What's Wrong With Fat? (16 page)

When leptin was initially discovered, many thought that it provided the key to a miracle weight-loss drug, and the pharmaceutical company Amgen paid Rockefeller University, where Friedman was employed, $20 million for the rights to the leptin gene. Amgen agreed to pay many times that amount if the hormone proved successful in producing weight loss. Yet, a preliminary study in 1997 produced disappointing effects. It turned out that very few fat people actually lack leptin. 62 More research is ongoing that is examining the precise role leptin and other genes play in determining body weight and appetite. 63 This points to the way in which a biological frame invites pharmaceutical and surgical solutions.

If highly effective weight-loss drugs were available, one would expect them to be marketed as a solution to the
biological
or
genetic
problem of obesity. Yet, available or recently available weight-loss drugs only produce very small amounts of weight loss, typically by reducing appetite, as in the case of Meridia (Sibutramine, withdrawn from the market in October 2010), or by blocking the absorption of fat, as in the case of Xenical (Orlistat). Moreover, both of these drugs are meant to be used in combination with a weight-loss diet and physical activity, thus still requiring people to make behavioral changes. Similarly, weight-loss surgery, in which part of the stomach is stapled or amputated, is best understood as facilitating dieting, by reducing appetite and making it physically uncomfortable (even gastrointestinally excruciating) to overeat, rather than surgically correcting a faulty stomach or metabolism. Indeed, a surgically altered stomach is less effective in absorbing nutrients, one of its primary functions. 64 Thus, while we might expect pharmaceutical companies and weight-loss surgeons to promote a biological framing of obesity, this potential has not yet been realized.

Nongenetic biological factors have also been shown to shape body weight. For instance, the Dutch Famine Study is often cited as evidence that prenatal environment influences body size. The Dutch famine of the winter of 1944 to 1945 was created when a German blockade cut off food and fuel shipments from farm areas to the densely populated western provinces. During what was called Hungerwinter, rations were as low as 400 to 800 calories a day, or less than a quarter of the recommended adult caloric intake. 65 There have been scores of studies examining the effects of prenatal malnutrition and calorie deprivation on the babies born soon after the Hungerwinter. For example, a 1976 historical cohort study, of 300,000 19-year-old men examined at military induction, showed that exposure to the famine as a fetus during the first half of pregnancy resulted in significantly higher rates of obesity. 66 A 1999 study among 50-year-old men and women found that maternal malnutrition during early gestation was associated with higher BMI and waist circumference in the 50-year-old women but not in the men. The authors argued that these findings suggest that “perturbations of central endocrine regulatory systems established in early gestation may contribute to the development of abdominal obesity in later life.” 67 This type of research is at the intersections of biology and social factors and is used to demonstrate the limits of individual choices.

Some scientists have argued that certain viruses may result in weight gain, which constitutes another sort of biological argument that, if it were to gain traction, could potentially shift blame away from individuals as well as spur research into prevention and treatment of the relevant viruses. 68
Yet, in that viruses are contagious, it could also worsen fear and stigma of fat people as sources of contagion. For instance, a 2012 Newsy report on a study showing obesity and liver disease were contagious in mice noted that this “seems potentiality pretty scary. Just by being near someone who’s overweight, you could be too,” the news reporter suggested, as the camera showed images of “headless fatties.” 69 Others have argued that certain pharmaceutical drugs, including many of those prescribed for mental illness, may be responsible for some proportion of the U.S. (and world) population becoming “obese.” 70 This is another sort of biological argument that complicates accounts solely stressing individual factors.

Fat acceptance activists often emphasize the heritability of body size in order to counter stereotypes of fat people as lazy gluttons and to argue that fatness is like other protected legal categories, including race and sex category. For instance, one member of the National Association to Advance Fat Acceptance (NAAFA), a 57-yearold nurse, says she tells women in NAAFA workshops that they should not be blamed for their weight because they “were born to have this tendency.” She tells them: “Society wants to blame it on you. It’s not your fault. If it was your fault then everybody that overate would be big, and that’s not true because you see tons of people who eat constantly and remain thin. It’s their genetics and their metabolism, and you look at them scarfing down stuff all the time and they never seem to gain an ounce, whereas you have to just smell the fumes and you put on ten pounds.” By analogizing fatness to disability, race, sex, and height, fat rights activists shore up the biology frame.

It is not surprising that fat rights activists would pursue a strategy of insisting that fatness is an ascribed characteristic, like race or (many cases of) disability, rather than a behavior, like smoking. With the important exception of religion, U.S. law grants rights to people based on being members of “protected classes,” which at the federal level include ascribed characteristics such as race, sex, and national origin. Since the civil rights movement, several identity groups—including women, gays, and the disabled—have “bridged,” or likened, claims of discrimination against their group onto more established forms of discrimination in an attempt to gain legitimacy. 71 Thus, the term
sexism
was chosen to evoke the preexisting term
racism
,
thereby conveying the similarity of these forms of discrimination.
Claiming difference as innate is a common political tactic in the U.S. legal context, in which race provides the starting point for theorizing other forms of inequality. 72 The gay rights movement has similarly latched on to arguments about the genetic basis of sexual orientation to argue that sexual orientation deserves the same group protections as race or gender.

