“Optimizing” Health in the Time of COVID-19: How Neoliberal Health Orientations Dictate Families’ Responses

Abstract

Neoliberal health orientations that emphasize specific health behaviors provide frameworks for how class-advantaged Americans understand themselves and their health. The family is a consequential pathway for such privilege to be enacted. Using dyadic interviews with U.S. parents and teenagers, the authors explore how families in two middle- to upper-middle-class, health-conscious cities reoriented their beliefs and practices around health in response to coronavirus disease 2019. Neoliberal health orientations were still the logic many families used to approach health, even as public health messaging focused on protecting vulnerable groups. The authors find that before and during the pandemic, teenagers experienced intense pressure to maintain a classed, thin body via diet, participation in sports, and exercise. Families that adhered closely to neoliberal ideals and encouraged these practices felt that their health behaviors boosted immune defenses against coronavirus disease 2019. However, parents and teenagers worried about the worsening of their fitness and diet. The authors discuss implications for public health and inequalities.

Adolescence is a developmental stage marked by self-discovery, including making increasingly agentic decisions embedded within group norms. Health is an important domain of identity in which teenagers must make choices informed by others’ viewpoints. Health orientations and the behaviors that enact them are socially classed. Specifically, the production of a thin, effortlessly fit body that is perceived to have been attained through hard work reflects class-privileged ideals (Luna 2019; Mollborn and Modile 2022). Neoliberal health perspectives, in which individuals are perceived as moral for disciplining their bodies, have gained traction as a status marker (Cairns and Johnston 2015; Charmaz 2020). Although this classed view of health has been intensifying over time (Crawford 1980), the coronavirus disease 2019 (COVID-19) pandemic introduced significant disruptions in viewpoints and behaviors around health (Manning et al. 2021). Health behavior emphases that were previously associated with less class-privileged groups, such as hygiene and hand washing (Mollborn and Modile 2022), suddenly eclipsed lifestyle behaviors in their expected implications for public safety, becoming salient for everyone. Public health messaging also focused on protecting vulnerable others from viral transmission. Given these sudden changes, in this study we ask: How did people in two class-advantaged U.S. communities with preexisting neoliberal health orientations make sense of and respond to health threats during the early COVID-19 pandemic?

We study this sudden shift in class-privileged norms around and understandings of health by interviewing parents and teenagers during the early pandemic. The families were in a longitudinal study for five years before these interviews. In this study, we use the previously collected data as context. We focus on separate interviews with parent-teenager dyads conducted in the early months of the pandemic. In these interviews, we found that parents and teenagers with high levels of investment in health performances that produced a thin body in line with middle-class ideals such as self-control felt that dieting and physical activity were moral decisions. When the pandemic abruptly changed their health risks and health behavior norms, they retained this neoliberal health orientation to help make sense of risk and protection during the pandemic, arguing that diet and physical activity gave them improved COVID-19 immunity. The health behaviors they believed fostered stronger immunity were used as a mark of distinction from other groups. Despite these efforts, parents and teenagers expressed intense worries about their worsening fitness and diet during the pandemic, reflecting extreme pressures given their articulation of physical activity and diet as strategies for avoiding the virus. Concerns about protecting others were relatively less emphasized. These findings illuminate how familial neoliberal health orientations can translate into new beliefs when sociocultural contexts of health change, intensifying norms and disparities.

Background

Neoliberal Health Orientations

Individuals enact a habitus, or an embodied and actionable reflection of a social location (Bourdieu 1986b). This Bourdieusian theory is far-reaching and has from the start addressed health and the body. Beyond sports participation as a raced and classed phenomenon (Bourdieu 1988), Bourdieu introduced the idea of bodily capital, or how appearance, perceived attractiveness, and physical aptitude are valued in community fields. Taken together with behaviors, bodily capital forms a signal of cultural capital, conferring benefits to those who can conform to standards that are more valued in their field (Hutson 2013).

