Men and the War on Obesity

A Sociological Study

Lee F. Monaghan

• Publisher: Routledge
• Year: 2008
• Print ISBN:
  9780415407120
• eBook ISBN:
  9781134134502
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

Is obesity really a public health problem and what does the construction of obesity as a health problem mean for men?

According to official statistics, the majority of men in nations such as England and the USA are overweight or obese. Public health officials, researchers, governments and various agencies are alarmed and have issued dire warnings about a global 'obesity epidemic'. This perceived threat to public health seemingly legitimates declarations of war against what one US Surgeon General called 'the terror within'. Yet, little is known about weight-related issues among everyday men in this context of symbolic or communicated violence.

Men and the War on Obesity is an original, timely and controversial study. Using observations from a mixed-sex slimming club, interviews with men whom medicine might label overweight or obese and other sources, this study urges a rethink of weight or fat as a public health issue and sometimes private trouble. Recognizing the sociological wisdom that things are not as they seem, it challenges obesity warmongering and the many battles it mandates or incites. This important book could therefore help to change current thinking and practices not only in relation to men but also women and children who are defined as overweight, obese or too fat. It will be of interest to students and researchers of gender and the body within sociology, gender studies and cultural studies as well as public health researchers, policymakers and practitioners.

1 Introduction

Beyond militarized medicine

Fat fighting, resistance and the relevance of men

Big Joe presented himself as physically and emotionally strong. However, he almost felt under siege when discussing a TV programme where members of the public telephoned in and berated those whom medicine might label overweight, obese or even morbidly obese. As a counterpoise to ‘being pushed into this section of people’ who were deemed undeserving of healthcare, Big Joe talked about being happy with his size, his relatively good health and his masculine credentials or social fitness. In short, this hardworking family man resisted the imposition of what Goffman (1968) calls a ‘spoiled identity’, though such resistance would appear fraught and contested. This is because medical authorities and proponents of public health are drawing from and amplifying the Western cultural fear and loathing of fatness, or fatphobia, with claims about a global ‘obesity epidemic’ (WHO 1998). This is defined as a ‘disease’ – attributable to ‘sedentary lifestyles and high-fat, energy-dense diets’ (WHO 1998: xv, xvi) – that should be tackled, or aggressively fought, by militarized medicine.

Medicine’s military metaphor, as explained by Sontag when discussing the war on cancer, first became popular in the 1880s and has ‘a striking literalness and authority’ (1978: 70). Consider the declarations of former US Surgeon Generals, men who have been touted as the country’s leading health educator. C. Everett Koop popularized the expression ‘war on obesity’ in 1997, citing an alleged annual death toll of 300,000 Americans (Mayer 2004: 999). Robert Carmona (2003) then called obesity ‘“the terror within”, a threat that is every bit as real to America as weapons of mass destruction’. US medicine is known for its ‘aggressive approach’ (Gimlin 2007a: 45). However, the Surgeon Generals’ ruggedly masculine rhetoric is also echoed in other nations with military imagery offered alongside alarmist claims about the ‘ills’ of ‘weight’ (a crude proxy for fatness). In Ireland, The Report of the National Taskforce on Obesity (2005: 6) calls ‘body weight the most prevalent childhood disease (sic)’ in Europe. This report repeatedly uses the words ‘target’ and ‘tackle’ and cites physiology literature with titles like ‘Waging War on Physical Inactivity: Using Modern Molecular Ammunition against an Ancient Enemy’. The UK House of Commons Health Committee’s report is equally moralizing and bellicose: as well as featuring a chapter titled ‘Gluttony or Sloth?’, it quotes the Chief Medical Officer, who calls obesity ‘“a health time bomb” that must be defused’ (UK Parliament 2004: 8). Slenderness, it seems, is obligatory in wartime.

