What's Wrong With Fat? (13 page)

While many fat rights activists and organizations advocate a right to health and health care, others express strong concerns about healthism, or the moral imperative to be healthy and pursue health, and worry that pursuing health is seen as a prerequisite for claiming civil rights. 153 As one fat rights activist explains in an interview, “I want to remove [health] from the rights equation altogether and say this is a human right, give it to me.” This activist is not rejecting the idea that she (or others) have a right to engage in health-inducing activities, but she vehemently refuses the idea that her civil rights should be conditional on her engaging in health-enhancing behaviors at an individual level. A 50- year-old fat acceptance activist, weighing “somewhere around 400 pounds,” and having worked in the restaurant business for most of her life, similarly writes on a list server that, while she appreciates the work done by HAES researchers, she mistrusts any moral imperative to be healthy, whether that is measured by weight or by behavior: “I am not saying that the fat revolution means that I should be able to eat junk food and lay on the couch. But, ya know, I should be able to eat junk food and lay on the couch. My health care concerns should be between me and my HAES-savvy medical professional.” By arguing that her health care concerns should be between her and her (HAES-savvy) medical professional, this respondent rejects the premise that obesity—or even individual practices related to nutrition and physical activity—should be a imposed upon her, while claiming a right to sensitive and respectful health care.

Similarly, Jonathan Robison, who holds a doctorate in health education/exercise physiology and a master of science in human nutrition and has served as co-editor of the
Health at Every Size Journal,
is extremely wary of substituting concern about weight with concern about nutrition and/or fitness. He disputes the value of an approach to health and illness that focuses on individuals trying to control epidemiologically based risk factors, such as weight, nutrition, and physical activity. Instead, he advocates addressing social phenomena that detract from health, such as violence, prejudice, social isolation, and materialism. In a spirited debate about whether health professionals should talk about foods as being “good,” “bad,” or “better” than others, on a list server entitled “showmethedata” and dedicated to critical analysis of obesity research, Robison writes on November 11, 2004: “What is really absurd in my opinion, is suggesting that one food is “better” than the other. Good and bad is a moral judgment—it has nothing to do with science and nothing to do with nutrition. From a nutrition science perspective, some foods are more nutrient dense or have more fiber or have less fat than others. Good and bad relating to these foods (with the possible exception of spoiled foods) adds nothing to our understanding of the foods themselves, establishes a slippery slope from which there is no escape, and sets people up for continued confusion and anxiety about eating.”

Several list server participants expressed concern that Robison’s stance is too radical to be influential in mainstream medicine, and yet other fat rights activists similarly speak of rebelling against expectations that they should restrict their eating. For instance, one fat rights activist explains how, at a restaurant, “one of our friends was like there’s no way you could possibly eat all these cheese fries. I’m like ‘Really, do you want to see me?’ I did, you know, I ate every single one.” Several of the 46 profiles on the Chubsters website flaunt consumption of food. “Frito Lay,” for instance, lists her weapon of choice as monosodium glutamate. “Holy Hightop” lists her fatal flaw as Swedish fish. “Cell U Lite” lists her motto as, “Got Beef?
Can I have some?” “Fatty Bang Bang” is happiest when “eating a fine and mature cheddar,” “Apple Hard” is happiest when “cuddling, snuggling, having dirty, pervy sex and eating pudding,” and “Sweetie Kolakube” is happiest when “bathing in chocolate.” As Chubsters founder Charlotte Cooper explains: “Somehow, embracing fat stereotypes enabled us to subvert them, and perhaps rob them of their power over us.” 154

By comparing fatness to race, disability, and sexual orientation, fat acceptance activists have had some success in asserting fatness as a valuable form of diversity. In this way, they have been able to take advantage of the growing importance of diversity as a corporate value that is seen as enhancing efficiency by allowing industry to benefit from new ideas, opinions, and perspectives generated by greater workforce diversity. 155 For instance, Marilyn Wann says she was hired in 2001 by Chevron to give diversity training about body size after being recommended by one of her neighbors, a gay man and ex–punk rocker who was now an employee at Chevron and on the diversity committee. Wann mentions that this was just after the statute passed in San Francisco banning weight-based discrimination but says that she thought that they were more generally “motivated by the urge to have a cool workplace on some level.”