Cultural capital bolsters group advantage by drawing distinctions between privileged and lower-status groups (Bourdieu 1986a). Since Bourdieu, the definition of cultural capital has expanded to focus on distinctions and local norms that can help explain the reproduction of privilege. Parents transmit cultural capital advantages to their children, including around health (Calarco 2011; Lareau 2011; Nomaguchi and Milkie 2019). Modern elites are encouraged to have omnivorous tastes (Peterson and Kern 1996) and are expected to perform both ease and calibration (Cairns and Johnston 2015), where they must demonstrate effort to attain an ideal, but it should also look easy (Khan 2013; Luna 2019). With displays of health, this translates to maintaining a thin body, exercising, and eating “right” while ensuring that this appears effortless (Cairns and Johnston 2015; Khan 2013; Luna 2019). Health performances supporting bodily capital are transmitted intergenerationally: children adopt a classed habitus from communities, parents, and peers.

Modern health is often framed as an achievement through personal choice (Crawford 2006). Mothers position themselves as moving children toward neoliberal ideals of health and childhood through ethical consumption (Cairns, Johnston, and MacKendrick 2013; Lauritzen 2008; Webster and Gabe 2016), including during COVID-19 (Calarco and Anderson 2021). Through dietary choices, privileged children learn to see themselves as morally superior, more knowledgeable, and putting in more work than low–socioeconomic status people (Fielding-Singh 2019). Much of this sense of self starts with cultural beliefs about health and value “In a health-valuing culture, [where] people come to define themselves in part by how well they succeed or fail in adopting healthy practices and by the qualities of character or personality believed to support healthy behaviors” (Crawford 2006:402). As such, with risk being socially constructed (Tierney 1999), individuals often frame morality and health around consumption, rather than responsibility to others (DeSoucey and Waggoner 2022). For example, some privileged mothers who distrust medical interventions choose to avoid fully vaccinating their children even though it may present a risk to other children (Reich 2016). Thus, health behaviors are key to constructing the self as virtuous.

Societal cultural trends undergird these constructions of self. Since personal health became a fervor in the 1970s (Crawford 1980), such displays of health are considered a neoliberal achievement. Neoliberalism emphasizes a lack of governmental involvement, positioning health and weight specifically as personal choices and promoting healthism as a panacea (Ayo 2012), which allows personal blame when people experience poor health (Charmaz 2020). As displays of health have increasingly become synonymous with middle-class values such as self-control (Crawford 2006), the ideal of a thin body viewed as reflecting a natural love of hard work and discipline explains how individuals enacting a white, upper-class habitus understand themselves as deserving of privilege, justifying inequality (Luna 2019; Mollborn and Modile 2022). Ultimately, the enormous cost of maintaining health is not seen as vanity but rather as a moral imperative for citizens (Ayo 2012).

The COVID-19 Pandemic

The pandemic has had broad societal impacts (Matthewman and Huppatz 2020). Although the onset was a challenging time for most individuals, the developmental impact on adolescents was outsized. This population experienced disruptions that negatively influenced their mental health (Andrews, Foulkes, and Blakemore 2020; Fegert et al. 2020) and magnified social control from parents (Fish et al. 2020; Gabriel et al. 2021). In short, youth who were already vulnerable were destabilized further during this time (Ghosh et al. 2020).

Early in the pandemic, hygiene and social distancing took over from diet and exercise as the salient concerns in public discourse, as did protecting the health of more vulnerable groups. None of these concerns was prevalent in neoliberal health orientations manifested before the pandemic (Brookes 2021), seemingly making them a poor fit for this new set of health risks. Yet neoliberal health orientations persisted and perhaps even intensified. In this study, we explore how neoliberal health orientations translated to the new context of a communicable disease in a pandemic. Because these parental attitudes can shape adolescents’ lives, we study parents and teens together to examine how health orientations and behaviors in families changed with the onset of the pandemic.

Methods

In this longitudinal study, we focus on families in two middle- to upper-middle-class communities in the western United States. Dyadic interviews with 23 parents and their 24 teenage children from 20 families were collected to discern how families understood health both before and during the pandemic. In this article, we emphasize two sets of 2020 interviews: wave 3 with parents and wave 4 with their teenage children. To collect data during the pandemic (Vindrola-Padros et al. 2020), interviews were virtual (Pocock, Smith, and Wiles 2021). Interviewees received $50.