Amidst this aggressive moralizing, and its uptake and recycling in various contexts (Rich and Evans 2005), it is understandable why Big Joe felt annoyed and complained ‘it’s almost as if you’re breaking the law for being overweight’. Some readers may feel the same, though they may not be aware of the uncertain and contested status of the scientific field from which obesity epidemic claims emanate, alongside recent literature that urges a rethink of this issue (for example, Campos 2004, Gard and Wright 2005, Monaghan 2005a, Oliver 2006). In such a context, I think Big Joe’s resistance was reasonable. It could even be considered healthy. It provided an alternative to dieting, which is seldom successful and is risky (Aphramor 2005), the use of weight-loss drugs and other medical technologies that may be worse than the ‘condition’ they purportedly ‘cure’ (Kassirer and Angell 1998; also, see Ernsberger’s preface to Campos 2004). Big Joe’s words also provided a shield that deflected possible attacks on him as a person (Cahill 1998), which was important given the bombardment of larger people with the medically and government ratified message that their bodies are unacceptable. Sounding like a fat activist, who treats this issue in political terms, Big Joe redefined the problem: people actively make fatness into a problem for others and this is not really motivated by a genuine concern for their health and well-being. My contact obviously condemned members of the public, though, as seen later in the book, he also challenged government endorsed obesity fighting campaigns. Yet, scientists might justify the attack on medicalized fatness using dichotomous reasoning that separates the person from the body. The title of Friedman’s (2003) article is illustrative: ‘War on Obesity, Not the Obese’.

Such definitional practices, which manufacture fatness as a correctable problem and fuel fatphobia on an unprecedented scale, are problematic. They do not invent fat hatred afresh but they clearly reinforce and actively foster cultural disdain towards adiposity, a feminized body tissue. In this book I will maintain that institutionalized fat fighting is questionable, if not objectionable, but also more or less resistible even among people with a personal investment in it. The following is thus critical, rather than supportive, of obesity warmongering and the battles and hatred it mandates and incites. A critical approach is necessary for many reasons. Among other things, people are and have bodies (Turner 1992). Rather than objectified bodies to be aggressively targeted and tackled, people are embodied subjects living in a symbolically meaningful and divided social world. This point fits with understandings from embodied sociology, which is attentive to the ways in which bodies are the source, location and medium of society (Shilling 2003). Other social scientists recognize this. When discussing the US war on obesity, Herndon (2005) warns about ‘collateral damage’ from ‘friendly fire’. After remarking ‘[a]dvocates of the war against obesity imagine themselves engaged in a battle for our nation’s health’, she adds: ‘[w]hat many doctors, public health officials and concerned journalists writing in support of the war against obesity fail to recognize, however, is that war against obesity also means a war against fat people’ (129). In a related vein, Rich and Evans (2005) challenge what they call ‘the obesity discourse’, i.e. institutional knowledge and practices, dominated by medicine, which categorize/constitute bodies and carry a moral agenda that ‘can lead to forms of size discrimination and oppression’ (341).

Social scientists often conceptualize the attack on fat in gendered terms, with feminists typically challenging fat hatred because of its negative impact on many women and girls (for example, Bartky 1990, Bordo 1993, Orbach 2006, Wolf 1991). Female fat activists and fat acceptance scholars, some of whom identify as feminists, also critically extend such thinking with reference to ‘really’ fat women who often encounter prejudice, discrimination and oppression in everyday life and clinical settings (Brown and Rothblum 1989, Cooper 1998). Lucy Aphramor, a health professional, has also told me about her recent focus group research among large British women, some of whom were spat at in public (personal communication 2007). However, in seemingly contradicting the feminist argument that it is female fat that is despised, men also risk social censure if they are seen as fat in everyday life. Little is known about this within the current academic literature, though I would maintain that the relevance of researching men extends beyond the empirical and could augment feminist and fat activists’ efforts to challenge ‘intolerance and insensitivity: in a word, sizism’ (Joanisse and Synnott 1999: 49). This is not meant to imply that men and women are equally victimized, though it does mean being open to similarities and possible shared interests within a gender order where masculinity is constructed relationally and in opposition to femininity.

