Must hear and obey!!

Must hear and obey!!

This week I stumbled upon another one of many articles in the Guardian complaining about fat-shaming, which is apparently something society does unsuccessfully to try and force everyone to be skinny. In an interesting parallel, this week Rabbett Run has an article digging through the role of Big Tobacco in funding libertarians to talk up smoker-shaming. This “assault on smokers” is a common complaint of the Clarksons and Telegraph-letter-writers of the world: sure, smoking is bad for your health but the anti-tobacco movement has “gone too far” and now it shames and ostracizes smokers and treats them like second-class citizens (in the words of Rabbett Run’s libertarian scholar, they are parallel to the treatment of Jews in Germany!)

An interesting similarity of language exists between the anti-fat shamers and the anti- anti smokers. There is a lot of public debate about how to handle obesity, and a lot of it is denialism of varying forms:

  • Straight-up denialism, such as this book from one of the Lawyers, Guns and Money bloggers, which claims obesity is not harmful for health, the scientific research is wrong and there is nothing to fear. This crosses the political spectrum, but is usually also associated with suspicions about the diet and weight-loss industry and/or an ideology of personal health choices
  • Politically-motivated rejectionism, often feminist, which associates obesity concerns with body-normative biases and society’s obsession with controlling women’s appearance. An example of this is Fat is a Feminist Issue by Susie Orbach, which associates campaigns against overweight with historical attempts to control women’s appearance. These campaigners may deny the role of obesity in poor health (such as the Healthy at Every Size movement) or they may accept the increased risks and fall back on a logic of personal choice, but in either case these rejectionists are politically-motivated: their first concern is the ideological impact of scientific research on and public health campaigns against overweight, and this motivates their stance
  • Adaptationists, who think that it is too late to reverse trends to obesity, and/or that they are built into our society now, and so we are better off learning to adapt to these trends than try to undo them. In the medical field this manifests in a belief that we should find pharmaceutical solutions to the health challenges of obesity, rather than behavioral campaigns. This stream of thought is also common amongst anti-fat shamers and the Healthy at Every Size movement
  • First world shamers, who believe it is shameful of rich westerners to worry about eating too much when so many people in the world are starving. These deniers want us to accept that fatness is a sign of a stable and functioning society and something the world should (implicitly, usually) aspire to – similar to how some AGW denialists think that burning fossil fuels is an inevitable and necessary part of economic growth and something we should encourage the world to do, rather than trying to find alternative development paths. These first world shamers also usually ignore the fact that overweight and obesity is a heavily class-biased phenomenon in rich countries, and increasingly a problem of the poor only
  • Free choicers, who think that we should all be able to take any health risks we want if they don’t affect others, and who see obesity purely as a personal decision (i.e. fat people eat too much). Some of the adaptationists also take this view of fat as an entirely personal decision, and sadly so do a lot of public health policy-makers who want to fix the problem. Seeing obesity as a consequence of personal behavior inevitably means that public efforts to reduce prevalence of overweight will be seen as intrusive and restrictive of civil liberties, and enables these free-choicers to reframe the debate in terms of personal choices and freedom rather than the structural and social changes that are actually needed to reduce overweight. This argument is more potent when deployed in the obesity debate because it is much easier to claim that obesity doesn’t harm others
  • Skinny-shamers, the kind of hippy punchers of the anti-fat shaming movement, who see thinness as disgusting or at least present themselves in opposition to it. This fat and proud movement is distinctly political, though not necessarily associated with any party, and it is embedded in a broader cultural movement in the anglosphere towards rejecting any form of attention to appearance at all. This movement sometimes has an influence on the fashion world, especially in its attempts to redefine very thin and small models as wrong – it sometimes engages in its own form of shaming, attacking the skinny and small as wrong or ill
  • Anorexia bait-and-switchers, perhaps a subset of the fat-proud and feminist denialists, who associate campaigns against overweight with anorexia, and suggest that body-normative ideas drive young women to anorexia. In fact anorexia is a serious mental health problem not caused by social pressure or women’s magazines, and this link is spurious but it has a strong hold in popular culture, and is a powerful rhetorical device. Note that it also often relies on its own form of body-shaming, treating anorexic bodies as disgusting and accepting that they are deeply unhealthy, and often the spectrum of this body-shaming extends to women who are not unhealthy, just thin

