What's Wrong With Fat? (5 page)

Body size also intersects, however, with class, race, and gender in important ways. 68 For instance, weight-based discrimination has been shown to be most salient for middle-class white women, who are penalized more for being fat—in the workplace, in the marriage market, and in public spaces—than are both white middle-class men and also, according to several studies, women of color. 69 The reasons for this are not entirely clear. For the gender comparison, the greater premium put on beauty for women, compared to men, may explain the difference. In comparison with women of color, white women have more class and racial privilege to lose by being fat, whereas the prospects of women of color of all sizes are limited by racism. For instance, in an interview with me, Bill Fabrey, the founder of the National Association to Aid Fat Americans (NAAFA, later renamed the National Association to Advance Fat Acceptance), explained how he was outraged when
The
New York Times
declined to publish a photo of his fiancée in the marriage announcements in the late 1960s. Because their class and racial background was similar to those whose wedding announcements were published, Fabrey chalked this up to weight-based discrimination. If he and his fiancée had been poor blacks, however, they may not have sent in a wedding announcement in the first place and, if they had, may very well have assumed the rejection was due to racial or class bias. And yet, in a context in which overt expressions of racism are decreasingly tolerated, and in which rates of “obesity” are disproportionately high among the poor, African American women, and Mexican American men and women, condemnation of people for being fat may offer a socially acceptable way of expressing racism and classism. 70

FAT DEVILS AND MORAL PANICS

Previous research has shown that particular issues are more likely to become lightning rods for cultural anxieties when they evoke deeper fears about marginal populations. Thus, U.S. legal scholar Dorothy Roberts has shown how heightened public concern in the 1980s United States about a “crack-baby epidemic” drew on fear and hatred of poor black women and led to greater social control and punitive policies concerning them, while obscuring other forms of substance abuse that were more common among wealthier white women (and men). 71 Based on this line of work, we would expect higher rates of “obesity” among the poor, African American women, and Mexican American men and women both to intensify public concern over the “obesity epidemic” and also to color how this issue is discussed. 72

Indeed, U.S. political scientists James Morone and Rogan Kersh have shown that galvanizing support for government intervention into personal consumption (e.g., alcohol, cigarette, or drug consumption) has historically required, among other things, that a behavior be mentally connected to “demon users,” that is poor, immigrant, or otherwise socially marginal populations. 73 British sociologist Stanley Cohen coined the term
moral panic
to speak of an exaggerated concern over an issue that involves an alleged breakdown in public morality and
folk devil
to speak of the people who are blamed. 74 In discussions of obesity, the folk devils (or demon users) are portrayed as fat people themselves, who are seen as bringing obesity on themselves through bad personal choices, thereby creating problems for society as a whole. (One could call them “fat devils.”)

A satirical cartoon published in
The New York Times
,
and shown below in image 1.2, entitled “How Obese People Are Responsible for Everything Bad,” pokes fun at the idea that fat people are scapegoated, while obscuring how this often reinforces other forms of inequality based on class, race and gender. 75 It shows a sequence in which: 1. Obese person [depicted as white male of unknown class background] eats cake, causing 2. a button to pop from shirt, turning on a propane torch, 3.which causes
global warming
and 4. heats water,
killing endangered species
.
5. Condensed water causes flower to grow, 6. tipping box containing nuclear secrets, 7. which fall into a spy’s hands, causing
nuclear proliferation
.
8. Spy runs away on a treadmill, which turns a buzz saw that, 9.
cuts down a Brazilian rain forest
.
While this cartoon is satirical, real news stories present similar arguments. “If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21 percent of health-care spending,” a 2009
USA
Today
article claims. 76 “America’s growing waistlines are hurting the bottom lines of airline companies as the extra pounds on passengers are causing a drag on planes,” according to a 2004
USA Today
article, concluding, in the words of a spokesman for the Air Transport Association of America, “Passengers gain weight, but airlines are the ones that go on a diet.” 77 “The extra fuel burned also had an environmental impact,” this article notes, “as an estimated 3.8 million extra tons of carbon dioxide were released into the air, according to the study.” 78 A 2009 CNN article notes: “Another reason to stay in shape: Thinner people contribute less to global warming, according to a new study.” This article cites research claiming “because of food production and transportation factors, a population of heavier people contributes more harmful gases to the planet than a population of thin people. Given that it takes more energy to move heavier people, transportation of heavier people requires more fuel, which creates more greenhouse gas emissions, the authors write.” 79

Image 1.2:
A satirical rendition of the scapegoating of fat people. Credit: Ron Barrett.

Such accounts obscure the fact that wealthier people tend both to be thinner and to fly more on average than the less affluent. Accounting for these patterns would complicate the claim that fat people contribute more to global warming than do thinner people. In contexts in which food is scarce, being fat signals access to limited resources. Yet in the contemporary rich nations, in which there is an abundance of cheap sources of calories, the wealthiest—who still consume far more per capita than average citizens—are now often the thinnest. Despite this, fat bodies continue to be read as the embodiment of greed and over-consumption. In fact, fat people’s relative lack of power (both because they are less likely to be wealthy and because fatness is independently stigmatizing) makes them an easy target.

