Change Your Diet, Cure Your Illness: The Content and Consequences of Chronic Illness Food Blogs

This year, the World Health Organization expects chronic disease to account for 75 percent of all deaths worldwide. The internet is an increasingly popular source of health information for those suffering from chronic illness. Online blogs, numbered at 152 million have become one of the most popular forms of web content. Specifically, healthy food blogs have emerged, enabling experts and non-experts alike to dispense health and diet information to large numbers of people. However, blogging in the social sciences remains an understudied phenomenon. This project studies the messaging of 65 popular chronic illness healthy food blogs and the potential consequences of the messages including the role of race, gender, and socioeconomic status. I find that two narratives persist on the blogs—the failure of western medicine to heal illness and the benefits of altering diet. These narratives result in empowerment through individual agency and community building for the bloggers. The messages on the blogs are also endangering in their individualization of health, side-stepping structural explanations for health. This research demonstrates chronic illness food blogs as sites for examining the dual effect of self-empowerment through health knowledge and the impact of surveillance and policing of their own and others’ bodies.


Introduction
As chronic illness is on the rise worldwide, experts and non-experts alike have stepped in to solve the health issues of millions. Besides medical doctors as a source for health information, the internet is now one of the most popular ways that people find information about health issues. In fact, 8 in 10 Americans turn to the internet for health information (PEW, 2011). A unique site to examine the dissemination of www.scholink.org/ojs/index.php/csm Communication, Society and Media Vol. 3, No. 4, 2020 2 Published by SCHOLINK INC. health information on the internet is through the healthy food blogs of women suffering from chronic illnesses. Women healthy food bloggers and the experiences they record in their online blogs illustrate the struggle to become well, as a woman, in today's society and are writing en masse on the internet about how to cure, heal, and manage illness and health through food and diet. They are influential through the sphere of social media, especially Instagram. Instagram accounts connected to healthy food blogs have upwards of one million followers. Many of these bloggers go on to publish cookbooks and make a name for themselves in the world of food and health (Technorati, 2014). Food blogs are unique in their ability to allow individuals to be cited as experts and are relatively free of gatekeeping (Meyers, 2012;Ritzer& Jurgenson, 2010). Despite their enormous popularity, there has been little research done on food blogs across disciplines (Rodney et al., 2017;Dejmanee, 2015). With the rise in popularity of social media outlets like Instagram, Facebook, snapchat, and twitter these blogs have gained immense popularity as sources of information on health, wellness, and diet.
Food blogs and concurrent messages about health and food are significant because of their sociological and broader significance. They are a publicly popular yet academically understudied phenomena. They are potentially influential as they attract hundreds of thousands of followers who buy the bloggers' cookbooks, like their posts and comment on their Instagram pages (Johnston et al., 2013;Trivedi-Grenier, 2008). An exploration of health and wellness food blogs is a rich site to explore attitudes about health and diet in relation to food and morality. The research question addressed in this paper is: what cultural and moral frames about health and food emerge in chronic illness healthy food blogs?
For this article, I examine frames from chronic illness focused healthy food blogs two narratives persist on the blogs-the failure of western medicine to heal the women and the benefits of altering diet and lifestyle. These narratives result in empowerment through individual agency and community building for the bloggers. Simultaneously, the messages on the blogs are endangering in the tendency individualize health, drawing upon healthism and side-stepping structural explanations for health. This research demonstrates chronic illness food blogs as sites for examining the dual effect of self-empowerment through health knowledge and the impact of surveillance and policing of their own and others' bodies, especially bodies that are viewed as unacceptable in today's society.

Chronic Illness and Western Medicine
Chronic illness is a major leading cause of death. Chronic illness or disease (Note 1) includes diabetes, obesity, cancer, high blood pressure or any other condition that "lasts a year or more and require ongoing medical attention and/or limit activities of daily living" (Warshaw, 2006). The World Health Organization estimates that three quarters of all deaths will be the result of chronic disease in 2020 (WHO). The health industry, fitness industry, health and food corporations, pharmaceutical companies, western medicine, and the government are attempting to address these perceived problems and all make 3 Published by SCHOLINK INC.
suffering from chronic illness come face to face with as a first line of defense in combatting their illness.
However, many chronic conditions cannot be solved by traditional western medical approaches and/or little research has yet been performed on the many chronic illnesses that exist.
An alternative approach taking hold is the belief by many that food and diet are a large part of the solution to a variety of chronic illnesses. This is especially true in the lives of food bloggers, when conventional western medicine may fail to address and cure these illnesses. Healthy food bloggers suffering from illnesses and broader health concerns are writing en masse on the internet about how to cure, heal, and manage illness and health through food and diet, reflecting a larger population also suffering from similar conditions. These food bloggers are also lay experts (Epstein 1995) whose personal, individual knowledge related to their own health journeys supersedes western medical advice. Cairns and Johnston (2015), in their research on gendered messages about food and body, claim that expert knowledge is essential to healthy eating discourses in the United States. While I agree, I also bring light to how non-expert, or lay knowledge is also essential to healthy eating discourse. Therefore, this project contributes knowledge on how lay people become experts in specialized fields outside of traditional expert knowledge.

