Hi folks! Last time I was here on Super Strength Health I talked about the problematic nature of the “obesity epidemic,” the profound limitations of the BMI, and how, contrary to what the media and diet gurus tell us, the science linking health to weight is often ambiguous, sometimes contradictory, and very limited. This time I’m going to look at how health has become a moral issue and a way that we (are expected to) contribute to society, which has profound implications for the ways we understand the roles of food and exercise in our lives and our culture.
Okay, so it used to be that the way that we, as a society, thought about “citizenship” (not in the “what it says on your passport” way, but in the “what it means to be a fully participating member of society” way) involved both participation in the public sphere (voting, running for office, sitting on boards) and the dual contributions to society of both the production and consumption of goods. But as more and more production is moved overseas, the primary way that the citizen contributes to society is through consuming and thus supporting global capitalism. Thus, “we buy and eat to be good subjects”.
However, as you all may have noticed, we society has a lot of issues around fatness. Unrestrained consumption doesn’t quite “work”, and so we are subject to this horrid, ever-present tension to consume more than at any time in the past, while striving to be thinner than at any time in the past. In the realm of these contradictory edicts, success is gained by the citizen who can self-sacrifice through deprivation and discipline in order to achieve thinness while simultaneously engaging in the hedonistic consumption of readily available, highly palatable foods.
Walking that tightrope is very, very difficult. It involves near-constant surveillance in the form of calorie counting, points counting, carb-eschewing, steps counting, and just generally being very vigilant about what goes in your body. This constant surveillance is a very, very good distraction. Because it’s hard to concentrate on foreign policy when you’re dreaming about the doughnut in the kitchen that your coworker brought in but you don’t feel like you “earned” it in your morning spin class. And this surveillance isn’t just expected of bigger bodies, because those who are currently “normal” weight are considered at risk of becoming overweight and then obese.
Remember all those issues we have around fatness? Well, here’s the really insidious part: those folks who are able to stay thin while consuming lots—and remember this doesn’t have to mean consuming lots of burgers and french fries, it can be $16 fresh-pressed juices and cleanses—are considered good, active citizens who are self-disciplined and rational (even though you and I know that self-discipline and rationality have little to do with body size) while those who fail to achieve the twin duties of eating and thinness are considered irrational and lacking discipline. And it’s no coincidence that those who are often unable to stay thin in the face of abundant consumption are usually poor and often people of color.
It is also no coincidence that we focus on individual efforts at health (or at least thinness) rather than structural issues ranging from economic inequality to lack of safe outdoor spaces to be active in. And there’s even a name for this single-minded, individualistic, focus on health via thinness: Healthism. Rather than improving health, this overwhelming focus on thinness is actually really dangerous for a lot of folks. From the lopsided social status of those who are and aren’t able to meet societal ideals of thinness to the disordered behaviors many (primarily—but not solely—young women) engage in while trying to get ever thinner, healthism does a lot more damage than good. And as citizenship has come to be represented by our ability to be thin in the face of overwhelming consumption, what we eat and whether we exercise become morally fraught decisions.
Though how I move my body should be about no more than how it makes me feel alive and grounded and energized, the choice to exercise is not morally neutral in contemporary North American culture. One way to think about the increasingly moral weight of exercising (or not exercising) is to look at the increasing secularization of society—as more of us split from organized religion (or are raised without it entirely) we no longer have one agreed upon set of morals such as, oh, say, the ten commandments. We are also an incredibly individualistic society, which has turned the moral realm into one of individual actions and consequences. In this context, the pursuit of fitness has become a morally positive act individuals can take not just for themselves but for the good of society as well. But the attitudes we see surrounding exercise—especially in health promotion—reinforce social separation since certain populations have lower rates of physical activity (due to less free time, for example, because of multiple jobs, and inadequate safe space to exercise) and are thus considered in need of governmental intervention (notably, though, that governmental intervention is never in increasing minimum wage or affordable childcare—factors that would very much improve the health of many economically marginalized people—but rather informational campaigns promising health in exchange for walking and vegetables).
