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By Kerry Tremain Television's Dr. Phil crusades against fat. Fashionable Vogue magazine reports that obesity will soon surpass smoking as the cause of preventable deaths, accompanying the article with grainy photos of faceless, naked women that one doctor calls "every-woman-who-reads-Vogue's worst nightmare." Public health officials and editorialists label obesity an epidemic. Julie Gerberding, M.P.H. '90, the head of the Centers for Disease Control (CDC), declares it a greater health threat than bioterrorism. Americans' obsession with body weight is nothing new, of course. What is new, in the last two years, is the public attention directed toward the dramatic spike in weight gains that began two decades ago.
More disquieting still is the explosion of obesity among children. Debilitating weight-related illnesses that once were virtually unknown in children--like Type II diabetes, which can lead to blindness, limb amputations, and heart attacks before age 30--are no longer uncommon. Health officials worry that if these trends continue, the current generation of kids could become the first in American history to have shorter life spans than their parents. Berkeley's Center for Weight and Health, and its co-director Pat Crawford, sit at the academic epicenter of the explosion of concern over obesity. The Center is a successor to a long line of public health research at the University concerned with childhood weight and fitness, including groundbreaking longitudinal studies of kids' weight and health, some of them still continuing. In April, the Center hosted a multi-disciplinary conference entitled "Confronting Obesity," which featured national stars in weight and nutrition studies. So it's surprising to learn that Crawford and her colleagues feel ambivalent about talk of an "obesity epidemic." To illustrate what she means, Crawford pulls out her recent study published in the American Dietetics Journal on counseling Latina mothers of young children about weight issues. Latinos have one of the higher rates of obesity, but many of these mothers don't see their children's weight as a cause for alarm. "Their feeling tends to be: What weight problem?" Crawford says. "They think their kids are just fine." When presented with photos of children of various sizes aged 3-4, many of the mothers chose the moderately fat ones as the "best" or "healthiest." A representative comment was: "This one looks the healthiest to me, not fat or thin. I think if he gets sick, he'll make it through...because if children get sick they lose weight fast." A single-minded focus on bringing down weight will not help these mothers or their children, Crawford says. Her study suggests that culturally effective nutrition-education efforts for Latina mothers need to focus on healthy eating and physical activity, not weight. The lesson applies more generally, too, Crawford believes. Although she is pleased that people are beginning to pay attention to the causes and consequences of weight gains, she worries that too much emphasis on obesity as an epidemic could further stigmatize fat people, who already suffer what a top CDC official calls "the most stigmatizing condition in our society." The focus should be on healthy behavior, she says--and weight is not a behavior. Crawford's colleague, Joanne Ikeda, says prejudice against heavier children--how it saps self-esteem, which in turn renders programs designed to help kids get more active or eat healthier foods less effective. Simply put, making kids feel bad about their bodies is a terrible way to encourage them to get fit. The educational programs Ikeda has developed for schools emphasize "health at any size." But will such a positive message stand up to the national anxiety over obesity? Natalie Boero, for one, is worried that it won't. Boero, a Cal graduate student in medical sociology, studies the messages conveyed by the health profession and the media about obesity. She claims that labeling obesity an "epidemic" is unleashing a new wave of blame and guilt toward fat people, and notes that obesity rates are higher among groups that already experience other forms of discrimination, including the poor and African-Americans. "The focus has been on how to make fat people thin, not how to make fat people healthy," she says. Studies by the Cooper Institute in Houston have shown that fat people who exercise regularly perform better on treadmill-fitness tests than thin people who don't. But we automatically assume fat people are unhealthy, says Boero. "We also automatically assume that thin people are healthy. Health is the new moralism, the way to know people's worth." Dieting and morality have a long linkage in America. Spencer Graham--the 19th-century proselytizer who gave us the graham cracker--believed that a diet of unleavened bran bread and water would clear up any number of spiritual and physical troubles, including masturbation. It didn't work, of course. Neither, says Boero, do contemporary diets. "We've been trying to make people skinny for years, and it's never worked. America has the biggest diet industry in the world. Yet any person who has dieted repeatedly knows that you lose twenty pounds and it comes back as twenty-five. It's a cycle of yo-yos. Over the long haul, 95 percent of diets fail miserably." Discouraged about losing weight, many people give up on fitness as well. More ominously, Boero says, people do unhealthy things in pursuit of thinness, like smoking. "Trying to make kids thin is especially dangerous," she says. "You can really mess them up--psychologically and metabolically--by getting them dieting at a young age. That's when girls tend to develop eating disorders. That's when they're likely to have the most shame and discomfort with their bodies." And the obsession with staying thin can haunt women the rest of their lives. "I was eating breakfast with my 86-year-old grandmother a couple of weekends ago," Boero says. "I asked her if she wanted another piece of toast. She said, 'No, I'll get fat.' She's this tiny slip of a thing, but she's been concerned about being fat her entire life. My god, if you can't quit worrying about it at 86, when can you?" But the CDC says that the weight gains in the last 20 years constitute a new phenomenon that is having catastrophic effects on the nation's health--especially that of children--and is creating unmanageable burdens on the health-care system. They argue that issues related to weight should worry us all.
