You likely know -- from innumerable sources, my rants among them -- that obesity is epidemic among children and adults alike, and counts among the most urgent of public health threats in the modern world. While the U.S. remains the epicenter of this slow-motion disaster, its scope and toll are increasingly global.
You may also be aware that among the many consequences of obesity that collectively threaten not only years of life, but the life in those years, is prejudice. Bias against obesity runs both wide and deep. However short the list of socially acceptable prejudice has become in an increasingly "PC" world, obesity seems still to be on it.
To my knowledge, no group is more committed to shining a light on this shameful issue, and letting that light work its disinfectant effects, than my colleagues at Yale's Rudd Center for Food Policy & Obesity. Among them, Dr. Rebecca Puhl has emerged as a leading voice on this topic. Dr. Puhl's most recent paper, hot off the presses, highlights routinely biased portrayals of obese individuals in photographic images shown on news websites.
Before moving on, I want to emphasize that obesity bias is, indeed, shameful. We don't blame victims of asthma for their asthma -- we look for a cause in the interaction of genetic vulnerability and environmental factors, and focus on treatment. So, too, for heart disease, diabetes, cancer, and meningitis. By attacking the victims of epidemic obesity, we single it out from other threats to health for no justifiable reason, compound its harms, and divert resources from attacking its causes.
But now back to my main theme. Obesity bias is, indeed, rampant, and well-documented. But in all of the literature on the topic that I have seen, one important element is only rarely addressed. Seldom does anyone ask: why?* Why are we prone to bias against obesity in the first place?
The knee-jerk response might be that we don't like how obesity looks -- on ourselves, or others. But that is not an answer, it just reframes the question: why don't we look how obesity looks? To some extent, what we do and don't find attractive is a matter of personal taste. To some extent, a matter of cultural taste -- or fashion, if you will -- which changes across both place and time. But the strong feelings about obesity seem to be quite different in kind as well as degree from feelings about plainness or homeliness in general. Something very fundamental seems to be in play.
Maybe that fundamental thing is survival. Maybe the origins of obesity bias run right past culture, to the bedrock of biology. I'll try to make the case.
Consider, for purposes of illustration, the persistent lure of fast food, junk food, energy-dense food, oversized portions, and all-you-can-eat buffets in an age of epidemic obesity. In some ways, this makes as much sense as a drowning person demanding a bucket of sea water. Why continue to crave what we already have in excess? At a cultural or attitudinal level, this seems sheer madness.
But we're not all crazy; we're just conditioned. Throughout most of human history, calories were relatively scarce and hard to get (and physical activity was unavoidable). Calories per unit of currency spent- whether that unit was time, work, sweat, blood, or dollars -- was a valid measure of food value. This is why more food is widely, if not universally, embraced as "better." This is why food and currency are, in fact, equated, as in "earning dough," "being the bread winner," and/or "bringing home the bacon."
But we have devised a modern world in which physical activity is scarce and hard to get, and calories are all but unavoidable. Oversized portions and all-you-can buffets no longer give us anything we need at low cost- they offer us a chance to get fat and sick at no extra charge (and invite many of us to spend a fortune trying to lose the weight we gained for free). As a measure of value, calories-per-dollar is, to any rational assessment, obsolete. It has, in fact, become both silly and harmful.
A very similar case might be made for obesity bias. In the world the way it has always been until quite recently, calories were a rate-limiting commodity in the struggle to survive. The more any one of us acquired, the fewer would be available to the rest of us -- like the grass in Garret Hardin's famous "tragedy of the commons." Calories are the quintessential "commons" in the long expanse of human subsistence.
In a clan struggling for sustenance, think about what obesity would represent: the inequitable distribution of calories. One person getting more than their share -- and thus, potentially leaving less for the others. The rest of the clan would look on and see in obesity ... a threat to their survival. This hypothesis would also account for those 16th century paintings by Rubens and others, in which some extra flesh was clearly admired, desired, and perhaps envied.
Maybe what we think is a conscious attitude about obesity is, in fact, a survival impulse wired into our DNA. Does anyone want to subjugate their judgment to that of selfish, and in this case, misguided genes?
Why bother to ask 'why'? Because knowing why something is broken, rather than merely that it is, might help us fix it. I believe this is one of those times knowledge can be power. If we know why we tend to be biased, perhaps we are better empowered to stop. We should not be ruled by the thoughtless drives of biology, by anachronisms of survival -- when we can rise above them to nurture the better angels of our nature.
You need not be lazy to under-exercise and gain weight in the modern world; you simply need to live in the modern world. You need not be gluttonous to overeat and gain weight in the modern world; you simply need to live in the modern world.
There are, for most of us, plenty of calories to go around. Obesity now threatens the health not of those looking on, but of those affected. Bias against it is not just wrong; it is outdated, and silly. More understanding of overweight is overdue, as is a dedicated societal attack on the problem, rather than its victims.
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
*my thanks to Dr. Puhl for pointing out those few occasions when she, and others, have posed this question
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
David Katz, M.D.: No Obese Child Is an Island
Carole Carson: Obesity: Character Flaw or Neurochemical Disease?
