Swap It, Don’t Stop It is that you ‘can lose your belly without losing all the things you love’ by making ‘simple’ swaps of behaviours related to eating and physical activity. The campaign’s central character Eric is made from a balloon, as are all of the other characters and visual items used in the campaign. Eric claims thatover the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy! The campaign has produced around 30 branded resource items including brochures, posters, cards, fact sheets, recipes, and print, radio, television and online advertisements. All resources include references to Eric and most also include the image of the tape measure used in the Measure Up campaign. The Swap It, Don’t Stop It campaign also includes resources specifically directed at Indigenous Australians including two posters from the generic campaign with a dot painting motif added to the background. MethodologyThe epistemological position in this project was constructivist (Crotty) and the theoretical perspective was critical theory (Crotty). Multimedia critical discourse analysis (Machin and Mayr) was the methodology used to examine the social marketing campaigns and identify the discourses within them. Critical discourse analysis (CDA) focuses on critiquing text for evidence of power and ideology. CDA is used to reveal the ideas, absences and assumptions, and therefore the power interests buried within texts, in order to bring about social change. As a method, CDA has a structured three dimensional approach involving textual practice analysis (for lexicon) at the core, within the context of discursive practice analysis (for rhetorical and lexical strategies particularly with respect to claims-making), which falls within the context of social practice analysis (Jacobs). Social practice analysis explores the role played by power and ideology in supporting or disturbing the discourse (Jacobs; Machin and Mayr). Multimodal CDA (MCDA) uses a broad definition of text to include words, pictures, symbols, ideas, themes or any message that can be communicated (Machin and Mayr). Analysis of the social marketing campaigns involved examining the vocabulary, grammar, sentence structure, visuals and overall structure of the text for textual, discursive and social practices.Results and DiscussionIndividual ResponsibilityThe discourse of individual responsibility is strongly evident in the campaigns. In this discourse, it is ultimately the individual who is held responsible for their body weight and their health. The individual responsibility discourse is signified by the discursive practice of using epistemic (related to the truth or certainty) and deontic (compelling or instructing) modality words, particularly modal verbs and modal adverbs. High modality epistemic words are used to convince the reader of the certainty of statements and to portray the statement-maker as authoritative. High modality deontic words are used to instil power and authority in the instructions.The extensive use of high modality epistemic and deontic words is demonstrated in the following paragraph assembled from various campaign materials: Ultimately (epistemic modality adverb) individuals must take responsibility (deontic modality verb) for their own health, including their and weight. Obesity is caused (epistemic modality verb) by an imbalance in energy intake (from diet) (epistemic modality verb) and expenditure (from activity) (epistemic modality verb). Individually (epistemic modality adverb) we make decisions (epistemic modality verb) about how much we eat (epistemic modality verb) and how much activity we undertake (epistemic modality verb). Each of us can control (epistemic modality) our own weight by controlling (deontic modality) what we eat (deontic modality verb) and how much we exercise (deontic modality verb). To correct (deontic modality verb) the energy imbalance, individuals need to develop (deontic modality verb) a healthy lifestyle by making changes (deontic modality verb) to correct (deontic modality verb) their dietary habits and increase (deontic modality verb) their activity levels. The verbs must, control, correct, develop, change, increase, eat and exercise are deontic modality verbs designed to instruct or compel the reader.These discursive practices result in the clear message that individuals can and must control, correct and change their eating and physical activity, and thereby control their weight and health. The implication of the individualist discourse is that individuals, irrespective of their genes, life-course, social position or environment, are charged with the responsibility of being more self-surveying, self-policing, self-disciplined and self-controlled, and therefore healthier. This is consistent with the individualist orientation of neoliberal ideology, and has been identified in various critiques of obesity prevention public health programs that centralise the self-responsible subject (Murray; Rich, Monaghan and Aphramor) and the concept of ‘healthism’, the moral obligation to pursue health through healthy behaviours or healthy lifestyles (Aphramor and Gingras; Mansfield and Rich). The hegemonic Western-centric individualist discourse has also been critiqued for its role in subordinating or silencing other models of health and wellbeing including Aboriginal or indigenous models, that do not place the individual in the centre (McPhail-Bell, Fredericks and Brough).Obesity Causes DiseaseEpistemic modality verbs are used as a discursive practice to portray the certainty or probability of the relationship between obesity and chronic disease. The strength of the epistemic modality verbs is generally moderate, with terms such as ‘linked’, ‘associated’, ‘connected’, ‘related’ and ‘contributes to’ most commonly used to describe the relationship. The use of such verbs may suggest recognition of uncertainty or at least lack of causality in the relationship. However this lowered modality is counterbalanced by the use of verbs with higher epistemic modality such as ‘causes’, ‘leads to’, and ‘is responsible for’. For example:The other type is intra-abdominal fat. This is the fat that coats our organs and causes the most concern. Even though we don’t yet fully understand what links intra-abdominal fat with chronic disease, we do know that even a small deposit of this fat increases the risk of serious health problems’. (Swap It, Don’t Stop It Website; italics added)Thus the prevailing impression is that there is an objective, definitive, causal relationship between obesity and a range of chronic diseases. The obesity-chronic disease discourse is reified through the discursive practice of claims-making, whereby statements related to the problem of obesity and its relationship with chronic disease are attributed to authoritative experts or expert organisations. The textual practice of presupposition is evident with the implied causal relationship between obesity and chronic disease being taken for granted and uncontested. Through the textual practice of lexical absence, there is a complete lack of alternative views about body weight and health. Likewise there is an absence of acknowledgement of the potential harms arising from focusing on body weight, such as increased body dissatisfaction, disordered eating, and, paradoxically, weight gain.Shame and BlameBoth Measure Up and Swap It, Don’t Stop It include a combination of written/verbal text and visual images that create a sense of shame and blame. In Measure