Abstract
While most sociology students are well prepared to think critically about inequalities involving race, gender, social class, and sexuality, the topics of body weight and health present some challenges for classroom discussion. Primarily, this is due to the body’s status in contemporary society as simultaneously malleable (able to be changed) and intractable (an indicator of moral worth). Such associations lead to cases of size discrimination—what is often called “sizeism”—with impacts similar to what is experienced around race and gender discrimination. To challenge students’ taken-for-granted assumptions regarding weight and health, I detail two classroom techniques involving deconstructing the obesity “epidemic” and comparing the pro-ana community to bodybuilders for their similar use of extreme behaviors to achieve ideal bodies. In this way, students learn to critically assess something that has held a stigmatized position (fatness) as well as something that has held a valued position (thinness).
The connection between assumptions of health and appearance is well established in U.S. culture, even if scholars have found these associations to be uncorrelated and problematic (Kolata 2007; Saguy 2013). For example, Jutel and Buetow (2007:432) note how a muscular build may bias a physician’s assessment, such as when a bodybuilder is proclaimed to be “healthy” even though using steroids to achieve their physique. Individuals with bodies judged to be overweight or obese face the opposite problem—pronouncements of ill health without considering objective measures such as blood pressure, cholesterol levels, or resting heart rate (Ferraro and Holland 2002). While visual indicators are important criteria for any medical practitioner, beliefs about health and appearance are so common that even lay people feel justified in making judgments. Hutson (2013) finds that because of their thin and muscularly toned bodies, personal trainers are often seen as not just healthy but as health experts who can diagnose and treat medical conditions. Thus, despite the adage to “never judge a book by its cover,” it is clear that individuals regularly make determinations about others based on bodily characteristics. This deeply ingrained connection between appearance and health is evident in contemporary debates around body size as well as in students’ resistance to thinking critically about body weight.
I encountered this resistance when teaching a course on the sociology of the body. In a lecture on health and weight, I facilitated a discussion about the “Health at Every Size” movement—a body-positive initiative that stresses physical activity and healthy eating for people of all body weights (Bacon 2008). The goal of this discussion was to challenge what students typically thought of as healthy versus unhealthy bodies and expand the idea of health to include all people, regardless of size. Comments from students, however, illustrated the entrenched relationship between thinness and health. As one student said, “I mean, it’s nice to be all ‘I’m fat and healthy!’ But really, if you’re fat, you are not healthy,” to which many others nodded along in agreement. As a sociologist and teacher, I found this to be particularly disappointing given that I knew these same students to be highly capable critical thinkers around issues of race, class, gender, and sexuality—other traditional areas of social inequality. Yet the dominant correlation of bodily fatness with unhealthiness (and to a large extent badness) meant that I needed to do some additional work to dislodge these associations that had sedimented over a lifetime of media consumption and social messages about bodies.
In this article, I describe how I began some of these classroom conversations around body weight and health using strategies involving the obesity “epidemic” and the pro-ana (short for “pro-anorexia”) movement. Before detailing these topics, I first suggest that “sizeism”—discrimination based on body weight and size—remains an unrecognized form of inequality, often complicated by the body’s status as simultaneously malleable and intractable. Because bodies are seen as able to be changed as well as indicators of a person’s moral qualities, individuals with nonidealized weights face discrimination in social life. To help students begin thinking critically about body weight as an axis of inequality, I use empirical evidence from critical obesity scholars to deconstruct the obesity “epidemic” and explain how recent studies have questioned the accuracy of the Body Mass Index (BMI) for reflecting health. Next, I detail my strategy of using the pro-ana movement to interrogate idealized forms of embodiment, such as with bodybuilders who employ similarly extreme measures to reach their desired physiques. In this way, students learn to critically assess something that has held a stigmatized position (fatness) as well as something that has held a valued position (thinness).
Sizeism, Stigma, and the Morality of Body Weight
Why is body weight such a contentious social issue? Why does this particular topic cause students (and others) to suspend their critical thinking skills? One possible answer lies in the contradictory status of the body in society: as simultaneously malleable and intractable. On the one hand, the body presents itself as malleable in that bodily appearance may change due to such practices as dieting, exercise, cosmetic surgery, and even clothing choices. On the other hand, bodies are seen as intractable—essential aspects of the self that are reflected in outer characteristics like race and gender. Because the body is considered to be both an indicator of one’s personal qualities (intractable) and within one’s control (malleable), body weight often functions as a type of moral barometer. That is, fatness is seen as proof of one’s badness, just as thinness is seen as proof of one’s goodness (Boero 2007).
