The Perils of 'Fat Acceptance': density-as-destiny and other myths.

ON my office wall hangs a framed New Yorker cartoon of a map of the United States that labels the entire country "Too Fat," save for the dot designating Los Angeles as "Too Skinny." I chose it as a parody both of the field in which I work--health and nutrition--and of the area in which I live: Malibu, California. Camryn Manheim, author of Wake Up, I'm Fat!, described Southern California as a place "where people shop for groceries in bikinis." What for fat people are "the two most terrifying things in the world, shopping for food and being practically naked, these sun-soaked creatures do simultaneously."

Which is why I thought this Land of the Lean a curious choice for this year's annual conference of the National Association to Advance Fat Acceptance (NAAFA). I decided to investigate, drawn by both proximity and paradox. A conference premised on persuading people to accept rather than fight their fat seemed not just out of sync with its surroundings, but also out of step with the times.

Not a day goes by without fresh headlines about the prevalence, health risks, and mounting medical costs of obesity. This drumbeat of bad news, however, did nothing to deter those gathered at the LAX Marriott for four days of seminars on such topics as socializing at the pool-side luau and "Ample Hygiene for Ample People." To the extent that these research results were mentioned at all, they were dismissed as further proof of a society conspiring to make fat people feel bad. It put one in mind of what it must have been like to attend a gathering of student Marxists after the fall of the Berlin Wall.

Thus news of the increased risk for cancer, heart disease, birth defects, osteoporosis, and diabetes among the overweight and the obese was greeted with defiance and waved off with denial. Besides, NAAFA members make use of rising weights as an opportunity to redefine normal. As Michael Fumento pointed out in his prophetic book Fat of the Land (1997): "The fat activists seem to take great comfort in the growing American waistline, seeing it as both a confirmation and a matter of safety in numbers."

With 2,500 members, NAAFA's numbers--and those of similar groups such as the Body Image Task Force and the Network for Self Esteem--remain relatively small. The real measure of their success lies in the degree to which society has come around to their point of view. If setting a size-acceptance gathering smack dab in image-obsessed L.A. seems ironic, it actually represents a dichotomous phenomenon underway across the land. As Americans have grown fatter, two things have occurred: One is the rise of the billion-dollar diet industry, the other is the emergence of a culture of accommodation. The first caters to those who want to lose weight, with advice ranging from the helpful and healthful to the harmful and fraudulent. The second caters to those who despair of losing weight by telling them to drop the guilt, not the pounds. In the lexicon of the latter, restrained eating is invariably described as "starving," gluttony is defended as "enjoying life" (even as it shortens it), and corpulence is euphemized as "curvaceous." Such language may make one feel better about being fat, but only at the cost of perpetuating the choices that helped create the condition.

'FAT AS FATE'

While fat activists have raised some legitimate concerns--lobbying doctors for wider examination tables, for example, or pressuring car manufacturers to provide seatbelt extensions for the extra-large--their view of fat as fate has undermined both individual efforts to overcome obesity and society's ability to deal with it effectively. The recent spate of fast-food lawsuits took advantage of enduring ambiguity over who bears responsibility for weight gain. At the same time, the equation of weight with other immutable traits, like race, has provided grounds for workplace-discrimination suits.

Indeed, the pioneers of fat acceptance modeled their movement after those of other aggrieved groups. Susie Orbach's 1978 bestseller Fat Is a Feminist Issue exhorted women to abandon their diets in rebellion against unattainable beauty ideals allegedly imposed by capitalism and patriarchy. But as this oppressed minority grew into an overweight majority, so did its literature, soon including such titles as Big Fat Lies; Thin Is Just a Four-Letter Word; Eat, Drink & Be Merry; You Count, Calories Don't; Life in the Fat Lane; and What Are You Looking At?: The First Fat Fiction Anthology.

