A sociological critique of the Health at Every Size movement

The Health at Every Size (HAES) movement has become a popular alternative to the dominant scientific discourse on obesity, particularly among fat activists and the fat acceptance movement as well as some nutritionists eager to avoid an over-emphasis on body weight in their work with clients. First developed by American psychotherapist and nutritionist Linda Bacon (2010), the main argument of HAES is that good health and physical fitness can be achieved regardless of body size. As such, the approach agrees with the assertions made by many other obesity sceptics that fatness does not necessarily cause ill-health and premature mortality and that losing weight may not improve health status (see here for my previous post on the contentions of obesity sceptics).

A central plank of the HAES approach is that weight loss by means of continual dieting attempts and punishing exercise regimens should not be the main goal of those seeking to live a healthier life. Instead of attempting to follow the rigid guidelines of medical advice on losing weight and focusing exclusively on this objective, individuals should instead follow their bodies’ intuitive lead in choosing their diet and exercise activities. They should learn the instinctive hunger and fullness cues of their bodies and eat accordingly, whether or not following these cues lead to weight loss. For example, in an information sheet about HAES (2008) Bacon notes that ‘We all have internal systems designed to keep us healthy – and at a healthy weight. Support your body in naturally finding its appropriate weight by honouring its signals of hunger, fullness and appetite’.  In a YouTube video she claims that as long as ‘you stop fighting yourself, achieving and maintaining the weight that is right for you is effortless – your body does the job for you’.

A further integral part of the HAES philosophy, and one that bespeaks Bacon’s other training as a psychotherapist, is that people should accept their bodies’ size and weight, and learn to love themselves. The ‘Health at Every Size promise’ is that ‘You can feel better about yourself. You can feel loved, accepted, and vital – and you can improve your health – regardless of whether you lose weight’ (Bacon, 2010: 2, emphasis in the original).

For someone reading the HAES manifesto as put forward by Bacon and others, it all seems so simple: love yourself and others will love you; trust your body’s instincts and good health will follow. The HAES philosophy appears to be eminently laudable, avoiding the kinds of fat stigmatisation and victim-blaming that are so pervasive in medical, public health and popular discussions of body weight (Lupton, 2012). Yet I would argue that there are elements of the HAES discourse that should be held up to critical examination. It is time to challenge its assumptions and to identify the inconsistencies and the brand of rigid thinking that underpin HAES, just as critics have done in relation to scientific anti-obesity discourse.

In her writings on HAES, Bacon constantly refers to the body’s natural ‘set-point’ which ensures that too much weight is not gained if one makes sure to follow one’s body’s cues. References to ‘turning over control to your body’ assumes that the body is a natural entity that has its own wisdom independent of where it is sited or what experiences it has gone through.

While I agree with and support the major principles of accepting a range of body sizes and shapes and that everyone, regardless of their size and shape should seek a lifestyle that is both pleasurable and healthy, as a sociologist, I tend to approach the words ‘natural’, ‘instinctive’ or ‘internal cues’ with suspicion. From a sociological perspective, the ways in which we understand, view, represent and live our bodies are always sited within cultural and social contexts. The body is viewed as a complex interplay of biology, society and culture, in which it is extremely difficult to extricate one element from the other.

I also find the continual position of ‘your body’ as a separate entity from ‘you’ in HAES discourse problematic. This discourse reproduces the classic Cartesian duality of the mind/self as separate from the body/flesh and turns it on its head. Instead of the rational mind positioned as superior to the fleshly body, here the body is represented as ‘wise’ and all-knowing, to which the mind/self should relinquish control. Yet as theorists such as Merleau-Ponty have argued, we cannot separate ‘self’ from ‘body’: we always and inevitably experience the world as embodied selves.