Scholars have found that such associations often lead to the stigmatization of fatness and the valorization of thinness. For example, a study by Richardson et al. (1961) finds that when schoolchildren were asked to rank who they would most like to be friends with from an assortment of pictures—many of which included visible physical disabilities—obese children ranked last. Other studies have demonstrated similar results (Alessi and Anthony 1969; DeJong 1980), including recent research by Latner and Stunkard (2003) that replicated the Richardson et al. (1961) experiment, illustrating the persistence of views regarding body weight. Puhl and Heuer’s (2009) meta-analysis of research documenting the fatness stigma finds overwhelming evidence that obese individuals face discrimination in employment settings, health care settings, educational settings, and interpersonal relationships. Kwan (2010) suggests that certain types of embodiment—specifically thinness—operate in similar ways to racial and gendered privilege, providing advantages to individuals as they navigate public spaces and manage their bodies. Scholars believe that what perpetuates this stigma involves how some bodily features are understood as achieved, instead of ascribed, characteristics (Adler and Adler 2015; Goode 2014). As Cogan (1999:239) writes: “A central belief about obesity is that it is self-induced through overindulgence, gluttony, and laziness, which allows us to blame the obese individual.” Indeed, when DeJong (1980) manipulated pictures of overweight teenage girls to include an explanation that they suffered from a thyroid condition, sympathy toward them increased substantially. Thus, when bodily fatness can be explained as a condition that is out of one’s control rather than indicating that one is out of control, stigma is reduced.
This interplay between the body’s presumed malleability and intractability is important as it helps to explain why weight remains an often unrecognized factor in inequality, what is referred to as “sizeism.” Anti-fat bias may originate from a variety of sources and has a long history within U.S. cultural life. As Farrell (2011:5) notes, “The development of fat stigma, I realized, related both to cultural anxieties that emerged during the modern period over consumer excess and, importantly, to prevailing ideas about race, civilization, and evolution.” Regardless of the source, anti-fat prejudice may lead to overt discrimination. One of the most well-known examples involves Jennifer Portnick, a San Francisco jazzercise instructor who was fired for being “overweight” even though she was able to perform all of the routines (Kwan and Trautner 2011b). Puhl, Andreyeva, and Brownell (2008) compare rates of reported weight discrimination in employment to other types of discrimination. They find that individuals with a BMI of 30 or higher experienced discrimination at a rate of 5 percent for men and 10 percent for women, making weight similar in effect to age and race. 1 The material outcomes of such disadvantage involved lower earnings for heavier individuals across all racial categories, particularly for women (Cawley 2004; Hamermesh 2011).
Given that sizeism is experienced by people regardless of gender and race, it is noteworthy that there remains no legal recourse for individuals who report weight discrimination. Unlike gender and racial inequality, body weight is not protected under federal law. Michigan is the only state to pass weight discrimination legislation, and the District of Columbia, Santa Cruz, and San Francisco have passed city ordinances to prevent weight discrimination in employment. Rhode (2010) suggests that the continued unregulation of anti-fat bias is illogical in a culture that values equal opportunity based on performance. In many jobs, she argues, weight would have no bearing on a person’s ability to carry out employment-related tasks. Yet such discrimination does take place and, as Kwan and Trautner (2011b:56) note, relies on a continued belief that “The fat body is thought of as a personal choice and a moral failing, so, by that logic, fat people are blameworthy and deserving of discrimination.” Thus, because of the body’s assumed malleability, these laws have been difficult to enact.
Such impasses in the legal realm are curious given that race and gender remain protected categories and aspects of embodiment. Although scholars have illustrated that race is a social construct with little to no basis in genetics (Yudell 2014), visible differences between individuals—what are called “phenotypic variations”—mark people through skin pigmentation, hair, eye and nose shape, and height. Phenotypic characteristics have long been constructed as intractable and beyond an individual’s control. These visual cues, however, are not devoid of meaning and led to a history of essentialist beliefs about the innate abilities of women and men as well as the inferiority of non-white races (Yudell 2014). Accordingly, discrimination based on any trait seen as irrelevant to job performance, such as race and gender, was made illegal through the Civil Rights Act of 1964.
Recently, though, these intractable characteristics have proven to be somewhat malleable. For example, scholars have documented the experiences of transgender people, some of whom have transitioned from one biological sex to another (Connell 2010; Pfeffer 2010). Similarly, racial features that were previously seen as immutable have been altered through cosmetic procedures such as double-eyelid surgery for Asian individuals who want wider, more Caucasian-looking eyes (Kaw 1993). Thus, much like body weight, gender and race possess both malleable and intractable qualities. Unlike body weight, however, current laws protect people from gender and race discrimination and reflect our cultural values regarding equal opportunity. Because of this, Rhode (2010) believes that the same test should be applied to body size—as a trait that is irrelevant for a person’s performance in most jobs—making it a protected category at the federal level.
