What's Wrong With Fat? (28 page)

The language of war creates fear, making citizens easier to manipulate and more willing to give up civil liberties. The “war on terror” metaphor was used to gain wartime powers for former President George W. Bush, many of which have continued under President Barack Obama, to imprison people for years without a trial, to justify wiretapping American citizens’
phones, and to create full-body airport scanners. 43 The “war on obesity”
metaphor has been used, among other things, to shift federal funding from tobacco research to obesity research and from food stamps to obesity prevention, to speed up Food and Drug Administration (FDA) approval of weight-loss drugs and overlook potential side effects, and to send “BMI report cards” home to parents in Arkansas and Pennsylvania. In extreme cases, the war on obesity has been used to justify removing fat children from their parents’ custody. On an individual level, the “war on obesity” language sets people up to regard their own body fat with hostility, as they fight their personal “battles of the bulge.” 44

WHAT PERSONAL RESPONSIBILITY FRAMES DO

As we have seen, blame for obesity is typically framed as a question of personal responsibility. This frame foregrounds cases in which people are fat because of unhealthy lifestyles, while obscuring cases in which people are fat despite healthy lifestyles or those in which people are thin despite being sedentary and subsisting on “junk food” and cigarettes. Some dieters may feel empowered by the personal responsibility frame, as it promises success for those who exert sufficient willpower. Yet, by presenting fatness as evidence of immorality (i.e., gluttony and sloth), the personal responsibility frame may also facilitate the shaming and blaming of fat people, as when a major newspaper quotes science reporter Michael Fumento describing anti-fat prejudice as “a helpful and healthful prejudice for society to have.” 45

Moreover, if weight is understood as a (poor) choice, it may seem justifiable to punish people for being fat, by, for instance, charging a higher amount for health insurance policies to the heaviest people. Indeed, as part of the growing hold of neoliberalism, more and more U.S. employers are requiring that workers who weigh more than a certain amount (or who smoke or have high cholesterol) pay a greater share of health care costs.
Specifically, policies that impose such financial penalties on employees have doubled between 2009 and 2011 and are predicted to double again between 2011 and 2012. 46 On March 31, 2011, Arizona governor Jan Brewer announced that she was proposing fees for Medicaid recipients who “lead unhealthy lives.” She proposed a fine of $50 annually for childless adults who are “obese.” Defending the proposal, the assistant director of Arizona’s Medicaid program invoked the importance of people taking “personal responsibility” for disease “that costs the state more money.” 47
By focusing on social welfare programs, such policies target the poor. New York mayor Michael Bloomberg’s proposal to prevent the use of food stamps for the purchase of soda or other sugary drinks would similarly have a disproportionate impact on the poor. 48 In 2001, a benefits office in Lübeck, Germany, threatened to reduce a 53-year-old woman’s welfare benefits if she did not go on a diet. 49 One study found that people who believe that obesity is the product of “sinful behavior” are more likely, than those who do not share this view, to support charging overweight people more for health insurance. 50

Furthermore, if fatness is framed as a life-threatening condition that is under individual or parental control, then it does not take a huge conceptual leap to assume that fat children are victims of parental abuse. And if they are being abused, it may be justified to remove them from their parents’ care. Indeed, there are several cases in which children have been removed from their parents’ custody because their fatness was itself evidence of abuse and/or neglect. These cases are conceivable only because obesity is being framed
both
as a life-threatening condition
and
as a problem that is largely under individual control. If it were believed that one could be fat and healthy or that body size is dictated by genetic factors, no child would be wrested from their parents for being fat.

In one case in 2009 in Dundee, Scotland, child protective services removed a newborn child from her mother, while she was still recovering in the hospital. According to news reports, the couple, who has six children, were warned that they would face losing custody if they could not get their older children’s weight under control. 51 Authorities had already removed two children, ages 3 and 4 from the family home, leaving three other children with the couple. The order to remove the baby was overturned only after the couple promised to work with Dundee Child Protective Services to improve the health of their children. 52

British authorities have said that more fat children are likely to be put on “at risk registers” or taken into foster care if the “obesity epidemic continues to escalate,” demonstrating how the public health crisis frame is leading to greater surveillance and social control. 53 According to David Rogers, the Local Government Association’s public health spokesman, “Councils would step in to deal with an undernourished and neglected child, so should a case with a morbidly obese child be different? If parents consistently place their children at risk through bad diet and lack of exercise, is it right that a council should step in to keep the child’s health under review?” 54 Again, this statement depends upon a framing of obesity as both a medical problem and an issue of personal responsibility.

Earlier that year in South Carolina, Jerri Gray, the African American mother of 555-pound 14-year-old Alexander was charged with neglect for failing to control her son’s weight. 55 The boy’s mother had been contacted earlier by the local department of social services about her son’s weight and was issued a treatment plan. Jerri Gray was on a very limited income and had difficulty paying for gas money, making it difficult for her to make her son’s medical appointments. 56 When she missed some of them and he continued to gain weight, the state sent notice that Jerri would lose custody of her only child. She panicked and fled town with her son. After they were found, Alexander was put in foster care, and Jerri was charged with two counts of felony: custodial interference, which carries a five-year sentence, and child neglect, which carries a 10-year sentence. 57 The state’s action assumes a personal responsibility frame, in which Alexander’s weight is taken as direct evidence of parental neglect, as opposed to being seen as, say, a product of sociocultural constraints, biological factors, or some combination of both. The punitive approach taken by the state of South Carolina echoes the criminal prosecution and imprisonment of poor and pregnant African American women who are found to have consumed crack cocaine when pregnant. 58

