16 September 2009

Research: Foresight, Tackling Obesities: Future Choices is still a load of rubbish

I've been revisiting Foresight this week, reading the second edition of the project report, published in 2007.

Foresight, Tackling Obesities: Future Choices is the name of a project commissioned by Sir David King KB ScD FRS, Chief Scientific Advisor to HM Government, who was then Head of the Government Office for Science. King commissioned the report because he was concerned about what he thought was the rise of obesity and its cost implications for the UK. The report has become the government's go-to resource in terms of developing anti-obesity policy and has sprouted an Independent Expert Advisory Group.

I wanted to have a look at Foresight again because I'm working on a paper about the war on obesity as a metaphorical conflict, and I'm struck by the repetition of the expression "tackling obesities" in the report. It makes me think of wrestling with an invisible foe, like something Captain Kirk might wrassle with on an old episode of Star Trek. This must be how the report's authors and advisors see fat people, a nebulous enemy that needs taking down by them, and not so far off from the supposed enemies of the war on terror. Obesities is pretentious too, but not as pretentious as 'obesogenic,' which this project may have coined.

I also wanted to revisit it because I noticed recently that two Health At Every Size proponents were using the Obesity System Map fairly uncritically. I think this map is baloney, and that Foresight is no friend to HAES, so I wanted to have a look at the report again and try and see it from their points of view. Could it be a useful tool?

There are more problems with this report than I have time to write about today, but I want to mention a couple of things.

The report is wrong, and wrong in the most amazing ways, because it starts from a popular position that is simplistic, and also wrong. Remember the parable about building a house on firm foundations? This house is built on sand.

King commissioned the report with the explicit belief that obesity is a problem and the implicit assumption that fat people could not also be healthy. I don't think obesity is the problem, I think social attitudes towards fat people go a long way in affecting people's health. I think my health as a fat person is threatened by a health service that tries to withhold treatment from me until I lose weight, or tries to coerce me into profitable but unhealthy weight loss regimens; or the stress and social repercussions of being stigmatised or discriminated against, and the internalised self-hatred this can engender. I think my health is more threatened by these things than by the wobble of my belly, and that the cost to the nation of obesity-related health problems is really about what hatred costs the nation. I also know that the size of one's body does not necessarily correlate with the health of one's habits.

Foresight is fixated on energy balance (calories in + calories expended = body size), a polite, 'scientific' way of blaming fatness on gluttony and sloth, even though they also make confusingly inconsistent genetic claims for fatness. They build fantastically complicated Obesity Systems Maps around this assumption. If this was a project about how to make people eat less and exercise more then it would be more successful, I have no problem with proposals to increase the availability of good quality food, or opportunities to ride my bike. Unfortunately the project is built on the assumption that fatness is synonymous with an energy balance that's out of whack and that therefore fat people must be prevented from existing and eradicated because they cost too much. Rather than working with fat people in a compassionate and respectful way, this is a project that seeks to further disempower, punish, scapegoat and marginalise fat people for daring to exist, instead of using state resources to manage the social systems and structures that contribute to poor health in the first place.

Foresight, Tackling Obesities: Future Choices fascinates me because it says more about state power and its manifestations, values and beliefs than it does about me and my life as a fat person.

The report claims scientific purity a number of times and seems oblivious to the idea that science is also a product of ideology, or might be influenced by such worldly entities as, perhaps, corporate sponsorship by the diet industry. It astounds me that the report can claim to be objective when the list of reviewers and advisors includes professors, Knights, a Lord and a Dame, so firmly is this work entrenched in the values of the establishment and the upper class. This class background is particularly problematic given that a large chunk of the report is concerned with the question of What To Do About Poor Fat People? As is so often the case in obesity research, the notion of nothing about us without us is irrelevant, fat people are absent and abstracted. The battle cry of the war on obesity is that it is a war against obesity, not "the obese" (a term which also abstracts and dehumanises us!), but how does one make the distinction?

