20 June 2013

Yes, I am a disease

The American Medical Association (AMA), the largest organisation of healthcare practitioners in the US, has just declared that obesity a disease. In doing so they have gone against the recommendations of their very own research and policy advisors, the Council on Science and Public Health.

Fat blogs Dances With Fat, Living 400lbs and Fatheffalump and writers elsewhere have spelled out why declaring obesity a disease is a problem for fat public health, I won't repeat their claims here. The short version is that pathologising fatness will make it harder to advocate for the things that actually do make a difference to fat people's health, eg diminishing stigma and investing in Health At Every Size (HAES)-style models of wellness.

The AMA say that classifying obesity as a disease means that more money can be corralled to fight it. I want to add my voice to those who say that defining fatness as a disease does little more than entrench and validate a market for weight loss.

I want to remind people that the construction of obesity within institutions such as the AMA, and the discourse more generally, is not part of a polite debate where people with different opinions can play fairly as equals. It is naïve to think that, with enough evidence or the right argument (our own version of the magic bullet), conservative institutions such as the AMA, who are always the most resistant to change, will see the error of their ways in upholding an oppressive model of obesity and come around. This is not about good science or rational argument. Obesity is an monodimensional industry of power, it's about the use of fat people to generate profit, about marketing hatred.

This convinces me more than ever that providing a counter discourse for fat based on an evidence base for HAES, for example, might not be that effective a strategy for changing the status quo. I am not against research grounded in HAES, but I see its use as an evangelising strategy as fighting for what amounts to crumbs of visibility within a paradigm (medicalisation, capitalism, healthism) in which liberation can never be founded.

I support the activists who are challenging the classification of obesity as a disease (see #NotADisease), and share the concern about how this ramping up of obesity rhetoric will affect people at its sharp end (no doubt the people who are already made vulnerable and marginalised by US health policy). However, I also think that this is another chessboard move of a dynasty that is losing its grip on the resource it needs most: willing fat people.

I had a conversation with a friend last week in which we talked about who exercised power in obesity discourse. The obvious answer would be that organisations like the AMA wield power. But I said that fat people also get to exert a lot of power. We have the power of experience, of being the people at the heart of things, of our bodies and of community. Disability theorists and activists have demonstrated many times that the allegedly powerful ones need us a lot more than we need them.

Although the AMA news is terrible, I think it's worth remembering that fat activists are moving away from the values that underpin obesity discourse, and have been doing so for a long time. A new cohort of politicised fat scholars are moving through the ranks and are threatening the parameters of traditional obesity research. Beyond the academy, our networks are gaining in strength, breadth and momentum. How long will it be until we have our own models for fat community health provision? Therapy practices like mine are only the beginning.

I understand the panic and upset about being labelled as a disease, it is utterly dehumanising. At the same time, the AMA is not the authority of me or my experience as a fat person. In many ways, I do feel like a treatment-resistant disease; one that is attacking the values that the AMA upholds like a virus in its system*.

Meanwhile, I think that there are a number of tactics that fat activists might make use of in order to resist this ridiculous classification:
  • Learn how to read and evaluate research so that it's easier to distinguish between what is useful and what is not.
  • Develop open source repositories of information and engage with research justice.
  • Projects like Transpulse in Canada offer a great model for building a research base. This benefits the community directly and on their terms, and is not just an exercise in convincing the mainstream of the right to exist of a particular group. See Community Based Research for more examples.
  • Understand that research and health are not the only ways of understanding fat. Learn about how queer and disabled activists have resisted medicalisation as the definitive model for understanding people.
  • Keep talking to each other about our bodies, health, and lives. Use our lived experience as a baseline for evidence.
  • Develop critical approaches to capitalism and healthcare as an integral part of the work on developing accountable fat health strategies.
  • Don't allow organisations such as the AMA to push us around. This latest escalation of the war on obesity is another desperate gasp of a dying empire.


* It is here that I turn to the work of the early AIDS activists and the ways in which they used their own classification as diseased to attack the institutions and policies that had failed to act on their behalf, and which had effectively signed their death warrants. Fat activists, aka The Diseased, might want to take note of the following, for example, and substitute hatred, stigma, crappy weight loss intervention etc for 'disease':
"Imagine what it would be like if, each time a lover, friend or stranger died of this disease, their friends, lovers or neighbors would take the dead body and drive with it in a car a hundred miles an hour to washington d.c. and blast through the gates of the white house and come to a screeching halt before the entrance and dump their lifeless form on the front steps." David Wojnarowicz courtesy of ACT UP New York.

9 comments:

Anonymous said...