It is not a coincidence that these cases have typically involved families who are poor, immigrants, and/or from ethnic minorities. AnaMarie, who, in 2000, the state of New Mexico wrested screaming from her parents and put in foster care—on the grounds that her weight was life threatening and was her parents’ fault—was Latina. The social worker’s affidavit stated that “the family does not fully understand the threat to their daughter’s safety and welfare due to language or cultural barriers,” even though AnaMarie’s mother was born in the United States and spoke fluent English. 59 Leslie Abbott, who lost custody of her son, Terrell, in 2007, after months of fighting neglect charges related to his body weight, was a poor and black single mother. She said she would have to quit her minimum-wage job to have the time to follow her son’s health regimen but could not survive without the income. 60 This is consistent with larger trends in the United States, in which the poor are more vulnerable to punitive state policies than wealthier families, in large part, because they are more dependent on public assistance. 61

PROMISES AND PITFALLS OF SOCIOCULTURAL FRAMES

As we have already seen, there is a growing focus on sociocultural determinants of weight among people who consider overweight and obesity to be a public health crisis. Social policy researchers and policymakers hope that shifting the focus away from individual behavior onto the practices of food corporation will enable meaningful new regulation of the food industry, in much the same way that shifting focus onto the corporate practices of “big tobacco” led to more extensive regulation of that industry. 62

One might also expect greater emphasis on environmental factors to undermine the tendency toward blaming individual fat people. This hypothesis has scarcely been tested, however, and the available evidence is mixed. One study found that people who ascribed to a “toxic food environment” theory of obesity were more likely, than those who did not, to express support for antidiscrimination policies. Yet, it also found that these people were
not
significantly
less
likely to support raising insurer premiums for those who are overweight or obese. 63

Surely individual people are not to blame if increasing population weight is chiefly the result of “obsesogens,” in pesticides, dies, perfumes, cosmetics, medicines, food additives, plastics, fire retardants, solvents, and so on, that people have no choice but to ingest. 64 Yet, blaming a “toxic
food
environment” is less likely to let individual people off the hook. That is because, while it may be exceedingly difficult to eat healthfully when there is an overabundance of cheap, tasty, and fattening food and when healthier options are hard to come by, it is conceivably possible if one is sufficiently disciplined and educated. Indeed, as we have already seen, discussions of sociocultural factors are often accompanied with talk of how people need to work harder and become better educated so that they can better navigate an increasingly difficult and hazardous set of food options.

In fact, many of the policy interventions being discussed are designed to alter the environment so as to help people make better “choices,” pointing to the dominance of neoliberalism. Thus, obesity researcher James Hill tells me in an interview: “We have to... modify the environment to help people maintain the behaviors we’re trying to get them to maintain.” Even in France, where, as we have seen, there is more emphasis on the social determinants of obesity, the actual policies being proposed tend to focus on changing the environment in order to change individual behavior. 65

Interventions that focus on specific environments, such as low-income urban centers, may increase the supply of fresh fruits and vegetables and/or opportunities for exercise in these locales. However, these policies do not address the underlying social inequalities that concentrate artistic, independent, and healthful restaurants, beautiful outdoor amenities, and vibrant public spaces in elite suburbs and gentrified urban centers, while making these neighborhoods unaffordable to most. 66 That is, places with wealth attract businesses that cater to the food tastes of its residents and generate taxes needed to improve and maintain public spaces. Yet, the very desirability of these neighborhoods drives up home prices, which, in turn, makes them inaccessible to many. 67

Blaming cultural factors risks stigmatizing the nation or ethnic group associated with the given cultural practices and attitudes. Thus, when French commentators blame the invasion of inferior American culinary traditions for rising obesity rates in France, they shore up national pride by creating an American other. Similarly, blaming “unhealthy” culinary practices and beauty ideals among African Americans or Mexican Americans for higher obesity rates among these populations serves to stigmatize these groups. In that this involves a dominant social group imposing their beliefs and practices as superior to those of dominated classes, it constitutes what French sociologist Pierre Bourdieu calls
symbolic violence
. 68 Such arguments elevate the cultural preferences and practices of elite groups as healthy and thus virtuous. Geographer Julie Guthman has critiqued the alternative food movement for exactly this reason, arguing that it “gives rise to a missionary impulse, so those who are attracted to this food and movement want to spread the gospel.” She explicitly compares this movement to early colonial encounters, in which Europeans tried to convert others to their religion, government, art, and manners. 69

BIOLOGY AND BLAME

As we have seen, obesity is typically framed as a disease that is brought on by bad individual choices. But what about when obesity is understood as a disease caused by biological or genetic factors beyond individual control?
Those who are actively seeking to lose weight may feel discouraged by a biological/genetics frame, whereas those who have lost a considerable amount of weight and have kept it off and consider it to be their proudest accomplishment may feel that a biology frame minimizes this achievement. However, one might expect a biology frame to lessen the blame heaped on fat people for being fat, no?

Indeed, medical sociologists have long argued that treating a condition as a disease removes the blame associated with it precisely because people tend to think of diseases to be caused by factors outside of personal control, although we have already seen that this does not hold true for the case of obesity. 70 A commonly cited example is that of alcoholism. Whereas we used to talk disparagingly about
drunks
, we now speak compassionately about the challenges of being someone with a genetic propensity to
alcoholism
, or so this argument goes. 71 Citing this research tradition, U.S. sociologist Jeffery Sobal has argued that, in medicalizing fatness, the earlier moral connotation and emphasis on personal blame were supplanted by a “scientifically neutral portrayal as a condition of illness.” According to Sobal, whatever negative moral tinge obesity still has is but a
vestige
of “the overwhelming interpretation of obesity
in the past
as a moral and not medical problem.” 72 Psychologist and obesity researcher Kelly Brownell echoes this same sentiment in an interview with me, commenting that if calling obesity a disease “takes away some of the blame from the people who have it..., then
disease
is probably a good way to characterize it for the time being.”