Up, the central character starts out as young, slim man, and as he ages his waist circumference grows. When he learns that his expanding waistline is associated with an increased risk of chronic disease, his facial expression and body language convey that he is sad, dejected and fearful. In the still images, this character and a female character are positioned looking down at the tape measure as they measure their ‘too large’ waists. This position and the looks on their faces suggest hanging their heads in shame. The male characters in both campaigns specifically express shame about “letting themselves go” by unthinkingly practicing ‘unhealthy’ behaviours. The characters’ clothing also contribute to a sense of shame. Both male and female characters in Measure Up appear in their underwear, which suggests that they are being publicly shamed. The clothing of the Measure Up characters is similar to that worn by contestants in the television program The Biggest Loser, which explicitly uses shame to ‘motivate’ contestants to lose weight. Part of the public shaming of contestants involves their appearance in revealing exercise clothing for weigh-ins, which displays their fatness for all to see (Thomas, Hyde and Komesaroff). The stigmatising effects of this and other aspects of the Biggest Loser television program are well documented (Berry et al.; Domoff et al.; Sender and Sullivan; Thomas, Hyde and Komesaroff; Yoo). The appearance of the Measure Up characters in their underwear combined with their head position and facial expressions conveys a strong, consistent message that the characters both feel shame and are deserving of shame due to their self-inflicted ‘unhealthy’ behaviours. The focus on ‘healthy’ and ‘unhealthy’ behaviours contributes to accepted and contested health identities (Fry). The ‘accepted health identity’ is represented as responsible and aspiring to and pursuing good health. The ‘contested health identity’ is represented as unhealthy, consuming too much food, and taking health risks, and this identity is stigmatised by public health programs (Fry). The ‘contested health identity’ represents the application to public health of Goffman’s ‘spoiled identity’ on which much stigmatisation theorising and research has been based (Goffman). As a result of both lexical and visual textual practices, the social marketing campaigns contribute to the construction of the ‘accepted health identity’ through discourses of individual responsibility, choice and healthy lifestyle. Furthermore, they contribute to the construction of the spoiled or ‘contested health identity’ through discourses that people are naturally unhealthy and need to be frightened, guilted and shamed into stopping ‘unhealthy’ behaviours and adopting ‘healthy’ behaviours. The ‘contested health identity’ constructed through these discourses is in turn stigmatised by such discourses. Thus the campaigns not only risk perpetuating stigmatisation through the reinforcement of the health identities, but possibly extend it further by legitimising the stigma associated with such identities. Given that these campaigns are conducted by the Australian Government, the already deeply stigmatising social belief system receives a significant boost in legitimacy by being positioned as a public health belief system perpetrated by the Government. Fear and AlarmIn the Measure Up television advertisement the main male character’s daughter, who has run into the frame, abruptly stops and looks fearful when she hears about his increased risk of disease. Using the discursive practice of claims-making, the authoritative external source informs the man that the more he gains (in terms of his waist circumference), the more he has to lose. The clear implication is that he needs to be fearful of losing his health, his family and even his life if he doesn’t reduce his waist circumference. The visual metaphor of a balloon is used as the central semiotic trope in Swap It, Don’t Stop It. The characters and other items featuring in the visuals are all made from twisting balloons. Balloons themselves may not create fear or alarm, unless one is unfortunate to be afflicted with globophobia (Freed), but the visual metaphor of the balloon in the social marketing campaign had a range of alarmist meanings. At the population level, rates and/or costs of obesity have been described in news items as ‘ballooning’ (Body Ecology; Stipp; AFP; Thien and Begawan) with accompanying visual images of extremely well-rounded bodies or ‘headless fatties’ (Cooper). Rapid or significant weight gain is referred to in everyday language as ‘ballooning weight’. The use of the balloon metaphor as a visual device in Swap It, Don’t Stop It serves to reinforce and extend these alarmist messages. Further, there is no attempt in the campaigns to reduce alarm by including positive or neutral photographs or images of fat people. This visual semiotic absence – a form of cultural imperialism (Young) – contributes to the invisibilisation of ‘real life’ fat people who are not ashamed of themselves. Habermas suggests that society evolves and operationalises through rational communication which includes the capacity to question the validity of claims made within communicative action (Habermas The Structural Transformation of the Public Sphere; Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society). However the communicative action taken by the social marketing campaigns analysed in this study presents claims as uncontested facts and is therefore directorial about the expectations of individuals to take more responsibility for themselves, adopt certain behaviours and reduce or prevent obesity. Habermas argues that the lack or distortion of rational communication erodes relationships at the individual and societal levels (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Structural Transformation of the Public Sphere). The communicative actions represented by the social marketing campaigns represents a distortion of rational communication and therefore erodes the wellbeing of individuals (for example through internalised stigma, shame, guilt, body dissatisfaction, weight preoccupation, disordered eating and avoidance of health care), relationships between individuals (for example through increased blame, coercion, stigma, bias, prejudice and discrimination) and society (for example through stigmatisation of groups in the population on the basis of their body size and increased social and health inequity). Habermas proposes that power differentials work to distort rational communication, and that it is these distortions in communication that need to be the focal point for change (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Theory of Communicative Action: The Critique of Functionalist Reason; Habermas The Structural Transformation of the Public Sphere). Through critical analysis of the discourses used in the social marketing campaigns, we identified that they rely on the power, authority and status of experts to present uncontested representations of body weight and ‘appropriate’ health responses to it. In identifying the discourses present in the social marketing campaigns, we hope to focus attention on and thereby disrupt the distortions in the practical knowledge of the weight-centred health paradigm in order to contribute to systemic reorientation and change.ConclusionThrough the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. 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