The Obesity Myth: Why America's Obsession with Weight Is Hazardous to Your Healthby Paul Campos
�Campos makes his case against the �fat kills� dogma with unimpeachable evidence. The Obesity Myth should be required reading for every health professional in America. I believe any open-minded person who reads this book will conclude that we've been duped by a pack of self-serving lies. And we cannot get at the truth without first recognizing those lies. … See more details below
�Campos makes his case against the �fat kills� dogma with unimpeachable evidence. The Obesity Myth should be required reading for every health professional in America. I believe any open-minded person who reads this book will conclude that we've been duped by a pack of self-serving lies. And we cannot get at the truth without first recognizing those lies. The Obesity Myth is a great place to start.� Glenn A. Gaesser, Ph.D., professor and director, Kinesiology Program, University of Virginia
Is your weight hazardous to your health? According to public-health authorities, 65 percent of us are overweight. Every day, we are bombarded with dire warnings about America's �obesity epidemic.� Close to half of the adult population is dieting, obsessed with achieving an arbitrary �ideal weight.� Yet studies show that a moderately active larger person is likely to be far healthier (and to live longer) than someone who is thin but sedentary. And contrary to what the fifty-billion-dollar-per-year weight-loss industry would have us believe medical science has not yet come up with a way to make people thin.
After years spent scrutinizing medical studies and interviewing leading doctors, scientists, eating- disorder specialists, and psychiatrists, Professor Paul Campos is here to lead the backlash against weight hysteriaand to show that we can safeguard our health without obsessing about the numbers on the scale. But The Obesity Myth is not just a compelling argument, grounded in the latest scientific research; it's also a provocative, wry exposé of the culture that feeds on our self-defeating war on fat. Campos will show:
* How the nation's most prestigious and trusted media sources consistently misinform the public about obesity
* What the movie industry's love affair with the �fat suit� tells us about the relationship between racial- and body-based prejudice in America
* How the skinny elitewith their �supersized� lifestyles and gas-guzzling SUVsproject their anxieties about overconsumption on the poorer and heavier underclass
* How weight-loss mania fueled the impeachment of Bill Clinton
In this paradigm-busting read, Professor Campos challenges the conventional wisdom regarding the medical, political, and cultural meaning of weight and brings a rational and compelling new voice to America's increasingly irrational weight debate.
Author Biography: A professor of law at the University of Colorado and a nationally recognized expert on America's war on fat, Paul Campos is the author of a weekly opinion column that appears in more than forty newspapers nationwide. His articles have appeared in The New Republic, The Wall Street Journal, the Los Angeles Times, USA Today, the San Francisco Chronicle, and The Boston Globe.
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Read an Excerpt
IS YOUR WEIGHT hazardous to your health? According to America�s public health authorities, there�s an 80% chance that it is. From the Surgeon General�s office, the Centers for Disease Control, the National Institutes of Health, and our leading medical schools, America�s anti-fat warriors are bombarding us with dire warnings: According to such sources, no less than four of every five Americans maintain a medically dangerous body mass (nearly two-thirds of us are said to be overweight, while almost half of the rest of the nation is categorized as too thin).
If these claims sound implausible, there�s a very good reason why: because they�re false. Indeed, given that Americans are enjoying longer lives and better health than ever before, the claim that four out of five of us are running serious health risks because of our weight sounds exactly like the sort of exaggeration that can produce a cultural epidemic of fear, bearing no relation to any rational assessment of risk.
On the other hand, given the pervasiveness of America�s fear of fat, it�s only natural that many readers will react skeptically to a claim that this fear has no real medical or scientific justification. For one thing, it is always disturbing to acknowledge that authoritative social institutions can and sometimes do seriously mislead the public: At some level everyone would like to be able to trust our culture�s experts and authority figures when they claim to know what�s best for us. Indeed, when I began researching this topic five years ago, I assumed the fact that being �overweight� was a serious health risk was so well established that this aspect of the subject was hardly worth discussing. Yet in the course of plowing through dozens of books, hundreds of articles in medical journals, and countless interviews with medical and scientific experts, I discovered that almost everything the government and the media were saying about weight and weight control was either grossly distorted or flatly untrue.
What I discovered was that a host of eminent doctors, scientists, eating disorder specialists, psychologists, sociologists, and other critics of America�s obsession with weight and weight loss have concluded that �overweight� and �obesity� are not primarily medical issues at all. In the wake of a century�s worth of unsuccessful attempts to find a cure for the �disease� of a higher-than-average weight, a diverse and distinguished group of critics has come to see weight in America as primarily a cultural and political issue. Indeed these opponents of the war on fat have subjected the supposed medical justifications for that war to devastating criticisms. Such critics point out that there is nothing new about either America�s �obesity epidemic,� or the public health warnings it inspires. For more than fifty years now, government officials have been making the same dire predictions concerning the public health calamity that is about to befall us as a consequence of the nation�s expanding waistline (as long ago as the 1950s, nearly half of America�s adult population was supposedly overweight).
One goal of this book is to make it clear that several decades� worth of grim prophecies regarding the devastating health consequences of higher-than-average weight have turned out to be spectacularly inaccurate. Another is to explicitly politicize what in fact is a political issue, by expanding America�s public debate about weight and weight control to include the opinions of people who do not run weight loss clinics. This isn�t a rhetorical exaggeration: It has become routine for government panels charged with the task of making public health recommendations regarding weight to consist exclusively of people who run weight loss clinics.
As a lawyer I thought I had become accustomed to the extent to which people are willing to bend, spindle, and mutilate the truth in the pursuit of their own interests. But nothing could have prepared me for the sheer extent of the distortions that feed America�s rapidly intensifying weight hysteria. (Consider that a search of the major media for stories regarding the �obesity epidemic� reveals a twentyfold increase in such stories over the course of the last five years.) This book documents how the current barrage of claims about the supposedly devastating medical and economic consequences of �excess� weight is a product of greed, junk science, and outright bigotry. It blows the whistle on a witch-hunt masquerading as a public health initiative, by exposing the invidious cultural forces that encourage us to hate our bodies if they fail to conform to an arbitrary and absurdly restrictive ideal. And it outlines how we can begin to embrace a saner definition of what constitutes a healthy lifestyle and a desirable body.