Legal codes are not the only arenas that can reflect cultural values—classrooms too are spaces that may reify dominant ideologies. Of course, they are also places for challenging such ideologies. As has been the case with race and gender, a variety of scholarly disciplines have worked to disrupt the association between scientific racism/sexism and the assumed capabilities of women and racial minorities. Teachers at both the high school and college levels have inserted these conversations into their lessons to help students navigate essentialist beliefs that may still manifest today. However, very few discussions critically assess the links between body weight, body size, health, and morality. What we need are tools for starting some of these dialogues—beginning with the understanding that both students and teachers have inculcated long-standing attitudes equating fatness with unhealthiness and with badness. Pushing back against these assumptions using theory and empirical data requires additional work on the part of educators. To that end, I detail some of the techniques I have used to get students thinking critically about the meaning of body weight by deconstructing the obesity “epidemic” and comparing bodybuilding to the pro-ana movement.
Deconstructing the Obesity “Epidemic”
One of the most effective topics I have found to teach critical perspectives on body weight, sizeism, and health involves deconstructing the obesity “epidemic.” Concern with body weight is a ubiquitous issue, and even students who do not regularly watch the news or consume health information will have encountered debates about obesity. Previously, I have used this material in courses of 25 to 40 students that covered a variety of subjects including Sociology of the Body, Introductory Sociology, and Health and Society. Although different instructors will adapt the following topic to their own particular teaching style and group of students (flipped classrooms, in-class exercises, active learning environments), I found that a blended lecture and discussion format works well for delivering the information. This is primarily because the lesson itself relies on laying out ample empirical evidence that rebuts the prevalent linking of fatness with unhealthiness.
By systematically presenting information that is at odds with widespread “commonsense” knowledge, I am engaging in the sociological tradition of “debunking” (Berger 1963)—the use of scientific data and critical perspectives to push back against assumptions about the social world. LeMoyne and Davis (2011) suggest that debunking taken-for-granted knowledge is useful for teaching about the construction of social problems and is an important addition to discussions of the “sociological imagination.” Indeed, C. Wright Mills (1959) put forth his own version of debunking by encouraging people to think about how what they believe to be “personal troubles” (individual-level problems) may actually constitute more widespread “public issues” (social-structural problems). As the topic of obesity illustrates, it is often conceptualized as a personal trouble—as a problem of individual willpower. However, through deconstructing what led to the increase in obesity, it becomes clear that the case is better conceptualized as a public issue resulting from institutional power and the redefinition of BMI categories. Such revelations expose students to the importance of actively questioning taken-for-granted assumptions and the value of a sociological perspective.
One consideration for instructors involves their own embodiment in the classroom, particularly when teaching about appearance, body weight, and body size. As has been illustrated, authority in the classroom is often tied to visible characteristics involving gender and race (Heckert et al. 1999; Hendrix 1998). Accordingly, both women and racial/ethnic minorities often must actively work to establish authority. In a study exploring the classroom interactions of faculty women of color, Pittman (2010) finds that they experience challenges to authority, questioning of their competence, disrespect toward their scholarly expertise, and a mixture of threats and intimidation. This is particularly the case when minority instructors teach on the topics of racial and gender inequality as students perceive them to be “biased.” Lusk and Weinberg (1994) note how this sentiment manifests when discussing controversial topics in the classroom: Members of nondominant groups are discredited more easily in the participants’ minds. This dynamic also affects the way instructors from various groups conduct themselves in the classroom in discussions of controversial topics. A “radical” position taken by a white male instructor may be more palatable to students than the same point as made by a woman or by a person of color. (P. 303)
Instructors may find a similar experience with body weight. Individuals who present as “thin” might be seen as more credible because they are deconstructing a system that benefits them while individuals who present as heavier or overweight (or, simply not ideally thin) may be seen as less credible because they are critically assessing a system that does not benefit them. In these instances, some students step into the role of defending the status quo or become, as N. Davis (1992:232) terms such exchanges, “the resisting class.” Guthman (2011) encountered such resistance among her students after inviting fat activist and author Marilyn Wann to speak in her class. As one student wrote, I will admit, Wann was a good public speaker, but her message was not something I was buying into. . . . So this morbidly obese woman gets up in front of the class and begins giving her very biased explanation of why being fat is OK. . . . She was full on supporting FAT America. (Guthman 2011:50)
Such resistance is another reason why I have found teaching this material via a lecture and discussion to be useful as it relies heavily on empirical data. For those students interested in defending the status quo, it becomes increasingly difficult to do so with the mounting evidence illustrating that thinness does not necessarily equate to health and that fatness is not a death sentence.