Take the concept of ‘internal cues’ for example. The HAES literature suggests that such cues are natural, instinctive, biologically determined and therefore appropriate to follow. But if nothing else, the sociology of the body and indeed, the sociology of food and eating (Lupton, 1996) have shown us motivations can never be fully or purely ‘internal’. They are experienced via social and cultural lens, including our own life experiences and our siting within the particular cultural context into which we were born and grew up. Bacon acknowledges this to some extent when she compares French with American attitudes to food and eating practices in a brief section in the book, but does not extend this idea to the rest of her argument. She also acknowledges the emotional dimensions of eating and food cravings. Here again, however, Bacon positions these embodied sensations as individual rather than as social products, and as separate from, rather than an integral part of, the self: elements, indeed, of the ‘inauthentic body’ which one should not obey. So which sensations of our bodies should we listen to? Which are the most ‘wise’ and ‘authentic’ and on what basis should we make these judgements?

Another important aspect of HAES that requires more critical examination is the concept that we should accept our bodies whatever our size and the assumption that this will lead to better self-esteem, a goal in itself. But such attempts to improve self-esteem from within fail to recognise the continuing fat prejudice and loathing that continues to exist within our society. Bacon argues that HAES will ‘give you the tools … to live in a body you love’ (2010: 5). But this is similar to asserting that prejudice, discrimination and stigma based on such features as a person’s ethnicity or race, or their age, can be dealt with by ‘loving yourself’. Such an approach attempts to change individuals’ behaviours rather than wider societal attitudes, and the problem therefore remains personal (Murray, 2008). Whatever one’s own attitude about one’s body, the external societal meanings will remain unchanged, and prejudice, discrimination and stigmatisation will continue to exist. Fat people themselves, however, hard they try, may struggle to accept their body size in such a punitive social environment. Their inability to ‘love themselves’ may well become yet another source of shame and guilt.

References

Linda Bacon (2010) Health at Every Size: the Surprising Truth About Your Weight. Dallas: Benbella Books.

Deborah Lupton (1996) Food, the Body and the Self. London: Sage.

Deborah Lupton (2012) Fat. London: Routledge.

Samantha Murray (2008) The ‘Fat’ Female Body. Houndmills: Palgrave Macmillan.

Can a thin person write about fat?

In recent years a field of study that has come to be entitled ‘fat studies’ has developed, largely in response to the discourse around obesity in developed countries. Just as gays, lesbians, bisexual and transgendered people have chosen to reappropriate the once pejorative word ‘queer’ for their own purposes, attempting to reinstate it as a positive self-identifying and political term, some academics and activists seek to use the word ‘fat’ to describe corpulent people in a positive, accepting manner.

In her foreword to The Fat Studies Reader, a ground-breaking collection of radical essays critiquing dominant cultural representations of fatness, well-known fat activist Marilynn Wann (2009: ix) defines fat studies as ‘a radical field, in the sense that it goes to the root of weight-related belief systems’. She contends that fat studies rejects the following assumptions: ‘that fat people could (and should) lose weight … that being fat is a disease and fat people cannot possibly enjoy good health or long life … that thin is inherently beautiful and fat is obviously ugly’ (2009: ix).

Interest in fat studies is such that there is now a new journal (Fat Studies: An Interdisciplinary Journal of  Body Weight and Society) and regular conferences and sections of major conferences devoted to this topic. Taking its name from other critical areas of interdisciplinary study such as gender, queer, black, Latino/a, postcolonial studies, those who designate themselves as part of this field tend to share the following ideas:

• they prefer the terms ‘fat’ or ‘fatness’ to what they view as the medicalised terms ‘overweight’, ‘obese’ or ‘obesity’;
• they challenge the dominant biomedical perspective on the relationship between fatness and ill health and disease (see here for my previous post on the contentions of obesity sceptics);
• they represent fat people as members of a minority group that contends with routine discrimination and marginalisation;
• they seek to counter and resist such discrimination and marginalisation;
• they often adopt a feminist or queer approach in their critiques.

The sculpture Bronskvinnorna (The women of bronze) outside of the art museum (Konsthallen), Växjö, Sweden. The sculpture is a work by Marianne Lindberg De Geer.  (Photo credit: Wikipedia)

There is no lack of evidence to demonstrate that these writers are correct in identifying highly negative meanings and experiences around fat embodiment, many of which have been apparent in popular and medical discourses for centuries (see here for my discussion of fat phobia). A central theme for many writers in fat studies, as well as in the areas of what are variously entitled ‘fat activism’, the ‘fat acceptance movement’ or the ‘size acceptance movement’ is that they themselves identify as ‘fat’ people. Adopting the position that ‘the personal is the political’, they view their activities as part of a political project.