I began working on this project, in part, because I suspected a well-known critic of the war on fat (Richard Klein) was on to something when he pointed to �a growing awareness that the whole culture of dieting and rigid exercise is the root cause of the fat explosion.� I have since discovered that, as disturbingly accurate as that insight into the perverse paradox at the heart of the war on fat was, the damage wrought by this war goes far beyond its tendency to expand our waistlines. Historically most attempts to marginalize and shame some disfavored class of people have focused on minority groups of one sort or another. The war on fat is unique in American history in that it represents the first concerted attempt to transform the vast majority of the nation�s citizens into social pariahs, to be pitied and scorned until weapons of mass destruction can be found that will rid them of their shameful condition. As we shall see, this is a phony war, fought against an enemy that cannot be defeated, because he does not exist.
The rejection of the war on fat is based on a simple principle: that tolerance toward an almost wholly benign form of human diversity is the least we should expect of ourselves, if we wish to lay claim to living in a civilized culture. The war on fat is an outrage to values�of equality, of tolerance, of fairness, and indeed of fundamental decency toward those who are different�that American culture celebrates (often with good reason) as essential features of our nation�s character. And in the end nothing could be easier than to win this war: All we need to do is stop fighting it.
The war on fat has especially devastating consequences for women. Indeed, I�m not sure I�ve ever met an American woman who genuinely likes her body. I don�t doubt there are such women in contemporary America (especially among ethnic minority groups). Still, after having interviewed hundreds of women regarding their feelings about food, fat, body image, and what it�s like to deal with these issues in America today, I can�t say I�m confident I�ve actually encountered such a person.
The stories these women would tell were always sad, sometimes harrowing, and often appalling. Some of them have been included in this book. I wish I could have included many more: Recently, a young woman from what is considered a privileged background recounted to me, in the course of describing the weight hysteria that dominated the milieu in which she was raised, how a girl she grew up with was never permitted to go on a date without first being weighed by her father. If the number on the scale was too high, she was forced to go jogging before her date arrived.
We live in a culture that tells the average American woman, dozens of times per day, that the shape of her body is the most important thing about her, and that she should be disgusted by it. How can one begin to calculate the full emotional, financial, and physiological toll exacted by such messages? And although women pay the highest price for our national obsession with weight, the cultural hysteria regarding this subject is becoming so intense that, increasingly, men are beginning to show signs of the damage that is done to people when they are told constantly that there is something fundamentally wrong with them.
Whether we are supposedly too fat, or too thin, or too sedentary, or too prone to eat unhealthy food, our medical and governmental authorities never tire of hectoring Americans about our imperfections. Between, on the one hand, our punitive public health nannies, and, on the other, the entrepreneurs who hawk health club memberships, workout equipment, Botox, Viagra, and dozens of similar drugs, as well as thousands of varieties of cosmetics, various sorts of plastic surgery, and most of all a seemingly unlimited parade of diets, each of which promises us the illusion of perpetual youth in the guise of slenderness, we have constructed a culture that ensures that relatively few people will ever be at peace with their bodies.
In America today the medical and public health establishment has managed to transform what has traditionally been considered a vice�physical vanity�into that most sacred of secular virtues: the pursuit of �health.� In the context of the war on fat it has done so by systematically distorting the available evidence regarding the relationship between weight and health, by severely exaggerating the risks associated with that evidence, and by pretending that an extremely complex subject is actually quite simple.
These are harsh charges, but if anything, they understate the scandal that is the war on fat. Never before in American history has so much junk science been exploited to whip up hysteria about a supposed public health �epidemic.� The health establishment�s constant barrage of scientifically baseless propaganda regarding the relationship between weight and health constitutes nothing less than egregious abuse of the public trust. This propaganda has played a key role in creating a culture that makes tens of millions of people miserable about their bodies: Worse yet, it has done so for crass economic motives. The war on fat, which is supposedly about making all of us healthy, is really about making some of us rich.
Yet, as we shall see, the sources of America�s weight loss mania go well beyond the fact that the dietary- pharmaceutical complex finds it profitable to nurture and exploit our national obsession with thinness. It is no exaggeration to say that in many respects contemporary America is a fundamentally eating-disordered culture. A much-noted sign of this can be seen in the binge-sized portions that are now standard fare in our restaurants and fast-food emporia. A less-noted piece of evidence is provided by the almost overtly anorexic quality of much of the current hysteria about fat. One explanation for the remarkable distortions of the medical evidence in which those who prosecute the case against fat indulge is that many of these people see that evidence through anorexic eyes. Let me be clear: I am not claiming that all such persons are technically anorexic (although some undoubtedly are). What I am saying is that the anorexic mindset is far more common than our narrow definition of what constitutes instances of the syndrome itself, and that this mindset has played an important part in producing America�s growing intolerance of even the mildest forms of body diversity.
Consider that anyone who attends a conference on the �obesity epidemic� in America today is likely to find that a good number of the participants are extremely thin, high-achieving, upper-class white women, many of whom appear to have both strong perfectionist tendencies and a pathological fear and loathing of fat. Any accurate account of the war on fat must grapple with the fact that many obesity researchers, eating disorder specialists, nutritionists, etc., belong to the precise social groups that are at the highest risk for anorexia nervosa�and that indeed a significant number of these individuals display at least some of the classic symptoms of the syndrome. For example, by some estimates, an actual majority of dietitians either have or have had eating disorders. It is true that, to the extent such persons have both recovered from and come to terms with their eating disorders, their backgrounds can improve the quality of their work. But it is also clear that large numbers of people who make it their professional business to counsel Americans about weight and health remain either actively eating disordered, or prone to the same patterns of thinking that fuel such behaviors. In short, much of the advice Americans get about weight can be compared to getting advice about drinking from people who are alcoholics and don�t know it.