David Katz, M.D.: Are Weight Loss and Common Sense at War?
David Katz, M.D.: When Doctors Judge Their Obese Patients
Obesity bias based on disgust: study
Obesity - Weight Bias among Health Professionals Specializing in ...
We evolved in an environment where food supplies were uncertain, it took a high energy output to get your food,and concentrated calorie sources were hard to come by.
If you lucked out and fell upon a windfall then the evolutionarily smart strategy was 'pack on the pounds' because you probably won't be this lucky for long.
Now you can hop into your SUV and burn dead dinosaurs to drive down to the all-you-can-eat and stuff yourself with deep fried twinkies and sugar frosted bacon 24/7.
What body types are considered sexy are entirely cultural and highly variable from individual to individual. Witness all the porn sites with models over 300lbs.
I would argue that the opposite of evolutionary obesity bias may have also been true, as to a certain extent, obesity could be seen a sign of wealth and strength. That is to say our ancestors who knew nothing about modern nutritional science would've likely perceived fat people as stronger and richer than skinny ones, and likely would've been correct in many cases. For example, the original sumo wrestlers were members of the warrior caste in ancient Japan.
Of course, now that many of us live in a world where it is easy to get fat, our subconscious minds may be reversing these biases that our ancestors likely had. Children from wealthy families who are fed healthy food often during their formative years are more likely to develop fast metabolisms and stay skinny no matter how much they eat, whereas children for whom calories were more scarce during youth tend to develop slower metabolisms in order to compensate.
Not always correctly, we associate obesity with ignorance of the simplest nutritional information, perhaps even with illiteracy. Rightly or wrongly, we associate it with lack of self-discipline and of parental responsibility. We associate it with cheap food and lack of culinary culture. In short we associate obesity with poverty.
That will change only if food scarcity once again becomes the norm, and fatness once again becomes a sign of prosperity.
Larger point: Does such a prejudice serve us now? It's hard to encourage discrimination against people for any reason, but this country has a huge problem with obesity and the related problems (higher incidence of diabetes, hypertension, joint and cardio problems, etc). I'm all for acceptance, but as a former big man, I have to say that a whole lot of my health problems receded when I dropped weight. This country's healthcare problems go hand-in-hand with the universality of a sedentary lifestyle and a built environment of suburban sprawl--the American Academy of Pediatrics said as much a few years ago when they blamed suburban building patterns for the childhood obesity epidemic. we need to get a handle on this sooner rather than later.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;123/6/1591
As I say in my comment above yours, there is however an in-born prejudice against the outward signs of poverty - and in our century, obesity is one of them.
There are RARE genetic defects that cause extreme cases of obesity. Other wise it is caused by choices. period. Sure, some people might have genetic dispositions to metabolize slower or pack on a few more lb. than the next person, but we all fight our own bodies in one way or another.
I think its true that society and the modern world make it harder to be healthy. but that doesn't make over weight people victims of anything but themeless. if there were no thin, healthy people in the world I would be saying something different... but there are. millions. I see a guy in my neighborhood running every pushing a 3child stroller with two dogs. in his mind... there is no excuse. thats why he is not over weight.
As for a bias??? what ISN'T there a bias for? we are evolutionary biased agains un healthy people.d. people judge smokers, drug addicts, and people who drive under the influence. so why shouldn't people judge someone who lacks the self control, dedication, and self respect to be a healthful adult???
now, I don't lack compassion. I feel for people who are over weight. I want to help. but this article doesn't help, it passes the buck.
I've observed something in my life that renders most of your argument null and void. I've struggled with weight all my life. At times I've been slender with an athletic build, but my weight creeps back up to obesity levels. I've always blamed myself even though I seemed to eat less than my skinny friends and definitely wasn't getting less exercise. As I got older, I watched what my friends ate and their exercise levels - thinking that if I just did what they did, surely I'd remain slender, or get slender like them.
Wrong. Terribly wrong. I found that these friends of mine binge eat several times weekly - one 98-pound friend could out-eat me twice fold (a 200lb + man) and never gain an ounce. You might say, well, she exercises more. No way. She just doesn't. I began to talk to people like me as well - those who struggle with their weight. Many of them had similar experiences as me. They ate less than "thin" people, usually exercised more, and still remained heavy.
My point is that you don't anything about why some people are overweight. Instead you choose to express your complete ignorance of the subject on HP. I'm sure you'll get plenty that will agree with you. After all, anything that happens to an individual MUST be their fault, or wish fulfillment, or whatever. Right?
http://www.sciencedaily.com/releases/2007/10/071016074958.htm
It all adds up.
I live in DC and I know of neighborhoods that don't have a single grocery store. What they do have is a McDonald's, Burger King, or mini-mart/liquor store on every other corner. The only food available is calorie-dense, nutritionally bereft, over-processed junk. And don't underestimate the pull of the dollar value menu. When you are living off minimum wage, and you can walk down to the corner and buy dinner for your whole family for $5, or go miles out of your way (probably taking 2 buses and walking a half mile) to get some fresh vegetables, which would you choose?
Until fresh, nutritious food is available to everyone in *every* neighborhood, this country will never have the opportunity for a healthy population.