About five years previously, we recruited participants for a study on “parents, kids, and well-being.” We recruited through social media, e-mail list servers, referrals, personal contacts, and public fliers to reach multiple community segments. Thus, this nonrepresentative sample includes families from multiple sociodemographic positions, neighborhoods, and social networks. Families from 23 elementary schools (private, charter, and public) and homeschooling families were represented. We observed 30 families in their homes and interviewed 56 parents from these and other families.

We contextualized pandemic interviews in the larger longitudinal study. The 20 families interviewed during the pandemic had previously participated in parent interviews, focus groups, and/or family home observations. The 20 wave 1 families that had also participated in wave 2 of data collection 2 years later were invited for wave 3 parent interviews during the early pandemic, and 17 families agreed. We supplemented this sample with 3 families that had participated in observations and interviews at wave 1 but not wave 2. Children aged 12 years and older from the wave 3 pandemic families were invited for wave 4 interviews. Our data followed these families through elementary, middle, and high school. Most had focal children in the fourth or fifth grade at wave 1 in 2015 to 2016. At that wave, most data were collected from mothers (80 percent). At wave 1, 77 percent were married and the rest divorced, single, or widowed. Most interviewees were white (86 percent), with 8 percent identifying as Asian American and 6 percent Latino. Most parents and almost all children were U.S.-born. We used occupation, housing, and education data to classify 59 percent of families as upper class, 29 percent as mixed or middle class, and 12 percent as working class or poor. Parents were on average 48 years old at the pandemic interviews, and teenagers ranged from 12 to 18 years old, with an average of 15 years. An institutional review board approved data collection. All parents consented to both their participation and that of their children in writing, and all interviewees also consented verbally during interviews.

The community sites, Greenville and Springfield, ¹ both had housing median costs and levels of education that were higher than the state average. Both were majority white, with Springfield having a significant Latino population. Greenville had a significantly higher housing median cost and more highly educated residents. For the themes discussed here, the communities did not differ substantially and thus were combined for analysis. Both communities placed unusually strong emphasis on classed behaviors such as diet, exercise, physical activity, and thinness. These communities also experienced overwhelming acceptance of COVID-19 isolation behaviors, social distancing, and masking. According to national data collected at the time, county residents self-reported high adherence to masking, with 80 percent reporting that they “always” wore a mask when around non–household members (Katz, Sanger-Katz, and Quealy 2020).

The waves of data collection represent two adjacent but distinct pandemic phases. Twenty-three parents were interviewed via Zoom from April to May 2020, which was during the implementation of stay-at-home orders and school closures. From July to August 2020, we interviewed 24 of these parents’ teenage children. These interviews were via Zoom and typically conducted in private spaces. At this point, the county where all but one family lived was in a safer-at-home phase in which people were required to mask and socially distance in public. In interviews, we asked parents and teens about how COVID-19 had affected family life, social contexts, health lifestyles, and health, as well as about how things had been before the pandemic.

We found the longitudinal and dyadic interviews important for uncovering patterns around ideas about health and COVID-19. Interviews facilitate understanding of motivations and social processes (Rinaldo and Guhin 2022; Small and Cook 2021). Dyadic interviews allow us to compare how parents and children talked about similar events or interactions. Although many dyads’ accounts agreed, divergences were analytically useful. We highlight quotations from interviewees here as a means to situate individuals in their circumstances for better understanding of how they made choices (Jerolmack and Khan 2017).

Electronic transcripts were manually coded using flexible methods using MaxQDA software (Deterding and Waters 2021). We first coded interviews from teenagers, then parents, then triangulated with previous waves of data. We began to code specific themes about health orientations. We focused on existing views on health, narratives about vulnerability to COVID-19, and how families handled exceptions to protocols. We returned to the data to cross-check conclusions. This analysis is interpretive, emphasizing that we do not know the truth of participants’ behaviors, but rather how they talked about their identities and actions (Lamont and Swidler 2014).

Findings

Families overwhelmingly followed community norms and local COVID-19 public safety protocols: both parents and teenagers described masking and socially distancing regularly, avoiding travel and crowds, and foregoing usual activities, especially those banned by local ordinances. These families were likely more compliant with COVID-19 regulations than in many other geographic locations (Janning et al. 2021; Katz et al. 2020).