What, after all, leads medical authorities to conclude that a 146-pound woman of average height is �overweight�? Beyond the fact that it�s economically profitable to classify her as fat, we should remember that, for those in the grip of what the eating disorders literature calls �anorexic ideation� (i.e., the tendency to interpret the world through an anorexic lens), a 146-pound woman is fat. Indeed, some obesity researchers are now recommending that the body �ideal� should be redefined to exclude anyone with a body mass index above 21.9�a definition that would make a 128-pound woman of average height �fat.� Such recommendations, I would suggest, are the natural consequences of allowing persons who see the world through anorexic eyes to define what �normal� means. On one level, this claim shouldn�t even be controversial: After all, it�s now routine to acknowledge that the stick-thin models and movie stars who are held up for emulation to America and the world are quite literally images of an anorexic ideal.
Why is there so little outrage over this? Anorexia nervosa has by far the highest fatality rate of any mental illness; eight million Americans are estimated to be suffering from eating disorders; tens of millions of others regularly engage in disordered eating of some sort; and yet somehow, the fact that much of American culture�from the sound stages of Hollywood to the office of the Surgeon General�is in the grip of an anorexic worldview is something that is more or less taken for granted.
For too long, too few people have been willing to condemn that view for being the destructive distortion of reality that it is. This book is for everyone who lives with the daily consequences of the lies that an eating- disordered culture tells them about their bodies. It is for everyone who has been told they are too fat�or too thin. It�s for everyone who has been encouraged to believe the propaganda of our public health authorities, instead of listening to the truth being told to them by their own bodies: that living a joyful, active life�one that includes the calm enjoyment of the many pleasures afforded by food�promotes health and longevity, while trying to conform to some arbitrary body �ideal� does damage to both. To the tens of millions of Americans who are being made miserable by the lies of the weight loss industry, and its mouthpieces in the medical and public health establishments, I would say this: Rejecting those lies requires nothing less than an act of personal and social revolt. And nothing less than a revolution is needed to overthrow America�s eating-disordered culture, with its loathing of the most minimal body diversity, its neurotic oscillation between guilt-ridden bingeing and anorexic self-starvation, and its pathological fear of food, pleasure, and life itself.
Indeed, our whole diet culture is ultimately all about fear, and self-loathing, and endless dissatisfaction. That is the culture we live in. That is the culture we must change. If you have spent much of your life hating your body, because you have been told over and over again that there is something wrong with it, this book will explain just how false that message is. And it will explain exactly what has gone wrong with a culture that demands you hate the body you were born with.
This book has three parts. Part I, �Fat Science,� provides a concise overview of the current medical literature on the relationship between weight and health. Many of the facts in this section are likely to astonish anyone who has relied on the mass media for information on this topic (they certainly astonished me). Contrary to almost everything you have heard, weight is not a good predictor of health. In fact a moderately active larger person is likely to be far healthier than someone who is svelte but sedentary. Moreover, the efforts of Americans to make themselves thin through dieting and drugs are a major cause of both �overweight� and the ill health that is wrongly ascribed to it.
In other words, America�s war on fat is actually helping cause the very disease it is supposed to cure. In the chapters that follow, we will see that:
-The health risks associated with increasing weight are generally small, in comparison to those associated with, for example, being a man, or poor, or African American.
- These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people, and the same mortality rate as thin active people.
- There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence that short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.
- Despite a century-long search for a �cure� for �overweight,� we still have no idea how to make fat people thin.
As this part of the book will make clear, the war on fat has reached the point where systematic distortion of the evidence has become the norm, rather than the exception. The basic strategies employed by those who profit from this war are to treat the most extreme cases as typical, to ignore all contrary data, and to recommend �solutions� that actually cause the problems they supposedly address. And, as in all wars, truth ends up being the first casualty.
To a shocking extent, much of the highest profile obesity research being done in America today turns out to be little more than propaganda masquerading as the results of disinterested scientific investigation: propaganda that has been bought and paid for by our nation�s $50 billion per year weight loss industry. The book�s first section illustrates the extent to which Americans have become as addicted to junk science as we are to junk food�and it lays the groundwork for exploring that addiction�s profound cultural and political consequences.
As we will see in Part II, �Fat Culture,� the war on fat ultimately has very little to do with science. The doctors and public health officials prosecuting that war would have us believe that who is or isn�t fat is a scientific question that can be answered by consulting something as crude as a body mass index chart (the BMI is a simple mathematical formula that puts people of different heights and weights on a single integrated scale). This, like so many other claims at the heart of the case against fat, is false. �Fat��or as our anti-fat warriors prefer to put it, �overweight��is a cultural construct, not a scientific fact. For instance, according to the public health establishment�s current BMI definitions, Brad Pitt, Michael Jordan, and Mel Gibson are all �overweight,� while Russell Crowe, George Clooney, and baseball star Sammy Sosa are all �obese.� (A common reaction to such absurdities is to object that the BMI definitions aren�t meant to apply to people in �good shape.� In fact, those who make claims about the supposed link between increasing body mass and ill health do not make exceptions for movie stars, athletes, or anyone else. According to America�s fat police, if your BMI is over 25 then you are �overweight,� period. Note also the radical difference between how our culture defines �fashionable� thinness for men and women. If Jennifer Aniston had the same BMI as her husband Brad Pitt, she would weigh approximately 55 pounds more than she does.)
The truth is that to be fat in America today means to weigh more than whatever a person�s particular social milieu considers appropriate. As we shall see, this means it is perfectly possible�and in a certain twisted sense even �reasonable��for a 130-pound white college student of average height to consider herself �fat,� while a working-class African American woman who weighs 50 pounds more is not likely to think of herself as �overweight� (and she, too, will be correct in her self-assessment). In other words, fat in America is a state of mind, rather than some objective fact about our bodies.
