ABC News reports that some obesity experts wonder if the president's nominee for surgeon general, Regina Benjamin, cannot effectively perform her job because she is overweight. The experts quoted are, indeed, experts. James Anderson is a well-regarded professor of medicine at the University of Kentucky. He lectures Benjamin: "It's important to walk the walk and not talk the talk. We need role models who are attempting to be leaders for change in health and lifestyle to be role models." The explicit premise is that people who have successfully lost weight are the only people who can give reliable advice on weight loss. That's understandable, although not logical. The implicit premise is kind of insidious: it assumes that Benjamin is grossly overweight, which isn't true; it erases the distinction between obesity and being a few pounds too heavy; and it replicates the harmful cultural assumption that weight loss depends on willpower and choice and has little to do with culture, society, environment or physical space. It is absolutely true that anti-obesity forces lack a national spokesperson who is respected cross-culturally. At the same time, the struggles of Oprah Winfrey, who has access to material resources that most of us do not, much more realistically represent the lives of most Americans who struggle with weight. People who tend to lose weight and keep it off tend to be disproportionately wealthy, white, and have the material resources (like a bike) to struggle successfully against their environment; people who tend to be skinny, naturally, inherit from their parents a predisposition against excess fat storage. That someone like Oprah can be so rich and so unsuccessful demonstrates how terribly difficult and unrealistic the willpower model really is. Role models are important, particularly in the black community, where different social norms about obesity and different community structures (health disparities, lack of access to fresh foods, different (and more negative) views about the future) play a fairly significant role in sustaining and nourishing food addiction and obesity. Benjamin will be quite effective if she uses her role to pay attention to these ecological factors.

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