Though divergent in their aims, both the diet and the anti-diet books employ the same method: mind over matter. The diet books do this by enlisting willpower to lose weight, the anti-diet books by using wishful thinking to dismiss its importance altogether. Similarly, NAAFA endeavors to advance acceptance by retreating from reality. Upon registering for the conference, I entered a world in which "fat people are far less likely to get almost every form of cancer ... than thin people" and in which dieting--not poor food choices or overeating--is the real cause of weight gain. For those who found their grip on unreality slipping, there was a refresher seminar entitled "Relapse Prevention for Recovered Dieters" to help them guard against those moments of weakness "when weight loss looks seductive." Indeed, what was seductive here was not washboard abs or buns of steel, but rather the Buddha-like bellies and pillowy posteriors celebrated by the few FAs (fat admirers) here to meet BBWs (big beautiful women) and attend the "Men Who Love Fat Women" session.

I arrived at the conference with a degree of anxiety, fearing not just that I would fail to fit in, but that my very presence would attract hostility. As a Size 4 workout fanatic, I am one "skinny bitch," in the view of fat apologists. As sitcom-actress Mo'Nique comically observed in her book Skinny Women Are Evil, "Skinny bitches know who they are. If your dress size is in the single digits, chances are I'm talking to you. You're evil and need to be destroyed." With this indictment ringing in my ears, I marched my skinny behind up to the registration table. The extra-large lady behind the desk eyed me with animosity, a Botero staring down a Giacometti. I told her that I was pre-registered and as she searched for my name I busied myself examining the buttons for sale, buying a handful in a hapless gesture of good will. But which one to wear? "Large and In Charge"? "FAT by nature, PROUD by choice"? I settled on "Woman of Substance" and stashed the rest in my complimentary welcome bag.

For my first seminar I was torn between a "Chair Dancing" class and a session entitled "Worth Your Weight." I chose the latter even though, by that calculation, I was obviously the most worthless member of the group. Our facilitator, Barbara Altman Bruno, Ph.D., author of Worth Your Weight, led the lecture/group-therapy session on attitudes toward fat in modern America and different cultures through the ages--recounting how fat women have been prized in Soviet Russia, Third World Africa, and ancient Egypt. Her point, of course, was that perceptions of beauty are relative rather than absolute, so it makes little sense to "weigh our worth" in scales equilibrated by Madison Avenue.

This view of the fungibility of beauty ideals is an oft-repeated and over-exaggerated one. Sure, flappers were flat-chested, and postwar wives were wasp-waisted by Dior, but, for the past half-century in America, fashionable figures have, by and large, been anything but Rubens-esque. It's true that, every season, women's magazines run their "in" and "out" columns and, like clockwork, inform us once again that "curves" are in and "super-thin" is out, but the only real difference between Gisele Bundchen and Kate Moss is a couple of cup sizes. As for Marilyn Monroe's famous Size 14, I've seen the actual dress she wore in her nationally televised birthday serenade of President Kennedy, and it stands as Exhibit A in size-inflation: By today's standards, it would comfortably fit a Size 8.

But Dr. Altman Bruno is correct in a deeper sense. While ideals of beauty may not change that dramatically over the course of our lifetime, our own exteriors--whether lithe or large--will. To set one's self-esteem by how well we match up against the ageless, unlined faces and adolescent bodies that adorn fashion covers is masochistic madness. Fitness, sunscreen, plastic surgery, and hormone therapy may temporarily postpone the inevitable, but unless we can finally bring ourselves to accept what we cannot change--in this case, the passage of time--we are destined to despair. It's only when this axiom is applied to the condition of obesity that I get lost. But belief in density as destiny lies at the heart of fat acceptance. So immutable, in this view, is one's weight, that even to try to change it is as futile and, indeed, dangerous as attempting to alter natural law.

GOOD FOODS AND BAD

Although "Worth Your Weight" was supposed to be about cultural attitudes toward fat, as I discovered it is impossible to sit through more than 15 minutes of one of these seminars without someone circling back to the evils of dieting. Dr. Altman Bruno told our group, "The best way to develop an eating disorder is to go on a diet, because it makes some foods good and some foods bad."

