What's Wrong With Fat? (32 page)

WHAT TO DO?

But how does knowing all of this help us address the real challenges that we face? What does it suggest about how we should respond to children who tearfully ask their parents why they are fat? For one, knowing that social preference for thinness is not universal can be liberating. Understanding how the emphasis on poor individual choices is partial and obscures important social and biological forces beyond personal control may make parents less likely to sigh and shamefully look away when their children ask why they are fat.

On a deeper level, this book has highlighted how the questions we ask are often more important than the answers. Awareness of how obesity itself is a frame and how there are other ways of understanding the problems typically discussed
as obesity
opens up a new set of questions: is a fat child being bullied at school? If so, the child may have a bullying problem, rather than a weight problem, requiring intervention from the teacher or principal. Is a child consumed with self-doubt and a feeling of worthlessness? If so, perhaps her or his parents need to address these issues directly.

Focusing instead on an individual’s inability to lose weight can, in fact, mask or even excuse weight-based discrimination and stigmatization. As part of doing research for this book, I collected many different kinds of data. I coded hundreds of news media reports, read hundreds of scientific studies, and conducted scores of formal interviews. Over the past decade during which I directed this research, I also had countless discussions with people who were themselves grappling, in different ways, with how to discuss fat. Some of these discussions provided glimpses of possible futures that are occluded by current conversations about weight. One involved a clinical social worker, whom I will call Eleanor. She told me of a longtime client—let’s call her Leah—who had struggled for years with being 50 to 70 pounds heavier than what was considered “normal weight” for her height and often expressed self-consciousness about her weight. In their sessions, Eleanor and Leah explored the sources of Leah’s emotional eating. Eleanor referred Leah to a nutritionist, who helped her lose 20 pounds, but then Leah’s weight plateaued, and she came to hate the nutritionist. Despite this, they were able to address Leah’s history of sexual abuse and fears of being sexually attractive, and she developed a positive romantic relationship.

Yet Leah’s body weight continued to trouble her, and she would often become quiet and despondent and talk about how unhappy she was with her eating. Eleanor became increasingly frustrated with what she considered “wasted sessions.” Finally, Eleanor, who had been reading some of the health at every size and fat rights literature, tried a different approach. She turned to Leah and said: “Look, if you were black, we wouldn’t be talking about how to change the fact that you are black. You live in a society where people assume you can change your weight, change who you are. You’re a healthy woman. I won’t engage in this discussion anymore. You’re setting yourself up for failure.” Leah broke into tears, saying: “You’re the first person who gets it.”

After that critical session, Eleanor was able to shift the focus from Leah’s weight to the bullying Leah had endured because of her size. “How come the grown-ups in your life weren’t there to help you through this?” Eleanor asked. “Why didn’t they step up for you?” Eleanor thereby reframed Leah’s pain as a “trauma issue” rather than a “size issue.” In so doing, Eleanor helped Leah grapple with the past trauma and mourn her lost childhood.
She also helped empower the adult Leah, who is now capable of standing up for her own needs and has chosen a career that involves counseling children and families. Eleanor stressed that this was a risky move that may have alienated a newer patient but worked in this case because of close rapport. This story drives home a central point, illustrated graphically in illustration 6.1: it is possible to reframe fat and doing so can have profound implications in people’s lives. It is precisely for this reason that the research documented in this book matters.

Just as Leah’s focus on her inability to lose weight had been preventing her from addressing her history of bullying, so a single-minded focus on body size may prevent scientists from investigating other health risks. In a joint 2007 keynote address to the National Association to Advance Fat Acceptance (NAAFA) and the Association for Size Diversity and Health (ASDAH), clinical psychologist Deb Burgard spoke to this, asking audience members to “imagine what it would be like to hear reports day after day on the costs of
weight prejudice
in lost productivity, increased healthcare costs, premature death, or as a risk factor for other diseases.” 33 She suggested that such reports would motivate different sorts of public action: “Imagine a war on weight
prejudice.
Imagine millions of dollars of funding available for the studies on and programs for the prevention of weight stigma.
Imagine jubilant studies showing a 3-fold decline in dieting over the last 10 years. Imagine having to demonstrate no difference in care between patients of varying BMI as a criteria [sic.] for hospitals and clinics being accredited, or to become eligible for federal funding.” 34 Indeed, studies are seldom published that estimate the number or deaths attributable to social factors, such as low education, racial segregation, low social support, individual-level poverty, income inequality, and area-level poverty, making a study published on this in 2011 a rare exception. 35 Yet, this type of work, by drawing public attention to these issues, has the potential to generate moral outrage and direct public resources to addressing these issues.

In 2001, I was invited to present a paper to a research group run by Kelly Brownell, who has published important work documenting weight-based stigma, while also advocating for more government action to address the “obesity epidemic.” 36 He is especially well-known for his advocacy for taxes on “junk” food. In my talk to Brownell’s research group, I suggested that a focus on body size might be obscuring real health issues, while worsening weight-based stigma. The group seemed largely persuaded by my talk, so I asked Brownell directly why he persisted in talking of “obesity,” rather than, say, “nutrition.” He responded that it was the only way to compete for scant public attention. He did not believe that an epidemic of junk food could attract as much notice.

Illustration 6.1:
Like lenses, different fat frames lead us to see the same phenomenon dramatically differently. Illustration by Ian Patrick.

