In recent decades, America has been waging a veritable war on fat. In Fat-Talk Nation (Cornell University Press, 2015), Susan Greenhalgh tells the story of today’s fight against excess weight by giving young people an opportunity to speak about their experiences. The following excerpt, taken from Part 1 “The Politics and Culture of Fat in America,” offers a brief history of the national war on fat and how it has affected the campaign’s main target: young America.
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By all accounts, America is in the midst of an obesity epidemic of catastrophic scale in which rising proportions of the public—now two-thirds of adults, and one-third of children and adolescents—are obese or overweight. Between the late 1970s and 2012, the proportion of Americans who are obese rose from 15 to 34.9 percent among adults and from 5 to 16.9 percent among the young. Although the rate of increase has recently slowed or stabilized in some groups, the now-heavy burden of fat, influential voices maintain, continues to threaten the nation. In the dominant story told by government, public health, and media sources, the country’s fatness is eroding the nation’s health, emptying its coffers, and threatening its security by depriving it of fit military recruits. The response has been an urgent, nationwide public health campaign, officially launched by the U.S. surgeon general in 2001, to get people—and especially the young—to eat more healthfully and be more active in an effort to achieve a “normal” body mass index (BMI). Toward that end, the surgeon general’s office and other government departments concerned with the public’s health have repeatedly urged all sectors of American society—from parents to elected officials, to school administrators, health-care professionals, leaders of nonprofits, and private companies—to help reduce the burden of fat. First Lady Michelle Obama’s “Let’s Move!” campaign, which aims to “solve the challenge of childhood obesity within a generation,” is only the latest initiative in what has been the nation’s standard approach to remedying the problem of growing girth for the last decade and a half.
American antipathy toward fatness is nothing new. For roughly the last 150 years, being fat has been seen as a cultural, moral, and aesthetic transgression that marked one as irresponsible, immoral, and ugly—“grotesque” in the indelicate language of former Surgeon General C. Everett Koop (who served 1982–1989). In the last few decades, however, there has been a critical cultural shift in our concern about fatness, from “self-control” (or virtue) to “health.” The now routine definition of excess weight as a disease, the rapid growth in medical research, and the proliferation of news on obesity and overweight mark this cultural shift. As the sociologist Abigail C. Saguy argues, the biomedical frame for understanding obesity has become so naturalized that people do not even realize it is a conceptual frame, one among many possible frames.
While weight as an attribute has been medicalized, that is, defined as a medical condition requiring diagnosis, two categories of weight—overweight and obesity—have been pathologized, treated as diseases in themselves. No longer are chunky and fat people merely “lazy”; in the current discourse they are also biologically defective; chronically ill; at risk of yet other, obesity-related diseases; and in need of ongoing medical treatment. It is this “diseasification” of higher weights, and its framing within a narrative of obesity-induced national decline, that has justified our government’s intervention in the obesity “epidemic” and the use of taxpayer dollars to support these interventions. With two-thirds of American adults and one-third of children now deemed abnormal and in need of remediation, there would appear to be strong grounds for taxpayer-supported government involvement, including not just public health actions but also financial support for a mushrooming research enterprise devoted to understanding the causes and consequences of this new disease. This disease model of weight, requiring government management, has not replaced the moral model of body size but has built on it in ways that greatly intensify the already heavy pressures to be thin.
Because personal health in our culture is a mega-value, equivalent to the good life itself, the medicalization of weight has had huge societal consequences. In the national anxiety that has grown up around the obesity problem—what sociologists such as Natalie Boero call a moral panic, marked by exaggerated concern about the threat to core American values—these broader consequences of treating heaviness as a disease have received scant notice. But they deserve our closest attention. The shift to health as the primary grounds for concern about adipose bodies has led to a dramatic expansion of the social forces seeking to intervene. The result has been an explosion of fat-talk of all kinds. By fat-talk I mean communications of all sorts about weight—spoken words, written texts, visual images, and moving videos—along with the associated practices, such as dieting, exercising, and many others. Where do we hear fat-talk?
