‘If you think it’s simple, then you have misunderstood the problem.’
Bjarne Stroustrup, Texas A&M University1
‘YOU BIG FAT pig,’ were the words twenty-two-stone Marsha Coupe heard before being violently assaulted. Not by some drunken thug but by a respectably dressed middle-aged woman on an evening commuter train.
‘I was returning home . . . and a woman sitting across from me started kicking me,’ Marsha recalls. ‘She said, “Hey fatty! You should not be on the train, you need two seats!”’2
Fifty-three-year-old Marsha, who suffered severe bruising and who doctors feared might lose an eye, was shocked but not especially surprised by the unprovoked attack: ‘Fat people are fair game for everyone,’ she explained wearily. ‘I’ve had beer cans thrown at me by youngsters, but the abuse doesn’t just come from the obvious places. The normal rules about behaviour, respect and common courtesy don’t apply to us.’3
Her attacker fled before the police could be called.
‘There is true aggression towards overweight people and it comes down to fear and a complete lack of understanding of the issue,’ says psychologist Ros Taylor. ‘People think, “I can control what I put in my mouth so why can’t they?” But we’re not all the same, we don’t all start from the same point.’4
According to the Americans with Disabilities Act of 1990, anyone who is significantly overweight can expect to ‘continually encounter various forms of discrimination, including outright intentional exclusions, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failures to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities.’5
‘Society’s increasing hatred of fat and obsession with thin is creating appalling prejudice,’ agrees psychologist Susie Orbach, author of Fat Is a Feminist Issue. ‘It is allowing people to feel justified about abusing fat people.’6
Many people with a weight problem accuse politicians and the media of encouraging intolerance by promoting obesity scare stories that provoke disgust, mockery and moral outrage.
‘The government and the press have created an atmosphere where people think they have a legitimate right to go up to an overweight person and tell them how to live their lives,’ says Marsha Coupe. ‘To them we are all the anonymous pictures of fat people they see in the papers and are the cause of all society’s ills, as well as a drain on the NHS. We deserve what we get. We’re not people with feelings.’7
Research by Rebecca Puhl and Chelsea Heuer, from the Rudd Center for Food Policy and Obesity at Yale University, strongly supports this view. ‘Numerous studies have documented harmful weight-based stereotypes that overweight and obese individuals are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor willpower, and are noncompliant with weight-loss treatment,’ they report. ‘These stereotypes give way to stigma, prejudice, and discrimination against obese persons . . . Perhaps because weight stigma remains a socially acceptable form of bias, negative attitudes and stereotypes toward obese persons have been frequently reported by employers, co-workers, teachers, physicians, nurses, medical students, dieticians, psychologists, peers, friends, family members, and even among children aged as young as three years.’8
Rebecca Rees and her colleagues from the Institute of Education at the University of London have revealed that being young and overweight can transform growing up into a nightmare. After analysing thirty studies involving young people aged between twelve and eighteen, and going back almost twenty years, they uncovered a terrifying litany of verbal and physical bullying on a daily basis. This included ‘being threatened with a knife, beaten, kicked, pushed down stairs and having objects thrown at them.’ More commonly, overweight children had to endure verbal and social abuse such as name-calling, deliberate and extended isolation, whispering and sniggering. Much of this occurred in school and, in some instances, left them so scared they refused to attend.9
Physical Education lessons were cited as a particular source of hurtful and humiliating ridicule. ‘Day after day, you’re terrified,’ one youngster told researchers miserably.10
Unsurprisingly, these attacks impacted negatively on the emotional health of the victims, reducing confidence and increasing loneliness, depression and anxiety, especially when it came to visiting public spaces. Shopping trips and other social events often left them feeling marked out as different and excluded. ‘I . . . just wanted to be part of the crowd and not to stick out like a sore thumb,’ Huw, an overweight seventeen-year-old reported. ‘Because sticking out . . . when someone sees the person who looks, who is bigger than . . . almost everyone there, that makes you feel really bad.’
