Rationales for Anti-aging Activities in Middle Age: Aging, Health, or Appearance?

Abstract

Purpose

We explore the motivations of middle-aged consumers of anti-aging products and services in relation to aging, health, and appearance. Admission of use of anti-aging products and services could align a respondent with a stigmatized group, old people, and also connotes a feminine concern with aesthetics. For these reasons, people, particularly men, will be unlikely to report using them for this purpose.

Design and Methods

Semi-structured, in-depth interviews were conducted among 19 men and women aged 42–61 years. Topics included their perceptions of bodily changes and their responses to these. We analyzed data qualitatively.

Results

Respondents frame their uses of anti-aging products in terms of health and appearance, not anti-aging per se. Both men and women see anti-aging as related to beautiful appearance and thus as a feminized activity. Both are concerned about appearance, but in gendered ways. Overall, respondents conflate bodily appearance, health, and aging in their constructions of anti-aging.

Implications

This conflation maintains inequality by stigmatizing old age as unhealthy and unseemly. Our results point to the limits of studying the consumption of anti-aging products and services if researchers ask only about anti-aging uses per se. They also point to the ways that discourses of health and appearance naturalize ageism, as they suggest that old age inheres in bodies that “naturally” decline and thus should be excluded.

Critical gerontologists have revealed ways that age intersects with gender to produce unequal outcomes for men and women in employment, as others assume that women age more quickly than men do (Hurd Clarke, 2011; McMullin and Berger, 2006). This paradigm focuses on how bodies serve as markers of this differential aging, just as they signify subordinate status in other inequalities (e.g., female, and non-White in a Western context). Partly due to demand for the eradication of such signs of change and fears of such loss of age status, the “anti-aging industry” has burgeoned. The American Academy of Anti-Aging Medicine (A4M) claims 26,000 members from 120 countries (WorldHealth.net, 2015); and estimates of the entire industry places its worth at $292 billion worldwide (Consumer Reports on Health, 2015).

Despite the massive profits generated by this industry, however, we know little about consumers, reported to number at over 90 million (NewYou, 2015). We do not even know what they consider to be anti-aging products and services. What comprises the anti-aging industry is neither straightforward nor simple; the products and services that fall under this heading are wide ranging, reflecting the complexity and breadth of cultural constructs of aging: physical changes, ranging from functional limitations to wrinkles; and how these are construed.

In this paper, we draw on the insights of critical, cultural gerontology and ask, who uses anti-aging products and services, and how do they describe coming to do so? Do they see them as responses to aging, and how might their paths toward such consumption vary by gender? We perform qualitative analysis of data collected from in-depth interviews among 19 middle-aged men and women in the United States, concerning their feelings about, and responses to, their aging bodies. Analysis of their responses can reveal patterns in the construction of aging bodies and how people may resist such signs in a postmodern era of body modification. In particular, the possible range of responses to bodily changes—related to issues of—may not be clearly differentiated. To the extent that consumer concerns with aging, health, and/or appearance blur together, they can naturalize age relations, likening old age to poor health and unattractive appearance, and thus justify age-based exclusion.

Background

Several factors can influence both the use of anti-aging products and services and the acknowledgment of their use. We begin with a brief discussion about pressures to engage in anti-aging strategies and then turn to stated motivations for so doing.

As a broad approach to aging, critical gerontology encompasses feminist, Marxist, and other critical perspectives on later life (Bass, 2009). These approaches share the belief that aging processes and experiences of old age are socially constructed (Phillipson, 2009). They explore the ways that intersecting relations of inequality, including various forms of ageism, shape those experiences (Calasanti, 2009). Foci include structured dependency, cumulative disadvantage; the medicalization of aging; naturalization of age inequality; and metaphors for aging that construct it as disease, death, and disability (Estes, Biggs, & Phillipson 2003: 3).

Since Butler (1969, p. 243) first described ageism as “the discrimination against people because they are old,” research has documented its pervasive and consistent nature. Inequality based in age relations means that, once deemed “old,” people lose power and status such that they are excluded from social institutions, denied citizenship rights, and lost control over their bodies and other resources (Bytheway, 1995; Calasanti, 2003; King, 2006). As a result, people often avoid identifying themselves as old, even to the extent of not interacting with others deemed to be old (Minichiello, Browne, & Kendig, 2000; Townsend, Godfrey, & Denby, 2006).

