Annual Reflections In Depth Perspectives

scanner Art by Richard Lance Williams
This Issue: Health & Well-Being

The Terror Within -Maggie Macary
Is Fatness A Disease Or A Cultural Construct

The theory of the human body is always a part of fantasy. It is the mystery of ourselves, of our nature, as imagined by the memoria, whose possibilities of imagination are governed by archetypal patterns. Theory-forming is thus as free and fantastic as the imagination.1      –James Hillman

The body is the most and the least of an individual. It exists as incarnation, the flesh as ground in which we experience the realities of time and space. The body moves; it perceives; it is existence in the world. It creates both the portal of our perceptions and the boundaries of our physical limitations. Yet the body is as James Hillman suggests, in part, imaginal; a fantasy; a mystery; a myth. Hidden in its flesh and scars are stories that are intensely personal and at the very same time, profoundly symbolic of the culture in which the body exists.

Personal and yet cultural, the stories of body weave back and forth, over and under the day world of our consciousness. The subtle patterns reveal themselves in our dreams and unconscious biases and in the mythopoetic movement of our metaphors and our stories. Philosophies and theories about the body are labyrinthine. Winding through and around cultural beliefs, scientific theories, and moral judgments, the body can be discovered and reimagined through stories, myths, and metaphors.

At present there is no story about body more compelling than the story of fat bodies. To be fat in contemporary culture is terrible. Filled with experiences of worthlessness and abjection, people with fat bodies are labeled morally, psychologically and physically faulty. The salvation that comes from weight loss invokes a mythological metamorphosis in which archetypal forces battle for one’s life and soul through the size of one’s waist. To be fat in contemporary culture is no minor character flaw. It jettisons the fat person passed the boundaries of civilization where the abject closes in.

The abject is a psychological, philosophical and mythological term. Philosopher Julia Kristeva identifies the abject as that which breaks and erases the borders of civilization, disturbing identity, systems of control, and moral order. The abject moves beyond any sense of morality, into the immoral, the sinister, the scheming. “It is death infecting life,” Kristeva explains, “It is something rejected from which one does not part, from which one does not protect oneself as from an object.”2 Experiencing the abject “beseeches and pulverizes the subject,” writes Kristeva, breaking apart the psychological realms of subject and object. It is the fearsome discovery of the impossible within.3

Fatness invokes this terrible fear of the abject, invoking an immorality, which breaks apart the borders of the civilized. A fat body instigates deep fear and loathing; its sinister ripples trigger loathing and disgust. In contemporary American culture, fatness is no mere moral or physical fault; it is a mortal threat; a weapon of mass destruction aimed at the center of one’s being and the center of the culture. Fatness is unpatriotic. It is a terrorism that destroys from within.

The Surgeon General of the United States, Richard Carmona created this terrorism metaphor by equating fatness to terrorism in his 2003 keynote speech to the National Managed Health Care Congress Summit. He warns the American people:

I call it ‘the terror within,’ a threat that is every bit as real to America as weapons of mass destruction. Obesity is destroying us from the inside. That is why I call it “the terror within.”4

According to Carmona, our own fat bodies and destructive lifestyles are destroying us from the inside, causing major health crises and disrupting cultural norms. Author Paul Campos interprets Carmona’s statements to indicate that the United States Department of Health has made fatness a greater concern to the well-being of the nation than nuclear, chemical or biological weapons of mass destruction.5 The imaginal power of fatness to disrupt society is great indeed!

Hidden beneath such terrible anxieties are pathological fantasies that invoke the mythical realm. James Hillman writes that fantasies of sickness are authenticated in the psyche, not in the natural world. “Only in mythology,” argues Hillman, “does pathology receive an adequate mirror, since myths speak with the same distorted, fantastic language.”6 Just as Hillman interprets “sociology as an enactment of
myths,”7 I see through the fear of fatness into mythical metaphors that offer a different perspective than psychological, sociological or medical perspectives.