We turn, now, to the politics of food. While those in the upper classes in North America have increasing availability to high-quality food thanks, in large part, to globalization, those living in poverty are largely limited to a diet of highly palatable, high fat and calorie, low nutrient foods. The fast food industry, in many ways, serves as the ideal case study for this. The increased availability of food, due in large part to government supports in the form of subsidies, as well as the deregulation of health and safety mechanisms allows fast food to fill the need created by the attack on living wages: profoundly underpaid workers can afford to eat (and thus contribute by consuming) substantial amounts of calories because hyper-processed fast food is so cheap.
Finally, I want to talk about “nutritionism,”  which refers to the focus of dieticians, nutrition scientists and public health authorities on individual nutrients rather than foods as a whole. See, the thing is, we know what a healthful diet looks like: largely plant-based, few processed foods, not too much. And recommendations along those lines basically don’t change. Yet the public is more confused than ever about what to eat: Paleo? Primal? Raw vegan? Gluten-free? Raspberry ketones? Bacon-wrapped-bacon smothered in bacon?
Nutritionism has also been heavily used in the marketing of various foods over the past three decades, often using the qualities of a single nutrient to imbue a sense of health into the product as a whole. As you can see any time you walk in to Whole Foods or (and I do not recommend this) watch Dr. Oz: every week there is a new “super food” that will cure all that ails you (because a small study found that a super concentrated extract of a substance found in that juice may be correlated with a slightly lower risk of some-scary-disease). Because there is a lot more money to be made in the supplement of the week than in living wages, affordable childcare, safe environments, and universal medical care.
 Guthman and DuPuis (2006),
 (Scrinis, 2008)
Please visit Josey’s blog Here
Illustration by the wonderful and talented Joanna S. Quigley
I have a guest post for you today.
When I think of the term “obesity epidemic” my skin crawls. It’s an incredibly ominous turn of phrase, one with confusing parameters, based on a system that doesn’t apply to a lot of people (I’m talking BMI here.) Although I have always known that I am skeeved out by the way body mass index is used to shame people, I didn’t exactly have the language to talk about why. Thank goodness for this article, and my friend Josey Ross.
Neoliberalism and Health Part 1: The Obesity Epidemic
by Josey Ross
We’ve all heard about the obesity epidemic. We’ve all seen the footage on 20/20 or the nightly news of large, headless bodies intercut with Big Gulps full of soda and fists full of potato chips. And many of us have felt uncomfortable with the rhetoric used in the “fight against obesity” but maybe haven’t been sure why. Is it the unsettling awareness that those headless bodies belong to real people with real feelings? Is it the use of the word “epidemic” which evokes fears of uncontrollable spread and imminent death? Or is that we ourselves (or perhaps someone we love) have large bodies and yet are healthy—with consistent exercise routines and healthy, nourishing diets, and no indicators of the diseases that are always listed any time the word obesity is uttered.
Maybe it’s a little bit of all of these things. Or maybe it sparks a few questions: who profits from this language? Why do we understand obesity this way? Is obesity necessarily synonymous with poor health?
I wrote, recently, on my blog a series on Neoliberalism and Health—looking specifically at how culture and politics shape our understanding of what health looks like and why the focus on obesity may be misplaced. Lacy kindly asked me to guest-blog here on Super Strength Health and suggested I throw away the jargon (good idea!) and make it a little bit more accessible since academic writing isn’t exactly where most people go to relax after a hard day.
So let’s talk about this “obesity epidemic”. Despite the surety of diet gurus and Dr. Oz, when it comes to the so-called dangers of obesity, the science just doesn’t stack up. Rather, it seems, obesity may be a symptom of a larger set of issues including the hyper-palatable and exceptionally abundant Standard American Diet and the fact that we are, as a culture, way too sedentary for good health.
Any time we hear obesity we are sure to hear these three letters follow: B-M-I. But what is the BMI? The Body Mass Index basically calculates a person’s body fat by dividing weight (in kgs) by the square of height (in metres). Interestingly, the forerunner of the BMI, the Quetelet Index, had nothing to do with obesity or even health. Rather, it was developed by a statistician in the 19th century who was trying to quantify “the normal man”. Flash forward to the mid-20th century and you’ll find an insurance company that noticed a link between mortality and height-weight ratio. In order to maximize the money that the insurance company could make off of its customers it developed a table defining “ideal weights”—basically, the lower your risk of death the less likely it is the insurance company has to pay out a settlement. So they can charge people with a higher risk of death more for a life-insurance plan to maximize their profits. Which, you know, is kind of crappy but also precisely what we expect insurance companies to do. So nothing too shocking here.
