What's Wrong With Fat? (14 page)

Among those who take the public health crisis framing for granted, there are nonetheless lively debates about who or what is to blame for the alleged crisis. An article on an online parenting forum, entitled “Obesity Epidemic in America: Who Is to Blame?” provides an illustration of this. The article considers who and what is to blame for childhood obesity without ever questioning whether “childhood obesity” should be considered a problem in the first place. 1 The author and most commentators in the accompanying forum overwhelmingly emphasize personal responsibility. According to the article’s author, “just because [fast food companies] make it, I don’t have to eat it,” a sentiment with which the overwhelming majority of the 100 forum commentators agree. 2 A handful of respondents, however, suggest that the food industry, cultural factors like eating on the run and a heavy reliance on automobiles, or biological/genetic factors also play a role.
“I don’t think people are totally responsible for bad foods that they eat,” opines one commentator, arguing that food labels are often incomprehensible and that “you don’t have many options when you go out to eat or buy packaged meals to cook at home.” Another notes that “healthy food is EXPENSIVE,” while “junk food” is cheap, convenient, and tasty, and that this severely limits the choices of the working poor. A couple of commentators implicate yo-yo dieting in weight gain, and one notes that certain fetal environments can predispose people toward obesity as adults. I refer to these different ways of assigning blame for obesity as
blame frames
.

As anthropologist Gayle Rubin has noted of homosexuality, “The search for a cause is a search for something that could change so that these ‘problematic’ [phenomena] would simply not occur.” 3 In other words, discussions about what causes homosexuality or obesity are driven by the assumption that it would be better if these phenomena did not exist at all.
Stated differently, heated debates over the relative validity of various blame frames tend to reinforce the understanding of fatness as a medical problem and/or public health crisis. Some fat rights activists weigh in on these debates, asserting that genetic and biological factors largely determine body size. They hope this will help counter the entrenched idea that fatness is a product of sloth and gluttony, while establishing it as a legitimate basis for making rights claims. However, other fat acceptance activists are loath to engage in these debates at all precisely because they recognize Rubin’s insight that the search for a cause implies that the phenomenon itself is undesirable. 4 Yet, particular blame frames have their own distinct logic that has political and social implications, making them important objects of study.

Drawing on in-depth interviews with leading obesity researchers and fat rights activists, qualitative and quantitative analyses of hundreds of U.S. and French news media articles, and secondary research, this chapter shows that a personal responsibility frame largely dominates discussions of obesity in the United States, although a sociocultural frame is gaining traction. By contrast, and despite the rise of genetic and biological explanations in other areas of life, biological explanations of obesity are much less common. 5 Like the problem frames discussed in the previous chapter, these three blame frames, including personal responsibility, sociocultural, and biology frames, are ideal types. 6 They are not exhaustive, in that one could identify additional blame frames and subframes.7 In actual debates, people often draw on more than one of these frames. Nonetheless, these three frames capture many of the major cleavages in contemporary debates.

The dominance of a personal responsibility framing of obesity is not random. Powerful economic and political interests, including the food industry and politically conservative U.S. politicians, have promoted a personal responsibility frame. This frame also taps into deep-seated U.S. political and cultural traditions of self-reliance and the increasingly powerful political-economic ideology of neoliberalism, in which costs are shifted from the state to individuals and families. 8 Left-leaning academics and policy-makers have increasingly pushed a sociocultural frame, which draws on a competing political tradition of collective responsibility and social justice. 9 Biologists and geneticists, as well as some fat acceptance activists, have insisted that genetics and other biological factors explain the bulk of variation in individual body weight. However, this line of argument, which has not been pushed by powerful economic or political interests, has been dwarfed by the emphasis on individual responsibility and, to a lesser extent, sociocultural factors.

This may not seem to be especially surprising or unique to the topic of fatness. After all, previous research has shown that the news media typically individualize social issues, treating them as morality tales, rather than focusing on impersonal and complicated social factors. 10 Yet, as we saw in the previous chapter, fatness has carried a particularly negative moral valence in the United States for some time. To examine the extent to which an emphasis on personal responsibility and blame is greater for fatness than for other issues, I conducted systematic comparative analysis of U.S. news reporting on obesity with U.S. news reporting on the “thinness-oriented” eating disorders anorexia and bulimia. While fatness is more common among the American poor and minorities, anorexia and bulimia are diagnosed most often in middle-class white women and girls. As I show in this chapter, U.S. news reports are more prone to blame individuals for being overweight or obese than for having anorexia or bulimia. In other words, it is not simply that the U.S. news media treat all issues in terms of individual responsibility. Rather, they are more likely to treat fatness, than “thinness-oriented” eating disorders, as an issue of personal responsibility and moral failing. 11

To capture the extent to which this is a specifically U.S. phenomenon, I conducted a second comparative analysis, this time between obesity news reporting in the United States and obesity news reporting in France. I found that the tendency to frame overweight and obesity as issues of personal responsibility is indeed greater in the United States, which has entrenched political and cultural traditions of personal responsibility. In France, where there are stronger traditions of social solidarity and collective responsibility, news media reports emphasize sociocultural factors to a far greater extent than do the U.S. news media. 12 Before turning to the news media analysis from which these three frames emerged, let us begin by sketching out the contours of each of these three blame frames. These are also summarized in table 3.1 below.

