»Counter the errors of fat activism with facts and evidence
Denna artikel omnämns i efterordet till ”Cyniska Teorier” och publicerades i Dietistaktuellt i mars 2019. Läsarreaktionerna var tämligen talande för den tydliga demarkationslinjen mellan vetenskapligt orienterade dietister och de som värderar ”alternative ways of knowing”, det vill säga de som ansluter sig till den ”kritiska” traditionen. I den förra gruppen fanns det dietister som skrev till Helen Pluckrose och tackade henne för värdefull kunskap. I den andra ville man stoppa denna oortodoxi.
Fat Studies and Fat Activism may seem like a relatively new phenomenon, but in fact, scholarly theorizing and cam-paigning around the acceptance and even the promotion of obesity has been in existence for at least fifty years. The National Association to Advance Fat Acceptance began in the US in 1969 and the Fat Underground followed shortly afterwards in the 1970s.1 These ideas soon travelled to Europe. The reason Fat Activism feels new, however, is because it is gaining an unprecedented amount of prestige and influence and rapidly gaining the power to put pres-sure on medical scientists, medical practitioners and medical research organisations. This is an alarming development which endangers health and to be able to counter it, it is essential to understand how it works.
There are three main brands of Fat Activism presenting themselves at this time. We could think of them as 1) Radical fat feminist activism, 2) Liberal celebratory body positivity and 3) Intersectional marginal-ised identity activism.
Arguably, the most influential Fat Scholar and Activist is Dr Charlotte Cooper, a British academic who usefully charts the emergence, growth, evolution and diversification of, largely feminist, organised action on behalf of the obese. In her book, Fat Activism: A Radical Social Movement, Cooper provides evidence of the emergence of a Fat Activism within the Radical Feminism of the 1960s and 70s and particularly within lesbian feminism and separatism. How-ever, she observes that Fat Activism now is very much entrenched within intersectional (postmodern) third wave feminism which works on a very different ethos. She is al-so highly critical of the body positivity movement which she sees as largely neoliberal, individualistic and of benefit to the privileged. It will be useful to look at these different kinds of Fat Activism in order to understand the epistemological and ethical framework that the most influential threat to medical science is coming from.
Firstly, it is important to recognise that Radical Feminism is not any feminism which has views which could be considered radical but a particular movement within feminism with clearly defined tenets. Second-Wave Radical Feminism, which included lesbian separatism and political lesbianism, was and is rooted in materialist analyses of gender relations. It largely saw and still sees society as dominated by both patriarchy and capitalism which are inextricably entwined. The materialist worldview is frequently Marxist and decidedly socialist. The radical feminist branch believes gender to be entirely a social construct in which men are an oppressor class and women an oppressed class. These classes are biological and related to reproductive function. A patriarchal and capitalist society, in the materialist radical feminist view, regards women as the property of men and places strong expectations upon them to be sexually attractive, unobtrusive and focus on childbearing and rearing. The pressure to be slim is part of this. By restricting women to the private sphere, men are enabled to control the public sphere where the positions of power are and control the money. Therefore, being obese was seen by some radical feminist and lesbian activists as a form of rebellion against expectations to be slim, unimposing and conventionally desirable to men.
The Body Positivity movement comes from a form of liberalism which when feminist, is often associated with choice feminism, post-feminism or, disparagingly, neo-liberal feminism. It is an individualistic form of activism which puts the onus on the obese individual to be positive about her (or his but usually her) obese body and ignore unkind comments or social pressure or even medical pressure to lose weight. There is an optimistic, “New Age” self-love, cele-bratory aspect to its focus on loving one’s own body as it is.
This is altogether too positive for the radical feminist fat activists who reject such individual responsibility and look to collective political action to revolutionise societal norms. It is also too positive for the intersectional (postmodern) activists who see society in terms of systems of power and privilege constructed by discourses which determine what is legitimised as knowledge. They see fat people as having a marginalised identity which needs to be taken into account alongside other forms of marginalised identity like gen-der, race, disability and sexuality. It is these activists who are most influential right now.
