Recycling stereotypes is not a form of courage

Last week I wrote a post in response to the article Fat City, by Dr Karen Hitchcock, an article which has been described as compassionate and courageous. The use of the term ‘courage’ is popping up a lot and I want to talk about why it’s not an appropriate word, and I’ll use her essay as an example.

Dr Hitchcock is a physician working in a bariatric practice, though not a bariatric surgeon herself, as I understand it. She is also author of a book of short stories, and seems to be interested in using her medical experience for her literary career. Her article Fat City is one result, which chronicles her time working in a bariatric clinic dealing with obese and morbidly obese patients who are being considered for weight loss surgery.

Now, I’m not sure how experienced a doctor she actually is, as an article she wrote in 2012 describes her journey to find a specialisation to settle into – in that essay, she eventually chose general medicine. In 2012 she was a registrar, which means she hasn’t yet qualified as a specialist. Yet, here she is one year later, writing a lengthy piece about the obesity epidemic, from the position of an expert in the field.

Despite its patina of compassion, the essay is extraordinarily mean spirited. Dr Hitchcock spends a lot of time discussing how ugly fat is, and how society will never accept fat people as beautiful, as though that has any bearing on the medical consequences of fat. She also pretty much accepts the notion that obesity and morbid obesity are the consequence of people scarfing down junk food. She compares this behaviour to her own ability to lose weight easily, just from putting down her fork.

In other words, what she dishes up is the standard, popular idea of obesity as a failure of willpower by ‘them’, the others. ‘They’ are ugly, smelly and lacking in self discipline. ‘They’ do not exist as human beings embedded in any kind of context.

Contrast this with the work of two Canadian obesity specialists, Dr Arya Sharma and Dr Yoni Freedhoff, who are both regular bloggers. They are genuine, long-established experts in their field and one thing they are both acutely aware of is how stigma affects their patients. They’re also aware that ‘obesity’ is not one thing, and may see weight stabilisation as a worthy goal, rather than weight loss to reach some socially-prescribed ideal. In their writings, their patients are real people, who are active participants in their treatment. In Dr Hitchcock’s world, patients are ‘them’ – caricatures of flesh who don’t really have any existence apart from their gargantuan adipose tissue.

So what’s my point?

It’s that Dr Hitchcock has expended more than 5,000 words (many of them in highly literary combinations) to present a stereotype of fat people. What she’s offered up is pretty much what any commenter on any article about obesity offers – that ‘they’ should just put down the fork. Eat less, move more. Simples. And that ‘they’ are costing ‘us’ (virtuous, non-fat people) lots of money.

This kind of tired thinking should never have been able to reach such a prominent platform. Yet not only was the piece published, but commenters and letter writers lauded it as ‘courageous’:

This subject has been examined intensively in the lay and scientific press in the past decade but the unpalatable and unvarnished truth has seldom if ever been exposed as clearly as this. 

(From a letter to the editor.)

It’s exactly the reaction that Nick Ross got when he said that rape was ‘complex’ and that ‘rape isn’t always rape’. Read the comments on the many articles about it – people saying that here, finally, is someone with the courage to say the truth.

What’s going on is that writers like these give people permission to embrace stereotypes. They rebuild a comforting old-fashioned world where women really are gold diggers, women really do cry rape for no reason, fat people really are gluttons who need to be scolded and shamed, and headscarf-wearing immigrants really are all just terrorist incidents waiting to happen. They reinforce entrenched power structures. It’s full-on permission to be narrow minded and indulgent – and that’s always a tremendous psychic relief. It makes the world simple again. It makes us secure in our self righteous positions. It reinforces privilege.

So what would real courage look like? Real courage is saying the unpalatable. It’s whistle blowing. It’s speaking truth to power and taking blows on behalf of the marginalised and the oppressed. Real courage is Turkish journalists willing to go to jail for reporting the truth, or Greek journalists being harassed for revealing the rotten heart of power. That’s courage.

This other stuff is just entertainment. Of a particularly nasty sort.

An open letter to Dr Karen Hitchcock, author of Fat City

Dear Dr Hitchcock,

Clive James recently complained about the lack of literary hatchet jobs in American cultural life. From reading the uncritical reception your obesity article Fat City attracted, it seems that Australian letters are in an even more dire state.

