What is fascinating about this book is the vivid and detailed information that San Jose State University sociology Associate Professor Natalie Boero provides about what it's like to be fat. Especially interesting is her experience with Weight Watchers and Overeaters Anonymous in Chapter 3. She went to their meetings and conducted interviews. She analyzed and reported on the various degrees of success and failure experienced by clients. She compared and contrasted the two approaches and exposed the underlying assumptions. In short, Weight Watchers uses a diet-based, point-counting formula while Overeaters Anonymous follows the Alcoholic Anonymous approach.
Boero labels their differing approaches respectively as the "normative pathology model" and the "unique disease model." She thinks that Weight Watchers see women as "emotional eaters...prone to excess." In the Overeaters Anonymous mindset, obesity is a "chronic and incurable disease" best treated with a 12-step social program.
Also fascinating was Chapter 4 in which Boero looks into bariatric surgery and finds it wanting justification. She makes a strong case by showing that even after surgery many people were still obese and others became obese again. Even the successful clients were not home free since they had to maintain a strict diet lest they extend their stomachs making it likely that they would gain back the weight they lost. She argues that it is a serious question about whether "gastric bypass is more akin to a surgically enforced eating disorder than it is to a surgical cure for obesity." (p. 121)
I think the book would have reached more readers if Boero had begun with these chapters since they are eye-opening and interesting. Chapter 1, which is mostly about the politics of obesity associated with the U.S. Department of Health and Human Services' "Healthy People" publication, is so heavily qualified and painstakingly wrought that it's annoying to read. Nonetheless she makes a good point when she argues that "moral entrepreneurs" have framed the rise in the average weight of Americans as an epidemic so that they might benefit financially by providing treatments. I have no doubt that this is correct.
Chapter 2, which is on the media's bias against fat people, was less than enthralling and not entirely convincing. While there certainly is a bias in favor of the thin and beautiful in the media, that is not necessarily the media's fault. People in general prefer to see and hear about the thin and beautiful. Blaming the media for the bias of those who consume media isn't entirely fair.
But what I found problematic is that Boero concentrates on the political and sociological aspects of the "epidemic" so intensely that she fails to acknowledge the real public health problem. She focuses on how unfair it is to denigrate people, especially women, for being fat seemingly without realizing that the health risks that come from carrying around all those extra pounds are real and need to be addressed.
I also didn't care for her designation of the public health problem as a "postmodern epidemic" fueled by "moral panic" and "chaos." It's a theme that she repeats over and over again throughout the book. A postmodern epidemic (as I came to understand by reading this book) is a socially constructed epidemic, and its cure is not medical but social. For Boero that cure comes in the form of the Health at Every Size movement whose principles include "Accepting and respecting the diversity of body shapes and sizes."
It's hard to argue with that except for the fact that overweight and obese people in the vast majority of cases are at greater risk from a variety of health problems including diabetes, heart attacks and cancer than are those whose weight is closer to the norm. This has been overwhelmingly documented in hundreds of studies and in the actuary tables kept by insurance companies. The fact that SOME people can weigh more than what is considered normal does not change the truth that carrying too much fat is dangerous to your health, and by the way, limits your lifestyle choices.
When she criticizes the media for not giving more exposure to the minority of scientists who think being overweight is okay or at least not that big a problem she reminds me of climate change deniers. On page 98 she even takes a stab at "conventional scientific wisdom" making me wonder how unconventional scientific wisdom might stack up. Again, the fact that SOME authorities deny the health risks of being fat doesn't change the reality.
But Boero tries. She writes, "...at its most basic level, the obesity epidemic is about women." (p. 55) The fact that women more often than men try to lose weight (according to Boero 80% of bariatric patients are women) doesn't alter the fact that the public concern about obesity is about health.
And if it isn't about women it's about attitude. She reports (p. 101) that what the "size acceptance community" wants to do is not so much help people lose weight but to work to "change a fat phobic society." In short, Boero seems to dislike the idea that people are personally responsible for being fat. She sees poverty and prejudices against minorities and other cultures as a major factor in the epidemic, and in this she is no doubt correct at least in part. Poor people lack easy access to health care and they can't afford whole, fresh foods and must get the vast majority of their calories from denatured and highly processed foods. However she doesn't mention the fact that greater health care costs that result from people being fat must come out of somebody's pocket. Should the obese pay higher health insurance premiums? She doesn't address this question.
The book is not without its entertainment value. I got a kick out of all the sociology-speak and the jargon (some of which is encountered above) to which we can add this gem, which includes the use of "foreground" as a verb: "Postmodern epidemics clearly foreground both the positive and negative aspects of medicalization." (p. 5) For balance (perhaps) Boero uses "regain" as a noun as in "Most of these people had experienced regain some time after their surgery..." (p. 80) In the bariatric chapter we encounter "redundant skin" and "long-term pouch care," which returns us to the reality of the obesity epidemic.
--Dennis Littrell, author of "The World Is Not as We Think It Is"