In this regard, critical, cultural gerontologists note that bodies serve as principal markers of age, such that changes to them alter status within age relations (Calasanti, 2005; Laz, 2003). Unlike such other inequalities as gender or race, status within age is temporal, such that the passage of time moves people from privileged categories—youth adulthood and middle age—to the disadvantaged status of old age (Calasanti, 2003).

Current constructions of old age present that process as malleable and under personal control (Estes et al., 2003). In this increasingly neoliberal context, with its admonitions that individuals take responsibility for their lives, science and technology promise to liberate us, and merchants, among others, pressure us to resist bodily aging. Although we cannot avoid aging entirely, the pitch goes consumers can and should buy anti-aging products and services to minimize its effects. As Jones & Pugh (2005, p. 254) note, such signs of aging as “sagging, wrinkling, and graying … are … symbols of a lack of control, which is unacceptable in contemporary society.” We may take such bodily signs of old age to indicate disease and decline; and many equate health with goodness and moral virtue. Attractiveness and health are thus linked in anti-aging advertisement, in which both men and women should strive to have bodies that appear good-looking and healthy as they age (Calasanti, 2005).

With its focus on old age as a subordinated, stigmatized social location, critical cultural gerontology researches the maintenance of inequality via the mundane social distancing from old age. In that context, we expect aging people to distinguish themselves from “old” people when they are able to do so. We study how aging people relate themselves to that subordinate group, as in the open consumption of products geared toward forestalling aging.

Whether, when, and why consumers use anti-aging products and services remains largely undocumented. Overt use of “anti-aging” products and services requires admitting concern about aging and acknowledging movement toward membership in a stigmatized group. Furthermore, Fishman, Settersten, and Flatt (2010) argue that the general public perceives the term “anti-aging” to focus on aesthetics and thus predominantly the realm of women. By contrast, people tend to see health as a higher ideal, even a duty (Hurd Clarke, 2011), in which the body is “a site for moral action” (Conrad, 1994, p. 385). Lay understandings of health are broad and include aspects ranging from absence of disease to functional ability, energy, and healthy lifestyles (e.g., Herzlich 1973, Jylhä, 2009) and thus might subsume anti-aging practices as well.

Anti-aging practitioners contribute to the conflation of aging and health as they distance themselves from both aging and aesthetics, adopting new labels for their services and practices that stress health and the lifelong nature of their endeavors. Employing such names as “preventative medicine,” “functional medicine,” and “age management medicine,” these providers emphasize health and aging as a process that can be managed. Thus, clients are not old people but are middle aged; middle age brings awareness of bodily changes and should inspire us to “manage” our aging (Fishman et al., 2010). As Fishman et al. (2010) and Mykytyn (2008) show, anti-aging practitioners present themselves not as “curing” aging (as if it were a disease), but instead as “optimizing”: aiming for health that is not just “excellent health ‘for his age’” but at its peak, “the best-a-body-can-be-and-has-ever-been, generally denoting a 25–30 year old body” (Mykytyn, 2008, p. 317). Mykytyn argues that, as a result, anti-aging “is the ultimate form of medicalization. Effectively everyone is/will become a patient because a diagnosis need not precede intervention. [Anti-aging] … is focused as much on health preservation as it is on health restoration” (2008, p. 317). This medicalization blurs the line between anti-aging and the promotion of health, removing it from the realm of later life (and association with a stigmatized group) while also emphasizing its importance to younger ages.

What we hear from consumers about the anti-aging industry may follow this trend toward conflation of anti-aging and health. Still, appearance concerns may also be mixed in, as bodies serve as markers of both age and health. Thus, men and women may both concern themselves with how their bodies look, and research indicates that they may do so in gendered ways. For instance, aging men are focused on musculature and the appearance of physical capacity, while women’s concerns relate to beauty (Hurd Clarke, 2011; Hurd Clarke and Korothchenko, 2011). Along these lines, Lodge and Umberson (2013) find that middle-aged men focus on how their bodies appear to function. However, they also find that the gay men in their sample focus on appearances in terms of youthful attractiveness. Thus, the intersections of sexuality with gender may complicate this picture.