Or maybe it’s just a symptom of how endlessly entertaining we find discussions of fat people. This is, after all, the era of obesity pornography. From the Biggest Loser to magazine weight loss stories, we gloat over fat people. Talk about them obsessively. Enjoy the frisson of socially-sanctioned disapproval that comes over us every time we read about the undeserving fatties hoovering up our hard-earned tax dollars.

If we didn’t have actual fat people to represent all our social anxieties, we’d have to make them up.

So although you’d expect a fresh new dispatch from the front lines of the obesity epidemic would need to be highly original – what else is there to say on the subject? – it turns out not to be so.

Your essay, for example, dishes up the same stereotypes from Obesity Central Casting, such as Emily and her gargantuan, pizza-gorging family.

Emily is only the first of many warmed-over cardboard cutouts. There’s the “educated” fattie who has “soft, white skin” (An imprecise description. You must know that soft, white skin is the hallmark of the Caucasian female.) There’s Nora, who crams sweet biscuits into her mouth as fast as she can open the packets. There’s the specialist physician, fat and sweaty, a hypocrite of the first rank. Because, of course, his weight negates anything he has to say. Nothing new here.

But what a lost opportunity. Despite their mountains of adipose tissue, your characters are not fully fleshed. You do not allow them to tell their stories of how they got so big. Instead, the reader must rely on your opinion, which is that fatties are fat because they lack willpower:

“Who wants to eat less – of anything – when food is so good and plentiful?”

Dr Hitchcock, that’s so trite. Why waste more than 5,000 words on a view that’s already widespread? Squadrons of concern trolls stand ready to swarm the internet at any time, saying the same thing as your essay, but much more concisely.

For a personal essay to rise above the level of a blog post, it needs to wrestle with something. (Asking: “what can we do?” and then throwing your hands up in disgust doesn’t count.) What’s required is a burning question.

Here’s one. Apparently when you’re in the presence of the obese, you rapidly lose weight. Five kilos gone from having to explain to them the way the digestive tract works!

If the essence of story is conflict, that’s your story right there.

The obese revolt you at a visceral level and yet – admit it! – you can’t get enough of these smelly, foul people. You work with them. You write about them. Expend some literary energy exploring your own profound contradiction. Make yourself the lens through which society can examine its own attitudes to fat people.

Fascination. Repulsion. Strong stuff.

Dispense with irrelevant non sequiturs, such as your discussion of whether society will ever consider fat attractive.

It is, of course, true that fat people are unredeemably ugly.

Apart from those plus size models that you call “freakishly well-proportioned Amazons with flawless faces”.

Or, as we lay people call them: models. Freakishly well-proportioned people with flawless faces who more than 95% of us fail to resemble.

But you’re writing from the position of medical expert, deconstructing the worst health crisis of our age. Your opinion on the aesthetics of fat is a distraction. People with broken spines are also pretty misshapen – but imagine if neurologists started writing essays criticizing them for it. It would somewhat confuse the ‘spinal injuries are a medical problem’ angle.

If you want to draw attention to how ugly fat people are, take up photography.

Second, take a leaf out of the New Yorker’s book and fact check. They would never publish a sentence like “Very few people get obese and none get morbidly obese through the consumption of home-cooked whole foods”, because it’s flatly untrue. I’m typing this from an airport in the Caucasus, a part of the world that eats the revered ‘Mediterranean diet’ of vegetables, nuts, fish and fruit. Starbucks, McDonalds and all the other corporate food-pushers have yet to get a foothold. Yet, as I tap away, I note there are obese people here too. As in the West, it’s the poor who are the fattest, despite the punishing physical labour they must expend to survive in this part of the world, coupled with their exemplary diet.

Don’t believe me? Then seek out one of Australia’s most famous food reviewers, so you can ask him whether his Rabelaisian figure was shaped by fast food. You may have a hot bowl of fresh-made dumpling soup thrown at your head, but taking risks for art is, after all, a time-honoured imperative.

Or why not use obesity as a metaphor to examine social change.

