Must hear and obey!!
This week I stumbled upon another one of many articles in the Guardian complaining about fat-shaming, which is apparently something society does unsuccessfully to try and force everyone to be skinny. In an interesting parallel, this week Rabbett Run has an article digging through the role of Big Tobacco in funding libertarians to talk up smoker-shaming. This “assault on smokers” is a common complaint of the Clarksons and Telegraph-letter-writers of the world: sure, smoking is bad for your health but the anti-tobacco movement has “gone too far” and now it shames and ostracizes smokers and treats them like second-class citizens (in the words of Rabbett Run’s libertarian scholar, they are parallel to the treatment of Jews in Germany!)
An interesting similarity of language exists between the anti-fat shamers and the anti- anti smokers. There is a lot of public debate about how to handle obesity, and a lot of it is denialism of varying forms:
- Straight-up denialism, such as this book from one of the Lawyers, Guns and Money bloggers, which claims obesity is not harmful for health, the scientific research is wrong and there is nothing to fear. This crosses the political spectrum, but is usually also associated with suspicions about the diet and weight-loss industry and/or an ideology of personal health choices
- Politically-motivated rejectionism, often feminist, which associates obesity concerns with body-normative biases and society’s obsession with controlling women’s appearance. An example of this is Fat is a Feminist Issue by Susie Orbach, which associates campaigns against overweight with historical attempts to control women’s appearance. These campaigners may deny the role of obesity in poor health (such as the Healthy at Every Size movement) or they may accept the increased risks and fall back on a logic of personal choice, but in either case these rejectionists are politically-motivated: their first concern is the ideological impact of scientific research on and public health campaigns against overweight, and this motivates their stance
- Adaptationists, who think that it is too late to reverse trends to obesity, and/or that they are built into our society now, and so we are better off learning to adapt to these trends than try to undo them. In the medical field this manifests in a belief that we should find pharmaceutical solutions to the health challenges of obesity, rather than behavioral campaigns. This stream of thought is also common amongst anti-fat shamers and the Healthy at Every Size movement
- First world shamers, who believe it is shameful of rich westerners to worry about eating too much when so many people in the world are starving. These deniers want us to accept that fatness is a sign of a stable and functioning society and something the world should (implicitly, usually) aspire to – similar to how some AGW denialists think that burning fossil fuels is an inevitable and necessary part of economic growth and something we should encourage the world to do, rather than trying to find alternative development paths. These first world shamers also usually ignore the fact that overweight and obesity is a heavily class-biased phenomenon in rich countries, and increasingly a problem of the poor only
- Free choicers, who think that we should all be able to take any health risks we want if they don’t affect others, and who see obesity purely as a personal decision (i.e. fat people eat too much). Some of the adaptationists also take this view of fat as an entirely personal decision, and sadly so do a lot of public health policy-makers who want to fix the problem. Seeing obesity as a consequence of personal behavior inevitably means that public efforts to reduce prevalence of overweight will be seen as intrusive and restrictive of civil liberties, and enables these free-choicers to reframe the debate in terms of personal choices and freedom rather than the structural and social changes that are actually needed to reduce overweight. This argument is more potent when deployed in the obesity debate because it is much easier to claim that obesity doesn’t harm others
- Skinny-shamers, the kind of hippy punchers of the anti-fat shaming movement, who see thinness as disgusting or at least present themselves in opposition to it. This fat and proud movement is distinctly political, though not necessarily associated with any party, and it is embedded in a broader cultural movement in the anglosphere towards rejecting any form of attention to appearance at all. This movement sometimes has an influence on the fashion world, especially in its attempts to redefine very thin and small models as wrong – it sometimes engages in its own form of shaming, attacking the skinny and small as wrong or ill
- Anorexia bait-and-switchers, perhaps a subset of the fat-proud and feminist denialists, who associate campaigns against overweight with anorexia, and suggest that body-normative ideas drive young women to anorexia. In fact anorexia is a serious mental health problem not caused by social pressure or women’s magazines, and this link is spurious but it has a strong hold in popular culture, and is a powerful rhetorical device. Note that it also often relies on its own form of body-shaming, treating anorexic bodies as disgusting and accepting that they are deeply unhealthy, and often the spectrum of this body-shaming extends to women who are not unhealthy, just thin
Many of these types of obesity denialism seem to be similar in ideological composition to anti-vaccination or anti-AGW thinking. In AGW denial circles it’s common to read conspiracy theories about how the whole scare has been made up to transfer money and power to a clique; how it is cheaper and more effective to adapt than prevent; how attempts to mitigate AGW will lead to (and/or be driven by) restrictions on personal freedom. AGW denialists also often see AGW mitigation in terms of direct attacks on their personal choices rather than structural and cultural changes, for example in which they will lose individual direct choice over light bulbs and car makes, rather than seeing it in terms of industrial and community-level decisions such as changes in power generation or land use practices that no one individual can control. Arguments based on intervention in personal decision-making rather than group practices are much more amenable to conspiracy theories and assignment of nasty political motivations, and the obesity denial movement does have a fair share of such thinking.
