Fat Blame

How the War on Obesity Victimizes Women and Children

April Michelle Herndon

• Publisher: University Press of Kansas
• Year: 2014
• Print ISBN: 9780700619658, 9780700619658
• eBook ISBN: 9780700620333
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

A four year old Mexican American girl is taken away from her parents because she is obese and experiencing health problems related to her weight. Such a measure, once seen as extreme, quickly comes to be seen as a logical means of addressing a problem viewed as nothing short of child abuse. And yet, for all the purported concern for these children’s welfare, little if any mention is ever made of the psychological ramifications of removing children from their families. They are simply the latest victims of the war on obesity—a war declared on a “disease” but conducted, April Herndon contends in this book, along cultural lines.

Fat Blame is a book about how the war on obesity is, in many ways, shaping up to be a battle against women and children, especially women and children who are marginalized via class and race. While conceding that fatness can be linked to certain conditions, or that some populations might be heavier than others, Herndon is more interested in the ways women and children are blamed for obesity and the ways interventions aimed at preventing obesity are problematic in and of themselves. From bariatric surgeries being performed on children to women being positioned as responsible for carrying to term a generation of thin children, her book looks closely at the stories of real people whose lives are drastically altered by interventions that are supposedly for their own good.

As with so many practices surrounding bodies and health, like dieting, people are often simultaneously blamed and empowered through policies and interventions, especially those that seem to offer them choices. What Herndon reveals is how such choices only offer the illusion of being empowering. Rather, she shows how woman and children are pushed, pulled, and sometimes victimized by interventions such as bariatric surgeries, limits on reproductive technologies, and having their families broken up by the courts. Only by identifying members of this group as victims of discrimination, she argues, can we hope to return them to a fuller and richer kind of agency.

In declaring a war on obesity, the United States has said that fat is one of the most serious enemies it faces. Fat Blame asks us to confront the real enemy—the moral, political, and ideological significance of our every move in this "war."

CHAPTER ONE

Children First

Maternal Ideology in the War on Obesity

Maternal ideology . . . comes to function as a regulatory norm that authorizes the disciplining of women’s lives and bodies that results in the subordination of women’s interests to those of children in ways that often jeopardize the well-being of both.

—Karen Zivi, “Contesting Motherhood in the Age of AIDS”¹

Most women who become pregnant have fears and worries. What vitamins should I take? What about that glass of wine I had before I knew I was pregnant? Is it okay to eat shellfish? Will my child be fat because I am? Similar to admonitions against drinking, smoking, and consuming certain foods while pregnant, concerns about childhood obesity have now brought new pressures, recommendations, and warnings for women. In her advice manual, The Everything Parents’ Guide to the Overweight Child, Paula Ford-Martin advises women to breast-feed in order to minimize the possibility of obesity.² Recently, cesareans have become suspect, with doctors warning that delivering a child by C-section may significantly increase the risk of childhood obesity.³ In another parenting advice manual, Understanding Childhood Obesity, J. Clinton Smith cautions women to maintain a careful watch of calorie intake while pregnant because consuming too many calories is likely to lead to having an obese child.⁴ Of course, we now know that breast-feeding has many advantages for children, and for many years, doctors have been advising women against gaining too much weight during pregnancy because of the potential for complications during delivery. There has also been a movement back toward vaginal births whenever possible, as people have become wary of too many interventions during pregnancy. Yet, in recent years, the mounting cautions about maternal body weight and what is now referred to as “fetal overnutrition,”⁵ in particular, signal a turning point in the discussion about childhood obesity: increasingly, women’s bodies are seen as receptacles for pregnancies, and mothers as the foot soldiers in the battle of the bulge.

The concern over the childhood obesity epidemic continues to produce fast-moving, dynamic discussions and sometimes recommendations and policies that may not be based on evidence that they foster well-being. Some of these discussions and policies are now leading to what many may consider the ultimate “treatment” for childhood obesity by seeking to prevent pregnancies that even have the potential to produce fat children. This particular set of strategies for preventing childhood obesity necessarily undermines women’s reproductive rights, routinely represents certain women as bad mothers, and calls forth visions of the eugenics movement because the conversation seems to suggest that some people are worthy of reproducing (or being reproduced) but others are not. Though seeking to prevent fat children by preventing fat women from reproducing certainly affects fat women more immediately, the conversations occurring and policies being put in place potentially affect all women—regardless of their body size and regardless of whether they intend to have children.