Similarly Lisa Tealer, a senior manager of diversity and inclusion, chair of her company’s diversity council, and a NAAFA board member, told me that NAAFA was contacted in 2008 by the global human resources management-developing firm Hewitt Associates to participate in a “deep dive” panel addressing health disparities in underserved communities, including African American, Asian American, and Lesbian, Gay, Bisexual, and Transexual (LGBT) groups. Tealer and NAAFA chair Jason Docherty discussed the problem of size discrimination, drawing on a recently published article showing that the prevalence of weight discrimination in the United States was close to that of racial discrimination, which Tealer said provided them with legitimacy and a platform. 156 Tealer, who is also black, said there were “a lot of ‘ah-ha’ moments” in response to the arguments and personal stories shared. “For some folks, it was pretty overwhelming because they had just no idea what fat people face daily,” she says. She says that there was a “eureka” moment when members of the group realized that the wellness programs on which they were consulting with their clients were, in fact, creating a bias in the work environment. As a result of this initiative, NAAFA board members decided to prioritize the promotion of size diversity in corporate America and created a Size Diversity Toolkit and sent it out to more than 700 companies, academic institutions, and civil rights organizations. The toolkit provided the business case for size diversity, real stories of size discrimination in the workplace, business scenarios with discussion questions, and a resource list.

MIXING AND MATCHING

Understanding the internal logic of these six different problem frames allows us to see how actual claims about body weight often mix and match two or more of these frames and better understand the implications of such combinations. Some frames are complementary and self-reinforcing.
For instance, contemporary mainstream news media often discuss “obesity” as a medical problem, a public health crisis, and a moral issue. Fat people are portrayed as immoral not only because they are slothful and gluttonous but also because they are harming their health (and the nation’s health, not to mention the national economy) in the process. This serves to emphasize both the urgency of the issue and individual blame, a topic we discuss more in the next chapter.

In contrast, fat acceptance activists routinely combine aspects of a health at every size frame, beauty frame, and fat rights frame. These all resist the negative characterizations of fat people, but do so in different ways and with different implications. For instance, a health at every size frame challenges the notion that fat people are inevitably unhealthy but reinforces the notion of health as a central cultural value. A beauty frame expands what counts as beautiful to include fat women, rather than proposing a more radical critique of how people (and especially women) are judged on the basis of beauty. In contrast, a fat rights frame attempts to place rights, rather than health, at the center of debate.

Specifically, research on the negative health effects of weight-based discrimination and stigma combine the health at every size and fat rights approach. For instance, some studies have linked weight-based discrimination on the part of medical professionals to higher rates of cervical cancer among “obese” women. 157 Building on studies showing that the chronic stress associated with lower socioeconomic status can lead to autonomic disregulation, in turn predisposing people to diabetes, heart disease, and hypertension, other researchers have examined whether chronic stress associated with weight-based stigma and discrimination can have the same effect. 158 For instance, one study, using survey data from the United States, found that discontent with one’s body weight was a stronger predictor of mental and physical health than was BMI and that this effect was stronger for groups known to suffer from greater weight-based stigma, including women compared to men and whites compared to blacks and Latinos. 159 Men who desired to lose 1 percent, 10 percent, and 20 percent of their body weight respectively suffered a net increase of 0.1, 0.9, and 2.7 unhealthy days per month, relative to those who were happy with their weight. For women, the effect was greater: 0.1, 1.6, and 4.3 unhealthy days per month.