Many of these types of obesity denialism seem to be similar in ideological composition to anti-vaccination or anti-AGW thinking. In AGW denial circles it’s common to read conspiracy theories about how the whole scare has been made up to transfer money and power to a clique; how it is cheaper and more effective to adapt than prevent; how attempts to mitigate AGW will lead to (and/or be driven by) restrictions on personal freedom. AGW denialists also often see AGW mitigation in terms of direct attacks on their personal choices rather than structural and cultural changes, for example in which they will lose individual direct choice over light bulbs and car makes, rather than seeing it in terms of industrial and community-level decisions such as changes in power generation or land use practices that no one individual can control. Arguments based on intervention in personal decision-making rather than group practices are much more amenable to conspiracy theories and assignment of nasty political motivations, and the obesity denial movement does have a fair share of such thinking.

In reality the battle against overweight and obesity cannot be won with individual changes: overweight and obesity arises only partially from personal choices, and a lot of it is driven by structural and social factors that individuals cannot change. You can’t make a decision to walk to work if your work is far away and there is no public transport; you can’t make a decision to eat healthily if there are no decent sources of fresh fruit and vegetables near your house, or if almost all the food you buy is poorly labelled and full of sugar. It’s also much much harder to stay thin if your job involves sitting for 8 hours a day, and personal decisions to do something personal to offset a structural factor are much harder to make than personal decisions that go along with that structural factor. Furthermore, cultural practices are insidious and hard to change: ideas about wasting food that come from a poorer time, types of food and eating practices are not easy to change by the time one is an adult steeped in a certain food culture. But because public health policy-makers cannot change broad structural factors outside of their discipline, like public transport and town planning, they have to focus on the things they can touch: personal behavior. This is easily construed as preaching or trying to restrict freedoms.

Of course fat shaming does happen in our societies but it’s not driven by health concerns: it’s another manifestation of a long-lasting and deeply-entrenched sexism in our society. It’s also a reflection of the fact that traditionally aesthetic values were of great importance, and people who deviated from certain aesthetic norms have been shamed for that. Compared to the way people with tattoos or men with long hair used to be treated, for example, fat shaming is nothing: no one obese ever got refused entry to Disneyland for being fat, for example. Public health campaigns do not, generally, utilize fat shaming as part of their repertoire, and the association of fat shaming with public health concerns about obesity is another example of denialism at work – and a very effective way to dampen the debate about what to do about this growing problem.

And make no mistake, it is a big problem. The continuing growth of overweight and obesity is going to have huge costs for health systems, and people who are proud to be fat now are not going to be so pleased with their personal health decisions when the musculoskeletal and cardiovascular problems start to bite in later life (when reversing the process is hardest). With the decline of smoking in the developed world, obesity is becoming the next big risk factor that will bring a wave of disease with it. Worse still, in many low- and middle-income countries overweight and obesity rates are also skyrocketing, but these countries have fragile health systems with weak financing that are not ready to manage a huge growth of chronic illness. This is a global problem, and denying it will delay the necessary steps to resolve it, leaving many countries facing an unexpected cost and health problems they aren’t prepared to deal with. Sound familiar?

I don’t think that obesity denialism is a product of Big Tobacco or Big Sugar, as was the anti-anti smoking lobby or AGW denialism. It also lacks a dimension of harm that the anti-vaccination movement carries with it (since fat kids can’t accidentally infect and kill other fat kids the way unvaccinated children can). But it has similarities with both, in terms of its scientific ignorance, the rhetorical tactics it deploys, and its blithe ignorance – or even celebration – of the problems it causes. The linked Guardian article is suggesting a need to add fat-shaming to the list of discriminatory activities that should be outlawed in Britain, which makes me think of the inclusion of “political” objections to vaccination in vaccination laws. Perhaps it’s time to start treating obesity denialism a little more seriously, before it gets a serious grip on our legislative and public health processes, making it harder for our societies to move out of a path that is ultimately not going to be good for us …

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