Topic Details and Instructional Strategy
To begin this lesson, I open with a short news video about the obesity epidemic. Although many videos are widely available (given the topic’s prominence in news media), I prefer a relatively recent clip reporting basic information about the phenomenon. 2 After viewing the video, I ask students: “Based on the information in this video or your own knowledge, what is the obesity epidemic, and why is obesity a problem?” Usually, the students relate that obesity is a major health crisis (both globally and locally), that it is causing health care costs to rise, and that it is a rapidly growing problem. I then ask, “What are the causes of obesity?” This typically stimulates a lengthy discussion where students reiterate most of the standard explanations for obesity: increased consumption of sugary snacks, junk food, too much fast food, lack of exercise, lack of playing outdoors, too much time spent inside playing video games, sedentary jobs, and no individual willpower to either eat better or start exercising. The purpose of this discussion is to gather together what students currently know about obesity. It draws on their cultural knowledge of the topic and effectively displays the prevailing ideologies about body weight. It is important to acknowledge that each of the factors they suggest may indeed lead people to gain weight. However, what caused the obesity “epidemic,” I tell them, had little to do with diet and exercise and more to do with changing how we measured if someone was obese or not.
I explain that the obesity “epidemic” began in earnest on June 17, 1998, when the National Heart, Lung, and Blood Institute (NHLBI) issued new guidelines for assessing weight and health using the revamped Body Mass Index (National Institutes of Health 1998). Whereas previous to the new guidelines people could possess a BMI of up to 27.9 and still be classified in the normal category, the new guidelines shifted the acceptable range down to a maximum of 24.9, and anyone 25 or higher became labeled overweight or obese (Squires 1998). This change increased the number of overweight and obese people in the United States from 61.7 to 97.1 million, or 55 percent of the adult population, effectively ushering in the modern American obesity “epidemic” (Flegal and Kuczmarski 2000). Although intended to bring U.S. standards in line with World Health Organization guidelines, Flegal and Kuczmarski (2000:1078) warn: “This example calls to attention the actual effect that a shift in BMI criteria can have on determining the population at risk.” Soon after these BMI changes, two studies cemented the link between fatness and negative health outcomes. Both Mokdad et al. (1999) and Allison et al. (1999) found that body weights above normal increased mortality risk, seeming to provide empirical evidence to support the NHLBI guidelines. These studies became widely disseminated in the media as evidence of the epidemic, thus furthering the panic around body weight.
After providing background information on the topic, I typically ask a rhetorical question (if a student in the class does not ask something similar): “So what if the guidelines changed? Isn’t it better that people know if they are at risk because of their weight?” Certainly, it is the case that people should have accurate knowledge about weight and health. However, I explain that many scholars do not believe the current BMI categories accurately reflect these associations. Recent stirrings within medical and scholarly communities have begun to challenge established connections between “excess” weight and poor health. Supported by epidemiological research, many studies find that body weights in the overweight and even obese I 3 ranges do not significantly raise one’s mortality risk. According to Flegal et al. (2013), normal and overweight constitute the healthiest categories to inhabit, while obese I shows only minimal increased risk. The study also finds that the categories with the highest mortality rate include underweight, obese II, and obese III. Other research has noted a protective health benefit for individuals in the overweight and even obese 4 categories, particularly among chronically ill populations who benefit from additional energy stores when undergoing treatments (Carnethon et al. 2012; Doehner, Clark, and Anker 2010; Lainscak et al. 2012; Romero-Corral et al. 2006). However, Flegal et al. (2013) find that such an effect occurs more widely within the population, not necessarily only for chronically ill individuals. Bodily thinness has also come under medical scrutiny (Flegal et al. 2005), as those in the underweight category (BMI < 18.5) as well as the lower range of normal (BMI 18.5–22.9) have shown a higher incidence of death (Flegal et al. 2005). Roh et al. (2014) find that underweight poses a risk due to a combination of factors including physical frailty, the inability to recover from external injury, increased rates of depression and suicide, and health-related issues such as cancer and cardiovascular disease. Similarly, Cao et al. (2014) suggest that underweight comprises the highest risk among all BMI categories—anywhere from 60 to 90 percent higher than normal, while obesity only increases the risk of death compared to normal by 30 to 40 percent.
