U.S. Surgeon General Richard Carmona claims that obesity is the “terror within,” and that “unless we do something about it, the magnitude of the dilemma will dwarf 9/11 or any other terrorist attempt.” This alarmist rhetoric reflects two decades of increasingly intense concern that America is eating itself to death.
News reports on the “obesity epidemic” have exploded in recent years, eclipsing coverage of other health issues, including smoking, hunger/malnutrition and eating disorders. Yet a growing number of researchers have critiqued the medical science behind these claims, pointing out that epidemiological studies find an association between mortality and body mass in only the heaviest 6% and lightest 3% of the population. This association weakens when other factors, like diet, exercise or socioeconomic status, are taken into account. Further, a highly publicized study published by scientists at the Centers for Disease Control and Prevention (CDC) in April 2005 discredits earlier claims that 400,000 deaths each year are associated with overweight and obesity; the revised figure is closer to 25,000.
I believe that much of the current concern about obesity in America reflects what sociologists call a “moral panic” rather than a genuine health crisis. Obesity is not primarily the medical issue it is made out to be. It is a scientifically, politically and morally contested concept.
The largely unwarranted assumption that body fat is a symbol of gluttony and sloth not only shapes the questions and conclusions of medical researchers; these same prejudices affect the way the news media report on these findings, shaping the responses of policy makers. The way body weight is framed in public discussions can shape our moral views and strongly affect patterns of social inequality.
Seeing obesity as “risky behavior” links the problem to smoking and stresses the role of individual food choices and activity levels, while obscuring the role played by factors such as biology, genetics, cultural ideas of beauty and socioeconomic status. This framework of “personal responsibility” legitimizes social inequality and health disparities.
For if heavier bodies are taken as visible proof of bad food choices and refusal to exercise, then the poor and minority groups - who, on average, weigh more than richer and whiter people - have only themselves to blame. That, in turn, makes it easier to minimize or ignore altogether structural factors that lead to ill health, such as poverty or lack of health insurance.
Despite American political traditions that emphasize anti-discrimination and multiculturalism, the “obesity as risky behavior” framework has mostly stymied a competing argument that sees fatness as a natural, inevitable, even desirable manifestation of human diversity. Arguments about the need to accept a diversity of sizes are viewed as excuses for unhealthy behavior.
Even the 2005 CDC study was attacked as providing people with an excuse to indulge in fatty foods rather than as rigorously scientific evidence that the panic over fat is overblown. Little wonder fat-rights activists find themselves in the uncomfortable position of debating scientists instead of being seen as targets of invidious bigotry.
Saguy, assistant professor of sociology, is writing a book about contemporary medical and political debates over body weight in the United States and France