‘Fatness Outside of Morality’: On The Obesity Debate
The obesity debate is everywhere at the moment - along with an accompanying moral panic focused on overweight bodies. Karen Hitchcock’s controversial essay in the current Monthly takes a grim look at the issue, from her perspective as a doctor in an obesity clinic. Author and commentator Mel Campbell is persuaded by Hitchcock’s arguments, but disturbed by her ‘patronising’ tone. She calls for us to keep moral judgement out of the obesity conversation.
What’s the difference between fatness and obesity? The first is a descriptive term for fleshy, larger than average body size. The second is a global moral panic that pins legitimately troubling public health issues on fat bodies. The ‘obesity crisis’ is cultural, even though its expressions of fear, disgust and shame are veiled in the language of science.
I’ve spent the last year writing about such distinctions in the context of clothing size and fit. Finding well-fitting clothes is a practical issue. Yet I’m constantly irritated by the way it becomes an ideological one. Discussions about size and fit are immediately derailed as we mash together public health, body image, nostalgia and marketing in repetitive, confused and emotive ways.
In this context, I read Karen Hitchcock’s recent Monthly essay on obesity with great interest. Hitchcock is a doctor who works in a clinic with a group of bariatric surgeons. Her job is to treat the health problems associated with patients’ weight – such as diabetes, hormonal imbalances and high blood pressure – and to suggest how they can modify their eating and exercise habits.
Hitchcock’s arguments about the adverse effects of being very fat and the fatal allure of ‘bad’ foods are alarming but persuasive, as are her clinical experiences with the strain that a large amount of weight places on the body. It’s certainly troubling that we are medicalising what is really a social issue.
But it’s hard to have a constructive public discussion about obesity when scientific research and medical authority are used as moral justification to shame and blame fat people.
In my book Out of Shape, I identify a rhetorical mode in public debate that I’ve dubbed ‘scienciness’. Just as ‘truthiness’ is something that feels intuitively true without requiring any evidence, sciency writing uses the language of science to normalise the judgments we make about other people’s bodies.
Hitchcock’s essay was frustrating for me because she understands the way culture works on us, yet in her position of authority as a doctor she also regurgitates its worst messages. She lists the tools of her trade – ‘our ears, our voices, our hands, our pills and our scalpels’. But she leaves out the most important – her eyes.
‘I do not wish to humiliate them or shame them. I do not wish to turn my fat patients into freaks,’ she writes. But does Hitchcock realise how appallingly patronising the gaze she turns on fat people is?
For a start there’s class snobbery, as an American named Emily is ‘the fattest person I had ever seen outside a caravan park’. Emily’s husband is ‘some kind of professional; I didn’t know they even made suits that big’.
Obesity debates often reference class in a simplistic way, as if sedentary lifestyles and copious consumption of processed food were somehow native to the poor. But poverty and obesity don’t correlate nearly as neatly or strongly.
A 2011 Northwestern University study found that people who feel socially powerless tend to choose larger portion sizes to bolster their status. Conversely, those who feel powerful associate status with smallness and slimness.
It’s no accident that slim body ideals are fostered and policed by those who possess socioeconomic privilege and cultural capital. Journalists. Advertisers. Celebrities. And doctors. These ideals are ingrained through the act of looking – whether we’re looking at celebrity gossip, makeover TV shows, stock images of ‘headless fatties’ illustrating obesity stories (cop a look at the pics The Monthly used!), or at our own bodies in the mirror.
In my book, I coin the term ‘orthovestia’, from the Latin for ‘correct’ and ‘clothing’. Orthovestia is the notion that only ideal bodies are fit to be seen in public. From an early age, pop culture teaches us that some body shapes are ‘good’ and others ‘bad’, and that to be socially successful, anyone with a flawed body must change or hide it using diet, exercise and ‘flattering’ clothing. Orthovestia often comes disguised as kindly, sensible advice, which we’re supposed to accept gratefully.
To do otherwise is to be immoral, irresponsible, even hypocritical. Hitchcock summarises orthovestia perfectly when she writes, ‘Today when we look at those who are thin, part of what we see is a triumph of will over gluttony, so the beauty is a moral beauty; it has little to do with health.’
So it’s disheartening to see her set that insight aside to indulge in grotesque, abject vignettes of fat people being irresponsible with their health.
The hospital bedside of an ‘educated’ patient is decadently ‘piled high with literary novels, open blocks of chocolate and teddy-bear biscuits’ as Hitchcock’s stethoscope sinks into the patient’s ‘soft white flesh’. Another patient ‘struggled to lie flat on the examination table’ and ‘could not even see’ her ‘unkempt’ feet. And as Hitchcock watches a very fat doctor deliver a conference paper, ‘his face got red and stains of sweat spread from his armpits. Obesity is genetic, he argued, wiping his brow: obesity is a disease.’
Recently, New Jersey state governor and Republican presidential hopeful Chris Christie – who is very fat – good-naturedly mocked himself by munching a donut on the Late Show with David Letterman. However, former White House physician Dr Connie Mariano sparked a political drama when she told CNN, ‘I’m worried about this man dying in office.’
Kim Beazley, that ‘big fat so-and-so’ with no ‘ticker’, would be sadly familiar with this dovetailing of physical fitness and fitness to hold public office. Much as Beazley’s bulk dogged his political career, Christie was forced to call a press conference to outline his ‘plan’ to lose weight.
But the governor came out swinging. ‘I find it fascinating that a doctor in Arizona who has never met me, never examined me, never reviewed my medical history or records, knows nothing about my family history, could make a diagnosis from 2400 miles away,’ retorted Christie.
I’m not a fat activist, but I believe the fat-positive community can usefully remind us that people deserve joy and basic human respect at any body size. And the Health at Every Size movement offers some good ideas about fostering that joy and respect.
‘This is where we are heading now: fatness, outside of morality,’ Hitchcock concludes gloomily. Well, good! We do weight-related illnesses a terrible disservice when we entangle medical treatment with moral judgment.