Rather than focusing on behaviors, our analyses uncover specific cultural narratives interviewees deployed to characterize their beliefs before the pandemic (which we could cross-check against earlier interviews and observations), and how these narratives shaped their understandings during the pandemic as they integrated shifting risks and epidemiological concerns. In many families, both teenagers and parents described strong neoliberal health orientations, especially maintaining a classed, ² thin body reflecting stringent adherence to diet and exercise. Especially among parents, discussion of diet and physical activity was much more explicit than body size, suggesting the latter topic may have been taboo.

We found that this orientation had profound implications for how families viewed their own protections against COVID-19. Many parents with neoliberal health orientations believed this gave them stronger immune defenses and talked about using these health behaviors to protect their families from COVID-19. Because they viewed themselves as upholding a personal responsibility for maintaining good health through diet and exercise, they were able to draw on preexisting cultural narratives of distinction when approaching the pandemic. Despite public health messaging that focused on protecting vulnerable groups, these parents either avoided discussing others outside the family or held them up as a contrast to justify intergroup distinctions. We first establish how parents and teenagers described their pre-pandemic investment in neoliberal health orientations in retrospective accounts during the pandemic interviews, triangulating these narratives with previous observations and interviews. We then examine how families with neoliberal health orientations applied these cultural narratives and moral framings to make sense of health during COVID-19. This connected to what teenagers drew from these narratives and how understandings of collective responsibility did or did not fit into them. We close by demonstrating how these beliefs created new worries about health concerns because of the lockdown.

Neoliberal Health Orientations

Families spoke fairly similarly about Greenville and Springfield as hubs of health. They described expectations around being physically active and around healthy eating that involved fresh foods, eschewing “junk food” such as sugar and fast food. Parents described intensive investments of time and money in sports. They emphasized healthy food choices, such as banning sweets entirely or “always cooking from scratch.” Marian described how she conceptualized “a healthy lifestyle” for her daughter, saying, “What I push her to do is just eating healthy. Eating vegetables and eating fruit and eating, and making sure she gets exercise every day and good sleep.” This orientation to health was typical of parents.

Parents highlighted the choices they thought reflected good health practices. Quite a few parents talked about their children adopting diets they felt were healthier, such as vegetarian or gluten-free choices. Heather said of her daughter, “I think she’s veering toward vegetarianism,” and followed up by saying, “We could all stand to eat like her.” However, these choices came from explicit advice and rules rooted in long-held beliefs. When we first collected data from these families, when the children were 9 to 11 years old, many parents had strict rules around children’s diet and scheduled multiple sports or other structured physical activities. Gina said both she and her ex-husband “both prioritize nutrition and the exercise and lecture them.” Some parents were more strict than others. Ellen told us of an incident when her child was acting out, and after some questioning, admitted a friend had given her several kinds of candy. Ellen said she told her, “So I just explained to her what that does in her brain and how it changes her chemically like a drug would.” Parents often had strong beliefs and investments in neoliberal health orientations and communicated them through modeling behavior, discussions, and specific rules.

We asked the teenagers broad questions about their understandings of health, encompassing themselves, families, peers, and the community. We found they overwhelmingly defined health as diet, exercise, and thinness. Teenagers explained that multiple influences had shaped their views. They described community pressures to participate in sports and adhere to narrow definitions of nutritional health, such as omitting sugar entirely. Callie, who described herself as liking fitness and being on multiple sports teams, focused on activity and diet when describing health in her community and contrasting it to other, less “healthy” places:

Most people I know are involved in sports. We eat pretty healthy; we try to eat healthy. I think most people eat healthy too around here. People bike, people hang out outside, and go walk everywhere and go bike everywhere. I think people are pretty active, people bike everywhere. I’d say we’re on the healthier side of the world, I guess.

Teenagers were aware that their communities emphasized certain constructions of health.