In reality the battle against overweight and obesity cannot be won with individual changes: overweight and obesity arises only partially from personal choices, and a lot of it is driven by structural and social factors that individuals cannot change. You can’t make a decision to walk to work if your work is far away and there is no public transport; you can’t make a decision to eat healthily if there are no decent sources of fresh fruit and vegetables near your house, or if almost all the food you buy is poorly labelled and full of sugar. It’s also much much harder to stay thin if your job involves sitting for 8 hours a day, and personal decisions to do something personal to offset a structural factor are much harder to make than personal decisions that go along with that structural factor. Furthermore, cultural practices are insidious and hard to change: ideas about wasting food that come from a poorer time, types of food and eating practices are not easy to change by the time one is an adult steeped in a certain food culture. But because public health policy-makers cannot change broad structural factors outside of their discipline, like public transport and town planning, they have to focus on the things they can touch: personal behavior. This is easily construed as preaching or trying to restrict freedoms.
Of course fat shaming does happen in our societies but it’s not driven by health concerns: it’s another manifestation of a long-lasting and deeply-entrenched sexism in our society. It’s also a reflection of the fact that traditionally aesthetic values were of great importance, and people who deviated from certain aesthetic norms have been shamed for that. Compared to the way people with tattoos or men with long hair used to be treated, for example, fat shaming is nothing: no one obese ever got refused entry to Disneyland for being fat, for example. Public health campaigns do not, generally, utilize fat shaming as part of their repertoire, and the association of fat shaming with public health concerns about obesity is another example of denialism at work – and a very effective way to dampen the debate about what to do about this growing problem.
And make no mistake, it is a big problem. The continuing growth of overweight and obesity is going to have huge costs for health systems, and people who are proud to be fat now are not going to be so pleased with their personal health decisions when the musculoskeletal and cardiovascular problems start to bite in later life (when reversing the process is hardest). With the decline of smoking in the developed world, obesity is becoming the next big risk factor that will bring a wave of disease with it. Worse still, in many low- and middle-income countries overweight and obesity rates are also skyrocketing, but these countries have fragile health systems with weak financing that are not ready to manage a huge growth of chronic illness. This is a global problem, and denying it will delay the necessary steps to resolve it, leaving many countries facing an unexpected cost and health problems they aren’t prepared to deal with. Sound familiar?
I don’t think that obesity denialism is a product of Big Tobacco or Big Sugar, as was the anti-anti smoking lobby or AGW denialism. It also lacks a dimension of harm that the anti-vaccination movement carries with it (since fat kids can’t accidentally infect and kill other fat kids the way unvaccinated children can). But it has similarities with both, in terms of its scientific ignorance, the rhetorical tactics it deploys, and its blithe ignorance – or even celebration – of the problems it causes. The linked Guardian article is suggesting a need to add fat-shaming to the list of discriminatory activities that should be outlawed in Britain, which makes me think of the inclusion of “political” objections to vaccination in vaccination laws. Perhaps it’s time to start treating obesity denialism a little more seriously, before it gets a serious grip on our legislative and public health processes, making it harder for our societies to move out of a path that is ultimately not going to be good for us …
Compromise and Conceit 
April 5, 2015 at 1:25 am
I’m a bit “fattist”, I must confess. I understand that we live in a society with easy availability of junk food and where sedentary lifestyles have become the norm. But this is something, as individuals, we have complete control over.
We can choose how much we eat and what we eat. We can also choose not to exercise everyday. The “can’t afford healthy food” argument has never convinced me because I live off lentils and chickpeas and both things are healthy, low fat, and as cheap as chips. And no, my mother never taught me how to cook with chick peas and lentils. I looked up recipes on the internet which anyone can do. I also go running or cycling everyday and neither activity costs me anything.
