What's Wrong With Fat? (8 page)

Indeed, the experiences of fat women have provided the inspiration for some of the earliest work on the hazards of weight loss followed by weight regain (called weight cycling or yo-yo dieting) and on the risks associated with weight-loss surgery. Most NAAFA members can share personal stories of “yo-yo dieting.” For instance, a 44-year-old administrative assistant and member of NAAFA says she “doubled [her] weight through dieting in a little over twenty years.” She explains that she started off weighing 125 pounds at 5’2” but felt that she should not weigh more than 110 pounds at that height and began a series of diets, each of which led to temporary weight loss followed by even more weight gain. “I still believe that had I never dieted, I’d still be pretty close to that 125,” she says. Another woman told me, through tears, how her pediatrician counseled her mother to dilute her formula at the age of four months because she was too fat. A series of enforced weight-loss diets followed, only to leave her fatter and with disordered eating. NAAFA members similarly share horror stories of the physiological and psychological damage they endured from having taken prescribed amphetamines for weight loss during adolescence, the friends who died from complications related to weight-loss surgery, or the painful side effects they and others suffered—not to mention weight regain—from weight-loss surgery.

It was in “talking to the people at NAAFA” that neuroscientist Paul Ernsberger first thought of scientifically examining the complications associated with weight-loss surgery and testing whether weight-loss diets lead to subsequent weight gain and possible health consequences. 28 Not fat himself, Ernsberger has, in his words, a “large wife.” While a graduate student in the late 1970s and early 1980s, he joined NAAFA and saw many of the women members have gastric bypass surgery, then be “in and out of the hospital with complications,” prompting him to research the complications associated with this surgery. 29 As a result, Ernsberger says he was made chairman of the NAAFA advisory board. Later, several NAAFA members told him how their health temporarily improved when they lost weight, but, when they gained it back, their health statistics were worse than before the surgery. Ernsberger then spoke to several physicians, who confirmed that they had seen this cycle in their patients. Reviewing the scientific literature, he found research on the topic from the 1950s and 1960s, but “then it just stopped, like it hit a brick wall,” in 1972. So Ernsberger conducted his own research on the topic, finding that weight cycling leads to hypertension in animal studies. 30 In the mid-1990s, he testified against the approval of weight-loss drug Redux (part of the notorious phen-fen cocktail that ultimately was linked to heart valve failure). By Ernsberger’s account, he would have never conducted the research without exposure to the experiences of women in NAAFA.

Unlike Ernsberger, Steven Blair has not been personally involved with NAAFA or other fat acceptance groups. However, he says that his own experiences as someone who is “short, fat and bald,” despite running 75,000 miles over the past 35 years, informs his research. Other researchers and clinicians talk about how an experience with eating disorders led them to a health at every size approach. For instance, Bacon writes in a conference paper delivered at the 2009 NAAFA convention that “as long as it is more difficult to live in a fat body, I have to fear becoming fat. This resulted in an eating disorder I endured when I was younger, along with accompanying difficulties with food, body image and self-esteem.” 31 Similarly, Joslyn Smith, who has served as vice president of the ASDAH board, as a member of the public policy committee for ASDAH, and on the diversity task force for the National Eating Disorders Association, explains that she got involved with HAES as a direct result of having struggled, despite her large body size, with symptoms of anorexia. She said that she came to a realization that if she didn’t change her way of thinking, she “wouldn’t survive.” 32

To the extent that the fat field is dominated by the assumption that being fat is a medical problem and public health crisis and that weight loss is the goal, those who challenge these assumptions are at a disadvantage for acquiring resources. Different researchers respond to this challenge in various ways at specific points in time. For instance, Glenn Gaesser acknowledges in an interview with me that he has emphasized weight loss as a measure of his intervention’s success, in order to receive NIH funding. In contrast, neuroscientist Ernsberger says that he has had difficulty getting NIH funding for his work on yo-yo dieting, since it has to pass muster by peer reviewers who are typically “so-called experts who are running weight-loss clinics” and who reject the premise that weight cycling is harmful. He says he “can’t blame them entirely, because if I was running a weight loss clinic and I believed that it was harmful to repeatedly lose and regain weight, I would have to close shop.” Still, he says that “if I’d had funding, I would’ve been able to go a lot further” with this research. Ernsberger expresses frustration that “what’s been defined as an obesity expert is somebody who treats obesity.” Political scientist Joan Wolf refers to this as the “expert paradox,” through which “precisely what qualifies certain individuals to serve as advisers can hinder their ability to assess the literature objectively.” 33

