The West has grown terrified of obesity. To read the figures put out by the
International Obesity Task Force, one might believe we were in the midst of
an obesity epidemic that will swamp our health service and ruin the lives of
the next generation.
We are told that by 2050 half of the children in the UK will be obese. Without
being glib and dismissing the justified concern about the growth in obesity,
we need to contextualise this and see it as part of the high level of eating
difficulties which beset people in the West. Many of the eating
difficulties, which include compulsive eating and bulimia, are less visible
than obesity but they are no less widespread; indeed, they are more
prevalent.
Teenage girls in particular are so caught up in worries about their body size
that very few of them eat in relation to appetite and stop when they are
physically satisfied. Such concepts as appetite and satiety elude them. They
are a generation who have grown up with mothers who worry about the
acceptability of their bodies and who they have seen be inconsistent, wary
and often anxious about their own eating, size and body shape.
These daughters have learnt from early on to be cautious around food, relying
on rules and regulations, which they occasionally rebel against, rather than
biological cues. What has become the eating norm for teenage girls is far
from what would have been considered “normal” eating 20 years ago.
Playing about with appetite, or eating only on weekends, or just one meal a
day, or some such scheme, can indeed lead to thinness, but because it cannot
be sustained, it can equally well lead to fatness. Emotional and biological
rebellions against a life of food restriction, deprivation and compulsive
exercising can produce either anorectic-style responses or what appears to
be its opposite - out-of-control eating.
From the therapist's point of view, these two forms of managing food share
complementary characteristics. Anorectics have a tendency to overestimate
their size. The obese tend to underestimate theirs. Neither see themselves
as they are. Nor do either have an easy time accepting their appetites.
The people whose eating difficulty expresses itself in an anorectic manner are
so afraid of appetite and desire that they create a situation in which they
are indeed hungry, they experience it, but their hunger is there to reassure
them that they can do without nourishment, that they do not require much.
Their emotional and physical appetites feel unwieldy and wrong unless they
are overridden. In controlling their hunger and what emanates from them,
they are showing us a food-oriented version of a response to a false body.
People who eat in an out-of-control fashion also find hunger and need
intolerable: they cannot bear to experience their need. Their response to
the dilemma of appetite and desire is to eat in advance of feeling what for
them is too painful a call of hunger. It is possible to understand this
prophylactic eating as another version of the false-body phenomenon.
Whether striving for thinness, afraid of it or managing it, a fear of appetite
and an unreliable body sense stalk many girls' and women's days. Thinness
has become an aspirational issue, a means to enter what on the surface
appears to be a new classless society. But it is - falsely, I believe -
promoted as a health issue in which the psychological underpinnings of
appetite and thinness are bypassed. Often behind the desire for thinness -
which affects those who are fat, those who are thin and all sizes in between
- there exists an unhappy, unhealthy relationship to food and to the body.
When confusions are created around size, when size depends on the
transformation of personal biology and not on knowing and responding to when
one is hungry and when one is satisfied, there can be no peace.
The sense of having a stable body whose size and appetites one knows and can
trust is elusive. The recent emphasis on the Body Mass Index (BMI) compounds
the problem. Interestingly, few medical people who are actually working in
the area of nutrition and obesity find it a useful measure. There are better
predictors for heart disease and diabetes that depend on the girth around
the midriff area rather than the BMI, which is itself a crude measure of the
ratio between height and weight. It was devised by the Flemish scientist
Adolphe Quetelet in the mid-19th century, when the infatuation with social
Darwinism made statistical measures all the rage.
In 1995 the World Health Organisation, under pressure from the International
Obesity Task Force, revised the BMI in such a way that 300,000 Americans who
had previously thought they were “normal” weight woke up to find themselves
reclassified. Brad Pitt and George Bush, for example, were now overweight (a
UK example would be Linford Christie), and George Clooney and Russell Crowe
were obese. I think we can see how preposterous these classifications are
and thus question the estimates categorising 50 per cent of our children in
danger of becoming obese.
We can also question who is helped by this reclassification and examine the
deleterious effect it has on our relationship to our bodies, especially if
we look back to the 1950s, when ads proclaiming “Skinny? You'll miss
out on summer fun!” sold “super wate-on” tablets to help women “put on
pounds and inches of healthy flesh” to encourage that era's aesthetic, which
was certainly a 27-plus BMI.
