I think, therefore I am: Part One

The wheels of change turn slowly. It would take more than three decades from when the health dangers of fat stigma and prejudices and their internalization were first recognized, for them to be addressed again by researchers. A study by researchers at Columbia University in the upcoming issue of the American Journal of Public Health examines negative body image and concerns about weight and their effects on physiological and psychological health. Feeling fat and unhealthy is far worse for our health than actually being fat, their research suggests.

Before we look at this research and recent supportive medical studies, let’s step back in time and hear from the professor who was one of the first in recent history to put these connections together.

In the early 1970s, the original members of the Fat Underground and the New Haven Fat Liberation Front were first accessing the medical literature and realizing that what researchers and government health agencies had known about obesity and dieting for decades was considerably different than what fat people were being told. FU's founder, Dr. Sara Golda Bracha Fishman, Ph.D. (who wrote under the pen names Aldebaran and Vivian F. Mayer), wrote in a 1977 article in State and Mind for therapists:

Virtually all studies quoted as evidence that fat is unhealthy were done on fat people who are severely persecuted for their weight, and in most cases are chronic dieters. The few studies existing of fat people who do not diet and do not endure persecution find that they are very healthy.

The best known of these latter studies are of the Rosetans. This was a community of 1,700 Italian immigrants in Roseto, Pennsylvania, who were an enigma to public health officials. They were naturally extremely fat and followed none of the conventional “healthy” lifestyle or dietary recommendations. In fact, they did everything “wrong,” enjoyed food and life. Yet, they also enjoyed exceedingly good health and had a fraction of the diabetes and heart disease of surrounding towns and, in fact, of the entire nation. As Aldebaran explained to the Los Angeles Times on January 8, 1976:

These Rosetans are notably fat as a group and cheerfully consume large quantities of high-calorie, high-cholesterol Italian foods. Yet they enjoy remarkably good general health, dying from heart disease at about one-third of the national toll, and being afflicted with diabetes at only a quarter of the rate of the population at large. Teams of researchers from the University of Oklahoma investigated the Rosetans three times, in 1962, 1964 and 1967, but could find no explanation for the low incidence of supposedly obesity-related disease among their number. One researcher did suggest that “contentment" might have something to do with it.

“It seems", commented Aldebaran, “that the Rosetans liked themselves a lot and thought it was pretty neat that they were so fat. They felt no anxiety or stress about it and didn't find it undesirable. But when the fat children of these fat parents went into the mainstream of American society, and went on diets, they began to suffer from obesity-related diseases at the same rate as the rest of the population...

Statistics on the health of fat people are most often based on fat subjects found in medical settings, where it is unlikely that they will have avoided either subjection to dieting or feelings of intense anxiety about their health. Such fat patients, who have been sufficiently serious about weight loss to have consulted a doctor, are people under stress who may have gone on and off diets repeatedly, each time losing weight only to regain it again. The dangers of such a procedure have been known for more than a decade.”

The more facts they uncovered in the medical literature (documented even back then) disproving popular fears and beliefs about obesity, about the physiological and psychological harms of dieting; about the near 98% ineffectiveness of weight loss interventions in producing permanent weight loss, and that “attempts to lose weight actually cause or aggravate every disease that is typically blamed on fat!”, the angrier these early activists became towards the medical profession (“organized medicine”) and fat prejudices. Their writings might sound radical even today, but the science they'd gathered continues to be shown over and over again.

“The medical advice to ‘lose weight’ is negligent and cynical, because doctors actually know what kind of harm they inflict,” Aldebaran wrote. Research has found the same results year after year, she said, yet the medical profession continues to fail to re-examine its position towards fat people and dieting. Even Dr. Ancel Keys had documented the damage to the heart muscle and the vascular system and blood pressure from dieting, and Dr. Hilde Bruch has warned of the extreme damage done to nerves and other tissue by low-calorie diets, she wrote.

Aldebaran pulled out a copy of the 1966 U.S. Public Health Services Report “Obesity and Health,” which acknowledged the failures of weight loss interventions and of their detrimental health effects, and read an excerpt which said: “Repeatedly losing and gaining weight may be more harmful than maintenance of a steady weight at a high level... It is possible that a patient whose weight has fluctuated up and down a number of times has been subjected to more atherogenic stress than a patient with stable though excessive weight...If an animal has once been obese and then has been repeatedly reduced it will have a shorter life expectancy than an animal which has never been reduced.” She added:

This is as true for the person who weighs six hundred pounds as for the person who would like to weigh twenty pounds less than she does. However outrageous such a claim may seem, it is based on practical logic. Is it any healthier to starve off six hundred pounds than to starve off twenty pounds? Is it any easier? Are not hunger and self-hatred unsafe at any size?