Schools also espoused these ideas. Ellory sought help for an eating disorder in middle school after she “had a pretty bad nutrition class that still haunts” her. She explained that the class was calorie-based and sorted foods by “good” and “bad,” emphasizing the dangers of overeating. Bryce said his school focused on “trying to keep a healthy body.” When asked if that meant diet and exercise, he answered, “My classes mainly just taught what diet we should try.” Parker said that school messages about health were specific to exercise as well. The messages at school included “‘Oh, you got to do 30 minutes of exercise every day, stay healthy . . . .’ And, they always said it every day, that’s when it started.” Teenagers had a variety of views about whether what was taught in schools was positive, but those messages were in line with community norms reflecting neoliberal health orientations.

Teenagers had typically internalized local norms about body size. Elias said, “I think there is a bit of body pressure, just because it’s Greenville.” An athlete, he immediately connected health to his appearance: “Being healthy is very important to me. I just want to have a good physique, something I’m happy with looking in the mirror every day.” Similarly, Jake, another athlete, said that health “would mean not getting fat, I guess.” Several teenage interviewees feared gaining weight with age.

Alongside the communities and schools they had chosen for their children, most families articulated investments in neoliberal health orientations. Most teenagers named their parents as their main source of knowledge about health and making healthy choices. Hannah articulated a strong integration between community norms and her parents’ neoliberal health orientation:

[Where I learned about health] was mostly my parents because they really like to work out and eat vegetables and stuff. They’re kind of your average Greenville parents. And they kind of roped me into that lifestyle that was like, eat vegetables and work out every day. So that just kind of became what I do.

Most of the teenagers interviewed said that their parents set explicit health standards. The beliefs teenagers held affected how they understood their communities and created distinctions between themselves and others.

Although teenagers knew that their communities espoused neoliberal health orientations, families had differing levels of investment in them: Not every family emphasized diet, physical activity, or having a thin body as “good health.” Nearly everyone emphasized at least one aspect of this orientation, but some families did not adhere to all aspects, for example, by focusing on sports but not nutrition or emphasizing body positivity regardless of size. This was echoed in some teenagers’ resistance to some aspects of neoliberal health orientations. Ellory was typical of members of such families in feeling conflicted to a neoliberal health orientation. She felt that her community’s access to outdoor activities was positive but also said,

I did have kind of a disordered relationship with food for a while. I think [living in Greenville] was part of it, and body stuff, too, so I think that’s kind of a negative . . . diet culture stuff, yeah, was not so positive.

She felt most community peers were “healthier than the average teen” but said, “I think there’s a lot of high eating disorder rates and a lot of pressure.” Ellory simultaneously considered aspects of her community’s neoliberal orientation to be “healthy” and critiqued messages about body size and diet.

Neoliberal Health Orientations and Perceived Protection from COVID-19

The COVID-19 pandemic revealed how parents and teenagers used or adapted their preexisting health orientations in a new epidemiological context that emphasized social distancing and hygiene over diet and exercise. This new context also stressed caring for others’ health risks over one’s own for those in good health. Despite these rapid shifts, many families that adhered to neoliberal health orientations retained and deployed these orientations to make sense of health during the pandemic. Specifically, these parents spoke about shoring up their own and their children’s immune defenses against COVID-19 via diet and exercise to protect their families. Parents sometimes cited the “science” of the benefits of exercise and diet in relation to protection against COVID-19 despite a relative lack of public health messaging around the topic. In fact, the strategies described by these parents were not part of broader recommendations to protect from the virus, such as social distancing or masking (which families did adhere to). Narratives about collective responsibility or protecting others outside the family were typically absent or downplayed among parents. Implicitly part of, yet interestingly absent from, this conversation was obesity, a touchstone of classed health beliefs (Guthman and DuPuis 2006; LeBesco 2011) and, at the time, a much-discussed risk factor for COVID-19 complications. This reflected most parents’ (but not as many teenagers’) ongoing silence around obesity when discussing neoliberal health orientations.

“Boosting the immune system” via diet and physical activity was an explicit strategy to strengthen protection against the virus. Tara, a mother in Greenville, talked about her family’s use of health behaviors to boost their pandemic immune defenses: “We are definitely into getting lots of sleep, eating really healthy food, eating consistently, taking care.” Similarly, Monica referenced lifestyle behaviors and linked them to intelligence when describing her family’s COVID-19 precautions: “Our approach is about, we live healthy, we try to be smart, and we try to reduce risk obviously of contracting certain viruses.” Kathleen, who worried about her son Aiden’s mental and physical health during the pandemic, was explicit about teaching him that exercise could boost his health and protect him from COVID-19:

I definitely model it. I thought it was very egalitarian for me to create a house rule, so I wasn’t picking on anybody in particular. I just said to the family, I said, “I think there’s a strong connection between your physical and your mental and emotional health, especially during these times, so I think that all of us should spend at least 30 minutes moving each day. I don’t care what it is that you do.”

