Fat land : how Americans became the fattest people in the world (17 page)

WHAT FAT IS, WHAT FAT ISN T

For years, the "black men want big women and black girls feel good about being fat" doctrine dominated most popular discussion of fatness in the African American community. Often, it had the effect of pre-empting serious discussion of obesity's medical impact on black Americans. Instead, obese black girls became a vehicle for doing something that the media was increasingly happy to do: bash slim culture. (As one network affiliate commentator I watched one evening proclaimed, "Here is one group of girls who couldn't care less about looking like Kate Moss!") Uncritical acceptance of the doctrine even led some to propose a separate system for treating the black obese. Writing in the Journal of the American Dietetic Association, the authors Melnyk and Weinstein, after endless hand-wringing, eventually worked themselves up enough to admit the need for early intervention in cases of adolescent obesity. But only, they insisted, if the approach were grounded in "black belief systems." The priority, they wrote, should be "to eliminate a predominantly white Anglo Saxon ethnocentric viewpoint to prevent and treat obesity."

Beyond the twisted uses of the African American fatness doctrine, just how true were the data behind it? For the past five years social scientists studying the question have come away with one answer: not very. In 1999 a reassessment of the key early data that the doctrine was based upon was presented in the journal Perceptual and Motor Skills. The authors wanted to find out if the respondents to the original study had been overinfluenced by their own body weight; were the so-called "racial differences" in self-perception and other-perception really just differences in how fat people see the world versus how normal or thin people view the world, regardless of race? After adjusting for respondents' weight, the data could corroborate only one of the original studies' nineteen supposed differences between African and European American females (the importance of silky hair for European Americans). And one of the most celebrated "differences" between black girls and white girls dissolved entirely. "The importance of round buttocks for African American women disap-

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peared when controlling for respondents' weight," the authors concluded.

There was more. It was true that, in the initial study, African American men preferred larger body types in their African American mates than did Anglo males. But that difference — of about ten pounds — was manifest within an overall desired "universe" not of fatness, but of thinness. In other words, both black men and white men preferred thin women; it was merely their definition of what constituted thin that differed. As the researchers found, "Men and women, regardless of race, prefer slightly thin and average body types." Other age groups were restudied as well, and, again, when it came to the notion that black Americans were "comfortable" with being fat, the data cut the other way. In the year 2000, looking at 1086 male and female college students of all races at California State University at Los Angeles, psychologists at that school showed that "although it has been proposed that certain subcultures show greater acceptance of overweight and less tolerance of thinness and underweight in women, our findings demonstrate no significant race differences between women or men in different ethnic groups."

Does all of this matter? Increasingly, those who study the subject of self-perception and obesity argue that it does. A report in the journal Clinical Pediatrics looked at the self-images of an indigent, predominantly black population of children and the relationship of those self-images to their weight. The results were revealing. Thirty-nine percent of the girls and 67 percent of the boys were significantly overweight. Females tended to view themselves as fatter and males perceived themselves as thinner than their actual composition. Parents were "highly inaccurate" in perceiving such overweight, particularly when it came to their sons. The kids themselves "did not recognize the importance of exercise." This was hardly something to celebrate as a victory for black pride, leading the authors to conclude, in uncharacteristically blunt terms, that "bodyfat measurement and counseling should be done at an early age to improve this remarkable lack of perception about obesity" (emphasis added).

WHAT FAT IS, WHAT FAT ISN T

The common response to such recommendations often boils down to: Won't that make black girls just as weight-obsessed as white girls? "That's the big conundrum," says Richard MacKen-zie, a physician who treats overweight and obese girls at Children's Hospital in downtown L.A. "No one wants to overemphasize the problems of being fat to these girls, for fear of creating body image problems that might lead to anorexia and bulimia." Speaking anecdotally, he adds: "The problem with that is this: For every one affluent white anorexic you create by 'overemphasizing' obesity, you foster ten obese poor girls by downplaying the severity of the issue." Judith Stern, a professor of nutrition and internal medicine at the University of California at Davis, is more blunt about this issue. "The number of kids with eating disorders is positively dwarfed by the numbers with obesity. It sidesteps the whole class issue. We've got to stop that and get on with the real problem."