“Any doctor who tells a fat person who has dieted many times before to make yet another, doomed attempt at reduction is, in effect, saying, ‘Go kill yourself,’” she told the LA Times.

“Fat is not a health hazard [and] healthy fat people are not exceptional,” she wrote in a 1974 Fat Underground publication. “The many studies ‘proving’ that fat contributes to early death have been faulted time and time again by medical specialists, such as Dr. Ancel Keys who first pointed out that a widely-quoted 1948 study of heart disease was statistically invalid: not the fatter people in the study, but the older people, were relatively more prone to heart disease. Within any age group, heart disease ranged across fat and thin alike.”

Nor are the Rosetans the only peoples where the connection between fat and illness has been disputed, Aldebaran discovered, citing studies from half a century ago that are amazingly similar to recent research. For example:

A 1952, Mayo Clinic study found that fat people who stay fat actually have a better chance of surviving a coronary than slim people or fat people who try to reduce. During the early 1950's, a series of studies in Boston, Nashville, and Minneapolis showed the same range and distribution of fat and thin people among coronary patients as among people not suffering from coronary heart disease. Similar findings were reported by Helen and C. Wesley Dupertuis of Western Reserve University in Outlook, summer 1967. In follow-up studies these researchers found that at least 25% of the long-time survivors had reached their greatest weight since the original attack....

We are all, as a culture, caught in the Fat Illusion, she would later write. “We believe that our bodies' sizes are chosen and reflect personal control, and we ignore or reject all evidence that contradicts this belief.” It was the rationalizing of the oppression of fat people by putting them on diets and then blaming the resultant failures and health problems on them, that she criticized health professionals and therapists in some of her most zealous writing:

[P]sychology plays the same role pretty consistently — rationalizing the oppression of just about every group of oppressed people: women (“normally" passive and masochistic), gays (“confused sex-role models in childhood"), poor people (“unmotivated"), blacks (“low IQ"), etc., etc., and mystifying it all so that every unhappy woman, gay person, poor person, black person, fat person, etc., thinks she is hung up in the grips of a shameful personal problem.

The 99% failure of reducing diets is fat people's collective experience, and therapy tells us to ignore it. You can lose weight if you try hard enough. If you failed you were not motivated enough.

Having isolated us from our collective experience, therapy then invalidates us as individuals, with its claim that our fat is the result of “unnatural, bad" eating habits. As a result, you probably think we are not a “real" oppressed minority. I suspect you think we cause our problems by eating “like pigs" (i.e., subhumanly), and therefore refuse to take us seriously as long as you think that liberation for us would mean license to indulge in “degraded" habits, or that we need, not liberation, but “cure."...

I want to remind you... that, with all the dieting we do, fat people are often more half-starved than “overfed." Brainwashing us into believing we're gluttons is one way psychiatry and social pressure make fat people crazy. The average fat person does not eat any more [or differently] than the average slim person. Many fat people eat less than most slim people. We in no way choose to be fat (unless you call a reluctance — or physical inability — to endure semi-starvation on lifelong reduced-calorie regimens a “choice" to be fat). Most fat people I have known hate being fat. The notion that we only think we hate being fat, but subconsciously choose it, is pure therapy-bullshit. As long as I believed what psychologists told me, all l could conclude was that I was a very, very sick person who couldn't even trust her own desires. With such lies, therapy keeps fat people from developing the pride to challenge the authority of our oppressors.

“On a purely practical level,” according to Aldebaran, “the worst problem that a fat person can have with doctors is that any physician can say, ‘This fat person is not healthy...’” Whether fat is inherently unhealthy or not is beside the point, she wrote, since there is no effective way to change or prevent genetic diversity, and the prescribed medical interventions actually increase health risks. The bodily damage that fat people suffer doesn’t come only from weight loss interventions, she emphasized, but from the “persecution heaped on [them] for being fat.” This isn’t hippie-era mumbo-jumbo about mind over matter, but very real physiological effects of oppression and stigma. The biological effects of stress and discrimination are not unlike those documented among other groups, she wrote:

High blood pressure is the natural result of the sort of stress that fat people live under: daily ridicule, self-consciousness, shame, discrimination (in jobs, schooling, clothing and many other areas of life), rejection from social groups, and hunger; the struggle to stay hungry (surrounded by plentiful food and by slim people who eat it) and the continual sense of frustration and unworthiness because every attempt one has made to lose weight failed. The cycle of starving, then bingeing when the hunger becomes unbearable.... This “compulsive eating" is not “neurotic." It is an absolutely natural reaction to intense, prolonged hunger.... Not all fat people are sedentary, but those who are probably suffer a lot more than sedentary slim people, because the lack of exercise isn't a choice; it is imposed on us by those slim chauvinists who gather to gawk every time we go out to play, or swim, or dance or just plain walk. There is only so much one can hear of “Hey, lookit that blubber ass!" before a person who's already been beaten down with a message of inferiority gets intimidated, gives up and stays indoors.

