It isn't hard to find article after article expounding upon the scourge of obesity in our society today. The most popular magazines know a little teaser on the front page about weight loss will always sell more. Slower moving academic medicine has cottoned on to the trend with scholarly writing on various, unsuccessful weight loss measures. Bands of young women cannot help but jealously ogle the newest pop star or actress singled out for her recent weight loss or demonize one who has recently ballooned. Not to ignore the supposed even-handed media like the New York Times, any number of weight loss tips (written by an exercise-fanatic who herself does not look well) can be found regularly in the Science Times section.
The fetish of "fatism" and the concomitant obsession with thinness is so pervasive as to have surpassed the current mode and become an accepted fact of life today. Everyone wants to be thin: it is considered healthy, attractive and necessary for survival and success. No one wants to be fat, which equals lack of willpower, sloth and undesirability. It has become much too easy to forget of course that this is a cultural preference. There are many, usually poorer, countries for which the opposite is true. In fact, the flip-flop of thin-fat preference is all but new, a few decades old. How has it not only become the norm but unassailable? Now even the most sober, rational parts of society cling fiercely to this notion, as if it were handed down from on high.
The most insidious means that leads skinny to prevail over fat is the medical establishment. Although it is clear that the mass media preference follows the current mode, that is to be expected. Fashion and trends are meant to be fickle. As much as the general population blindly follows the movements of the famous, what is fresh and new is meant to be upended regularly, and the masses will follow. However, the medical establishment, and often confusing medical journalism, moves much more slowly. The growing medical treatment for obesity now dominates many of the brightest minds of medicine and comprises a vast array of new preventative, medical and surgical treatments. It has become impossible to ignore how mainstream the public health problem of obesity has become and how no one can question its veracity.
What goes unnoticed is that acceptance of a general issue by the establishment reinforces a prejudice by the masses. When government and law supported slavery, the general public felt vindicated in the belief in such an abhorrent practice. When psychiatry included homosexuality as a mental illness, the hatred of gays was accepted. That doesn't mean that being overweight can be compared with bias against innate parts of who we are. However, it does highlight the power of the establishment to sanction accepted bias. The rational justification of the dangers of obesity shouldn't condone blatant prejudice.
The way people sneer at an overweight person walking down the street, avoid him on the subway or scoff at him on a TV show now feels accepted, a part of daily life. The irony is that although a fuller figure could become a la mode in a moment, the medical prejudice against obesity will take much longer to overcome. Although the rationale of the medical risks of obesity are clear-cut, the overarching risks of promoting thin over fat are great. Where are the articles on the scourge of thinness? The underfed, underweight population risks osteoporosis, various vitamin deficiencies and anemia. The chronically underweight also are always at a cognitive loss, struggling to think clearly and to maintain a normal memory. Moreover, it isn't just the underweight who suffer. The number of overweight and even normal weight people who diet comprises a larger and larger percentage of our population. One effect of "fatism" is a general sense that everyone could stand to lose some weight. The pervasive and unchallenged diet industry has the freedom to tout one crash diet after another and guilt people, fat and thin, into severely restricting their food intake. These normal weight people starving on the newest diet are not able to function at a normal level. Even more troubling is the assumption based on the set point theory of weight explained in a recent post. The long-term effect of chronic diet restriction is overeating to compensate for recurrent starvation. The overeating and body's instinctive fear of famine triggers the body to slow metabolism, store fat and paradoxically gain weight. In fact, the drive for thinness in the general population may actually be worsening the obesity problem. We all need food to survive, yet this basic fact is summarily ignored for the supposed common good of facing obesity or perhaps facing our own misguided prejudice.
Medicine itself needs to own up to the risks of chronic starvation and an underweight population. This goes beyond those with eating disorders and instead highlights the general population risking their health by following the unsubstantiated advice of the powerful diet industry. Education is not just about a new government-sponsored food plate but a goal of weight normalcy. The population needs to be aware of the risks of chronic food restriction, and the diet industry needs clear guidelines as to what is medically acceptable. A strong voice against thinness and dieting might at least open the door to a backlash against this dangerous fashion and simultaneously ease the bias against the overweight.
The next post will apply these thoughts about diet and the drive to thinness to children and the risk not just of developing an eating disorder but of a culture of youth that prizes thinness over everything else.
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