Monday, September 13, 2004

Fat Girls, Obesity, and the American Obsession with "Thin"

So, I did get the inevitable "ping" for my "No Shit, Sherlock" post about the latest study CNN has decided to publish that purports that cardio problems are not necessarily linked to "obesity" or "overweight" as much they are to a sedentary lifestyle. No matter their weight, women (the study only involved women) who exercised for half an hour at least three times a week were healthier than those who did not, though those who did not may have been "thinner."

My poster sites the UK's NHS (National Health Service) website, though not a specific article - it appears he took the quoted text from the NHS Encyclopaedia. I don't particularly need a specific article, of course, because the US is already way ahead of the obesity-speak than the UK (I read The Guardian regularly, so I've kept up with their pacing of the US regarding obesity as a disease, school lunch reforms, rising fear and panic about slothful, gluttonous children, and outsized women et al). The US has, of course, already gone far past this and moved into gastric bypass surgery on demand (As I recall, there are currently appeals to the UK's NHS to perform this surgery free of charge to "patients." Gastric bypass surgery reduces the size of the stomach, inhibiting how much one can eat, and in effect, you suffer from malnutrition for the rest of your life, and have to subsist on supplements until the last breath leaves your body). What most studies have not done is separated out the sedentary and non-sedentary and controlled for that factor when making judgments about the correlation between weight and one's propensity for disease. They've even "discovered" a great thing to do with "obesity hormones": inject them in women suffering from anorexia or female athletes who've trained so hard that their bodies have dipped below the 10% body fat requirement that allows them to menstruate. Yes. That's right. Instead of telling a woman who wants to get pregnant that she should "gain weight" (that 10% body fat requirement is there for a reason), they'll inject thin women with leptin to trick their bodies into thinking that they've got enough resources to nourish children! Great!

I've watched the increasing medicalization of fat with some amusement, trepidation, and disgust. When I was five or six, and first got the Fat Talk from Concerned Adults, it had to do with their fear that I would be outcast at school, and in later life, lack for a sexual partner. The health aspect was peripheral at best. Now "obesity" is categorized as a "disease" whose symptom is "excess body fat." unfortunately, "excess body fat" is an extraordinarily relative term. "Excess body fat" isn't a disease. It's a symptom. For most of history, body fat has been a "symptom" of health and prosperity. The truly excessive body fat that impeded movement, the sort linked to sloth and gluttony, was most derided in the Christian era. Christianity had an abhorrence for the physical "earthly" body that still lingers into today, though today it's called "not letting oneself go," or "attaining self-perfection" - and both terms are now considered positive.

Want to know what the indicator of excess body fat is today? The BMI system. Where did the BMI system initially come from? Insurance companies. Who did all the medical studies to figure out the simple height/weight formula? No one. MET Life looked around at the people in the office, did some quick averaging, and printed up the now ubiquitous BMI charts. Yep. That's it. Not one single study was conducted in order to create the BMI charts. No doctors sat down with control groups, nobody measured body mass composition (muscle to fat ratio). For a far more realistic (but, I think, not quite lenient enough) BMI chart based (again, not on scientific evidence ::sigh::) on the goal weights of others in your age/height/gender range, and how drastically this differs from the very odd BMI charts promulgating the internet (the MET Life BMI chart, the insurance one, is the one you'll see most often. The other was, indeed, concocted by doctors - back in 1974, when they were trying to work out medication dosages, not critique fat or lack of it), check out this site.

My biggest issue with BMI is that few of them take age into account, and NONE take body shape and body mass into account (each individual has a differing bone and muscle density). According to the MET Life BMI, Brad Pitt is obese. Seriously. Muscle is heavier than fat. If your goal for "healthy" is taking up *less* space in the world, you may as well do this.

My quarrel isn't with health. I think we should all be able to take a couple flights of stairs without being out of breath. You should be able to walk a mile or two for fun, without feeling like you're going to die afterward. You should be able to lift things, to bend and twist and interact within the world without feeling like you need to sit down every five minutes. And for those with the time, money, and will, I'm a big proponent of competitive sport and conditioning, all of which require a balanced diet to keep the body running properly. This means you're likely going to have a very low amount of body fat - but it doesn't mean you're going to be "thin" in the supermodel sense of the word. Being that "thin" for most women means loss of muscle mass and loss of the ability to produce children.

The average white American female teenager's ideal body type is 5'7, 117lbs. One female survivor of Auschwitz measured 5'2, 55lbs. Add 10lbs per inch to get her to 5'7, and she's very nearly the American teen ideal.

How fucked up is that? I make "jokes" about concentration-camp chic, but they aren't really "jokes." They're not funny.