Dr. Rock Positano has also written provocatively on the medical “mystery of the Rosetan people,” not describing their contentment in terms of body acceptance, as such, but as enjoying a gusto of living and enjoying supportive family and community relationships. Governmental health officials descended upon this town in the early 1960s to learn why their mortality rates had always been a fraction that of every surrounding community, even though they drank the same water; lived in similar neighborhoods; had the same income and occupational mixes; same races; had been eating similar diets, rich in starches and fats, as immigrant peoples in surrounding towns, etc. Experts had expected to find that the Rosetans were following popularly-prescribed ‘healthy’ lifestyle, exercise and dietary practices. Not so. As he writes:

In all ways, this happy result was exactly the opposite expectation of well-proven health laws. The Rosetans broke the following long-life rules, and did so with a noticeable relish: and they lived to tell the tale. They smoked old-style Italian stogie cigars, malodorous and remarkably pungent.. not filtered or adulterated in any way. Both sexes drank wine with seeming abandon, a beverage which the 1963 era dietician would find almost prehistoric in health value.... Rosetan men worked in such toxic environs as the nearby slate quarries [like the men in surrounding towns]...and gruesome illnesses caused by inhaling gases, dusts and other niceties. And forget the Mediterranean diets of olive oil, light salads and fat-free foods. No, Rosetans fried their sausages and meatballs in lard. They ate salami, hard and soft cheeses all brimming with cholesterol...breads, pastas, desserts and carbs...

Over decades of study, researchers found that most of the population exhibited the traditional cardiac risk factors, diabetes, cholesterol, smoking, hypertension and obesity without ever succumbing to heart attacks, even over three decades of follow-up. Researchers thought, at first, that the Rosetans might carry some special, protective genes, but that proved not to be the case. Rosetans who moved away, even to the nearby village of Bangor, lost whatever magic the town possessed against disease.

While the Rosetans actually suffered from anti-ethnic discrimination from immigrants in nearly mining facilities, said Dr. Positano, they had a strong, supportive family and social life. “No one was alone in Roseto. No one seemed too unhappy or too stressed out,” he wrote. “The magic of Roseto was the total avoidance of isolated individuals crushed by problems of everyday life. Rosetans didn't feel isolated or crushed, rather they avoided the internalization of stress.”

But something changed over recent years as they became more modernized [and medicalized?] and their supportive social environment appeared to dissipate. They became less healthy. By 1992 surveys, they had similar rates of heart disease as other towns, he said.

Extensive medical papers have been written about the Rosetans over the decades, studying various theories to dead ends, and examinations of health records from 1935 and 1925 have most often concluded that the supportive, accepting, cohesive, positive environment of families and community, devoid of ostentation and judgment, were the primary differences between the decades of good health and more recent rates. The fact remains, that obesity and “unhealthy” foods were not what determined poor health.

The early fat activists felt that the most important, helpful and healthful thing fat people needed was a supportive, accepting community, as was shown by the Rosetans. They supported “fat liberation” as being just as needed as other liberation movements of the time. They quickly realized, however, what a long and difficult a process it was for a fat woman to come to terms emotionally with the idea that her own obesity is probably genetic in origin and is permanent, that she doesn’t “overeat” or eat differently than a thinner person, and that she doesn’t need to become obsessed with health because she is fat, Aldebaran said. “Most fat women’s feelings about fat are so dreadful, that they have really ‘numbed out’ in that area — they can accept incredible insults without reacting,” she told the LA Times. “But when they start to get in touch with the numbed feelings it is excruciatingly painful — so we have needed to have constant support groups to help us stop feeling wretched about ourselves, to stop feeling worthless and ugly” and diseased.

That was then. In Part Two, we’ll look at the latest research on the health effects of fat prejudices and how we feel about our weight.

© 2008 Sandy Szwarc. All rights reserved.

[Photo and text courtesy of Largesse archives and with Sara’s permission.]