The blogosphere and comment threads were a buzz last week over an article on the Marie Claire website in which a dating and relationship advice columnist, Maura Kelly, writes:
“I think I’d be grossed out if I had to watch two characters with rolls and rolls of fat kissing each other … because I’d be grossed out if I had to watch them doing anything. To be brutally honest, even in real life, I find it aesthetically displeasing to watch a very, very fat person simply walk across a room — just like I’d find it distressing if I saw a very drunk person stumbling across a bar or a heroine addict slumping in a chair.”
She was writing about the CBS sitcom Mike & Molly, featuring an overweight couple who apparently met in a support group for the overweight (I’ve never watched, or heard of, the show before this article so pardon any misunderstanding I have about it’s plot). She went on to write that obesity is something people can control if they put their minds to it. Overall she was critical of any messages in the media that might normalize obesity out of concern for rising health care costs for illnesses associated with being overweight and/or inactive.
In the days following the publication of the post, there was an overwhelming response largely consisting of anger over her insensitive and discriminatory statements. A few days after the post, the creators of the show posted a response to the article, and Sharon Osbourne called the author “a discredit to women“. Even the ladies on The View had a few things to say about it. Within 4 days of the article’s web publication, more than 1500 comments were submitted. I admit I did not read every single one, but the general sense I got from scanning through many was that people were outraged about the insensitivity of the article, wanted to see Marie Claire accountable for allowing such a post on their website and promised to make the author’s upcoming book on relationships a failure.
I read the article and I got angry. But, I also wondered if one could apply a skeptical approach to her article and its claims. Granted, much of what she wrote was her own opinion and we probably aren’t able to operationalize exactly how ‘grossed out’ she becomes at the sight of an obese person. But we can evaluate two prominent claims in her post that appear to be the foundation of her disgust of the ‘plump’ among us: 1- obesity costs Americans a lot of money, and this cost is greater than those associated with anorexia (or underweight disorders) and 2- obesity is “something that most people have a ton of control over. It’s something they can change, if only they put their minds to it.”
In order to evaluate the validity of the first claim we must first assert that obesity is, in fact, a bona fide health risk. In order to conclude that obesity itself costs money, we have to define obesity as the root problem. And with a quick scan of the relevant literature it’s easy to walk away with that conclusion. Sturn (2002) found that obesity results in a 36% increase in health care expenses (to put this in context, smoking or having smoked results in a 21% increase in medical expenses). Finkelstein, Fiebelkorn & Wang (2003) estimated that in 1998 obesity was responsible for about 9% of healthcare spending. However, a further read of their study revealed that the standard error they estimated in evaluating the difference between the medical expenses of obese individuals and normal weight individuals left them unable to conclude obesity was the culprit. A standard error resulting in overlapping distributions around sample averages means that the difference in averages could be the result of outliers in either group and not necessarily a trend. On average, the obese sample had higher medical expenses (out-of-pocket, medicare and medicaid), but this detail about the estimated margin (and in absence of the raw data) we do not know to what extent it could be attributed to outliers.
A point that Sturn (2002) makes, one that could also be revelatory of Finkelstein, Fiebelkorn & Wang (2003) results, is that “obesity” itself is not a cause of health problems; it is associated with health problems and may itself be (actually probably is) a symptom itself. You see, the health issues related to obesity, such as hypertension, high blood pressure and diabetes can be more parsimoniously explained by poor diet and a sedentary lifestyle. Since a poor diet and a sedentary lifestyle might also be factors in a person coming to be obese, it is possible that obesity itself is not the problem. So, it would be entirely possible to have a sample of individuals who appear obese, and some are as such due to unhealthy lifestyles, while others are just larger than most.
And I know it’s an evil trick of someone trying to make a research point to refer to cases of very healthy people who appear obese, and very unhealthy people who appear fit, but, there is somewhat of a point to be made there. Yes, there are other problems related to simply being large; such risks for arthritis, asthma (which can be attributed to the physical difficulties of carrying excess weight). However, the trend has been to target obesity itself as the main culprit of a host of health related risks.
So, the claim that obesity is disgusting because it costs Americans a lot of money is and also isn’t supported by the data. Obese people, on average, have higher medical expenses and illnesses that are correlated with obesity due cost millions each year, much of these costs can be more so associated with the behaviors (that themselves can also lead to a person to be obese) than body size alone.
