CONSULTATION: On Obesity

An interview with Chin Jou. By Kate Womersley.

Chin is a lecturer in History of Science at Harvard University. This semester she is offering a course on The History and Politics of the American Obesity Epidemic, and her book, The United States of Fat: A History of “Bad Food,” Obesity, and the Federal Government, is forthcoming from University of Chicago Press. 

REMEDIA: Can you tell us an anecdote that illustrates the interest and complexity of obesity as a field of research?

Chin Jou: One of the students taking my course asked her teaching fellow why there are no fat people in our class which has an enrolment of 86. She’s right, nobody in the class is even remotely overweight. That might not be surprising as it’s Harvard and there just aren’t many overweight students around. But the girl then mentioned that her roommate is obese and feels hostile to the fact that the course even exists. This roommate is comfortable with her weight and thinks that the course problematizes obesity and further stigmatizes it.

It really doesn’t, in fact. I don’t take the concept of an obesity epidemic for granted. We look at fat acceptance groups and social constructionist arguments which question whether or not obesity is a bona fide public health crisis. We interrogate whether correlation is the same as causation with regard to co-morbidities [type II diabetes, heart disease, high blood pressure] and obesity. But the teaching fellow’s story is interesting as it makes sense that a student might be uncomfortable being a ‘token’ overweight person in the class.  There is the possibility that such a student might feel self-conscious if her or his classmates are constantly looking at the individual for their responses to issues raised in the course.

R: And what is the response you get when you tell people that you work on obesity?

CJ: I started researching obesity in 2005 and when I mentioned this to either people I knew or people I met at cocktail parties they’d go on rants about how many obese people there are these days, or they would say how fat people have no willpower (despite all the evidence to the contrary). Or they might say how they were once overweight themselves but, through discipline, they were able to reach and maintain their current weight. I would just listen and obviously had opinions but was curious to let them go on. The public invariably privilege slenderness and believe that willpower can transcend biological constraints. People often cite articles they might have read in the New York Times about obesity (and such articles are published almost every day). Unlike more esoteric topics, everyone has something to say about obesity and tends to feel that they are an expert.

R: Given that people are so open with you, do you use interviewing as a research method in your academic work?

CJ: I certainly see a place for that among medical anthropologists, and I did interviews with biomedical researchers when I was at NIH, but I was interviewing them to get a handle on the science rather than for ethnographic purposes. I didn’t use contemporary anecdotes as a source in my dissertation because I focused on obesity at the turn of the 20th century.

R: It is surprising to see that the term ‘obesity’ was first used in English in the 1600s. How did obesity become a modern buzzword and such a controversial issue?

CJ: With regard to the etymology, the seventeenth-century French term was obésité, used to refer not exclusively to people and body size so much as anything that was considered fulsome, even inanimate objects. In the US it wasn’t generally used to describe a medical condition until the nineteenth century. The idea that being overweight is a moral failure has endured since then, and has not subsided despite biological studies which suggest obesity’s complicated etiology. Eating less and moving more is still the dominant means of weight control in the public imagination, and what biomedical researchers are finding has not percolated down to the public, in my view. But in what ways do you see obesity as a controversial issue?

R: Well, it attracts both disdain and fascination. Saying a celebrity is fat or skinny seems to endlessly draw people. Just look at the Daily Mail website. There’s a tension that at the same time we’re perhaps becoming more skeptical of medical opinion, a hungry market is growing which wants to be told to the letter by diet ‘doctors’ what to eat.

CJ: I actually just gave a lecture on Atkins. The figures pushing these diets tend to be marginalized in the medical profession. Dr. Robert C Atkins who trained at Cornell as a cardiologist does actually have the credentials. But when he started publishing his diet plan in 1972 there was a lot of pushback from the medical community. Everyday dieters want to be given a very specific weight-loss plan, but don’t seem to pay too much attention to whether the medical establishment is behind it. It seems rare that dieters consult with their family doctors before trying a popular plan, and one reason the medical establishment is often hostile to things like Atkins is because they circumvent medical authority.

R: But aren’t these rules and regimens odd in a country which celebrates choice and plenitude?

CJ: It’s like people who love to have personal trainers at great expense. Back-episodes of Supersize vs. Superskinny [a British TV show where an extreme ‘overeater’ swaps diets with an ‘under-eater’] explore different ways to get the perfect body. In one episode the presenter, Anna Richardson, is trying to get an ideal J Lo-type bum, or the next episode might focus on Richardson getting rid of her ‘batwings’. Richardson enlists a personal trainer who tells her the exact exercises to do. She doesn’t seem to think that she can do it on her own and perhaps wants that accountability that comes with having a personal trainer.

R: Are there documents from the past which offer dietary and lifestyle advice, and how do they compare to those today?

CJ: They’re strikingly similar. The first bestselling diet book was published in America in 1918 and was written by the physician Lulu Hunt Peters in California, entitled Diet and Health with the Key to the Calories. It sold 2 million copies, and was in continuous publication until the 1930s. In her book Hunt Peters lays out precisely how many calories people need to be consuming to maintain weight. At the beginning of the book she tells us that one pound of fat is equivalent to 4000 calories and there is a list of calorie counts of various foods. People bought that. It was empowering. Before calorie counting came out (and this was the first widely published book to employ calorie restriction as a method of weight control), calories were used differently. In World War One, the US food administration published the calorie content of items in an effort to get people to adhere to food conservation programmes. They compared the number of calories in beans with those in meat for example, to suggest cheaper alternatives. But in 1918, here came a book that told people they can change their bodies if they just follow the prescriptions. But this is also demoralising. If you fail to lose weight, the implication is that you cheated on your diet. Hunt Peters encourages readers to make a punctilious log of calorie intake – a new method of self-surveillance –  adding an externalisation of guilt that perhaps wasn’t there before.