On that, the academics at the Confronting Obesity conference agreed. They point to excessive TV watching; cheap, big-portioned fast foods; neighborhoods designed for cars, not walking; and generally sedentary lifestyles as culprits in the surging obesity statistics. The conference focused on ways to re-engineer daily environments. As positive initiatives inspired by the new focus on fat, they cite efforts to get kids unstuck from the television, like national Turn Off TV Day. Kaiser Permanente's support groups for encouraging healthier eating and physical activity are an important component of designing better systems to treat chronic illnesses of all types. And a new generation of city planners uses obesity statistics to advocate for neighborhoods where you can again walk to the corner store or to school. One conference speaker, Kent Brownell of Yale University, anticipates a full-scale confrontation with the food industry over childhood obesity--much like the campaign against tobacco companies over marketing cigarettes to young people. He claims that food manufacturers use many of the same tactics as tobacco companies to sell fattening and addictive foods to kids, and that such practices won't stand up to public scrutiny. But William Dietz, the keynote speaker and a pediatrician who heads a program on weight and nutrition at the CDC, is optimistic that the food industry will respond to the current concerns by introducing new products, as they have in the past. "I don't think food is tobacco," he says. "Look at the plethora of low-carbohydrate products that have emerged. Ten years ago it was low-fat products. The moves the industry has made lately are based on marketing research that shows them that there's a growing demand for products that will address the obesity epidemic." The surge of attention to the obesity crisis is creating public pressure for change. The success of the book Fast Food Nation, and the new movie Super Size Me are harbingers of a shift in attitudes. As parents watch their children get heavier and find themselves competing with television and movie marketing over their kids' diets, they are apparently souring on fast-food companies. In a survey released this spring, majorities of Californians favor measures like banning junk-food ads on TV and even putting special taxes on fast foods to fund public health measures directed at childhood obesity. Many schools have banned soft-drink vending machines and fast-food carts. And trial lawyers are preparing class-action lawsuits to force change on the industry, which feels threatened enough that they petitioned friends in the House of Representatives to pass legislation this year banning such suits. The food industry's defense is simple: they produce what the market dictates; what people eat and how much they exercise are matters of personal responsibility. They're not alone in emphasizing personal responsibility. Dr. Phil does. And many physicians argue it is ultimately up to the patient to change. "The individual can do a lot," Natalie Boero says. "But it's the nation's responsibility to make healthy foods and safe places to play available--to put its money where its mouth is. And it's not a person's responsibility to endanger her health in pursuit of trends sold through fear and idealized images. Personally, I do feel responsible for living the most active, healthy life I can--and for calling an injustice an injustice." She belongs to Padded Lilies, one of several fat activist organizations, the largest of which is the National Association to Advance Fat Acceptance. The message, Boero says, is: "Stop dieting now. Fat people are no blight on society, and it's not a moral issue. It's an issue of rights, like any other discriminated-against group." It will take "practically a social revolution to de-glamorize waif-like thinness," Boero acknowledges. "But in the long run, if Americans can't divorce being healthy from being thin, we'll all lose out." |
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