The message about the health consequences of obesity have been around for decades now. No-one can claim they don’t know that being obese is bad for their health.
Losing weight is not rocket science: eat less, eat healthy foods, and exercise everyday.
April 5, 2015 at 11:14 am
I don’t agree that obesity is purely a matter of personal behavior and discipline. There are big structural determinants of dietary quality and physical activity, which is why obesity is a class-based thing in the U.S. and UK and also why rates are so much lower in parts of Asia. Casting it in personal responsibility terms restricts the response to weak personal behavior interventions and plays into the rhetorical perspective of denialists. A lot of these people think that criticizing fatness means denigrating them as people (fat shaming) precisely because they see obesity as either personal choice or unavoidable personal genetic destiny. If we can break down that part of the denialist idea then we can get them to address it as a social problem rather than a personal failing, potentially building a bridge for dialogue.
April 5, 2015 at 3:36 pm
Isn’t it a combination of both? Personal behaviour AND cultural/societal factors.
I agree that developing cities that encourage an active lifestyle with lots of walking and cycling are important and I am the first to advocate for these things. But there’s also an element of personal choice here. Lifting the responsibility entirely off the person who is fat is not going to help them at all. And if they play no role in their weight whatsoever then do we need to control what people eat from a government-level? With the freedom to eat whatever we want comes a bit of responsibility in being sensible about it.
I’m friends with an obesity surgeon. He told me that before they perform stomach-stapling and similar operations, the patient must demonstrate a commitment to losing weight and they have to lose 10kg. It doesn’t matter how much their starting weight is; the goal is 10kg and they have to reach this before getting approval for the surgery. My friend meets with these patients regularly to monitor their weight and see how they’re progressing. On one occasion he had a patient who said, “I’ve been eating lots of healthy things. Now when I go to McDonalds I eat the fillet o’ fish.”
At one point someone has to tell her that she can’t lose weight and eat at McDonalds. It is her choice whether or not to buy fast food and it appears she does not even realise that this is a bad choice. It seems it has become inappropriate to tell a fat person that eating at McDonalds is not a good idea when this is exactly what they need to know.
I also saw a fund me campaign recently for an American who had previously been obese but was now a healthy weight and was trying to raise money for an operation to remove the excess skin. It looks like he’s raised the funds now which is great:
http://www.gofundme.com/brianflemming
I think this is the something the public health service should fund but that’s not the point I want to make. If you read his bio, the turning factor for him in losing weight was not people being sympathetic and blaming society for his obesity, it was one woman who got angry with him and told him he was wasting his life and that he should be ashamed of himself.
April 5, 2015 at 3:37 pm
Sorry, I should have quoted your first sentence in full. It looks as though you agree with that statement when you were saying you disagree. Feel free to edit my comment to include your full quote.
April 6, 2015 at 8:21 pm
Okay, but effective public policy is a mix of personal and collective incentives (“smokers stink” alongside tobacco taxes and restrictions on smoking, first in workplaces and then…), varied as the situation changes. So “It’s bad to be fat” has a place, alongside taxes on fast food, subsidies for fresh food, transport changes and so on. It maybe just has to be a minor place, given that fat people are stigmatised without government help.
April 6, 2015 at 10:51 pm
Rachel if someone doesn’t realize that doing something is bad for them, you can’t couch their failing in terms of personal responsibility. This is a big problem in the overweight trends over the past 30 years – changes in information over time and cynical marketing have led to all kinds of destructive patterns of eating. See e.g. the “low fat” foods that are full of sugars. Most adults don’t even know what their daily calorie requirement is or how much the food they’re eating contributes to it – if people don’t understand this they can’t take responsibility for it. This is undoubtedly a failing of public health campaigners but in health care ignorance is an excuse – which is why the anti smoking lobby has worked so hard to curtail Big Tobacco’s influence on the media and the medical community.