For example, discuss how the obesity epidemic first appeared in the US around 1980 and then quickly spread throughout the English-speaking world. What happened at the same time? How about the rise of  Thatcher and Reagan’s neoliberal economics? You hint at the role of economics, but then you back off. Could you make a stronger argument that the overconsumption of food is just one manifestation of hyper-consumption? Maybe compare and contrast one of your weak-willed obese patients with a feckless young professional using her house as a cash machine, withdrawing money from her mortgage to buy things she doesn’t need, and thereby setting herself up for a retirement on the taxpayer’s mercy. They’re the same behaviours, it’s just that the consequences of one is more visible.

Or, conversely, could gorging on fast food be the consolation prize for being left behind in the mad dash for status and wealth?

Or why not turn the question of obesity on its head. Ask how it’s possible that so many people remain of normal weight, in a world specifically designed to provoke all of our ancient, biological responses to food.

In developing that theme, you might look at who’s missing from your bariatric practice. Do the powerful come through your door? Is your waiting room full of financiers, lawyers, media stars? If so, what do they have in common with the call centre workers, the nurses, the unemployed and the depressed, and other people at risk of obesity? Could you make an argument that there is something inherently unhealthy about modern working life, which prioritises long hours and snatched food on the run over treating the body with the care it needs?

Or how about looking at relentless ingestion as an eating disorder, a kind of reverse anorexia? Your lonely, unemployed patient who eats constantly may not be eating because he has an empty life – perhaps he has an empty life because there’s no room left for anything but his eating.

A personal experiment is always compelling. You could change your diet drastically, for research purposes, to discover what it’s like for a fat person to make that all-important lifestyle change. What’s it like to have to eat separately from all your family and friends, because you can no longer participate in the culture you’re embedded in? Take up your own recommended diet of vegetables and egg whites, to demonstrate that it really does “fill you up”; keep going for months, and keep a journal, so you know the precise day that your body finally revolts against the relentlessly bland diet.

If this is going too far from your original intention, stick to your first theme – that obesity is a moral failing – and explore it. Why is it, do you think, that willpower collapsed so catastrophically in 1980 in one country, and why did this moral collapse spread like an epidemic?

Of course, the only answer to the obesity crisis in the end – I’m sure we can agree – is “don’t get fat”. Once the BMI crosses the dreadful 3-0 mark, a cascade of bad things begins to happen that are difficult to reverse. Prevention is the only true solution.

Have you thought about going commercial and writing a book of essays, one patient per essay? You could linger over the unpleasant details – the skin diseases, the rotting feet– while unleashing the full force of your contempt. Not only will you scare potential fatties straight, but the cash registers won’t stop ringing.

That’s because the market for obesity pornography is… well, I’m struggling to find a metaphor that’s not an obvious pun. But it’s big and getting bigger. The appetite for fat stories is expanding faster than the market can satiate it. Everyone will read it.

It’s not, of course, the territory of the great medical writers like Oliver Sacks, Siddhartha Mukherjee or Atul Gawande – but to get where they are, you’d have to add research, knowledge, experience and facts to your arguments. Plus the special ingredient that makes their essays so compelling:

Compassion.

Best of luck,

Chloe Dawson

The breathtakingly nasty attack on Kate Winslett

I’m regretting the 20 quid I handed over to get through the Telegraph paywall. I like catching up with Boris Johnson’s latest literary soliliquoy, or hearing the latest dire prediction from Ambrose Evans ‘Bear Market’ Pritchard.

A bit of Telegraph controversy adds a frisson of interest to breakfast. Then, if I’m bored, I turn to the Daily Mail to marvel at the depths to which their columnists will sink. That’s the world we live in now, where columnists have to get shriller and snarkier to cut through everybody else’s shrillness and snark.

But the attack on Kate Winslett in yesterday’s Telegraph is such a work of exaggerated bile, such a tapestry of nastiness, that I want my money back.

Here’s the short version: Kate Winslett is a shameless slut who can’t keep her legs together, because she’s been married three times and had a kid each time.

I know? Outrageous, isn’t it? The sheer cheek of the woman. Especially the way she’s tried to cover up her sluttiness by getting married.

Not like Donald Trump, who’s got five sprogs by three different women. Or Mick Jagger, who has seven children by four women – in between dozens of affairs both hetero- and homosexual. Or Hugh Grant with his illegitimate kid.