Indeed, it is possible that linking issues of nutrition, physical activity, urban planning, food production and distribution, economic inequality, and a host of other issues to fatness may be the only way to make people take notice. This is because many people are terrified of becoming fat.
Identifying
demon users
(i.e., slothful gluttons) and
demon industry
(i.e., the food industry) may be necessary to garner public support for government intervention, especially at a time characterized by critique of government and deregulation. 37 If so, the stigmatization of fat people in talk of the “obesity epidemic” is not simply an unfortunate oversight but is, in fact, an integral and necessary part of this moral crusade. 38 Yet, as we have seen, there are important but seldom-discussed social, medical, and economic costs of this approach.

Moreover, lumping such disparate issues as nutrition, food insecurity, physical activity, stress, food production and distribution, and social inequality together under the banner of
obesity
may constitute a barrier to fixing them. If little Joey has a poor diet and is getting little or no physical movement, this may be a topic of legitimate concern for him and those who love him. However, addressing these issues does not require a discussion of obesity. That is, eating poorly and not getting physical activity can be addressed as independent barriers to wellness. Indeed, given that improving one’s diet and getting more exercise does not always lead to significant weight loss, addressing these behaviors directly may be more productive.

If they have the means, Joey’s parents could make a concerted effort to stop buying highly processed foods and sugared drinks, replacing them with fruit and vegetables. They could limit screen time or get out for walks as a family. They could sign up Joey for swimming lessons or in the local soccer league. Taking these steps does not require a discussion of weight.
Rather, they can be framed as efforts to spend more time together as a family, to enjoy a greater variety of foods, to have more energy, or to experience being part of a team. Similarly, adults can make a concerted effort to improve their own diets and get more activity themselves for the intrinsic benefits of these behaviors, rather than as part of an effort to lose weight.
In fact, given the high likelihood that such changes will produce little or no weight loss, framing them as a means to weight loss is likely to end in disappointment. Yet, if they are framed as ends in themselves, people may stick with these intrinsically health-promoting behaviors, even if they lead to little or no weight loss.

It may be, however, that there are deeper underlying psychological or economic issues that explain Joey’s poor diet and sedentary lifestyle. In this case, focusing on Joey’s “weight problem” may woefully miss the point.
It may be that what needs to be addressed is an untenable economic situation in which each parent is working three minimum-wage jobs to make ends meet. Joey’s family may be among the 11 percent of the U.S.
population and one-third of people in some poor urban areas suffering from food insecurity, defined as lacking the money to buy food at some point in the past 12 months. 39 Like that of many in this situation, Joey’s weight may be the result of food acquisition cycles, in which a drop in food consumption at the end of the month after food stamps have run out is followed by an increase in (high-caloric) food consumption at the beginning of the next month when the new month’s food stamps come in. In this case, a focus on personal and parental responsibility for weight obscures the larger societal problems and inequalities that are causing his high body weight. More important, in all of these situations, Joey’s “weight” problem serves as a decoy that masks the more serious challenges and risks he, his family, and many others face.

If Joey’s elevated weight is due to environmental toxins, including plastics, pesticides, and hormones in our food and other products, it cannot be solved on an individual level but requires structural changes to not only food production and distribution but also industrial production more generally. In fact, the increase in fatness may be an adaptive—rather than pathological—response to higher levels of toxic chemicals in the environment, through which the body stores toxins in fat to keep them away from vital organs. 40 In many cases, if environmental toxins are a public concern, they can be addressed directly, rather than as a problem only in so far as they contribute to “obesity.”

Some people worry that questioning the extent to which
obesity
represents a public health crisis plays to the interests of the food industry, which uses its economic power to unduly influence nutritional guidelines and protect agricultural practices that undermine the nation’s health. 41 Yet, as long as the problem is framed as “obesity,” food industry representatives can and do emphasize that there are many factors, besides food consumption, that contribute to body size, while promoting weight-loss products. In addition, an emphasis on body size cannot accommodate many important issues related to food production and distribution, including the labor conditions of agricultural workers. 42

In the introduction, I promised that, when you put down this book, you would never hear the word
obesity
the same way again. Having just concluded this book, you might now realize that
obesity
is not simply a neutral description of reality but that it connotes a powerful frame, one that is even more powerful because it is rarely recognized as such.

I hope that reading this book has led you to ask different kinds of questions. This is true for a reader of a pre-published version of this book, whose 10-year-old daughter is at the 95th percentile of weight for her age and sex (based on height and weight tables from the 1970s when children and adults were considerably thinner). She told me that this book made her question the idea that thinness is necessary for health and exposed her to the idea that fatness is considered beautiful in many other cultures. But she also recognized that she and—more important—her daughter are living in a society that values thinness. What should she do, she wondered, with this knowledge? Should she try to help her daughter lose weight, not for health reasons, but so that her life will be easier? If body size functions as a form of inequality, should she try to gain thin privilege for her daughter?
Alternatively, should she contest this form of inequality? Would it even be possible to make her daughter thin? Would it be possible for her to let her daughter be at the weight she is and not be miserable herself? More broadly, she asked, “Can I encourage my daughter to be her own person, or are we inextricably linked to social expectations and practices?” These are difficult questions. But the best questions are difficult ones. And good questions are better than good answers.