It is in the mythical realm that I discover the foundational fantasies that haunt the fat body. Myths, according to David L. Miller, are “plots emplotting conections.8 The plot of the story creates connections that transform through time into contemporary culture. Within a myth’s narrative structure, old stories exist hidden in cultural and scientific biases and theories. The categorization of fatness as a moral failure or as a biological disease and the accompanying fears of that categorization is not a new story but rather a connection to an old plot.

The move to define fatness as an ambiguous medical condition is one such connection to a hidden plot. The over-abundance of scientific studies and theories regarding the nature and effect of fatness are another. The following section briefly outlines some of the theories and controversies regarding fatness. Each one offers its own fantasies regarding the human body and weighty relationship to its body weight, fantasies that incorporate many mythologems. This section will not attempt to define those mythologems at present, but rather to allow the reader to experience the imaginal potentiality of scientific theories about fatness.


Fatness As Obesity

In the last century the term fat has been replaced with a new word, that of obese. What is obese? From Latin words ob, away and edere, to eat, obese means to “have eaten until fat.” The word first entered the English language in the 17th century. Obesity is defined as a condition of being grossly overweight with an abundance of body fat (OED). Immediately there is a problem with the term “over” weight. It implies a weight exceeds a standardized medical criterion or the non-objective observance of a societal norm. That societal norm about weight varies and has changed frequently over the last 100 years, creating an ambiguity in the notion of obesity. Since the 1950’s, the medical and scientific community has sought a consistent, statistical set criteria for the conditions of overweight and obesity without actually measuring body fat by using what A.M. Prentice terms “surrogate means”.9

Between 1959 and 1980, the MLIC weight for height tables developed by the insurance industry standardized a surrogate means criteria for determining overweight and obesity in America. In 1980, the U.S. Department of Agriculture and the U.S. Department of Health and Human Services begins to jointly issue Dietary Guidelines for Americans that includes weight-for-height tables, another form of surrogate means. As Kuezmarski and Flegal note, after 1980, the use of the BMI or “body means index” to define overweight and obesity becomes widespread, even as the means of calculating and interpreting the results continue to change.10 The BMI is currently the standardized weight measurement used internationally by governments and by the medical and weight loss industries.

As A.M. Prentice argues, the BMI is an anthropometrical measurement that calculates a ratio between height and weight and gives a corresponding value of weight adjusted for height. The use of anthropometrics such as the BMI is controversial because it misleads about body fat content and misrepresents the body fat in athletes, children, pregnant and lactating women, and non-Caucasians.11 Although the medical community is well aware of its limitations, the BMI and other surrogate methods of measuring excess body fat remains widely recommended as the most cost-effective means of identifying individuals with an excess of body fat. In 2000, an editorial in The American Journal of Clinical Nutrition by Van S. Hubbard comments:

Ideally, health-oriented definitions of overweight and obesity should be used that are based on the amount of excess body fat at which health risks to individuals increase. In this manner, obesity would be identified such that individuals would have a weight-responsive comorbidity. Unfortunately, no such definition currently exists.12

Despite these controversies, the Surgeon General’s 2001 report on overweight and obesity, in agreement with the World Health Organization, still generally classifies overweight and obesity using the BMI.

In 1998, the Department of Health and Human Services redefined overweight and obesity via the BMI measurement in a 1997-98 National Health Study. The new measurement, defined on the DHHS website, classified adult individuals with a BMI ≥25 as overweight, while those with a BMI ≥30 as obese. Prior to 1997-98, a BMI ≥27.8 for men and a BMI ≥27.3 for women were used as criteria for overweight. David Martosko, Director of Research for The Center for Consumer Freedom, a lobbying group for the food industry, testified in 2003 before the FDA. He notes in his speech that the DHHS’ reclassification of the BMI in 1998 changed the statistics of Americans overweight from 28% under the old classification to 51%. Martosko further remarks:

…the 1998 redefinition re-classified 39 million Americans as “overweight.” They literally went to sleep one night at a government-approved weight, and woke up “over weight” the next morning, without gaining an ounce.13

While the definitions of excess weight seem controversial, there is no doubt that American’s weight continues to expand because of changes in diet, stress, and sedentary lifestyles. When do these weight gains become health risks? This is yet another controversy among scientific professionals. However as the below studies and editorial comments show, the definitions and means of measurement of overweight and obesity remain ambiguous pseudo-scientific terms. Such ambiguity reveals a fantasy about sickness that can only be revealed by examining their mythical metaphors.


