Can We Please Acknowledge the Role of Cultural Standards in How We Speak About Body Size and How Much We Eat?

The first paragraph of the introduction to The End of Overeating by David Kessler is:

I’ve learned to recognize overeating in restaurants all over America. It’s not hard, because people who have been conditioned to overeat behave distinctively. They attack their food with a special kind of gusto. I’ve seen them lift their forks, readying their next bit before they’ve swallowed the previous one, and I’ve watched as they reach across the table to spear a companion’s french fries or the last morsel of someone else’s dessert. Certain foods seem to exert a magical pull on them, and they rarely leave any on their plates.

I would never take a companion’s french fries without their explicit permission, and I would not eat the last morsel of someone else’s dessert because eating other people’s leftovers grosses me out. But otherwise, this does describe the way that I eat, particularly rarely leaving anything on my plate after I finish eating. By this description, I ‘overeat’. Eh, whatever. I’m okay with this. What I’m NOT okay with is the next paragraph:

As I watch this kind of impulsive behavior, I suspect a battle may be taking place in their heads, the struggle between “I want” and “I shouldn’t,” between “I’m in charge” and “I can’t control this.” In this struggle lies one of the most consequential battles we face to protect our health.

On one level, I have trouble even comprehending this. It is such a firmly entrenched habit for me to eat everything on my plate that it is hard for me to understand people not planning to eat everything on their plates. If you aren’t planning to eat it, why did you put it on your plate? And if a restaurant put too big a portion on your plate to eat in one sitting, you’re going to take the leftovers home since you paid for them, right? As long as I don’t discover something awful about the food as I’m eating it, I always intend to eat everything on my plate. I make the decision about what and how much to eat before it reaches my plate, not after, so it’s pointless to struggle between “I want” and “I shouldn’t” at that point. Is this considered weird in American culture?

On another level, I want to tell Kessler “**** you!” That is nothing at all like what is going on in my head when I eat food. And for some reason, Kessler attributing those thoughts to me rankles me. If that’s how he thinks when he’s eating, fine, if he considers the way I eat to be ‘overeating’ and ‘impulsive’, fine, but I don’t want him to act like he knows what I’m thinking when he’s so far off the mark! It is much more accurate to describe me as eating with ‘a special kind of gusto’ – when I’m eating I want to enjoy it as much as possible, dammit.

It’s not just these opening paragraphs – throughout the book, Kessler assumes that everyone who eats in the way he describes attributes the same kind of thinking and value judgments to this behavior, when in fact not all of us do, and that is even before considering that this thinking often comes from specific cultural standards rather than some inevitable human reaction. For example, when I was in South Korea, I was complimented for leaving my plates so clean after I finished eating. I learned that, in traditional Korean culture, eating EVERYTHING on one’s plate is a gesture of respect, and leaving any food on one’s plate after eating – even a single grain of rice – is a sign of disrespect (though it is okay to refuse to put food on one’s plate in the first place – in fact, some Koreans I met advised being very careful about what to put on one’s plate to ensure we could respectfully eat it all). Obviously, I prefer the traditional Korean interpretation of this behavior to Kessler’s interpretation, but the main reason I mention the Korean interpretation it to make clear the role of cultural context.

In fact, my own habit of eating everything on plate, even when (not often, but occasionally) I’m already full probably owes a lot to how my mother raised me. My mother did not grow up in the United States, and has a different cultural understanding of how to relate to food.

And it’s not just David Kessler, I’m only picking on him because I have his book on hand to quote. Throughout American culture, there are these little (or big) allusions and references which assume that ~everyone~ relates to eating in the way that Kessler describes. If I could find it, I’d quote an essay which says that ~all~ American women are trained to see food as the enemy to be resisted as much as possible (uh, I’m an American woman, and I’ve never seen the food I eat as an enemy to resist). But it’s okay that I can’t find the specific essay I have in mind because it’s not unique – there are many other essays which say something similar.