Although race and class are topics that make most Americans nearly as uncomfortable as fat itself, any extensive discussion of weight-related issues must explore the many connections between these three subjects. �Fat Culture� outlines how such disparate topics as Gwyneth Paltrow�s fat suit, Michael Jackson�s attempts to become white, Elvis Presley�s expanding waistline, the �food porn� of high-end restaurant menu prose, and the kidnapping of a three-year-old girl by the state of New Mexico because she was �too fat� are all fundamentally interconnected.
Americans love to moralize about fat because, among other reasons, fat has become a convenient stand-in for various characteristics that have been traditionally associated with the pariahs of the moment. �Fat Culture� explores how and why Americans who would never dream of consciously allowing themselves to be disgusted by someone�s skin color, or religion, or social class, often feel no compunction about expressing the disgust elicited in them by the sight of people who weigh anything from a lot to a little more than our current absurdly restrictive cultural ideal.
Such reactions are ultimately political in the broadest sense; and Part III, �Fat Politics,� traces the political consequences of an ideology that equates thinness with virtue and fat with vice. Indeed this ideology drives both the science and culture of our national obsession with weight and weight control. This part of the book describes how that obsession came to play a key role in the impeachment of the president of the United States; and it explores the powerful political meanings and messages that Americans have come to ascribe to the shape of peoples� bodies. The argument in these chapters suggests that, for upper-class Americans in particular, obsessing about weight can become a way of dealing with (or rather not dealing with) far more significant issues involving consumption and overconsumption.
In American culture, the urge to moralize and medicalize as many aspects of personal behavior as possible runs deep. Today epidemiological regression analyses have largely taken the place of the sorts of exhortations once represented by Jonathan Edwards� eighteenth-century sermon �Sinners in the Hands of an Angry God.� Nevertheless, as Part III will make clear, the motivating impulses behind such apparently dissimilar texts turn out to have a number of things in common. At bottom, the obesity myth is both a cause and a consequence of what sociologists call a �moral panic.� It is a particularly tenacious example of the same sort of impulse that fueled hysteria about demon rum, reefer madness, communists in the State Department, witches in Salem, and many other instances of our eternally recurring search for scapegoats, who can be blamed for the decadent state of American culture in general, and of the younger generation in particular.
Our anti-fat warriors are right about one thing: How we approach issues of weight, weight control, and body image tells us a great deal about what kind of people we really are. Much like their Calvinist spiritual ancestors, those who prosecute the war on fat treat the most extreme forms of intolerance as the surest signs of virtue. And, as we shall see, in their unwillingness to brook dissent, their eagerness to sniff out heresy, and their ultimately tragic devotion to a task that can neither be completed nor abandoned, those who have transformed the Protestant work ethic into the American diet ethic are worthy heirs to a tradition of life- warping fanaticism.
Anyone who writes a book challenging the conventional wisdom on a controversial topic knows in advance that his arguments will be misunderstood, caricatured, and generally distorted by those who have the most to lose from the possibility that the challenge might be effective. Although it is futile to attempt to avoid that fate by anticipating it, it still might be useful to state a few points as clearly as possible from the outset, for the benefit of skeptical readers willing to consider the merits of this particular challenge.
The obesity myth is based on three claims: that �excess� weight causes illness and early death; that losing weight improves health and extends life; and that we know how to make fat people thin. It is true that these claims are not completely false. After all, as every good propagandist knows, a social myth is much more effective when it is based on a grain of truth.
This book does not argue that there is no relationship between weight and health. It argues, rather, that the health risks associated with higher-than-average weight have been greatly exaggerated, while all sorts of related but far graver risks have been ignored. In particular, this book emphasizes that poverty, poor nutrition, and a culture that makes it easy for Americans to be sedentary are important public health issues in America today. We should be encouraging Americans to be physically active, to eat well, and to provide reasonable access to medical care for those among us who lack it. What we should not be doing is telling Americans that they will improve their health by trying to lose weight. As we shall see, there is very little evidence that attempts to achieve weight loss will improve the health of most people who undertake them, and a great deal of evidence that such attempts do more harm than good.
Nevertheless, it�s important to be realistic about the actual motivations that lead people to try to lose weight. This book acknowledges that, given the enormous premium our culture places on thinness, Americans have all sorts of reasons for wanting to lose weight that have nothing to do with health. But it also points out that treating cosmetic weight loss as if it were a medical and moral issue tends to make people both considerably fatter and a good deal unhappier than they would otherwise be.
Finally, it would be unfair to the reader not to reveal from the beginning that this book has an autobiographical dimension of a rather ironic sort. I lost a great deal of weight while working on this book, thereby transforming myself, in the course of undertaking a comprehensive critique of America�s obsession with weight loss, from an �obese� forty-year-old man into someone who currently maintains what our public health establishment mischaracterizes as an �ideal� weight. I will explore the significance of this peculiar fact in the book�s final chapter. For now I merely note that, given the dismal history of diets in America, it would only be fitting if the first really effective diet book consisted of a wholesale denunciation of the very idea of diet books. Indeed in the course of this project I discovered that there were distinct advantages to being a fat person hiding inside a thin body. Who, after all, can describe a prison more accurately than one of its inmates?
Fear and Loathing in Los Angeles
THE COVER of the March 2000 issue of Harper�s magazine features a photograph of an artwork entitled Sundae 1, by Jeanne Dunning. The photograph is of the head and shoulders of a person of indeterminate gender, lying on his or her back. The person�s face is completely smothered by an artfully stacked mound of whipped cream, topped with a cherry.
The cover story the photograph is meant to entice readers to sample is �Let Them Eat Fat: The Heavy Truths About American Obesity,� by Greg Critser. This essay is in many ways representative of the sort of reportage regarding weight-related issues now appearing on a daily basis in the nation�s major newspapers and large-circulation magazines. The basic thesis of such stories is almost always the same: Americans are eating themselves to death. Yet readers of these stories who remain willing to look just below their surface of alarmist claims and distorted statistics will often find evidence of things a good deal more disturbing than the number of calories in a Double Whopper with cheese. In this regard, �Let Them Eat Fat� is an especially revealing document. Indeed, its author�s unusual candor makes this essay an excellent introduction to the underlying cultural sources of our increasingly intense obsession with the dietary habits and waistlines of our fellow citizens.
