The Obesity Epidemic

Science, Morality and Ideology

Michael Gard, Jan Wright

• Publisher: Routledge
• Year: 2005
• eBook ISBN: 9781134365647
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Increasing obesity levels are currently big news but do we think carefully enough about what this trend actually means? Everybody – including doctors, parents, teachers, sports clubs, businesses and governments – has a role to play in the 'war on obesity'. But is talk of an obesity 'crisis' justified? Is it the product of measured scientific reasoning or age-old 'habits of mind'? Why is it happening now? And are there potential risks associated with talking about obesity as an 'epidemic'?

The Obesity Epidemic proposes that obesity science and the popular media present a complex mix of ambiguous knowledge, familiar (yet unstated) moral agendas and ideological assumptions.

1 Science and fatness

The first section of Steven Jay Gould’s (1996) Life’s Grandeur is called ‘How shall we read and spot a trend?’. Gould’s subjects here are nothing less than the meaning of life on earth and the cherished human idea of ‘progress’. He begins by discussing people’s tendency to use both the word and the metaphor of ‘progress’ whenever they talk about ‘natural selection’ and ‘evolution’, even though formal evolutionary theory suggests no such thing. For Gould, this is a mistake because, as with pre-Copernican and pre-Darwinian ways of thinking, it tries to locate humanity at the centre of creation, constructing it as the crowning achievement of life on earth. The idea of ‘progress’ also assigns to evolution a sense of inevitability, as if the only reason for there being life in the first place was to produce human kind. So even though we may think humans are the embodiment of ‘progress’, we should not forget that Homo sapiens is ‘only a recent twiglet on an ancient and enormous genealogical bush’ (Gould 1996: 41).

The idea of ‘progress’ is also an example of the way people retrospectively impose order on events so that we might understand (or think we understand) what has happened. After all, not only are random events and systems virtually impossible to predict or control, it is also extremely difficult to tell a good story about them. ‘Progress’ is a good story, something which no doubt partly explains its popularity and Gould shows how people as varied as footballers, artists, journalists and scientists often use the word ‘evolution’ as code for ‘progress’. While we may be inclined to assume that footballers and journalists are more likely to fall into these unfortunate habits of mind than scientists, Gould’s message is that this is also a trap – scientists, as much as any other group of people, often think in predetermined, pre-packaged ways which, rather than telling it ‘like it is’, interpret data so that they fit the story they wanted to tell all along.

Writers and scholars have often noticed that archetypal stories and ideas, such as the idea of ‘progress’, co-exist within cultures alongside their opposites. For example, the idea of essential human goodness exists, no doubt, partly as a consequence of the opposite idea that at their core humans are self-centred animals acting on base instincts. In the same way, the story of inevitable decline in human affairs is just as familiar as the one about inevitable progress. Gould (1996: 79) writes: ‘Remember that our cultural legends include two canonical modes for trending: advances to something better as reasons for celebration, and declines to an abyss as sources of lamentation’.

At the risk of committing the same folly of ‘trend spotting’ that Gould warns against, the story of decline seems particularly prevalent in the current age. It is as if we now live in a time of perpetual crisis – everything from democracy to law and order and public transport is often said to be either in crisis or on the verge of one. But crises are not limited to institutions. Human beings, both their bodies and minds, are also under siege from threats of one kind or another. As a recent magazine article puts it:

There seems to be a new one each week. In the last three months alone, we have had a swathe of them reported: shoplifting, methamphetamine, addiction, diabetes, meningitis, schizophrenia. Yes, we are in the midst of an epidemic of … epidemics.

The article goes on:

The most serious, costly and deadly of these, say health experts, is obesity. We are told that our ballooning weight leads to disease and early death and is costing millions in health spending. Competing headlines make a catastrophe of the situation, as we ‘declare war’ on this ‘ticking time bomb’. We are force-fed a monotonous mantra: we are fat and getting fatter, and we must lose

(Lockett 2003: 17)

The ‘monotonous mantra’ to which the article refers – the so-called ‘obesity epidemic’ – is the subject of this book. In our view, the time has come for a critical appraisal of the idea of an ‘obesity epidemic’ that allegedly afflicts a large proportion of the countries of the world and threatens a global health catastrophe. To take up Gould’s point, while there appears to be a trend of some kind – the number of people who are classified as overweight and obese does seem to have increased – the way we ‘read’ or interpret this trend is subject to people’s preconceived ideas and biases. For example, a central argument in this book is that people have latched on to the idea of an ‘obesity epidemic’ because it conforms to a familiar story about Western decadence and decline. The ‘obesity epidemic’, so the argument goes, is the product of an ‘effortless’ Western lifestyle which has become progressively hostile towards physical activity and dietary restraint. In other words, Westernized living makes you lazy, gluttonous and, eventually, fat. We will argue that this represents a serious misreading of Western life as it currently exists. However, it is a popular version of a familiar story which pre-dates by centuries the relatively recent spike in overweight and obesity statistics.