After presenting this empirical evidence, I open the floor for discussion and ask students to share their thoughts. What I hear most often is a version of the following: “If being overweight isn’t bad for you, then why do you always read about how terrible it is to gain weight?” I acknowledge that this is an excellent question and use it as an opportunity to discuss news media and framing contests—both how such contests arise and their effects (Best 2001; Hilgartner and Bosk 1988; Jutel 2010). In most cases, framing contests represent turf wars between different social institutions, or “obesity epidemic entrepreneurs” (Monaghan, Hollands, and Pritchard 2010), each battling for the right to frame an issue in a particular way and thus to regulate the problem (Gusfield 1967). News media reporting on obesity contributes to its framing not just as a social problem but as a dire moral panic (Campos et al. 2006). Typically, this is accomplished by using sensationalistic language and by conflating the categories of overweight and obese (Saguy and Almeling 2008). As has been shown, overweight and obese have very different health outcomes, but they become fused in the minds of viewers, which results in heightened anxiety over gaining any degree of weight.
By the end of the discussion, students will have encountered a variety of new ideas about body weight while being provided with tools for understanding the climate surrounding obesity in the United States. Certainly, the most important goal is to stimulate critical thinking and model how one might apply such lenses to other situations when asking questions about measurement, categorical shifts, and institutional power. Importantly, many students may leave this lecture and discussion somewhat unsettled as their underlying beliefs about body weight have been challenged—things they took as “facts” before the lesson are no longer so certain. This is an intended outcome, and many students relate in emails or reading responses that they are no longer sure what to think about body weight and health. As one student wrote in her weekly response: “I always thought the thinner you are, the healthier you are. Period. Now I don’t know what to think. I guess I’ll have to start reading more about this to figure it out for myself.” Although debunking may cause some students to feel dissatisfied that there is no definitive answer to the question of body weight and health, its purpose is to stimulate their curiosity to know more and evaluate evidence for themselves using a sociological perspective.
Pro-Ana Movement and Bodybuilding
Another useful technique for helping students confront assumptions about body weight involves comparing bodybuilding to the pro-ana movement. On the surface, of course, these are two very different topics. While bodybuilding and strength training are generally valued activities, behaviors associated with anorexia, such as starvation and purging, are not. Yet, individuals involved in bodybuilding and the pro-ana subculture both rely on extreme practices and intense bodily management to achieve (or strive for) an idealized body—albeit one that is valorized and one that is stigmatized. Comparing and contrasting these two cases is useful for problematizing widespread beliefs about embodiment, health, and fitness.
One of the difficult aspects of teaching this material is that anorexia, bulimia, and other eating disorders are common among college-aged individuals, particularly women (Kitsantas, Gilligan, and Kamata 2003). It is likely that many students will have struggled with body image issues and in some cases resorted to various types of disordered eating. Because of the likelihood, this is one of the lessons where I provide advance notice about the topic—what is currently referred to as a “trigger warning.” I do not regularly issue trigger warnings in most of my classes when confronting inequalities surrounding racism, sexism, classism, or heterosexism as exposing students to the realities of inequality—even those they might find difficult or uncomfortable—is itself part of the learning process. Yet, some topics are more clearly cases where such warnings are appropriate, particularly when discussing issues that may retraumatize individuals such as: sexual violence, drug abuse/addiction, rape, domestic abuse, physical assault, hate crimes, animal abuse/cruelty, and eating disorders. All of these topics have an important place in classroom discussions as they constitute real social problems that went unacknowledged for too long. Letting students know ahead of time that a certain subject will be covered is ultimately at the discretion of the instructor. However, it has been my experience that students usually appreciate such advance warnings because it allows them to engage in the readings, activities, and discussions rather than retreat from them.
Topic Details and Instructional Strategy
For teaching this lesson, I use a combination of lecture and an in-class exercise where students evaluate a series of photos. In the exercise, I ask students to rate a person’s level of “fitness” on a scale of 1 to 10 (where 1 is low and 10 is high). 5 I use eight photos altogether: four images of professional fitness models and four images of Olympic athletes who have (what would be considered) non-idealized bodies in terms of weight, size, and shape. These athletes were selected from a photography project by Howard Schatz who documented an array of Olympic athletes’ bodies by sport (Schatz and Ornstein 2002). The four athletes I use are: Shane Hamman (weightlifting), Cheryl Haworth (weightlifting), Adam Nelson (shot put), and Dawn Ellerbe (hammer throw). I searched Google Images to find pictures of the athletes in regular clothing and poses so as not to mark them as Olympians or athletes. The four photos of fitness models may be any the instructor deems useful for the exercise but should show them in either regular clothes or workout attire (not any from magazine covers that signal they are models). 6 I display each image one at a time and ask students to mark down their rating of the person’s fitness from 1 to 10, along with any notes about why they rated them that way. After the evaluation is finished, I then go back through each picture and ask volunteers to explain the logic for their scores. What this accomplishes is to illustrate widespread agreement among students about assumptions of fitness based on appearance, as often the fitness models will garner 9s and 10s while the athletes receive 5s and lower.