The campaign to police and monitor every aspect of the female life seems to be stepping up. It’s like a noose tightening around our collective throats.

Was it always like this? Did Elizabeth Taylor face this avalanche of vitriol when she had multiple marriages? Or are things getting viler by the minute?

My faith in humanity has been shaken further by reading how many commenters actually agreed with the piece.

And when Zoe Margolis pointed out that Kate Winslett’s daughter is old enough to read this piece of trash about her mother, there were still people wagging fingers.

I guess at least it’s a sign of rising equality in one respect. It used to be women on welfare who faced such social outrage when they had children by multiple partners. Now, no woman is immune from the fury, regardless of how wealthy, talented or successful she is.

Let’s face it – if it’s open season on Kate Winslett, nobody’s safe.

Plastic surgery and the creepiness factor

It’s been pointed out to me in reactions to my last post, that it’s not just women who get a reaction to plastic surgery – Michael Jackson suffered it too.

OK, Michael Jackson’s surgery was freakish. I think we can pretty much agree on that.

Cliff Richard’s ‘Peter Pan’ look is a bit weird too.

And as for Donald Trump’s orange face and hair piece…

Something about plastic surgery freaks people out (when done badly). I stand by what I said earlier, that women who get cosmetic procedures done upset people because they seem to be gaming biology – trying to mimic youth and beauty past their time, rather than just stepping aside and agreeing to be invisible, which is the price women usually pay for grey hair and wrinkles.

Everyone who says they love women who are ‘natural’ rarely mean it. If so many people truly loved the au naturel older woman, she wouldn’t have such a hard time in the romance and job market. But I digress.

When we age, unpleasant things like attrition of facial bone begins to happen. It’s how we recognise that someone is older. Perhaps if you layer youthful, wrinkle-free skin over the top of an older skull, it confuses the biological signals, in both men or women – in the same way it can seem weird looking at a young person with heavily lined, sun-damaged skin. Not all biological reactions are reproductive, after all. Some are about assessing our place in the dominance hierarchy, or working out whether the other person is a threat or not.

If this is true, then cosmetic procedures like teeth whitening shouldn’t bring down social disapproval. You can have pearly whites at all ages, more or less. And, in fact, I rarely see any derisive commentary about people who have had their teeth capped or whitened (unless they’ve gone for biologically unlikely blazing white teeth). Rhinoplasty equally doesn’t seem to attract such anger, maybe because the shape of the nose doesn’t tell you much about the person’s age or reproductive potential, until they’re very old and the growth of extra cartilage has kicked in.

But anything that messes with signals of youth and vigour – Botox, breast jobs etc – may creep people out because its overlays signals of youth with signals of age. Or because the unnatural nature of the procedure – breasts that stick out – sends a jarring signal of some kind. Perhaps we can tell in a single blink that a body of certain proportions is likely to have breasts of a certain size, and it’s visually dissonant when we see something else.

Does this mean that cosmetic enhancements are bad? I think it means if you’re going to do them, make sure they’re really good.

Of course we’re cultural creatures too, not just biological ones. For what it’s worth, I think that all these cosmetic procedures are starting to signal something else – place in the social hierarchy. For people of a particular demographic, wrinkle-free jaws, subtle botox, hair regrowth and perfect teeth are becoming not just normal, but expected. The quality of the ‘work’ is important too – a perfectly manicured jaw line signals wealth and prestige – even if it’s clearly unnatural – because it implies a top surgeon.

Maybe there will come a time when people get angry at those who get cosmetic procedures on the grounds that they’re “trying to be better” than they really are, in a social sense more than a biological sense. I can imagine this in class conscious Britain. Or maybe having a naturally aging face will become a sign of aristocracy, where someone is so secure in their social position that they don’t need it, as opposed to the pushy mercantile or financial class.

What I don’t believe, at all, is that cosmetic enhancement attracts such social disapproval simply because people prefer the natural look. There’s a lot more than that going on.

How do we solve the Botox dilemma?

Whenever the question of cosmetic procedures comes up, in almost any forum, there will be a rush of people claiming that it’s better to stay as nature intended. Whether it’s Madonna being mocked for her puffy face or women saying they prefer a face with character, society comes down hard on women who visibly use cosmetic enhancements.

