Last week, I wrote about obesity as a failure of self-discipline. A lot of you wrote back to let me have it. In the Fray, blogs, and e-mail, you told me I was wrongheaded and just plain mean. Some of this is miscommunication, but it's my fault. I was trying to explain something important, and I botched it. Let me try again.
The topic was a study published in the New England Journal of Medicine. It documented weight trends in a social network originating in Framingham, Mass. What the study illustrated, according to its authors, was "psychosocial mechanismsof the spread of obesity" through "a change in [one's] perception of the socialnorms regarding the acceptability of obesity." As your friends get fat, you start to think their degree of fatness is OK for you, too.
That's the important point. Now let's talk about what it means—and doesn't.
1. It doesn't mean you should ditch your fat friends. The study's implication, as I described it, is that "if you find yourself caught in a fattening social network, you have three options. You can resist the fattening norm. You can try to reverse it. Or you can ditch your fat friends." The authors discouraged the ditching option on the grounds that friendship is good for your health. Instead, they suggested, you should spend more time "forming ties with underweight or normal weight friends."
Ugh. This is a classic case of scientists inventing the kind of argument they're comfortable with—a scientific one—for what's really a moral point. The invented argument is well-intended but bogus. If you spend more time with "underweight or normal weight friends," you're spending less time with overweight friends. That's a mathematical and social fact, just like more time at the office means less at home. Nor does the healthiness of friendship require you to keep your fat friends. By trading them in for thinner friends, you'd end up with just as many friends as you had before. So, I made those points, because I don't like deceptions.
Then I did something stupid: I ended the piece. I neglected to spell out what I assumed: You shouldn't ditch your fat friends anyway—not for health reasons but because the point of friendship is that you don't go around ditching your friends every time that might be "in your interest." Your friend may develop an addiction, fall on hard times, or get a disease. Standing by him could become inconvenient in lots of ways. Do it anyway, because a person is more than his wealth or his disease and because friendship is more than convenience. If your friend develops something harmful and remediable, such as an addiction, you should help him fight it. That's what I was clumsily trying to say.
2. It doesn't mean all fat is acquired through lack of discipline. Some fat, as I explained last week, is genetically or environmentally induced. But I added that
such factors can't account for the spread pattern documented in this study. Genetics can't explain it, since having a fat friend was more likely to predict a person's obesity than having a fat sibling was. Environmental constraints can't explain it, since faraway friends made a difference, while next-door neighbors didn't. Availability of food can't explain it, since friends had a bigger effect than spouses did.
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.