To summarize, motivations for using anti-aging products and services can reflect concerns related to age (trying to avoid a negative status), health, or appearance; and stated reasons might both conflate these and vary by gender. This paper draws upon interviews among middle-aged respondents to examine the extent to which they attribute their use of anti-aging goods and services to shifts in age, health, and appearance. Results indicate that respondents use many anti-aging strategies but rarely label them as such.

Present Study

This study uses U.S. data gathered from in-depth interviews collected in 2006 and 2007 from middle-aged (aged 42–61 years) men and women. The sample was gathered through a combination of convenience and snowball procedures and was diverse by gender and sexuality; of the 9 men and 10 women interviewed, 16 were heterosexual and 3 were nonheterosexual. In other respects, the sample was relatively privileged. All were White and fairly well-educated: of the 6 who did not have a college degree, 2 had high school diplomas and 4 had completed from 1–3 years of college. The remainder of the sample (11) had completed college and even advanced degrees. All were employed, with 15 occupying professional and semi-professional positions; 2 held pink-collar jobs; and 1 each man and woman worked in labor that was primarily physical in nature.

These data were collected as a part of a larger study that received institutional research board approval and sought information on men’s and women’s experiences of and responses to their aging bodies. A qualitative, open-ended approach was employed as the goal was both to explore bodily changes and the terms in which respondents made sense of these. A semi-structured interview schedule allowed interviewers to use questions consistently across interviews, but flexibly, to allow for free-flowing discussion of topics as they came up and for the emergence of issues that interviewees found personally relevant. Data were collected and analyzed in an iterative process, leading to the development of new questions in later interviews (Taylor & Bogden, 1998). Topics covered in the interview guide included respondents’ changing bodies and concerns; their ideas about age-appropriate behaviors and appearance; ageism; knowledge and use of anti-aging products and services; and their thoughts about growing older. To ascertain respondents’ use of anti-aging products and services, respondents were asked, first, what “anti-aging” products and services meant to them and then whether they engaged in such anti-aging activities. Later in the interview, they were asked about their use of different products and services that Mehlman, Binstock, Juengst, Ponsaran, & Whitehouse, 2004, p. 305) derived from their study of the anti-aging industry. This list that we refer to as the anti-aging industry (AAI) list in our analysis includes “cosmetic treatments and surgery; exercise and therapy; food and beverages; vitamins, minerals, and supplements; and cosmetics and cosmeceuticals.” While some of these strategies might be more extreme, time-consuming, or costly than others, to the extent that they are touted as anti-aging, we sought to understand the degree to which consumers see them as such, why, and how this might vary by gender.

Conducted at locations chosen by respondents, interviews averaged more than 2hr. They were recorded digitally and professionally transcribed, with the exception of one, in which technological failure intervened. In this instance, the handwritten notes taken at the time of the interview were used for analysis. The analytic strategy involved a process of inductive reasoning and theorizing (Taylor & Bogdan, 1998). The first author developed an initial code sheet. She and two other researchers then read key interviews independently. Intercoder agreement was reached through a series of discussions wherein codes were modified and finalized. We used QSR NUD*IST 6.0 to examine further themes already delineated and to explore their relationship with one another. This software did not guide the analysis per se but provided ancillary help.

Findings

The Meaning of Anti-aging: Appearance as Beauty

All respondents, whether they believed in the efficacy of anti-aging products and services or not, said that these have to do with appearance, by which they meant beauty. For example, Carrie said that anti-aging products and services were about “Appearance….[They are fighting] looking old, appearance of skin, skin, hair, weight, cellulite….[Y]ou lose your smoothness, wrinkles, … sagging, the skin sags. Ah, elasticity. … Hair loss …Cellulite … Lumpy … Not smooth anymore.” Even though Shelly doesn’t believe anti-aging products work, she sees them as linked to appearance conceived in terms of the attractiveness of smooth skin rather than the visual spectacle of some sort of activity or performance: “It’s a joke to me … it’s just silly, the concept that you think this moisturizer is going to work that much better for you than that moisturizer, when you should have been drinking water and not smoking and limiting your alcohol intake as well as exercising the whole way through and then you won’t have all of those wrinkles.” Likewise, Dreama depicts anti-aging in terms of beauty, as a product for women: “Anti-aging means … Botox or some laser or some skin stretching, whatever. … [Trying to fight] wrinkles mostly and sagging skin…. And … women with the breast jobs, you know they don’t like sagging breasts and they want to have that youthful look so they have the implants.”