Why do most fat activists like yourself so blatantly ignore the fundamental efficacy of empirical research? You speak of the imperativeness of being aware of research and how to interpret it, yet you ignore the vast array of peer-reviewed research showing an indisputable causative relationship between obesity and morbidity. I believe that fat people should be respected and have exactly the same opportunities as normal weight individuals. Of course, thin people are not inherently better fat people. But, quite frankly, one cannot ignore science. Being fat is a lifestyle choice and it is one associated with significant morbidity. HAES is not, I repeat not, scientifically sound. You are picking and choosing (weak) data to support a subjective agenda. As a general concept, this is very dangerous in terms of inhibiting society's progression toward objective, logical thought.

Dr Charlotte Cooper said...

Hi Greg.

These statements do not ignore emprical data:

"Learn how to read and evaluate research so that it's easier to distinguish between what is useful and what is not.

Develop open source repositories of information and engage with research justice.

Projects like Transpulse in Canada offer a great model for building a research base. This benefits the community directly and on their terms, and is not just an exercise in convincing the mainstream of the right to exist of a particular group. See Community Based Research for more examples."

This statement clarifies that empirical data is not the only way to explain the relationship with fat and health.

"Understand that research and health are not the only ways of understanding fat. Learn about how queer and disabled activists have resisted medicalisation as the definitive model for understanding people."

In addition: the data does not necessarily reflect our lived experiences of being fat. This means that better data are needed.

Doc M said...

It's not a disease, but by classifying obesity as a disease will cause insurance to pay for treatments that it previously did not. And remember, the AMA classifies baby crying as a disease. It's part of the game. However, psychologically, it can be damaging to have that thought somewhere in your head that you are a disease.

Susie Kline said...

I think anonymous should research the research. There is no causative relationship between obesity and morbidity. Research has shown that obese people actually live longer than some thin people. There also is no causative relationship between obesity and most of the obesity illnesses--causation and correlation are different things.

It isn't until people understand the research that HAES will be respected and understood.

Weight loss is not scientifically sound--as in there are no studies that can find any method of weight loss that actually works--and that is what people need to focus on.

Anna said...

At least one good thing may come out of this travesty: some people who otherwise wouldn't ally with the FA movement will move in our direction. For example, my sister has never really understood my interest in FA, but suddenly having the AMA say that she's diseased seems to have hit a nerve that none of my links or posts or impassioned speeches could reach.

screaming fatgirl said...

The AMA is not saying "you" are a disease. They are saying that a physical condition which you possess is a disease. The issue here is whether or not fat *defines* you as a person. A person with a cleft lip would not say, "I am a cleft lip." Having a cleft lip is a medical issue, but it does not mean the entire person is a condition.

If you identify so much with your obesity that you are equivalent to it, then I can see why this is so upsetting. I'd think that the first step in being seen as a person is to see yourself as one, not as some physical description or, yes, medical state.

Writing articles that say, "I am a disease" is reducing yourself down to being synonymous with your fat. Considering how hard fat advocates labor to convince others that they are more than their bodies, this attitude represents a contradiction.

Dr Charlotte Cooper said...

Doc, part of a game, yes, exactly.

Susie, what I've written here is that I don't think that 'understanding the research' will make much difference. This is a discourse of power. Evidence be-damned.

Anna, I'm not so optimistic!

Screaming, I identify as fat. I have used disease here as a metaphor. There is also some irony to this post.

closetpuritan said...

You ignore the vast array of peer-reviewed research showing an indisputable causative relationship between getting old and morbidity.

You ignore the vast array of peer-reviewed research showing an indisputable causative relationship between being male and early mortality.

You ignore the vast array of peer-reviewed research showing an indisputable causative relationship between pale skin and skin cancer.

Those versions sounds kind of weird, don't they?


Having genes that predispose you to being fat is a lifestyle choice and it is one associated with significant morbidity. Deciding not to resist your body's homeostatic weight regulation mechanisms not, I repeat not, scientifically sound. You should make weight loss and maintenance your major hobby or else move to a hunter-gatherer/subsistence farming/Amish community. Amish life is scientifically sound, HAES is not. /sarcasm

Thinking that science tells you what you SHOULD do with the data is very dangerous in terms of inhibiting society's progression toward objective, logical thought. Science doesn't do "should". Also, you're not as well versed in science as you think if you see obesity as a "lifestyle choice". Unless you consider "living in a first-world country" a lifestyle choice.

Kerri said...

So then...if as a fat woman who now (apparently) is disease-laden because I am fat declares that I am not diseased - does that make me psychologically diseased too? In my denial of my disease I mean.

You know - I'm sick because I say I'm not?