What's Wrong With Fat? (31 page)

All of this speaks to what obesity, as a frame, causes. This has been the focus of the entire book and is addressed most directly in chapter 5. In that chapter, I showed that people who read news reports that frame fatness as a public health crisis are not only more likely to say that it is medically dangerous to be fat but are also more likely to express anti-fat prejudice. In contrast, those who read news articles arguing that one can be fat and fit or condemning weight-based prejudice and discrimination are not only less likely to agree that “obesity” represents a public health crisis but also
less
likely to express anti-fat prejudice.

In some cases, for some people, being told that one is at an unhealthily high weight may encourage a person to adopt a healthier lifestyle that may have beneficial effects, even if they do not lead to weight loss. However, as I discussed in chapter 5 and as Chastain also stresses, for many people, the emphasis on thinness and weight loss has a host of adverse psychological and even physiological effects. These include over-diagnosis and treatment of “obesity-related” illnesses for the 55.4 million “overweight” and “obese”
Americans with
normal
cardiometabolic profiles and under-diagnosis and treatment of the 16.3 million “normal weight” people with
abnormal
cardiometabolic profiles. 16 It includes the millions of fat Americans who receive little or no preventive medical care, either because health insurance companies will not sell them medical insurance or because these companies charge an exorbitant amount for them because they are “morbidly obese.”
Negative attitudes about and discourteous behavior toward fat people on the part of medical professionals discourage others with health insurance to see their doctor regularly. Thus, as we have already seen, the higher rate of cervical cancer among women with BMIs over 30 is largely due to the fact that they are less likely to get regular Pap smears. 17 In other words, while done in the name of health, the medical framing of fat is literally making us sick.

Many have noted that the medical and public health framing of fat has a disproportionate impact on women, who are more likely than men to pursue different methods of weight loss. 18 As a result, women have also suffered disproportionately from dangerous products, most dramatically in the mid-1990s when about 45,000 women were believed to have developed serious lung or heart diseases from taking the weight-loss cocktail phen-fen. 19

As we have already seen, policies that aim to punish people for making bad personal choices, which are assumed to be the cause of higher body mass, target the poor and people of color for the simple reason that they are most dependent on public assistance and most vulnerable to public surveillance. One social researcher has gone as far as to argue that “the call to take political action against childhood obesity apparently equals a call for political action against the poor and weak individuals in society.” 20 Recently, U.S. government programs and weight-loss companies have specifically targeted people of color. Georgia’s Strong4Life campaign featured a disproportionate number of children of color, while First Lady Michelle Obama chose Beyoncé Knowles as the face of her national campaign against childhood obesity. Recently, diet company Nutrisystem chose Janet Jackson as their representative, whereas Weight Watchers selected Charles Barkley and Jennifer Hudson. Increased targeting of people of color in public and private weight-loss campaigns seems to be inspiring a new wave of fat activism among people of color. 21

There are some who stand to gain a lot from a public health crisis framing and, as a result, will continue to promote it in the United States and abroad. Importantly, the idea that obesity is a deadly disease provides pharmaceutical companies with a powerful argument for why the Food and Drug Administration (FDA) should speed up review of weight-loss drugs, while tolerating risks associated with them. In February 2012, a federal advisory panel overwhelmingly recommended approval of Qnexa, which was poised to become the first new prescription weight-loss drug in 13 years. 22 Crucial in the panel’s positive recommendation were arguments, made by the pharmaceutical company Vivus that produces the drug and some obesity specialists, about how obesity itself causes health problems.
Vivus persuaded the panel that the health problems allegedly caused by obesity off-set the potential risks of the medication, including heart disease and birth defects. 23

A public health crisis frame creates a sense of urgency that not only helps pave the way for new weight-loss drugs but also helps justify policy interventions designed to lower population weights and provides researchers with a powerful rationale for demanding greater funding of obesity research, even at the expense of other research. When fatness is viewed through both a public health crisis
problem frame
and a personal responsibility
blame frame
, it may seem justified to impose fines or surcharges on obese patients for health insurance or even to remove fat children from their parents’ custody. Indeed, there have been several of such cases documented recently in the United States and in Great Britain. 24 The personal responsibility frame is consistent with a larger trend toward neoliberalism, involving the privatization of public resources and the reduction of a social safety net. By contrast, a focus on sociocultural or biological causes for “obesity” may make people less likely to blame others for being fat, while reinforcing the sense of fatness as pathological.

