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7 October 2005Printer-friendly versionEmail a friend

The Obesity Myth
The 'war on fat' is a witch-hunt masquerading as a public health initiative.

by Paul Campos

Is your weight hazardous to your health? According to America's public health authorities, there's an 80 per cent chance that it is. From the Surgeon General's office, the Centers for Disease Control, the National Institutes of Health, and our leading medical schools, America's anti-fat warriors are bombarding us with dire warnings. According to such sources, no fewer than four of every five Americans maintain a medically dangerous body mass (nearly two-thirds of us are said to be overweight, while almost half of the rest of the nation is categorised as too thin).

If these claims sound implausible, there's a very good reason why: because they're false. Indeed, given that Americans are enjoying longer lives and better health than ever before, the claim that four out of five of us are running serious health risks because of our weight sounds exactly like the sort of exaggeration that can produce a cultural epidemic of fear, bearing no relation to any rational assessment of risk.

On the other hand, given the pervasiveness of America's fear of fat, it's only natural that many readers will react sceptically to a claim that this fear has no real medical or scientific justification. For one thing, it is always disturbing to acknowledge that authoritative social institutions can and sometimes do seriously mislead the public: At some level everyone would like to be able to trust our culture's experts and authority figures when they claim to know what's best for us. Indeed, when I began researching this topic six years ago, I assumed the fact that being 'overweight' was a serious health risk was so well established that this aspect of the subject was hardly worth discussing.

Yet in the course of ploughing through dozens of books, hundreds of articles in medical journals, and countless interviews with medical and scientific experts, I discovered that almost everything the government and the media were saying about weight and weight control was either grossly distorted or flatly untrue.

What I discovered was that a host of eminent doctors, scientists, eating disorder specialists, psychologists, sociologists, and other critics of America's obsession with weight and weight loss have concluded that 'overweight' and 'obesity' are not primarily medical issues at all. In the wake of a century's worth of unsuccessful attempts to find a cure for the 'disease' of a higher-than-average weight, a diverse and distinguished group of critics has come to see weight in America as primarily a cultural and political issue. Indeed, these opponents of the war on fat have subjected the supposed medical justifications for that war to devastating criticisms.

Such critics point out that there is nothing new about either America's 'obesity epidemic', or the public health warnings it inspires. For more than 50 years now, government officials have been making the same dire predictions concerning the public health calamity that is about to befall us as a consequence of the nation's expanding waistline (as long ago as the 1950s, nearly half of America's adult population was supposedly overweight).

One of my goals in addressing this issue is to make it clear that several decades' worth of grim prophecies regarding the devastating health consequences of higher-than-average weight have turned out to be spectacularly inaccurate. Another is to politicise explicitly what in fact is a political issue, by expanding America's public debate about weight and weight control to include the opinions of people who do not run weight loss clinics. This isn't a rhetorical exaggeration: it has become routine for government panels charged with the task of making public health recommendations regarding weight to consist exclusively of people who run weight loss clinics.

As a lawyer I thought I had become accustomed to the extent to which people are willing to bend, spindle and mutilate the truth in the pursuit of their own interests. But nothing could have prepared me for the sheer extent of the distortions that feed America's rapidly intensifying weight hysteria. (Consider that a search of the major media for stories regarding the 'obesity epidemic' reveals a twentyfold increase in such stories over the course of the past five years.)

The current barrage of claims about the supposedly devastating medical and economic consequences of 'excess' weight is a product of greed, junk science, and outright bigotry. It is a witch-hunt masquerading as a public health initiative, by exposing the invidious cultural forces that encourage us to hate our bodies if they fail to conform to an arbitrary and absurdly restrictive ideal. Through exposing the war on fat for what it is, I hope we can begin to embrace a saner definition of what constitutes a healthy lifestyle and a desirable body.

Vanity: from vice to virtue

I began working on my book The Obesity Myth in part because I suspected a well-known critic of the war on fat (Richard Klein) was on to something when he pointed to 'a growing awareness that the whole culture of dieting and rigid exercise is the root cause of the fat explosion'. I have since discovered that, as disturbingly accurate as that insight into the perverse paradox at the heart of the war on fat was, the damage wrought by this war goes far beyond its tendency to expand our waistlines.

Historically, most attempts to marginalise and shame some disfavoured class of people have focused on minority groups of one sort or another. The war on fat is unique in American history in that it represents the first concerted attempt to transform the vast majority of the nation's citizens into social pariahs, to be pitied and scorned until weapons of mass destruction can be found that will rid them of their shameful condition. This is a phony war, fought against an enemy that cannot be defeated, because he does not exist.

The rejection of the war on fat is based on a simple principle: that tolerance towards an almost wholly benign form of human diversity is the least we should expect of ourselves, if we wish to lay claim to living in a civilised culture. The war on fat is an outrage to those values that American culture celebrates (often with good reason) as essential features of our nation's character - equality, of tolerance, of fairness, and indeed of fundamental decency towards those who are different. And in the end nothing could be easier than to win this war: all we need to do is stop fighting it.