I accept that this is a way that many Americans (and many non-Americans) relate to food. What really irritates me is the assumption that ~everyone~ is like this, an assumption that is so firmly entrenched that they don’t even bother to say it outright – because they don’t recognize it as culturally specific.

I’ve known people who consider eating garlic and onions to be taboo. They, however, don’t assume that everyone else share their values. This is why, even though I eat garlic and onions myself, I find discussion of eating-garlic-and-onions-as-taboo to be much less irritating that pervasive casual remarks about how some food is allegedly both irresistable and something to be feel guilty about eating, and that people are supposed to experience intense internal dilemmas about whether or not they should eat it, even when it’s already on their plates.

And then there is that last bit “In this struggle lies one of the most consequential battles we face to protect our health.”

The book presents itself as being firmly based on scientific evidence. And as far as I can tell (I’m not a scientist) it does present a lot of good science about habit formation and how people react biologically/psychologically to different kinds of foods. Yet the book never bothers to explain how being overweight/obese is bad for health. I get it; the book’s mission is to talk about ‘overeating’ not to persuade readers that being fat is a health issue in the first place. But, uh, couldn’t the book at least make a cursory pass at the scientific evidence about how weight affects physical health? Especially since the book claims that this is “one of the most consequential battles we face to protect our health.”

I’m not any kind of health or scientific expert, but I’m going to take a pass at this by looking at mortality at different body-mass indexes. There are many problems with this approach: there is a lot more to physical health than mortality (arthritis isn’t fatal but is still a physical health problem), something that is true for an overall population isn’t true for every individual, etc. etc. etc. I get it. I’m just trying to get a glimpse at the forest, I’m not trying to present a complete picture of the forest, and I’m certainly not saying anything about the trees.

This study finds that people who are ‘overweight’ and ‘grade 1 obese’ don’t have a higher level of all-cause mortality than people who are ‘normal’, whereas ‘grade 2’ and ‘grade 3’ obese people have a much higher all-cause mortality. This article based on this study claims that the older study is seriously flawed, and that both ‘overweight’ and ‘grade 1 obese’ people have higher all-cause mortality rates.

I don’t have the expertise to judge which of these studies has better methodology. But even the latter study finds that mortality rates are much higher for grade 2 and grade 3 obese people than for ‘overweight’ and ‘grade 1 obese people’.

These studies don’t establish anything about causality. Since, at least in the United States, obesity is correlated with poverty, it’s possible that a lot of the mortality is due to various effects of poverty rather than obesity itself i.e. if these people suddenly became ‘normal’ weight but were still living the same kind of poverty, their poverty might continue to kill them. I doubt that this is sufficient to fully account the much higher mortality rates for grade 2 and grade 3 obese people, but it is conceivable to me that these confounding effects could account for much of the elevated mortality rates among ‘overweight’ and ‘grade 1 obese’ people (if the latter study accurately measures mortality). Or maybe not. And poverty isn’t the only potential confounding factor I can think of. Casuality is harder to pin down than correlation.

Let’s say, for the sake of argument, that most of the casuality is more weight -> higher mortality. The conclusion I would draw from these numbers is that ‘grade 2-3 obese’ people would get the biggest change in mortality from lowering their weight to ‘grade 1 obese’. From there downwards additional weight loss brings diminishing returns (until they become negative).

The above paragraphs is already more effort into trying to figure out the relationship between body weight and physical health that David Kessler bothers to put into his 251 page book (I haven’t looked at the endnotes, but if he only discusses this kind of thing in the endnotes I don’t think it counts).