As we write, the ‘obesity epidemic’ as a bad news story is at fever pitch in both scholarly journals and popular reporting (Anderssen 2000; Brownell and Horgen 2004; Critser 2003; Dietz 2001; Kelly 2003; Klein 2004; Radford 2002; Strauss and Pollock 2001; Tabakoff 2002; New York Times 2001 ; Wang 2001; Waters and Baur 2003). And just as Gould noticed that neither footballers nor scientists were immune from making the erroneous slide from the theory of evolution to the story of ‘progress’, this book will show that, scientific credentials or not, people find the story of Western decadence and decline irresistible when it comes to discussing obesity.

Tied up with the causal story of Western decadence and decline are claims about the consequences of the ‘obesity epidemic’. To take just one recent example (Fox 2003: 1): obesity is claimed to be the world’s ‘number one health problem’ with the potential to ‘reduce life expectancy by 10 years or more’. We are concerned that discussion (both popular and scientific) about the consequences of increasing numbers of overweight and obese people may be just as misguided as talk about why it is happening. In this book we explore the possibility that the dire predictions and sheer intensity of ‘obesity talk’ has more to do with preconceived moral and ideological beliefs about fatness than a sober assessment of existing evidence.

The central argument of this book is that there are many questions that we should ask before putting our faith in the idea of an ‘obesity epidemic’ or our energies into trying to solve it. In order to make this argument, we will consider the ‘obesity epidemic’ from a variety of angles. We will examine what scientists and non-scientists say about it, especially its causes and solutions, and ask whether these things are true or even make sense. We will ask whether it is just possible that the problem of obesity has been significantly over-stated. We will examine the ways in which preconceived ideas and beliefs have shaped what people say about the ‘obesity epidemic’. We will offer readers alternative ways of thinking about the phenomena of overweight and obesity from the ones which are currently dominant. And we will conclude this book by arguing that, rather than a global health crisis or an ‘objective’ scientific fact, the ‘obesity epidemic’ can be seen as a complex pot-pourri of science, morality and ideological assumptions about people and their lives which has ethically questionable effects.

Certainty and uncertainty

The scientific literature on overweight and obesity is now huge. As with any area of knowledge, decades of sustained scholarship and research have produced a proliferation of fields and sub-fields of specialization in which, as the adage goes, more and more is known about less and less. Viewed sympathetically, the current state of knowledge about overweight and obesity could be seen as an incomplete jigsaw for which the pieces are gradually being found and fitted together. From this viewpoint, the general causes and cures for what has been called the ‘obesity epidemic’ are basically known – modern Western societies have become more sedentary, people are consuming too much food, particularly high-fat food, which is cheap and widely available, and we must now eat more wisely and exercise more often. Many people researching and writing about overweight and obesity will readily admit that the specifics of this line of argument remain to be completely fleshed out. For example, the significance of a person’s genetic inheritance in determining their propensity to gain weight remains controversial, as does the exact preventative effect of exercise on particular diseases. However, the overall picture, of an increasingly sedentary and overfed Western (and, increasingly, non-Western) populace is now widely accepted.

In this book we offer a different perspective. We argue that the current state of our scientific ‘knowledge’ about overweight and obesity is not so much incomplete as confused and replete with flawed and misleading assumptions. More controversially, we will argue that it is difficult to see how the scientific study of overweight and obesity is ‘progressing’ – leading to more useful, sophisticated, humane and ethically defensible knowledge – at all. Many of these problems seem simply to result from the reluctance of researchers to read outside of their own discipline. For example, many scholars who write for medical and scientific journals claim that reported increases in childhood obesity are partly the result of less time being devoted to physical education in schools, and then go on confidently to predict that more school physical education will lead to less overweight children. No link between school physical education and either the long-term health, body weight or physical activity levels of children has ever been established. Indeed, some physical education scholars have speculated about whether physical education, as it is often taught, is not more likely to dissuade children from being physically active (Tinning and Fitzclarence 1992).

However, there is more to the story than sheer academic insularity. Some of the problems with current knowledge about overweight and obesity appear to be more wilful and are the products of a determination to see the world in particular ways. For example, the overweight and obesity literature is dominated by the idea that Western society in general is more sedentary than in the past when almost no empirical evidence for this claim exists. In fact, there are many core ideas within the science of body weight and health and the mediating role played by exercise and diet which are simply assumed to be true.

Sometimes the most interesting thing about reading scientific research articles occurs when authors write in non-scientific ways. It is in these moments, when scientists ‘loosen up’ and move away from dry data description and analysis to a more speculative and even informal register, that the full significance of their work, not to mention the sheer intellectual skill which produced it, becomes apparent. But this change of register can be revealing in other ways. It can also signal the moment when the authors have turned their minds to the question of causation. As most scientists will readily admit, it is extremely uncommon that raw data alone explains what is going on. To do this, scientists are often forced to step outside of their data and to venture into fields of knowledge where they have much less formal training and expertise.

