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Anorexia Nation

Reprinted from Health At Every Size Journal
by Paul Campos JD, MA
Spring 2005
VOL. 19 / NO. 1
©1999 Gürze Books

If we wish to understand the irrationality of America's war on fat, we must understand the extent to which "overweight" and "obesity" are cultural constructs and political issues, not merely medical terms. It shouldn't surprise us when public health officials and obesity researchers deny this: After all, treating "overweight" and "obesity" as strictly medical issues implies that only health professionals are authorized to speak about them.

To abdicate the scholarly discussion of fat to medical personnel is to beg the crucial question of whether fat is primarily a medical issue at all. Consider the very terms "overweight" and "obesity." Although in theory these could be merely descriptive terms, in practice they have become synonyms for pathological conditions. To call people "overweight" (BMI 25) or "obese" (BMI 30) is to claim they have something wrong with them. Specifically, these terms are now used to describe what is supposedly a disease—a disease that manifests itself in the form of having a body that weighs "too much."

Yet when one examines the medical literature for confirmation of the claim that having a BMI of more than 25 or 30 means that a person weighs too much, it soon becomes clear that this claim is extraordinarily poorly supported by the actual medical evidence. Body mass is only a weak predictor of health, especially in comparison to far more powerful predictive factors such as fitness levels, socio-economic status, and access to health care. Furthermore, the evidence that significant long-term weight loss in itself improves health is slender to non-existent. When one then considers that medical science has yet to discover any intervention (other than radical and dangerous surgeries with largely unknown long-term effects) that produces significant long-term weight loss in any but a tiny minority of so-called overweight and obese people, and that there is a great deal of evidence that such interventions actually do more harm than good, the situation becomes even more puzzling. Finally, when in addition to all this, one contemplates the powerful evidence that the strikingly-beneficial health effects of physical activity and good nutrition seem to be almost completely independent of whether such lifestyle factors produce weight loss in the supposedly overweight and obese, it is difficult to avoid the conclusion that the current public health focus on making the heavier-than-average thinner is profoundly irrational.1

In short, such a radical disconnect between the scientific evidence and the policies advocated by the American public health establishment requires explanation. I suggest that considering fat as a social, political and economic issue helps explain why it tends to be treated so irrationally by public health officials. Consider the following arguments, which are laid out in greater detail in my 2004 book, The Obesity Myth.

The Economics of Fat
The American weight loss industry is a $50 billion per year business, which is burdened with a problem that in most business contexts would be considered fatal: its products don't work.2 How does an industry that boasts a 95% failure rate, and whose products often feature harmful side effects, manage to stay profitable? Essentially, by convincing its customers of two things: that losing weight is a medical and moral duty, rather than merely a cosmetic goal, and that the failure of the industry's useless, expensive, and dangerous products is caused by defects in the customers who buy them.

In order to accomplish these things, the weight loss industry looks to obesity researchers for confirmation of its claims that thinness in general, and weight loss in particular, are beneficial to health. And it rewards researchers lavishly for rendering these services. Obesity research in the United States is funded largely by the diet and drug industries; that is, the economic actors who have the most to gain from the conclusion that being heavier than average is a disease that requires aggressive treatment. And such support goes far beyond the funding of research studies. As Laura Fraser points out in her expose of the diet industry, Losing It, "Diet and pharmaceutical companies influence every step along the way of the scientific process. They pay for the ads that keep obesity journals publishing. They underwrite medical conferences, flying physicians around the country expense-free and paying them large lecture fees to attend."3

One of the most disturbing aspects of the war on fat is that many obesity researchers will admit (off the record) that the official aim of that war—to make fat people thin—doesnÕt make any scientific sense. Fraser, for instance, reports that when she asked one researcher, who has pointed out in print that dieting is usually ineffectual and psychologically damaging, to comment on the policies of a well-known commercial weight loss program of whose scientific policy board he was a member, he replied, "What can I say? I'm a consultant for them."4 In my own research, I have encountered a number of similar comments. For example, in the course of a long interview, I questioned a prominent researcher about methodological flaws in a widely-cited article he had co-authored. These flaws obscured the fact that while the benefits of weight loss, if any, remain largely unknown, the benefits of becoming more active and eating a balanced diet are well-established. After admitting that my criticisms had force, the researcher asked to speak to me "as a colleague rather than a journalist." He went on to explain that, while it made little scientific sense to focus on weight loss rather than beneficial lifestyle changes that usually produced little or no long-term weight loss, "the media and the public do not listen to us if we talk about lifestyle changes. The only thing that gets attention is claims about obesity."

