Obesity Epidemic

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O besity as a category has been the subject of much public debate over the past decades. It has become the target of public health concern and part of a rethinking of where the sources of danger for the public may lie. Such a rethinking mixes and stirs many qualities together to provide a compelling story that defines "obesity" as the "new public health epidemic." Defining where danger lies is central to a rethinking of obesity as the central problem of public health. Given that dieting culture today claims to "cure" obesity, the warning of George A. Bray should be taken seriously:

The studies of diet have shown that no diet is ideal. Cannon showed that gastric contraction is a hunger signal modified by food in the stomach. Diets modifying every nutrient have been published by a gullible and optimistic public. If any of them had "cured" obesity, it is hard to see what the market would be for the next diet.

Today the media is rife with warnings about the "obesity epidemic." "Epidemic" was first evoked in public health terms of the "epidemic of heart disease" for which obesity (and smoking) were seen as major causes (Moonman 1976). By 1987, the media began to evoke the specter of epidemic obesity as a problem in itself. " 'Childhood obesity is epidemic in the United States,' said Dr. William H. Dietz Jr. of New England Medical Center" (Haney 1987). Headlines such as "Obesity Epidemic Raises Risk of Children Developing Diabetes" grabbed the attention of the reader (Lawrence 2004). Even those reporters who are a bit more attuned to what the term "epidemic" may imply tend to agree. "To describe what has happened as an epidemic may seem far-fetched. That word is normally applied to a contagious disease that is rapidly spreading. But the population that is obese has grown 400 percent in the last 25 years" (Derbyshire 2004). Even the food industry feels that they are well positioned, for who is "better suited to solve the obesity epidemic" than they are (Fusaro 2004). The "wellness" industry too is aware of the potential of the obesity epidemic: "According to a new study, Americans consider childhood obesity as serious a problem as smoking or school violence, exceeded only by substance abuse as a health threat to school-age children" (Anon. "Public Sees Childhood Obesity" 2004: 28). In both of these cases, the industries concerned will make money; obesity is a growth industry.

From the U.S.A. to Australia, the "obesity epidemic" has become a "political issue" (Anon. "Size Up Options" 2004). The British Labour Government in 2004 admitted that it had removed the tackling of this epidemic from its public health goals and belatedly published a major account of the epidemic including horror stories about the death of a three-year-old girl from obesity (National Health Service 2004). According to the press, there was no question that "her death was due to over-feeding and bad parenting" (Finnegan and Madeley 2004). The story turned out to be a poor indicator of the epidemic as the child died of a genetically transmitted disease of which obesity was only one factor.

Obesity is not itself a "disease" but rather a phenom-enological category that reflects the visible manifestation of body size, which potentially can have multiple (multi-factorial) causes. No one dies from "obesity." One dies from those pathologies that may result from extreme

202 OBESITY EPIDEMIC

excess weight. Indeed, obesity may be a tertiary cause of morbidity or mortality; it may lead to diabetes, which may lead to vascular disease. Thus, the image of an "epidemic" of obesity demands a single, clearly defined cause for this "disease," much as has been done with other recent epidemics of infectious diseases. Indeed, it is striking that the assumptions about the causality of "obesity" as having a single cause are part of the urban myth of disease (Johnson et al. 1994).

Politicians' use of the term "epidemic" is very much in line with that of the medical profession. "Obesity and sedentary lifestyle are escalating national and global epidemics that warrant increased attention by physicians . . . and the pivotal role will be played by physicians and other health care professionals in curbing these dangerous epidemics ..." (Manson et al. 2004). As early as 2002, The Lancet warned about the global "obesity epidemic" and provided a detailed account of the public health discussions of this new killer (Larkin 2002). In 2004, E.B.R. Desapriya of the British Columbia Injury Research and Prevention Centre for Community Child Health Research in Vancouver, BC (Canada) warned that

The obesity epidemic poses a public-health challenge. Obesity has a more pronounced effect on morbidity than on mortality, and an increase in its prevalence will have an important effect on the global incidence of cardiovascular disease, type 2 diabetes mellitus, cancer, osteoarthritis, work disability, and sleep apnoea. A 1% increase in the prevalence of obesity in such countries as India and China leads to 20 million additional cases. The state of childhood obesity in the U.S.A., Canada, and many other countries worldwide has reached epidemic proportions; the Canadian prevalence tripled between 1981 and 1996.

(Desapriya 2004)

We are, everyone agrees, in the middle of an obesity "epidemic."

"Epidemic" is a technical term from epidemiology meaning any "large-scale temporary increase in the occurrence of a disease in a community or region, which is clearly in excess of normal expectancy." Yet, it is "widely used to describe clusters of diseases in general [although it has] traditionally been used when infections strike a population" (Blakemore and Jannett 2001: 249). "Epidemic" maintains a powerful metaphoric connection to contagion. It can, of course, be applied to any disease, no matter what its cause, all injury (including gunshot wounds, as the Centers for Disease Control found to its political embarrassment a number of years ago) or other health-related event. It may be global (pandemic), but it is always defined by its rate of increase, not its universality.