In the news there has been a veritable explosion of articles on obesity. Between the early 1990s and 2010, the number of published news reports on obesity rose from virtually none to 6,000 a year. Feature articles in news, women’s, and science magazines appear regularly, accompanied by cover images of fat babies holding gigantic tubs of french fries or fat children snorfing down double-scoop ice cream cones. (Such images have become less common in recent years.) In the political sphere, anti-fat legislation aimed at limiting food ads for children, requiring food labeling in restaurants, or reengineering car-centric environments is advancing at the federal, state, and municipal levels, producing noisy debates over the “nanny state’s” right to tell Americans what they should eat and the ability of hefty officials to govern. The New Jersey politician Chris Christie has received more than his share of press commentary about his size.
Corporate interests have been a major force behind the escalation of fat-talk. Slimming down has become a huge sector of the economy as the pharmaceutical, biotech, fitness, food, and restaurant industries have figured out how to use a rhetoric of medicine (“it’s good for your health”) to exploit people’s fear of the disease of fat to generate some $60 billion annually in profits. In our image-saturated world, the ads of corporate America, with their trim figures and seductive messages, have been powerful forces behind the growing fixation on fat. Building on an already deeply ingrained culture of thinness, the new medically driven concern with weight loss has also propelled corpulence to the center of our popular culture. The new genre of Fat TV—featuring weight-loss reality shows such as The Biggest Loser (NBC), Weighing In (Food Network), and Celebrity Fit Club (VH1)—is only the most conspicuous of these new forms of fat culture. Finally, in everyday social life, fat-talk has become a routine way of communicating with one another as we visually size people up; comment on their body size, the fit of their clothing, the food they are eating, and so on; and judge them according to their adherence to the normative thin-body ideal. The harsh warnings of Elise’s grandmother and the cruel jabs of Lauren’s classmate are perfect examples of fat-talk in action. It is no exaggeration to say that fifteen years after the official launching of the war on fat, America is obsessed with fat—what it means for us, how bad it is for us, and what we must do to rid our individual and collective selves of it. We have become, in short, a fat-talk nation, in which fat-talk is ubiquitous, marking good and bad, deserving and undeserving Americans.
In this way, what started as an urgent public health call to action in the early 2000s has grown into a massive society-wide war on fat that involves virtually every sector of American society and leaves few domains of life untouched. In the late 1990s, former Surgeon General Koop, one of the most outspoken and influential warriors in the battle against tobacco, coined the term war on obesity to draw attention to the need for a national mobilization against fat that was every bit as forceful as the nation’s war on tobacco. In 2004, in the wake of 9/11, then–Surgeon General Richard Carmona described the rise in childhood obesity as “every bit as threatening to us as is the terrorist threat we face today. It is the threat from within.” Such metaphors are not innocent. In likening fat people, including fat children, to terrorists, Carmona was justifying an all-out war against fat individuals that entailed treating them as veritable enemies of the American people and the American way of life. The message was not only that it is un-American to be fat but also that hostility toward large people was warranted and necessary and beneficial to “us all.”
In this book, I call this broad-based campaign a war on fat. I use the term war not just because some government and public health advocates routinely use that metaphor but also because that word captures the feeling of many of its targets that not just their bodies but also their persons are under perpetual attack. I use the colloquial word fat because that is the term many heavy people prefer, finding the official term obesity too objectifying. And I focus on the war on fat, rather than on obesity, because this is a war not just on obesity (defined in terms of the BMI) but on every extra pound of flesh, whether the excess is on an “obese,” “overweight,” or “normal” body. The twenty-first-century war on fat is profoundly remaking the political, economic, social, and cultural worlds in which we live in ways that are very partially understood. Although this book deals only with the United States, weights are rising around the world, producing what the World Health Organization calls a “global pandemic of obesity” and, in turn, urgent efforts by governments and transnational bodies to contain it. The problem, then, is not only an American problem; increasingly, it is a global problem. Given the centrality of America in the world, how we respond is likely to affect policymakers and ordinary people in the tens of millions around the globe. Will the warlike approach to obesity championed by the United States be a positive model for the rest of the world? That question is rarely asked in public and health forums, but it should be.