The essay itself opens with what its author clearly intends to be a shocking and horrifying tableau: In the intensive care unit of the University of Southern California�s medical center in downtown Los Angeles, a twenty-two-year-old man whom Critser names �Carl� is being intubated, while surgeons �labor to save his life.� Critser informs us that Carl weighs 500 pounds. The author then quotes the patient�s mother: ��Second time in three months,� [she] blurted out to me as she stood apart watching in horror. �He had two stomach staplings, and they both came apart. Oh my God, my boy ...� Her boy was suffocating in his own fat.�
�Here ... writhed a real-life epidemiological specter,� notes the shocked and horrified author, employing a metaphor that suggests Harper�s editors were not at the top of their games when this piece came across their desks. (As we shall see, neither were the magazine�s fact checkers.)
The magazine�s readers are never told what medical condition has occasioned this emergency. Given the assertions made in the rest of his essay, I suspect it may come as a surprise to the author to learn that �suffocating in your own fat� does not constitute a recognized medical diagnosis. More to the point, using �Carl�s� unspecified medical problems to introduce a discussion of weight and public health is typical of the sorts of anxiety-provoking distortions employed by America�s anti-fat warriors. Only a tiny percentage of the 135 million adult Americans who the government claims are �overweight� are anywhere near Carl�s size. By focusing on the most extreme cases, those prosecuting the war on fat copy the drug war�s most deceptive tactics: Just as the average American who our government labels a �drug abuser� is someone who smokes marijuana occasionally, the average American being harassed by our public health authorities about her supposedly unhealthy weight is a 150-pound woman, not a 500-pound man.
But leave all this aside for the moment. Critser goes on to cite the usual scare statistics about an �obesity epidemic� in America, before offering up a particularly choice quote from David Satcher. Satcher, who succeeded C. Everret Koop as Surgeon General, is perhaps even more unhinged on the subject of obesity than his fat-obsessed predecessor. �Today,� Satcher solemnly intones to a gathering of federal bureaucrats and policymakers, �we see a nation of young people at serious risk of starting out obese and dooming themselves to the tough task of overcoming a serious illness.�
The rhetorical stakes are then ratcheted even higher with a quote from William Dietz, the director of nutrition at the Centers for Disease Control (Critser employs the neat journalistic trick of always characterizing the most histrionic of his sources as �the most careful� and �normally reticent� experts): �This is an epidemic in the U.S. the likes of which we have not had before in chronic disease,� Dietz says. Critser expands on this ridiculous claim�which any journalist armed with a scintilla of skepticism would recognize as exactly the sort of thing a CDC honcho angling for a bigger slice of the federal health research pie might say�with an even more preposterous observation of his own. �The cost [of obesity] to the general public health budget by 2020,� Critser predicts, �will run into the hundreds of billions, making HIV look, economically, like a bad case of the flu.� (An outbreak of influenza in 1918 killed between twenty and forty million people worldwide, including 675,000 Americans, but never mind.)
The essay goes on to frame its subject in a manner that�no doubt unintentionally�recalls Jonathan Swift�s eighteenth-century masterpiece of satirical invective, �A Modest Proposal,� in which Swift suggested that the Anglo-Irish ruling class should encourage the Irish poor to fatten up their children, and then sell them for slaughter: �How is it that we Americans, perhaps the most health-conscious of any people in the history of the world, and certainly the richest, have come to preside over the deadly fattening of our youth?� Critser asks.
Before getting to his answer, I should note that to this point �Let Them Eat Fat� has been fairly standard stuff. I simply never would have believed, before I began to study the issue of fat in America, how inaccurate most of the mainstream journalism regarding this issue actually is. Typical newspaper and magazine articles on fat are generally worse than worthless: Such stories tend to be nothing more than lemming-like compendia of various gross distortions, fed to a compliant media by those in the medical and pharmaceutical establishment who profit directly from the constant escalation of America�s weight anxiety. (If stories on the drug war consisted mainly of rewrites of press releases from the White House�s Office of Drug Policy, they would be about as reliable as the average journalistic foray into the war on fat.) Readers of this Harper�s article, and of the hundreds of pieces of journalism churned out annually that repeat its central claims, will never guess that there is a raging debate in the medical literature about whether �obesity� is even a useful concept. They will never be given a hint of the fact that, in the words of the editors of the New England Journal of Medicine, the case for the claim that fat is a significant health risk is �limited, fragmentary and often ambiguous.� They are not going to be informed that far more Americans do serious damage to their health by attempting to lose weight than by gaining it. And they will never hear of the powerful evidence gathered over the past two decades that a lack of cardiovascular and metabolic fitness, not an excess of fat, is the key to understanding ill health among both fat and thin Americans.
No, most readers will come away from such articles with the belief (as I did, when my knowledge of the subject came from similar sources) that �obesity� is a major health risk in America, if not an outright epidemic disease�one that dwarfs AIDS in its potential to devastate the children of the poor and the pocketbooks of the rich (more on that particular connection in a moment).
Of course all of this is either greatly exaggerated or flatly untrue. I ask readers to forgive a bit of repetition, intended to fight the reflexive incredulity that, as a consequence of so much weight loss industry propaganda, the following facts tend to elicit among even the best-informed audiences: Weight is on the whole a poor predictor of health. Even quite fat people have better health, on average, than fashionably thin women. Fat active people have half the mortality rate of thin sedentary people. Levels of physical activity are far better predictors of health than body mass. Dieting does far more damage to health than being fat. And so on.