I thought back to when I was 15 and went on my first diet, and realized she was right. Among my favorite foods at the time were pecan-sandy cookies, butterscotch sundaes, Cheetos, and cream soda. As a result of loving these foods a little too much I found my jeans a little too tight and so began what would become a lifelong habit of reading food labels and counting calories. I learned that, measure for measure, fruits and vegetables had relatively fewer calories whereas cookies and junk food had relatively more--so I could eat all I wanted of the former, but very little of the latter if I wanted to lose weight and keep it off. So, yes, dieting can definitely make some foods good and others bad--and all that we've learned in recent years about fiber and phytochemicals, on one hand, and processed carbohydrates and partially-hydrogenated oils on the other, serves to reinforce that distinction.

Such sharp-edged distinctions are unwelcome at NAAFA, where roundness reigns and no food need fear discrimination. But while the all-foods-are-good message is cast into plain relief at a conference where the unhealthy results of alimentary inclusiveness are on ample display, the larger and more important truth is how this message, and other fat-acceptance standards, permeate our culture at large. Indeed, other than the context, there's little difference between Dr. Altman Bruno's message and the culture-wide conventional wisdom that "all foods can be part of a balanced diet."

Obviously, there is literal truth to this argument: No single food is responsible for obesity. Just as obviously, and more importantly, some foods--energy-dense, low-nutrient foods--are more responsible than others. By emphasizing the largely irrelevant assurance that eating foods such as ice cream and potato chips once in a while won't kill you, we obscure the far more fundamental fact that their regular overconsumption ultimately may.

This misplaced emphasis finds its parallel in the idea that images of lanky-limbed models encourage eating disorders such as anorexia. It's possible, but far from proven, that they do. But we are not faced with an epidemic of thinness. Whatever subliminal signals are being sent by the fashion spreads of Elle and Vogue, they are clearly being overwhelmed by accompanying editorial content preaching beauty-at-any-size. Contributing to this schizophrenia are conflicting vices--gluttony and vanity--and competing evolutionary drives: sex and survival. Gluttony abets over-consumption in the interest of surviving the next famine; vanity encourages approximation of existing beauty ideals in order to attract a viable mate. But whereas these biological bents have been with us for ages, the spike in obesity is a relatively recent phenomenon. In the past two decades alone, obesity has doubled; the percentage of children and adolescents who are overweight has more than tripled--surpassing over 9 million youths today.

CULTURAL DRIFT AND LAISSEZ-MANGER

While the main drivers of this change were agricultural, economic, and technological in nature (e.g., cheap sweeteners, shelf-stable fats, labor-saving inventions), less tangible forces were also at work. Most significantly, mores shifted markedly in a more permissive, selfreferential direction, influencing both our outlook and our behavior regarding issues ranging from drugs to sex to divorce. Society's approach to food and body size was not exempt from this drift.

Unfortunately, the very values needed to deal with the rising ubiquity of low-cost, high-calorie foods--namely, self-restraint and delayed gratification--were simultaneously going out of style. Similarly, while the number of new candy, gum, and snack products on the market was increasing tenfold in the two decades after 1980, our approach to child feeding changed as well. The tangible factors responsible for childhood weight gain--e.g., school vending machines, more junk food, and less exercise--have been widely recognized, as has their result. Far less remarked upon is how a simultaneous sea change in cultural values may have contributed to the problem: Namely, how a new laissez-faire approach to children's discipline encouraged a laissez-manger approach to their diets as well.

In Fat Land: How Americans Became the Fattest People in the World, Greg Critser describes how a new generation of child-rearing experts "tended to view the child as a kind of infant-sage" whose appetite should serve as the "guide to how parents should feed him." Thus the reference point for proper diet was anchored in subjective sensation rather than rational thought--in accordance with the progressive intellectual currents of the times. Critser cites the popular parenting book Are You Hungry?: A Completely New Approach to Raising Children Free of Food and Weight Problems, in which authors Jane Hirschmann and Lela Zaphiropoulos argue that children "themselves should have the responsibility of determining the foods they eat."