Cohen argues that, in order for a moral panic to emerge, there must be a consensus that the beliefs or actions being denounced not only are damaging in themselves but are also symptoms of a deeper condition. 80 The alleged obesity epidemic is seen as a symptom of a wide range of issues, including moral laxity, corporate greed, and addiction. Cohen further argues that moral panics identify sympathetic victims. In the case of childhood obesity, fat children are often depicted as victims of child abuse, as in this news article: “Parents who do nothing to prevent obesity in their children are guilty of abuse, if not legally then morally.” 81 In the context of airplane travel, thin people are described as victimized by heavier travelers.
“Why is it that if I say anything about being stuck between two huge people on an airplane, I’m being politically incorrect?” asks a Los Angeles actor in a 2010
Los Angeles Times
article. “I work out religiously, watch what I eat and am very healthy. Yes, I’m fed up with [obesity].” 82 Reports on the economic costs of obesity paint the nonfat as victims, in that they are unfairly burdened with the cost of fat people’s unhealthy lifestyles. In the words of one woman: “I am completely and utterly frustrated with rising healthcare costs due to the deluge of fat Americans taxing the healthcare system.” 83

Economic analyses suggest that there are many institutional and social structural factors contributing to higher spending on health care in the United States over time and as compared to other industrialized democratic nations, including the higher incomes of medical professionals and expensive new technologies. 84 Yet, these forces are abstract and do not lend themselves to simple morality tales. It is easier to blame fat people for bankrupting society because of their self-indulgent ways. Such rhetoric draws on increasingly influential arguments that individuals are personally responsible for taking care of their health and guarding against illness. 85
Such arguments are at the heart of neoliberalism, also known as trickle-down economics and championed by Ronald Reagan in the United States and Margaret Thatcher in England. Neoliberalism shifts responsibility for public welfare from governments to individual people and markets. It represents a marked departure from a risk-sharing approach to health, which assumes that illness depends largely on genetic and social factors beyond individual control. According to this view, even those who do everything right can and will get sick at some point. A risk-sharing frame asks not how much a specific person will cost, but how a health insurance policy can equitably fund a system that ensures that every participant will receive the care he or she needs, while acknowledging that some people will have greater health care costs than others. 86

As the above news media examples illustrate, scientific expertise plays a central role in debates over “obesity” (i.e., fat as a medical and public health crisis). Indeed, medical science is another one of the factors that has been shown to trigger moral crusades. 87 The science does not even have to be accurate to have an impact, but it does have to be disseminated by policy entrepreneurs. 88 The news media are one important arena for the spreading (and contestation) of such medical findings. People and groups engaged in debates over obesity are keenly aware of the important role science plays in shifting public opinion. In fact, some science is produced with its political effects in mind. For instance, the authors of the editorial cited in the news media suggesting that obesity is driving up airline costs admit that their primary goal in doing this research was to highlight a new area in which “the obesity epidemic has unexpected consequences beyond direct health effects.” 89 It was neither to test this assumption nor to evaluate the importance of increasing body weight relative to other factors that may also be contributing to airline costs. 90

ESTABLISHING AND CONTESTING MEDICAL AUTHORITY

Gender scholars have long criticized the fashion media for glorifying emaciation and contributing to body-image and eating problems. 91 However, they have been relatively quiet about how medical science and news reporting may contribute to the very same problems. This is surprising given a long tradition of feminist critiques of medical authority in other areas. 92
This book fills this gap by examining how medical research, public health campaigns, and news reports contribute to a “cult of thinness.” 93 It investigates how publication bias and interpretive bias shape how research is conducted and written up, what research is published, which research is covered in the news media, and how journalists and the public interpret it. 94 It examines how “the desire not to be drowned out by the cacophony of information about health and the body” leads health policy campaigns, researchers, and journalists “to minimize methodological problems, overstate findings, and exaggerate danger.” 95 In addition to explaining the dominance and implications of understandings of fat as a medical problem and public health crisis, this book also examines competing frames of fat as healthy, beautiful, or a basis for civil rights claims.

This book builds on research showing how cultural assumptions shape the production and reception of scientific knowledge. 96 For instance, U.S. political scientist Joan Wolf has demonstrated how ideas that good mothering requires “behavior that reduces even infinitesimal or poorly understood risks to offspring, regardless of the potential cost to the mother” influence how scientists, journalists, and health policy campaigns discuss the health benefits of breast-feeding and health risks of bottle-feeding with infant formula. 97 She argues this is part of a neoliberal risk culture, in which social problems are “individualized and internalized, and crises linked to poverty or prejudice are perceived and lived as personal failures.” 98 Similarly, U.S. sociologist Elizabeth Armstrong shows how beliefs about maternal responsibility lead to punitive responses to women who drink when pregnant. 99 One might similarly expect attitudes about personal responsibility for health to shape scientific and popular understandings of the causes and responsibility for “obesity.”

I borrow U.S. sociologist Steven Epstein’s concept of
credibility struggle
to examine how different researchers and activists (and activist-researchers) compete to establish their own credibility and discredit their opponents in debates over corpulence. Epstein has shown not only how Acquired Immunodeficiency Syndrome (AIDS) activists rejected mainstream medical knowledge about AIDS but also how they sought to “stake out some ground on the scientists’ own terrain.” In addition to reforming science by exerting pressure from the outside, they sought to “perform science by locating themselves on the inside.” 100 The AIDS movement, in turn, provided a model and new spaces for other activist-experts, including fat acceptance and Health at Every Size ® activist-researchers, to challenge scientists on their own turf. 101