Healthism and Medicalization
The current political and economic context of neoliberalism has fostered an individualized approach to health labeled "healthism" (Crawford, 1980). Healthism focuses on individual responsibility and moral imperatives, labeling certain foods as good and bad and ultimately certain bodies as good (thin, white) and bad (fat, of color). The underlying belief of healthism is that good health will lead to happiness (Contois, 2015;Bacon, 2015). In many ways, healthism parallels religion in the belief that following a certain set of rules or mandates will lead to salvation/happiness. Cairns and Johnston look at what they call the "do-diet", a modern, gendered formation of healthy eating. They assert that the do-diet allows women to feel empowered in choosing to eat healthy in today's neoliberal world. Women face the challenge of expressing agency through consumer choice while also constraining themselves through disciplining the body through diet. Both Cairn's and Johnston's sample and my own demonstrate alignment with the individualization of health, risk avoidance, and health as a moral duty (healthism).
My sample is unique in that the chronic illness healthy food bloggers are a population who have not successfully avoided risk and are plagued by health problems as opposed to existing in a state of peak health. My research helps answer the broader sociological question of how individuals with chronic illness negotiate their identities in a context of healthism and more broadly, how any individual contends with the mandates of healthy eating in today's neoliberal context.

Food Blogs, Gender, and Self Help
In the United States, self-help literature has been popular for decades among the masses, traditionally written by experts in the field and aimed to solve people's problems on an individual level. Today, blogs  (Rak, 2005, p. 176). Because of this, blogs are the perfect site to examine how individuals are discussing their "selves" in connection to food and health and a public conversation around these posts.
The existing previous research on food blogs in the social sciences looks at their gendered content (McGaughey, 2010;Noren, 2011). Women dominate the blogosphere as both producers of food blogs and consumers (Cairns & Johnston, 2015;Matchar, 2013;Parsons, 2015). For this reason, scholars have approached food blogs from gendered and feminist perspectives (Rodney, Cappeliz, Oleschuk, & Johnston, 2017) Academics have also researched how blogs are representative of disordered eating behaviors (Boepple & Thompson, 2014;Lynch, 2010). My research extends the analysis of self-help into the internet and more specifically, blogosphere, demonstrating how self-help alters and adapts to changes in technology.