The researchers found that being large did not make youngsters any more tolerant of those who were similarly overweight, however. ‘Fat people, I hate fat people,’ one teenage Scottish girl told them. ‘I don’t hate their personalities, I just don’t like the way they look. I just don’t know why folk would do that to themselves.’11
Generally, overweight young people saw others with large bodies as being either lazy or incapable of controlling their greed – or both. For all of them the ideal body size for a young woman was thin, while for a man it was muscular and fit-looking. As with adults, any failure to match these ideals tended to be blamed on a lack of self-control. In one study ‘participants stated “quite fervently” that a young person’s size was their own responsibility,’ comments Rebecca Rees, ‘and in only two studies did young people suggest that some responsibility might lie elsewhere. Young people who felt, or already were large made it clear that they knew they had to do something and tended to be critical of their own self-will.’
The researchers concluded, sadly, that: ‘The perspectives of young people in the UK . . . paint a picture of a stigmatising and abusive social world.’12
Douglas Degher and Gerald Hughes, from Northern Arizona University, report that the development and acceptance of a ‘fat identity’ occurs in several well-defined steps. It often starts with teasing and bullying at school, leading to the victim identifying themselves as a ‘fat boy’ or ‘fat girl’.
This can then lead to a range of psychological coping mechanisms, such as denial (‘I am not fat I am just a bit chubby’) and avoidance (‘I refuse to think about my weight’) to compliance (‘I will go on a diet not for myself but to please others’).13
And, as Dr Ian Campbell – a specialist at the Overweight Clinic at University Hospital, Nottingham, and honorary medical director of the charity Weight Concern – points out, ‘The result is the people who need the most help don’t seek it. They are left feeling guilty and undeserving.’14
While (as we explain in Chapter 3) there are people who take pride in being seriously overweight, research and practical experience suggest that most do not. When Dr Colleen Rand, a cosmetic surgeon at the University of Florida, asked forty-seven formerly obese men and women whether they would sooner have some disability rather than regain their previous weight, the replies were surprising and shocking. All said they would rather be deaf than obese, nine out of ten (91%) preferred to lose a leg or even go blind (89%)! As one put it: ‘When you’re blind, people want to help you. No one wants to help you when you’re fat.’15
Small wonder then that anyone with a serious weight problem can become discouraged, depressed and even despairing. It is a cruel irony that these are emotions that can lead to comfort eating, as we explain later, in Chapter 9.
But before we go on to look at the real reasons why the world is becoming obese, we should spend a few moments considering what precisely this term actually means. What, for example, is the difference between being overweight and obese? How is the distinction made and, even more significantly, how accurate is the main method used to determine it?
At 6 feet 2 inches tall and weighing, at his heaviest, 260 lb, the Austrian/American actor and one-time governor of California has a Body Mass Index (BMI) of 33.3. The clinical definition of a lean or rather ‘normal’ BMI is anything between 20–25 kg/m2. The range 25–29.9 kg/m2 is considered overweight, and the cut-off for obesity is 30 kg/m2. This would seem to mean that a man once described by the Guinness Book of World Records as ‘the most perfectly developed in the history of the world’ was severely obese!
Which is, of course, nonsense.
The error arises because Schwarzenegger, who began his career as a weightlifter and still works out daily in the gym, is so muscular. When it comes to calculating BMI, it is the weight of his skeletal muscle rather than adipose tissue (muscle is about 18% denser than fat), which results in such an absurd conclusion.16 It also highlights one of the main problems with using BMI as a measure of any individual’s fatness. So what exactly is the BMI, why was it invented and how is it currently being used and abused?
The statistical technique for comparing people’s weight was invented by the eighteenth-century Belgian statistician and polymath Adolphe Quetelet.17 At the request of the Belgian government, who wanted a quick and easy technique for determining obesity levels among the general population, he created a standardised measure based on an individual’s weight divided by the square of their height. It was an assessment technique that, he always emphasised, could, and indeed should, only be used to assess groups and never individuals.