Moreover, such sidestepping denies poor minority girls a principal — if sometimes unpleasant — psychological incentive to lose weight: that of social stigma. Only recently has the academy come to grapple with this. Writing in a recent issue of the International Journal of Obesity, the scholar S. Averett looked at the hard numbers: 44 percent of African American women weigh more than 120 percent of their recommended body weight, yet are less likely than whites to perceive themselves as overweight. Anglo women, poor and otherwise, registered higher anxiety about fatness, and experienced far fewer cases of chronic obesity. "Social stigma may serve to control obesity among white women," Averett reluctantly concluded. "If so, the physical and emotional effects of greater pressure to be thin must be weighed against reduced health risks associated with overweight and obesity."

In other words, perhaps boundaries, an unpleasant but good thing for affluent white people, are also a good thing for poor and middle-class black people.

Even when an occasional healthy thin role model for the poor gets trotted out, the modern media are apt to use her not as a goad

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to trim down, but as a justification to stay fat. Consider the lengthy cultural discussion that took place in 1999 over the "meaning" of actress Jennifer Lopez's ample derriere. The debate began when Vanity Fair published a photo, taken from behind, of the actress wearing nothing but tight, lace-up underwear. Because Lopez, to paraphrase Raymond Chandler, has a body that "would make a bishop kick a hole in a stained glass window," many sat up and took notice. The New York Observer proclaimed, "Ms. Lopez has a nice big muscled butt — a-hoo-ga!"

Immediately a number of large-size ethnic celebrities jumped on the bandwagon to say how great it was that "someone who isn't perfect" was being considered so attractive. So did a number of columnists. Writing in Salon.com, the normally low-key writer Erin Aubry was moved to the literary equivalent of a civil rights march: "Being a black woman with a similar (all right, bigger) endowment, I felt an odd mixture of pride and panic. Was this a passing Hollywood fancy or a giant step for butt-kind? . . . Would my own butt, which I have alternately embraced and lamented and written about extensively as a metaphor for tortuously unrealized black assimilation in America, finally get its aesthetic props?" On Oprah, Lopez paraded about in her tight cigarette pants as Oprah checked out Lopez's derriere and proclaimed, "You go, girl, in them pants!"

Yet nowhere did anyone comment on one other reason Jennifer Lopez might be so popular, particularly among young Latinas. Could it simply be that they want to look like her — a perfectly fit, tight-bodied woman, lean from years of professional dancing, with, when all is said and done, a nice but not very big rear end at all? That wouldn't, of course, be "the right way" to see it. But it might be the accurate way.

Gender is the media's other preoccupation when it comes to interpreting obesity. Its origin lies in the tremendous popularity of the 1978 bestseller Fat Is a Feminist Issue, which tutored a whole generation of young professionals on the subject. In that book, the British psychotherapist Susie Orbach presented a nuanced,

WHAT FAT IS, WHAT FAT ISN T

passionate look at female compulsive eating and its roots in patriarchal culture. "Compulsive eating in women is a response to their social position," she wrote. The opposite was also "true": Anorexia, Orbach (and several others) held, derives from modern culture's obsession with unattainable thinness, often in the form of thin models, thin celebrities, and even thin clothing. "Fat is a social disease, and fat is a feminist issue," Orbach wrote. "Fat is not about self-control or lack of will power. ... It is a response to the inequality of the sexes."

Modern epidemiology to the contrary aside, how true is the underlying notion here — that too much fat awareness somehow causes eating disorders? Once again, the data — and the experience of physicians, health workers, and others in the field — consistently indicate otherwise. The resident historian at Cornell University's Department of Human Development and Family Studies, Joan Jacobs Brumberg, who has written the only thorough, objective history of anorexia, put it this way: "An early and distinctive psychopathology of middle class life, the disease itself [anorexia] preceded the familiar body image imperatives usually associated with it. A historical perspective shows that anorexia nervosa existed before there was a mass cultural preoccupation with dieting and a slim female body."