I find it interesting that a lot of the discussion of public health campaigns against overweight and obesity has this subtext of concern about public health campaigners stigmatizing people. Where did this concern come from? Public health campaigns are not built on stigmatization, and health promotion theory avers stigmatization at every turn (many campaigns aim to reduce stigma e.g. of HIV or mental health problems). Health warnings on cigarette packets don’t say “if you smoke while pregnant you are a bad mother” and there is no public health campaign I am aware of that says “fat people are bad.” So where does this undercurrent of concern come from? I think it is the result of Big Tobacco’s work polluting the well of health promotion. The article at Rabbett Run that I linked to shows a clear campaign paid for by Big Tobacco to talk up discrimination and stigmatization as a fear, by a man who seems to think that telling people they can’t smoke inside is the same as Auschwitz. But where is the stigma? Jeremy Clarkson is a famous smoker and he is feted throughout the land even when he punches his underling in the face; Scruton is a famous smoking advocate and is seen as one of the UK’s greatest philosophers of aesthetics[1]. These people are doing alright. Yet everyone is talking about public health campaigns against smoking as if they are stigmatizing people, and the implication is that public health campaigns against fat people will go the same way.
I think this is an unfounded suspicion, built up by Big Tobacco, and they have effectively poisoned the well so that other health campaigns – against drink driving, or overweight, or excessive dangerous drinking – are immediately viewed with the same suspicion that they’ll do what they did to smokers. This language of free choice and victimization that has been built up around smokers is seeping into other targets of public health campaigns, and it might not be so pervasive if it weren’t for the efforts of Big Tobacco to make it so.
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fn1: which is weird, since he hates heavy metal, which Britain invented.
April 8, 2015 at 9:43 am
I was going to point out that your types of deniers could be applied to political Islam too, but then realised your model can be applied to almost anything that is seen as a “problem” because it’s largely describing a range of responses from self motivated opposition to accommodation to approval/acceptance. We could probably map these categories onto video game violence, Australian senate reform, whether the One Ring is a corrupting influence or your categories themselves [1].
That doesn’t automatically invalidate your thinking, but does suggest to me that your willingness to compare things back to AGW is primarily based on “How stuff I dislike is all pretty similar”. Maybe dropping the comparison to AGW or tobacco lobbying would result in a similar model but without the “denialist” stigma you’re slinging around?
Of course, your model lacks a category of misanthropic troll, so it can’t perfectly model human responses. But that’s easy enough to fix.
[1] For the record, I think you’re a straight up denialist when it comes whether your model can describe itself and a politically motivated rejectionist on LotR books v movies.
April 8, 2015 at 10:37 am
That’s an interesting point Paul, so I guess I should clarify that what I mean and what I think most people mean when they talk about “denialists” is people who reject a robust and authoritative consensus on a scientifically or historically identifiable problem. This restricts the common use of the term to people who reject the consensus on vaccination, AGW, smoking and cancer, and the holocaust. I am arguing to add obesity to this list, and it’s a common ploy of those who disagree with me to claim that the consensus is weak or confused – my argument is that this is no longer the case so they are denying rather than engaging in a meaningful debate. I would say the same now is mostly true about nuclear power: before Fukushima, in the absence of proper research from Russia, it was possible to argue about the existence of an authoritative consensus on whether nuclear power can be managed safely, but now I think it’s safe to say that the science is in and we know how to handle this technology, so the green movement needs to cut its denialism on this.
On the other hand, political islam and LoTR don’t have a definitive and authoritative consensus. Everyone from “ISIS” to Richard Dawkins claims to be an expert on political islam, and the spectrum of political islam in practice runs from Turkey (state-controlled Islam) to Saudi Arabia (Islam-controlled state), with in between countries with complex and mixed responses to Islam, such as Malaysia or Bangladesh. I think in that context it’s hard to have a concept of a denialist to e.g. the claim that political Islam is a threat to western democracy, or that Islam is designed to try to take over states. That doesn’t mean there isn’t a debate and that various people aren’t wrong about stuff, of course. The same with LoTR: even Tolkien himself isn’t an authority on his own work (since we deny the right of the author to control how his or her work should be interpreted), and there is no other definitive consensus on e.g. race or class or gender in Tolkien[1]. There’s nothing there to deny, nor will there be until people accept my pre-eminence in this field.
So in this regard it’s not just “stuff I dislike is pretty similar” but “there appear to be similar arguments for rejecting consensus understanding of health risks.”
Also, when I think about the typology I have given here, maybe anti-obesity people are more similar to pro-smoking or anti-AGW people than anti-vaxxers. Is the title of my post wrong? And is this consistent with my suspicion that anti-vaxxers have no relationship to Big Tobacco?