Whatever its broader consequences, the war on fat has not yet reduced the national waistline. Despite the huge investment of public and private resources to fight fat, rates of obesity have scarcely budged. Between 2003–2004 and 2011–2012, there was no significant change in obesity prevalence among youth or adults. There was, however, a substantial decline in obesity among preschool children ages two to five, a finding that appears promising but remains unexplained. The reasons obesity has stopped climbing in most groups remain unclear; the slowdown could be related to basic biology—a saturation of the population that is genetically vulnerable to weight gain in our environment—and have little to do with the war on fat. The response has not been to step back and rethink the nature of the adversary and the warlike approach to its eradication; the response has been to hunker down and fight even harder. For example, health officials in some areas have turned up the heat on fat kids and their parents. In late 2013, Children’s Healthcare of Atlanta released a controversial video, “Rewind the Future,” which was aimed at warning negligent parents by graphically depicting the future of a child, Jim, whose diet of junk food led to massive weight gain and eventually a heart attack. With a growing recognition of the limits of diet and exercise, and a marked rise in obesity-related diseases, anti-fat advocates are left with few treatment options other than surgery and drugs. Weight-loss (or bariatric) surgery—which is very costly, carries substantial risks, and imposes severe dietary restrictions for the rest of the patient’s life—has been extended to new patient categories, including severely obese adolescents as young as twelve. Since 2012, the Food and Drug Administration (FDA) has approved four new diet drugs: Belviq, Qsymia, Contrave, and Saxenda. Like fen-phen, which was withdrawn in 1997 after evidence emerged of serious heart-valve damage, all have the potential to cause cardiovascular and other problems. And none of the drugs are very effective. With large proportions of Americans labeled ill, few safe and effective cures in sight, and a growing reliance on costly and risky methods, today’s approach to fat hardly seems like a promising route to creating a healthy, vibrant, revitalized America.
In all the public talk about the national plague of obesity and the lazy, irresponsible fat people who are bringing the nation down, there is one voice that is rarely heard: the voice of those targeted by the war on fat. Young women such as Elise and Lauren are the main targets of the war on fat, yet the kinds of stories they tell are virtually never heard. Almost every day on the news, we hear from medical researchers and government officials announcing a new finding about the health effects of obesity or a new campaign to tax soda; we hear from corporate advertisers and spokespersons promoting weight-loss products; and we hear from anxious parents and teachers concerned about their chubby young charges. Once in a while a lone voice can be heard complaining about the cultural hatred of fat. In fall 2012, for example, the feminist blog Jezebel carried an angry article titled “It’s Hard Enough to Be a Fat Kid without the Government Telling You You’re an Epidemic.” Complaining bitterly about the common assumption that fat kids are fat because they eat too many Pizza Poppers and bowls of chocolate cereal, the author, once a fat kid and now a fat adult, argues that the anti-fat campaign amounts to an anti-people campaign that will do more harm than good. Around the same time, Jennifer Livingston, a full-bodied TV news anchor in Milwaukee, spent several minutes on the air responding to a man who had e-mailed to inform her that “obesity is one of the worst choices a person can make” and that she was a poor role model for young girls. Using the occasion as a teaching moment, Livingston insisted that such attacks are not acceptable and that we need to teach our kids kindness, not cruelty. The outpouring of support she received leaves no doubt about the sea of unhappiness and pent-up exasperation that exists about the maltreatment of overweight people in our culture. Yet sympathetic outlets for such complaints are few indeed. As is usually the case with Internet critics, just as quickly as a fat-rights voice emerges, it disappears from public view, leaving no lasting cultural critique, no sustained challenge to the dominant approach to the problematic of weight as an epidemic. And if heavy adults are rarely heard, heavy children and adolescents, the campaign’s major targets, are virtually inaudible.
This excerpt has been reprinted with permission from Fat-Talk Nation: The Human Costs of America’s War on Fat by Susan Greenhalgh and published by Cornell University Press, 2015.