Some researcher-scholars are trying to change these institutional constraints. 34 For instance, U.S. nutritionist Linda Bacon recounts how, in the summer of 2009, Joslyn Smith offered training in lobbying for members of NAAFA and ASDAH. Smith, in turn, speaks of the positive reception that the group of 53 ASDAH and NAAFA members got from congressional staff members “on the Hill.” In a context in which getting 15 minutes is considered a lot of time, she said numerous people got hour-long meetings. Smith, Bacon, U.S. psychologist Deb Burgard, and Australian health-promotion manager Lily O’Hara set up a meeting with “someone high up” at NIH who was overseeing grants for NIH. They explained to her how the wording of many grants excluded research that did not include weight loss as a measure of the success of the nutritional and/or exercise intervention. The ASDAH members were invited to help reword grants to make them more open-ended. Bacon comments that she is “amazed that we were able to help her to make new options.”

While ASDAH members work to change the way in which body size is studied within the context of health, some scholars in the humanities, social sciences, and law, in concert with fat rights activists, are creating a new field of study around
fatness
as a form of social identity. In so doing, they are following in the footsteps of gender studies, African American studies, Chicana studies, ethnic studies, and other interdisciplinary fields of research that build on related political movements. In a forward to
The Fat Studies Reader
,
Marilyn Wann describes a fat studies approach as offering “no opposition to the simple fact of human weight diversity, but instead looks at what people and societies make of this reality.” 35 The publication of
The Fat Studies Reader
in 2009 was an important watershed in the establishment of this new field. Five years earlier, Wann founded the fat studies list server and invited about 50 researchers working on weight-related topics (including me) to join. Wann already knew many activists doing work on this topic, thanks to the many talks she had been giving on college campuses for about eight years. The list membership grew over time so that, as of August 20, 2012, it had 674 members, including a mix of scholars, activists, and activist-scholars. Since then, there has been a proliferation of fat studies panels at national and regional conferences of various academic associations.

In contrast to work by scholars and clinicians that takes a health at every size approach and thus challenges obesity researchers on their own terms, fat studies as a field seeks to change the terms of the debate by placing social inequality and fat subjectivity—rather than health risk—at the heart of the analysis. Given the focus on fat subjectivity, as an important object of fat studies scholarship, being fat oneself is potentially a source of authority, rather than discrediting within this new area of study. 36 Stated differently, while devalued in the fat field as a whole, fatness is a valued form of bodily capital within this specific part of the fat field. 37

More generally, this speaks to the way in which the internal logic of particular problem frames has independent consequences for what kinds of claims and claimants are credible. To fully understand this point, we must carefully examine the distinct logic of each of these frames. These six frames—immorality, medical, public health crisis, health at every size, beauty, and fat rights—are ideal types. In other words, actual claims about body weight often mix two or more of these frames, as we will examine at the end of this chapter. By understanding the internal logic of each of these frames, however, one sees how debates over obesity/fatness are best understood as encounters between different ways of understanding fatness.