I also want to remind you all that I do not endorse moral healthism; I’m convinced that being ‘grade 2-3 obese’ causes serious harm to physical health; that does not mean that I think ‘grade 2-3 obese’ people are obliged to do anything about it. Most importantly, ‘grade 2-3 obese’ people deserve just as much dignity and respect as people of other body sizes. (I’m willing to cut Kessler some slack for moral healthism because he’s a public health professional, and part of the job is public service announcements. That said, I noticed that, even though the book goes to great lengths to explain how the increase in overeating was caused by changes in the social/economic/cultural landscape, and that individual people are not at fault, his proposed solutions are focused on the individual – telling them how to stop overeating – not on changing the broader social/economic/cultural landscape, such as making governments restrict the sale of soda drinks, or ending food deserts and food swamps.) (To be fair, he does support legally requiring nutritional labelling in restaurants and tried to push that when he was working for the Food and Drug Administration).

And then, much later in the book, this leaped out (I’m the one who bolded the text):

But to achieve other goals, like maintaining weight loss and eating healthier food, I need to behave differently. The problem is that my brain hasn’t been trained to respond to the message “No, it would be better for my health and my looks if I don’t do this.”

Looks?

Clearly, this isn’t just about physical health.

I don’t necessarily have a problem with people choosing to change their weight in order to change their looks, especially if it’s tied to their economic livelihood (professional models, for example) (I mean, I might critique how the modelling industry pressures models to change their weight, or models who body-shame others, but I wouldn’t criticize the choices models make about their own body sizes). I can appreciate that some aesthetic expressions work better with certain body weights.

I am also very aware that notions of physical beauty have far more to do with cultural standards than physical health. Most people, including me, are going to choose to conform to their culture’s standards of physical beauty to some degree. But I wish people expressed awareness that they are conforming to current cultural standards, rather than treating it as some universal truth about physical beauty which doesn’t need to be clearly expressed. For an example of how a different culture could understand body size and physical beauty, here is a great article about how medieval western Europeans viewed fatness and thinness.

As I said before, my recent effort to lose weight was not motivated by health concerns (well, I was concerned about the long-term impact of body weight on my skeletal system, given my family’s history of arthritis. Come to think of it, the period in my adult life when I had the lowest body weight was also the period when I experienced the least foot pain, and I haven’t felt much foot pain since my recent weight loss, so maybe there’s a connection). My motivation did, however, have something to do with culture. If I lived in a different cultural environment, I might not have tried to lose weight, or I might have tried to lose even more weight. For example, if I lived in medieval Western Europe, I might have tried to become much thinner in order to signal my preference for celibacy.

Ultimately, I find that he has different values than I do, which is especially irritating when he casually assumes that the reader shares his values. He implies that it is natural for for fat people to think of themselves as ugly and disgusting without acknowledging the role of culture, and never denounces the bullying of fat people (yes, he makes a clear case for ‘it’s not people’s fault if they are fat’ but that is as far as he goes against bullying); I always want to make it clear that I am opposed to bullying people because they are fat, and I think it’s important to discuss the cultural/social context around judgements, including internalized self-judgements, that fatness makes people ‘ugly’ or ‘disgusting’. He claims that ending obesity is one of the greatest gifts we could grant future generations; I can think of a LOT of things which would be much greater gifts for future generations (for example, if I had a choice between ending obesity or ending intimate terrorism/domestic violence, I’d pick the latter in a heartbeat, it wouldn’t even be a competition).

If Kessler had put in even a page about the scientific basis for claims that being overweight/obese are bad for physical health, he would have affirmed that we need to pay attention to the science (and scientific understandings change over time – notice the different conclusions of the two studies I mentioned). By refusing to do so, and by slipping in references to how losing weight improves looks without discussing it head-on, he is relying on culture, not science, to motivate people to ‘stop overeating’ and lose weight. Worse, he’s pushing the cultural standard implicitly, through casual remarks, in a “Doesn’t everybody want this? Why do I even have to spell it out?” way (I took the quote from Mallika Rao though she said it in a very different context). Even just being explicit about the cultural standard, saying something along the lines of ‘we want to lose weight to better conform to our cultural values’ would be an improvement, because that would acknowledge the role of culture, which would invite the reader to think about what degree they wish to conform … and whether they may wish to alter our cultural standards.