Other scholars prefer the terms ‘critical obesity studies’ or ‘critical weight studies’ to describe their writings on the social and cultural dimensions of obesity discourse (for example, the contributors to the collection edited by Rich, Monaghan and Aphramoor, 2011). The emphasis in these terms is on the word ‘critical’, as these scholars seek to identify and challenge the taken-for-granted assumptions circulating in mainstream lay discourses and in the biomedical and public health literature on obesity/fatness.  Here again, many of these writers actively avoid the use of the term ‘obesity’, preferring instead to use the term ‘fat’. Such writers may themselves identify as fat, but this is not the case for all or even many of them.

Some commentators in fat studies and fat activism have expressed very negative opinions about people writing on the topic who do not themselves identify as fat. When I was working on my book on fat politics and fat embodiment (Fat, published this month), this was an issue of which I was highly aware, as I have always been a thin person and have therefore never personally experienced the stigmatisation and marginalisation to which many fat people have been subjected.

However, as I point out in my book, fat people are not the only individuals who have been singled out for attention in contemporary anti-obesity discourse. Mothers of young children, regardless of their own body weight, have been positioned as key targets in anti-obesity campaigns and programs because they are viewed as responsible for monitoring and disciplining their children’s diet and weight. As one such mother, I have found myself the subject of moral discourses in relation to the ‘child obesity epidemic’ , implicated in the network of expert advice directed at mothers (see here for a previous post on the topic of maternal responsibility for children’s weight). The voices of mothers with young children have not often received attention, except when researchers want to determine how well they are conforming to advice on controlling their children’s weight. Yet there are many difficult ethical questions to negotiate as a mother in response to weight control issues. How, for example, do mothers ensure that their children are healthy without instilling a hatred and fear of fat or of their own body if they do not conform to the ideal of slim embodiment?

Another argument against the rigid categorisation of people as ‘fat’ or ‘not fat enough’ to write about the politics of fatness and obesity is that fatness is a fluid and unstable category, depending on the historical and cultural context and personal experience. People who may officially be categorised as ‘normal weight’ according to medical guidelines such as the Body Mass Index (BMI) may still feel ‘fat’, particularly if they aspire to or admire the kind of extreme thinness displayed by models and celebrities. People who were once medically categorised as ‘obese’ or ‘overweight’ but then lost a great deal of weight and reduced their weight to a  ‘normal’ BMI may still identify as  ‘fat’. Conversely, people who have always been large-bodied may resist being labelled ‘overweight’, ‘obese’ or ‘fat’ because they view their weight as normal and appropriate for them. What has been considered ‘fat’ in one historical era has fluctuated according to the prevailing norms of beauty and medical advice.

Further, it may be contended that everyone, regardless of body shape or weight, is caught up in or reacting to obesity discourse in some way or another. According to several public health campaigns and policies, we are all potentially fat people, unless we take steps to constantly monitor and discipline our bodies. Whether or not we identify as ‘fat’, it is difficult to escape the prevalence and dominance of anti-obesity discourse and fat phobia. Willingly or not, resistant or accepting, we are all implicated in the contemporary discourse that positions fat people as morally deficient, undisciplined, sick and inferior.

References

Lupton, D. (2012) Fat. London: Routledge.

Rich, E., Monaghan, L. and Aphramor, L. (2011) (eds) Debating Obesity: Critical Perspectives. Houndmills: Palgrave Macmillan.

Wann, M. (2009) Foreword: Fat Studies: An invitation to revolution. In Rothblum, E. and Solovay, S. (eds), The Fat Studies Reader. New York: New York University Press, pp ix-xxv.

My new book ‘Fat’

My latest book Fat has just been published as part of Routledge’s Shortcuts series.

In contemporary western societies the fat body has become a focus of stigmatizing discourses and practices aimed at disciplining, regulating and containing it. Despite the fact that in many western countries fat bodies outnumber those that are thin, fat people are still socially marginalized and treated with derision and even repulsion. Medical and public health experts insist that an ‘obesity epidemic’ exists and that fatness is a pathological condition which should be prevented and controlled.