There are recent calls within social studies of the body to explore such issues. As maintained by Bell and McNaughton: ‘So widely is the net of deviance and its attendant gaze being cast, that it is impossible to continue to deny or downplay the impact of the war on fat on both women and men’ (2007: 126, emphasis in original). The degradation of men’s bigness as unhealthy fatness is not historically peculiar (Gilman 2004, Huff 2001, Schwartz 1986, Stearns 1997) but it is currently reproduced on an unprecedented scale by biomedicine, the dominant organizing framework of modern medicine. This is amplified in ‘public health’ discourses with reference to men’s imagined fatness; i.e., men’s discursively constructed, rather than real, bodies that are assumed to be fat and risky. Inseparable from a larger gender order that seeks to rationalize bodies (for example, through calculability and efficiency), this degradation could be termed ‘symbolic violence’ or communicated violence (Bourdieu 2001). Given the role of experts in communicating risk (Beck 1992, Giddens 1991), this violence is often deemed acceptable, if not laudable. However, in departing from Bourdieu’s (2001) concept of symbolic violence, this degradation and associated masculine domination is not always subtle and gentle. Declarations of war are a case in point, though the following ‘informative’ quote is also noteworthy because it ridicules men’s imagined fatness when explaining the standard measure of overweight and obesity. This is from a male doctor on a British Broadcasting Corporation (BBC) health web page, with the vocabulary of health (risk) and personal responsibility providing a sugar-coated rationale for his militant irony:

More than half of the men in the UK are denting their seats because they’re too fat – and that number is increasing. You can work out whether you’re a healthy weight or putting your health at risk by calculating your body mass index (BMI). Use our BMI calculator or work it out using this formula: Take your weight in kilograms and divide it by your height in metres and then divide the result by your height in metres again. Underweight = BMI less than 18.5. Healthy weight = 18.5 to 24.9. Overweight = 25 to 30. Obese = 30 to 40. Severely obese = 40-plus.

(BBC Online 2007)

The BBC is not unique in using the idea of men’s fatness to amplify fatphobia and sizism, which, as I will maintain, are likely to hit women and children hardest. Health organizations, researchers and other ‘claimsmakers’ (Best 1995) routinely define men as overweight, obese or fat and especially vulnerable to illness and early death. No punches are spared as men’s apparently ubiquitous ‘fat’ and ‘unfit’ bodies are set up for a violent-sounding tackle – presumably because ‘real men’ can take this and it is supposedly in their best interests. Thus, during its UK Department of Health sponsored conference, Tackling the Epidemic of ‘Excess’ Weight in Men, the Men’s Health Forum (MHF 2005) bemoaned men’s greater tendency than women to exceed a ‘healthy’ weight. In their policy report they state that two-thirds of men in England and Wales are overweight or obese and claim a large ‘waist’ is ‘hazardous’. Promotional leaflets for their conference also visually supported this message with a photograph of a man’s fat stomach and taut shirt. Within this idiom, men’s intra-abdominal or central obesity is especially risky – and, if it was not, then the harms of fatness would surely have to be invented to justify this not-so-subtle symbolic violence. Similarly, a recent book from a US weight-loss researcher focuses on men’s stomachs and advises men to ‘get rid of that potbelly’ – something that renders men pregnant according to the book’s cover (Schauss 2006). The National Audit Office’s Tackling Obesity in England (NAO 2001) also immediately targets men’s fatness. Featuring an image and quote from fat Falstaff, a character in Shakespeare’s Henry IV, the report’s front cover proclaims fleshy men are frail. Here fat is deemed corporeally polluting and emasculating: it spoils men’s appearance, identities and, like a cancerous growth, poses a life-threatening risk for the unaware male. ‘Watch out!’ exclaims the front cover of Schauss’s (2006) book, ‘That potbelly can kill you!’

In this book I will bring in men’s own voices and interpret these using a critical framework. Theoretically and politically informed, I am critical of instituted meanings and practices that define bodies as objects to be cut down in size, rather than critical of ‘big’ men who may have already suffered the slings and arrows of a fatphobic society. My aim is to promote healthy scepticism and productive dialogue among interested parties in ways that are open to the mutual imbrications of the biological and social. I will elaborate upon my methodology and other contextual concerns below but centrally this is a qualitative study that explores health- and weight-related issues among a small sample of men mainly living in England. It includes observations from a slimming club, in-depth inter-views (N=37) and other data (for example, informal conversations with men in everyday life). Most research participants were at a reported weight-for-height that biomedicine labels ‘excessive’ and while many were slimming, others were not. Rather than ridiculing and advising these men within a larger context of masculine and class-related domination, I will do something different. I will offer an ‘appreciative understanding’ (Matza 1969) of their views and efforts to reclaim and enact socially fitting masculinities – a case of being seen as regular fellas rather than deviant and woman-like.