Yet all the evidence says that the younger and more beautiful  someone looks, the more benefits accrue to them.

So why the hostility?

People disapprove of cosmetic surgery not because they honestly think that laughter lines and grey hair are better – if people really did believe in embracing aging, they wouldn’t get laser eye surgery or get their hips replaced – but because they don’t like being tricked.

Trickery is pretending something is other than it is, in order to reap a gain, whether that’s financial or just for the satisfaction of humiliating somebody else. Human beings don’t like it, unless it comes in the form of entertainment. That’s why there are strong penalties in law for all kinds of trickery.

So perhaps cosmetic surgery attracts hostility because it seems an attempt to play tricks on one of the deepest human impulses – the urge to reproduce. Beautiful young women have always been highly desirable as reproductive partners, which is why 50-year old women don’t get picked as trophy wives, or as lures at motor shows. There are good reasons for this at a cellular level: youth and symmetrical proportions tell a tale of health that can be passed down to the next generation.

But perhaps a woman who looks younger than her chronological age creates anxiety because she seems to be overturning this.

A woman who gets a cosmetic procedure done and who is open about it will face everything from derision to outright scorn, particularly if (like Madonna) it’s very obvious that she’s had it done. Why?

Maybe, because at a deep level, people feel she’s tried to pull a con that didn’t work. She’s trying to seem younger or prettier than nature made her. She’s stepped out of the box assigned to her.

Cosmetic procedures, when done well,  will genuinely make you look younger and more symmetrical. Lasers whisk away redness; botox smooths out wrinkles; rhinoplasty reshapes the nose. A study published last year revealed that volunteers cannot correctly guess the age of people who’ve had facelifts – they pegged the patients as much younger than they really were. So most women who get cosmetic procedures done will, in fact, look younger and prettier.

There are good reasons why plastic surgery can be a bad idea: health risks; the way that the acceptance of cosmetic procedures is slowly becoming an imperative to have them; the way that they reinforce an ever-narrower beauty stereotype. The more women embrace Botox, the more they have to, because not doing it becomes the new definition of ‘letting yourself go’.

But let’s stop pretending that cosmetic procedures are just vanity, and that people who have them are insecure people who should look as nature intended. Perhaps the real reason they arouse such hostility – when many of them are less intrusive and permanent than a tattoo – is because people are uneasy when women refuse to step aside.

I’m not suggesting that cosmetic procedures are a good thing – or a bad thing. But even now, in the 21st century, it seems that many of the decisions we make about other people, from agism at work to whether people are fit to hold public office, are based on reproductive imperatives that have nothing to do with whatever the issue at hand is. Telling women comforting lies about how they’re just as valuable to the job and romance market when they have grey hair, when women are judged more harshly than ever before for their looks and perceived age, is going to do nothing to stop the headlong rush to the hairdresser – or the plastic surgeon.

If Madonna is being mocked now for her cosmetic procedures, just imagine how much more she’d be mocked for looking visibly old. She’s in a cruel bind.

When women really are valued for more than their looks, plastic surgeons will go out of business. Until then, you can’t ask an individual woman not to grab an advantage when it’s offered. Or mock her for doing so.

Food and height

I am wearing a new pair of pants today. I love ‘em. They’re a Dutch brand. And they’re just a teensy bit too big.

If I’d bought the equivalent size pants from France, they’d fit. From Italy, they’d be a bit small.

And it occurred to me that the further south you go, the smaller the people get. Walk through Stockholm and it’s like walking among blonde gods and godesses. Walk through Amsterdam and it’s like walking through a forest. Never go to a live concert in Holland – you won’t be able to see over them.

Portugal? Good looking, smaller people.

And yet the further south you go, the better the diet. Olive, olive oil, fish, tomatoes and all the other dazzling components of the Mediterranean diet. The more north, the worse it gets, because the more they rely on fried meats and potato (and fish, obviously, in Scandinavia). But the taller they get.

OK, some of this is genetic. But take a petite Frenchman and stick him in America and the children he has there will be more robust looking than he is.

Maybe diet isn’t all good or all bad. The northern diet will harden your arteries. But it can’t be all bad either, because it seems to make people strong.