As for the controllability of obesity, this one is a bit trickier. I wasn’t able to really find many studies that examined causal factors in an individual excess weight. I was, however, able to find studies that found the degree to which obesity is believed to be individually controllable is correlated with the amount of negative stereotyping a person engages in regarding obese individuals. Likewise, attempts to reduce controllability beliefs have little effect on reducing the stereotypes (Tiggemann & Anesbury, 2000a, 2000b). Jeong (2007) found that news related to genetic attributes of obesity did lead to more willingness to be helpful to an obese person, but this varied depending upon the strength of controllability beliefs.
It is difficult to really measure what leads to a person being obese. There are some arguments for a genetic contribution, an apparent involvement of socio-economic factors, and of course, poor diet and/or lack of exercise. But, the fact that I couldn’t find much literature comparing behavioral and non-behavioral causes of obesity, I doubt Maura Kelly did, meaning I doubt her statement regarding how obesity is under one’s own control was informed by research. If anything her overall position supports previous findings that relate such beliefs with discriminatory feelings towards obese persons.
I would argue the second of the two most prominent (and measurable) claims can also be dismissed, but remains plausible.
A few days after the initial article, an update was posted in which Ms. Kelly apologized for the original piece, calling her comments insensitive and unproductive. She clarified that she was not commenting on the overweight, but the obese and added that the sight of an anorexic person elicits the same discomfort as an obese person because she assumes they all suffer from eating disorders (another assumption based on physical appearance – there’s a word for those kinds of assumptions). This is especially ironic because in her initial post she preemptively disregarded arguments about anorexic models being “sick” by claiming that some are “naturally skinny”.
My main problem with her apology, however, was that it sounded an awful lot like Clint McCance’s apology; she’s sorry for her choice of words, but not the underlying feelings. And this is the problem that I have with discrimination of the overweight – people rationalize making hateful statements that generalize an entire group of people by one definitional criteria, then attempt to mask it as some noble gesture enacted out of concern. If you think overweight people are “gross” – then own it. Don’t pretend like you’re just worried about their cholesterol.
As a side, and personal, and less scientific, note, I’m a fat girl. I’ve always been a fat girl. Some of my earliest memories in middle school involve being called fat by my classmates (and 4-eyes, do kids still get called 4-eyes?). I don’t really remember being terribly bothered by my thickness by the time I got to high school, if I had been at all before then. That could also be because the boys figured out that, while I was thick, thick also meant a generous bosom, so I was popular. As a matter of fact I don’t think I’d think too much about my size at all if it weren’t for everyone in the world forcing me to regularly. I can’t eat a salad without someone asking me how my diets going (can’t a girl just like salad?). So, I think what bothered me the most about Ms. Kelly’s article was the comments, truthfully. While most regarded Ms. Kelly’s remarks as inflammatory and discriminatory, a lot seemed to sympathize with the plight of the overweight – as if all thick girls in the world are struggling to be thinner and this article would damage our fragile nature. We’d all end up face first in a tub of ice cream and self-pity.
While I don’t like the Maura Kelly’s of the world, I also don’t like the implicit discrimination and presumptuousness of the sympathetic.
References
- Clarke, P., O’Malley, P.M., Johnston, L.D. & Schulenberg, J.E. (2009). Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986-2004. International Journal of Epidemiology, 38(2) 499-509
- Finkelstein, E. A., Fiebelkorn, I. C., & Wang, G. (2003). National Medical Spending Attributable To Overweight And Obesity: How Much, And Who’s Paying?. Health Affairs Millwood Va Then Bethesda Ma-, 22.
- Jeong, S. H. (January 01, 2007). Effects of news about genetics and obesity on controllability attribution and helping behavior. Health Communication, 22, 3, 221-8.
- Sturn, R. (2002). The Effects Of Obesity, Smoking, And Drinking On Medical Problems And Costs. Health Affairs, 21, 245.
- Tiggemann, M., & Anesbury, T. (January 01, 2000). Negative Stereotyping of Obesity in Children: The Role of Controllability Beliefs. Journal of Applied Social Psychology, 30, 9, 1977.
Her assumption (yes, you can certainly bet that she had no science behind what she said) that obese people are so by choice — that they could and would lose the weight if only they really tried — is very widely shared, and comes from this, I think (also an assumption; I have no science here either): “If I eat less, I lose weight. Therefore, if ‘they’ eat less, they will lose all that extra weight as well.”
Of course, it’s not that simple, and no one would say similar things about people with heart conditions, for example. It’s rather a cycle: the social stigma prompts people to make these sorts of assumptions, and believing the assumptions increases the social stigma.