Beriberi

I have a love-hate relationship with television; as a radical fat feminist, the mainstream values paraded across the screen make steam come out of my ears, but often a state of horrified fascination prevents me from tearing my eyes away. This happened most recently with NBC's "The Biggest Loser," the latest in the series of mainstream mind candy like "Extreme Makeover," "I Want a Famous Face," and "The Swan." Unlike the latter shows, where participants go under the knife, the transformations on "The Biggest Loser"-a show where fat people compete to lose the most weight, while being coached by "celebrity trainers" and tempted by "disallowed" foods (Paulsen)-are left to willpower and self-denial.

"The Biggest Loser" is completely dependent on the assumptions and misinformation about weight and dieting that saturate mainstream media, reinforced by the increasing hysteria about the "obesity epidemic." The argument goes something like this: Fat people are fat because they eat too much and lay around all day, and fat is ugly, plus unhealthy! If fat people just worked out and didn't eat so much, they could become thin and beautiful like the rest of us, and all their problems would be solved. A People Magazine article speculating on the motivation behind the makeover-show trend stated, "As obesity becomes an epidemic and fully two-thirds of all Americans are overweight, authentically slim, good-looking people are becoming rarer and rarer. In other words, we are in the throes of a beauty shortage. And we have applied our typically optimistic, boot-strap attitude to the situation: If we can't grow pretty people, we'll make them. What used to be solely a function of luck can now actually be an accomplishment, something earned through hard work and persistence" (Williams, p. 50).

Enter "The Biggest Loser." Despite the supposed ugliness of fat people, the participants on this show seem to have been chosen for their good looks, and their curves in the form-fitting tank tops and shorts they wear throughout the program are very appealing. As I watch the show, I realize how unusual it is to see really fat bodies on television. However, neither participant nor viewer can be allowed to appreciate their appearance as it is. The contestants are filmed deriding themselves and their bodies for being weak, ugly, and unhealthy. As part of the first episode, the two teams are made to compete at pulling cars around a track; a camera inside the car focuses on their t-shirts tightening across their bellies and thighs as they squeeze through the car window to take their required turn at the wheel. Rather than a demonstrating the strength of fat people-able to pull a car!-the contest fosters fat hatred by displaying the bodies this culture disparages in vulnerable, uncomfortable positions.

The two teams are supposedly on "opposing" diet plans-the "Eat More Diet" and the "Eat Less Diet." However, reading over the sample menus makes it clear that these diets are hardly different. They are both low-carbohydrate diets, the current fad; they both rely on the same processed "diet" foods like fat-free cold cuts and gelatin packs sweetened with potentially toxic chemical sweeteners. Ultimately, the "Eat More Diet" probably provides only a few hundred calories more per day than the "Eat Less Diet." In short, neither is a program that will teach people how to nourish themselves with real food. One participant is reduced to tears, the diet plan has so confused her about food intake; she believes that eating less than 600 calories a day "can't be enough," but the program has clearly made her doubt herself. Participants berate each other for their food choices and conspire against those who are seen to be eating "too much"; a very thin physical trainer shouts in their faces as they undergo excessive, exhausting, apparently painful workouts. Yet in this environment of intense physical activity and limited food intake, a 400-pound man is criticized for eating six pieces of bacon when given the opportunity. Underlying all the interactions between the participants is the assumption that body weight is completely subject to manipulation of food intake and exercise; I want to cry as I experience viscerally the expectation that these fat people can control their own body size. As the show ends, the contestants line up to be weighed; their hope that they will be judged worthy is practically visible as we learn that on this extreme, punishing, selfdenying, ultimately unsustainable regimen, some participants have lost over 20 pounds in one week-all in the quest for "health," of course.

But let's apply some simple common sense to the conventional attitude toward weight that "The Biggest Loser" promotes. Given the vast array of weight-loss diets that have made the rounds since the 1950s, you'd think fat would be a thing of the past, wouldn't you? Surprise, surprise-diets don't work. And in a stroke of capitalist genius, the diet industry has not only made billions of dollars selling us products that don't work, they've convinced us that it's our fault! If we only had more willpower, we'd be thin-we have no one to blame but ourselves. But just in case we were thinking of resisting wasting money on diets, with stultifying regularity the media obediently produce some new scare tactic about the "health risks of obesity" to maintain the public frenzy over weight and dieting. So, once more, with feeling, a summary of the current state of medical knowledge about fat:

* There's no clear explanation for why fat people are fat. The New England Journal of Medicine calls fat people "ordinary people who happen to be heavier than average, probably from some mixture of nature, nurture, and choice." (Kassirer & Angell, p. 53)