Too many people have conflated "health" with "thin." When I read all of these reports about the Evils of Obesity, I want to hit people. The language is flawed. When we talk about the Evils of Fat, we aren't talking about health, anymore than when we're talking about abortion we're talking about preserving some sort of mythical life (as opposed to the life working to bring the other to fruition, a nurturing that only succeeds 2/3 of the time anyway, without medical intervention of any sort, but I've already done that rant).

We're talking about fat people. We're talking about beauty, misogyny, aesthetics, and (the dirty word in America, though Britain is rife with talk of it) class.

We live in a largely sedentary society whose bottom rungs work a couple of jobs just to make ends meet. They often have children, and if they're women and/or single mothers, they're working upwards of three jobs including the care of their children and the maintenance of a home life. When you come home after standing at a mindless job for 12 hours, you want to come home and collapse. Exercise? Very funny. McDonald's and some mindless TV will do. Besides, how much does proper exercise cost? Sure, you could walk around the block, but what if you're in a shitty neighborhood (as many poorer people are)? What if, in addition to a merely bad neighborhood, you get home well past dark, living in a city with the highest murder rate in the country (Ah, Chicago)? You'd have to be able to afford a gym fee, or an exercise bike. And let me tell you, when it comes down to paying the heating bill or getting an exercise bike, guess what wins out?

Rich people - or single "young professionals" like me, who have no kids to take care of and were lucky enough to scrape out an education and slither into cozy desk jobs - have excess money, excess time, and the will to spend it. The times in my life when I've been the most out of shape were when I was the poorest (working two jobs and going to school, trying to pay rent and live on my own for the first time; and again in South Africa, once again desperately trying to pay bills, and this time around, also complete a master's degree in a foreign country). When life is a breeze, you've got more time to pay attention to status indicators like weight, and if you're looking to move up in the workplace or go on media tours, you're definitely making "image" a priority.

"Image" being the key term here.

If "health" were the biggest issue here in the US, we'd have a national health care system. We'd have a welfare system that supported people beyond the subsistence level, and a minimum wage that afforded people the ability to keep a roof over their heads that didn't belong to their hand-me-down car. If we were really so freakin' concerned about other people's health and welfare, you'd see less disgust at the Evils of the Fat and more interest in improving working wages, working hours, childcare, and access to education.

The "obesity epidemic" is another handwave. It's not a disease. It's a symptom. For those few who are actually sedentary, obese adults in the "dangerous health" range (the "healthy" range actually spans an 80lb range, not the narrow 15-lb range the MET Life bullshit BMI spouts on about) where "excess weight" impedes mobility, it's a symptom of a system catering to old white men with old white money. We're being peddled drugs and operations toted by old white male doctors who're getting rich on spreading Fear of Fat the same way Bush is trying to get himself re-elected through Fear of Terrorism (because he did such a great job "protecting" us three years ago).

I'm a firm believer in taking care of yourself: of eating good food, hanging out with good friends, drinking good wine, going on long walks on the beach and long bike rides in the park, and pursuing projects that make you the best person you can be. I resent being told by a screaming news media funded by dieting companies and profiteer doctors (it's all profiteering in the US) that I should hate myself for everything I do and don't do, that I should spend the best moments of my life counting every calorie, declining every beer, and passing up on social occasions because I haven't jogged 18 miles today so I can fit into the latest Abercrombie & Fitch 00.

Sure, fat people die of heartattacks.

But you know what? Thin people do too.

No more spin. I'd like some straight talk.

5 comments so far. What are your thoughts?

Vincent Holland-Keen said...

Being the inevitable "ping"er, I'm unclear on the message being given here. Obesity does increase the risk of a number of health problems. Okay. The US media, by the sounds of it, have sensationalised the issue and skewed the message so that people feel that they need to be thin, rather than fit and healthy - because you can be thin and unhealthy and overweight (though perhaps not obese) and fit.

Though it's using it as an imperfect metaphor, this almost sounds like the argument used by proponents of the recent war on Iraq against those who opposed it. If you're against the war, you're in favour of Saddam Hussein. Similarly, if you try to tell people about the dangers of obesity, you're perpetuating the oppressive culture of emaciated 'perfection'.

I'm sure that's not the intent, from what I've read of your blog I can't imagine that you'd ever put forth an argument as ill-considered as that given by those in favour of war and it is a complex issue, as shown by you pointing out that its a condition that disproportionately affects those of low socio-economic status - but surely the focus should be on making sure the right message is put across, rather than attacking the distorted message propagated by the media and running the risk of undermining the genuine warnings about obesity.

Kameron Hurley said...

Hey, Vincent, thanks for stopping by.

I was hoping the post above explained my discomfort with the War Against Obesity. As I don't want to do this one to death, I'll just respond on a few points...