Just a thought.

Should we pay people to be healthy?

The Atlantic is running an interesting story about US employers using financial rewards and penalties to ‘nudge’ employees to better health. One of the examples given is a program where employees who take certain ‘wellness’ steps pay less in health premiums than employees who don’t.

This is a uniquely US situation, because employers in the US offer health insurance as part of salary packages. But, you know, where the US goes others follow, so it’s worth taking a look.

So, the first point is that if a company can take action to bring down its bills (in this case its insurance premiums), you can’t ask it not to. If I were a financial controller, I’d be implementing gym sessions for everybody.

But although the financial impulse is understandable, the whole idea is deeply problematic.

The first problem is the destructive effects of financial incentives on things which were formerly free. There’s a good book about this, called The Moral Limits of Markets, that discusses how monetising basic human interactions corrupts them. Historically, health is its own reward – you exercise and eat well because it makes you feel great. But in a system where people are financially rewarded for making changes, those who have always taken ‘the right’ actions will now feel ripped off.

Can you imagine? Here you are, a weight-conscious fitness fanatic who goes running every morning before fixing yourself a breakfast of blueberries on oatmeal, who now finds that your cholesterol-riddled, smoking colleagues are actually being paid to do the things you do anyway. And you get bupkiss. Suddenly your proud achievements are now a source of grievance.

Not only that, but is the new emphasis on getting those healthcare costs down going to result in workplace bullying of the fat, the sick, the disabled… the just-don’t-cares? Under the guise of ‘encouraging’ one another, will a hostile form of healthism take over?

(And if you’re reading this, thinking that bullying is perfectly OK if it saves money, then you’re a perfect example of the corrupting effects of monetising discussed above.)

The second problem is the intrusiveness. It’s one thing to ‘nudge’ professionals to load up on salad at lunch time – but it’s quite another to suggest that employees should get regular blood tests, or be tethered to electronic monitors like pedometers. The people who are most likely to be controlled in this manner are the people who are already the most powerless – people whose bums are glued to the seat in call centres, for example, whose very toilet breaks are clocked.

They’re not only the easiest people to control, but they tend to have the unhealthiest habits, which is no surprise: The combination of high levels of stress and boredom with low levels of autonomy and financial reward are extremely bad for your health. (Indeed, have a look at the relationship between some jobs and weight published recently.)

Such monitoring will be ‘voluntary’, of course, except that anyone who doesn’t get with the program is likely to find themselves looking for another job.

And then there’s linking of health, intrusive monitoring and consumerism:

Vitality might track your gym visits, activity using pedometers and accelerometers and attendance at Weight Watchers meetings, and in exchange you earn redeemable points that can be used to purchase items — movie tickets, iTunes gift certificates, hotel stays — from the Vitality Mall.

So good habits are no longer their own reward.

In fairness, the programs quoted in The Atlantic piece sound effective: Between 2007 and 2011 King County saved $14.6 million due to the improved health of its employees and their families.

Governments have always played a role in public health, from putting everyone through tuberculosis x-rays to insisting on vaccinations, to putting in sewage systems. But the government does it at a population level. Inspectors don’t come round to your house – except under very extreme circumstances, like bubonic plague – and check your online diary to see how many steps you’ve done.

The sheer Orwellian nature of the private sector taking on this role should raise questions. The idea that any company, or its contractors, could soon have the ability to interrogate someone’s health is an astounding intrusion. And, yes, maybe you have to ‘opt in’, but if the nudge is big enough, that opt in becomes a must in.

And this is before even touching on the subject of how people with serious (or embarrassing) health issues will be dealt with, and whether that information can possibly stay private in an environment where everybody is exhorted to do yoga together.

Finally, let’s not mention the unmentionable: the link between low wages, high stress, low environmental control and poor health outcomes, which might be better solved by higher wages and improved working conditions, than vouchers to Weight Watchers.

I’m sure lots of people will really enjoy getting out for lunchtime walks with colleagues, or learning how to Zumba. And many people will be happier and healthier for it. Because encouraging people to spend time with one another doing activities is good for both body and soul.

But dispensing with bodily autonomy isn’t healthy at all.