Not only was anorexia not the fault of the mass media, Brumberg wrote, it was — and is — hardly the "widespread disease" so often proclaimed by its main interest group, the American Anorexia and Bulimia Association (AABA). "The association's materials routinely state that anorexia and bulimia strike a million Americans every year and that 150,000 die annually," Brumberg wrote. But after looking deeply at the epidemiological data, Brumberg arrived at a very different — and more accurate — number, 1.6 per 100,000. So why all the attention? The answer, she wrote, is that most anorexics come from the upper middle class — in her words "a highly specific social address." And that, she concluded, "reflects a basic medical reality — that there are fashions in diagnosis."

There was another thing wrong with the skewed attention to

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anorexia, Brumberg wrote. "I am disquieted by the tendency to equate all female mental disorders with political protest. Certainly we need to acknowledge the relationship between sex-role constraints and problematic behaviors in women, but the madhouse is a somewhat troubling site for a female pantheon. To put it another way: as a feminist, I believe that the anorectic deserves our sympathy but not necessarily our veneration."

Yet although no serious scholar has ever challenged Brum-berg's numbers, or her class analysis, venerate is exactly what a whole new generation of journalists have chosen to do when it comes to anorexia. Writing in a May 1999 issue of the New York Times Magazine, the author Jennifer Egan actually took to comparing the anorectic and the suffering of the modern anorectic to that of Saint Catherine of Siena. Egan's principal example: Princess Di, who, because of her own well-known bouts of anorexia, "can legitimately be called a popular saint." That Egan's saint came from a rather supremely specific social address didn't seem to affect her beatification either.

One reflection of such conflicted notions about obesity can be found in the still strong resistance, in some quarters of the nation, toward body composition tests of school-age children. The tests are usually performed by PE or health education teachers using a small pair of calipers applied to either the calf or triceps muscle. Simple, quick, and relatively unintrusive, the calipers test is one of the few ways a contemporary parent can get objective information about fatness and their child. Yet whenever such programs are initiated, usually by some active, passionate health education teacher, "parents sort of freak out," says Professor J. R. Whitehead, of the Department of Physical Education and Exercise Science at the University of North Dakota. Whitehead, who has studied body composition testing for more than twenty years, acknowledges that part of that reaction is normal — parents don't want anyone touching their child who doesn't absolutely have to touch their child. But some of the reaction is irrational, he says, "like the notion that a fat test will somehow make a kid feel bad about himself and then launch into a lifelong course of anorexia."

WHAT FAT IS, WHAT FAT ISN T

To find out if such fears had any basis, Whitehead studied groups of seventh graders. He divided them into three groups. One group received the body composition test and were then taught about the health and medical reasons for such a test; a second group was merely measured; a third, unmeasured, group served as a control. The students then completed a series of scientifically vetted questionnaires, designed to plumb what impact the testing might have had on their self-image or self-esteem. The results were clear. There were no effects "on social physique anxiety," Whitehead concluded. "The results support the premise that skinfold calipers can be used in an educational context to facilitate cognitive learning without causing adverse affective consequences" — without causing bad body images. Similar studies of fifth and sixth graders, and another of college students, came out the same. "I don't come to that conclusion lightly," Whitehead says. "I am as concerned about body image issues as the next parent — I worry about it as regards my own daughter and her friends, but that is not what anyone should fear when it comes to body testing. They should see it as a way to teach kids about one health-fitness measure, and as a possible medical issue."

Another consequence of the obsession about anorexia is to skew the medical system in its favor, and to bias it against treatment and prevention of obesity. Today, there are several safe, effective drugs in the anti-anorexia arsenal. Insurance companies and HMOs recognize their importance, and pay for them as part of a patient's course of treatment. Such is not the case when it comes to obesity. Neither of the approved anti-obesity drugs — Orlistat and Meridia — is considered particularly effective. Neither can be prescribed to children or adolescents. And insurance companies are notoriously resistant to paying for them.