Once the discussion of the ratings is finished, I ask students: “In your opinion, how many people think that an Olympic athlete is someone who is fit?” When most students agree (by a show of hands), I tell them: “Of the eight pictures you just saw, four of them are Olympic athletes. Which ones are the Olympians?” This causes some degree of consternation as they wrestle with the realization that the “fittest” people in the pictures may not be athletes. After allowing discussion to go on for a short time, I reveal to them the four people with the lowest fitness ratings were the athletes, while the others were models. I then show pictures of the Olympians competing in their respective sports to prove they are athletes as well as magazine covers of the fitness models. 7 Clearly, all of the Olympic athletes are “fit” for their particular sport, even if they do not possess bodies that align with ideals of thinness and muscle tone. I conclude the exercise by making the point that appearance is rarely an accurate gauge of either fitness or health, neither of which should be conflated with what is considered to be “beautiful” for men and women. This divide between appearance and assumptions of health, I explain, becomes apparent when comparing the activity of bodybuilding to behaviors by people in the pro-ana community.
I begin by noting that the pro-ana movement is somewhat oddly named given its stated aims and goals. The adherents claim that they do not promote the eating disorder of anorexia and actively resist the pathologizing label of anorexic (Boero and Pascoe 2012). Rather than being “pro” anorexia, this group of predominantly young women subscribe to behaviors that produce anorexic-like bodies—not anorexia (they claim), the eating disorder. It is a careful line to walk for individuals in this subculture, and the title of the movement obscures their overarching purpose—namely, to engage in specific practices that generate an idealized body (Riley, Rodham, and Gavin 2009). The methods used are dangerous and unhealthy, including starvation (eating as few calories as possible each day), worshiping pictures of bone-thin models known as “thinspo” (short for “thin inspiration”), intense self-surveillance, community policing bordering on bullying, and forced regurgitation of food using liquid soap (Boero and Pascoe 2012). Scholars report that various websites provide tips for staying thin such as cutting an apple into eight parts to eat throughout the day, spraying food with inedible substances to discourage eating, making a meal and throwing it away, and using deception to hide their activities from family members, such as leaving dishes out or wearing heavy clothing before being weighed at the doctor’s office (Harshbarger et al. 2009). Such practices, while disturbing, are carried out in service of achieving an extreme body that is—in their minds—the ideal body to inhabit.
It is at this point that I pause and “check in” with students about the material being presented. I ask, “What are your thoughts or reactions to this information about pro-ana communities?” Often, students respond with incredulity or disbelief that people would undergo these extreme measures. Many express sympathy toward those who believe such practices are necessary. And in some cases, students are angry. As one student said in a reading response, “It is infuriating we live in a culture that convinces girls they should do these things to their bodies.” After listening to the reactions, I present information on the health risks of such behaviors by discussing scholars and health officials who have spoken out against the pro-ana movement as well as its attendant sister movement, the pro-mia (or, pro-bulimia) movement (Brotsky and Giles 2007; Harshbarger et al. 2009). Their concern is justified, I tell them, as a recent study found that anorexia has a significantly elevated mortality rate (Arcelus et al. 2011), positioning it as one of the most dangerous eating disorders. Epidemiological studies of body weight have found that people with a BMI in the underweight category (BMI < 18.5) have a considerably higher risk of death compared to the normal, overweight, and even obese categories (Cao et al. 2014). It is clear that pro-ana behaviors can lead to extreme thinness and dangerously poor health. Yet, when analyzed from a critical perspective, the practices of individuals in the pro-ana movement do not appear entirely dissimilar from others who are trying to build ideal bodies, such as bodybuilders.
