History is funny. When looking back over social mores and people’s thinking from decades ago, generations ago, even centuries ago, we often find ourselves puzzled. How could nearly everyone have been so benighted, so wrong about, say, forced sterilization of psychiatric patients, or the infamous Tuskegee syphilis experiment? Wasn’t the “right answer”, the upstanding answer, the humanitarian answer obvious?
My 5-year-old granddaughter recently said to her mother in amazement “Mom, can you believe it– in the old-fashioned days black people and white people couldn’t eat at the same restaurants. They couldn’t marry each other. They couldn’t sit next to each other in the movie theater. Can you believe it?”
I thought about my childhood. I was raised in Palo Alto, California and my father, a former Marine Corps fighter pilot, was an enthusiastic supporter of the civil rights movement. Lord knows why, he was born and raised in a small town in Utah, not known in those days for open-mindedness. Our cousins, raised in the South, did not share his optimistic view of racial integration. Was our families’ vocal support of the civil rights movement possible because our father taught us what to think? Certainly we disagreed with him openly on other issues. Thinking back on racial segregation it seems even more obvious than it did at the time that it was wrong (to say nothing of slavery!). Looking back from our vantage point in 2016, it seems incredible for educated people not to have known how wrong it was. Today even a 5 year olds knows better.
A more recent example than racial segregation in the United States comes from my medical school years in Germany in the 70’s. Mostly my German friends did not speak about the war that their fathers (and mine) fought. Certainly they did not speak about the Holocaust. It seemed as incredible to them — young medical students — as to me, that Hitler could have come to power in the first place. How much more incredible was it that Jews from all over Europe were herded into camps, tortured, beaten, starved and finally murdered. How could everyone have not known it was wrong?
In case you think I’m going to blog about the similarities between the rise of National Socialism and the rhetoric of certain current presidential candidates, let me reassure you. I’m actually going to take aim at another – perhaps less obvious to some – dehumanizing prejudice in American life: fat prejudice.
It would be nice to think we could identify “wrong thinking” early on, rather than waiting decades to look back and identify it as such. If that were so we could spare all humanity a great deal of suffering. And yet every time I read a scientific article about the complex origins of obesity, metabolic syndrome, and type II diabetes, I am made uncomfortably aware that the prevailing prejudice against people of high body weight is not even slightly influenced by the influx of new scientific data on these complex issues.
For example, take the case of a recent article in the journal Environmental Health. This was a meta-analysis, meaning a review of all the high quality studies on the subject that independent investigators could find. The article states that “the health outcomes of interest were diabetes, hyperglycemia, measures of anthropometry, cardiovascular disease (CVD) and hypertension”, all conditions from which overweight and obese people are said to suffer disproportionately. And yet these are also conditions which many people – even by some who read journals like Environmental Health on a regular basis! – still attribute to a lack of “willpower”.
The authors of this meta study wondered whether fatness and its consequences might be a result of exposure to BPAs (bisphenol phosphates), an ingredient in plastics which is ubiquitous in our environment. BPAs, they tell us, are “endocrine-disrupting chemicals (EDCs) because of their ability to interfere with synthesis, secretion, transport, metabolism, binding action, or elimination of natural blood-borne hormones, and to induce obesogenic or diabetogenic effects”. In other words BPA is suspected in making people fat and giving them diabetes.
They conclude: “there is evidence from the large body of cross-sectional studies that individuals with higher [urine] BPA concentrations are more likely to suffer from diabetes, general/abdominal obesity and hypertension than those with lower [urine] BPA concentrations.”
OK. So that’s bad news. So exactly how and where are we exposed to these chemicals that have the ability to make some of us fat?
They respond: “The primary source of human exposure to BPA is presumed to be via the ingestion of food which has been stored or reheated in BPA-lined containers, but recent data suggest there is at least some exposure from drinking water, dental sealants, thermal paper and, to a lesser extent, inhalation of household dust particles.”
Great. That sounds like the answer is “everywhere”.
The knowledge that these environmental obesogens affect our metabolism in pathological ways may not be news to some of you. And yet I continue to be amazed and taken aback at those who know (or should know) this information and yet are unable to apply it to their own world view. They continue to speak of and to obese people as if they were too gluttonous to control their appetites, too lazy to exercise, too slothful to run, and in fact are making a “choice” to be fat. They endorse health insurance and workplace policies that would penalize people whose BMI is above a certain number (nevermind that BMI has been discredited time and again as an effective tool to assess an individual’s health). They applaud school PE classes that humiliate overweight kids by openly talking about their “BMI” and “fitness quotient”. IQ results would never be posted at school, but somehow posting people’s weight and fitness testing is supposed to be “incentivizing”?
Really folks, given the massive disincentives to in American society being fat, does anyone seriously believe one would “choose” to be so?
For the social scientists out there here’s another, downright disturbing article from Environmental Health entitled “Endocrine Disruptors Alter Social Behaviors and Indirectly Influence Social Hierarchies VIA Changes in Body Weight.” Its conclusion: “developmental exposure to environmental xenobiotics [substances foreign to the body] shifted behavior towards increased anxiety and decreased interest in social interactions. Our mouse model reproduces negative associations between social hierarchy status and body weight. These results suggest that manipulation of body weight by endocrine disruptors may affect social ranking.” Translation: the societal effects of these foreign substances go far beyond an individual’s health.
I have read several equally disturbing accounts of people advocating for the removal of obese children from their homes by the government and placing them in custodial care. (If this doesn’t smack of the Third Reich, I don’t know what does). Obesity in children, so their reasoning goes, is child abuse. This proposal was apparently seriously entertained, enough that Medscape felt compelled to publish an article discussing it and to ask the professional medical academies to speak out against it.
No matter what the professional academies say, I know there are many people out there who feel scorn and pity for overweight children and believe that if their families just endorsed “healthy eating” and “exercise” the problem would be solved. That this attitude flies in the face of mounting scientific literature on the abysmal failure of diet and exercise as effective, long term treatment of obesity and metabolic syndrome, is rarely discussed.
I challenge everyone to read widely in the world of obesity medicine and come away thinking that we know with any degree of certainty what the cause of human metabolic syndrome, type II diabetes and high body weight is. Clinical clues are beginning to come to us from bench scientists and geneticists, but they wage an uphill battle against preconceived notions and entrenched fat prejudice.
I started this blog wondering why people could not see through the prejudices of their own generation. We send our children to institutions of higher learning by the hundreds of thousands, and yet critical thinking faculties appeared to be no more common than they ever were. I am convinced that once the science is clear we will look back on fat prejudice the way we look back on racial prejudice. They will be ashamed and appalled that they could ever have acted against their fellow humans in such ignorance. Remember the apologies Alabama governor George Wallace issued at the end of his life? “Those days are over,” he said, asking for forgiveness for his own behavior and attitude towards African Americans, “and they ought to be over”.
We should not let that be us. Let’s not make it possible for some future little girl to tell her mother that in the “old-fashioned days” people punished other people socially, verbally and clinically for their body size. Each and every one of us has a responsibility to ensure that we don’t conspire to allow history to repeat itself.