The Intersectional Marginalised Identity activists draw on a number of theoretical frameworks which are rooted in postmodern theory. These include postcolonial theory, critical race theory, intersectional feminism, queer theory, critical theories of ableism and fat studies.2 All of these forms of theory are either entirely founded in postmodernism or have influential branches which are. Therefore, they share the conception of society in which knowledge is a con-struct of power and power serves the interests of dominant groups. They deny objective truth to exist but believe in multiple truths using a standpoint epistemology. That is, they believe that one’s knowledge is specific to one’s identity and where that identity is positioned in structures of power and privilege. Therefore, those methods of knowledge production we consider most effective and things considered to have been established to be true to the best of our ability using them are actually constructs of power created by those groups seen as powerful — wealthy, white, heterosexual, able-bodied men. This includes science and reason. Different knowledges are believed to be held by other groups and to have been unfairly disadvantaged. They now need to be foregrounded while more established understandings of knowledge need to be sidelined. The “inter-sectional” framework is named for the symbolism of an intersection in which an individual can be hit by discrimination on any combination of marginalised identity factors and “fat” is one of them. As Solovay and Rothblum put it in the preface to their Fat Studies Reader:
”Every person who lives in a fat-hating culture inevitably absorbs anti-fat beliefs, assumptions, and stereotypes, and also inevitably comes to occupy a position in relation to power ar-rangements that are based on weight. None of us can ever hope to be completely free of such training or completely disentangled from the power grid.”
Because different forms of Fat Activism exist, when one encounters an activist who argues for Fat Acceptance and opposes the terms “obesity” and “overweight” in favour of the term “Fat” which they insist to be neutral, one cannot immediately be sure what ideology is motivating them. However, the dominant form of Social Justice scholarship and activism at the moment is the intersectional one. This approach has accumulated a significant amount of prestige and been incorporated into a variety of university courses, employment codes of conduct, cultural commentary and politics. The positive-sounding words ‘diversity,’ ‘inclusion’ and ‘equity’ which so often mean identity-based division, exclusion of certain viewpoints and inequality of oppor-tunity have been accepted as the pinnacle of human rights and equality work. This causes well-intentioned liberals and image-conscious employers to incorporate a great deal of postmodern ideology and activism into their policies and worldviews. It is likely to be this form of Fat Activism which is presented as authoritative and institutionalised.
In any case, this article is being written for an audience of mostly medical scientists and fortunately, in this capacity, it is not necessary to be able to distinguish between various ideologies and theoretical frameworks. The primary objective of scientists is to discover what is true and communicate it to the general public. What they need to know in a professional capacity is that Fat Activists are generally motivated to reject medical science around nutrition and obesity for ideological and theoretical commitments.
Fat Activist arguments against the medical consensus that obesity is unhealthy and implicated in several cancers, Type 2 diabetes, heart disease, joint problems and PCOS among other problems take many forms. One common form is avoidance of the data on obesity and health. Some-times this is just ignored entirely in favour of purely theoretical arguments that concerns about obesity as a health issue is really about fat hatred, control of women’s sexual-ity or “healthism” (the position that everybody has a mor-al responsibility to be healthy). Cooper, for example, in her groundbreaking book, Fat Activism, says:
”I am not going to explore whether or not fat people are healthy, the prime concern in the world of obesity, although I am very much interested in how fat people cope with being treated as unhealthy.”
Alternatively, it is not uncommon to hear the claim that medical scientists, researchers and professionals are financially motivated to claim that obesity is unhealthy, so they can treat it. As Deb Burgard claims: “The financial and political stakes in demonizing ’obesity’ are profound. It is rare to find researchers who are not paid consultants to the weight loss industry”. Another form of avoiding engaging with the information is to take the pure postmodern epistemic approach and insist that medical research is only one way to know about fat and that it is less valuable that fat people’s subjective knowledge of the experience of being fat. For Cooper, who draws on Michel Foucault and Judith Butler, “embodied community knowledge” – that drawn from shared experiences of being fat – is more important.
Sometimes empirical arguments are made by fat activists. They might point out that fatness has been and is regarded as an indicator of health in other cultures and claim this shows our current preference for slimness to be a social construct. Obviously, this denies the possibility that there is a right answer to whether or not obesity is healthy. Alternatively, activists might show evidence that every disease argued to be correlated with obesity is also found in thin people. This is an ignorance of statistics akin to “My grandad smoked 40 cigarettes a day and lived to be 92 while my next-door neighbour never smoked and died of lung cancer at 60. There-fore, smoking doesn’t cause cancer”. It is particularly common to be shown statistical evidence to support the argument that diets don’t work.  In these cases, accurate statistics are presented which show that most obese people who follow a weight loss programme then regain the lost weight. This focus on the poor long-term success rate of short term weight loss programmes may show that they are not the best way to address obesity in the long term but it fails to take into account all the people who maintain a healthy weight long-term by consistently eating moderately and exercising.
Nevertheless, Fat Activism, like most forms of activism, makes some valid points and raises some important questions. There is much evidence that obese people face dis-crimination and negative perceptions which are not war-ranted by their weight. There are legitimate concerns that many fail to seek help for medical problems due to anxiety about being judged for their weight. Children who are obese are frequently bullied and children as young as five worry excessively about becoming overweight. The link between poverty and obesity is not well understood and has perhaps been interpreted too simplistically. It is possible there is some truth in claims that, for some healthcare professionals, obesity is too often used as a catch-all diag-nosis for symptoms which should be investigated separately.  While navigating this ethical minefield with a view to helping people, it is particularly important that we have the best possible information about what is true.