The war on fat may make no scientific sense, but it makes excellent economic sense. There is little money to be made by encouraging people to be more active and to eat a balanced diet. On the other hand, in the current climate of media and government hysteria about the supposed fat explosion, making alarmist claims about how fat kills has become, as several academics told me, a particularly fruitful strategy for writing successful research grants. Thus the war on fat has become economically self-sustaining, both in the marketplace and in academia, despite the lack of evidence to justify it.

The Psychology of Fat
Another aspect of the war on fat to which the media has given very little attention is the extent to which that war is driven by what can be termed "anorexic ideation." This refers to the sort of distorted thinking that leads people (mostly women) who are not "overweight" in cross-cultural or historical terms—let alone in any valid medical sense—to see themselves as fat, or on the verge of becoming fat, or at least in serious danger of becoming fat if they do not maintain the constant vigilance regarding food recommended to them by our public health officials. Those officials seem to pay no attention to the danger that their advocacy of food and weight obsession will produce yet more eating-disordered behavior, in a nation in which perhaps eight million people currently suffer from diagnosed eating disorders, and tens of millions of others engage regularly in eating-disordered behavior.

Significant pluralities, or in some cases actual majorities, of American women—especially, but not only, white upper- and middle-class women— freely admit to being terrified of becoming or remaining fat, and of feeling "fat" even when they are, by historical and cross-cultural standards, fairly or even very thin. Over the course of the last century, what has been considered the ideal body weight for American women has, making allowance for occasional fluctuations of fashion, been drifting constantly downwards. The Gibson Girl was thinner than the voluptuous ideal of the 1890s, while the Flapper was thinner than the Gibson Girl, and so on and so on, reflecting a long-term trend that has produced the current age of Calista Flockhart and Kate Moss. Apparently the only practical limit to this ongoing process is that we have now reached a point where the cultural ideal for womenÕs bodies is barely distinguishable from the bodies of women diagnosed with full-blown anorexia nervosa.5

This cultural norm becomes especially destructive when it is internalized by those who are at the forefront of the war on fat. One explanation for the remarkable distortions of the medical evidence that have enabled our current climate of hysteria regarding body mass is that many of those who distort this evidence see it through anorexic eyes. Let me be clear: I am not claiming that all such persons are technically anorexic or otherwise eating disordered (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 role in producing AmericaÕs 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 sophisticated 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 highest risk for developing eating disorders in general, and eating disordered thinking in particular. In short, much of the advice Americans get about weight can be compared to getting advice about drinking from people who are alcoholics and donÕt know it.

The Politics of Fat
UCLA sociologist Abigail Saguy has suggested that our current hysteria about weight can be understood as a moral panic.6 "Moral panic" is a concept first developed by Stanley Cohen in the 1960s to describe a recurrent social pattern. First, a group is characterized as dangerously deviant. The members of the group are treated as what Cohen calls "folk devils," that is, people who become the focus of exaggerated or irrational fears regarding their supposed dangerous or putative depravity. The media whip up public concern on the subject through alarmist reporting that exaggerates the extent of, and the danger actually presented by, the people in question. This in turn leads decision makers to act, with the stated goal of eliminating or at least controlling the folk devils and their dangerous behavior. Whether or not the action is successful, the panic eventually recedes, as public attention moves onto other threats, whether real or imagined.7

Classic moral panics include reefer madness, communists in the State Department, and Satanic ritual abuse in our day care centers. Saguy has put forth the intriguing hypothesis that "overweight" and "obese" people are America's new folk devils, and that the current drive to do something about the increasing body mass of the population has all the hallmarks of a moral panic. I believe she is correct, and would add that a fundamental source of this panic may be the projection of cultural anxieties about consumption in general onto the specific issue of caloric consumption.

