What's Wrong With Fat? (15 page)

When asked to comment on studies showing that weight-loss diets have extremely low success rates over the long term, these and other obesity researchers emphasize that even a 5 to 25 percent success rate means that weight loss is possible, even if it is difficult. 28 A group of obesity researchers have even established a “National Weight Control Registry” to follow “over 5000 people who have lost significant amounts of weight and kept it off for long periods of time,” in order to show that permanent weight loss is possible and to identify why some people are successful at long-term weight loss. 29

The Republican Party has championed personal responsibility as a means of reducing public expenses. Thus, in discussing the HealthierUS program, which focused on providing information and empowering individuals to take responsibility for their health, President George W. Bush discussed the importance of individual people “making healthy choices [in order to] do the right thing for our future.” 30 Republican Senator Tom DeLay said in 2004: “If you eat a lot of food and you get sick, it’s your responsibility, and not the restaurant’s.” 31 Democratic First Lady Michelle Obama has also emphasized personal—as well as parental and community—responsibility in her
Let’s Move
campaign to combat childhood obesity.

The Center for Consumer Freedom, a food and restaurant industry advocacy group, has evoked “personal responsibility” and “consumer choice” in an attempt to discredit efforts to regulate the food industry. 32 It has published a series of advertisements poking fun of lawsuits targeting the food industry, initiatives to regulate food distribution, and food labeling. An advertisement that ran in 2004 features a close-up photo on a white man’s protruding belly, on which black letters ask: “Did you hear the one about the fat guy suing the restaurants?” At the bottom of the ad it says: “It’s no joke. He claims the food was too cheap so he ate too much!”
Below that, it says: “Learn more about the erosion of personal responsibility and common sense. Go to: ConsumerFreedom.com.” 33 Another advertisement that ran as early as August 2002 and as recently as September 30, 2009, told readers that the New York Department of Health’s campaign against soda is saying to consumers: “You are too stupid... to make good personal decisions about foods and beverages.” After asking if “food cops and politicians” have “gone too far” in “attacking food and soda choices they don’t like,” the ad says, “It’s your food. It’s your drink. It’s your freedom.” 34

SOCIOCULTURAL FRAME

A sociocultural frame represents one reaction to the personal responsibility frame, in which people’s choices are viewed as constrained by social factors, including the food industry, the urban environment, poverty, or cultural factors. A growing number of activists, researchers, writers, and filmmakers, including Michael Pollan, Eric Schlosser, Marion Nestle, Greg Critser, and Morgan Spurlock, and a burgeoning alternative food movement attribute increasing obesity rates to American food production, distribution, and economic policies. 35 At its most basic, the argument is that Americans are fat because the United States produces too much food. A corollary of this argument is that U.S. policies subsidize unhealthy higher-calorie food (e.g., corn, soy, sugar, wheat) relative to lower-calorie foods (e.g., fresh fruits and vegetables). A further variation of this argument focuses on how industrial capitalists have replaced ingredients with cheaper and more fattening industrial substitutes, such as high-fructose corn syrup in place of cane or beet sugar, to maximize profits. Some critics blame the country’s growing waistlines on the advent of “supersizing” and “value meals,” in which customers are charged a small additional amount for receiving a much larger portion. 36 Others point to the power of food advertising to induce desire for unhealthy foods, especially in children. 37 Nutritionist Marion Nestle has powerfully argued that the food and agriculture lobbies, particularly meat and dairy interests, have hijacked government regulation of food, to the detriment of American health and waistlines. 38 Some researchers and policymakers refer to these various factors as an
obesogenic
or
toxic food
and exercise
environment
.
39 Rather than portray consumers as freely making choices, this frame stresses induced demand.

Less common is an argument that environmental toxins, or
obesogens,
may be the cause of increases in population weight. This perspective emphasizes the interaction of social and biological factors and thus also draws on the biological frame, discussed below. According to this theory, toxins are thought to be found not only in food additives but also in pesticides, dies, perfumes, cosmetics, medicines, plastics, fire retardants, solvents, and so on. It is thought that the human organism may produce additional body fat as a way to store industrial toxins away from vital organs. 40 Even exposure to small amounts of these toxins is thought to have large and irreversible effects if exposure happens at certain critical times, and genetic variability is thought to make some people especially susceptible. Moreover, it is thought that there can sometimes be a huge, even intergenerational, lag time between exposure to these chemicals and a response in terms of weight gain. According to this theory, the increases in population weight observed in the United States in the 1980s and 1990s could be partially a delayed effect of exposure to endocrine disrupting chemicals in the United States during the postwar period. 41

The well-funded and influential International Obesity Task Force (IOTF) at times has, although not exclusively, evoked a sociocultural frame, as in its position paper “Waiting for a Green Light for Health? Europe at the Crossroads for Diet and Exercise,” which cites the need to protect children “from the ‘aggressive’ advertising and marketing techniques that sustain the pressure to adopt unhealthy patterns of consumption and activity.” 42
News reports often acknowledge how “decisions about whether to smoke, how much to drink, how much and what kinds of food to consume, and activities in which to engage are the result of strong cultural and commercial signals,” 43 thereby blending a focus on personal responsibility with a recognition of sociocultural constraints. Discussions of sociocultural factors often emphasize the specific role played by the food industry, as in the following news media excerpt: “Experts cite various causes for the obesity epidemic, ranging from super-size portions at fast-food restaurants to lack of physical activity.” 44 In that these discussions identify the food industry as a “demon industry,” this may help mobilize social support for government intervention. 45 Specifically, this line of argument provides a justification for greater government regulation of food production and distribution, as when a news article discusses sociocultural factors in the context of calling for the removal of soft drinks from schools, restricting food ads aimed at children, and mandatory calorie labels at restaurants. 46