In Foresight, Tackling Obesities: Future Choices, the modern world is characterised as a no-good place fast heading for chaos where fatness is linked with climate change. The past is a better place where there were allegedly fewer fat people. Progess is suspicious, the authors decry investment in a potential magic bullet treatment for getting rid of obesity, the way to get rid of fatness lies in solid, puritanical and moralistic endeavours such as taking personal responsibility for the problem, enacting self-surveillance and doing hard work over a lifetime. Whose values are these?

There's a sense of omnipotence hubris about the text, a belief that what is decreed at this high level must surely be a universal law. It would be funny if it weren't so tragic. Yet the authors overestimate their power because they are unwilling and unable to address their critics, and they are far removed from the grassroots movement of people who are busily dismantling their fortress. They know we exist yet they misread us. In the project report there is a tiny mention on page 30 which states: "Obesity has become stigmatised, triggering the appearance of 'fat and proud' movements in the USA." They suggest that this is a debate about appearance rather than health, which is not true, neither is it true that such a movement only exists in the US. I'm intrigued that they call us 'fat and proud' because of course that is the name of my book, though not the name of fat acceptance/size acceptance/fat rights/fat lib, whatever it is this movement is called. And also, of all the possible fat politics resources they could reference, they choose to cite this rather sorry site. My feeling is that, for now, their ignorance is our gain, let's just carry on with our work.

By the way, if you want to have a look at any of these reports, they are massively funded so you can order a range of high production value booklets, CDs, posters and other assorted crap from the project's website and they will be sped to you by courier immediately! For free! I'm not making this up. I could paper my walls with this lovely, thick, heavy, glossy stuff if I had a mind to.


Anonymous said...

"I think social attitudes towards fat people go a long way in affecting people's health. I think my health as a fat person is threatened by a health service that tries to withhold treatment from me until I lose weight, or tries to coerce me into profitable but unhealthy weight loss regimens; or the stress of being stigmatised or discriminated against, and the internalised self-hatred this can engender. I think my health is more threatened by these things than by the wobble of my belly, and that the cost to the nation of obesity-related health problems is really about what hatred costs the nation."

This paragraph is pure gold. Thanks for a thoughtful analysis of this piece.

Charlotte Cooper said...

Thanks pal.

Emerald said...

Sounds sadly typical of current British government policy. They start off with a set idea of what the 'facts' on fat and health are, and they stick to that come hell or high water regardless of the actual evidence. Which is unscientific, to say the least.

Coincidentally, on military metaphors: I just took over the post of a work colleague who moved to another department, and in clearing out her office, discovered a Weight Watchers cookbook, circa 1972. In the blurb, they refer to the recipes being mouth-watering enough for non-dieters 'or as we call them, civilians'(!) Slightly disturbing.

wonderful woman said...

do they actually explain why they are using 'obesities'? I quite like the idea of saying, 'oooh, i've an attack of the obesities today' or pronouncing it like 'Obi Cities'... but doubt that's what they had in mind.

Charlotte Cooper said...

Emerald, I think you are right!

That WW books sounds fascinating. Civilians! Wow.

Charlotte Cooper said...

Wonderful Woman, they do explain the plural somewhere, but I can't find it right now and there's no index. I think it has something to do with their central thesis that there are multiple systems that create obesity (have a look at their insane obesity maps) so Obesities refers to that. It is bullshit on such a grand scale that I'm scared to give it brain space in case it takes me over. Like I said in the post, so amazing, incredibly wrong.

I think they coined obesogenic too, it appears all over the place in the report.

Really, you should have a look at it, it's mind-blowing.

Toronto realtor said...

very good article. I enjoyed reading it and I agree with many things. the problem is somewhere else than in energy balance. elli

Deb Lemire, Queen Bee Productions said...