Is Excess Fat a Disease?

A disease is defined as an impairment of health or a condition of abnormal functioning according to the OED. Is fatness a disease? The medical community is not in agreement on this topic as arguments, research projects and philosophical debates continue to attempt to categorize fatness and its impact on health. One such controversy has to do with the notion that not all body fat is equal in terms of its health risk. Excessive abdominal fat is related to an increased risk of Non-Insulin Dependent Diabetes (commonly referred to as Type II Diabetes or Insulin Resistance), hypertension and kidney and heart disease. Some research studies rely more on waist-to-hip ratios (WHR) to determine obesity and to relate to abdominal fat to a higher risk of disease of metabolic diseases such as Non Insulin Dependent Diabetes or heart disease.

An editorial in the New England Journal of Medicine in January 1998, “Losing Weight —An Ill-fated New Year’s Resolution”, began a major controversy when the authors, Jerome P. Kassier, M.D. and Marcia Angel, M.D. proclaimed:

Unfortunately, the data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous. Most of the evidence is either indirect or derived from observational epidemiological studies, many of which have serious methodological flaws. Many studies fail to consider confounding variables which are extremely difficult to assess and control in this type of study. For example, mortality among obese people may be misleadingly high because overweight people are more likely to be sedentary and of low socioeconomic status. Thus although some claim that every year 300,000 deaths in the United States are caused by obesity, that figure is by no means well established. Not only is it derived from weak or incomplete data, but it is also called into question by the methodological difficulties of determining which of many factors contribute to premature death.14

Kassirer and Angel contend that the move to classify fatness as a disease and therefore a serious cause of mortality is inspired by “political correctness” which tends to “medicalize behavior we do not approve of”.15 Since 1998, the editorial is continually cited in debates and articles regarding the notion of fatness as a disease or as a cause of death, with little resolution.

A recent book by lawyer Paul Campos, The Obesity Myth, takes aim at the misuse of statistics to claim that fatness represents a disease that leads to other chronic disorders. Campos writes:

First, when anti-fat warriors discuss correlations between increasing body mass and various diseases, they invariably leave out the other half of the story: specifically the part that chronicles both the ambiguity of the evidence in regard to the positive correlations between fat and disease, and the main negative correlations between increasing weight and serious illness.16

Campos confronts the weight lost industry by insisting that the invocation of statistics geared to correlating weight gain with serious illness is misrepresentative. He claims that the correlation between fatness and mortality in statistical studies is assumed to be causal when there is really no proof that causality exists. Campos further argues that the studies on excess weight and comorbidity of other diseases are flawed by their funding sources (primarily the weight loss industry.)17 Obesity journals produced by and for the medical industry reflect another level of bias according to Campos because a large portion of their advertising revenue is from pharmaceutical and other weight-loss associated companies.18 Paul Campos claims, as well as a growing minority, that generalizations about the health consequences of excess weight cause more harm than good and that the BMI is an unscientific measurement that creates an imaginary medical situation.19

In contrast, the growing influence of the American Obesity Association, a nonprofit lobbying organization, contends that fatness is not only a “serious chronic disease”, but that it is epidemic (AOA). The website is filled with stories from people struggling with excess weight and claims to be a support mechanism for those suffering from a disease. The site also contains database of healthcare providers, clinics, corporations, non-profit organizations, small business, government officials and agencies that provide a service, product or work related to the issue of fatness. The site also includes lobbyist information and continual updates on attempts to change healthcare law to recognize fatness as a disease.

