Have you ever been in a conversation with someone who had a good point to make, but went so over the top that they lost you anyway? Someone who, if they’d kept their arguments reasonable and their criticisms balanced, might have swayed some opinions, but whose rhetoric got so unhinged that they probably did more harm than good to their cause? (Not so long ago a wise friend wrote a parable along those lines with regard to our political culture.) You know the type, right? People who should maybe let other people do the talking for them, because they just completely lose their shit and make things worse?
So it is with Paul Campos and the subject of obesity. The man has some good points to make, but he makes them so badly and so vociferously that he loses people who might otherwise nod in agreement with what he’s trying to say.
Behold his essay in Salon, “Anti-obesity: The new homophobia,” a heaping helping of facepalm:
“Homosexuality” and “obesity” are both diseases invented around the turn of the previous century. Prior to that time, being sexually attracted to someone of the same gender or having a larger than average body were, to the extent they were thought of as social problems, considered moral rather than medical issues: That is, they were seen as manifestations of morally problematic appetites, rather than disease states.
The same medical establishment that pathologized same-sex sexual attraction and larger bodies also offered up cures for these newly discovered diseases. Those who deviated from social norms were assured that, with the help of medical science, homosexuals and the obese could become “normal,” that is, heterosexual and thin.
In the latter half of the 20th century these frames were challenged by gay rights and fat rights advocates. Within these movements, the words “gay” and “fat” had similar purposes. They were intended to depathologize what medicine called “homosexuality” and “obesity,” by asserting that different sexual orientations and body sizes were both inevitable and largely unalterable, and that being gay or fat was not a disease.
Campos is trying to make the point that same-sex attraction and being overweight are equivalent in that they are unfairly pathologized, and that both are innate and immutable characteristics. I think there is a kernel of something good in there, though to what degree being overweight is innate and immutable is unclear. Certainly it raises the question that, if obesity is something that is inevitable, why have the rates of obesity risen within the United States so sharply within the past few decades? It is implausible to posit that something intrinsic in Americans changed within that span of time, though what precise factor(s) account for the change is a subject of much contentious debate. If being overweight is an innate characteristic of those who are obese, why are there so many more of them now?
Leaving aside the rather blithe way Campos conflates society’s views about homosexuality and obesity before the turn of the last century (and, let’s face it, today), he seems to imply that the medicalization of these “conditions” happened within some kind of vacuum. In reality, of course, medicine was merely one part of a culture that, as a whole, stigmatized both of these issues. By offering “cures” for homosexuality, doctors were misguidedly trying to help patients conform to social norms. The difference with obesity is that doctors aren’t trying to “cure” it because society believes fat people are perverts (like they did and still to a great degree do with gay people), but because being overweight leads to a whole host of health problems. The only reason to “fix” homosexuality is that society says that there is something wrong with being gay per se. The reason to try to help obese people lose weight is that they will be far less likely to suffer from numerous life-shortening illnesses. They are not equivalent goals.
Indeed, the most striking parallel between attempts to turn gay people into straight people and efforts to turn fat people into thin people is that both almost invariably fail. The long-term success rate of such attempts is extremely low. When it comes to the various forms of conversion therapy, the medical establishment now acknowledges this. This acknowledgment, in turn, has helped medical authorities recognize that it does not make sense to label “homosexuality” a disease, and that therapy for same-sex sexual attraction is both unnecessary and more likely to do harm than good.
But when it comes to fat, the fear and disgust elicited in this culture by fat bodies (reminiscent of the reactions elicited traditionally by same-sex sexual relations) prevents the public health establishment from recognizing that the various “cures” it advocates for “obesity” have been demonstrated again and again to be every bit as ineffective as conversion therapy has been shown to be for “homosexuality.”
Here Campos makes his best point, and the one that I agree with. Indeed, I have already expressed sympathy for the argument he is making. It is incredibly hard for overweight people to lose weight effectively and sustainably, and I think both the medical community and society as a whole are far too glib and dismissive of that reality. Treating overweight people as moral failures is appalling, and the overwhelming majority of non-surgical obesity cures are woefully unsuccessful, at least in the long term. If he had stuck with this point, he would have been far more convincing. But he doesn’t.
The pathologizing of gay and fat bodies springs ultimately from the same cultural source: the desire to ground moral and aesthetic disapproval in the supposedly objective discourse of science and health. It is true that fat people are at a higher risk for certain diseases (although the extent to which higher weight correlates with increased mortality and morbidity is greatly exaggerated). But trying to, for example, lessen the prevalence of diabetes by eliminating “obesity” makes no more sense than trying to lessen the prevalence of HIV infection by eliminating “homosexuality.”
The moral and aesthetic disapproval for gayness was the only reason it was pathologized. It was pathologized long before the advent of HIV, and remains pathologized in large segments of America and beyond completely independent of the AIDS crisis. Medicine tried to change homosexuals because society said being homosexual was wrong, not because it was a risk factor for some other undesirable outcome. “Curing” homosexuality was an end unto itself, and a wrong one.
The reasons for trying to “cure” obesity are related to health and wellness. The medical community is trying to prevent numerous illnesses and infirmities that are related to obesity, not because of moral disapproval but because being overweight makes people sicker and can significantly worsen their quality of life. Or at least that should be its reason for addressing the issue. I would be a fool to deny that fat people are stigmatized, and that there is a tremendous degree of shame and humiliation that is foisted on them by an unkind society. I agree without hesitation that treating the overweight as unworthy of dignity and respect is a disgrace, and insofar as physicians’ interactions with their overweight patients are informed by similar attitudes they should be ashamed of themselves.
But there are real problems that being overweight can lead to. Campos links to his own article under “greatly exaggerated” above, and it does raise questions about confounding factors in predicting the exact degree that obesity affects the morbidity and mortality of patients. But it takes no effort whatsoever to find a huge body of evidence linking obesity to numerous illnesses that worsen and shorten people’s lives. I suppose it is Campos’s prerogative to dismiss this body of evidence as flawed or overblown, but all I can say in response is that I dissent. Obesity makes people less healthy in the long run, and helping patients be as healthy as possible is what doctors are meant to be about.
Are there lots of great points that Campos has buried in his piece? Yes. Obese people are treated with contempt by a judgmental society that is largely ignorant of how genuinely hard it is for people to lose weight sustainably. Medical intervention has been largely unsuccessful at mitigating this difficulty. Insofar as a morally judgmental attitude informs the way that physicians treat their obese patients, they should redirect their attention to the health problems their patients face, not to a misguided focus on willpower or strength of character. I am on board with all of that.
But medicine’s specious “treatment” of homosexuality was predicated on the belief that to be homosexual was wrong and perverted. Remove that belief and the need to “treat” homosexuals evaporates. But even if we remove any moral judgment from our view of overweight patients, that won’t make them any less likely to develop osteoarthritis in their knees or suffer from coronary heart disease. It is outcomes such as those that medicine seeks to prevent, and why it continues to try to find effect ways of combating obesity. That Campos cannot appreciate these distinctions makes his polemic a failure.