Given this equation of appearance as beauty, respondents regarded products for aging men not as “anti-aging” but in terms of activity and performance. When John was asked about what he thought it meant if a product or service calls itself “anti-aging”, he responded, “That would mean to me that they will focus on your appearance and help you to achieve particular qualities that are seen as youthful. That might mean hair color; that might mean skin treatment. I see those as definitely the two big things. …When I hear about anti-aging products, I primarily think of them focusing in my mind as appearance. I mean, do I consider Viagra an anti-aging product? Not in that sense.” For John, equating Viagra with performance rendered it not an anti-aging product. Aligning anti-aging with beauty, he defined Viagra out of the realm of anti-aging altogether.

Finally, Carl related anti-aging activities to appearance in the gay community as well. When asked if some gay men take part in anti-aging activities, he spoke of men in a city with a relatively large gay population, and said, “Oh, sure. I mean I think if they had the money I am sure they would. … And if, well, … man, if you look at the [dating] ads from [the city]…. [The guys are] … either much older or early 20s, and the older guys are doing things to make themselves look younger. … They all either seem to be physically fit and have had some sort of cosmetic surgery (laughter!) or they are very wealthy and don’t seem to care.”

Conflation of Aging and Health

That respondents identified anti-aging products and services so readily with beauty and with women (and, apparently, a heterosexual context) may have deterred them from admitting their use, as we have shown earlier. However, examination of their responses to the AAI list reveals that they also avoided acknowledging their consumption because they had conflated aging with health. Any respondent may see that what she or he does as an individual is about health, a legitimate focus for bodily practices that does not align the respondent with those who are growing old. Respondents sometimes spoke of health and aging as if they are the same, that one indicates the other, as is apparent in Carl’s allusion to physical fitness, above. Either way, ill-health and advancing age remained entwined in their minds.

For example, in talking about why she uses anti-aging products and services, Elizabeth said, “It’s hard for me to separate health from aging right now.” Nora said that she exercises for about 20min in the mornings, “both for health and anti-aging, but again, anti-aging means maintaining health.” Finally, when discussing impotence with aging, Mike said that, “if you live a healthy lifestyle and do what you are supposed to do, you aren’t going to have any problem. Statistically, most people are not going to have any problems.”

Jake’s interview exemplifies the conflation of anti-aging and health motivations, one that fits well with anti-aging practitioners’ views. Jake is aware that human growth hormone (hGH) is promoted as an “anti-aging” product, but claimed his interest in it—and in the endurance drink he imbibed during the interview—bears on optimizing health and performance: “I don’t think of [those products] … as slowing down [aging]…. I think of them as enhancing your performance …. And to be honest with you, if they were legal, I would use those things … [M]y opinion on hGH is, if it makes you faster, stronger, you have to tell me what’s wrong with it, you know. … I would have no problem if those were legal [to] use them. … I never used … steroids because they are harsh on the body, and I know that. Never have, never will, but the hGH product is not that hard on the body and it helps you heal, you know... [B]asically the things that I’ve used are … performance enhancing, not, definitely not anti-aging. It’s more like getting stronger, faster.”

Respondents asserted that the route to both health and the fight against aging required remaining active, being energetic, performing. Mike says, “It’s the adage, ‘if you don’t use it, you lose it.’ So, the less active you are, the quicker the aging process is gonna come up on you … You never stop [working on your body]. That goes on forever.” Similarly, Shelley spoke of the importance of being a “participant in life” for aging well: “you aren’t sedentary …. you are moving around and you are an active participant in life versus a couch potato … and I think that makes a difference.” In Jim’s depiction, old age is the opposite of being active, a stance that again conflates aging with health/physicality. He says, “I do associate aging with sedentary existence, and so if one appears more youthful, then one is less likely to be sedentary. And I view sedentary as decline ….”