MATERNAL IDEOLOGY AND MOTHER BLAMING

Arguably, women are subjected to a set of standards pertaining to their mothering practices that constitute a type of ideology. In her work on women and motherhood during the AIDS epidemic, Karen Zivi argues that the meaning of motherhood was renegotiated by the presence of AIDS, which she says shaped a kind of “maternal ideology” against which women’s mothering practices were judged. She writes, “Maternal ideology [was], in other words, used to judge women, to determine if they [were] engaging in acceptable mothering practices, and to decide whether the regulation of their lives and the circumscription of their rights [was] warranted.”⁶ In this particular maternal ideology, motherhood became “inextricable from public health and rights arguments,” at least in part due to the idea that a public health crisis involving children was afoot.⁷ Women who were HIV-positive were almost automatically slotted as “bad” mothers according to this maternal ideology, an ideology that suggested no logical woman could possibly want to have a child because of the risk of passing on the virus. Women with HIV who wanted to have a child or who actually had a child became caricatured as uncaring and reckless rather than represented as complex, rational decision makers who had the ability and also the right to make choices regarding their bodies and reproduction. In short, as Zivi shows, the framework of maternal ideology distilled HIV-positive women down into “conduits of contagion” and suggested they “had an allegedly deficient ‘moral universe’ that compromised their ability to be good mothers.”⁸

Against the narrative backdrop of HIV-positive women as bad mothers carelessly risking passing HIV to their fetuses, many policy makers sought to intervene by recommending mandatory HIV testing for all pregnant women. Their thinking was that “if women could not be ‘responsible’ or ‘logical’ enough to keep from putting infants at risk, then it was the state’s duty to intervene. Women who posed a threat to the health of their children because of their morally irresponsible behavior, should, they argued, be the subject of regulatory public health policies such as mandatory testing. That was the duty of the state in the time of crisis.”⁹

The rhetoric of “crisis,” “epidemic,” and “war” tends to spawn and validate policies and interventions that might otherwise seem extreme. Further, the fight against fatness in children has drawn the interest of the state in ways that are similar to those of the “war against HIV.” In fact, several antiobesity campaigns have recently intensified their focus on the role of maternity and, in particular, on maternal weight gain in an effort to wage what they think will be a more effective battle against obesity in children.¹⁰ The idea seems to be that the best course of action is to stop obesity in children before it ever starts by preventing pregnancies deemed “at risk” for obesity. One such campaign is Shape Up America! (SUA), a nonprofit effort founded by former surgeon general C. Everett Koop in 1994 that now maintains close ties to Michelle Obama’s government-sponsored Let’s Move! campaign. On the front page of its website, SUA offers a link to (and a downloadable version of) a 2012 article entitled “Severe Obesity: The Neglected Problem,” which was published in Obesity Facts: The European Journal of Obesity. The authors, John G. Kral, Ruth A. Kava, Patrick M. Catalano, and Barbara J. Moore, essentially argue that in order to stem the tide of obesity, interventions are especially important for people of reproductive age:

To stem intergenerational transmission of obesity, there is an urgent need to i) prevent obesity and SO [severe obesity] in people with reproductive potential, ii) prevent pregnancy in those already obese and severely obese, and iii) effectively treat people currently affected with SO to minimize the risks of gestational obesity and optimize healthy outcomes for mother and offspring. If Society [sic] is willing to prosecute drug-abusing mothers, and warn of alcohol and tobacco use during pregnancy, should we not be serious about preventing obese pregnancies?¹¹

As is often the case with discussions of childhood obesity,¹² the authors begin by talking about people of reproductive age, but as they move forward, it becomes apparent that it’s women of reproductive age who are actually their focus—as evidenced by their references to “pregnancies” and “drug-abusing mothers.”