R: And do you think that this is typically American? That willpower and rigor offer a grand narrative of equal opportunity?

CJ: Absolutely. What that book did was to say that a calorie is a calorie is a calorie. But now we know that if you eat a cookie and I eat a cookie it will have different metabolic effects on our bodies which might mean that you don’t gain weight and I would. But there wasn’t room for that kind of complication in this book. It did democratize the idea of weight control and empower people to think that through industry they could make it to their goal weight. But it also suggested that failure was their fault.

R: Today, particularly on news websites aimed at women, the vocabulary of blame and pity are everywhere.

CJ: Yes, and on those websites different narratives can come out of the same photograph to say that a celebrity is too fat or too thin or ‘normal’. In terms of the blame game, in the beginning of the 20th century as well as in popular media today, the individual was the only culprit. The medical voices talking about hormones were in the minority. Now biomedical researchers tend not to blame individuals but will blame, for instance, a mutation in the leptin receptor gene (leptin is one of the hormones responsible for satiety). Health experts blame food manufacturers for creating a ‘toxic’ food environment where there is so much choice but a lot of the food is devoid of nutrition – highly processed and loaded with sugar and saturated fat. These also happen to be the cheapest foods. But in the popular mindset, these factors have not diminished the cult of personal responsibility.

R: So what can be done to stem the obesity epidemic, if in fact it exists?

CJ: Well the media doesn’t allow for such a complicated narrative. They don’t really question whether the epidemic exists or entertain the idea that it might be a fluid construction. What I mean by that is the Body Mass Index for what constitutes obesity changes. In 1998 it was lowered from 27.5 to 25. The outcome of this was that overnight in the US 25 million Americans became obese, despite the fact that they hadn’t gained an ounce. It was just because the threshold had been reduced. Most Americans don’t know that and the media don’t really advertise it. Science reporters get their information from obesity researchers and the public health community, but those who question the epidemic tend to come from fat acceptance groups and a few contrarian scientists, like the political scientist at the University of Chicago, J. Eric Oliver who wrote Fat Politics. He says that the epidemic is overblown. Those critical voices are not represented in the media. I’m not suggesting there either is or there isn’t a public health crisis. I actually have very agnostic views about it, but we definitely need to pay attention to the social context that gave rise to what is now known as the obesity epidemic.

R: What kind of research about obesity is going on right now in the scientific community?

CJ: A study that got a lot of press recently was by David Ludwig who is an endocrinologist at Boston Children’s Hospital and a professor at Harvard Medical School. He compared the efficacy of three diets: the low fat diet, the low carb diet, (like Atkins) and the low glycemic diet (which he advocates). His argument is that white foods (processed bread, sugars, white rice) are broken down in the body very quickly, blood sugar spikes, and insulin causes the sugar to be stored. This leaves you feeling hungry soon after you’ve just eaten. Those foods stimulate appetite and don’t give your body the chance to burn fat. The study found that Atkins was the most efficacious in terms of weight loss, followed by low GI, with the low-fat diet resulting in the smallest amount of weight loss. Ludwig still advocated low GI because long term it was more sustainable and did not have so many potential health risks (though those associated with Atkins have not been proven). This got tons of press because it was practical advice and was easy for the news media to translate from the medical community to the public. But studies that look at obesity at a molecular level to investigate which peptides and proteins are implicated and the metabolic pathways of obesity, generally remain in science journals, both peer reviewed and popular ones, but are less frequently reported in places like USA Today, although they are occasionally covered in  the New York Times, such as those articles by Gina Kolata. But those stories may be less useful for the reader who simply wants to glean advice to apply in her own life.

R: Time often looms large in those features as it’s such a powerful way of selling anything, like book titles which promise you can lose a stone in two weeks or two months. Do you think this has reached new extremes?

I just assigned a reading called ‘Bridal Hunger Games’ which is a New York Times article from a few months ago about the drastic measures women take before getting married, particularly the diet trend of having a feeding tube hooked up to your nose. The women are essentially fasting but they still get supplied with nutrients. By this method they can lose a stone in a week. It’s our version of foot-binding. For a historian a hundred years from now reading about this procedure, it could seem very odd. But then if they were to read about it alongside all those Daily Mail articles in a culture of constant policing where one spot of cellulite is blown up in the Daily Mail’s photographs and criticised or a 5 pound gain is made into a big deal, it may make more sense to the future historian.

R: Although you’re not offering direct prescriptions, would you say you’re encouraging a critical outlook?

CJ: Yes, and I hope the students are getting this in a very practical way from the obesity course. I hope from now on when they read articles about obesity they will have a historical perspective on the issues and read critically.

R: For an interested general reader, is there a particular book in the field you would recommend?

CJ: The one that my students seemed to have responded to to the greatest extent, and not necessarily positively, but have found the most provocative, is the one I mentioned earlier by J. Eric Oliver, Fat Politics. This puts forward a social constructionist argument. It’s very unsettling at first. It’s not gospel but it certainly is thought-provoking as it interrogates the familiar statistics, such as that two thirds of all Americans are overweight or obese.

R: And more generally, a book on the history of medicine that has inspired you in either its method or subject matter?

CJ: I really like Nancy Tomes’ The Gospel of Germs. This book shows how the idea of germ theory affected Americans’ everyday lives. For instance, she even discusses why we have white porcelain toilets. It had to do with paranoia about germs, the white porcelain making it clear when the toilet’s dirty and needs cleaning. I like these books that reveal something about the texture of everyday life in the past rather than a more abstract discussion of medical ideas. There’s of course room for those as well, but it’s great when you can learn about how ordinary people experienced new medical theories.

© Remedia.2012

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