In collapsing a multitude of eating problems into the newly minted disease of
obesity, we see the legitimising of commercial enterprises that swell their
profits by creating panic around size and shape. Despite the newspaper
column inches and the television documentaries about the obesity epidemic,
there are few sustainable facts here. The studies claiming that 365,000
people a year in the US will die from obesity, that one in three children
are obese and that a BMI of under 25 is optimum have all been shown to be
fanciful. In fact, on the National Institute of Health's reanalysis of its
own figures, one in fifteen children are seriously overweight in the US and
some 26,000 will die from obesity-related diseases. Contrast this with the
US figures for smoking-related deaths per annum of 600,000.
Obesity is a problem. I don't want to underestimate it. But I want to be sure
that we see the social, psychological, class, visual, nutritional and
commercial issues behind the so-called crisis. People may be eating more
than their bodies require, their bodies may not be processing their food
well, they may be eating foods that are hard to metabolise. This is
certainly one part of the body story. So, too, is the aspirational thin-body
story emerging in the new economies of eastern Europe, Arabia and Asia.
Then, too, the fat body may be refusing our visual and aspirational culture,
saying, “I don't want this. I can't manage this,” or telling a story of the
unhappiness which is encased in the fat body. The fat body could be
challenging our overpowering preoccupation with image. It might signal a
dismissal of childhood eating regimens. Or it might be more a statement
about consumerism and the impossibility of so-called “choice”.
If we recognise how ways of eating can indicate a crisis around the body, it
is possible to see that fatness is as much - if not more than - an
indictment of our culture as it is a site of individual “failure”. Given
that obesity is now being linked to poverty and low income, we also need to
take note of class issues and how aspiration plays out for many who
experience economic exclusion.
And of course more complex thought is required to supplant the oversimplistic
talk of calories in and calories out that dominates government thinking. We
need to insist on the links between the rise of obesity and the
intensification of visual images of thin people; the introduction of long
shelf-life foods saturated with fats, soy and corn syrup; the extraordinary
growth of the diet industry; and the segmentation practised by the food industry,
which takes out fat from one food, such as milk, and sells it back to us in
another.
These four events parallel the rise of obesity. You could produce a graph
showing the rise in the sale of low-fat milk and another that showed rising
obesity numbers and they would fit perfectly.
Similarly, a graph of the growth of the diet industry would fit with one
showing the rising numbers of larger people. And it is also the case that
the rise in obesity statistics coincides with our increasingly sedentary
lives and the preponderance of images of the incredibly lean.
Health economists and city planners are hard at work discussing the impact of
the car and the design of our towns, shopping centres, rural transport and
lighting in order to encourage us to move our bodies and eat sensibly as a
matter of course. That is very important. But this focus can miss out on the
emotional, psychological and class meanings attached not only to food and
eating but to size. In an image-based culture, the conscious and unconscious
meanings of fat and thin are highly complex. While fatness might be regarded
as laziness and indulgence, this is far from the experience of the eater
with bulk.
The designation of fat as worthy of scorn and dislike, and of fat people as
outsiders who should not only dislike themselves but also be discriminated
against, is growing. This is not a new phenomenon (hence the organisations
that exist to defend the rights of fat people) but the disrespect has
intensified. Fat and fatness are now demonised and are seen as signals of
class.
Yes, there are class issues involved in food distribution, food costs and
nutritional education, but the contempt with which people talk about fat and
fat people indicates something else. This is now viewed as a condition to be
avoided, since it signifies both a loss of psychological control and
membership of the wrong class, with an implied set of false aspirations.
There is some discussion now about whether the diseases that are becoming more
prevalent, such as diabetes, actually cause obesity or are caused by it.
Some are suggesting that the content of food (such as high concentrations of
corn syrup) can produce diabetic responses.
There is also clear evidence that the most protective weight for health
purposes is a BMI of 27.5 (if one accepts the BMI at all) - a figure that is
presently in the recently designated overweight category. Interestingly,
overweight people who exercise have a lower mortality rate than thin people
who do not.
So one is led to wonder why thin has erroneously become the gold standard for
health. Could it be that though the evidence does not support the idea of
thinness as healthy and good, the overwhelming power of today's visual
aesthetic has affected even doctors and medical researchers?
Extracted from Bodies by Susie Orbach, published today by Profile Books.
Available from BooksFirst priced £9.89 (RRP £10.99), free p&p,
on 0870 1608080; timesonline.co.uk/booksfirst