Funded in part by pharmaceutical companies and various medical organizations, AOA lobbies government entities to support IRS deductions for weight loss programs and increase health insurance coverage for pharmaceutical and surgical weight loss treatments. The continual number of alarming research reports spurs AOA. These reports from a variety of worldwide medical organizations in 2001 and 2002 signify a growing epidemic of fatness.

AOA lobbies to recognize excess fat as a disease, rather than a lifestyle choice, because research funds, drug and surgical solutions and insurance coverage become more available to treat fatness and the more than $30 billion diet industry will experience an even greater boon. Their other stated desired benefit is to reduce the stigma for fat people by making it a medical condition rather than a lifestyle choice.

The United States government itself is ambivalent as to whether excess fat is a lifestyle choice or a disease. The Surgeon General on the DHHS website observes that both overweight and obesity are results of an imbalance involving excessive calorie consumption and/or inadequate physical activity, an imbalance in the exchanges of energy in the body. This points at lifestyle choices, that is, over-consumption of food and lack of exercise as the primary causes of excess fat, not disease. At the same time, DHHS is also increasing the list of metabolic disorders that create obese conditions, pointing to disease as a leading cause of excess fat.

In July 2004, the Federal Medicare program reversed its long-standing policy that obesity is not a disease, but a lifestyle choice, when they announced that Medicare would review treatments for obesity and overweight in order to determine the effectiveness of treatments for obesity and overweight in order to determine the effectiveness of treatments in resolving weight problems. As an article in the Washington Post discusses, this announcement is seen as a critical step in defining obesity as a disease rather than a mere lifestyle choice.20

Despite the continued controversy, it is unclear whether excess fat creates disease or that diseases may have, as one of their symptoms, excess fat. For years, doctors and scientists, as well as the public, have assumed that excess weight is caused by lifestyle choices: a simple imbalance of too much caloric intake with not enough caloric expenditure, a problem with energy exchanges. Most treatments for excess fat, including diet, exercise programs, and surgical solutions, focus on reducing caloric intake and/or increasing caloric expenditures through exercise. Treatment for fatness revolves around the theme of self-moderation and the virtue of restraint and sacrifice.

Anticipating the worldwide health impact of fatness, research studies seeking the causes and potential cures for weight have multiplied in recent years. These studies reveal interesting insights about the causes of excess fat, suggesting that in many cases, something more than a mere energy exchange problem complicates the body’s metabolic ratios. While the following is just a sample of some of these research themes and projects, they reveal the complexity of the metabolic systems in the human body that regulate weight while furthering the debate over whether excess fat is a disease, a biological adaptation, genetic programming, or a lifestyle choice. Each of these theories invokes a hidden fantasy about the body.


A Biological Mother Complex

Since 1965 the National Institute of Health (NIH) has studied generations of the Pima Indians of Arizona, a people with an extremely high incidence of excess fat and diabetes, as the NIH website documents that Pima women with gestational diabetes have children with a much higher risk of excess fat and diabetes. The study concludes that a mother’s high blood sugar during pregnancy has a lasting impact on her offspring’s metabolic condition. The Pima study is multi-generational, causing some researchers to speculate that the condition of a grandmother’s pregnancy has a long-term impact not merely on her children, but also on her grandchildren and great grandchildren. The website documents that as metabolic disorders compound through generations of Pima Indians, there is an increasing rate of fatness and diabetes in offspring at younger ages.