As I explain to students, by “bodybuilder” I do not mean people who go to the gym and participate in strength training, even with the explicit goal of developing a degree of musculature. Rather, a bodybuilder is someone who attempts to intensely sculpt (and often grow) specific muscles while shedding fat to further enhance the display of those muscles. Many individuals involved in bodybuilding may compete in amateur, semi-professional, and even professional bodybuilding contests. However, to garner the greatest social rewards or to even be competitive, bodybuilders must engage in a variety of questionably healthy activities such as extreme starvation, food restriction, excessive exercising (going to the gym two and three times a day), and the use of steroids or other performance-enhancing substances (Probert, Palmer, and Leberman 2007). Indeed, pre-competition routines are often so rigorous that bodybuilders themselves admit to the dangers involved. As Jake, one of Probert et al.’s (2007:280) interviewees, states: “You are starving your brain of carbs half the time, getting yourself to a point that is extreme and then go and dehydrate yourself on top of that.” While many individuals involved in bodybuilding may not always want to build the kinds of bodies suited for competition, the activity itself remains widely valued despite the associated health hazards. 8
Scholars have noted numerous health and mental health risks related to building highly muscled bodies. While traditional anabolic steroids are technically prohibited from most major bodybuilding competitions (Santonja 2016), it is commonly understood within bodybuilding communities that steroids are required to be competitive (Monaghan 1999). As physicians note, steroid use is associated with adverse effects such as impaired liver functioning, cardiovascular issues, high blood pressure, reproductive complications including lower sperm count and reduced testes size, and psychiatric effects such as aggression and mood swings (Kutscher, Lund, and Perry 2002). Olivardia et al. (2004) find that bodybuilders are more prone to depression and eating disorders, while Duggan and McCreary (2004) suggest that media representations explain men’s disordered eating due to the equation of masculinity and muscularity. Some scholars term this drive toward bigness in men bigorexia (Mosley 2009), drawing a similarity to women and higher rates of anorexia. As is evident, there are many potential physiological and mental health concerns associated with bodybuilding. And such risks become more apparent when compared with individuals in the pro-ana community.
Both bodybuilders and pro-ana adherents engage in extreme practices to build ideal bodies. Certainly, both subcultures are involved in a rigorous policing of diet—particularly as bodybuilders approach a competition but also in more everyday life contexts. Bodybuilders, much like those in pro-ana communities, utilize tricks to lose or gain weight involving starvation and binging (Probert et al. 2007). Also, their respective online groups rely on a high degree of support and shaming (Brotsky and Giles 2007; Monaghan 1999). Whereas pro-ana forums are filled with members reminding each other to not eat or using fat-shaming rhetoric (Brotsky and Giles 2007), bodybuilding forums relate similar messages when members post pictures of their bodies for others to critique (Smith and Stewart 2012). Often, these critiques are delivered in terms of derision and mockery, interspersed with praise and motivational messages—similar to what is seen on pro-ana message boards (Boero and Pascoe 2012). In this way, bodybuilders and pro-ana community members are using demonstrably dangerous techniques to achieve what they consider to be an ideal body. Comparing a popular activity such as bodybuilding with a stigmatized activity such as pro-ana behavior reveals something important about the current value system surrounding bodies. It suggests that although each involves extreme conduct, the negative health consequences of bodybuilding often go unrecognized. It also raises an important question for students: How can they reconcile the similarities between these activities when they have been told that bodybuilding is good and anorexia is bad?
One of the outcomes of this lesson is that it allows students to encounter a pedagogical debate that has been ongoing for some time—what can be described as “cultural relativism” versus “moral absolutism.” Cultural relativism is the acknowledgement that norms, values, and practices vary by culture, which determines—within that context—what is right or wrong (Donnelly 1984). Moral absolutism, on the other hand, encompasses the belief that some actions are intrinsically right or wrong, regardless of cultural context. Often, relativism is criticized as leading to a state of moral paralysis—a situation where individuals are unable to speak out against various atrocities and human rights violations. As Schopmeyer and Fischer (1993:194) note, “this doctrine appears to justify the acceptance of any cultural pattern—slavery, marital rape, genocide—no matter how inhumane or brutal, in the name of ‘tolerance.’” For example, the debate over female circumcision in some African communities often becomes framed as religious tradition versus “mutilation” (Bell 2005).
The topic of pro-ana communities brings such concerns to the forefront of classroom discussions. As a sociologist and social constructionist, providing students with an understanding of how values and norms vary by culture is an important aspect of my teaching. This typically involves withholding judgment and playing “devil’s advocate” when discussing difficult material (Hedley and Markowitz 2001). With that said, I also make clear to students that I am not—by comparing it to bodybuilding—endorsing pro-ana practices. My goal is to provide ample evidence illustrating the clear health risks of pro-ana behaviors and bodybuilding, such that students may conclude each is a relatively dangerous pursuit. Part of instilling critical thinking skills includes modeling decision making based on scientific research rather than myth, prejudice, or ignorance. Instead of leading to a state of moral paralysis, presenting many sides of an issue through a cultural relativistic lens leads to informed judgments that take into account multiple perspectives. In this way, the intention of the lecture is not to normalize pro-ana behaviors but to problematize the valorization of bodybuilding and other similarly intense body surveillance techniques.