This "self-demand" feeding rests upon the notion that children naturally know what foods their bodies need and when they are full. While this may hold some validity for infants and toddlers, study after study demonstrates that after about age five, children, like adults, do not know when they are full. Portion size is far more likely to determine a child's food intake than any internal cues. At a time when children needed parents more than ever to shield them from an increasingly fattening food environment and to set limits on consumption, experts were telling parents to butt out. Parents, in turn, were all too grateful to be relieved of the entire Passchendaele of arguing with kids over what and where to eat.

The chief reason to question fat acceptance is not that it makes it harder for fat adults to lose weight, but that it makes it easier for children to gain weight. The more we treat fat as something beyond our control, the more we will candy-coat its consequences, the more parents will be disinclined to set limits on food, the more vulnerable we will leave children to sophisticated food marketing, and the more likely they will be to put on pounds that will potentially doom them to an adulthood of obesity, health problems, and early death.

On my second day at the NAAFA conference, I decided to check out the party line on childhood obesity by attending a seminar called "Save the Kids" with Marilyn Wann, publisher of FAT!SO? magazine and author of a book by the same name (of which half the proceeds went to NAAFA's Kids Project to combat fat prejudice in schools). The book made her a celebrity among this crowd, and deservedly so: It's a hilarious how-to guide to surviving being fat with your sense of humor and self-esteem intact, complete with a paper doll of the portly Paleolithic fertility icon Venus of Willendorf, outfitted with a wardrobe of lingerie, workout togs, and dashiki ("for the protest rally").

Wann was the only speaker I heard who made a point of emphasizing the importance of exercise and nutrition (her book contains an ode to broccoli, and her favorite ways of preparing it). Indeed, the reason she is so concerned with the recent spate of new childhood-obesity programs--which she calls "abolish the fat children" programs--is that she fears they may do "more harm than good by reinforcing stigma and poisoning kids against nutrition and exercise." Wann is also of the school that believes parents should "let the child decide how much to eat." It's impossible not to admire her work in schools, which she began after hearing the story of Brian Head, the high-school sophomore in Georgia who at 15 was driven to suicide by ceaseless taunting about his weight. Wann speaks out in schools against fat phobia because, she says, "I simply don't want any more fat children to die."

THE TRIUMPH OF SELF-DELUSION

Wann and her fellow fat activists lose credibility, however, when they insist that excess weight is harmless to health. The truth is that emotional trauma is just one of the ways in which obesity hurts children. There are orthopedic problems, such as arthritic joints from overburdened limbs, slipped hips, and Blount's disease, in which the legs bow under excess weight, causing knee pain and limiting mobility. There are respiratory diseases like Pickwickian syndrome--in which shallow breath caused by excess abdominal fat leads to oxygen deprivation--sleep apnea, allergic asthma, and weakened lungs. There is hypertension, high blood pressure, and fatty build-up in the arteries of overweight children--all forerunners of coronary heart disease. And, most prevalently, there is the rise in a disease once thought to afflict only adults: Type 2 diabetes.

Unfortunately, many parents and school officials refuse to talk about these dangers for fear of fostering fat-phobia, or encouraging eating disorders like anorexia nervosa. Never mind that bingeing and compulsive eating are disorders, too. Never mind that the tiny number--epidemiologically speaking--of anorexics and bulimics is dwarfed by the legions of overweight and obese children. (In New York City elementary schools, fully half of schoolchildren are overweight or obese.) Never mind that anorexia afflicts mostly white, upper-middle-class girls, while the children at highest risk for obesity are disproportionately low-income minorities. Only the heartless among us could fail to be moved by the plight of obese children, who, according to a recent study published in the Journal of the American Medical Association, rate their quality of life as low as that of children undergoing chemotherapy. But to challenge fat acceptance is not to endorse self-loathing or condone body bigotry. We do our children no favors when we downplay the dangers of obesity in the interest of safeguarding self-esteem.