‘Bringing in’ men is important for empirical, theoretical and political reasons. Empirically, social scientists express an interest in the human consequences of the war on obesity but there are big gaps in the knowledge base. Little is known about how men live and experience their bodies, how they discuss weight-related issues and how they present themselves in the midst of a putative crisis (Bell and McNaughton 2007). Researching men could be considered especially important because men’s health has attracted considerable media, if not social scientific, attention in recent years with reference to their supposed ignorance about their bodies and rising obesity (Watson 2000). Others also note the paucity of sociological research on men’s talk about body matters more generally (Gill et al. 2005). I therefore heed Bell and McNaughton’s (2007) point that men’s experiences cannot be ignored, though I do not call any of my contacts ‘fat’ given the potential offensiveness of this term. Another reason is that what is considered ‘fat’ in everyday life is a contingent social judgement rather than an objective scientific fact, with most men who are medically labelled overweight or obese on the BMI probably rejecting this measure (cf. Monaghan 2007).

This study is theoretically informed, as elaborated below, but I also seek to inform social theory. In line with a sociologically imaginative approach that views personal troubles and public issues as inextricably linked (Mills 1970), studying men and the war on obesity furthers efforts to rethink various oppositional dualities that have implications for discussion and practice inside and outside of sociology. Thus, mention was made above to the unsatisfactory separation of the person from the body as a rationale for warmongering. This separation is part of a larger series of dichotomies in Western thought that shape the truncated obesity debate such as: good/bad, fitness/fatness, biology/society, mind/body, reason/ emotion, object/subject and sex/gender. These ride roughshod over the richness and complexity of the real world where oppositional dualities are blurred despite considerable investments in maintaining them (Williams and Bendelow 1998). For example, consider how bodies sexed as male are positioned as feminine because of the social meanings of their real or imagined fatness, and how this subordination may evoke an emotional yet insightful response that could be considered personally healthy even if not socially transformative.

Undertaking empirically grounded and theoretically informed research also offers political gains. I am not offering what Connell (2000: 193) calls a ‘“competing victims” rhetoric’ but, as made clear by Big Joe, men also risk getting hurt in the war on obesity and this should prompt those who care about public health to reflect more on their actions. This is a message that female fat activists have long expressed (Freespirit and Aldebaran 1973) and their words have largely fallen on deaf ears. I should stress that I did not begin this research with an explicit political agenda that aimed to challenge institutional sizism. Big Joe might have sounded like a fat activist when addressing the politics of gendered identity but I never expected my small sample of men, many of whom were recruited at a slimming club, to ‘do politics’ and promote fat acceptance. This task is difficult enough even for feminists who are personally seduced by fat activism and experience size discrimination (S. Murray 2005)! However, by undertaking research, participating in online groups and reading and writing, this study has taken me down an unexpected road. A study on men has prompted me to critically draw from fat politics, which is mainly formulated by women in order to challenge the sexist trivialization of anti-fat prejudice and ‘fat oppression’, i.e. ‘hatred and discrimination against fat people, primarily women, solely because of their body size’ (Brown and Rothblum 1989: 1). While I would qualify social oppression views and reject some fat activists’ arguments (see Chapters 2 and 3), this book is intended as a critical complement to such thinking. During this research I have learnt to see fat oppression as a real, emergent process that is not tied to female bodies though it is aimed at bodies that are positioned as feminine (disgusting, despised, dependent, passive, unhealthy) regardless of their biological sex. Within this field of masculine domination – which is potentially injurious not only for particular women but also men whose bodies supposedly symbolize ‘failed’ manhood – it is hardly surprising that fat oppression is often trivialized. This book aims to challenge that trivialization and sensitize more people to what has been called ‘one of the last “safe” prejudices’ (Smith 1990).

