I was trying to distinguish two categories of fat: the kind some people acquire despite their best efforts and the "psychosocial" kind nearly all of us can get from slacking off. Some people came into the Framingham study carrying the first kind. As the study went on, others developed the latter kind. I was too sloppy about maintaining this distinction. For example, I wrote, "Obesity spreads culturally." No. Some obesity spreads culturally.
3. Stigma is dangerous. What most infuriated readers was my conclusion that "responsibility and stigma are part of the solution." To the extent that fat is acquired through lack of discipline and loss of concern about proper weight, that's true. But I'm having second thoughts about stigma, because its nature is more sentimental than rational. Sentiments are crude, probably too crude to distinguish one kind of fat from another. You can't tell from looking at a chubby guy whether he's cursed with bad metabolism or just watches too much television. So, stigma could do more harm than good. Somehow, we need to reinforce norms against "psychosocial" weight gain without blaming people who have been dealt a bad hand.
Also, I should have distinguished two different ways in which "socialnorms regarding the acceptability of obesity" can change. One is that people stop caring about being fat. The other way is that they still care, but their definition of fat slides. The Framingham study doesn't clarify which process was going on. If what's sliding is the standard of obesity, rather than concern about being fat in general, then people may not need a forceful cultural message against obesity. They may just need clarification of where the line is.
Many of you argued that there's already plenty of stigma against fat. If we're talking about people constrained by factors beyond their control, I agree, since in their case, any stigma is too much. But if we're talking about controlling the psychosocial spread of obesity among the larger population, then no, the current level of stigma isn't doing the job. Obesity is spreading worldwide, and sliding norms are a big part of it.
Exhibit A: Last year, nutritionists presented data from a study of middle-aged Americans. Participants were asked to classify themselves as underweight, normal weight, overweight, or obese. Then they were weighed. Only 15 percent of obese people, compared with more than 70 percent of normal and overweight people, classified themselves correctly.
Exhibit B: In a 1985 survey by the NPD group, 55 percent of U.S. adults agreed that "[a] person who is not overweight is a lot more attractive." By 2005, only 24 percent agreed. The firm concluded, "Perhaps Americans have found that the easiest way to deal with their weight is to change their attitude."
What these data suggest, together with the Framingham study, is a cultural erosion of norms against fat. We need to confront it. As somebody who preaches self-discipline to others, I'm sorry that my carelessness got in the way of making the point.