This situation occurs frequently when human beings are the subject of research. So even though scientific journals might report that the incidence of conditions such as clinical depression are rapidly increasing (some say we are in the midst of an ‘epidemic’ of mental illness), the reasons for this increase generate heated and absorbing scientific debates, in part because it forces scientists to think about the social and cultural worlds in which we live. Are modern, competitive, commercialized societies becoming increasingly ‘toxic’ or is it simply that the social stigma of mental illness is declining, resulting in more people seeking clinical help? Or is it something else? Whichever the case, those whose job it is to produce statistics about mental illness or treat the mentally ill must inevitably move outside of their area of specialization when people ask them ‘why?’. This is by no means a bad thing. Scientists and physicians, like everyone else, have a right to contribute to discussion about complex problems, particularly those, like mental illness, which appear to have both biological and social dimensions.

The study of obesity is another case in point. Measuring a person’s body weight and classifying them as overweight or obese tells us nothing about how and why they got to this point. This is an even bigger challenge when we are discussing large populations and yet the reasons given for the so-called ‘obesity epidemic’ have mostly been made up of the speculations of the scientific community, albeit speculations delivered with an air of certainty. So as well as being a critical assessment of the knowledge claims of ‘obesity epidemic’ researchers and commentators, this book is also about certainty and uncertainty – the ways in which sheer speculation comes to be thought of as ‘fact’, both in scholarly literature and the popular media.

People who talk about the ‘obesity epidemic’ often adopt a tone of absolute conviction. Both the extent of the problem and its causes are held to be self-evident. But as we will show, whatever we might say about the science of body weight, health, exercise and diet, the one thing we cannot say is that these are fields in which consensus is common. In fact, they are fields in which experts are constantly coming together in an attempt to formulate consensus statements precisely because it is so hard to achieve. What is interesting, then, is the way people who talk and write about obesity and its causes, in fields such as medicine, exercise science and public health, in the midst of great uncertainty, manage to speak with such unified certainty about the obesity crisis.

In this book we will suggest that when people talk about the ‘obesity epidemic’, the scientific uncertainties which exist tend to be papered over by unsubstantiated assumptions. It is as if empirical confusion and uncertainty has created the perfect environment for rampant speculation. This is an interesting state of affairs, not least because, as university teachers, we are constantly reminding undergraduate students to provide evidence for their beliefs and, where evidence is lacking, to reconsider their views. We point out the dangers of speaking in blithely uninformed ways about concepts and phenomena that have been thoroughly researched by others. We tell our students that this advice is not intended to discourage them from thinking creatively, but rather to show that crude generalizations are no substitute for careful, time-consuming and sometimes tedious scholarship. But at the level of public and scientific discussion, generalizations are, if anything, the lifeblood of ‘obesity epidemic’ thinking. Take the following example.

In 1999, the journal Medicine and Science in Sports and Exercise published a supplementary issue devoted to overweight and obesity. The issue, which we refer to a number of times in this book, presented the findings of the then recently held American College of Sports Medicine Consensus Conference on physical activity in Indianapolis. As the word ‘consensus’ suggests, the purpose of the conference and supplementary issue of the journal was to assess the state of scientific knowledge about the relationship between physical activity, overweight and obesity, and human health. In their introductory article, the leading obesity researchers Claude Bouchard and Steven Blair describe what they saw as the growing worldwide problem of obesity and concluded:

The tools available to reverse this unhealthy trend are remarkably simple in appearance as they center on the promotion of eating regular and healthy meals, avoiding high caloric density snacks, drinking water instead of energy-containing beverages, keeping dietary fat at about 30% of calories, cutting down on TV viewing time, walking more, participating more in sports and other energy-consuming leisure activities, and other similar measures. However, it will be a daunting task to change the course of nations that have progressively become quite comfortable with an effortless lifestyle in which individual consumption is almost unlimited.

(Bouchard and Blair 1999: S500)

In this passage two well-known obesity scientists are ‘caught in the act’ of speculation, although their tone of certainty may have the effect of obscuring the fact that they are speculating. While Bouchard is well known for his work on the genetics of physical activity and body weight and Blair is an exercise physiologist who works with obese people, they appear to have joined forces here to comment, perhaps even pass judgement, on society at large. As well as apparently claiming that people today generally eat too much unhealthy food, watch too much television and partake in too little exercise (all highly debatable claims in themselves), they then cast themselves in the roles of social commentators, even moral philosophers, arguing that nations have become ‘progressively … comfortable with an effortless lifestyle’. The use of the word ‘progressively’ is significant here because it suggests that people have become more ‘comfortable’ and life more ‘effortless’ than in previous times, claims which have certainly never been addressed, let alone substantiated, in the work of either author or, indeed, of other researchers working in the same fields. They then turn part social-psychologist, claiming that changing people’s behaviour will be a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Dedication
• List of illustrations
• Acknowledgements
• 1 Science and fatness
• 2 The war on obesity
• 3 The ghost of a machine
• 4 ‘Modernity’s scourge’: a brief history of obesity science
• 5 Fat or fiction: weighing the ‘obesity epidemic’
• 6 The search for a cause
• 7 Obesity science for the people
• 8 Feminism and the ‘obesity epidemic’
• 9 Interrogating expert knowledge: risk and the ethics of body weight
• 10 Beyond body weight
• References
• Index