In other words, body fat has become a synecdoche—a part that represents the whole—for a generalized anxiety that America is too big: that we consume too much, too quickly; that our cars, our houses, and our shopping malls are too large; that our imperial ambitions to make the world safe for democracy are too grand. Under these circumstances, obsessing about the eight or ten pounds of "extra" weight that the typical American adult has gained over the last two decades has become a convenient way of avoiding a more direct engagement with any number of issues regarding America's size, excessiveness, and out-of-control consumption.

For upper-class Americans in particular, it's easier to deal with anxiety about excessive consumption by obsessing about weight, rather than by confronting far more serious threats to our social and political health. Consider, for example, how much stronger the relationship is between health and whether or not one has health insurance than between health and whether or not one is thin. Then consider how much more media coverage is given to "obesity" than to the fact that one out of seven Americans has no health insurance of any kind.

Upper-class Americans are much thinner than their working-class and poor brethren, and they consume much more (there is an inverse relationship between body mass and income, and income levels largely determine overall levels of consumption). We may drive environmentally insane SUVs that dump untold tons of pollutants into the atmosphere; we may consume a vastly disproportionate share of the worldÕs diminishing natural resources; we may live in gigantic houses dozens of miles from our places of work—but at least we donÕt eat that extra cookie when itÕs offered to us.

Ask Your Doctor if Cultural Hysteria Is Right For You
Too often, people invoke science as if it were some sort of unique category of human thought and action, which remains largely immune from the forces that shape and distort other human endeavors. This is especially true in the case of medical science. In the secular world, doctors have become priest-like figures, who are thought to hold the keys to life and death themselves. "Ask your doctor if X is right for you," the billions of dollars of commercials paid for by pharmaceutical companies every year invariably ask us.8

I watched a football game on television with my father recently, during which we were subjected to numerous ads for erectile dysfunction products. Finally, in response to yet another request to ask your doctor if Viagra is right for you, my father, a physician, replied with well-warranted exasperation: "How in the hell am I supposed to know?" He was making two points: as an oncologist, what he knew about erectile dysfunction drugs would be limited to what drug company representatives told him, and, more important, the question of whether such a drug is "right" for a particular individual goes far beyond the question of specifically pharmacological expertise.

Doctors and scientists, however, are only human, and medical science is no less prone to the distorting effects of macroeconomics, personal neurosis, and political ideology than any other endeavor that involves large amounts of money and power. Fortunately, there are signs of growing interest among sociologists, political scientists, historians and psychologists, as well as among medical personnel, in the question of to what extent America's (and increasingly, the world's) fascination with fat is actually based on valid medical concerns, rather than on other, far less respectable—but perhaps in the long run far more important—cultural and political factors.9 The academic world is finally beginning to acknowledge that to treat "overweight" and "obesity" as questions of supposedly objective medical science is to miss precisely what is most important about them: the story of how these deeply contestable and largely arbitrary concepts came to be treated as among the most important means for categorizing and controlling contemporary human populations.

Paul Campos is a professor of law at the University of Colorado.

References
1. Campos, P. (2004). The obesity myth. New York: Gotham.
Gaesser, G. (2002). Big fat lies. Carlsbad, CA: Gurze Books.

2. Fraser, L. (1998). Losing it. New York: Plume.

3. Ibid.

4. Ibid.

5. Campos, P. (2004). The obesity myth. New York: Gotham.

6. Saguy, A. (forthcoming). Fat panic! The ÒobesityÓ epidemic as a moral panic.

7. Cohen, S. (2002). Folk devils and moral panics. Philadelphia, PA: Routledge, Taylor & Francis Group.

8. Angell, M. (2004). The truth about the drug companies. New York: Random House.

9. Additional sources:
Robison, J. & Carter, K. (2004). The spirit and science of holistic health. Bloomington, IN: Author House.
Gilman, S. (2004). Fat Boys. Omaha, NE: University of Nebraska Press.
LeBesco, K. (2004). Amherst, MA: University of Massachusetts Press.