The Royal College of Physicians' patchy and cynical new year's report on obesity

The predictable new year dose of fat panic kicked off today with widespread reporting of the Royal College of Physicians' (RCP) latest missive, complete with a plethora of headless fatties from the picture archives. The RCP is a charity that represents physicians and, according to its website, "takes a wide role in public health". Action on obesity: Comprehensive care for all, by one of the RCP's working parties, states that the current response to obesity by the NHS is "patchy" and could be resolved by a number of proposed initiatives.

Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.

But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about "severe complex obesity," a term they're obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it's not weight loss surgery that ruins fat people's health, it's the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we've already seen Jamie Oliver screw things up over here.

The report, its press release, and subsequent reporting, reiterates the usual stale fat panic rhetoric about demographics and increasing body weight, and reproduces the inconsistencies of this argument. An estimated cost of £5 billion per year is placed on 'obesity', based on secondary reports, all of which also estimate the cost or propose costs based on irrelevant evidence (I checked their methodology). This figure is therefore a fantasy. More confusingly, Action on obesity: Comprehensive care for all criticises these costs, whilst making a prolonged case for spending more on obesity treatment, presumably because that's what puts the bread and butter in its members' tables. It's nonsense.

This report is an example of obesity research which eschews a research justice framework – more about that in posts to come – but which makes a big honking noise about being for the benefit of humanity. But work like this, cynically capitalising on new years anxiety about fat, is a load of hot air, a waste of space, that serves no one but the members of the RCP, least of all fat people.

If the RCP were really serious about fat people's health, they would be investing in health at every size research, developing fat activist communities, and pioneering projects such as medical self-advocacy, anti-discrimination work, and other low cost, low risk initiatives that have proven track records in increasing fat people's well-being. But that's just crazy talk, isn't it?

Action on obesity: Comprehensive care for all

Karen Throsby and Charlotte Cooper double whammy at King's College London

Here are more details. Come and see Karen Throsby and I talk next week. Anyone can come, it's free, and there's a wine reception (hic) afterwards.

Obesity and the Rejection of Body Normativity
Wednesday 18 May 2011
CMCI Work Room (formerly the Art Exhibition Room, on the ground floor of the South East Block), King’s College London, Strand Campus
17:30-19:00 followed by a wine reception

Following our successful launch in 2010, GenderMatters@King's, a research network of gender studies and feminist theories across King’s College London, is now organizing a series of seminars on the theme of “Gender and Mental Well Being: Inter-disciplinary Perspectives”, funded by King's Graduate School. Our first seminar will focus on exploring the subject of 'Obesity and the Rejection of Body Normativity', highlighting not only the gendered aspects of institutional interventions that attempt to govern bodies, but also the emancipatory potential of 'body shape diversity' discourses on fatness and fat identity, and their contestation against the weight-centred approach toward health.

"What do I eat, love?"
Obesity surgery and the reproduction of gender
Karen Throsby, The University of Warwick

Obesity surgery is conventionally understood through the lens of weight-related health discourses; it is the intervention of last resort for those whose bodies are deemed both medically and socially to be dangerously, intractably fat. Approximately 80% of all obesity surgery patients are women, but the gendering of obesity surgery as a practice extends far beyond the distribution of men and women among the patient population. Drawing on ethnographic research conducted in an obesity surgery clinic, this presentation argues that the practice of obesity surgery, both within and outside of the clinic, not only leaves unaddressed troubling social and bodily gender norms, but actively reiterates and reproduces those norms. This presentation explores the gendering of obesity surgery, including patient candidacy, the everyday work of managing the post-surgical body, and the distribution of responsibility for treatment outcomes. I conclude by considering the implications of this for those working within critical fat politics.

"She was so viscerally happy in that moment"
Fat Activism for Well Being
Charlotte Cooper, The University of Limerick

Dominant obesity discourse in 21st century Western culture is steeped in the abjection of fat people, and that this impacts negatively on our health. A Social Model of fat activism remedies this problem by addressing systemic fat hatred and helping to create more livable lives for fat people (Cooper, 1998). Fat activism re-imagines fat embodiment and agency, collectively it spans continents and has historical links over four decades. Cooper will talk about her research into this social movement, and presents case studies which both support and reject body normativity.

Queer Hapas, fat activism and weight loss surgery

I've been reading Jackie Loneberry Wang's excellent zine Memoirs of a Queer Hapa #2, which takes a look at the author's queer-biracial identity. Hapa refers to people who are "mixed-race and of Asian descent". I especially like the author's Concluding Thoughts from an essay entitled The Emergence of Queer Hapa Identity in the United States, where she applies Queer Theory in a super-accessible way. Basically she talks about identities that transgress boundaries and expose the limitations of those boundaries. She says that Queer Hapa people confound others who ally themselves "to the notion of identity as fixed, immutable, and formed around a logic of separation and differentiation" (p14). Wang goes on to say that even though Queer Hapa is an uncontainable identity, naming and inhabiting it enables people to organise strategically and politically in ways that are anti-assimilationist and complex.

Wang's zine has helped me not only think about Queer Hapa identity, but also about another group of people, who may also include Queer Hapas. I think the ways in which Wang writes about identity is helpful in thinking about what tends to be the thorny relationship between fat activism and weight loss surgery.

Apparently, as someone smart told me recently, the situation is changing and people who have had weight loss surgery are no longer drummed out of fat activist community. But my experience is that weight loss surgery continues to represent considerable anxiety in terms of how to address it in fat activism, and that bullying, shaming and shunning are still everyday tactics. Even where people have moved on from using these strategies to police the boundaries of fat activism and critique weight loss surgery, their previous use continues to hurt and has not been resolved.

I am not an advocate for weight loss surgery, I would never choose it for myself, and I discourage people from choosing it where I can. I think it is more likely to deplete than enhance health, I mourn the deaths of people who have died as a consequence of surgery, and its marketing rhetoric is invariably fatphobic, full of lies, and profoundly problematic. But neither am I an advocate for boundary policing or bullying. I am looking for helpful and human ways of thinking about this stuff that goes beyond a condescending 'love the sinner hate the sin' tolerance within the movement for people who have had surgery or are contemplating it. I would prefer a world where weight loss industries did not exist, but I do not live in that world, and am unlikely to as long as capitalism exists. Instead I am part of communities of people where some have chosen this, including a number of excellent fat activists who I love and respect.

Anyway, so Wang's work has helped me think about this and my tentative thoughts are about fat activists who have had weight loss surgery also inhabiting a space that transgresses and exposes the limitations of certain boundaries and classifications. For example, that to be a fat activist always involves resisting weight loss, or that there are sides to be chosen where you are either for or against weight loss. Fat activists who have had weight loss surgery, especially unrepentant people for whom it was a positive long-term choice, inhabit a space that shows there are other ways of being, that fat activism doesn't have to be an either/or proposition, and that it can be really diverse. I'm mindful of the postcolonial concept of hybridity, you can be a mixture of things, even things that are supposed to be incompatible, and you don't have to make a choice between one state of being or another, you can be all of them.

Going back to Wang and thinking about the possibilities for organising around fluid and complex identities, I feel excited for the potential opportunities for fat activists and weight loss surgery in challenging dogmatism and pioneering new forms of fat activist embodiment. It gives me hope that people who are currently shamefully denigrated within the movement might no longer have to skulk around in the shadows like a dirty little secret, waiting in vain for an invitation to come and sit at the table, it could be that they've already got their own thing going on and that everybody else should take note.

Jackie's response: Zines, queer hapas, fat activism

Wang, Jackie Loneberry (2009) Memoirs of a Queer Hapa #2