4.09.2015

I just don't think that's my problem.
Food Issues Book Club - Weighing In, Chapter 3

Hello all!  Welcome to the NOiG Food Issues Book Club, wherein I read books about food stuff, summarize each book by chapter, and then attempt to apply that book chapter's ideas to the New Orleans food environment and my own experiences.  Fun right?!  Check out previous installations here.  I'd love it if you'd read along and join in!  And now, without further ado...

Weighing In, Chapter 3: Whose problem is obesity?

Summary:

"[I]nvoking health to talk about obesity can work against social justice."  In fact, it can create social injustice.

The idea that obesity causes increased healthcare costs for society is so commonly espoused as to have become a trope.  Figures are regularly calculated and repeated for these costs that are assumed to stem from obesity - whether or not there is any evidence that such is the case.  Such numbers assume that all ailments that might be associated with overweight are in fact caused by it.  Overweight people are thus villainized, painted as a burden for all.  Moreover, obesity is described as a "choice," the result of lack of self-control.  A failure of personal responsibility borne solely by individuals.  Lest we forget, though, "care for the sick is an economic burden only in heath care systems where profit is the bottom line and public services are underfunded and politically unsupported."

This view of obesity stems from healthism, a mentality that health is a moral imperative and the most important gauge of self-worth.  Pairing neatly with neoliberalism, healthism supports the anti-government, pro-corporate, "everything comes down to personal responsibility and opportunity and circumstance don't matter" mindset that rose to prominence in the 1980s and has yet to lose a grip on our culture.  The judgment as to whether someone conforms to the dictates of healthism is frequently - nearly always - based on the appearance of health (thinness and attractiveness) rather than any actual evidence of health.

In this framework, healthy (thin) people are moral, hard-working, and attractive.  Unhealthy (fat) people, by contrast, must be immoral, lazy, and ugly.  In short, healthism renders the obese both worthless and burdensome, a weight to bear for those who judge themselves superior.  Unsurprisingly, "healthism speaks to those who are already reasonably healthy."  These "reasonably healthy" people then feel, since fatness / unhealth has been deemed a choice and a result of laziness, that they have the right and even the duty to tell fat people to shape up.  Indeed, "those taken by healthism can display significant lack of tolerance for those who are not."  In this way, it "provides a veneer for neglect or exclusion" of all those who appear, based solely on aesthetic attributes, not to subscribe to healthism's dogma of get fit or die trying.  In this way, healthism excludes not only the overweight but also those with disabilities or with any other insurmountable barrier to obtaining visible optimum health. 

Healthism of course benefits those who do aesthetically appear to adhere to its demands - whether or not those individuals expend any effort to do so.  The naturally thin and beautiful are thus judged to be hardworking, moral, and self-disciplined regardless of the actual presence of these traits.  But healthism is bad even for people who can look the part: for those who do have to work for the look of health, it can encourage image obsession, narcissism, and even self-harm.

Healthism is bad for everyone.  To address obesity, and public health more generally, we must "think differently about health and where blame lies for health inequalities."

Discussion:

Based solely on my mother's continued reactions, the fact that I have become overweight (yes, per the uber-flawed BMI I am "obese") is literally the worst thing that has ever happened.  Ever.  Worse than my father being paralyzed.  Worse than Katrina destroying all our lives.  So, so much worse that she can barely contain herself from saying something about my appearance (not my health, mind you, my appearance) every. single. time. I. see. her.  Which in case you were wondering is about once a week.

Maybe this is some kind of karmic payback for the time when I was nine and told her that I didn't like fat people?  No, probably not.  My mother, it seems, has a lifelong paid subscription to healthism.  It's easy for her to do; for her whole life she's been effortlessly thin and petite.  She has never had an exercise regimen.  She doesn't count calories or even particularly watch what she eats (though she does stay away from the classic American trap of "junk food"... mostly).  In her eyes, she is healthy and I am not.  Never mind that she's had cancer.  Never mind that less than a year ago she literally almost died from sepsis.  Never mind that she has high cholesterol, high blood pressure, and osteopenia.  Never mind that she lives in so much chronic pain that she completely retired (from part-time, self-employed work - the only kind she ever engaged in from the time she had her first child) well before her 65th birthday.

It's clear to her that it's me - who is vegan and eats mostly whole foods, who wears a pedometer and does everything in my power to make my steps each day, who goes to the gym, who works full time and has a full social life and a successful marriage and engages in social activism, but who also happens to wear a size 18 in pants - who has the health problem.  I do have health problems, many of them.  And all of them are causes of, rather than the result of, my current weight.

What's worse, really, is that she seems to think that I'm doing this on purpose, remaining this size because I'm too stubborn or lazy to address it.  Though if that is what was happening she'd have no right to criticize it, it's simply not the case that this is a choice for me (or for many overweight people).  I'm sure that there are some people who are overweight because they eat poorly and/or are lazy, and could choose to eat differently and be more active and have the weight melt right off.  That doesn't mean that case is universal, and it also doesn't mean that anyone gets to tell them what to do with their bodies.

I have always had a large, thick frame and spent from my late teens through my early thirties wavering on the BMI line between "normal" and "overweight."  I struggled with body image, like most of the women I've ever known.  Then in 2011, a perfect storm of medication problems and stress and probably some unknown factors pushed my body to gain and retain about 60 pounds inside of a year.  I had to replace all of my clothes, and have since had to withstand CONSTANT comments on my appearance from friends, family, acquaintances, and strangers alike, including regular inquiries into "the pregnancy" (there isn't one).  YES REALLY.  ALL THE TIME.

The weight is here, and it's staying as far as I can tell.  I didn't do anything "lazy" or "undisciplined" to make it come, and I refuse to do anything unhealthy to make it go - or to apologize for my size.

As far as my social development goes, the experience has been good for me. While I was always aware of it, I've realized just how profound fat-phobia / discrimination is, and how entitled people feel to comment on, judge, and make assumptions about others' bodies and perceived behaviors.  I've discovered that if you wear higher than a size 14 but less than a 20 in women's clothing - or if god forbid you're fat but have small breasts - it's basically impossible to find clothes.  I have experienced the very ugly product of healthism that is fat shaming.  Some folks think it's actually a good thing!  A motivational tool that'll get us lazy fatties up off our asses.  I hope you all see the numerous problems with the assumptions made there.

Like all neoliberal ideals, healthism seems designed to create "haves" and "have nots," to outline an exclusive club for which many cannot ever meet the membership criteria.  Those in the club see no problem with this - despite the fact that many make themselves miserable or go to great expense to continue qualifying.  Sometimes I wonder when we are all going to WAKE UP and realize how indoctrinated we have become with ideas that benefit the few and hurt the many.  Of course, for that to happen we'd have to be happy with a club that lets anyone join.  Historically, those have always been the least popular.

In conclusion, an anecdote: While drafting this blog post I've also been engaged in an email exchange with my insurance company, which was of course trying to shaft me out of paying for some endocrinological testing.  The following exchange was had just an hour ago (verbatim from email). 
Her: I have sent the claim back to be reconsidered based on the secondary diagnosis that was filed.  The claim originally denied because the primary diagnosis was not a covered diagnosis under the plan. 

Me: I’d like to understand this – are you saying that hypoglycemia isn’t covered? 

Her: That was the secondary diagnosis that was filed, so we will reconsider based on that diagnosis.
Me:What was the primary diagnosis, obesity? 

Her: Yes
The entire country seems to think that our most pressing health problem is obesity. But just don't try to seek medical help for it unless you want to pay for it out of pocket, kay?  The best part, of course, is that's not even what I was seeking help for.  YAY AMERICA!

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