Sometimes more contradictory frames are mixed with varying results.
Thus, Joslyn Smith, vice president of the ASDAH board and a member of a diversity task force for the National Eating Disorders Association, personally subscribes to a health at every size frame. However, she explains how, as Senior Legislative Assistant for the American Psychology Association’s (APA) Public Interest Government Relations Office in Washington, DC, she was given an opportunity to add eating disorders to the APA’s policy agenda but that, as part of accepting this job, she was also required to promote APA obesity policy proposals. This required that Smith work within an obesity prevention language and thus within a medical frame. In response to these constraints, Smith explains that she emphasized the joint prevention of eating disorders and obesity and focused on weight-neutral health outcomes, such as improving nutrition and increasing exercise, rather than weight loss per se
.
As a result of Smith’s efforts, the APA’s official “recommendations to prevent youth obesity and disordered eating” recommend weight-neutral “efforts to reduce targeted advertising and marketing that promotes unhealthy foods and beverages to children” and “screening for physical, behavioral and mental health concerns related to poor nutrition and physical inactivity for individuals across the weight spectrum.” It further recommends public efforts to “increase body satisfaction among youth across the weight spectrum” and “bullying prevention and intervention programs that specifically address weight-related teasing.” 160 In other words, while the title evokes a medical frame with reference to the prevention of youth obesity, the content of the report adopts a health at every size and fat rights frame.

While Smith subordinates a medical frame to a health at every size frame, the Rudd Center for Food Policy & Obesity, of which Kelly Brownell is the cofounder and director, more evenly emphasizes obesity, public health crisis, and fat rights frames. Thus, its website describes the center as a “a non-profit research and public policy organization devoted to improving the world’s diet, preventing obesity, and reducing weight stigma.” 161
Researchers at the Rudd Center, including Kelly Brownell and Rebecca Puhl, have published important studies documenting weight-based stigma, as well as others that frame obesity, including childhood obesity, as a medical problem and public health crisis. For instance, a 2009 Rudd Center report on school food writes, “Childhood obesity, with its many related diseases—among them type 2 diabetes, cardiovascular disease, and asthma—is one of the most serious health concerns facing children today.” 162 Indeed, the Rudd Center’s consistent promotion of obesity and public health crisis frames has provoked the ire of many fat rights activists, eclipsing the important work the center has produced on weight-related bias and discrimination.

Fat rights activists dismiss the way in which weight-loss surgeons mix fat rights and medical frames as co–optation. The American Society for Metabolic & Bariatric Surgery evokes “widespread negative attitudes that the morbidly obese adult is weak-willed, ugly, awkward, self-indulgent and immoral” under its “Rationale for the Surgical Treatment of Morbid Obesity.” 163 While the problem identified (weight-based discrimination) draws on a fat rights frame, the solution (surgery-induced weight loss) draws on a medical frame. If this ploy angers fat rights activists, it is because it serves to supplant political resistance to injustice with medical efforts to change individual victims of oppression. Similarly, the children’s book
Maggie Goes on a Diet
,
discussed in the introduction, resolves the problem of Maggie being teased about her weight with the solution of Maggie’s weight loss. In the same spirit, “discrimination” is listed as one of the “hazards of obesity” in most current reviews and consensus statements on the issue, including the “Healthy People 2010” report. 164

Whether the perceived problem of obesity can or should be solved with dieting, surgery, or corporate regulation or some other means speaks to the issue of who or what is to blame and what, if anything, should be done. This, too, turns out to be best understood as encounters between different ways of understanding fatness. It is to these
blame
frames that we know turn.

In the previous chapter, we saw how the very term
obesity
marks fatness as a medical problem and public health crisis, as opposed to a primarily aesthetic or moral issue. We saw how some people reject the medical and public health crisis frames (and associated terminology), insisting that one can be fat and healthy, that fatness is beautiful, or that discrimination against fat people is wrong. As we saw, these different problem frames do not have equal standing in the contemporary United States. That is, the idea that fatness represents a medical problem and a public health crisis is largely taken for granted.