You would never guess any of this from reading or viewing the vast majority of stories published or broadcast about weight in the nation�s major media. Attempting to explain the causes of this remarkable level of distortion is one of the aims of this book. One source of that distortion is the understandable hunger to find simple explanations for complex problems. Americans are on the whole pragmatic people who like to believe problems have solutions, especially if these problems are subjected to the rigors of �scientific policymaking.� Simply assuming that heavier people are less healthy than thin ones, and that the former would be healthier if they were thinner, makes it much easier to draft nice, straightforward grant proposals, and to formulate nice, unambiguous public health policies. (It�s also a great way to secure funding from pharmaceutical companies.) A close cousin of this phenomenon is the professional deformation that takes place when an entire discipline is organized initially around a fundamentally mistaken assumption: in this case, the assumption at the core of obesity studies that higher than average weight is a significant independent health risk.
Another explanation, one illustrated well by the substance of the mainstream journalism discussing weight, is that almost all of us rely on the conventional wisdom regarding a particular subject for essentially all of our information about that subject. Unless we have some fairly specialized knowledge about X, our opinions about X will almost always reflect the opinions about X held by people like us. At bottom, journalists tend to believe what they believe about fat because what they believe about fat simply reflects the views about fat held by the people they know best�many of whom, of course, are other journalists. And even those among their circle who are not journalists will still tend to be people very much like them�upper-class, mostly white professionals who can for the most part be counted on to share the same basic beliefs as their journalist friends, spouses, and so on.
Given all this, it�s hardly surprising that journalists will often come to an issue such as the relationship between weight and health with the point of view that will frame the researching and writing of their stories already firmly in place. Since most of their research will, by necessity, consist of reading the work of other journalists on this same issue, supplemented, perhaps, by new quotations from the very same experts and government agencies that were quoted in these previous stories, the new stories inevitably end up looking very much like the old ones.
I have no affection for conspiracy theories; and most popular accounts of how information gets interpreted and distorted by the media tend to be both too rationalistic and too conspiratorial. But I will say this: The experience of reading hundreds of articles about fat published in our nation�s major media over the course of the last few years, while at the same time actually studying the primary scientific research regarding the subject, is something that can make theories of manufactured consent and the like begin to look fairly plausible. As the joke goes, a paranoid person is somebody who suspects what�s really going on. Except that it isn�t always a joke: Spend three years reading the scientifically spurious propaganda of the diet industry dressed up as �investigative journalism,� and then get back to me.
Anyway, back to �Let Them Eat Fat.� The most valuable feature of this essay is the relatively clear glimpse it provides into many of the emotions, ideological inclinations, and outright prejudices that help explain why we are beset by so many irresponsible public policies directed toward the issue of weight in America. This is, in a sense, to its author�s credit. For Critser does not, like so many other writers on this subject, wholly repress any explicit acknowledgment of the more disturbing impulses that fuel the war on fat.
Critser thinks he has found, on the streets of Los Angeles, the answer to his question regarding how Americans can be so health-conscious and so fat at the same time. A recent article in Glamour magazine, written by a Glamour editor whose assignment was to go an entire week without weighing herself or counting calories (this was clearly meant to be perceived by the magazine�s readership as a Herculean task) describes Los Angeles as a city where it�s �illegal to sign a lease if you have a body fat percentage of more than 6%.� That�s one side of the city to be sure (the west side, more or less). But in what Critser describes as �the heart of the San Fernando Valley�s burgeoning Latino population,� the situation is quite different. It is here that Critser attends the opening of a new Krispy Kreme doughnut store, and witnesses scenes that he describes in something akin to the tone of a Victorian missionary confronting the savage rituals of the natives, somewhere deep within the heart of darkness.
Critser interviews the manager of the store, who touches on the elaborate marketing strategies that go into choosing the location of a new Krispy Kreme outlet: ��The idea is simple�accessible but not convenient ... We want them intent to get at least a dozen before they even think of coming in.�� Critser asks the manager who these prospective marketing targets might be. �He gestured to the stout Mayan do�as queuing around the building. �We�re looking for all the bigger families.�� �Bigger in size?� Critser asks with what appears to be an almost pornographic air of fascination. ��Yeah.� [The manager�s] eyes rolled, like little glazed crullers. �Bigger in size.��
At this point I should say something about my own background. My parents came to the United States from Mexico in the year of my birth; my mother remained a Mexican citizen for twenty years after that; and I spoke only Spanish when I began going to school. All of which is to say that as a Mexican American, I�m naturally more attuned to the resonance of statements involving �stout Mayan do�as� than most of my fellow citizens. At the same time, however, I�m someone who has always been suspicious of identity politics in all of its forms, and who has said so repeatedly in print. Few things annoy me more than any sentence beginning �As a (Latino/gay/Asian/feminist etc.), I am offended by....�
I mention all this to give some context to my reaction to what follows in Critser�s essay�material whose full flavor cannot be appreciated without extensive quotation.
At my local McDonald�s, located in a lower-middle-income area of Pasadena, California, the supersize bacchanal goes into high gear at about 5 p.m., when the various urban caballeros, drywalleros, and jardineros get off from work and head for a quick bite. Mixed in is a sizeable element of young black kids traveling between school and home, their economic status apparent by the fact that they�ve walked instead of driven. Customers are cheerfully encouraged to �supersize your meal!� by signs saying, �If we don�t recommend a supersize, the super- size is free!� For an extra seventy-nine cents, a kid ordering a cheeseburger, small fries and a small coke will get said cheeseburger plus a supersize Coke (42 fluid ounces versus 16, with free refills) and a supersize order of french fries (more than double the weight of a regular order). Suffice it to say that consumption of said meals is fast and, in almost every instance I observed, very complete.
Again, note the lurid tone: You would think the author had been watching teenagers exchange sexual favors for crack cocaine, given the text�s mixture of salacious detail and horrified sanctimoniousness.