Many such as Gina had strong convictions about the “science” justifying this stance, stating, “I mean, it’s scientific. I think sleep is the biggest thing, and then exercise and nutrition. I’m really disciplined with myself on those things.” She elaborated on how that affected her family’s approach:

My main strategy is to get out every day. I think that’s really important for mental health and physical immunity. So I do two miles a day. Unless the weather is really bad, then I’ll do some yoga in the house or whatever. So that’s the main strategy, is to look after myself. So get physical exercise, eat really well, connect with friends and family through computers like we’re doing now.

Gina communicated to her children that these components were helpful for “optimizing” the body’s response to all manner of health threats, from the flu to cancer to coronavirus. Parents with neoliberal health orientations brought up boosting their families’ immunities through diet and exercise, concluding that their family had improved protection from contracting or experiencing complications from COVID-19.

Rarely did parents talk about both optimizing health and protecting others in the community. A notable exception was Alicia. She had a strong prepandemic orientation to family and viewed improved immunity as a way to strengthen family protections. Food and exercise, such as cooking or taking walks together, were emphasized as pathways to family bonding. However, Alicia and her family worried throughout their interviews about community members. She said,

I’ve said very explicitly, like, “All we have is our organism to defend us, and healthy eating, good sleep, and daily exercise is the best to keep our immune systems up.” . . . But especially with the exercise, I’m like, “It’s not exercise just to exercise. We really just have to be, everybody has to be, as healthy as possible because there’s a virus out there, and it’s very likely we’re all going to be exposed, or many of us at some point. And we have to keep our immune systems healthy.” So we’ve talked more explicitly about that.

Alicia spoke about how the family should be working to bolster their immune systems to be as healthy as possible should they be exposed. Throughout the interview, she expressed concern about coworkers and the older generation. In contrast, most interviewees who talked about improving their protections via immune-boosting health behaviors did not invoke others. Although there were widespread mainstream conversations around protecting frontline workers, interviewees typically did not bring them up except to highlight how lucky they were to be able to work from home or state that others should not be working in public. Similarly, although the national rhetoric during this time centered around healthcare workers as “heroes,” few interviewees from outside the healthcare field discussed this.

Not only parents but some teenagers used neoliberal health orientations to make sense of their family’s vulnerability to COVID-19. Ryan was committed to “eating right” for health. Before the pandemic, he played sports intensively and felt his family was more sports-oriented than most in Springfield, an active city. He said,

We haven’t been, I would say, the most cautious, because my parents think if you have a really healthy immune system and you’re staying healthy and keeping your body in good health, then you should be okay. But be cautious around anyone that’s had it, and that sort of thing.

He noted later in the interview that he had just heard of a teenage friend of a friend who had died of COVID-19. He said, “I would say some of my friends and me, too, don’t really care as much because you’re young. You’re not going to die from it. But that’s recently changed.”

Other teenagers with high investments in neoliberal health orientations did not talk about their immune systems, but they were also the least worried about their own vulnerability to COVID-19. Elias, who adhered to a very strict diet, became much less concerned about the virus once his grandparents survived it. He said,

I don’t think [my family is] that worried about getting it. I don’t know. I don’t know. I think they might be a bit weird about getting it, but I think it’s sort of stupid to be worried. It’s not like we’re very close to a solution, and there’s no real risk near anyone. I feel like it’s stupid to be this cautious.

These teenagers had long understood health as an individual responsibility to eat and move in certain ways and maintain a thin body. Like their parents, they were able to redeploy that understanding of health to strengthen their sense of protection against COVID-19. However, more teenagers than parents brought up concerns about community members’ health, as discussed below.