* There's no known method for fat people to permanently lose weight. The few studies that follow dieters long-term demonstrate failure rates between 85% and 95% for all diets studied; often participants gain back more weight than was lost. (Council on Size and Weight Discrimination)

* There's no evidence that fat people are unhealthy. There are no diseases that only fat people get, and there are many diseases that fat people get at lower rates than thin people. Furthermore, people with diabetes, hypertension, and other so-called "obesity-related" diseases often have better blood sugar and blood pressure readings with lifestyle changes that cause little to no weight loss, suggesting that fat itself is not the cause of these problems (Wann, p. 39). In fact, the world's largest study to date found the highest life expectancy in the group of people 60-75 pounds overweight by current U.S. government standards (Campos, p. 10).

* Weight loss itself may have unknown health risks. Since no studies have taken into consideration the fact that most fat people have a life history of dieting, they've failed to control for the possible negative effects of alternating starving and hinging, and losing and regaining weight multiple times (Mayer p. 29).

* Weight loss methods such as diet pills and surgery have documented negative side effects and risks, including the risk of death. Surgical procedures for weight loss, such as intestinal bypass (now mostly phased out due to severe complications), gastric bypass and gastroplasty (stomach stapling) can have serious complications, including a death rate of up to 10% (Washington Post 10/13/2004); follow-up surgeries are often required to correct hernias or to drain intra-abdominal abscesses. In a recent study, 39% of patients undergoing weight loss surgery were readmitted due to complications from their procedures. After surgery, patients are dependent on protein, vitamin, and mineral supplements for life, and may suffer from diseases like beriberi, which are normally found only in the severely undernourished (Szwarc).

This information is not new. Feminists have been critiquing the diet industry, the medical system, and mainstream ideas about body size and weight loss for decades. In an article written in the 1970s, Vivian Mayer exposed the biases and conflicts of interest inherent in research on body size, and suggested the need for a paradigm shift.

Fortunately, some researchers and health practitioners have begun to heed the call. Dietitian Karin Kratina developed four principles that have been adopted as the Health At Every Size (HAES) movement (CSWD). HAES advocates leaving behind the focus on weight; instead, we're encouraged to abandon attempts at weight loss and accept that healthy bodies come in different sizes. HAES encourages us to eat simple, unprocessed foods as much as we can rather than processed diet foods, to eat when we're hungry and stop when we're full, and to engage in physical movement that we enjoy for its own sake, rather than forcing ourselves into strenuous, regimented workouts with weight loss as a goal. And, unlike diet plans, pills, shakes, and weight loss surgery, these suggestions do not stigmatize or penalize fat people; they constitute a lifestyle that encourages all of us to be as healthy as we can be. The HAES movement has great potential to break the assumed connection between thinness and good health; it's simple, gentle and encourages all people to make healthy food and exercise choices while loving ourselves and our bodies, rather than punishing ourselves with diets and workouts under the mistaken assumption that we can control our body size.

References:

Campos, Paul The Obesity Myth: Why America's Obsession with Weight Is Hazardous to Your Health (Gotham Penguin, 2004)

Council on Size andWeight Discrimination, "For most people, body weight is not a matter of choice: The scientific evidence" 2000 (workshop handout)

Green, Michelle et al. "Beautiful Dreamers" in People, June 7, 2004, 58-63.

Kassirer, Jerome, and Marcia Angell. "Losing Weight: An 111-Fated New Year's Resolution." New England Journal of Medicine, January 1, 1998.

Kratina, Karin. "Tenets of the Nondict Approach" in King, Nancy, Karin Kratina, and Dale Hayes, Moving Away from Diets: Healing Eating Problems and Exercise Resistance. Helm Seminars, 1996.

Mayer, Vivian F. [2] "The Questions People Ask" in Schoenfelder, Lisa, and Barb Weiser, eds. Shadow On a Tightrope: Writings by Women on Fat Oppression. Aunt Lute Press, 1983, pp. 23-36.

National Association to Advance Fat Acceptance (NAAFA) Policy on Weight Loss Surgery at http://www.naafa.org/documents/ policies/wls.html

Paulsen, Wade. "NBC's 'The Biggest Loser' weight-loss reality show to premiere October 19" 9/28/2004 http:// www.realitytv world. com/index/aiticles/story.php?s=2940

Szwarc, Sandy. "Hey, Feds, Weight a Minute..." 10/26/2004 http:// www.techcentralstation.com/102604D.html

Wann, Marilyn. Fat!So? Because You Don't Have to Apologize For Your Size, Ten Speed Press, 1998.

Williams, Mary Llizabeth "Makeover Madness" in TV Guide, May 16-22, 2004, p 48-52.

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