In terms of theory and politics, this book also connects with and helps expand a new wave of studies that challenge obesity epidemic thinking and obesity warmongering (for example, Aphramor 2005, Bacon 2006, Burns and Gavey 2004, Campos 2004, Campos et al. 2006a, b, Cogan 1999, Cohen et al. 2005, Gaesser 2002, Gard and Wright 2005, Herndon 2005, Jutel 2005, LeBesco 2004, Mayer 2004, Miller 1999, Oliver 2006, Rich and Evans 2005, Robison 1999, 2005a). This literature complements, extends and is sometimes indebted to feminisms, fat activism and the Health at Every Size paradigm – a clinically informed approach, which focuses on improving people’s biomedical health and well-being without weight-loss being a necessary condition. Such writing challenges the institutional attack on medicalized fat and associated narratives of shame and blame. Contributors maintain that obesity science is overly reductionist, equivocal, largely ineffective, counterproductive, ethically suspect and depoliticizing. Largely written by people outside of sociology (for example, dieticians, nurses, exercise physiologists, physical educators), such work nonetheless recognizes the sociological wisdom that things are not as they seem (Berger 1963). This prompts me to critically explore the human significance of fat fighting and the idea that this really is the best way to promote health and well-being. Taken together, this amounts to a concerted effort to rethink current conceptualizations, promote productive dialogue and perhaps a paradigm shift that could foster more peaceful relations. This dialogue should occur throughout the social hierarchy and include health professionals and policy makers who have the potential to improve institutional practices as they affect men, women and children in their contexts of everyday life.

The remainder of this chapter has five objectives. First, the characteristics of a sociologically imaginative approach are outlined. Second, difficulties associated with exercising critical judgement are noted but the importance of this is underscored by connecting with relevant literature. Third, some words are offered on potentially offensive terms such as ‘fat’ and ‘obesity’. Fourth, the research is described. Finally, the chapter content is outlined.

A sociologically imaginative approach: From interpretivism to critical realism

Familiarity with the social world as presently constituted means that sociology can be difficult for newcomers. ‘Like a “fish in water” [that] does not feel the weight of the water” (Bourdieu and Wacquant 1992: 127), people habitually take the world for granted rather than treat practical circumstances as matters of theoretic interest. However, we are obviously not fish oblivious to surrounding water. For people who are curious about the life worlds we collectively construct, share and use to drown others with, sociology is an exciting and consciousness altering discipline. It has the potential to instil passion and interest in an often alienating world where, as Karl Marx once said, all that is solid melts into air.

Sociology comprises many approaches for systematically exploring the human condition as collectively lived and experienced. It embraces a myriad of concerns and comprises lively debate. Among other things, sociology considers how interpretations of the social and natural world are products of social activity. Hence, knowledge is socially constructed even when referring to something very real such as the body and the impact of social organization on life chances and health. Sociology makes clear that knowledge, meanings and actions do not arise in a social vacuum devoid of human interests and values, though some knowledge claims are more credible and socially just than others. Thus, some medical sociologists employing a realist epistemology (theory of knowledge) consider how increasing health inequalities are a product of core capitalist executive action and politics. In neo-liberal societies, which champion the individual, emphasis is placed on personal responsibility in ways that obscure the larger social dimensions of health and illness while benefiting ‘Greedy Bastards’, i.e. core executives and elite power groups (Scambler 2001, 2002).

When framed as a humanistic discipline, sociology is concerned with the question of what it means to be human and to be human in particular situations. Berger (1963: 189–90) explains that ‘sociology’s data are cut so close from the living marrow of human life that this question comes through again and again, at least for those sociologists who are sensitive to the human significance of what they are doing’. Sociology makes sense of people’s sometimes joyous but also painful lives as experienced with and among others. Sociology is also debunking and provides the intellectual tools for challenging the taken-for-granted. When discussing the relevance of sociology, Berger (1963: 198) discusses how those encountering the discipline may ‘become a little less stolid in their prejudices, a little more careful in their own commitments and a little more sceptical about the commitments of others’. Similarly, Stanley (2005) characterizes sociology as a discipline that rejects ‘god’s eye science’ and refuses to acquiesce to what is authoritatively defined as real, truthful, good, virtuous, natural or inevitable. She adds that sociology offers unsettling, potentially subversive yet ethical and relevant commentary. Rather than about simple irreverence this is about the possibility of seeing the world differently and perhaps more compassionately.

This is not guaranteed when discussing weight-related iss...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of tables
• Acknowledgements
• 1 Introduction: Beyond militarized medicine
• 2 Bodily alignment and accounts: From excuses to repudiation
• 3 Smoking guns, wartime injury and survival: Men and dieting
• 4 McDonaldizing men’s bodies? Rationalization, irrationalities and resistances
• 5 Physical activity and obesity fighting campaigns: Men’s critical talk
• 6 Conclusion: Social fitness and health at every size
• Bibliography