Obsession with Weight, Part 2

The Obesity Myth
by Paul Campos, J.D.

(Page 2 of 6)

In America today the medical and public health establishment has managed to transform what has traditionally been considered a vice - physical vanity - into that most sacred of secular virtues: the pursuit of "health." In the context of the war on fat it has done so by systematically distorting the available evidence regarding the relationship between weight and health, by severely exaggerating the risks associated with that evidence, and by pretending that an extremely complex subject is actually quite simple.

These are harsh charges, but if anything, they understate the scandal that is the war on fat. Never before in American history has so much junk science been exploited to whip up hysteria about a supposed public health "epidemic." The health establishment's constant barrage of scientifically baseless propaganda regarding the relationship between weight and health constitutes nothing less than egregious abuse of the public trust. This propaganda has played a key role in creating a culture that makes tens of millions of people miserable about their bodies: Worse yet, it has done so for crass economic motives. The war on fat, which is supposedly about making all of us healthy, is really about making some of us rich.

Yet, as we shall see, the sources of America's weight loss mania go well beyond the fact that the dietary-pharmaceutical complex finds it profitable to nurture and exploit our national obsession with thinness. It is no exaggeration to say that in many respects contemporary America is a fundamentally eating-disordered culture. A much-noted sign of this can be seen in the binge-sized portions that are now standard fare in our restaurants and fast-food emporia. A less-noted piece of evidence is provided by the almost overtly anorexic quality of much of the current hysteria about fat. One explanation for the remarkable distortions of the medical evidence in which those who prosecute the case against fat indulge is that many of these people see that evidence through anorexic eyes. Let me be clear: I am not claiming that all such persons are technically anorexic (although some undoubtedly are). What I am saying is that the anorexic mindset is far more common than our narrow definition of what constitutes instances of the syndrome itself, and that this mindset has played an important part in producing America's growing intolerance of even the mildest forms of body diversity.

Consider that anyone who attends a conference on the "obesity epidemic" in America today is likely to find that a good number of the participants are extremely thin, high-achieving, upper-class white women, many of whom appear to have both strong perfectionist tendencies and a pathological fear and loathing of fat. Any accurate account of the war on fat must grapple with the fact that many obesity researchers, eating disorder specialists, nutritionists, etc., belong to the precise social groups that are at the highest risk for anorexia nervosa - and that indeed a significant number of these individuals display at least some of the classic symptoms of the syndrome. For example, by some estimates, an actual majority of dietitians either have or have had eating disorders. It is true that, to the extent such persons have both recovered from and come to terms with their eating disorders, their backgrounds can improve the quality of their work. But it is also clear that large numbers of people who make it their professional business to counsel Americans about weight and health remain either actively eating disordered, or prone to the same patterns of thinking that fuel such behaviors. In short, much of the advice Americans get about weight can be compared to getting advice about drinking from people who are alcoholics and don't know it.

What, after all, leads medical authorities to conclude that a 146-pound woman of average height is "overweight"? Beyond the fact that it's economically profitable to classify her as fat, we should remember that, for those in the grip of what the eating disorders literature calls "anorexic ideation" (i.e., the tendency to interpret the world through an anorexic lens), a 146-pound woman is fat. Indeed, some obesity researchers are now recommending that the body "ideal" should be redefined to exclude anyone with a body mass index above 21.9 - a definition that would make a 128-pound woman of average height "fat." Such recommendations, I would suggest, are the natural consequences of allowing persons who see the world through anorexic eyes to define what "normal" means. On one level, this claim shouldn't even be controversial: After all, it's now routine to acknowledge that the stick-thin models and movie stars who are held up for emulation to America and the world are quite literally images of an anorexic ideal.

Why is there so little outrage over this? Anorexia nervosa has by far the highest fatality rate of any mental illness; eight million Americans are estimated to be suffering from eating disorders; tens of millions of others regularly engage in disordered eating of some sort; and yet somehow, the fact that much of American culture - from the sound stages of Hollywood to the office of the Surgeon General - is in the grip of an anorexic worldview is something that is more or less taken for granted.

For too long, too few people have been willing to condemn that view for being the destructive distortion of reality that it is. This book is for everyone who lives with the daily consequences of the lies that an eating-disordered culture tells them about their bodies. It is for everyone who has been told they are too fat - or too thin. It's for everyone who has been encouraged to believe the propaganda of our public health authorities, instead of listening to the truth being told to them by their own bodies: that living a joyful, active life - one that includes the calm enjoyment of the many pleasures afforded by food - promotes health and longevity, while trying to conform to some arbitrary body "ideal" does damage to both.

To the tens of millions of Americans who are being made miserable by the lies of the weight loss industry, and its mouthpieces in the medical and public health establishments, I would say this: Rejecting those lies requires nothing less than an act of personal and social revolt. And nothing less than a revolution is needed to overthrow America's eating-disordered culture, with its loathing of the most minimal body diversity, its neurotic oscillation between guilt-ridden bingeing and anorexic self-starvation, and its pathological fear of food, pleasure, and life itself.

Indeed, our whole diet culture is ultimately all about fear, and self-loathing, and endless dissatisfaction. That is the culture we live in. That is the culture we must change. If you have spent much of your life hating your body, because you have been told over and over again that there is something wrong with it, this book will explain just how false that message is. And it will explain exactly what has gone wrong with a culture that demands you hate the body you were born with.

This book has three parts. Part I, "Fat Science," provides a concise overview of the current medical literature on the relationship between weight and health. Many of the facts in this section are likely to astonish anyone who has relied on the mass media for information on this topic (they certainly astonished me). Contrary to almost everything you have heard, weight is not a good predictor of health. In fact a moderately active larger person is likely to be far healthier than someone who is svelte but sedentary. Moreover, the efforts of Americans to make themselves thin through dieting and drugs are a major cause of both "overweight" and the ill health that is wrongly ascribed to it.

In other words, America's war on fat is actually helping cause the very disease it is supposed to cure. In the chapters that follow, we will see that:

• The health risks associated with increasing weight are generally small, in comparison to those associated with, for example, being a man, or poor, or African American.

• These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people, and the same mortality rate as thin active people.

• There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence that short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.

• Despite a century-long search for a "cure" for "overweight," we still have no idea how to make fat people thin.

As this part of the book will make clear, the war on fat has reached the point where systematic distortion of the evidence has become the norm, rather than the exception. The basic strategies employed by those who profit from this war are to treat the most extreme cases as typical, to ignore all contrary data, and to recommend "solutions" that actually cause the problems they supposedly address. And, as in all wars, truth ends up being the first casualty.

Copyright © 2004 Paul Campos

About the Author

A professor of law at the University of Colorado and a nationally recognized expert on America's war on fat, Paul Campos is the author of a weekly opinion column that appears in more than forty newspapers nationwide. His articles have appeared in the New Republic, the Wall Street Journal, the Los Angeles Times, USA Today, the San Francisco Chronicle, and the Boston Globe.