Dominant discourses of health and fitness perpetuate particular ideologies of what it means to be “healthy” and “fit,” often conflating the two terms through conceptualizing the appearance of physical fitness as health. The discourse of healthism, a concept rooted in the economic concept of neoliberalism, fosters health as an individual and moral imperative to perform responsible citizenship, making the appearance of the “fit” body a valued representation of both health and self-discipline. This perspective neglects the social determinants of health and ignores the natural variation of the human body in shape, size, and ability, assuming that health can be seen visually on the body. Through a case study of one particular location of a popular commercial gym chain in an urban city of the Southwestern United States, this study employs a critical discourse analysis of the gym space itself including a collection of advertisements, photographs, and signs, in addition to participant observation and semi-structured interviews conducted with diverse women who exercise at this gym to explore how women resist and/or (re)produce discourses of healthism related to health, fitness, and body image. Ultimately, critical analysis shows that the gym itself produces and reifies the discourse of healthism through narratives of simultaneous empowerment and obligation. Though women in the gym reproduced this dominant narrative throughout their interviews, internal contradictions and nuggets of resistance emerged. These nuggets of resistance create fractures in the dominant discourse, shining light into areas that can be explored further for resistance practices through sense-making, necessitating a language of resistance.

Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation.