Art Resource
“The Love Letter,” by Fernando Botero
Abigail C. Saguy is no stranger to pushback. Since the sociologist began her research for What’s Wrong With Fat? (Oxford University Press), more than a decade ago, she’s experienced questioning from colleagues, journal editors, even her mother, who sent her every New York Times article on body weight and diet. “It was surprising to me because I didn’t realize the extent to which I had stumbled on a hot-button topic,” Saguy says on the phone from Los Angeles, where she is an associate professor at UCLA. “This clearly touches a raw nerve.” The questioning made for a better book, she feels, having forced her to be very clear about what she was arguing.
So what is she arguing? One place to start is her title. Saguy’s interest is more in the question than in the answer. She takes the concept of “framing” from the sociologist Erving Goffman to consider the ways fatness is framed as a problem.
Much has been written about the causes of the obesity epidemic. Saguy’s intent is to “turn that question on its head by asking what obesity, as a frame, causes.” In other words, what are the social implications of understanding fatness as a health risk? Historically in the United States, she says, the problem of fat has been framed first in terms of immorality—fat people are slothful and gluttonous—and only then by a medical frame, of individual health, and finally by the public-health frame of an epidemic. These “problem frames,” she notes, tend to emphasize personal responsibility for fatness over sociocultural or indeed biological causes.
Briefly, the author turns to France, where as an American grad student she completed one of her two Ph.D.'s. There, despite growing concerns about obesity, fat has been framed less in terms of personal responsibility. The French place equal blame on sociocultural factors, particularly on the invasion of fast-food culture from America. They blame “McDo” and its ilk. It’s also an aesthetic issue, she says, but not a moral one: “The French care about fashion,” but “you’re not a bad person if you’re an unfashionable person. You’re just maybe a bit unfortunate, but you’re not evil. So it doesn’t have the same bite.”
Saguy acknowledges that readers will want to know her views about the risks associated with a higher body mass. She accepts some links but feels that much is unknown. Associations are not causes, as she says any student learns in an introductory statistics or epidemiology class. For instance, do obese women have higher rates of cervical cancer because of their weight? Or is it that many obese women, feeling stigmatized, avoid going to the doctor to get Pap smears and other care? Or take Type II diabetes and its seemingly strong links to obesity. Consider, she says in the interview, a puzzling bit of data: Among people who have gastric-bypass surgery, why does the risk of diabetes drop immediately, even before they lose any weight?
Some have found the body-mass index problematic because as a calculation using height and weight, it doesn’t distinguish between muscle and fat. So a shortish, muscle-bound man, for example, can be labeled obese. There’s also the question of where the lines are drawn. Saguy notes that in 1998, the National Institutes of Health lowered a BMI cutoff point. Overnight, 29 million Americans became overweight.
Another frequent question for Saguy is whether she has a stake in the argument. Essentially, is she or has she ever been fat? For the record, the author says that her adult BMI has always been in the normal range, ruefully noting that this fact has enhanced her credibility. Promoting one of Saguy’s journal articles, a UCLA staffer insisted on including a description of the scholar as a “petite mother of two small children.” When Saguy protested, she was told that the wording would decrease the likelihood she would be “dismissed as some crazy person.” The scholar laments the fact that her potential bias as a thin person isn’t even brought up. Even members of the National Association to Advance Fat Acceptance whom she interviewed were pleased that a thin scholar was presenting their views.
Saguy extends her discussion of framing to the civil-rights and other arguments of such activists, as well as to “health at any size” advocates, including physicians, who challenge the notion that one cannot be both fit and fat.
Exploring fat-positive frames, Saguy argues that historically, fat has been seen as essential to female beauty. As in other accounts of fat allure, the prehistoric Venus of Willendorf figurine makes her usual appearance, as do Rubens’s “Three Graces,” figures characterized by Saguy as “moderately obese.” But surely, she is asked, much of the history of art deals with forms that are more plump than obese, more along the lines of a sensual Renoir nude? Yes, she agrees—but that nude would fall into the overweight category in any BMI chart.
Saguy’s book includes research comparing articles in The New York Times and Newsweek on obesity on the one hand, and on anorexia and bulimia on the other. Her hypothesis was that the news media are more likely to invoke personal responsibility in the case of obesity than in the case of eating disorders. That proved true. Then she examined articles that discuss another problem: binge-eating disorder, which involves the quick, uncontrolled consumption of huge amounts of calories in short time frames, but without the vomiting characteristic of bulimics. The Times columnist Jane Brody wrote memorably about her own youthful experience with the condition. But without the purging, people with binge-eating disorder tend to be heavy. Saguy found that articles tended to deny BED the status of a “real” disorder.
She also contrasts the media’s treatment of two reports, by two groups of scientists at the federal Centers for Disease Control and Prevention, published in the Journal of the American Medical Association. In a 2004 study, 385,000 “excess deaths” in 2000 were linked to overweight and obesity combined, with an additional 15,000 deaths attributed to poor diet and inactivity by the nonoverweight or nonobese. The second study, from 2005, used newly released data, adjusted for age, smoking, and other variables, and revised that figure downward, to just 25,815 deaths associated with overweight and obesity combined. The framing of the obesity epidemic is such that the news media, she argues, are more likely to question the credibility of the second study, despite the CDC’s coming out in its favor.
Yet where is the middle ground?, Saguy is asked. Can’t a person worry about obesity and its health effects and still feel it is wrong to stigmatize fat people? That’s the tack the Rudd Center for Food Policy & Obesity, at Yale University, tries to take, she answers. It draws attention to the obesity epidemic, while conducting important research on discrimination. Still, she wonders, what does pathologizing fat do to the fat person? “Feeling guilty doesn’t translate into taking care of your body.”
For fat children, feeling guilty may be accompanied by “size bullying.” Saguy supports Michelle Obama’s campaign for children’s health. “I have two children,” she notes. “I care about nutrition, I care about physical activity.” Her concern is the talk of “eliminating childhood obesity in a generation,” she says, “because you are talking about a body type.” Some kids are going to be in that category, whether for genetic, biological, or other reasons. “I think we need to tell them that we love them whatever size they are, but that we want them to be eating well, we want them to be active. We want all the same things for them that we want for the thinner kids.
“What we don’t want to tell them is that their body, in and of itself, is bad, is wrong,” she says. “I know that Michelle Obama doesn’t mean to be worsening the problem of size-bullying, but I worry that she might inadvertently be doing so when she tells kids that certain body types are not OK.”