When fatness is seen instead as “body diversity,” such surcharges and custody battles seem like an unjustifiable form of discrimination, and the “Stop Sugar-Coating It Georgia” campaign like a public campaign to promote bigotry and bullying. Taking this position, fat liberation activist Marilyn Wann initiated an online campaign called “I STAND against Weight Bullying,” for which she used a design template imitating the Strong4Life ads. Rather than “WARNING” in red bold letters, her ads had “I STAND” in hot pink, the color symbolizing “health and happiness and joy.” 25 Below was the rest of a fat-positive message. At the very bottom was written: “Stop weight bigotry. Health at Every Size.” The very first design featured a photo of Wann herself and the statement: “I STAND against harming fat children.
Hate ≠ Health.” She then asked people in her networks to submit their own photos and personal fat-positive statements, providing the basis for scores of additional “STANDards.” Messages included: “I STAND FOR BODIES OF ALL SIZES AND AGES TO BE FREE FROM BULLYING,” “I STAND FOR MAKING MOVEMENT ABOUT FUN & HEALTH, NOT SHAME & PUNISHMENT” (see figure 6.2 ), “WE STAND FOR SELF-LOVE FOR ALL PEOPLE. SHAME ≠ SELF-CARE,” and many more. These “STANDards” were then shared on Facebook, Twitter, Tumblr, Flickr, and other social networking sites. 26

Meanwhile, Ragen Chastain worked with several other members of the fat rights movement, including Wann, to create a campaign to raise money to put up billboards in Georgia featuring a size-positive response to the Strong4Life ads. She designed several billboards (different from the STANDards) and had people vote on their favorite. In eight days, they raised $21,721 from 1010 donors, enough to pay for several billboards and bus shelter posters. The billboard, shown in image 6.3, called “Healthy Kids 101,” looks like a photo of a chalkboard with the message: “Healthy Kids 101: Putting Me Down Will Not Make Me Strong.
www.STAND4EVERYBODY.COM
.” In the top right corner of the image in smaller, non-chalk-looking text, it says, “Brought to you by Health At Every Size®.” 27

Image 6.2:
One of Marilyn Wann’s STANDards. Photo by Michael Baxter.

Image 6.3:
“Healthy Kids 101” billboard. Artwork by Sabrina Wilson.

Given the economic, political, and social implications of how we discuss fatness, it is not surprising that such talk is highly contested. Researchers, doctors, public health authorities, and obesity organizations funded by pharmaceutical companies, have promoted an understanding of fatness as a medical problem and public health crisis at the national and global level. The news media, which use drama and morality tales to sell copy, have further fed the narrative of a public health crisis brought on by irresponsible individual and parental behavior. Within this context, fat rights groups and health at every size researchers struggle to promote their alternative message that fatness is beautiful, potentially healthy, and a valuable basis for identity and rights claims. 28 In the U.S. context, they off set their relative lack of cultural authority and economic resources by using inexpensive social media and building on powerful U.S. cultural tropes of equality, diversity, and multiculturalism with some notable successes.

STUDYING PUBLIC PROBLEMS

Thirty-five years ago, American sociologists Malcolm Spector and John Kitsuse argued that the study of social problems should focus on the processes through which certain “putative conditions” come to be understood as social problems. 29 They acknowledged that it is extremely difficult to resist entering the fray of debate over the
reality
of a social problem, such as obesity. Indeed, journalists, colleagues, and journal editors have continually pushed me to answer questions about whether or not obesity or overweight are actual medical problems or whether or not rising population weights truly represent a public health crisis. 30 Following in the tradition of the sociology of social problems, this book has explicitly
not
sought to establish the truth of obesity as a medical or public health crisis.
Rather, it has attempted to explain how claims about obesity-related health risks and an “obesity epidemic” have been promoted and accepted as truth, despite considerable scientific uncertainty and debate. This speaks to a central theme of sociology and a long-standing interest of my own: how particular social interactions and institutions produce specific accounts. 31
This book has also gone a step further to examine the social consequences of these accounts.

And yet, it would be disingenuous to deny that this intellectual project itself has material implications. Studying current understandings of fatness
as
frames—that is, as specific ways among others of understanding the world—undermines the taken-for-granted status of this particular representation. Just asking the question of how and why we understand fatness to be a public health crisis allows alternative perspectives to be considered. In this sense, this book has political implications. As a result, it is likely to strike the nerves of those who feel threatened by these alternative perspectives. Indeed, I have been surprised by the extent to which this research evokes anger, not only from medical researchers whose research funding hinges on an understanding of fatness as a public health crisis, but also from friends and casual acquaintances. When discussing this book at dinner parties and the like, I have periodically witnessed a generally level-headed friend burst into a diatribe about how fat Americans have become.
Clearly, this topic strikes a deep personal cord for many.

Analytically, this book contributes not only to our understanding of how fatness has been framed but more broadly to how social issues come to be defined in particular ways, with specific material implications. It has underscored the central role played by the people, groups, and institutions who participate in debates over fat, showing how their social location shapes their frames and affects the degree of social influence they wield. I have shown how, in this particular case, body size is a relevant part of the social characteristics that shape one’s perspective. This is especially true in discussions of body weight, in which the idea to study the health risks of yo-yo dieting and weight-loss surgery initially came from women in the fat acceptance movement who had personally experienced these problems. In other words, body size is an important and understudied dimension of social inequality, shaping one’s life chances and perspective. This book has shown how more powerful players, in terms of economic resources and cultural authority, have more influence in public debate. However, it has also pointed to the power of symbolic meaning. Specifically, master frames represent a potent cultural resource into which savvy people and groups can tap. 32 Thus, the fat rights movement has had more influence than one might expect given their small size and limited resources, in large part because they have been able to link their cause to powerful political U.S. traditions of equality and diversity.