Method
This paper examines the messages and framing of popular) chronic illness healthy food blogs (n=63)-defined by the presence of an illness, disease, or health condition negatively affecting the life of the blogger. Data for this project are collected from two main sources-personal health and wellness food blogs and personal Instagram accounts linked to these blogs. In order to determine which blogs qualified for consideration, a google search of "healthy food blogs" was conducted as a way of purposive homogenous sampling for those who identify as healthy food bloggers (Kemper, Stringfield, Teddlie, 2003 Next, I went to each blog site's "About" page. With the exception of one or two blogs, all blogs have "About" or "FAQ" pages. In order to be included in this research project, the blog author needed to mention any of these key words: "healthy", "wholesome", "whole foods", "wellness", "clean eating", "food as medicine" and/or make a connection between food and health. These words denote, from the blogger's perspective, a particular perspective and explicitly state the importance of the connection between food and health. If the blog's "about" page connected food and health the next step was to go to their Instagram profiles. Once I reached 200 blogs I went through each blog to collect data on these variables: gender of blogger, age range of blogger, nationality, race/ethnicity, geographic location, start date of blog, level of expertise in food and health (if any), type of diet or food preference, description of health journey (if any). For about ¼ of the blogs, this was relatively easy information to find and figure out. The gender was easy to identify through traditional gender markers such as dress, makeup, and identification as a mom. I determined the relative age range of the blogger through their reference to their age as a "20-something" or "30-something". If they did not explicitly mention age, I used pictures that they provided of themselves on the blog and the ages of their children (if mentioned) to estimate many of the women bloggers to be in their 30s. Statistically, data has also shown (Meyers, 2012) that most bloggers are women in their 30s. I determined geographic location usually by the explicit mention of where the blogger lived in their about page. If they did not provide this information, I went to their Instagram page. Some bloggers' Instagram profile pages provide location information. If this information was absent I scrolled through the profile's Instagram feed to look for any location tags.
Location tags are available when posting on Instagram to identify your location.
In terms of nationality, I used geographic location to clue me in to their nationality. I assumed the blogger was American if they lived in the United States, appeared white (the presence of light skin color), and did not mention being of another nationality, race, or ethnicity. For those bloggers who were not American, most of them discussed this in their "about" pages. They might say "I'm a Melbourne based food blogger, born and raised here" or "I'm one of the UK's top food bloggers", for example. I assumed the blogger was white if they had light/pale white skin unless they mentioned being mixed race or an ethnic last name.
One white appearing woman mentioned that she kept her maiden name "Garcia" when she married because she was proud of her Latino heritage on her father's side. I then categorized her as white/mixed ethnicity. If the blogger had dark skin and was American and lived in the United States and did not mention their race/ethnicity I categorized them as Black/African American in terms of race and ethnicity.
Bloggers with Indian background, Middle East Background, or Asian background usually identified themselves as such. I recorded level of expertise if the blogger mentioned having education or expertise in the area of food, medicine, or nutrition. I assumed they had no expertise if they did not mention. To determine the start dates of the blogs I used a variety of techniques if it was not made immediately visible in the about section through the blogger saying something like "I've been blogging since 2010". Because the layouts of blogs are all different I could only employ some techniques successfully on some blogs. On a simple blog layout, I was able to scroll to the bottom of the page where there was located a horizontal bar of numbers with arrows on either side. I was able to go the last page of posts and click on the very first post.
The date was usually recorded at the top of the post and I was able to determine the date of the first blog post.
Chosen blogs posts and Instagram posts (including image, caption, and comments) were coded using a grounded theory approach that combines deductive and inductive methods also known as abduction. The starting place for developing codes come from the initial research questions-informed by previous research and literature on this topic (Strauss & Corbin, 1990). The data are analyzed in relation to the research questions but theory is constructed from the data itself.
The blogs posts and Instagram posts were uploaded into a data analysis software called MAXQDA.
Through close reading of these posts, initial open coding took place, a process that allows for the description and categorization of portions of the blogs and Instagram posts based on their content. This entails identifying common words and themes and attaching a code to them and then writing initial memos about the data. Then another round of selective or "focused" coding occurred, which continued to identify important themes while eliminating others that no longer seem relevant. A codebook of relevant codes was created listing the codes and specific descriptions of the codes including examples and criteria for inclusion. Then focused coding took place, helping to refine the conceptual categories through the writing of advanced memos, turning codes into themes and concepts (Charmaz, 2006). When data saturation was reached, or no new data emerged the themes solidified and I wrote further memos about the data leading to potential answers to the research questions and further hypotheses (Bengtson, Endacott, Kang, Gonzales, & Silverstein, 2017;Kang et al., 2019).

Result
Almost every chronic illness healthy food blogger engages with two narratives related to their healthy journey: the benefits of altering diet and lifestyle and the failure of traditional medicine to address their health concerns. In this section I document how these women food bloggers discuss these two narratives.
I highlight the idea put forth by the bloggers that eating "real food" rather than engaging in modern medicine, is the path to a happier and healthier life, as well as the critical role of individual agency. In fact, it is the failure of western medicine that is the catalyst for the women to take their health into their own hands, utilizing their agency as individuals in a neoliberal world. My research positions these (mostly) white women food bloggers as subjects who both reinforce harmful individualizing ideology related to healthism while at the same time resist the imperatives of healthism and medicalization. They are complex subjects who exist at the intersection of race and class privilege while experiencing conflict with medical experts and the medical industry at large.

The Failure of Western Medicine
A major theme from the blogs is the failure of traditional western medicine to address the women's health issues. From diagnosis to treatment, western medicine seems to fail these women at every step. Bloggers point to this failure as the reason for why they took their health into their own hands or took "control of their health" as many bloggers say. Bloggers experience misdiagnosis, a lack of resolution for their health problems, and feel they are overprescribed pharmaceuticals, none of which get to the root cause of their chronic illness.
In terms of misdiagnosis and lack of resolution for their illness, bloggers say:  The method of taking health into their own hands, or this "other way"/alternate solution is changing their diet and realizing the power of whole foods and a healthier diet, "At the age of 12, I was taking 96 pills a week. Not so much your ideal childhood. Unfortunately, back then I had no idea that the food I was consuming was literally killing me. My doctors never mentioned diet to me, so it wasn't important, right? I was passed around from doctor to doctor, and unfortunately the most they could offer me were antibiotics, which basically worked like a short-term band-aid." Once again, the solution is in eating differently. As this blogger writes, The best thing I ever did for myself was to take the advice, that I should take my health into my own hands and "become an expert on you".
After a few years of suffering, multiple hospitalizations, and doctors telling me that what I ate wasn't a factor in my disease, I decided to take matters into my own hands and drastically change my diet.
The failure of western medicine forced these women to find alternate solutions to their health problems. The following section continues with the themes of individual agency and benefits of changing diet and lifestyle as solutions to the failure of western medicine.