Fat is a book about why the fat body has become so reviled and viewed as diseased, the target of such intense discussion and debate about ways to reduce its size down to socially and medically acceptable dimensions. It is also about the lived experience of fat embodiment: how does it feel to be fat in a fat-phobic society? Deborah Lupton explores fat as a cultural artefact: a bodily substance or body shape that is given meaning by complex and shifting systems of ideas, practices, emotions, material objects and interpersonal relationships.

Fat reviews current scholarship and research into obesity discourse and politics, drawing upon critical perspectives offered in the humanities and social sciences and by fat activism and the size acceptance movement. It will be an engaging introduction for the interested general reader, as well as for students across the humanities and social sciences.

July 2012 on ‘This Sociological Life’

Part of this month was devoted to writing my three-part series on digital sociology. The first two of these posts: ‘Digital sociology 1: what is it?’ and ‘Digital sociology 2: professional digital practice‘ were republished on the LSE Impact of the Social Sciences blog. I have been working on collecting these posts, along with some other writings on using social media in academia, into a document that I will publish electronically next month, entitled Digital Sociology: An Introduction (watch this space for news on when the document will become available).

I also published two Storify presentations this month. One looked at the homage to British medicine and the NHS in the Olympics Opening Ceremony (including reactions on social media) (it can be viewed here). The other Storify presentation summarised the proceedings of a forum on the Social Determinants of Health that I helped to organise at the University of Sydney (see it here).

My piece on disgust in anti-obesity campaigns appeared in The Conversation. I am continuing to write about how disgust is used in public health campaigns for a journal article. I have been collecting examples of public health campaign materials on a Pinterest board as part of this research: the collection can be seen here.

This month I also finally completed the second revised edition of my book Risk (first published by Routledge in 1999) and sent it off to the publishers. One of my blog posts this month drew on one of the aspects I cover in the book: risk, concepts of space and place and the Other.

My article ‘M-health and health promotion: the digital cyborg and surveillance society’ was published in Social Theory & Health this month (see here for details).

June 2012 highlights on ‘This Sociological Life’

Last month was the first full month in the life of this blog, and it was a busy one. One of the most popular posts of the month looked at the debate provoked by the obesity sceptics who challenge the orthodox medical view that (non-extreme) obesity is detrimental to health. Many interesting opinions were posted in response to the post, including clinicians and health promotion academics working in obesity treatment and prevention and activists advocating for the Health at Every Size Approach, as well as my own comments providing details about other work in this area and in fat studies. There were quite a few relevant sources cited to back up commentators’ arguments, so these comments would be a good place to look for those interested in the debate between anti-obesity exponents and obesity sceptics.

Other posts published last month looked at topics such as how women engage in voluntary risk-taking (‘edgework’) and how this differs from men’s edgework; pregnancy and loss of control of the body/self; the concept of the ‘good mother’ in relation to the ‘fat child’; the Australian government’s controversial introduction of a mental health check for three-year-old children; the new mobile device technologies and how they are being used for health promotion; and the concepts of the ‘milkmother’ and the ‘Yummy Mummy’ in contemporary understandings and experiences of motherhood.

Another popular post in June looked at how sociologists and other social scientists can use the social media platform Pinterest as part of their research and teaching. This post was republished on the LSE Impact of the Social Sciences website. I noted in the post that I have made my own Pinterest boards on my current research interests. They include ‘Medicine as Culture’, ‘Fat Culture’, ‘The Sociology of Infancy’, ‘The Sociology of the Preborn’, ‘M-health and the Digital Cyborg’ and ‘Public Health Campaigns’ (you can view the boards here). I was also interviewed for The Australian newspaper’s Higher Education section about using Pinterest in academic work.

In June I also wrote a guest blog for ‘Croakey’, the health section of the ‘Crikey’ discussion website on making an app as an experiment to see how easy being an ‘app developer’ is (). To view or download the app itself (which explains over 25 key concepts in medical sociology) go here. I continue to be fascinated by the capabilities of social media for academic work and have been busy experimenting with Twitter (@DALupton), Delicious and Storify.