But then the National Institutes of Health and the World Health Organization used these “ideal weight” values along with the BMI to calculate obesity and the problems started. So here are the big three issues with BMI: the data collected by the company was almost exclusively from Caucasian individuals but the BMI is used for people of all ethnic backgrounds (what else is new). What this means is obesity rates are overestimated in African Americans and underestimated in people of Asian descent. (There are likely other issues across ethnicities due to variations in bone structure and musculature but these are the two populations that have been studied). Another issue is that the BMI was developed to assess populations not individuals, which makes it somewhere between inappropriate and downright harmful when used at the individual level. Finally, BMI is not able to take into account different body compositions so really tall people, really short people, elderly people, pregnant people, and very muscular people tend to have BMIs that are very inaccurate reflections of their body compositions.
So we know the BMI is a crappy measure of body composition (never mind health itself) but it’s indisputable that North America has a problem with obesity and overweight, right? Well…not quite. See, for much of human history what we today call “overweight” (a BMI of 25-29.9) was considered a sign of good health—after all, you have enough to eat and don’t have any diseases or back-breaking labor that impact your ability to keep a bit of meat on your bones. But you’re right, there was some concern starting in the 1980s in medical and academic settings around the growth of obesity in America. But the idea didn’t really take hold until 2000. This happened for three reasons. The first was the publication of (methodologically flawed) maps tracing the “obesity epidemic” by the Centers for Disease Control. Rather than being simply an issue of statistics, it had become a spreading infection with brightly colored “hot zones”. The second is what has been called “the diseasing of America” which basically refers to the way that the health infrastructure branched out from infectious diseases which were quickly being eradicated or at least well contained into life-style issues in order to justify their continued existence and maintain profits. Perhaps most shocking is the fact that the BMI guidelines for what constitutes “normal weight” changed literally overnight in 1998 from 27 to 25. So several million Americans went to bed “normal” weight and woke up overweight.
So we’ve problematized the BMI and its essentially arbitrary cut-offs, right? But wait! There’s more! See, the narrow-minded focus on the BMI misses all sorts of things, from the fact that my happy weight is probably different from your happy weight even if we’re the same height, to the fact that it misses entirely all the other pieces of the health puzzle including exercise and food behaviors, the impacts of being wealthy or living in poverty, and the fact that access to healthy food and safe spaces is very much related to race and class.
Another issue is that the mountains of literature purporting to link obesity with poor health are, well, not that clear cut. Rather, the evidence that weight loss improves health is contradictory, and the literature used to prop up arguments linking overweight with poor health is full of problems, limitations, and ambiguities. And yet this problematic literature is used to push size-based approaches to health which have profound consequences including eating disorders, stigmatization and mental health issues for those who aren’t able to make themselves “thin”, and an excuse for the powers that be to ignore structural issues (also known as the social determinants of health) in favour of putting the focus on how much I eat and whether I exercise and whether my body fits a narrowly-defined “normal weight range”.
Next time I will look at how health has become a moral imperative, which has made food and exercise into moral issues. If you’re interested in a more in-depth (though admittedly less readable) exploration of these topics I invite you to check out my blog.
It has been a little quiet this week over at Super Strength Health, but rest assured, I have been writing my butt off. Today I had the (awesome, incredible) honor of posting the story of my descent into eating disorder behaviors, and my slow climb outta that garbage and into my current amazingly healthy life, on Choosing Raw.
Before you read, I should warn readers, that some parts of this story are a little dark, much darker than I have usually written here. If you are triggered by talk of struggle, please skip it! I didn’t use details that are TOO too gritty, but well, it was a sad time, and I told the truth. I want to be sensitive that that could bother some people.
If you’re still on board, feel free to click here to read the full tale.
Thank you for your continued support! Every comment, email, and person that signs up to have a free health history or coaching session fills me with joy.
I’ll see you Saturday for your weekly round up of links!