Yet, a biology frame, on its own, does not challenge the underlying assumption that fatness is a problem. In fact, by participating in a discussion about possible causes of fatness, fat rights activists may inadvertently shore up the idea that fatness is a problem. Communications scholar Kathleen LeBesco argues that “allowing oneself to engage” in debates about the extent to which body size is under personal control “drains pro-fatness rhetoric of its power.” 73 By painting fat people as the victims of biology (or any other external force), LeBesco argues that one also “paints them as incompetent and powerless.” 74 Moreover, this line of argument implicitly suggests that only those who have not chosen their condition deserve protection from discrimination.

DOMINANCE OF A PERSONAL RESPONSIBILITY FRAME

A biology framing of obesity remains relatively marginal. Moreover, when invoked, it tends to be subordinated to a narrative of personal responsibility. If you tune into a television show or pick up a newspaper article on obesity, you will most likely be told that body size is under personal control. If you watch the popular reality show
Biggest Loser Couples
,
you may hear a doctor ask a 20-year-old male contestant: “You have so much to live for. What are you doing?” to which the shamed contestant responds: “Throwing it away.” You may hear another contestant confess to this doctor, after being told that his death is imminent due to his weight: “I realize how selfish I’ve been,” to which the doctor replies: “It’s in your control.”
Later in the season, you may hear a muscularly toned and Hollywood-looking physical trainer explain to viewers: “To get in shape and to change your life doesn’t come free; you’ve got to earn it. And if they want it bad enough, if they can change themselves mentally and emotionally right
here, the rest will follow,” a theme with which contestants echo: “You’ve got to make it a battle to make yourself better.” 75 Illustration 3.1 provides a visual rendition of how health authorities blame individual people for weighing more than what they deem desirable.

While reality shows are especially sensationalist, the print media also heap blame on individuals, as in the following 2003 news article in the
Boston Globe
: “The two prime culprits for this expanding obesity are inactivity and overeating, and TV watching is linked to both of them. This is an important take-home lesson, now that school’s ending and children can finally relax. Too often they relax—just like adults—by spending lazy hours in front of the TV, which can be hazardous to both age groups’ health and well-being.” 76 Mentioning television watching as an example of sedentary activity simplifies the narrative of sedentary lifestyle as immoral, which may explain why television is the example of choice when it comes to discussing inactivity. I have yet to read an article about children becoming obese because they are spending too much time reading, doing puzzles, or playing board games. While these activities are sedentary, they are seen as beneficial in other ways for child development, muddying the simple narrative of obesity as the product of bad individual choices or behavior.

Illustration 3.1:
Finger pointing. Illustration by Ian Patrick.

Viewed through a personal responsibility lens, fat people are easily seen as self-indulgent, lazy, and/or ignorant, as in the description of this family: “Bruce and Lisa Smith never skimped much on food. Chips, fried chicken, canned fruit, sodas—they ate as much as they wanted, whenever they wanted. Exercise? Pretty much nonexistent, unless you count working the TV remote or the computer mouse. ‘We were out of control,’ says Bruce, 42.
And so was their son, Jarvae, who is 5 feet 4 and weighs 176 pounds.” 77 Few readers would consider working a TV remote or a computer mouse physical exercise. Rather, sarcasm is employed to convey disdain and contempt for the Smiths, who are portrayed as lazy and irresponsible individuals and parents. The press commonly blames childhood obesity on parents: “The problem [of childhood obesity] is so grave that some researchers predict that the life expectancy of today’s children could shrink by as much as five years. The key to reversing the trend? Parents.” 78 The fix is presented as a matter of common sense: “One simple way to get the entire family fit is to turn off the television and shut down the computer.” 79 By describing solutions as “simple,” those who are fat or have fat children are portrayed as stupid, ignorant, or willfully disobedient.

Food-industry lobbyists emphasize personal responsibility as a way of deflecting attacks on the food industry, as when the executive vice president for government relations at the Association of National Advertisers, an organization based in Washington, DC, whose members include food companies, says: “I don’t know of any little child who jumps in the car and drives to a supermarket and buys their own food.” 80 Rather, it “is the confounding truth that parents—whether distracted, oblivious or both—are ultimately to blame for what their children eat.” 81 According to a letter to the editor in
Newsweek
,
adults “who permit their children to eat as they please (meaning anything and everything)” must be either be “supremely ignorant or genuinely abusive.” 82

Even news media discussions of weight-loss drugs tend to highlight their ineffectiveness, thus serving to further emphasize the importance of behavior modification, as in this article that quotes a professor of nutrition discussing weight-loss drugs as an elusive “magic bullet” that distracts people from making necessary lifestyle changes: “Fewer people are doing what they know they should do. Instead, everybody just wants a magic bullet.” 83
Articles quote recognized experts, in this case director of the Center for Science in the Public Interest, Michael Jacobson, to give authority to the assertion that: “It may be that we enjoy our slothful, gluttonous lifestyle so much that we’ll just remain overweight until we come up with a drug to cure it.” 84 While one might assume that discussions of weight-loss surgery would frame obesity as a biomedical problem, news media discussions of surgical intervention also tend to stress personal responsibility, evoking patients who have surgery because they “could not do it on [their] own,” or quoting leading obesity researchers as saying that “it would be sad to think that people feel they can eat poorly, be inactive, and when they get overweight, have it fixed by surgery,” or a surgeon saying that “20 percent to 30 percent of people who get the lap band fail to lose more than 50 percent of their excess weight” because they “cheat by eating certain types of food that limit their weight loss or cause them to gain back weight.” 85