The dieting industry in America is a $3B a year enterprise. Many of the most popular obesity studies have been funded by programs with a vested interest in keeping bodies dissastified and yo-yoing: Weight Watchers has been a big funder of obesity studies for years. One of the biggest slaps in the face I got, switching back over from South Africa to the US, was the media blitz. A zillion channels selling me products that would soothe imperfections I didn't even know I had. During my abscence, I'd forgotten how intense the marketing media is here.

The "genuine warnings" about obesity need to be couched in different language. I'd argue that changing the language from "excess fat" (which, as I pointed out, is a relative term) to "sedentary lifestyle" and "unhealthy eating habits" would suit me fine. I worry because the vast majority of women, in particular, are confusing thin with health, and the media is helping them do that (And, I've just gotta say, as an aside, that that Saddam Hussein metaphor *is* pretty lame). I also think that this entire media obsession with obesity is filling in for far more politically dangerous discussions that everybody's too chicken shit to have. And in the mean time, women are trying to starve off their puberty fat, and everybody hates themselves. What kind of a society of people does all that self-hate produce?

Is there a difference between "overweight" and "obesity"? Certainly. But I'd be hard pressed to give everyone a line at where one ends and the other begins - body types are different. If, instead, we stop talking about fat and stop telling people they're gross and disgusting and start encouraging people to get outside and have a good time instead of locking themselves in a room and feeling miserable (which induces binge eating), we'll actually be talking about health and not "image," and I can sleep easier. Will changing the language change women's opinions of themselves (over 90% of eating disorders in this country affect women)?

No, likely not. Fat will be "in" when the US falls on its ass, there are widespread food shortages, and rich people are the ones hoarding food. We'll read long diatribes about how dangerous it is to be thin, how thin people are disgusting, and fat beauties will romp around our public discourse.

It's a language play. The vast majority of people in the world are still dying of infectious and parasitic diseases (related to poor diet and poor health care). I think we've got our priorities in the wrong place.

Vincent Holland-Keen said...

I wrote a post on my blog about rising depression rates that ties into this issue of how the media presents facts to its audience, but it remains just part of a culture that breeds dissatisfaction (though I should point I don't think this is a big, concerted conspiracy, it's just a malignant side effect of the consumer economy).

It should also be noted that while the hype isn't as virulent as that against obesity, there are warnings against being thin too - every now and again there will be a spate of stories about how more young boys and girls are developing anorexia. Kids don't just have to worry about being too fat, they also have to worry about being too thin and considering that our body self-image is invariably at odds with what we actually look like (the average woman will usually think she's fatter than she actually is), what's the hope that they'll settle for the happy medium in between?

I keep wondering how many of society's problems arise because people aren't taught how to be confident and self-assured. But I guess that's to be expected, because if everyone were confident and self-assured, who'd go out and buy all those self-help books telling you how find a better you in 28 days or your money back?

Kameron Hurley said...

I'm of the opinion that happy, fearless people don't buy things, and among the many books I'm picking up this weekend (Friday is payday) is Barry Glassner's _The Culture of Fear_.

I love the irony of that whole sentence.

Anonymous said...

okay -kameron, I've just run across your blog here and have to call you out. I work in the research field related to adipose tissue physiology and body weight regulation. You have thrown around these unsubstantiated claims about the science pertaining to adiposity, and it's time for you to back up what you say. Scientists get really pissed off when you claim we have an agenda or manipulate research findings to advocate a cause. There is a major difference between the testimonial-style claims made in advertising anmd the peer-reviewed scientific studies performed and replicated in labs around the world. If you want to say a study is fake, name its specific source, findings and indexed citation, along with your specific beef. Don't make chickenshit generalizations.

Now on to the educational portion of this post...
The reason why you can't say what "overweight" or "obese" are is because all of the traits related to adiposity are continuous variables. There is no biological discontinuity in the traits. BMI cutoffs are arbitrary in the sense that the world population doesn't naturally fall into three groups...

Having said this, there is overwhelming evidence demonstrating that co-morbidities related to adipose tissue physiology are linearly related to the amount of fat carried. There are metabolic consequences for adipose tissue when adipocytes store excess triglycerides for extended periods of time. After the body has all of its physiologic needs met by retaining some necessary amount of fat, carrying fat beyond this threshold will predispose an individual to greater risk for chronic metabolic conditions.

Carrying excess weight as fat is a complex condition related to both heriditary and environmental factors.
Furthermore, sex, age, body fat distribution, and other health factors are important determinants that influence how excess fat affects your long term health outcomes. Teams of dedicated scientists around the world are working everyday to better understand this complex metabolic process. I truly resent misinformed, uneducated rants attacking real work that is being done on real problems concerning human health. grow up kameron...
 

Posted by mike