Pro-fat propaganda has so insinuated itself into our way of thinking that surveys of greater body acceptance among increasingly overweight black girls are greeted with applause rather than alarm. One study found that 70 percent of black girls felt "satisfied" with their bodies--an attitude they carried on into adulthood. "Thanks to an accepting culture where being labeled 'thick' is considered a compliment," wrote Monica Wheeler in the Chicago Sun-Times, "black women have traditionally had more positive body images."

While treating fat as phat may provide black girls with a sense of self-esteem, it also eliminates their perceived need to change. As Greg Critser points out: "Such sidestepping denies poor minority girls a principal--if sometimes unpleasant--psychological incentive to lose weight: that of social stigma." While the fact that 56 percent of black girls do not get any regular exercise outside of school--as opposed to the 70 percent of white girls who do--may be primarily a function of economics and environment, I'd wager that white girls' much lamented "lack of satisfaction" with their bodies is at least partly responsible for why they are motivated to get moving.

Can feeling bad about being big be better for your health? One wishes it weren't so. One wishes weight loss were motivated by the desire to "be good to ourselves" rather than by shame, vanity, or the desire to appeal to the opposite sex. One wishes we all exercised out of sheer joy of movement rather than the need to burn calories. One wishes, above all, that we were valued for our inner qualities rather than for the way we look. This is why the blandishments of fat acceptance are so powerful, for they promise to grant such wishes and change unpleasant aspects of reality, not by requiring any effort on our part, but by fiat of make-believe.

Even in disagreement one sympathizes with the fat-acceptance activists, who want to believe that that they have no control over their size. Why? Because food is one of life's great pleasures, because dieting is difficult--indeed, more difficult in some ways than quitting smoking or giving up booze. Abstinence is not an option with food; every day we're challenged to make good choices. Weight, once lost, requires continued vigilance to ward off its return. Weighing these exigencies against the easy excuses offered by fat acceptance, one is reminded of Eric Hoffer's observation that "there are many who find a good alibi far more attractive than an achievement. For an achievement does not settle anything permanently. We still have to prove our worth anew each day: we have to prove that we are as good today as we were yesterday. But when we have a valid alibi for not achieving anything we are fixed, so to speak, for life." And in the case of obesity, a shorter life at that.

But so what? Aside from the $1,500 in additional, per-person annual medical costs associated with obesity--costs that are subsidized by the non-obese in the same way that tobacco-related health-care costs are subsidized by non-smokers--the burden of being big falls largely on the obese themselves. So why begrudge them their belief that their condition is the result of genetics rather than behavior, even if that alibi undermines any motivation to change?

Beauty may in the end remain in the eye of the beholder, but the practice of science and medicine relies on the premise of an objective reality in which truths--however unflattering, annoying, or inconvenient--are nonetheless true. In denying basic truths about fat, activists have turned the wisdom of the Serenity Prayer on its head. They urge acceptance of something that can be changed--excess weight--while trying to change what they cannot: the reality of its health risks. Even the most shameless among us would not dare pass off the unlovely wages of other risky behavior--smoker's cough, cirrhosis of the liver, hepatitis C, gonorrhea--as a genetic inheritance, much less a badge of pride. But when the substance abused is food, and when the consequence is corpulence, we are too willing to overthrow common sense in favor of politically correct platitudes like "beauty comes in all shapes and sizes."

To be sure, some of us are born with larger bone structures, or lower metabolisms. But very few of us were born to be obese. We can change how much we exercise and what foods we choose. Unlike acceptance, these choices require effort. For that reason, they promise a far more enduring esteem than that which rests on acceptance alone.

Jennifer Grossman is director of the Dole Nutrition Institute.