IMMORALITY FRAME

According to what I call an immorality frame, fat is condemned as evidence of sloth and gluttony. The problem is seen as a moral one, requiring a moral remedy: namely, greater self-restraint and faith in God. The master frame is that of sin. Fatness is thus likened to other sins, such as sexual immorality.
According to some accounts, the belief that fat was a sign of immorality began to spread in the late-nineteenth-century United States, firmly taking hold by the beginning of the twentieth century. 38 This represented a break from earlier periods and other places in which corpulence was appreciated as a sign of beauty and high social status. Some historians contend that this shift was largely driven by economic change. Namely, the agricultural and industrial revolutions had reduced food shortages so that fatness was no longer a reliable sign of wealth. As the poor got fatter, which they did at first in part to emulate the rich, the symbolic meaning of body size flipped, and fat came to signal
low
social status. As heft became a marker for lower prestige and status, people with greater resources had more ability and motivation to avoid the stigma of corpulence. 39

According to other accounts, while corpulence was a valued aesthetic in Europe into the late nineteenth century, thinness (at least in women) has been associated with self-control and whiteness since early in U.S. history.
In this national context, fatness has long been associated with lack of control, immorality, barbarity, and blackness. According to a recent historical study, fatness was temporarily fashionable in the late nineteenth century, thanks to the influence of wealthy female German immigrants, who championed a fleshy aesthetic to the American elite. However, it quickly fell out of fashion due to its simultaneous association with poor Irish immigrants. 40 This would suggest that, in the United States, the stigmatization of fatness and adulation of thinness were interrelated and profoundly raced, classed, and gendered processes. This further points to how the framing of fatness as immoral was closely linked to the framing of it as ugly or unfashionable, which remains a powerful framing of fat today that has been examined elsewhere. 41

In any case, it is clear that by the twentieth century, a slender body provided an important way for Americans to demonstrate not only their wealth and status but also their moral virtue. Beginning in the late nineteenth and early twentieth centuries, “an appropriately slender figure could denote the kind of firm character, capable of self-control, that one would seek in a good worker in an age of growing indulgence; ready employability and weight management could be conflated.” 42 In the United States, where there is a deep-seated cultural belief in self-reliance, body size was especially likely to be regarded as under personal control and reflecting moral fiber. In contrast, in France, fat remained more of an aesthetic than a moral issue, although slenderness rather than corpulence was now the valued aesthetic. 43

The original supporters for this frame have been (male-dominated) religious authorities. Sociologist Lynne Gerber has shown how contemporary Christian weight-loss programs continue to “frame the moral problem that body size represents in more traditional Christian terms, namely gluttony.” Gluttony, in turn, raises “concerns about control and lack of control, surrender to and rebellion against God’s will.” 44 While religious in origin, this frame has broad resonance in the United States. 45 Thus, in the contemporary United States, slenderness, or toned muscularity for men, is widely praised as the embodiment of willpower, restraint, moderation, and self-control, while the fat body is seen as the incarnation of moral failure, poor impulse control, greed, and self-indulgence. 46 For instance, Fumento describes anti-fat prejudice as “a helpful and healthful prejudice for society to have” because it is a “prejudice against overeating and what used to be called laziness.” 47 He condemns the fat acceptance movement for turning “what had been two of the Seven Deadly Sins—sloth and gluttony—into both a right and a badge of honor.” 48 As this idea has become secularized, its roots in Protestantism are obscured, and it appears to be universal. 49

MEDICAL FRAME

By the middle of the twentieth century, fatness was increasingly framed as a health condition requiring medical intervention. 50 This required that physicians persuade the public that corpulence was a medical (as opposed to predominantly aesthetic or moral) problem and that they were best qualified to deal with it. Calling fatness by the medical term
obesity
was crucial in convincing public opinion that fatness represented a medical problem.
According to sociologist Jeffery Sobal, mostly male physicians began to portray fatness as both a disease in itself and, beginning in the 1970s, as a risk factor for other diseases, including cardiovascular disease. This helped the medicalization of fatness to stick; it was a medical problem on two different fronts, both as a disease and as a risk factor. 51 Appealing to this double status, in an interview with me, obesity researcher James Hill calls obesity “a huge disease that’s driving all of our other chronic diseases.” The medical frame draws on a master frame of health. As we will see, the public health crisis frame and the health at every size frame also draw on a master frame of health. Indeed, part of what is at stake in the fat field is what “health” actually means.