Systems and self-esteem: Being helpful and constructive on obesity.

By Ashley White

I am not sure it’s possible to better articulate exactly how far off the mark anti-obesity campaigns tend to be that in the way Jezebel’s Lindy West has done right here:  It’s Hard Enough to Be a Fat Kid Without the Government Telling You You’re an Epidemic

She writes, “But first of all, though weight loss can certainly improve some people’s health, “fat” does not universally equal “unhealthy.” Health itself is a much more effective and specific goal. And campaigns like this—which target fat people instead of the system that makes them fat—do nothing but hurt that supposed cause. An anti-fat-people campaign is still an ANTI-PEOPLE CAMPAIGN.”

But, after this piece was published, West herself commented first, “Question. So, okay, if I’m saying that these ads are NOT HELPFUL–and a lot of you are agreeing with me–can anyone come up with a pro-health ad that would be genuinely helpful and constructive? Thoughts? What would that look like?

And so, I’ve been thinking on it.  Aside from killing subsidies to corn, boosting subsidies to a diverse array of plant crops, creating better ways to get good and affordable food to the North – which definitely must happen – and addressing poverty, education deficits, and infrastructure problems, what would be a radical approach to helping people attain healthy weights?

First of all, scrap the phrase “healthy weights”.  Health and weight, as Lindy West so lovingly tells us, are different things.  There are overweight healthy people who cost the health system absolutely nothing because they eat well and move a lot, and there are unhealthy people who have ‘normal BMIs’ but are one Red Bull away from a seizure.  When we talk about obesity, we’re really talking about being sedentary, about eating chemical food-like products, about how most people use food – a tangible – to make up for deficits in intangibles, like loneliness, grief, boredom, lack of self-efficacy.  It’s not about the weight.

Second, zone in on the humanity of it all.  Shame never works, it’s a negative tool used to create outcomes of fear, obedience and an over-reliance on social cues that are, for the most part and especially for women, perverse.  In social work, and in other fields that design to help people through changes, the goal is to, always, ‘meet people where they’re at’.  Not where they should be.  Or where they can be.  And, fundamentally, if people believe that where they are at is good enough, and that they themselves are good enough, they might be able to battle fat shame by doing things that reflect their self-respect, an acknowledgement of their self worth.  It’s the stories we tell ourselves and each other about how we’re fundamentally good enough because, well, we’re here.

So, what do we do?  If needed, we help kids learn about food, and how it comes to be.  The Cookbook Project is doing just that.  Then we help kids learn about themselves, their stories and their plans for the next parts of their lives.  This work helps youth build up some resilience to the onslaught of normative messaging about their bodies, hearts and minds that comes from self-hating parents, bullies, bad teachers as well as magazines and media whose currencies include apathy and narcissism.

For this work, we don’t need commercials, PSAs, posters or conferences.  We need communities of practice around self-esteem.  This work is possibly not policy-able.  But, it’s important because while it’s most definitely not about the weight, it’s also not not about the weight.

According to the almost useless ‘Obesity in Canada’ website of the Public Health Agency of Canada, “The economic costs of obesity are estimated at $4.6 billion in 2008 …based on costs associated with the eight chronic diseases most consistently linked to obesity. Estimates rise to close to $7.1 billion when based on the costs associated with 18 chronic diseases linked to obesity.”  The modelling of these costs is suspect because ‘linking’ a chronic disease to obesity could mean that obesity results from the chronic disease, or the chronic disease results from obesity.  The former means that it’s not obesity that costs us $4.6 billion, and the latter is a red herring because, as we discussed, being obese doesn’t mean being unhealthy.  When a fat person walks into a doctor’s office, the doctor doesn’t get to bill the Province for having to witness fatness.  And doctors don’t get to bill more for a respiratory exam on a fat person, than they do for a thin person.  So, the economic rationale for addressing obesity is really the economic rationale for addressing the food industry’s role in agricultural systems in Canada, poverty, education deficits, and infrastructure problems.  That is, the economic rationale for addressing obesity is really the economic rationale for running a good country.

For the same reason that smoking cessation programs don’t work, anti-obesity campaigns, which basically ask fat people to be less fat, cannot – as a matter of course – work.  For people who are overweight as a result of the food they eat, concentrated amounts of fat and sugar, found in almost all processed food, operate on the brain in a way that is biochemically more like a drug than like a food.  There is a scientific basis to why food soothes, but anti-obesity campaigns that don’t consider why so very many humans need soothing are simply damning to people who have ever been considered overweight.

A final note on how curious it is that an online publication dedicated to talking about social issues and celebrity culture in a legitimately comical and astute way has managed to better frame ‘obesity’ than the Public Health Agency of Canada, and definitely better than the Let’s Move effort of Michelle Obama.  If you look here and here, you will see political rhetoric masquerading as objective science-y facts.  When we frame the obesity issue as a one of problematic individual behaviour, as opposed to a shared public  structural problem, we justify disparities s in obesity rates among Aboriginal people, rural people and poor people.  We shift the conversation from avoidable, unjustifiable inequalities (these are known as inequities) to one where Aboriginal people, poor people, rural people and all other types of fat people are fat solely because they themselves have made bad decisions over and over again.  This absolves policy makers of responsibility to address the problems in ways that make sense because the problems lie with individuals, not systems.

Systems and self-esteem.  It really could be that simple.

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2 thoughts on “Systems and self-esteem: Being helpful and constructive on obesity.

  1. Just one thing I would add to this (excellent) analysis, to go one step further in the direction of systemic causes, is the emerging research linking poverty, chronic stress, hormone dysregulation (specifically elevated cortisol levels in chronic stress) and obesity. Cortisol is our stress response hormone, which is great in the short term, but long term exposure has an effect towards obesity, insulin resistance (type 2 diabetes), and atherosclerotic disease. The various forms and functions of exclusion in our society promote an unequal distribution in chronic stress states, which are related to obesity. Put simply: it’s not just that healthy food is expensive, it’s that being poor makes it more likely that your body’s hormone system will make you obese. This line of investigation puts the emphasis even farther away from a “just eat better and exercise more” perspective to looking at structural and socially-determined risk factors for obesity.

    • Ashley White says:

      Excellent advice, and this is certainly an appropriate extension of the analysis. Structural risk becomes even more important in light of this evidence on the role of cortisol.

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