And that is not all. Critser goes on to agonize over the contents of the �jumbo dietetic horror� he has witnessed, and to describe the �endocrine warfare� he believes is sure to erupt in the bodies of the wretched refuse of our teeming shores who engage in such flagrant self-abuse. Then he really lets us know what he thinks:
If childhood obesity truly is �an epidemic in the U.S. the likes of which we have not had before in chronic disease,� then places like McDonald�s and Winchell�s Donut stores, with their endless racks of glazed and creamy goodies, are the San Francisco bathhouses of said epidemic, the places where the high-risk population indulges in high-risk behavior. Although open around the clock, the Winchell�s near my house doesn�t get rolling until seven in the morning, the Spanish-language talk shows frothing in the background while an ambulance light whirls atop the Coke dispenser. Inside, Mami placates Miguelito with a giant apple fritter. Papi tells a joke and pours ounce upon ounce of sugar and cream into his 20-ounce coffee. Viewed through the lens of obesity, as I am inclined to do, the scene is not so feliz.
By now, we might wonder, why hasn�t the frantic author hurled himself bodily between that giant apple fritter and poor little Miguelito, or at least called the police? Indeed, at this point even the most anti-PC Hispanic you can find might well want to ask the author a couple of questions. Such as, did some urban caballero ride off with his girlfriend or something? And what is it with these skinny uptight Anglos, anyway? Who exactly deputized them to be the fat police at their local fast-food emporia?
Critser has an answer to these questions (or at least to the latter one). His focus on the ethnicity of all these Mayan do�as and peripatetic black kids and doughnut-crazed Mexicans has nothing whatsoever to do with the phenomenon of upper-class white people being revolted by the sight of fat, working-class, non-white persons, possibly of extra-national provenance, gorging themselves like animals in a viscerally disgusting (but actually quite tasty�ever had a Krispy Kreme doughnut?) bacchanal of forbidden treats. Oh no. He is merely sounding the alarm, in a desperate attempt to save these hopelessly simple people from themselves. �The obesity rate for Mexican-American children,� the author informs us sternly, �is shocking.� He returns to the scene of the ongoing doughnut crime: �The lovely but very chubby little girl tending to her schoolbooks ... will begin puberty before the age of ten, launching her into a lifetime of endocrine bizarreness that will not only be costly to treat but will be emotionally devastating as well.� Critser doesn�t need to add that all this �bizarreness� will also give her a big head start over all those anorexic (and therefore infertile) white girls in the nicer parts of Pasadena, in the Darwinian struggle to produce the next generations of (respectively) Krispy Kreme junkies and Diet Coke addicts.
To be fair, Critser doesn�t really want to focus on what he calls �the inevitable divisiveness of race and gender.� He wants to talk about the relationship between fat and social class. On this topic, he actually makes a good deal of sense. He notes that, in America today, the poor are fat and the rich are not�and he even considers the possibility that the rich would like to keep things that way. �In upscale corporate America,� he notes, �being fat is taboo, a sure-fire career-killer. If you can�t control your own contours, goes the logic, how can you control a budget and staff? Look at the glossy business and money magazines with their cooing profiles of the latest genius entrepreneurs: To the man, and the occasional woman, no one, I mean no one, is fat.�
One would hope that a journalist confronting a situation such as this�in which a physical characteristic was being used to disenfranchise a significant portion of the citizenry from the upper echelons of money and power�would display a modicum of curiosity about whether the things the people with the money and power were saying about the supposed awfulness of that physical characteristic were actually true. But, at this moment in America, when it is no longer possible to observe that a glossy brochure contains no pictures of women, or non-whites, without being expected to wonder if there�s a legitimate reason for that absence, it is still possible�and indeed almost obligatory�to assume there is a good reason for excluding fat people.
It would be difficult to come up with a better illustration of the distorting power of the war on fat than Critser�s explanation for why Americans�specifically poor and working-class Americans�are getting fatter, when being fat has so clearly become an enormous social disadvantage. According to Critser, it�s because America�s elites have been afraid to say or do anything to signal social disapproval of fat. Cowed by, among others, �a very vocal minority of super-obese female activists ... the media, the academy, public health workers, and the government do almost nothing� to let Americans know that being fat is undesirable. This hypothesis, of course, is simply insane on its face.
In America today, it is impossible for anyone above the age of about five�recent news reports indicate that fat anxiety is becoming common among six- to eight-year-olds�to somehow miss the fact that power and privilege in all of its forms are associated with thinness, and, especially in the case of women, unhealthy extremes of thinness. Go into any supermarket, look at any magazine rack, glance at any television screen, visit any movie theater, enter any office building, peruse any glossy entrepreneurial profile�indeed, walk down a city street with your eyes open, and you will get the message. What�s amazing is that, as we have seen, Critser gets the message loud and clear when he recognizes that thinness and economic privilege are closely connected in our culture�and yet he instantly forgets this fact when he attempts to explain why the have-nots are getting fatter.
His thesis that �those with true cultural power, those in the academy and the publishing industry who have the ability to shape public opinion� have been so cowed by feminists and the like that they display a systematic �reluctance to face [the] facts� about fat is, under the circumstances, nothing less than bizarre. After all, Critser�s essay itself manages to remain almost fact-free in regard to the obesity debate (indeed, he seems unaware there is a debate) precisely because it is a product of a cultural atmosphere in which investigative journalists writing for high-profile magazines have been so thoroughly brainwashed about the supposed health risks of fat that they don�t bother to engage in the most cursory investigation of their topic. Critser concludes on an apocalyptic note:
What do the fat, darker, exploited poor, with their unbridled primal appetites, have to offer us but a chance for we diet-and-shape-conscious folk to live vicariously? Call it boundary envy. Or, rather, boundary-free envy ... Meanwhile, in the City of Fat Angels, we lounge through a slow-motion epidemic. Mami buys another apple fritter. Papi slams his second sugar and cream. Another young Carl supersizes and double supersizes, then supersizes again. Waistlines surge. Any minute now, the belt will run out of holes.