Table 3.1.
BLAME FRAMES

A PERSONAL RESPONSIBILITY FRAME

A
personal responsibility frame
assumes that bad individual choices are to blame for obesity and that people need to learn to take more personal responsibility for their weight. Like the immorality frame discussed in the previous chapter, the personal responsibility frame focuses on individual failings. However, the immorality frame sees fatness as merely a symptom of an underlying problem of sloth and gluttony, whereas a personal responsibility frame portrays sloth and gluttony as the cause of the
medical
and
public health crisis
of obesity, as in the following news excerpt: “Obesity is largely the responsibility of individuals’ choices concerning diet and exercise.
Americans are becoming fatter because they are becoming more slothful and self-indulgent.” 13 Every reader of this book is familiar with this line of argument and in fact could probably recite it with their eyes closed, as it has a ubiquitous and repetitive presence in newspapers, magazines, and public health messages. Its omnipresence in the media landscape is not accidental; it forms the core of the rhetorical strategies adopted by many actors who have stakes in promoting personal responsibility in one form or another.

According to a personal responsibility frame, changing individual behavior is the key to reversing the alleged obesity epidemic. Thus, Republican-appointed Secretary of Health and Human Services Tommy Thompson launched a 2004 government-sponsored advertisement campaign as part of a larger effort of his department to “spread the gospel of personal responsibility.” 14 This ad campaign told viewers they could “lose midsection love handles and double chins one step at a time if they eat less and exercise more.” 15 Such approaches are characterized by an emphasis on individual behavioral changes as the key to weight loss: “Skate to work instead of driving. Fetch the newspaper yourself. Eat off smaller plates.
Take the stairs instead of the escalator. Get a dog and walk it. Eat half your dessert and more celery sticks.” 16

As is shown in table 3.1, the personal responsibility frame for obesity draws on a master frame of personal responsibility that, in turn, is linked to deeply seated U.S. beliefs in the value of self-reliance and suspicion of government intervention in the “private” sphere. 17 A personal responsibility frame is consistent with the tenets of neoliberalism, which has guided policy efforts in the United States, United Kingdom, and elsewhere to privatize public resources and spaces, to minimize labor costs by defanging unions; to reduce public services; to remove health, labor, and environmental protections on the grounds that they are bad for business; and to lower taxes on the wealthy. 18 “Do you really want the health police shouting ‘Drop the chalupa!’ in your kitchen?” a typical U.S. news article asks its readers, warning that “Americans will lose more than pounds if we give up responsibility for our own choices, and for the consequences that ensue.” 19

Supporters of a personal responsibility frame liken obesity to smoking, a behavior that is a recognized risk factor for lung cancer. This is an extremely common rhetorical strategy among the leading obesity researchers I interviewed. For instance, Theodore VanItallie drew on this analogy when asked if it was discriminatory to charge people who would be categorized as obese a higher health or life insurance premium: “I mean the same thing is true of smokers. Why should I have to pay a high life insurance [premium] because of all the deaths that are caused by cigarette smoking?” Comparing obesity to smoking implies that weight is a behavior rather than a trait that is largely beyond personal control. A highly cited 2004 study published in the
Journal of the American Medical Association
(
JAMA
) relied on this same logic when adopting a methodological approach that had been used to calculate the annual deaths due to smoking to compute “annual deaths due to overweight.” The authors assumed that calculating the number of deaths associated with overweight and obesity would allow them to “assess the impact of poor diet and physical inactivity on mortality,” implying that overweight
is
poor diet and physical inactivity. 20 Indeed, tobacco research, policymaking, and lawsuits against tobacco companies have provided a model for much research and policymaking on obesity.

Given this, it is not surprising that doctors, obesity researchers, and official health reports typically evoke individual responsibility. A survey of 89 general practitioners (GPs) with medical practices throughout the United Kingdom showed that, on average, GPs considered their patients’ tendency to eat too much, to eat the wrong foods, or not to get enough exercise as greater contributors to their obesity than genetics, glandular/hormonal factors, or metabolism. 21 Another study of 255 British health care professionals arrived at a similar conclusion, finding that providers believed that physical inactivity, overeating, food addiction, and personality characteristics were the most important causes of overweight. 22 A study of 600 general practitioners in France found that 30 percent considered overweight and obese patients to be lazier and more self-indulgent than normal-weight people, and 60 percent considered lack of motivation to be the most common problem in treating overweight and obesity. 23 In another study of 620 primary care physicians in the United States, more than 50 percent reported viewing obese patients as awkward, unattractive, ugly, or noncompliant. One-third of the sample further characterized these patients as weak-willed, sloppy, and lazy. 24 Similar patterns have been found in Australia and Israel. 25 Studies have shown that nurses also assume that obesity is the product of their patients’ bad personal choices. 26

Walter Willett, a Harvard epidemiologist who is often quoted in the news media and who is coinvestigator of the Nurses’ Health Study, a longitudinal health study of more than 100,000 nurses, says in an interview with me that he’s “yet to be convinced that there are very many people that if they are really serious about controlling their weight, can’t get their weight down under a BMI of 25.” Similarly, JoAnn Manson, also a Harvard epidemiologist and coinvestigator of the Nurse’s Health Study, says in an interview with me that people “know if they were to get up off the couch and do some more walking... it would be helpful to them, but they just don’t feel like it.” Every day, she says, they make a choice to buy “the Big Mac and French fries instead of a salad or roasted chicken.” The 2000 World Health Organization report similarly describes obesity as “largely preventable through lifestyle changes.” 27