The war on fat has especially devastating consequences for women. Indeed, I'm not sure I've ever met an American woman who genuinely likes her body. I don't doubt there are such women in contemporary America. Still, after having interviewed hundreds of women regarding their feelings about food, fat, body image, and what it's like to deal with these issues in America today, I can't say I'm confident I've actually encountered such a person.

We live in a culture that tells the average American woman, dozens of times per day, that the shape of her body is the most important thing about her, and that she should be disgusted by it. How can one begin to calculate the full emotional, financial and physiological toll exacted by such messages? And although women pay the highest price for our national obsession with weight, the cultural hysteria regarding this subject is becoming so intense that, increasingly, men are beginning to show signs of the damage that is done to people when they are told constantly that there is something fundamentally wrong with them.

Whether we are supposedly too fat, or too thin, or too sedentary, or too prone to eat unhealthy food, our medical and governmental authorities never tire of hectoring Americans about our imperfections. Between, on the one hand, our punitive public health nannies, and, on the other, the entrepreneurs who hawk health club memberships, workout equipment, Botox, Viagra and dozens of similar drugs, as well as thousands of varieties of cosmetics, various sorts of plastic surgery and most of all a seemingly unlimited parade of diets, each of which promises us the illusion of perpetual youth in the guise of slenderness, we have constructed a culture that ensures that relatively few people will ever be at peace with their bodies.

In America today the medical and public health establishment has managed to transform what has traditionally been considered a vice - physical vanity - into that most sacred of secular virtues: the pursuit of 'health'. In the context of the war on fat it has done so by systematically distorting the available evidence regarding the relationship between weight and health, by severely exaggerating the risks associated with that evidence, and by pretending that an extremely complex subject is actually quite simple.

An eating-disordered culture

It is no exaggeration to say that in many respects contemporary America is a fundamentally eating-disordered culture. A much-noted sign of this can be seen in the binge-sized portions that are now standard fare in our restaurants and fast-food emporia. A less-noted piece of evidence is provided by the almost overtly anorexic quality of much of the current hysteria about fat.

One explanation for the remarkable distortions of the medical evidence in which those who prosecute the case against fat indulge is that many of these people see that evidence through anorexic eyes. Let me be clear: I am not claiming that all such persons are technically anorexic (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 part in producing America's 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 accurate account of the war on fat must grapple with the fact that many obesity researchers, eating disorder specialists, nutritionists and so on belong to the precise social groups that are at the highest risk for anorexia nervosa - and that indeed a significant number of these individuals display at least some of the classic symptoms of the syndrome.

For example, by some estimates, an actual majority of dietitians either have or have had eating disorders. It is true that, to the extent that such persons have both recovered from and come to terms with their eating disorders, their backgrounds can improve the quality of their work. But it is also clear that large numbers of people who make it their professional business to counsel Americans about weight and health remain either actively eating disordered, or prone to the same patterns of thinking that fuel such behaviours. In short, much of the advice Americans get about weight can be compared to getting advice about drinking from people who are alcoholics and don't know it.

We have been encouraged to believe the propaganda of our public health authorities, instead of listening to the truth being told to them by their own bodies: that living a joyful, active life - one that includes the calm enjoyment of the many pleasures afforded by food - promotes health and longevity, while trying to conform to some arbitrary body 'ideal' does damage to both. Nothing less than a revolution is needed to overthrow America's eating-disordered culture, with its loathing of the most minimal body diversity, its neurotic oscillation between guilt-ridden bingeing and anorexic self-starvation, and its pathological fear of food, pleasure and life itself. Indeed, our whole diet culture is ultimately all about fear, and self-loathing, and endless dissatisfaction. That is the culture we live in. That is the culture we must change.

Fat science

Contrary to almost everything you have heard, weight is not a good predictor of health. In fact, a moderately active larger person is likely to be far healthier than someone who is svelte but sedentary. Moreover, the efforts of Americans to make themselves thin through dieting and drugs are a major cause of both 'overweight' and the ill health that is wrongly ascribed to it. In other words, America's war on fat is actually helping cause the very disease it is supposed to cure.

The facts of the matter are:

* The health risks associated with increasing weight are generally small, in comparison to those associated with, for example, being a man, or poor, or African American.

* These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people, and the same mortality rate as thin active people.

* There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence that short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.

* Despite a century-long search for a 'cure' for 'overweight', we still have no idea how to make fat people thin. The war on fat has reached the point where systematic distortion of the evidence has become the norm, rather than the exception. The basic strategies employed by those who profit from this war are to treat the most extreme cases as typical, to ignore all contrary data, and to recommend 'solutions' that actually cause the problems they supposedly address.

Fat culture

The war on fat ultimately has very little to do with science. The doctors and public health officials prosecuting that war would have us believe that who is or isn't fat is a scientific question that can be answered by consulting something as crude as a body mass index chart (the BMI is a simple mathematical formula that puts people of different heights and weights on a single integrated scale). This, like so many other claims at the heart of the case against fat, is false. 'Fat' - or as our anti-fat warriors prefer to put it, 'overweight' - is a cultural construct, not a scientific fact.