Other research studies take up this theme of a biological mother complex by examining the impact of a variety of intrauterine conditions on an offspring’s later development of metabolic disorders, including obesity. These studies link fetal malnutrition and/or maternal high blood pressure, increased blood sugar or increased insulin levels with an increased offspring risk of metabolic disorders, including excess fat.21

One study by Suzanne Ozanne proposes a theory called the “thrifty phenotype”, which suggests that a fetus adapts during maternal stress and malnutrition and that such adaptation changes the offspring’s metabolic systems, ensuring survival in poor post natal environments. Ozanne theorizes that when the post-natal environment is not poor, when there is in fact an abundance of food or the wrong type of food, the offspring’s body reacts by developing metabolic problems such as excess fat, diabetes and hypertension.22

A study of Sweden links low birth weights to a later mid-life increase in leptin resistance. Leptin, a hormone related to energy metabolism and appetite control, allows the body to experience satiation and therefore avoid over-eating. Fat people seem to have higher leptin levels and thus they develop leptin resistance causing a chronic state of overeating in the fat.23 These studies suggest that some people are programmed in utero for fatter bodies. In other words, it is a biological failing on the part of the mother that produces the conditions for fatness in children. The underlying story of all these studies suggests a biological mother complex (i.e. mother makes me fat.)


Hunter/Gatherer in an Agricultural Complex

According to the USDA website, as early as 1894, the United States Department of Agriculture began to publish food lists and dietary standards for the American population in an effort to educate the public on healthy diet and to ensure an adequate food supply. In 1992 the now famous Food Pyramid graphic was introduced by the USDA and quickly adopted by the American Medical Association (AMA), educators, and food corporations such as Kellogg, McDonalds and Pepperidge Farm. The Food Pyramid recommends a low-fat diet comprised mostly of grains, vegetables and fruits and low-fat proteins, a diet suitable for an agricultural environment. In short, the USDA recommends eating less fat and more carbohydrates with the premise that it is dietary fat that causes body fat.

As Gary Taubes documents in a searing New York Times article 24 entitled “What If It’s All Been A Big Fat Lie,” Americans ate less fat and more carbohydrates throughout the 80’s and 90’s. Annual grain consumption increased by almost 60 pounds per person, and caloric sweetners used to give nonfat foods its taste and appeal, primarily in the form of high fructose sugar increased by almost 30 pounds a person. Taubes reports that body sizes grew and grew, as did the incidences of diabetes and other metabolic disorders. By 2002, the Center for Disease Control (CDC) officially calls obesity “epidemic” and the medical researchers begin to examine the impact of a diet high in carbohydrates and low in fat, speculating that the USDA recommendations may have inadvertently exacerbated the obesity epidemic.

A diet high in carbohydrates is primarily a product of agricultural systems, a diet especially difficult for some genetic groups to tolerate. As early as 1962, researchers began to conjecture that there is a “thrifty genotype” which predisposes some people to fatness, a predisposition that has significant survival advantages in prehistoric times when food supplies were less abundant. Such thrifty genotypes are especially advantageous to hunter/gatherer societies.

While the thrifty genotype theory currently has less scientific favor than the thrifty phenotype theory, some researchers insist that it retains its validity as a theory, especially among non-European populations. Dr. Boyd Swinburn summarizes the findings of a 1999 Australian symposium entitled, “The Thrifty Genotype Hypothesis: Concepts and Evidence After 30 Years.” He writes that emerging knowledge and speculation about the dietary patterns in prehistorical times, combined with the influx of western lifestyles on indigenous populations may be responsible for turning the thrifty genotype from a benefit to a detriment. Swinburn editorializes that medical research tends to be “Eurocentric” so that research sets European morphology as a standard from which other ethnic groups diverge.25

As with thrifty phenotype theory, the thrifty genotype theory suggests that some people, especially those with non-European body types, are programmed to gain weight in an agricultural society whose major food product is grain. Fatness becomes not the body’s biological fault, but rather part of an environmental and lifestyle mismatch caused by the imposition of European lifestyles on non-European ethnic groups. The fault for fatness thus becomes part of a radical discourse, one more means of separating those in power from those who are not in power.


Stressed Out Lifestyles

Finally, researchers are confirming what most people intuitively know: that stress makes people fat. This is not merely due to stress-related eating, but to a complex metabolic process that occurs for highly stressed individuals. The identified culprit is cortisol, a hormone released by the adrenal glands during times of high stress. Researches such as Bjorntorp and Rosmond26 have shown that elevated cortisol causes increased abdominal fat. This condition seems especially pertinent to women and once more confirms the importance of waist-to-hip ratio (WHR) rather than BMI in determining health problems related to weight.

