One bioethicist's modest proposal to combat obesity through socially motivated self-hatred
People don't hate being fat enough, basically, according to Hastings Center bioethicist Daniel Callahan. In an editorial published in the Hastings Center Report, he argues that nothing -- not diets, drugs, sugeries, nor appeals to our health -- is working, and goes on to make the case for fat-shaming people until they start eating more salad.
"An edgier strategy is needed," is his (earnest and entirely devoid of irony) way of putting it.
The edgy strategy he came up with entails "social pressure combined with vigorous government action." Callahan likens it to the campaign to end smoking: The combination, in his experience, of being criticized, sent outside, and taxed for his "nasty habit" was the motivation he needed to quit.
"The force of being shamed and beat upon socially," he writes, "was as persuasive for me to stop smoking as the threats to my health."
So imagine his surprise when the same social smack-down was actually discouraged when it came to obesity: "I had not realized that smoking was the exception -- that the public health community generally opposes anything that looks like blaming the victim." He brings up, as an example, the opposition to blaming HIV patients for contracting the disease.
Callahan stops before suggesting that such patients brought HIV on themselves, but he clearly implies that obesity is a situation where the victim can and should be blamed for their condition. After all, we're already doing it unofficially. "The obese are said to be lazy, self-indulgent, lacking in discipline, awkward, unattractive, weak-willed and sloppy, insecure and shapeless." (It's not him saying that, he's only reciting what's already being said "among doctors and nurses.")
People who are overweight, he contends, remain hopelessly unaware of their plight. He references the study finding that Americans, as a whole, aren't aware that they're getting fatter. The obese majority of the public must understand that, "whatever they may think about the power and excess of government, it is inescapable in this case, as much as with national defense."
Callahan makes a case for himself not being that radical: he's only calling for "mild coercion" on the part of the government, in the form of Bloomberg-style bans and taxes, supplemented by what he calls "stigmatization lite." This low-cal, low-hatred version of stigmatization is edgy, just crazy enough to work -- so long as it doesn't lead to outright discrimination. It entails forcing overweight people to confront themselves in the mirror and ask themselves:
· If you are overweight or obese, are you pleased with the way you look?
· Are you happy that your added weight has made many ordinary activities, such as walking up a long fight of stairs, harder?
· Would you prefer to lessen your risk of heart disease and diabetes?
· Are you aware that, once you gain a signifcant amount of weight, your chances of taking that weight back off and keeping it off are poor?
· Are you pleased when your obese children are called "fatty" or otherwise teased at school?
· Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?
So it's a special kind of internalized discrimination. One might even suggest -- as Callahan himself does -- that such an approach would actually be empowering.
That last question in effect aims to make people acutely aware of pervasive stigmatization, but then to invoke it as a danger to be avoided: don't let this happen to you! If you don't do something about yourself, that's what you are in for. Many of the other questions invoke vanity as a value, or the good opinion of one's neighbors, friends, or fellow employees, or the risk of illness. Use all of them together, carrots and sticks. That will not much help most of those who are already overweight or obese. But beyond marginal improvements, most of them are already lost.
Abandon the lost causes and embark on a new era of zero tolerance for body fat. I can't see how anyone could possibly have a problem with that.
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