Not all families felt that neoliberal health orientations were an inevitable logic for understanding health during the pandemic, nor did all families center this behavior as protection against COVID-19. These other families had one of three reasons to deviate from the neoliberal health orientations that were so focal in their communities. These were families that were critical of neoliberal health orientations before the pandemic, families with a member with a chronic health condition, and low-income families. Rather than focusing exclusively on these behaviors as ways to build protection in their families, these participants spoke about concerns for their community and emphasized collective action in tandem with personal choices.

Neoliberal Health Worries

Families that had strong neoliberal health orientations and believed these practices protected them from COVID-19 worried considerably about how to enforce their usual high standards around diet and exercise in new lockdown conditions. These worries often resulted in extreme pressures. Parents mentioned these concerns more frequently than teenagers. Marian spoke about concentrating on healthy foods because her daughter had “been eating more unhealthy food during this pandemic because she loves to bake, so she’s been in the kitchen baking a lot more, so she’s making all these fattening, sugary foods.” She worried that her daughter didn’t care what she was eating and that now she was out of sports, “she’s used to being active, but during this pandemic, it’s just not. She just isn’t, so she’s not active.” When speaking about diet, exercise, and routine, she confessed, “I think just the worst part for me is more the paranoia about making sure that we stay healthy.” Her daughter did not discuss this worry, but she was an exception.

Some teenagers whose parents told us about worries around diet and exercise echoed these concerns. Monica was concerned that absent the structure of team sports, her son Elias was “exercising less now” despite his participation in daily physical activity. She worried about “managing” this and his consumption of fresh foods. Elias told us, “My health’s not great, but it’s okay,” in addition to feeling “out of shape” and like he was “getting fattier.” He elaborated, “I’ve been really lousy with training right now, even though I probably should be really strict on it. . . . I feel ashamed of myself like right now, because I’m being horrible with my [fitness].”

Similarly, although Michelle told us she was not worried about her daughter Hannah’s health, she mentioned concerns around gaining weight herself and Hannah “losing all her fitness outside of sports.” Although she said she was “allowing a little bit more inactivity” and liked baking, she said, “So we have baking projects all the time. Every weekend chocolate cookies are being made, or cupcakes, or something. Which is really yummy, but it’s probably not the healthiest thing.” When we asked Hannah how important it was to be healthy, Hannah said less so during the pandemic but followed up, “I feel like just because everyone on quarantine is like eating junk food and just like sitting around and watching TV.” Teenagers absorbed messages about these neoliberal health worries, specifically around diet and exercise, that were magnified in the lockdown.

Some parents were explicit that teens needed to exercise more or correct their eating habits during the lockdown. They discussed this in relation to worries about their own health. Tara said,

I’m cooking and eating a lot, and I’ve had a couple weeks of feeling disgusting, but I’m also exercising a lot and doing different things that I wasn’t doing, like I’ve been running, I ride my bike, which I never used to do. I still hike all the time. My daughter’s exercising a ton. My son is not exercising really at all. He’s lost all his fitness.

Her daughter, Callie, told us, “It’s so much harder to be active. It’s so much harder to find motivation.” She said of her physical activity specifically, despite working out daily, “I’m just trying to keep up with my fitness. Soccer definitely helps with that. It’s harder to find time to work out by myself.” Another parent, Heather, echoed this lens of her own health, informing her experience with her daughter Tori, saying,

She was just getting into this sitting for hours. It’s like, “You need to be aware of how inert you’ve become.” She said, “God, I feel better when I’ve exercised.” Or, “I’m sleeping better when I get outside.” I’m nudging her.

She said of encouraging her daughter to focus more on exercise:

Usually, you stay active to be healthy. I work out every day to be healthy, and it’s this very positive conversation, now it’s become this very loaded and heavy conversation. It’s strange to be telling them they’re not going to be doing things that are really important to their own health and wellness because of this larger, overarching issue. They’re smart people, they can understand that, but that’s a constant and difficult conversation that you’re having that you never would have had before.

Tori worked out daily, explicitly at her mother’s prompting. She said,

I would just do nothing all week. I don’t think it was very good for me . . . no more sports. I think around mid-April, my mom was realizing that we were having trouble keeping exercise up, so I started exercising six or seven days a week.