In 2000 a major study from the health Psychology program at the University of California, San Francisco headed by Elissa Epel examined the relationship between WHR and stress in 52 healthy, pre-menopausal women. Twenty-five of the women have a high WHR and twenty-seven have a low WHR. Their BMI ranged from very lean (19.6) to obese (39.8). The women were subjected to various stress-related situations and tests. The results, reported in an article entitled “Stress and Body Shape: Stress-Induced Cortisol Secretion is Consistently Greater Among Women with Central Fat” showed:

Women with a high WHR perceived greater threat, exerted less effort, and performed more poorly. Threat, in turn, was related to cortisol after challenge. At baseline, women with a high WHR reported greater chronic stress and negative affect. In addition, lean women with a high WHR scored higher in pessimism, negative affect, and passive coping.

The study concluded that there is a correlation between elevated cortisol in the body of women and increased abdominal fat, leading the researchers to conjecture that stress-induced cortisol secretions contribute to abdominal fat in women.27

In a follow-up study in 2001, the same research group headed by Epel investigated the relationship of high cortisol levels in women to increased food consumption. Reported in an article entitled “Stress May Add Bite to Appetite in Women: A Laboratory Study of Stress-Induced Cortisol and Eating Behavior,” they concluded that women with low cortisol consumed more calories on the stress day compared to women with low cortisol levels. This finding suggests that appetite increases with woman’s level of stress caused by changes in a woman’s hormonal composition.The study also suggests something that medical studies are just beginning to reveal. Women’s bodies are metabolically different from men’s bodies, and that these metabolic differences should be recognized in treating women for a wide variety of disorders.28

These types of studies that differentiate male bodies from female bodies in terms of their reflections and stress reactions are a variation of the very old Greek notion of genos gynaikon or the race of women which stands apart from the more generalized notion of human race. New ideas about fat bodies see through the old stories of classical Athens, through the cult gods and goddess of the polis to reveal a different perspective on body weight.

                                             ***
New ideas like these drive my own work forward. As a fat woman victimized for years by flat reflections and single-minded visions, I cannot do otherwise. I’ve spent 40 of my 50 years fighting an unrelenting demon that is body fat. I awaken most mornings in despair because of the over materialization of my body. I fear to look in a mirror and instead escape into a head-body split that refuses to recognize my own physical and emotional need and pain. I justify, agonize, diet and exercise, hypothesize and politicize my weight; I still remain fat.

The spatial awareness to which I now am removed is imaginal. For me, it is a turn into mystery, myth and plot; plots emplotting deeper connection within the writ of body.

AUTHOR BIO
Cultural mythologer, Maggie Macary worked on line through mythandculture.com between 2000-2006. Myth & Culture's mission statement listed its primary interest as one that helped enable people to find meaning in what seemed to be a meaningless world through the study of mythology and archetypal psychology both within the contemporary culture and within individual psyche. 

The primary focus of her writings sees mythic mind as providing the structure and meaning in contemporary life. Her dissertation research covers myths of fat body.



***permission to reprint the essays of Maggie Macary has been granted mythopoetry.com by the executor of the estate of Maggie Macary. Mythopoetry Scholar/mythopoetry.com wishes to thank Doug Macary& Martin Macary for their generousity in making her essays available to you.


Poetry

Lady Poets


additional essays by Dr Maggie Macary published to mythopoetry.com

Transcending the Leaky Vessel; Opening Pandora's Box

The Chryselephantine Athene

The Guardian At The Threshold

Pink Hearts Can't Be Broken

A Monotheistic State of Mind

A Depth Perspective In The World

The Dominant Fiction

What Is Myth, 2006 or Nymphs and Stuff

The Misuse of Myth

Myth-Making In America

Poetic Basis of Mind

The Mythos In the Logos


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