"Epidemic" seems to be a creation of the seventeenth century, borrowed from the French at precisely the same time as the term "obesity." In 1620, Tobias Venner's handbook of humoral good diet and health, where one of the first uses of the term obesity appears, notes that a fat and grosse habit of body is worse than a leane, for besides that it is more subject to sicknes, it is for all corporall actions farre more unapt. They are more sickly that have grosse and full bodies, not onely because they abound with many crude and superfluous humors, but also because they lesse (by reason of the imbicillity of their heat) resist extrin-sicall and intrinsicall causes that demolish their health.

(Venner1628: 196)

"Obesity" is, according to Venner, a disease process. Thomas Lodge in i603 needed to define this new notion of "Epidemick" for his readership: "An Epidemick plague, is a common and popular sicknesse, hapning in some region, or country, at a certaine time, caused by a certaine indisposition of the aire, or waters of the same region, producing in all sorts of people, one and the same sicknesse" (Lodge 1603: Bijb). Two decades later, Francis Bacon, in his The Historie of the Raigne of King Henry the Seventh (1622) can speak of the "sweating-sickness" as "was conceived not to be an epidemick disease, but to proceed from a malignity in the constitution of the air, gathered by the predispositions of the seasons; and the speedy cessation declared as much" (Bacon 1963: 6 and 33-4). "Epidemic" quickly takes on metaphoric meaning, as in John Milton's condemnation of an "epidemick whor-dom" in his 1643 treatise on divorce (Milton 1851: 2, 97). This movement between illness and metaphor continues in our contemporary anxiety about the epidemic of obesity.

What is seen to cause human "obesity" is varied over time. Today there seems to be a stress on a number of often conflicting causes (Chang and Christakis 2002). Central among them are social and genetic-physiological explanations:

1. A shift in "quality of life" and life expectancy. We live longer now, have less physically stressful occupations, and have easier access to more food.

2. A psychological dependency on food as a means of manipulating the immediate environment. This is an assumption that obesity is simply on a continuum with anorexia nervosa, which has been so defined by psychologists. Obesity is thus a mental illness.

3. Access to poor but abundant food and the absence of structures to engage in physical activity: the obesity of poverty argument.

4. The loss of control over our consumption of food because of our addictive behavior. Addiction is usually understood following the medical model of some type of pathological genetic predisposition in an individual or a group rather than a "weakness of will" (Miller 1980).

5. A "normal" genetic predisposition understood in terms of evolutionary biological drive to accumulate body fat in order to preclude starvation in times of famine (Kolata 2007). This is the "ob-gen" argument first put forth in the classic 1994 paper on the genetics of obesity in mice that concludes with an extrapolation about human beings (Zhang 1994, 6).

6. A disruption of normal growth because of the changes in the endocrine system though pathological changes including aging (also understood as pathological).

7. The result of infection. This had been argued by Jules Hirsch in 1982 (Lyons et al. 1982) and more recently has been advocated by Nikhil Dhurandhar (Dhurandhar 2001).

What is clear is that any single explanation maybe possible for any given individual but it is the social implications of "obesity" that have now turned it into an "epidemic."

The epidemic of obesity is actually presenting itself as a worldwide "moral panic," that is an "episode, condition, person or group of persons" that have in recent times, been "defined as a threat to societal values and interests" (Cohen 1972: 9). Thus, Stanley Cohen created the concept of a "moral panic" in the early i970s in his work on witchcraft trials and other such "constructed" phenomena seen as "epidemic." Obesity is characterized by "stylized and stereotypical" representation by the mass media, and a tendency for those "in power" (politicians, bishops, editors, and so on) to man the "moral barricades" and pronounce moral judgments. Moral panics need not be focused on "invented" categories such as witches; they can also be associated with real health problems as a way in which to magnify and shape their meanings. They can use "real" categories of illness to explain such health problems within the ideological focus of the time (Cohen

The anxiety about "epidemics" points up the danger that seems to lie in the concept of "moral panic." Obesity is now the central "danger" to confront all aspects or all societies (as it is seen as an epidemic of poverty as well as affluence). The spread seems like a contagious disease. Yet each discussion of obesity seems to choose some model for the cause and nature of obesity that can be the point of intervention to end this plague: Whether it is the danger of fast food, too much sugar or fat, too little exercise, damaged psyche or weak will, too-large portions, genetic predisposition, or hormonal imbalance. It is not unpredictable that there has been a strong argument for at least some cases of obesity being the result of an infectious agency—this fulfills all of the metaphoric power of the "moral panic" about fat and limits its locus to a specific and treatable cause. In the U.S.A., this is embodied by "the Center for Science in the Public Interest. That's the advocacy group that periodically issues breathless bulletins (Food porn!) warning that one food or another (eggs, soda, shellfish, Mexican food, Chinese food, French fries, donuts, beef, salt, etc.) is bad for you" (Anon. 2005). A magic bullet can be found which is simply more difficult for most of the other imagined biological or social causes postulated for obesity.

See also Aboulia; Anorexia; Binge-eating; Cannon; Children; Genetics; Infectobesity; Smoking

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