Hi Charlotte,
I am a HAES person who uses the systems map that was developed to accompany the Foresight project. I DO NOT use the Foresight study in any way in my work for all the reasons you so eloquently stated in your post. However when researching the project I found that Foresight commissioned a company, Shiftn, to develop a systems map to accompany the report. Shiftn has done similar systems maps for different countries on different topics, i.e. national security, agriculture trends, fuel, health care, etc. (website www.shiftn.com)

So I think it is important to distinguish between the two– Foresight (wrote the report) and Shiftn (create the systems map illustration.) I use the map to illustrate the complex system that exists when we talk about our bodies and how they are affected by many external and internal influences. I remove the title or re-label it as ‘energy systems map.’ I usually don’t bring up the study for which the map was originally developed. I do have a brief written up commentary that clearly outlines the difference if explanation is needed or if I am setting the map out on display.

So while I absolutely agree that the Foresight research is not worth the sanity points to read, the map, standing alone, can be a useful tool. It defies the argument that “if only fat people would just eat less and exercise more, they would be thin and no longer a problem.” Clearly looking at the map it is not that simple! (it’s ‘insane’ as someone commented). And there is something satisfying to me about using the map they think shows the problem with so-called ‘obesities’ to make an important point about HAES.

Zoe said...

Hey Charlotte! Great piece, as always. I was wondering if you know April Herndon's work. Though writing from a US perspective (so maybe not as relevant in the UK) she makes the important point that because rates of obesity, though allegedly rising across all population groups, most affect women, low income individuals and people of color, a "war on obesity" can easily be seen as a war on the fat: a group disproportionately made of up of marginalized individuals.

Charlotte Cooper said...

Hey Zoe,

I've never met April but I am well-acquainted with her excellent work. Her stuff on the war on obesity is pretty central to the paper I've been writing.


Charlotte Cooper said...

Hi Deb,

Thanks for this. I have so many thoughts in response to you! I'll try and be concise.

I'm glad that you find the Obesity Systems Map useful in demonstrating why 'Why don’t you just lose some weight?' is an unhelpful question.

I also support the process by which fat people and fat activists reappropriate fat-hating material. There was a great project at Nolose last year where people were invited to add their own thoughts, comments and art to a copy of one of Dr Phil's diet books. It was like talking back, so simple and easy and also powerful to see others adding their own thoughts and words to the piece too.

I did see your presentation of the map at ASDAH, and I was interested in your take, which I think I understand. For me, though, I would be very hesitant in using the Foresight maps. I'm calling it Foresight because although Shiftn produced it, it was Foresight who commissioned and paid for it. It is also Foresight that informs my understanding of it here in the UK, that's my context.

I accept that changing the title and adding some commentary changes the meanings of the map, but I think that this does not go far enough because the map itself is still largely unaltered. I think it's useful to show how systems can impact on individuals, but this map is missing some really important components, it understates the role of fatphobia, for example, and completely misses the existence of an organised and popular resistance to dominant obesity discourse. People like you and I do not exist to the people who commissioned and popularised this work, it reflects their concerns rather than ours. I also think it emphasises energy balance too highly, it places it absolutely central to the discourse, and still problematises 'obesity' in a way that I find quite unhelpful.

I think it could would be great to develop our own systems maps that better reflects who we are and how we live rather than try and appropriate something that misses so much of the important stuff. I think that would be a stronger appropriation, it could form the basis of a very powerful workshop exercise, for example. Without that, I think that the use of these maps is an endorsement of them rather than a coherent critique.

I'm also wondering why you don’t bring up the study for which the maps were originally commissioned. I'm imagining that this could be material for a really interesting - and fully informed - discussion.

Anyway, thanks for reading and commenting, I value your thoughts.


Deb Lemire said...

It is probably easier for me in the States to show the map without Forsight coming into the picture simply because Forsight is known in the UK and not here.

You are right the map does leave out much and does not reflect the reality that you and I experience. Although most of the lay people that I have used it with are just overwhelmed by the concept and grasp the point I am using it to make. Because most have not yet invested in the HAES paradigm to go to the next step.

I think it is a most excellent idea to do a workshop and develop our own systems map. Maybe even better to take this one and keep what works and tweak what doesn't. Could be very empowering. If it hasn't been done by the time we host our next ASDAH Conference, I hope you will take it on and facilitate it at conference and make it happen!

Thanks for your feedback on this and for your amazing website and your passion.


Charlotte Cooper said...

Deb, that sounds like a plan!