We are currently in a very precarious political climate where politicised postmodernism on the left and populist post-truth on the right together constitute a significant resistance to expertise and objective knowledge in favour of various emotionally resonant ideological narratives. When it comes to diet and weight issues, very few people have the necessary knowledge and experience to evaluate contradictory claims and all of us are vulnerable to believing what we want to believe or what is circulating within our various ideological bubbles. Those of us who want to make in-formed decisions based on accurate information are reliant on medical scientists, dietitians and health care professionals to be particularly conscientious about avoiding ideological bias when giving their expert opinion on what is true.
Despite the valid points it raises, the ideological, antiscientific fervour which dominates Fat Activism in practice should be a matter of concern to dieticians and other scientists in the field of nutrition and health. The consequences of Fat Activism being internalised by a dangerously obese individual include disability and death. For those who are finding losing weight very difficult and are suffering from low self-esteem, the body positivity movement is seductive. Humans are much more inclined to want to feel positively about themselves and have a supportive group than to discover what is actually true. Those who are ex-posed only to the ideological claims of fat radical feminists or intersectional feminists are being denied the opportunity to make informed decisions about their own health. Cancer Research and the World Health Organisation have come under great pressure to stop saying that obesity is re-sponsible for serious health problems and if campaigning succeeds in making it difficult for such organisations to publish findings and advice, even more people will be at risk of accepting faulty information which has been falsely legitimised for ideological reasons.
Even for those of us who are successfully overcoming obesity, Fat Activists can act as a significant deterrent. I am one such person. Deeply involved in studying political activism including Fat Activism, I have attempted to discuss the misinformation and pressure people trying to lose weight are presented with by Fat Activists. I have been scolded for saying that I suffer from joint pain, PCOS and prediabetes because of my obesity and told I am perpetu-ating stigma against fat people and healthism. It has been demanded that I do not celebrate my weight loss and the reduction of these problems publicly and receive encour-agement and support because this shames fat people. I have been told that my efforts are futile, and I will end up even fatter than I was. I have even been told that I am delud-ing myself by thinking people see me as a political and ac-ademic writer and should accept that all they see is that I am fat, and they judge me accordingly. Fortunately, I am a person of strong opinions and am deterred by none of this, but I cannot help thinking how this kind of bombardment might affect a more conflict-averse person or someone who fears being seen as perpetuating bigotry or someone who already lacks confidence in their own ability to sustain a healthy lifestyle.
Consequently, the difficult path we, as a society, must tread now is one which combines an ethical, non-discrim-inatory and compassionate stance towards obese people with an unapologetic promotion of the truth about how obesity impacts health. My job, as a liberal human rights and equality advocate who studies Social Justice ideology and activism, is to navigate this tricky terrain and argue for the best way to do that. In order to be successful in this, I am relying on you, dear dietitians and assorted medical scientists, to make your knowledge and expertise accessible to the layperson. Please do not shy away from the truth due to misguided concerns about stigma against fat people. Please do address the scholarship and activism coming out of various forms of Fat Activism and take its valid concerns seriously while countering its falsities calmly, clearly and with evidence. In this way, we can move forward ethically and realistically and give obese people the best possible chance of making informed decisions about their health.
1 Solovay, Sondra and Esther Rothblum “Introduction” in The Fat Studies
Reader New York University Press: New York and London. 2009. p4 2 Solovay and Rothblum, p2
3 “What is Health at Every Size” in Fat Studies Reader p47.
4 See also: https://friendofmarilyn.com/2012/04/05/the-epistemology-of-fatness/
5 See in particular Is “Permanent Weight Loss” an Oxymoron? The Statistics on Weight Loss and the National Weight Control Registry” by Glenn Gaesser in Fat Studies Reader 37-42
6 See in particular Lantz, P.M., House, J.S., Lepkowski, J.M., Williams, D.R., Mero, R.P., & Chen, J. (1998). “Socioeconomic factors, health behav-iors, and mortality: results from a nationally representative prospective study of US adults”. Journal of the American Medical Association, 279(21), 1703–1708.
Editor-in-Chief of Areo Magazine
The positive-sounding words ‘diversity,’ ‘inclusion’ and ‘equity’ which so often mean identity-based division, exclusion of certain viewpoints and inequality of opportunity have been accepted as the pinnacle of human rights and equality work. This causes well-intentioned liberals and image-conscious employers to incorporate a great deal of postmodern ideology and activism into their policies and worldviews. It is likely to be this form of Fat Activism which is presented as authoritative and institutionalised.
Artikeln har tidigare varit publicerad i Dietistaktuellt 2.2019