The Benefits of Healthy Eating
After modern westernized medicine fails to address the women's health problems, the women take their healthy into their own hands. They do this through educating themselves on alternate forms of healthcare and alter their diet and lifestyle leading to relief from chronic illness. It is evident from the blogs that these changes result in empowerment, health, and happiness for the bloggers, freeing them from lives previously spent ill. Bloggers note a critical point in their journey where they realize that changing their diet will change their lives. For example, one food blogger writes in her "About" section: Instead of feeling better after my diagnosis, I continued to suffer many months of deteriorating health until I made the transition to the Autoimmune Protocol, slowly reversing vitamin and mineral deficiencies and greatly improving my health.
She makes it clear that it wasn't until she changed her diet and lifestyle through the "Autoimmune protocol" that she started to feel better. Another woman points to real food as a way that her and her family began to heal, "Through good, natural, real food my family has overcome Hashimoto's Disease, chronic migraines, IBS, severe asthma and eczema." Another blogger says: "In the midst of dealing with a ton of health conditions, I realized I could help heal myself by eating REAL food, instead of the processed junk that makes people sick."  and happier than ever before." Another writes, "I began by cutting out the foods that I believed were causing me discomfort-> gluten, meat, dairy products, processed sugar and processed foods. I started incorporating more fibre from fruits, vegetables, nuts, seeds and gluten free whole grains. By making these changes to my diet and adjusting my lifestyle I noticed myself feeling more energised, happy and healthy." And, "I KNOW, I know in my bones that real food is the key to health, and a healthy, thriving life is the key to happiness." Not only will real food heal but it will make you a happier, healthier person. The link between health and happiness is made over and over again throughout the blogs.
The connection between health and happiness is striking and is reminiscent of religion and the promise of salvation. The relationship between health and happiness is also well documented in research on advertising, demonstrating that in order to sell products to consumers, corporations inspire buying through appeals to happiness. Similarly, these women food bloggers are "selling" their approaches to diet through happiness.
The two narratives presented above: the failure of western medicine and the benefits of changing diet and lifestyle illustrate a tension between what I term empowerment and endangerment. A focus on individual behavior and responsibility is a source of empowerment for the bloggers who find freedom in making their own decisions and choices about their health. Empowerment is also found in creating community and helping others in similar situations. At the same time, an individualized approach to health (as opposed to a structural approach) reinforces ideas that are harmful to disadvantaged populations without the privilege or access to take control of their health in the same way (for example, access to certain foods and grocery stores). Consequences of these narratives include the endangerment of the audience and the broader population. The individualizing of social problems ignores structural and institutional mechanisms for health issues and inequalities and potentially misinforms audiences on health issues.

Empowerment
The women bloggers frame individual agency through a lens of empowerment. They push back on modern medicine and resist medicalization by western doctors, asserting alternative routes to health.
They take on the task of fixing their health problems themselves in order to help others in a similar There is hope that you can turn your health struggles into a health success story." The message and goal to help others who are suffering is clear in Deliciously Ella's about page. She says, We knew we wanted to bring what we were doing to a wider audience though, as we wanted make delicious plant-based food even more accessible. So shortly after opening the deli, we set about starting the larger, and most effective way of reaching the most people possible, which was to launch our food products business. We're only getting started on our journey, but our core purpose has remained the same from when I wrote my first recipe, which is to share the joys and benefits of plant based living. It gave me my life and health back, and between us we can help millions of others too.
Nutrition Stripped also discusses accessibility, We believe people should have access to the education they need to support their health in order to make small changes at a time-an ambitious goal, but one that's a priority for us. While we're a health and nutrition company and yes, a business, one that sells products, we're also a company that shares our educational work and content largely for free.
The empowerment felt by these women is similar to what is described by Alondra Nelson (2011) in her discussion of the People's Free Health Clinics of the Black Panther Party in the 1970s. She looks at the concept of "self-health" in the clinics and writes, "Self-health was an important and transformative practice among feminist health radicals. 'Know your body, know thyself' Armour remembered. 'Had I not been doing {self-examination], I might not even be here today'" (89). The PFHC were a structural www.scholink.org/ojs/index.php/csm Communication, Society and Media Vol. 3, No. 4, 2020 12 Published by SCHOLINK INC. challenge to medicalization while the food bloggers challenge the medical establishment on an individualized level. However, both foster community and in this way, are collective. As part of a larger collective, white women food bloggers are part of a community struggle to alter and change western medical knowledge structures, provide accessible information, and help others in similar situations.
Although the context of white women chronic illness healthy food bloggers and women of color in the People's Free Health Clinics is vastly different, there is a parallel between the resulting empowerment felt for both groups of women by taking their health into their own hands. However, the white women food bloggers focus on individualized approaches to self-health as opposed to the institutional and structural perspective adopted by the Black Panther Party.
Empowerment is also found by these women through resisting medicalization. Women activists and organizers in Figert's (1995)

