Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic”

Conclusion. Health at Every Size or Thing at Any Price?

124 In the years since this research was first conducted, concern over obesity as a social problem has only intensified. The continued search for a miracle weight-loss drug and the expansion of weight-loss surgery eligibility to children and people at lower and lower BMIs has been facilitated by debates about the rising cost of health care, which put obesity front and center. The great recession has brought a new focus on cost cutting, and more and more companies are adopting policies that either offer incentives for weight loss or penalize the overweight and obese. Michelle Obama has chosen childhood obesity as the centerpiece of her agenda as first lady and has declared that we should aim to wipe out childhood obesity in the next decade. Other social and environmental movements, like the slowfood and locavore movements, have used social panic about obesity to make the case for their own agendas and, in doing so, have effectively alienated fat people who share their concerns about food production and distribution. In short, concern over obesity and its presumed catastrophic consequences is at the center of national debates around everything from the military to the economy, and obesity has become a rallying point for social causes as varied as environmentalism and education reform. I develop the concept of a postmodern epidemic to account for the pervasive and flexible place of obesity as a contemporary social problem. A postmodern epidemic is a new social form in which previously unmedicalized phenomenas are framed in terms of the moral panic and chaos characteristic of traditional epidemics of biological contagion and mass Conclusion Health at Every Size or Thin at Any Price? CONCLUSION 125 death. These postmodern epidemics center on the designation of problematic populations and the universalizing of risk and, at the same time, rely on individual self-correction to norms for their resolution. I argue that, given this shift in the definition of an epidemic, this expands the range of social phenomenas that can be designated as epidemics to the effect that larger issues of social structure and inequality can be reframed in terms of the public and economic threat posed by the deviance of particular individuals, bodies, and populations. In the case of the obesity epidemic, I have shown that its existence as an epidemic relies on historical understandings of fatness and the need to individualize responsibility for health in an era where state support for public health is low and income and wealth inequality are high. The ascendancy of the BMI as the statistical norm around which the epidemic is centered has facilitated the designation of entire populations as “healthy,” “diseased,” or “at risk” on the basis of a single number. This power of the BMI to abnormalize more than half of all Americans and to single out children, the poor, and minority populations serves to obscure the social determinants of health. Thus, it becomes useful to a government seeking to minimize spending on social services as well as to an industry seeking to profit from weight-loss efforts. As I showed in chapter 1, the agreement of the Department of Health and Human Services (DHHS), the North American Association for the Study of Obesity (NAASO), and the American Obesity Association (AOA) on the designation of obesity as epidemic remained, even as the DHHS sought to individualize both the problem and the solution, while the AOA and NAASO professionalized around efforts to further medicalize obesity and seek government funding for obesity research and surgical and pharmaceutical treatments. The second main contribution of this book is to show how interventions into the obesity epidemic are based on women’s individual attempts to manage the stigma of fatness through normalization projects designed to correct themselves not only to the norm of the BMI, but also, most significantly , to norms of gender, sex, race, and class. Looking at behavioral and surgical weight-loss programs showed that much of people’s motivation for weight loss comes from experiencing the social costs of deviating from these norms. In addition, normative constructions of the fat personality and women’s inherently abnormal relationship to food and eating also serve to individualize the frequent failure of both behavioral and surgical weight-loss methods. Even as population norms like the BMI and lay and professional discourses about fatness and fat people construct the epidemic, other conventional norms are embedded in its resolution. This is evident because although the...