These excerpts show that respondents often equated their attempts to avoid aging with maintaining their health. At the same time, their conceptions of health remained vague. They spoke of health less as absence of disease and more as physical capacity and performance. Their accounts also include normative expressions (“what you are supposed to do”) that exemplify the moral dimension of maintaining health.

Conflation of Aging and Health With Appearance

Sometimes, respondents conflated aging, health, and appearance. For example, Maggie noted that anti-aging products are for “wrinkles. … It’s a big one obviously. It’s skin stuff you know. Vaginal dryness. Ah, sagginess. Memory loss. Just health stuff.” Later in the interview, she noted that anti-aging products were meant to avoid “being labelled as unattractive. A lot of those products are aimed at that. All the stereotypes about being forgetful and hmm, what else? I guess just generally not as capable.” Here the equation of appearance with age and health was even more apparent. To be unattractive meant to be deemed old and incapable.

Indeed, when describing what they saw as an attractive person for their age, overwhelmingly, respondents spoke both of health, judged on the basis of appearance, and of aging. Shelley mentioned people who look good for their age as those who “have taken care of themselves up until now and so they look healthy; you can tell they have maintained more of a healthy lifestyle; that they continue to take care of their appearance rather than … letting things go …you still try to put an outward appearance. I think it’s how you dress and how you carry yourself, too. … [Y]ou can tell they have to have a healthy lifestyle or they wouldn’t look that good.” Likewise, Dreama noted that, in judging if someone looked good for their age, “I would be looking at their overall appearance, how they took care of themselves and their energy level, their vitality …”.

Mike followed suit, speaking of apparent health and age. “I evaluate on how I think they can act. I can look at their body and evaluate their body and pretty much figure out what they have done to be able to maintain where they are at with respect to their age. I’d go yeah, that’s pretty good, this person’s led a pretty good life, … they probably have good eating habits….Looking good doesn’t mean that you are at an ideal weight … but you can tell a person that is proactive with respect to trying to maintain themselves.” Carl also maintains that, in later life, to be attractive, one need not be model-thin but can look active instead. Speaking of a middle-aged man whom he finds good-looking, Carl, says, “He’s certainly in good shape. Not you know like hyper-good shape … but you know, fit, active. Well dressed. Not jelly. … I mean he’s fit, but he’s older so it’s not that trim sort of sinewy look anymore. It’s a much fuller look that I associate with a sort of healthy middle age that I think is really attractive.” Shelley also says it isn’t so much about being the perfect weight per se, but activity: “[M]y brother who is very gray looks great. … [H]e looks healthy and he looks active and he looks like he participates …I think that’s really what makes the difference.” The alternative to participation is exclusion. Respondents’ focus on activity allows them to relate this concern to health rather than aging per se and thus avoid aligning with a stigmatized group.

The links between good health, attractive appearance, and responses to their aging is typified in Shelly’s discussion of the AAI list. She acknowledged engaging in diet modification (which included taking supplements and vitamins and being careful about what she eats) and when asked whether she was doing so based on concerns for health, appearance or aging, she said, “I think all of the above, because I think the appearance piece of it is, if you don’t watch it, it gets out of hand and then you snowball, and then it’s so hard to go backwards, so yeah.” Particularly when considering exercise or diet, others responded in similar ways, regardless of gender. For instance, when asked about his motivations for his dietary regimen, John included health, aging, and appearance among them. He explained, “So, you know, health, in terms of my heart and cholesterol especially. Appearance, to be thinner. And, I guess age, in the sense of just keeping my joints younger in that they are not carrying on as much weight, I guess. … [I]t’s hard for me to [separate], I mean do I look younger because I am eating a lot of fiber or whatever? I guess in a sense that if older equals fatter, I guess that’s true.” Similarly, Mike, who took vitamins, minerals, supplements and herbal extracts, and who also worked out 6 days a week, was asked whether this regimen was based on health, appearance, or aging concerns. His response was that it was, “The whole package.”