Meanwhile, in other academic writing my article ‘”Precious cargo”: foetal subjects, risk and reproductive citizenship’ was published in Critical Public Health. Last month I continued work on the revisions for the second edition my book Risk, originally published by Routledge in 1999, and plan to submit the final manuscript to the publishers at the end of July. I am bringing the book up to date by including, among many other issues, discussions of Ulrich Beck’s and Anthony Giddens’ latest writings on risk and new governmentality approaches on ‘prudential risk’ in the context of the catastrophic events that have occurred since the turn of this century and which have resulted in different ways of understanding and dealing with risk.

Is being fat bad for your health? Obesity sceptics disagree

Obesity Campaign Poster (Photo credit: Pressbound)

For some years now,  obesity sceptics have argued against the mainstream medical and public health perspective on obesity. Writers such as Paul Campos (2004), Michael Gard and Jan Wright (Gard and Wright, 2005; Gard, 2011)  have published closely argued critiques of the obesity science literature. They persuasively identify the many inaccuracies, distortions, misleading assumptions and generalisations made in scientific and epidemiological research which have contributed to the idea that obesity is at ‘crisis’ or ‘epidemic’ levels and that being over the arbitrarily defined ‘normal’ BMI automatically damages people’s health.

Some specific points obesity sceptics make are as follows:

• It is not the case that there are far greater numbers of fat people now compared to several decades ago. While there has been a modest increase in average weight, this does not represent an ‘epidemic of obesity’.
• Life expectancy in western countries has risen, not fallen, despite alleged growing rates of obesity and the supposed life-threatening health conditions caused by obesity.
• There is no statistical evidence that being fat necessarily equates to a greater risk of ill health or disease. Statistics show that only those people at the extreme end of the weight spectrum (the ‘morbidly obese’ in medical terminology) demonstrate negative health effects from their weight. The data show that higher body weight may even be protective of health in older people.
• The epidemiological literature has been unable to demonstrate that significant weight loss improves fat people’s health status. Indeed continual attempts by fat people to lose weight can actually be negative to their health status if it involves extreme diets, being caught in a cycle of losing and gaining weight or poor dietary habits.
• Fatness is often a symptom rather than the cause of ill health and disease.
• There is no consensus from the scientific literature that people in contemporary western societies are less active now than in previous eras: indeed many people, particularly those from the middle-class, are highly physically active.
• No clear association has been found between activity levels and childhood overweight and obesity, or between children’s television watching habits and their body weight.
• Nor have studies conclusively demonstrated that relative levels of physical activity influence health status. Medical research has not been able to show how much exercise should be undertaken and how often to achieve and maintain good health and which diseases are affected or prevented by taking regular exercise.
• It is also very difficult to demonstrate scientifically the relative influence of genes in body weight.

In all these areas there are many contradictory and conflicting findings from research studies, making it difficult to anyone to make confident statements about these issues. As these obesity sceptics point out, many of the generalisations made by obesity scientists and public health experts simply disregard the lack of consistent, clear or conclusive evidence for such statements as ‘obesity is caused by lack of exercise and eating too much’ and continue to reiterate these assertions.

What obesity sceptics present, in essence, is a detailed critique of the ways in which political agendas and pre-existing assumptions shape the reporting and interpretation of medical and epidemiological data relating to body mass. Quite apart of its relevance to debate about whether the obesity epidemic exists and how serious it is, such an analysis is valuable in drawing attention to the work practices and knowledge claims of medical and public health researchers.

The assertions and critiques of obesity sceptics have failed to make an impact on mainstream obesity science, government health policy and anti-obesity public health efforts. Journal articles concerning the dangers of obesity continue to appear in medical and public health journals with monotonous frequency. Alarmist predictions continue to receive attention in the mass media. Governments in western countries have also continued to invest large sums to fund health promotion campaigns seeking to counter obesity. For example, the American ‘Let’s Move’ campaign, directed at controlling childhood obesity, was launched by First Lady Michelle Obama in early 2010, while on the same day President Obama created a Taskforce on Childhood Obesity. The Australian ‘Swap It, Don’t Swap It’ anti-obesity campaign commenced in early 2011. It would seem that there are powerful political and career investments in continuing to ignore the arguments of the obesity sceptics.