Conclusion
Encouraging students to think critically about inequalities surrounding race, gender, social class, and sexuality is a regular component of contemporary sociology curricula. However, many students (and scholars) have difficulty applying some of the same critical views to discussions of body weight and size. Partially, this is due to the body’s status as simultaneously malleable and intractable—that is, both an object capable of change and one that symbolizes a person’s moral and social worth. Thus, individuals are often held responsible for their body weight in ways they are not for other aspects of embodiment. To stimulate conversations around sizeism in the classroom, I utilize two techniques involving deconstructing the obesity “epidemic” and comparing bodybuilding with the pro-ana community. The goal of these discussions is for students to leave actively questioning why some bodies are valorized and others are stigmatized.
Although my intention is to encourage critical thinking about body weight and health, I am also opening up conversations regarding sizeism more generally. As an axis of inequality, the body has traditionally been overlooked in sociology (Frank 1991), even though scholars have illustrated that certain aspects of embodiment, such as beauty and attractiveness, are influential factors in employment and promotion (Hamermesh 2011; Kwan and Trautner 2011a; Rhode 2010). Including the body in analyses of inequality requires researchers to acknowledge that size discrimination exists and has an impact on people’s everyday lives and livelihood (Kwan and Trautner 2011b). Studying the material consequences of sizeism should be included in research measuring other effects, such as race and gender discrimination, to more fully account for the wide variety of factors influencing social inequality. However, such efforts will be difficult to achieve until scholars can resolve the tension between the intractability and malleability of the body. Some of this work can begin in classrooms, when instructors utilize empirical evidence to challenge taken-for-granted assumptions about body weight and health and body size and morality.
The topics of the obesity epidemic, pro-ana movement, and bodybuilding also have application beyond an analysis of body weight and health as they connect to many key concepts in sociology. For example, I have used the case of anorexia to illustrate “medicalization” (Conrad and Schneider 1992) by discussing the transition of extreme thinness from a symbol of spirituality into the mental illness of “anorexia” (Brumberg 1988). Also, the pro-ana community’s resistance to medicalization is interesting in its similarities (as well as contrasts) to other groups aiming to de-pathologize, such as with homosexuality (Conrad and Schneider 1992), transgender people (Burke 2011), and among intersex individuals (G. Davis 2015; Preves 2002). The construction of body weight as an “epidemic” has been useful in classroom discussions of moral panics (Campos et al. 2006; Cohen 1972), as it is possible to apply Goode and Ben-Yehuda’s (1994) six criteria to media representations of fatness and thinness (Saguy and Gruys 2010). Lastly, these topics clearly illustrate the social construction of stigma (Goffman 1963) and the relativity of deviance as individuals involved with pro-ana communities must often hide their behaviors while those of bodybuilders are on public display in gyms.
Facilitating classroom conversations involving weight and health is not intended to forcefully change students’ minds, persuade them that fatness is unequivocally healthy, or convince them that body weight isn’t something that can be changed. Certainly, within a given range (approximately 20–30 pounds), body weight is able to be changed with greater or lesser effort, depending on a variety of factors (Kolata 2007). Instead, the objective is to illustrate that thinness and fatness are not health opposites and that they are—on their own—poor measures of health. Providing a forum where students may critically engage with many sides of a debate, evaluate empirical evidence for themselves, and understand that science is far from unanimous about the negative or positive effects of body weight is a valuable exercise to produce more critical thought on a highly relevant and contentious social issue.
Footnotes
Acknowledgements
I would like to thank the editor of Teaching Sociology, Dr. Stephen Sweet, as well as the anonymous reviewers for their support and helpful input on this article. A version of this article was presented at the 2015 ASA meetings in Chicago as part of a teaching workshop that discussed critical perspectives on the body. My thanks to the session organizer Sharon Preves, as well as my co-panelists Jessica MacNamara, Michaela A. Null, Carla A. Pfeffer, and Erica L. Toothman, for providing the space to present and exchange ideas.
Editor’s Note
Reviewers of this manuscript were, in alphabetical order, Deborah Harris, Samantha Kwan and Abigail Saguy.