Such statements demonstrate that, in our respondents’ thinking, health can be inferred from appearance and that an active, slim, fit, and energetic appearance indicates good health and relative youthfulness. A healthy appearance is also conceived of as a sign of a proactive, responsible attitude toward maintaining one’s body and health through lifestyle, leading “a pretty good life”. These respondents distinguish between healthy, active, responsible, and youthful bodies on the one hand, and passive, careless, and old bodies—the “unhealthy others” (Crawford, 1994)—on the other.

Gender and Motivations for Anti-aging Activities

When we consider how gender shapes stated motivations for use of anti-aging products and services, we see that, indeed, respondents see anti-aging as concerning beauty and thus primarily as woman’s purview. Only women talked about anti-aging strategies in relation to appearance defined as beauty; they were concerned about not becoming “invisible,” as both Elizabeth and Mary put it. However, this does not mean that men did not care about their appearances. Instead, men would talk about care for their appearance in terms that focused on shaping bodies to look like they can perform.

Women: Appearance as Beauty

Earlier, we noted the ways in which respondents viewed anti-aging as women’s activity, motivated by aesthetics. As Shelley said, “[H]ave you ever noticed … that there’s nothing out there for men for anti-aging or very little … except for maybe going bald? … But it’s predominately geared towards women.” Implicit in this statement is that anti-aging products are cosmetics.

Indeed, many women were clear that they were concerned about their beauty. For instance, Maggie said, “I think you want to look good as long as you can.” She then discussed a long list of products and services she used, including moisturizers, alpha-hydroxy lotions, lipstick, and hair dye. She was also concerned to exercise, carefully regulate her diet (including ingesting various vitamins and supplements) and choose clothing to enhance her attractiveness (although she also discussed health and age as motivations). Barb noted that for women, advertisements revolves around wrinkle creams and balms to put “under your eyes and take away the bags and all of that.” Finally, Elizabeth said, “Oh, I buy them all. … I am always trying something different. … One is for wrinkles, one is for age spots … So, yeah I am always looking for something.”

Further, these products were not seen to be for men. Sue thought for a while about what anti-aging products might be related to men, eventually saying, “[T]he only thing I can think of for men … is Grecian Formula. (laughter!) … That’s the only thing I can think of … I don’t think of men using anti-wrinkle creams, those kind of products.” Similarly, Mary expresses an awareness that anti-aging equates to attractiveness for women, regardless of the means to get there: “I think a woman’s appearance is much more … there’s more things that you have to live up to in terms of, you know, hair and general fitness and a feminine attractiveness, all that kind of stuff … I think men can be sexually attractive all their lives really, but [for] women, there’s a cutoff point. There’s more, [women have] to do a lot more to maintain the illusion … than men do.” Nora also see such products for women as dealing with “the possibility of being viewed as unattractive and being viewed as irrelevant … and defined as, you know, having neither attractiveness nor use.”

Even anti-aging products and services not touted for aesthetics per se were seen to enhance women’s beauty as anti-aging, health, and attractiveness become intertwined. As Dreama said, “If you can do things that keep you from aging that’s not gonna be putting you in debt … then I think it would be good for you. I think … eating properly, nutrition, nutritional supplements, and if you could have a massage or any of the stuff that makes you feel good inside, it’s gonna show outward, and then all that beauty itself makes you feel good.”

Men: Appearance as the Image of Performance

Respondents also acknowledged that men also should be concerned with their appearances but said that they do so differently. Men need to look like they could perform. Nora delineated gendered approaches when she said that, for aging men, demonstrating their value revolves around “being able to perform, whatever [that] might be. … So, for women it’s very much about maintaining youthful appearance, skin, hair and so forth and for men as well, but for men it’s also about keeping your abs fit and your dick hard and all that stuff. [laughter!]”