In 1972 American physiologist Ancel Benjamin Keys renamed this measure the Body Mass Index or BMI.18 Today the formula for obtaining BMI (weight in kilograms divided by height in metres squared) is widely used by doctors and scientists to place people into one of five weight classifications – in spite of the fact the measure was never intended to be used on an individual basis in this way.
Anyone with a BMI of 18.5 or less is considered to be underweight.
A BMI of between 18.5 and 24.99 indicates normal weight.
A BMI of 25 to 29.99 means the subject is overweight. A BMI from 30 to 34.99 indicates severe obesity and, from 35 to 39.99, morbid obesity. Anyone with a BMI of 40 or higher is classified as super obese.19
The above categories apply to Caucasians only, with other parts of the world adopting different cut-off points. In Japan, for example, anyone with a BMI greater than 24 is deemed to be overweight,20 while in China being overweight is indicated by a BMI greater than 23. 21
While perfectly valid when applied to groups of people, when used to determine an individual’s weight the BMI becomes, in the words of Stanford University mathematician Professor Keith Devlin, ‘mathematical snake oil’. A perfectly healthy, athletic person can easily be categorised as obese in this system because they have more heavy muscular tissue. In spite of this drawback, BMI is widely, if unwisely, trusted. Devlin comments that: ‘Because the BMI is a single number between 1 and 100 (like a percentage) that comes from a mathematical formula, it carries an air of scientific authority.’22
As we saw with the case of Arnold Schwarzenegger, it fails to take account of the relative proportions of bone, muscle and fat, so the results may defy logic. Since bone is denser than muscle and twice as dense as fat, a combination of low fat with strong bones and good muscle tone will still produce a high BMI.
So while the formula works reasonably well for sedentary people, whose bodies combine a high relative fat content with low muscle mass, it gives entirely the wrong answer in the case of those who are fit, healthy and lean. It also very misleadingly suggests that there are precisely five main weight categories (under, over, obese, morbidly obese and just right) whose precise boundaries depend on a decimal place. Finally, BMI cannot account for allocation of adipose (fat) tissue. As scientists discover more about the function and activity of fat, they have become adamant that the proximity and quantity of fat to organs bears more relevance to health than a person’s body weight.
So the bottom line is that no one should take any notice of their BMI when assessing how fat they are. Remember: it was never intended to apply to individuals, just to groups of people. There are, admittedly sometimes more complex and costly, ways of determining body fat with great accuracy. They include skin-fold measurements, underwater weighing, bioelectric impedance, functional Magnetic Resonance Imaging (fMRI) and infrared detection.
A simpler rule of thumb is to use your waist circumference. For men, if this exceeds 40 inches, there is a high probability of obesity; for women the measurement is 35 inches or above.23
Ask someone why a person is overweight and they will most likely reply: ‘Because they eat too much and exercise too little!’
However, this is a crass oversimplification of what is likely to be a much more complex issue. When someone has a serious weight problem it is not an issue of culpability but of vulnerability. They have become, for reasons we will explain later in the book, hypersensitive to ubiquitous environmental food cues and the addictive rewards provided by foods rich in sugar, fat and salt.
While a combination of poor eating habits and insufficient exercise are undeniably part of the problem, they are by no means the whole or even the main reason for the obesity pandemic.
Ultimately, it has arisen because our modern lifestyles are dramatically out of step with our biology. We are all equipped with a digestive system that never evolved to cope with the easy and unlimited availability of high energy-dense (HED) foods we see today. Millions now work in stressful conditions, in largely sedentary occupations, under time pressures that enforce rushed meals augmented by energy-dense snacks. Many people are too time-poor and tired at the end of the day to engage in strenuous exercise, and many get insufficient sleep. We live in an obesogenic environment characterised by relentless and inescapable advertising and marketing of food.
In short, obesity primarily results not from self-indulgence but from a mismatch between natural physiological needs and conditioned psychological wants.