In his book The Anatomy of Disgust, William Ian Miller traces the ways in which that emotion is related to both fear and moral judgment. We become disgusted when what would otherwise remain mere contempt becomes enriched by, among other things, a fear of contamination: �We know when we are disgusted and we usually know when we are afraid. But the two are frequently co-experienced: thus the easiness and the justness of the collocation �fear and loathing.� ... Intense disgust invites fear to attend, because contamination is a frightful thing.�
Indeed it is. As Miller points out, disgust �operates in a kind of miasmic gloom, in the realm of horror, in regions of dark unbelievability, and never too far away from the body�s and, by extension, the self�s interiors.�
If one were forced to come up with a six-word explanation for the otherwise inexplicable ferocity of America�s war on fat, it would be this: Americans think being fat is disgusting. It really is, on the most important cultural and political levels, as simple as that. Critser�s article is merely an unusually clear example of the commonplace social process by which a visceral reaction is transmuted into an aesthetic judgment, which in turn becomes a series of (imaginary) facts about the relationship between weight and health.
Critser dismisses as �vulgar social psychology� the idea that hatred of fat might be driven by �our need for an identifiable outsider.� Yet a few strokes of Occam�s razor makes it evident that this is in fact a highly plausible explanation for the genesis of the sort of hysterical diatribe Critser himself produces, featuring as it does so much voyeuristic ogling of fat Mexicans enjoying giant apple fritters.
Fifty years ago, America was full of people that the social elites could look upon with something approaching open disgust: blacks in particular, of course, but also other ethnic minorities, the poor, women, Jews, homosexuals, and so on. (An example: I remember from my childhood in the 1970s that Polish jokes were a regular feature of Johnny Carson�s Tonight Show monologue.) Yet over the last half-century, the classes of candidates available for open pariah status have gradually shrunk. This has become a problem on at least two levels. As many a vulgar social psychologist has (correctly) observed, societies need pariahs. In most cultures, some class of people is more or less required to play the role of those who make everybody else feel superior by comparison. Furthermore, the feelings of disgust elicited in others by traditional pariah-class individuals do not simply disappear as soon as it becomes unacceptable to express those feelings openly.
As The Handbook of Obesity Studies notes (Critser himself cites this precise quote): �In heterogeneous and affluent societies such as the United States, there is a strong inverse correlation of social class and obesity, particularly for females.� In other words, on average, poor people in America are fat, and rich people are thin. A strong correlation also exists between obesity and ethnic minority status�one that goes beyond the class correlation itself. Particularly among African American women, changing class status does not appear to strongly influence obesity rates (in America, the demographic group with the highest obesity rate is that comprised of black women in their fifties). Critser notes this as well, and muses that some observers might claim �black women find affirmation for being heavy from black men, or believe themselves to be �naturally� heavy.� He then adds prissily that �such assertions do not change mortality statistics.�
This last observation is really too much. As we have seen, Critser does not appear to have looked at (or at any rate understood) any mortality statistics whatsoever. If he had, he might have discovered that studies investigating the relationship between weight and health among African-American women have found no correlation between increasing weight and mortality among such women, even at very high levels of �obesity.�
Yet ultimately all this is beside the point. The disgust the thin upper classes feel for the fat lower classes has nothing to do with mortality statistics, and everything to do with feelings of moral superiority engendered in thin people by the sight of fat people. Precisely because Americans are so repressed about class issues, the disgust the (relatively) poor engender in the (relatively) rich must be projected onto some other distinguishing characteristic. In 1853, an upper-class Englishman could be quite unself-conscious about the fact that the mere sight of the urban proletariat disgusted him. In 2003, any upper-class white American liberal would be horrified to imagine that the sight of say, a lower-class Mexican-American woman going into a Wal-Mart might somehow elicit feelings of disgust in his otherwise properly sensitized soul. But the sight of a fat woman�make that an �obese��better yet a �morbidly [sic] obese� woman going into Wal-Mart ... ah, that is something else again.
And, precisely because we live in a culture obsessed with fat hatred, the otherwise potentially disturbing fact that this woman, who often elicits feelings of disgust in white upper-class observers, also just happens to be poor and non-white can be dismissed by those observers as an irrelevant coincidence. (It�s difficult to imagine a magazine such as Harper�s publishing the sort of ethnic insults that fill Critser�s article in any context other than one in which those insults are aimed at fat people.)
At bottom, the reason upper-class Americans are so disgusted by, and terrified of, fat is that in this culture fat has the power to contaminate. Fat has the power, metaphorically speaking, to make us non-white and poor�and under current cultural conditions it is much easier for an upper-class white person to become fat than it is for him or her to become poor, let alone non-white.
Seen in this light, the almost pornographic quality of Critser�s descriptions of fat people eating fast food begins to make sense. For what Critser calls �we diet-and-shape-conscious folk,� a Krispy Kreme doughnut is not just a doughnut: It is a fetishistic, almost magical object, with the power to contaminate and transform those who allow themselves to be seduced by its quasi-erotic charms. Each bite of that doughnut, each moment of weakness that tempts us to supersize those fries, or to surrender to the orgiastic frenzy in which we imagine little Miguelito and the millions like him greedily ripping apart their enormous apple fritters, pushes us closer to death�and to something even worse.
In his studies of the comparative development of cultures, Jared Diamond has noted that as societies become more complex, they almost always become more sedentary, bureaucratic, and hierarchical. In America today, we are generally quite sensitive to the first two trends, while ignoring or denying the third. But who can deny that, in a nation where, as Critser himself puts it, �no one, and I mean no one� in the pages of the glossy magazines within which the elite project their image of themselves is anything like fat, the hierarchy of acceptable body types is becoming more rigid, exclusive, and well-defined than ever before?
The image on the cover of Harper�s is not merely, in one sense, pornographic: It is fraught with implications of death. A colleague to whom I showed the image to illustrate the concept of �food porn� commented that it was also, as she put it, an image of �death by sundae.� And indeed, when seen through the lens of the anxieties of the upper classes in America today�when seen through the eyes of we who are afraid of being enveloped, smothered, crushed, and, most of all, contaminated by the rippling mountains of fat cascading down the bodies of our social inferiors�the message of Sundae I becomes quite clear: Eat fat and die. Or worse yet: Become one of them.
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