Endangerment
While the women food bloggers use their individual agency to feel empowered and foster community, the messages about food and lifestyle proposed by the food bloggers are not only empowering but also endangering. The bloggers potentially endanger audiences on three levels: by individualizing social problems, through a dogmatic policing of diet and lifestyle, and giving out possible misinformation.
A source of endangerment is that the information on the blogs leads audiences to rely on individual level explanations and solutions for their health problems, sidestepping institutional and structural forces that shape health outcomes. Numerous quotes from "About" pages reveal messages such as this from Well Nourished, "Change begins with you as an individual but ultimately shapes your family, shapes your world.
Traditional neoliberal focuses on causes of health is largely individualized, "The focus on proximate risk factors, potentially controllable at the individual level, resonates with the values and belief systems of western culture that emphasize both the ability of the individual to control his or her personal fate and the importance of doing so (Becker, 1993)". This approach is particularly seductive for a variety of interest groups, including white women food bloggers because it targets certain core values of American society.
In addition, white women food bloggers possess the resources to achieve levels of health through individual intervention. Much of the food bloggers' messages line up with ideas connected to healthism which places responsibility on the individuals turning food choices into moral imperatives (Connolly & Prothero, 2008;Cairns et al., 2013;Moore, 2010). Healthism does not challenge inequality on a structural level, individualizing the perceived problem. The belief that an individualized approach to health will solve health problems is misleading and endangering.
In addition, the messages on these food blogs are somewhat dogmatic and result in potential policing of others' lifestyles. There is a general lack of acknowledgment in the blogs that different populations have different and unequal access to healthy foods and services. In Foucault's concept of "governmentality" Also, the bloggers guide audiences to question the medical establishment that could potentially be helpful depending on what illness they may be suffering from. For example, in the case of diabetes, if an audience member with diabetes refuses to see a doctor based upon the advice of a food blogger, their medical concerns will go unaddressed and may worsen. As most of these food bloggers are not medical experts with years of training, it is possible that their personal experiences with diet and lifestyle may not be right for everyone and in fact can be harmful, especially if the information provided by the blogger is incorrect.
The empowerment of chronic illness food blogging is balanced out by the potential endangerment from the messages on these blogs. Food bloggers tend to individualize health, leading to the belief that everyone is responsible and in control of their own health, ignoring structural and institutional forces that shape the lifestyles of individuals. This can lead to surveillance and policing of their own and others' bodies, especially bodies that are viewed as unacceptable in today's society. And finally, misinformation about health that is transmitted through the blogs to large audiences is dangerous to those from treatable ailments.

Discussion
The reach and influence of social media outlets like blogs and Instagram have greatly expanded in recent years. At the same time, so have the rates of chronic disease. Chronic illness food bloggers bridge these two worlds. This article demonstrates the role of women chronic illness food bloggers in providing audiences with information about health, diet, and lifestyle. There are two consistent narratives appearing throughout the 65 blogs-the benefits of healthy eating and the failure of western medicine. The failure of western medicine to address these women's health issues propels them to find alternate routes of healing. The main route they find is through changing their diets, which not only www.scholink.org/ojs/index.php/csm Communication, Society and Media Vol. 3, No. 4, 2020 17 Published by SCHOLINK INC.
heals them but also allows them to find happiness. The two narratives on the blogs create both empowerment and endangerment. Empowerment is created through questioning the medical establishment, resisting medicalization, and creating community among other bloggers and audiences who face similar challenges. Endangerment results from individualization of health issues leading to the belief that each and every person is entirely in control of their own health and well-being. This is dangerous because it fails to acknowledge structural explanations for health differentials. The narratives of the blogs are also endangering because they result in the policing and surveillance of health behaviors. And lastly, endangering because of the possible misinformation on these blogs and the advice directing away from western medical practitioners with the potential to solve certain health ailments.