By stressing how poor families are especially vulnerable to this toxic food environment, some commentators tap into concerns about social justice. Thus, economists point out that the high cost of fresh fruits and vegetables puts these out of reach for poorer households, while people living in low-income neighborhoods in the United States have limited access to facilities for physical activity. 47 Some news reports echo this concern, as in the following, quoting the coordinator of a food pantry who serves many poor families on Milwaukee’s south side: “It’s hard to eat healthy when you don’t have the gas on or you’re sleeping on the floor and you don’t have a refrigerator.” 48 Other scholars have argued that gender roles related to food acquisition, food preparation, and child-rearing mean that the toxic food and exercise environment has the greatest impact on women, and specifically on poor women and women of color. 49 A few scholars point out that the poor and people of color, including agricultural workers, are more exposed to chemical toxins that may be to blame for increased body mass at the population level. 50

Together these arguments draw upon a master frame of environmental justice, which seeks to redress inequitable burdens of pollution, crime, and other hardships. Environmental justice social movements have been especially critical of how U.S. environmental pollution and industrial facilities are disproportionately located in poor neighborhoods where there is a high concentration of ethnic minorities. 51 Those who use an environmental justice frame treat obesity as analogous to pollution, which harms people without their consent and has a disproportionately negative impact on the poor and minorities. The analogy works best in the case of environmental pollutants, as people have no choice but to ingest these. 52 It is harder to argue that “less healthful eating and physical activity patterns in some demographic groups” are “substantially due to social and physical environmental differences,” in that people conceivably can make better or worse food choices even in the face of strong environmental constraints. 53

Some emphasize that U.S. cultural practices, including eating on the run and multitasking, contribute to obesity. These discussions are compatible with, and often blend into, discussions of personal responsibility, as in the following 2003 news article: “We buy our kids Oreos and Nintendos, eliminate gym classes to improve math scores, sell pizza at school fund-raisers, use the TV as a baby sitter and drive kids everywhere in minivans equipped with cup trays to hold milkshakes and Slurpees. As a society, we have let kids down,” said Dr. Robert Bonow of Northwestern Memorial Hospital.” 54
The use of the collective
we
and reference to
society
shifts some blame away from individuals on to the collective. It suggests that changing broader cultural values and practices may be necessary to change individual behavior. However, changing individual behavior remains a goal.

Differences in subcultural attitudes about body size and eating are also evoked to explain higher rates of “obesity” among African American women and Mexican American women and men. Specifically, an alleged preference for bigger female bodies among African Americans and a taste for fried food among both African Americans and Mexican Americans are often cited as reasons for higher rates of obesity in these groups. While potentially shifting some blame away from individuals, this argument risks treating minority cultural practices and values as themselves pathological.

BIOLOGY FRAME

According to a biology frame, obesity is highly heritable, determined by genetic and other biological factors. For instance, molecular geneticist and MD Jeffrey Friedman likens body weight to height, arguing that the former is as tightly regulated by genetic factors as the latter. He concedes that people can often lose 10 pounds or so but insists that it is exceedingly difficult to lose large amounts of weight and keep it off. In other words, each person has a “set point,” or a certain weight range, to which his or her body naturally returns. While people can diet and lose weight temporarily, their weight inevitably drifts back up to where it started. This theory is consistent with studies of weight-loss programs, which show that people often lose a lot of weight at first but typically regain it within a year or two and, at best, are able to sustain a 5 to 10 percent loss. “In trying to lose weight,” Friedman says, “the obese are fighting a difficult battle. It is a battle against biology, a battle that only the intrepid take on and one in which only a few prevail.” 55 Discussing Friedman’s work,
New York Times
journalist Gina Kolata concludes, “Free will, when it comes to eating, is an illusion.” 56 Studies showing that identical twins reared apart have extremely similar BMIs and that identical twins are twice as likely as fraternal twins to have the same degree of overweight lend support for a biological frame. 57

A common objection to such arguments is that our genes have not changed in the past 30 years and therefore cannot explain the current “obesity epidemic.” To this, Friedman argues that the genes that make people fat need an environment in which food is cheap and plentiful, just as the genes that make people tall need an environment in which people are well nourished. He points out that Americans today are at least three inches taller on average than they were in the Civil War era because, unlike in earlier periods, American children today almost always get enough food for their genes to direct them to grow to their maximum height. Friedman argues that the situation is likely to be the same with weight. Today, children and adults in the United States can easily get enough food for their genes to direct them to grow as fat as they can be, a point of view widely popularized in Gina Kolata’s 2008 book. 58 He and others further point to the fact that not everyone has gotten fat in the contemporary environment as evidence that genetics or other factors mediate the effect of environment. Some see the leveling of obesity rates in the first decade of the twenty-first century as evidence that those who have the genetic tendency to get fat in the contemporary Western environment already have. 59

Friedman is credited with the discovery in 1994 of leptin, a hormone made by fat tissue that plays a key role in regulating weight. The idea is that, just as a thermostat monitors heat in a home, producing more heat when the house is cold and less when it is warm, so a fat thermostat in the brain monitors leptin levels. High leptin levels signal high amounts of body fat and reduce appetite, while low leptin levels signal insufficient body fat and increase appetite. Some believe that fat people might have the equivalent of a thermostat set too high or that is malfunctioning so that it takes more leptin than normal for the brain to respond. 60 In extreme cases in which children have no leptin, they are insatiable no matter how much they eat. One girl who had no leptin weighed 190 pounds when she was just eight years old; her parents had put a lock on the pantry to stop her constant eating. At nine years old, she began receiving injections of leptin, and the results were dramatic. After a week of injections, she ate no more than her siblings and at the same speed, rather than quickly devouring her food as before. Her weight plummeted. Other children and adults with no leptin had similar responses to leptin injections. 61