Other areas where I think the consensus is still forming: GMOs and the environment, geo-engineering and AGW, the equilibrium climate sensitivity, market measures to protect endangered species.
Other areas where I think there is a consensus: GMOs and health (no significant risk, though I guess one could design something bad), the health effects of alcohol (it has a clear j-curve), the importance of universal health coverage, my inherent coolness and objectivity, the importance of bees to fundamental ecosystem security
Other areas where I think there is insufficient data or research to form anything resembling a consensus: eCigarettes (potentially a great way to move people off cigarettes, health risks not understood); what is killing bees; when the Anthropocene started
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fn1: Which reminds me that I still haven’t written my post on why I think Tolkien was progressive about gender for his era.
April 8, 2015 at 1:12 pm
Even with you restricting your desired point to just “denialists”, it still seems your describing a human response to an objectionable proposition more than a specifically denialist mentality. Looking at your categories I also suspect it wouldn’t take too much work to shoe horn them into the 7 stages of grief.
I suppose my point is that assessing people and trying to categorise them leads to 1) models that can be understood and used by humans; 2) a loss in predictive power as the details of the people being assessed is abandoned to shoe horn them into the model.
This seems to be a frequent theme in economics and sociology. They can only predict the behaviour of spherical consumers in a vacuum. 🙂
To take a step forward rather than just carp, what predictive power do you think your model provides? Does it make any prescription for engaging these groups that a five year old wouldn’t be able to make? Because your analysis around individual choice with/versus required societal action doesn’t really seem to rely on the sub-division into these categories at all.
April 8, 2015 at 2:36 pm
Partly I’m interested in this simply for historical reasons. As you know there are people trying to understand what John Quiggin calls Agnotology (understanding ignorance, is probably how he would define this) and as you also know I disagree with some of the models he uses to understand how and why these people think the way they do, and by extension the rhetorical techniques that should be used to try and influence these movements. I’m also interested in the commonalities between these movements and their differences – in past posts I have suggested that the anti vax movement follows very different patterns to the anti-AGW movement, and implied this could be because of the influence of corporate funding in cohering some ideological streams in the latter. I also think that the commonality of rhetorical positions between the fat pride movement and the pro-tobacco movement is evidence of the success of the (known) tactic that big tobacco had of poisoning the whole well on health risks.
I don’t have a predictive model and I certainly don’t think blathering on a blog should be required to be practically useful to be interesting, but there are a few tactical points that I can see from my model. First of all, a lot of obesity denialists seem to be in denial of the existence of a consensus on the issue, and Dan Kahan has previously identified that individuals with anti-vax views can be brought around by inclusive language from someone they believe (probably another mother) that establishes acceptance of the consensus; perhaps the same tactic could work with obesity denialists if, e.g. a few famous fat people lost weight and talked in this way. Some early smoking fatalities (like Yul Brinner) also had a big effect on the anti-smoking movement by admitting they regretted starting – perhaps the same could be done with obese people. Recently there was a movie starring Julia Dreyfuss about her fat boyfriend and fat shaming; the actor who played the fat boyfriend subsequently died of a heart attack (I think) related to his weight. This is a kind of teachable moment, but it was buried in the media because, I think, the media don’t take obesity denialism seriously (and often inflame it, the way they used to inflame anti-vax ideas before the diseases came back and they started taking vaccination seriously again). Also, I think that more effort in public to show the public how much the public discourse on health risks has been corrupted deliberately by Big Tobacco would help people to be a bit more critical of ideas that seem straightforward to us now (like the personal freedom individual liberties ideology) but which in fact 20 years ago was being deliberately propagated and nurtured by Big Tobacco. Also, there are countries entering the obesity epidemic where education and policy could act to reduce the growth of similar resistance movements.
I would also like to see the media be a little more critical of the lines they’re fed on fat pride, fat acceptance and healthy at every size. I see a lot of reports about the growth of obesity and its risks in the Guardian, but almost all of the opinion pieces are denialist in tone and perspective. Perhaps it’s time that newspapers started giving more coverage to the real risks associated with obesity and overweight, and less time to the denialists.
But in the end my post is mainly just out of historical and philosophical interest … and I’m less interested in individuals’ ideas than in how those ideas are shaped and redirected by movements. And when you’re modeling the bulk motion of gasses, it’s fine to treat the individual particles as spheres in a vacuum …