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Fat Lies RevisitedObesity, self-discipline, and stigma.

Illustration by Robert Neubecker. Click image to expand.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 mechanisms of the spread of obesity" through "a change in [one's] perception of the social norms 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.

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William Saletan is Slate's national correspondent and author of Bearing Right: How Conservatives Won the Abortion War. Follow him on Twitter here.
COMMENTS

Remarks from the Fray:

It's interesting that scientists can't seem to make skinny people fat any more than they can make fat people skinny. When that happens I'll be more interested in what they have to say. The most interesting studies I've seen suggest that the use of corn syrup solids as a sweetener have more to do with climbing weights than any particular change in eating behavior. Most of the world is also less likely to work at jobs that involve physical labor: that people would have less muscle mass seems fairly preordained.

And I like your supposition that since bias against fat isn't working we just need to make it stronger. Sort of like if torturing people doesn't get accurate information just increase the severity, they'll get you're serious eventually.

--Justin

(To reply, click here.)

Somewhat less severe stigmatizing, or rather just teasing, is fine between male friends. Referring to your male friend as "fatboy" is normal, and if he starts crying or binge eating, then you can stigmatize him for being a pussy.

Female friends? Nope. Can't do it. In this case, you ought to find a better, more positive way to get them to lose weight. This is a major problem when dealing with a tubby daughter. My kid is overweight and I refuse to even acknowledge it. Why? Because I'm also responsible for her self esteem and hitting a 13 year old on her weight is way to, uh, heavy. So, no stigmatization, and in fact, the dad's always got to make the kid feel good about themselves.

Stigmatizing a daughter will just end up fucking her up in many fundamental ways that can be far worse than the health effects of obesity.

--doodahman

(To reply, click here.)

Your article of September 2, 2006 was fascinating in its juxtaposition of how humans evolved to survive periods of scarcity and the resultant irony of the current food surplus. It further points out the relatively recent link between poverty and obesity, primarily due to the creativity of the commercial "food" industry. In my opinion, in the United States at least, the only reasonable "excuses" for obesity are related to lack of education and/or economic well-being. I'm perfectly fine with whatever choices people make for themselves but our education system should start treating junk food and fast food a little more like it treats cigarettes and alcohol, so that children grow up knowing it's not really "food" in the sense of necessary sustenance, but rather a treat that is enjoyable in moderation but potentially harmful.

Stigma is the wrong word, but education and responsibility are critical.

--Looney

(To reply, click here.)

You have made a leap of logic by saying that fat stigma is the way to keep people thin. How do you know active stigma and active "don't get fat" messages are how thin people stay thin and encourage others in their social network to do the same? Is thinness spread by thin people telling other thin people not to get fat? Or is thinness spread by a subtle promotion of being active and eating well? Fat people aren't spreading fat by telling their friends to be fat, so why would you assume that telling people to be skinny would be effective? Isn't it more likely that I have friends that I admire that are skinny, these friends like to hike and tell me about hiking. Then, I think, hiking sounds like fun, I'm going to do more of it. Nobody told me I was fat and to cut it out. I think you are missing the subtle/subconscious way these messages spread- (getting fat or staying fit), which is really the most surprising part of the study.

--im1

(To reply, click here.)

One reason obese people often don't rate themselves as obese is because the medical definition doesn't square with most people's idea of what obese -- or really fat -- is. the little-reported truth is that health authorities, in part for political reasons having to do with establishing a public health crisis and increasing research money, arbitrarily lowered the weight (or BMI) that establishes someone as obese. They did this right around the time our obesity epidemic skyrocketed. By the current medical definition, most people become "obese" versus "overweight" when they gain a mere five pounds. The average person would not look at a borderline obese man or woman and think they're terribly fat. In fact, by the BMI defintions -- which are highly flawed, not accounting for body type or muscle mass -- some people would end up looking downright gaunt if they strictly followed the normal-weight guidelines.

--susan orenstein

(To reply, click here.)

Thinner friends trying their gee-whiz best to "help" overweight and obese friends as a kinder/gentler form of stigma is just not going to stop the fattening of Americans. But institutionalizing the stigma COULD. Smoking, one of the largest preventable sources of death in our country, is on a slow but sure decline, and it wasn't because a lot of non-smoking friends talked their smoker friends into stopping. It's because they banned the ads on TV and radio, they barred the stuff from restaurants and offices and other work places, they sued the hell out of tobacco companies and they got some cities now on a bend to make it as difficult as possible for smokers to light up anywhere else. Talk about stigmatizing, and thank goodness for that!! How I wish we could ban fast foods and processed dinners...

--Dana

(To reply, click here.)

There have been studies suggesting that dieting actually worsens obesity, long term. If that's true, the stigma against fat could be worsening the epidemic: mildly chubby people are made to feel bad and so they try to force their bodies to fit a thin ideal, starving themselves. Their bodies, hard-wired to want to carry a little extra weight, react by trying to store even more fat against what gets perceived as an intermittent threat of famine, and fitfully their weight increases over time, rising from mere chubbiness to morbid obesity.

I've also seen, anecdotally, a similar phenomenon taking place with exercise. Mildly overweight people become so embarrassed about their size that they start to withdraw from physical activities that will emphasize their extra fat. If you're carrying an extra 30 pounds, and you live in a society that idealizes slim people, you don't want to call extra attention to your problem by doing something where you get winded and sweaty faster than all your friends. Better to keep to couch-based activities. If you succeed in steering social activities away from those that subject you to extra stigma, not only will you get fatter, so will those you associate with.

It's possible that if our culture weren't so hung up about people being a bit overweight, we'd have a whole lot fewer badly overweight people.

--Arkady

(To reply, click here.)

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