IJE Advance Access originally published online on January 5, 2006
International Journal of Epidemiology 2006 35(1):207-208; doi:10.1093/ije/dyi262
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Book Review |
Essay Review of: The Obesity Epidemic: Science and Ideology. Michael Gard and Jan Wright (eds). Routledge, pp. 218, £22.99, 2005, ISBN: 0415318963.
The Obesity Epidemic: Science, Morality, Ideology, by Michael Gard and Jan Wright (New York: Routledge, 2005.) is an important contribution, perhaps a decisive one, to the global debate over the risks of fat. Decisive, because it addresses, in the most meticulous and patient way, the weight of scientific evidence that underlies the alarmist cries of obesity science—the body of knowledge and opinion about health dispensed by an alliance of medical professionals and public health bureaucrats, physical education teachers, and pharmaceutical researchers, whose views are widely circulated in the corporate media. The book is a radical critique of the objectivity of this epidemiological science. It demonstrates, in persuasive detail, with ample citations, that the epidemiological evidence underlying the interpretation of the data by obesity science is subject to skeptical consideration because it generally fails, on closer examination, to warrant the claims being made for it. The authors conclude: ‘In the end, the question of what is ‘true’ about the causes and consequences of overweight and obesity will probably prove to be immaterial. The important questions ... will probably be political, cultural, and social.’
The book aims to demystify the term in its title, The Obesity Epidemic, which is widely wielded by the medical and public health profession in order to characterize the proliferation of fat in our societies around the world. You might even say the book deconstructs the term, in the sense that it not only reveals its moral and political implications but also shows how they echo the whole institutional, medical, and official opinion of ‘obesity science’, about the dangers of fat. Not science, but opinion is what it proposes. The ‘obesity epidemic’ is more than a natural phenomenon, write the authors, it is rather ‘a social idea (ideology) constructed at the intersection of scientific knowledge and a complex of culturally-based beliefs, values, and ideals’. (p. 168) The expression, as they show, can be used formally and rigorously by epidemiologists to characterize the prevalence of a phenomenon. But it ‘conjures visions of a looming disaster’ when it evokes the terror associated with pandemic disease that requires drastic action. The use of the term, ‘obesity epidemic’ is properly speaking a piece of performative language in the service of an ideology—a purely speculative series of views that serve to motivate action or repress political activity.
The public discourse on obesity has become the vehicle of a moral and political agenda, an ideology, surreptitiously conveyed, in the name of science. This has given rise to the condition they succinctly describe: ‘More scientific information has increased stigmatization’ (9). In other words, the more science know about the mechanics of fat, the more that knowledge is used to promote a false idea of body weight—myths, lies, and statistical damn lies. The Enlightenment promised that more scientific information would make us free; science is increasingly in the service of our superstitions. Where once scientific rationality dissipated the clouds of mythical belief, increasingly we use science or pseudo-science to advance official myths and promote obscurantism—false consciousness, more or less venally motivated.
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Fat, in the media, is denounced in terms that are almost biblical in their moral disapprobation. As if the epidemic of obesity were some heresy that had dangerously spread to the heart of Western culture, in the wake of the 1960s when the ‘explosion’ of fat in America is thought by some to mark a moral crisis, a descent into cultural decadence. Obesity science, with little evidence, blames increased fat in children on their excessive immobility, on the arrival of virtual, video technology. It attributes our growing global fatness to the general decline of culture following the sexual revolution, even as it assigns ultimate responsibility for fatness to the individual in whom being overweight is a sign of gluttony and sloth, an index of humiliating personal failure. The interpretation of the causes and consequences of fat that emerges from the official use being made of epidemiological science is one that serves the political agenda of those who seek simultaneously to indict progressive culture, without engaging social issues, while constraining individual behaviour, in the name of public health, under the guise of doing it for your own good.
The authors skeptically wonder why it is overweight and obesity that have become an ‘epidemic’ in our societies, and not automobile accidents, for example, or pollution, which certainly kill many more people. The book addresses the interest that obesity science finds in advancing an ideologically motivated understanding of fatness, but it does so without dismissing it, without advocating a health position that approves or minimizes risk. The book merely argues for a greater skepticism toward the use that is being made of the data. And it demonstrates with extensive quotations, taken from a wide range of serious writers on fatness, how the data are often misused and misinterpreted, or simply ignored, in favour of traditional nostrums that summon us to watch our weight.
The authors Michael Grad and Jan Wright are aware of their apparent lack of the usual qualifications for speaking authoritatively about obesity: they are merely professors of physical education in Australian Universities, where health, as Nietzsche said it would, has become a fully recognized academic discipline, both scientific and sociological. It allows them to move with confidence and sure-footed assurance between the technical detail of epidemiological studies and the aesthetic theory that has been directed in recent years at the idea of fatness in our culture. It gives them a rare perspective and the academic credentials to examine obesity science with the caution and respect it deserves, in so far as it is science. But they are also able to situate that science, sociologically, examining with great sensitivity and tact how the science is put to use serving the ideological imperative to change behaviour in ways that serve the interests of certain groups or institutions.
It is one of the signs of the intellectual seriousness of this endeavour, that they take on the central but difficult question of the nature of the science underlying epidemiological conclusions—assumptions about health that require as their condition that one consider the body to be a machine. Health is defined in terms of the well-functioning of the machine. The authors are fully aware of the usefulness of that metaphor in promoting our understanding of human physiology: The heart, after all, is a pump. But the authors demonstrate the limits of thinking of fat in purely mechanical terms, as the ratio of calories ingested to energy expended; the resulting quantification falsifies actual conditions in the lives of the majority of overweight people, 7 out of 10 of us, to cite the latest statistics.1 Overweight and obesity, they argue, have only the most tenuous and certainly complex and contradictory relation to health—particularly at the level of the individual. ‘Grounds for uncertainty can be brought into play when causal relationships are no longer based on reasonable straightforward environmental factors, such as water quality or the absence or presence of a disease agent, but on complex human factors, which occur in social contexts.’ (p. 53).
‘The Obesity Epidemic’ is a book that will become an unavoidable reference in the on-going debate over the risks of overweight.
References
1 Vasan SR, Pencina MJ, Cobain M, Freiberg MS, D'Agostino RB. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med 2005; 143:473–80.
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