Abstract
In Killer Fat, Natalie Boero examines both the social construction of the obesity epidemic and the impact of that construction on fat people. To guide her work, she employs the concept of a postmodern epidemic, the characterization of a social issue in terms of moral panic and chaos normally associated with biological contagions. Since body weight is a biological measure, she argues, it was easy for policymakers and the medical community to frame the increasing weight of the population in terms of an epidemic. More important, however, are the consequences of this framing on the lived experiences of people participating in weight loss programs or pursuing surgical options to control their weight. The timeliness of Boero’s study is highlighted by the June 2013 decision of the American Medical Association to label obesity as a disease.
Boero begins her study with a discussion of public health framing and media coverage of the rising prevalence of excess weight in the American population. She traces the development of the Healthy People reports from the Department of Health and Human Services (DHHS) and the dramatic change in the prominence of body weight as a health indicator. She focuses on the American context, although an interesting addition to this discussion would be the role of the WHO and emerging international standards of obesity that influenced, and perhaps were influenced by, this shifting discussion in the United States. Boero focuses particular attention on the roles of the American Obesity Association (AOA) and the North American Association for the Study of Obesity (NAASO), both of which advocated for the adoption of a disease model of obesity. These organizations served as moral entrepreneurs in the decision-making process of the DHHS, advancing their organizations through their own claims—making and discrediting alternatives.
Some may criticize the use of the term “epidemic” to describe the increasing weight of the American population, but there is no doubt, as Boero admits, that the average body mass index (BMI) of the population has increased over the last several decades. What is interesting then, is not the fact of increasing body size, but the portrayal of this fact, and the reasons for the increase, by the media. In her second chapter, Boero explores how the media added fuel to the epidemic fire and helped create an atmosphere of fear around weight. The media created panic and chaos through their alarmist claims about the nature of obesity and its consequences. Ultimately, individuals are seen as responsible for their behavior and admonished to exercise better personal control.
This emphasis on personal responsibility provides the framework for the remainder of Boero’s analysis. In Chapter Three, she describes her ethnographic study of two organizations associated with weight control, Weight Watchers and Overeaters Anonymous. Through participant observation she provides a rich description of the experience of attending meetings of both groups. She seamlessly blends interviews with her observations of the settings, literature, and approaches of the programs. Her decision to focus on these two groups provides contrasting perspectives on the nature and cause of excess weight. Is it normative pathology, as argued by Weight Watchers? Or, is it a unique disease resulting from compulsive eating based on emotional, physical, and spiritual illness? The tactics of the two groups differ markedly and are rooted in these differing conceptions of the root nature of the problem. Weight Watchers, Boero argues, focuses on women and the need to develop new habits around food. In contrast, Overeaters Anonymous views overeating (not obesity) as a disease over which one has little control and from which a person is never cured. The emphasis is on recognizing this individual lack of control, and dependency on a “higher power” to aid recovery.
Chapter Four examines the increasing important role of bariatric surgery in the treatment of weight loss. She uses the lens of heterosexuality to highlight the gendered nature of the surgery and the experiences after surgery. While gender enters into the discussion of weight loss groups, it is in this chapter that Boero makes the strongest argument regarding gender. Her discussion of surgical weight loss “failures” poignantly illustrates how both gender roles and individual responsibility become internalized when one female patient comments that it was her failure, not that of the surgery, that lead to her weight gain. Those who regain weight, in this case a woman, are seen as being unable to maintain the emotional control necessary to retain the benefits of bariatric surgery.
In her concluding remarks, Boero brings in a discussion of the Health at Every Size (HAES) movement. This group, a network of healthcare professionals, attempts to shift the focus of the healthcare community to health rather than body weight as the appropriate concern. Interestingly, it is only when discussing the results of a single study, WomanCare Plus, that Boero offers specific research results, perhaps privileging those results above many other well-founded studies that have examined the relationship between health and body size. At the same time, she recognizes the danger of any movement to create an image that adherents are somehow “better” than others.
Boero’s book would be useful in graduate courses on gender, sociology of the body, and medical sociology. I would also recommend it as an example to those wishing to publish ethnographic research in a manner that is accessible, yet rigorous.