As in conversations about HIV, in discussions of obesity and pregnancy the welfare of fat women themselves becomes secondary to concerns about what they may pass along to their children. Regarding how women with HIV were talked about during the AIDS crisis, Kimberly Mutcherson observes, “To the extent that women found themselves mentioned in discussions of the growing plague, it was as vectors of disease transmission . . . to innocent newborns.”¹³ She goes on to show that the construction of women as the source of contagion contributed to troubling policies regarding women and mandatory testing: “In part, because women have been viewed as transmitters of HIV, they have been targets for adverse HIV/AIDS policies and legislation.”¹⁴ The authors of the article featured on the SUA site similarly justify their focus on women of reproductive age by claiming that when SO women “carry to term [they] are more likely to have fatter babies, who are more likely to be obese by the age of 4 and remain so through adolescence and into their reproductive years.”¹⁵ They go on to note that the “intergenerational transmission of obesity is stronger for maternal than paternal obesity, implying an important role in the uterine environment.”¹⁶ Kral and his coauthors maintain that recent evidence points to “metabolic imprinting on developing susceptible neural circuits during gestation and infancy” and that “the data suggest that parental obesity, by whatever mechanism(s), predisposes the offspring to obesity.”¹⁷ Thus, even though these authors acknowledge both that paternal obesity may play a role and that the data remain a bit unclear as to why parental obesity in general matters, they nonetheless insist that parents and especially mothers play a crucial role in passing obesity along to their children. The emphasis on mothers persists in the authors’ choice of language as well as in a great many of our cultural representations—in spite of the fact that some studies find that paternal BMI may exert as strong of a correlation to a child being overweight or obese as maternal BMI.¹⁸ And as was true of women who were HIV positive, the concern appears not to be for the women themselves but rather for the effect that their weight will have on others.

Fat women’s bodies are often portrayed as problems for others. In her article entitled “Normative Imperatives vs. Pathological Bodies: Constructing the ‘Fat’ Woman,” Samantha Murray takes readers back to what she considers a key moment when fat women became depicted as a source of trouble and anxiety for others. Citing Dr. James McLester’s 1924 article about fatness in women, which was published in the Journal of the American Medical Association, Murray contends that McLester “casts the fat woman as less-than-woman, less-than-human, unable to truly access her ‘inner self’; or perhaps she does not even have a core, but is merely an assemblage of the worst indiscretions and shortcoming of women.”¹⁹ McLester’s account was not centered on fat women’s health itself but rather on how their fatness affected others around them, primarily by being an affront to accepted aesthetics of female embodiment, leading Murray to conclude that “medical opinion of the ‘fat’ female body is not that it is a suffering body but rather that it is a source of suffering for others.”²⁰ The idea that fat women’s bodies bring suffering to others seems to also be present in an article by John Kral from 2004. According to Megan Warin and her coauthors,

Writing in the prestigious journal Pediatrics in 2004, [Kral] argues that all women, even “newborn girls,” have the potential to become “doubly damaging,” both polluted and polluting, since fat is passed on through the female body. Accordingly, the only way to curb the obesity epidemic is to “urgently” target young girls and young women; from birth to menarche, behavior modification in mothers and children should be the first choice in obesity prevention.²¹

Thus, although fat women may be particularly targeted, all women are constructed as representing the possibility of contagion because the specter of motherhood is so closely tied to being female. As Martha Fineman puts it:

As an institution with significant and powerful symbolic content in our culture, motherhood has an impact on all women—independent of the individual choice about whether to become a mother. It comes from the durability and tenacity of the assumptions made about any individual woman that are forged in the context of cultural and social forces that define the “essential” or idealized woman. For this reason, all women should care about the social and cultural presentation of the concepts of motherhood that are part of the process that constructs and perpetuates a unitary, essentialist social understanding of women. “Mother” is so interwoven with that notion of what it means to be a woman in our culture that it will continue to have an impact on individual women’s lives.²²

Fineman describes something that most women have experienced and that a great deal of feminist scholarship has commented upon. Regardless of whether or not a woman is a mother or has desires to be a mother, the cultural expectation is that she will behave in “motherly” ways by adopting culturally idealized attitudes toward children and caring for others. The idea that the words woman and mother are essentially interchangeable in the culture and that all women are possible sources of misery for others is certainly reflected in Kral’s arguments that women in general—not just those who wish to become mothers—must be counseled from “birth to menarche” in order to best curb the obesity epidemic and not be “doubly damaging.”

All women are subject to the kind of maternal ideology that so closely ties being female to motherhood, but in a political climate where fatness represents a moment of crisis, fat women in particular are at risk for facing judgments and interventions because their bodies are believed to signal a kind of failure. Much like the bodies of women with HIV are thought to indicate moral failings and desires run ...

Table of contents

• Front Cover
• Series Page
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgments
• Introduction: The Mother of All Wars
• 1 Children First: Maternal Ideology in the War on Obesity
• 2 There’s No Place Like Home: Fatness and Families in the Courts
• 3 Public and Private Shame: Using Children as Message Boards
• 4 What If the Cure Is Worse Than the Disease?: How We Treat Children in the Age of Obesity
• Conclusion: A Cramped Room
• Notes
• Bibliography
• Index
• Back Cover