References

Campos, P. (2004) The Obesity Myth. New York: Gotham Books.

Gard, M. and Wright, J. (2005) The Obesity Epidemic. London: Routledge.

Gard, M. (2011) The End of the Obesity Epidemic. London: Routledge.

Can a ‘good mother’ have a ‘fat child’?

Chrissie Swan with her sons

This week an Australian television and radio personality, Chrissie Swan, appeared in a cover story of a well-known national women’s magazine talking about her family. Swan has two sons, one a baby and other aged three. The story included photos of Swan and her sons, which demonstrated to readers that her elder boy, Leo, was rather chubby. Following publication of the story, social media forums erupted with a debate about whether Swan should have ‘allowed’ Leo to become fat and proffering advice about what she should be doing about it, including comments highly critical of Swan.

This criticism received much attention in other parts of the internet and on mainstream Australian news media. Swan was forced to appear on television and radio programs to defend herself. She noted that she herself had struggled with her weight throughout her life and had recently become aware that Leo was ‘a bit heavy’ and was working to do something about it. Swan also commented on the unkind nature of the comments and that she had been reduced to tears in response.

It is not surprising that this debate received so much attention. It brings together two extremely potent and value-laden cultural concepts: that of the ‘good mother’ and that of the ‘fat child’. Dominant concepts of the ‘good mother’ contend that mothers should closely monitor and regulate their children’s bodies, paying careful attention to their health and wellbeing and acting upon any problems that may arise. They should consult expert advice as part of their efforts to promote their children’s health.

The figure of the ‘fat child’ has received a high level of public health and mass media attention since the late 1990s. A moral panic has developed around the issue of ‘childhood obesity’ and it has been argued that children are now more overweight than at any other time in human history. Fatness in general is surrounded with moral meanings concerning lack of self-control, greed and laziness. When small children are considered to be overweight, these moral judgements are transferred to their mothers. As in the case of Swan, such women become positioned as ‘bad mothers’ who have neglected their children’s health.

What is also evident from the criticism of Swan is that mothers, particularly those in public life but also ordinary women, are constantly placed in a position in which their parenting and the way in which they care for their children are open to judgement from others. This begins when pregnant women in public spaces may be castigated by strangers for smoking or consuming alcohol. Judgement of mothers follows into early infancy, when women who do not breastfeed, or those who breastfeed in public, may be reprimanded and called to account by others. Throughout their children’s early years, problems or health conditions experienced by their children are frequently positioned as the result of a mother’s failings to heed expert or lay advice about how best to care for her children.

I have found in my own research with mothers about their beliefs and experiences of promoting their infants’ and young children’s health that they are highly aware of conforming to the ‘good mother’ ideal in taking responsibility for their children’s health, development and wellbeing. They are also aware of the judgements that other people made of their actions, including other mothers. Most mothers in my study were concerned about the ‘obesity problem’ and attempted to ensure that their children ate a healthy diet and exercised. They even tried to act as role models for their children in relation to these behaviours by disciplining and regulating their own bodies. But the women were also confronted with the fact that they do not have full control over their children’s health, development and wellbeing. Despite their mothers’ best efforts, children sometimes become ill or have an allergy, developmental or behavioural problem, or may refuse to eat the ‘right’ kinds of foods.

Concepts of health risks have become privatised to the sphere of the home and to the figure of the ‘good mother’. Notions of fate as causing ill-health or disease have given way to the idea that these conditions are the result of the individual failing to take up medical or public health advice to engage in health-promoting behaviour. As a result, women blame themselves for their children’s health problems, or are blamed by others. And the role of the fathers of these children in caring for them and protecting their health are barely mentioned.

References

Bell, K., McNaughton, D. and Salmon, A. (2009) Medicine, morality and mothering: public health discourses on foetal alcohol exposure, smoking around children and childhood overnutrition. Critical Public Health, 19(2), 155—70.

