28 May 2020
Big Is Not Beautiful
Huge is harmful.
By Lynda Goetz
Fat is not just a feminist issue, to twist the words of Susie Orbach. It has historically always been a political and cultural issue. For centuries and in many different societies, carrying excessive weight showed that one had the wherewithal to eat well. Being scrawny was the opposite; evidence of poverty, not power. Fat, a Cultural History of the Stuff of Life published in 2019, by Christopher E. Forth, a professor of history at the University of Kansas, is an interesting look at what being large has meant through the ages. Our current attitudes to fat are paradoxical. On the one hand there is the body positivity movement and on the other the gym, keep fit and personal training gurus exhorting us all to better healthier bodies; on one side the availability of massive choices of fast food, packaged food, sweets, biscuits and sugary drinks and on the other a focus on healthy-eating.
Will the ‘body positivity’ movement be one of the post Covid-19 casualties? Given the data which has come out during the pandemic regarding the adverse effects of obesity, this would seem to be likely. However, body positivity is not just about accepting obesity, although it does have its roots in the fat acceptance movement started in the 1960s in the States. The fat acceptance movement argues that fat people are the targets of hatred and discrimination and that this is unacceptable. Whether or not one believes this to be the case, over the last 40 or 50 years there has been an upsurge in campaigning for body image acceptance. Last week was Mental Health Awareness Week in the UK and having a positive acceptance of one’s physical appearance is clearly helpful in maintaining positive mental health. What, however, if being proud of being ‘big’, whilst good for one’s mental health, is positively dangerous for one’s physical well-being?
The science, which we all seem to be keen to follow these days, would suggest this to be the case. As far as doctors are concerned, this is absolutely not news. They have long pointed out that being overweight, or worse, obese, carries with it all sorts of downsides for health. Carrying excess weight makes extra work for all sorts of organs in the body. It can become self-perpetuating; the heavier one becomes, the harder it is to move one’s bulk around and take exercise; the larger one’s stomach, the more food it requires to feel satisfied; lack of exercise and excess calories pile on the weight. Not only does exercise become difficult but so does simply walking; feet become swollen; shoes don’t fit; people take to their beds and things only get worse.
Clearly, this is a worst-case scenario, but given that in this country it is estimated that around a third of adults are obese and over 60% are overweight, that accounts for an awful lot of the 67 odd million people in the country. In the States, it is estimated that the figure is even higher with, according to some data, 42.4% of adults being obese and another third overweight. The American author Lionel Shriver whose brother died at 55 of health issues related, she considered, to being morbidly obese, argues that normalising obesity is not the answer. To compare ‘sizeism’ with racism or homophobia is, she points out, to suggest that obesity is an unchangeable state.
In 2018 the University of East Anglia released a report saying that body positivity, fat acceptance and normalisation of plus-size was damaging to perceptions of obesity and undermined government initiatives to overcome the problem. It also meant that the overweight and obese were less likely to seek medical help for their condition. The chances of suffering from Type 2 diabetes, circulation, respiratory and heart problems are all increased by being obese. The movement also had an adverse effect on the ability of doctors to speak out and give advice to patients, although increasingly medics have been telling patients in need of operations that they need to lose weight before they can undergo surgery. Not only is it unpleasant for surgeons to have to cut through layers of ‘blubber’ before they can reach the organs they need to deal with (not to mention the difficulties of moving a seriously overweight person) but the risk to obese patients of developing post-operative complications is higher.
Data collected during the current coronavirus pandemic has now also revealed that those who are overweight are almost twice as likely to need to be hospitalised should they get coronavirus. Once hospitalised, they are also far more likely to end up in intensive care. Figures released earlier this month also showed that a quarter of all fatalities from coronavirus in hospitals in the UK were of people with diabetes (type 2 being associated with being overweight). Past studies have also shown that obese or overweight people were more likely to suffer from complications or even death from infections like flu. Boris Johnson himself is said to be privately convinced that the reason he ended up in intensive care when he contracted the virus was due to being overweight. He is now backing an interventionist anti-obesity strategy, which he was previously against. The so-called ‘Sugar Tax’ (properly called the Soft Drinks Industry Levy SDIL) levied on soft drinks by George Osborne during his time as Chancellor of the Exchequer and which came into force in April 2018 would appear to have had the effect of reducing sugar content in soft drinks as intended, but whether it had any real noticeable effect on sugar consumption is more in doubt.*
What is not in doubt is that the UK is suffering from an epidemic of obesity which endangers health. Being large has over the centuries always been to some extent a question of fashion. We have the highest obesity rate in Europe, and if all the time Public Health England’s campaign for healthier lifestyles is competing with campaigns telling us that all bodies are beautiful irrespective of size or shape, then those listening are getting very mixed messages. Plus-sized clothing ads and television programmes celebrating larger bodies are all working against the health message which the medical profession and the government needs to get out there. As we appear to live in an age of slogans, how about ‘Huge is not Healthy, Huge is Harmful’?