As we have shown in another report on this research, men often talked about the importance of having strong bodies—not just actual strength but also bodies that looked like they could perform (Calasanti, Pietilä, King, & Ojala, 2013). Darryl was proud to give his chest measurements as a sign that he was still in good shape; he also feared looking like he was not physically fit: “The thought of becoming the beer-belly, suffering from the ‘donelap’ disease—his belly had done lapped over his belt buckle—bothers me.” Likewise, Mike noted, “I enjoy being strong, therefore I do things to make sure that my strength maintains itself.” And Jake spoke of the importance of being physically fit, and his subsequent ability to perform: “I’ve always worked out. … all my life … I just remember football and running railroad tracks to try to get in shape and understanding that someday you may not have a lot, but if you can just be physically fit and healthy then you can ward off whatever…..”

Power, or at least looking powerful, is key. As Mary noted, “I think for men the whole notion of potency is just overwhelmingly important and dominating in advertisements and consumer imaging of what men need to counteract their aging.” And of course, as this statement and Nora’s make clear, the emphasis on strength and performance relates to the sexual arena as well. Carl elaborated the importance of sexuality in this way: “a lot of the products for men seem to focus on virility, sexual ability, keeping it up, getting it up, making it up (Laughter!). …. It’s maintaining your ability to get an erection and it’s also for maintaining muscle … it’s all part of that potency. The more muscular you are the more sexual you must be, I think.” In fact, most respondents spoke of the centrality of sexual performance to men’s anti-aging strategies; when they focused on performance rather than beauty, Viagra emerged as a key anti-aging product for men.

Although the focus on women’s attractiveness is also about being sexual, the emphasis here is different: women are to look attractive to signify they are sexually available to men. By contrast, an active, initiating sexuality is seen as central to masculinity. Reflecting on the use of anti-aging products and services for reasons of appearance, and differentiating between the importance of sexuality and virility to men versus women, Carl said it is “symbolic of something I suppose, you know, in the sense that it’s going to be … the way you can capture some other people …. I really think … being a man is very tied up with virility. So I don’t know that it is about other people. I really think it’s about being a man. It’s about yourself. For women, it’s about other people. It’s making that appearance impression different.”

As well, both men and women asserted that what men do concerning appearance generally differs from what women do. Men cannot use “an easy fix”; it must involve work. For example, Jake says that products for men and women are “totally different” and that men are “always going to be … looking for quite simply to be big and stronger ….” He believes it is easier for women to use products for appearance; and while he’d like to use some of those products, he realizes it would be inappropriate. Note in this excerpt as well how he conflates appearance, aging, and health: “For me to color my hair would probably be, man, you probably shouldn’t do that, you know? … I mean I don’t know too many guys … that color their hair that I would say [it] was probably a good idea. … I tell you right now, if I could not have gray hair, I wouldn’t have gray hair. ... that’s one thing that would definitely give my age away … but then I go, you know what? … I try to work on things that I can …. I think I’ve developed a good game plan on [being] healthy…because I don’t find attractive a 50-year old [man] that I go, ‘God, is his hair colored?’”

Others mentioned that some men might begin to use such things as skin care products a bit more than before but that this was not their main approach to anti-aging, nor would it be something that should be acknowledged publically. After Mike criticized those men who would opt for “a quick fix … put a Band-aid on something instead of taking care of what the Band-aid is covering,” he noted that, “males are doing this Botox mess, too … and all this kind of stuff … [But] they are not gonna advertise it like the females would … I think the guys still wanna hide that a little bit more … And I think the females want to promote it a little bit more to let the guys know that they are trying to do something to make themselves younger, to make themselves look better for you.”

Thus, while men may care about their aging appearances, and a small number might even engage in some of the beauty regimens mentioned by women, they would not characterize it in the same way or want others to know. By contrast, women (who are assumed to be heterosexual) would want men to know that they are trying to look better for men. As Jake said, “I think it’s presumed that … a woman will do… whatever to try to fight these [appearance] things, and … it’s not something men are proud of ….” John concurs, “You know I think people would look differently at a man when they know he colored his hair than they would a woman if they know she colored her hair.” In fact, in Darryl’s view, concern for how she appears to men is the essence of femininity: “I can tell a difference in women that take pride in being a woman than the ones that don’t care and don’t have any self-pride. I’ve seen women that are not the most attractive, but they do the best with what they’ve got and they worry about it and they doll themselves up—they work with what God gave them. I’ve seen other woman that got the tools to work with and don’t care. That disturbs me. … It doesn’t take a lot for a girl … to try to doll themselves up to look like a woman.”