For instance, according to the public health establishment's current BMI definitions, Brad Pitt, Michael Jordan and Mel Gibson are all 'overweight', while Russell Crowe, George Clooney and baseball star Sammy Sosa are all 'obese', (A common reaction to such absurdities is to object that the BMI definitions aren't meant to apply to people in 'good shape'. In fact, those who make claims about the supposed link between increasing body mass and ill health do not make exceptions for movie stars, athletes, or anyone else. According to America's fat police, if your BMI is over 25 then you are 'overweight', period. Note also the radical difference between how our culture defines 'fashionable' thinness for men and women. If Jennifer Aniston had the same BMI as her husband Brad Pitt, she would weigh approximately 55 pounds more than she does.)

The truth is that to be fat in America today means to weigh more than whatever a person's particular social milieu considers appropriate. This means it is perfectly possible - and in a certain twisted sense even 'reasonable' - for a 130-pound white college student of average height to consider herself 'fat', while a working-class African-American woman who weighs 50 pounds more is not likely to think of herself as 'overweight' (and she, too, will be correct in her self-assessment). In other words, fat in America is a state of mind, rather than some objective fact about our bodies.

Although race and class are topics that make most Americans nearly as uncomfortable as fat itself, any extensive discussion of weight-related issues must explore the many connections between these three subjects. Americans love to moralise about fat because, among other reasons, fat has become a convenient stand-in for various characteristics that have been traditionally associated with the pariahs of the moment. Americans who would never dream of consciously allowing themselves to be disgusted by someone's skin colour, or religion, or social class, often feel no compunction about expressing the disgust elicited in them by the sight of people who weigh anything from a lot to a little more than our current absurdly restrictive cultural ideal.

Fat politics

What are the political consequences of an ideology that equates thinness with virtue and fat with vice? This ideology drives both the science and culture of our national obsession with weight and weight control. In American culture, the urge to moralise and medicalise as many aspects of personal behaviour as possible runs deep. Today epidemiological regression analyses have largely taken the place of the sorts of exhortations once represented by Jonathan Edwards' eighteenth-century sermon 'Sinners in the Hands of an Angry God'. Nevertheless, the motivating impulses behind such apparently dissimilar texts turn out to have a number of things in common.

At bottom, the obesity myth is both a cause and a consequence of what sociologists call a 'moral panic'. It is a particularly tenacious example of the same sort of impulse that fuelled hysteria about demon rum, reefer madness, communists in the State Department, witches in Salem and many other instances of our eternally recurring search for scapegoats, who can be blamed for the decadent state of American culture in general, and of the younger generation in particular.

Our anti-fat warriors are right about one thing: how we approach issues of weight, weight control and body image tells us a great deal about what kind of people we really are. Much like their Calvinist spiritual ancestors, those who prosecute the war on fat treat the most extreme forms of intolerance as the surest signs of virtue. And in their unwillingness to brook dissent, their eagerness to sniff out heresy and their ultimately tragic devotion to a task that can neither be completed nor abandoned, those who have transformed the Protestant work ethic into the American diet ethic are worthy heirs to a tradition of life-warping fanaticism.

Why lose weight?

Anyone who writes a book challenging the conventional wisdom on a controversial topic knows in advance that his arguments will be misunderstood, caricatured and generally distorted by those who have the most to lose from the possibility that the challenge might be effective. Although it is futile to attempt to avoid that fate by anticipating it, it still might be useful to state a few points as clearly as possible, for the benefit of sceptical readers willing to consider the merits of this particular challenge.

The obesity myth is based on three claims: that 'excess' weight causes illness and early death; that losing weight improves health and extends life; and that we know how to make fat people thin. It is true that these claims are not completely false. After all, as every good propagandist knows, a social myth is much more effective when it is based on a grain of truth.

I do not argue that there is no relationship between weight and health. I argue, rather, that the health risks associated with higher-than-average weight have been greatly exaggerated, while all sorts of related but far graver risks have been ignored. In particular, poverty, poor nutrition and a culture that makes it easy for Americans to be sedentary are important public health issues in America today.

We should be encouraging Americans to be physically active, to eat well, and to provide reasonable access to medical care for those among us who lack it. What we should not be doing is telling Americans that they will improve their health by trying to lose weight. There is very little evidence that attempts to achieve weight loss will improve the health of most people who undertake them, and a great deal of evidence that such attempts do more harm than good.

Nevertheless, it's important to be realistic about the actual motivations that lead people to try to lose weight. Given the enormous premium our culture places on thinness, Americans have all sorts of reasons for wanting to lose weight that have nothing to do with health. But treating cosmetic weight loss as if it were a medical and moral issue tends to make people both considerably fatter and a good deal unhappier than they would otherwise be.

This is an edited excerpt from The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health, by Paul Campos, Gotham 2004.. Buy this book from Amazon UK or Amazon USA


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