Lupton, D. (2011) ‘The best thing for the baby’: mothers’ concepts and experiences related to promoting their infants’ health and development. Health, Risk and Society, 13(7/8), 637—51.

Lupton, D. (2012) ‘I’m Always on the Lookout for What Could be Going Wrong’: Mothers’ Concepts and Experiences of Health and Illness in their Young Children. Sydney Health & Society Group Working Paper No. 1. Sydney: Sydney Health & Society Group. Available at http://hdl.handle.net/21238351.

Loving yourself in a fat-phobic society

The 2012 season of the Australian The Biggest Loser focused on the loneliness and despair endured by the contestants.  Not only were the contestants forced to expose their semi-naked bodies to the viewing audience as part of the ritual weighing-in process, they were also encouraged to bare their souls. Thus, for example, a promo for the series showed one of the male contestants sitting on a stool gesturing to his fat body and saying “Look at me – no-one loves this!” Another male contestant said, “I’m ready for love” and the words ‘Love yourself’ scrolled across the screen.

The episodes featured the now-familiar visuals of the contestants pushed to exercise hard, shown sweating, red-faced and out-of-breath, grimacing in pain, crying and losing their temper as the hard-bodied and hard-faced instructors shout at them to force them to persist. Scenes involving the temptation of the fat people were also part of this series. The contestants in one episode were faced with a room full of junk food and sweet treats – chocolates, cakes and the like — as a means of testing their self-control and ability to resist temptation.

The underlying meanings of this program are all too clear. Fat people are lonely, unloved, emotionally volatile and sad; they deserve punishing exercise routines and stringent diets as part of their weight-loss efforts; they are childish and need a stern authority figure to force them into proper weight-loss habits; they find their gluttonous desire for treats difficult to resist. The focus on love in this season combines two ideas: that fat people do not love themselves, or else they would not have allowed themselves to become fat, and that no-one else is sexually attracted to them because of their fat bodies. Such people are represented as objects both of pity and contempt.

Recent critiques in the social sciences and humanities have drawn attention to the ways in which obesity is represented in medical and popular culture. In response to massive publicity given to obesity in western countries, including Australia, new areas of study focused specifically on the social and cultural aspects of obesity have emerged, entitled variously ‘critical obesity studies’, ‘critical weight studies’ or ‘fat studies’. They refer to a ‘fat-phobic’ society, in which fat people are excoriated and humiliated for their size, where it is assumed that fatness is the direct result of greed and lack of self-control and that fat people are inevitably unattractive to others.

Members of the fat acceptance movement have engaged in political activism in the attempt to overcome this discrimination and to reclaim the term ‘fat’, which they prefer to the ‘o’ words – overweight and obese.

Some social scientists and nutritionists have examined the obesity science literature and argued that much of it is characterised by generalisations and speculations, and that the contention that overweight (as distinct from morbid obesity) automatically poses health risks has not been scientifically proven. It is further argued by these critics that continual attempts by fat people to lose weight can actually be negative to their health status if it involves extreme diets, being caught in a cycle of losing and gaining weight or poor dietary habits.

Partly as a response to this critical position, a movement called Health at Every Size has emerged which champions the idea that good health may be experienced at a range of body weights if attention is paid to regular exercise and eating healthy foods. From this perspective ‘loving yourself’ may well involve relinquishing the desire to lose a lot of weight and instead acknowledging that a healthy lifestyle may be achieved even if one does not conform to the cultural ideal of slenderness.

The critical position and the Health at Every Size movement raise important questions for how the public is educated about the health effects of overweight and obesity. In the meantime, programs such as The Biggest Loser continue to profit from perpetuating negative representations of fat people in a fat-phobic society and humiliating and punishing their contestants for their sin of being fat.

Further reading:

Fat Studies journal (http://www.tanf.co.uk/journals/UFTS)

Michael Gard and Jan Wright (2005) The Obesity Epidemic: Science, Morality and Ideology. London: Routledge.

Michael Gard (2011) The End of the Obesity Epidemic. London: Routledge.

Deborah Lupton (2012) Fat. London: Routledge (due for publication in September)