Finally, as Mike’s previous comment indicated, men made clear that they believed that one needed to work at their appearances. Greg talked about the importance of “burning it off” if he ate something he should not, by which he meant exercising. He said “you … want to stay physically fit [and] that’s clearly anti-aging. …but I subscribe to the fact it requires work. It is work.” And while Jim says he has come to realize that “work harder doesn’t solve everything,” he also admits that “I still work hard to control things. [laughter!]” Women also talked about the importance of exercising, eating well, or otherwise monitoring their bodies, but they never talked about it as work.

Discussion

In this study, we use a critical, cultural gerontological approach to explore the reasons middle-aged adults give for their use of anti-aging strategies. This paradigm focuses us on the subordination of old people that social distancing from old age sustains. Despite entering a time of life where bodily changes become hard to ignore, we suggest that middle-aged people maintain ageism by disavowing engaging in anti-aging for two reasons: (1) they do not align themselves with a stigmatized group—old people and (2) in line with previous studies (Fishman et al., 2010; Hurd Clarke, 2011), the label “anti-aging” attaches to beauty, the purview of women only. The men are highly unlikely to say that they do (or should) engage in anti-aging activities. To do so would be doubly stigmatizing, associating with two marginalized groups, women and old people. Where women may focus on beauty, men disavow that pursuit and speak of performance instead.

Given the neoliberal dictates of individual responsibility for health (Crawford 1994; Estes et al., 2003), and the wide range of what can fall under that, it is not surprising that our respondents often ascribe their behaviors to health. However, both women and men among our respondents conflate health with aging and appearance. Not only did they often provide two or more reasons for bodily practices but they often equate one to the other such that, for example, using an anti-aging product might be thought to be helpful to health and thus also prevent aging. In their accounts, “good” and youthful appearance suggests an active lifestyle and individual responsibility to live properly. This healthism, an individualized concept of fitness achieved through consumption and discipline, roots bad health in personal flaws and moral failure.

Documenting this conflation of health, appearance, and aging helps us to understand the logic of some anti-aging medical practitioners and to see the ageism that can underlie their discussions of health. Activities focused on health reaffirm both the morality of the individual and the supposition that we can read health on the surfaces of bodies. Appearance thus becomes an issue of social assessment and judgment (Skeggs, 2005). Those unwilling or unable to meet expectations regarding healthy and active appearance risk being deemed to be “aging” in the negative sense of that word.

Few people would say that the improvement of health posed a problem; and we do not argue that here. We point instead to the critical issues masked by the conflations documented above. First, the conflation makes the effects of anti-aging difficult to measure. Because many respondents define anti-aging in terms of health care, they do not report it in “anti-aging” terms. Researchers relying on such self-reports must be wary of what and how they measure. Second, the neoliberal emphasis on personal responsibility implies more control over our health than individuals have, as well as over the outcome of social policy not obviously amenable to personal consumer choices. Third, discourses of health and appearance naturalize ageism, suggesting that stigmatized old age inheres in bodies that “naturally” decline and thus should be excluded, unless persons can somehow reverse the process through aggressive consumption.

These conflations promote the ideas that (1) the low status imputed to old age is mere expression of nature, (2) we can control, even reverse our bodies’ aging, and (3) others can infer age on the basis of health and discern one’s health from appearances. The gender differences in how men and women judge appropriate appearances remain important, but the ultimate message is similar: men who are healthy and not aging look like strong, active performers; women who are healthy and not aging are attractive and “toned”—their bodies are smooth and without cellulite but not necessarily strong. These gendered perceptions affirm that those whose bodies do not meet these ideals may count as both unhealthy and “old” and thus deserve exclusion.

Limitations on our research result from the small sample size and narrow geographic range from which we have drawn; it cannot be generalized. It provides instead a vocabulary, a set of terms that respondents use for their discussions of anti-aging. Further research can reveal terms used by other populations, in part by focusing on their care for health and appearance, and provide measures of the relative popularity of the terms and justifications that they use. Such research may contribute to the discovery of the mechanisms of ageism, in its intersections with gender and other relations of inequality.

References