Teenagers who were careful about diet and exercise, often watching what they ate and working out daily, still identified pressures from their parents to maintain these health practices. Because adhering to neoliberal health orientations through diet and exercise were now considered the main way to protect oneself from COVID-19, in many cases, these extreme pressures had intensified even more than before the pandemic.

Discussion

Neoliberal ideas of health, in which individuals perform health morally by regulating their diet, exercise, and body size, are deeply classed. Although individuals performing these behaviors often believe they are doing the right thing as healthy citizens, it is a foundationally individualized orientation. Parent and teen interviewees who had long adhered to these ideas and integrated them into their identities portrayed themselves as having improved immune protection against COVID-19 because of their health behaviors. They deployed this perceived protection on behalf of their nuclear families and, although their social distancing behaviors generally adhered to official guidelines, were highly focused on physical activity, nutrition, and sleep. Although this strategy was not true of all participants, it was consequential for many privileged families navigating new terrain during the stay-at-home orders and produced pressures around diet and exercise. Despite working so hard to regulate diet, exercise, and body size, parents and teens alike expressed intense worries that they were not adhering enough to these ideals during the pandemic and were therefore putting themselves at risk, both for their physical health in general and for contracting COVID-19. These intensifying pressures likely mattered both for individual well-being and for inequalities.

In this study, most of the time, parents and teenagers took health mandates seriously. They adhered strictly to strong community norms of masking and distancing and often judged others who did not. However, interviewees who had strong preexisting beliefs in neoliberal health orientations did not often discuss risks to others in the community or essential workers. Instead, they applied existing narratives about their own and their families’ neoliberal health behaviors, such as diet and exercise, to the COVID-19 context. Thus, this translated into intensifying normative pressures around diet and exercise because of the lockdown and epidemiological stakes of the pandemic. Families believed their neoliberal health behaviors offered protection against COVID-19 and thus must be maintained. Parents did not have outlets such as school or sports to help handle the pressure of monitoring and enacting neoliberal health contexts. This further located the responsibility of maintaining these behaviors on the family. Adolescents were suddenly without ways to regulate their relationships to diet and exercise without their parents, which intensified scrutiny of these behaviors. This led to these families worrying about retaining a classed thin body through diet and exercise during the lockdown.

We contribute to the literatures on cultural capital and neoliberal health by using the pandemic as a site for understanding familial neoliberal health orientations. The intergenerational teaching of these behaviors and associating them with intergroup distinction and morality privileges children with more cultural capital (Cairns et al. 2013; Lareau 2011; Mollborn, Rigles, and Pace 2021). We argue that this orientation is therefore, in many cases, inherently competitive. The benefits conferred by a neoliberal health orientation work only if an intergroup boundary is drawn. Even without an imagined other to separate from, the neoliberal health orientation is not about promoting community health. At its core, in this orientation health is an individual or family endeavor, rather than a community one. Although the community was indeed an important source of norm transmission of neoliberal health orientations, these communities’ orientations were not perceived as prioritizing the health of the collective.

Future research should examine pandemic responses and narratives among class-privileged families in politically conservative communities, as our study sites were overwhelmingly liberal. Research must also disentangle racial/ethnic from class influences on health orientations and pandemic responses. We believe that synergistic privilege at the intersection of race and class at the community and family levels strongly shaped our participants’ narratives, but because of a lack of racial diversity, we could not disentangle these influences. Finally, heightened pressures on teens around diet and exercise spurred considerable stress and anxiety, whose longer term consequences our data could not explore.

As this study shows, narratives have considerable power, for example in justifying inequalities. We argue that public health campaigns must consider how teenagers are taught about health by families, schools, and communities, especially when preexisting neoliberal health behaviors emphasized self and family. The emerging pandemic necessitated group-focused epidemiological approaches, but preexisting notions of health were so strong that they outweighed these new notions for many interviewees. Public health messaging must wrestle further with the strength of preexisting beliefs. Emphasizing taking care of oneself through diet, exercise, and a thin body does not necessarily translate well to pandemic settings when the collective good is an important route to maintaining individuals’ health. The absence of a collective emphasis in preexisting health beliefs may lead people to struggle with reorienting their focus when faced with new epidemiological situations.