Road Trip: Part II

What would Tocqueville say? A journey continues, from Seattle to San Diego via Alcatraz and an obesity clinic
Who's Afraid of the Obese?
From Atlantic Unbound:

Flashbacks: "The War on Fat" (September 4, 2002)
A trip through The Atlantic's archives offers revealing insights into American body politics.

Of course there are obese people in America.

Of course there is a physical obesity that is often seen as a metaphor for a more general obesity that affects cities, businesses, the hubris of politics and finance.

And yet … Is there really as much of it as they say there is—and, especially, as much as anti-American literature claims there is?

And isn't this matter of obesity more complicated than the caricature of it, including, of course, the American caricature?

Ever since my arrival in America, in all the little towns I've gone through, I have kept my eye out for those notorious clusters of fat people featured in European tabloids. Perhaps I didn't look carefully enough; perhaps I traveled through the wrong places; but I didn't spot many more fat people here than in any provincial French town.

I read the American statistics meant to alert public opinion to this new epidemic, which is supposedly in the process of overtaking smoking-related illnesses as the leading preventable cause of death in the country. I read a study this very morning that explains, in the emphatic "state of emergency" tone the press loves to use when it declares war on crime, drugs, terrorism, or, now, obesity, that the proportion of officially overweight people in America has just risen above 65 percent, while 30 percent of Americans are classified as obese and that number is increasing and will continue to increase by at least five percent a year. I trembled. I thought ahead. Like all readers of the study, I could envision a time when, at this rate, 100 percent of the population would be afflicted by the virus—until I noticed that the method of calculation used, the well-known BMI (body mass index, which measures the relationship between height and weight), places the bar so low that if the same measure were applied to many European countries, roughly the same percentage of people would be affected.

I looked at other statistics, alleged to show the correlation between obesity and mortality; I read the studies of the Behavioral Risk Factor Surveillance System (what a name!) and the American Obesity Association (which calls, flat out, for the institution of "fat taxes" like the taxes levied on tobacco); I read all the government investigations of obesity, investigations whose comparative alarmism is such that it reduces AIDS to the rank of a flu epidemic. But I also read studies from Cornell University and the National Center for Health Statistics; I read a study by Glenn Gaesser, a professor at the University of Virginia; I read an essay by Paul Campos on the "myth" of obesity; and I've been told that there are experts who, not content with questioning the previous studies, not content with denying a cause-and-effect relationship between the increase of BMI and mortality, demonstrate, for instance, that overweight nonsmoking white men die from cancer less often than non-overweight subjects.

In short, lost in these arguments and numbers, no longer knowing what expert to turn to—and incapable of reaching a decision in the other, connected battle over the responsibility of junk food, or of McDonald's, Pizza Hut, Burger King, and Wendy's, for this degenerative transformation of American bodies—I end up going this morning to the Lindora weight-loss clinic, here in Los Angeles, which is said to be one of the leading establishments in the battle to the death against obesity. I interview Cynthia Stamper Graff, Lindora's president and CEO: dark-green suit, red hair, artificially perfect smile, forehead smoother than nature, photos of Reagan and Thatcher over her desk. Did she know them? No, but she admired them, she said. Wasn't it after they left office that this epidemic began? It could hardly be pure chance, was the implication, that the most famous of America's overweight people, Bill Clinton, became president soon after. I look with her at the other pictures mounted on the walls, "before" and "after" photos of some of the "big losers." It's suddenly unclear to me whether they went through this clinic or the NBC reality show The Biggest Loser. I interview one of these "losers," Traci Smith, thirty-six years old, 488 pounds on arrival, who can't say enough about how much her life has changed since she entered the system. She is only one of many who, each year, for about $1,200, begin by taking a ten-week course of treatment in one of the thirty or so centers belonging to the company. Especially after meeting Traci, after seeing this newly thin woman who has strangely kept all the gestures, postures, ways of walking and thinking—in short, the entire fate—of a fat person, I think I understand two or three things.

I understand, of course, that there is a weight-loss business that is gaining on the junk-food business.

I understand that the former has an advantage over the latter in being able to rely on the prestigious testimonials of science and medicine.

Even better, I understand that inventing obesity—that is to say, claiming first that being fat is a disease, second that this disease must be treated, and third that it will never, despite treatment, be completely cured—creates a type of dependence that is at least equal to that produced by the inventors of flavors, fragrances, and packaging that are designed to develop a loyal following among junk-food consumers.

So we can't put the blame on junk food, fly to the rescue of citizens intoxicated by the new engineers of taste, support them in the lawsuits they are bringing, for instance, against McDonald's, unless we add right away that they are the guinea pigs of not just one but two competing lobbies—one having the advantage over the other for having discovered a regime that is almost more restrictive.

Big Brother once again. No longer a cop but a doctor in everyone's body. Worse than a doctor, a statistician, imprinting his implacable orders onto the quick of live flesh.

Will we end up penalizing the fat?

Will we forbid them access to food deemed harmful?

Will we put scales at the cash registers of fast-food restaurants, to weigh people before selling them Super-Sized Happy Meals?

And will we see, thanks to these new norms, the return of forgotten attitudes that existed during Prohibition?

We know well the mechanisms at play here. How, starting with the control over bodies, one imperceptibly reinforces control over society. How, beginning in Europe, the medical establishment lent a hand to the political establishment by offering procedures of examination, classification, diagnosis, evaluation.

The United States has reached that stage—later than Europe, but making up for lost time. It's the last of those "open medical governments" that Foucault, in The Birth of the Clinic, amusingly contrasted with Fichte's closed commercial State—and in which he saw one more decisive step forward in the history of servitude.

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