July 10, 2021 | 11 minutes read | Tags: Oppression and Liberation, Long reads

On Health, Anti-Fatness and Capitalism

Everyone has a right to genuine and non-coerced health, and to be free to pursue or not pursue health to whatever extent they see fit, without damaging material consequences. One day, we will be - and we must work towards this future with everything we have.

On Health, Anti-Fatness and Capitalism

The Queen's Speech in May 2021 included a plan for hospitality businesses with more than 250 employees to label their food with calorie counts. This idea, ostensibly part of the government's plan to tackle the moral panic known as the obesity epidemic, is not new. Indeed, it's an idea that has been floating around for more than a decade.

This exists in addition to plans to restart the National Child Measurement Programme post-lockdown. The programme, which began in 2006, involves weighing children at reception age and in Year 6, although the National Obesity Forum is, predictably, suggesting more frequent weigh-ins. If stomach surgery for fat children was worth encouraging back in 2013, why not endless weigh-ins for them now?

But what is really going on here? These plans will do more harm than good, and are little more than a distraction from the true harm caused by the government’s handling of the pandemic.

A Note on “Obesity” and the “Obesity Epidemic”

Medical and social science have found that the terms “obese” and “obesity” further anti-fat discrimination, and imply that fatness is an indicator of health status and morality. “Obesity” is a medical definition based on the racist and outdated Body Mass Index (BMI) and fat activists have requested that we use neutral descriptors (fat) instead.

The “obesity epidemic” is a moral panic. The correlation between “weight” and “health” is weak (apart from at the extremes). The extent to which those correlations are causal is poorly established. There is no evidence that turning fat people into thin people improves their “health”, and the attempts themselves are harmful. At its core, the obesity epidemic is an expression of the idea that, under capitalism, we cannot choose what to do with our bodies. The rhetoric surrounding the obesity epidemic is a classic moral panic: fat people are seen to be damaging society and they must be removed, by making them thin people or by excluding them from public life and denying them the resources necessary to survive. As we explore below, fat people are routinely denied healthcare or offered healthcare too late, and are often excluded from taking part in social activities because physical spaces are not created to accommodate all bodies.

A Note on “Health”

The bourgeois definitions of “health” and “ill-health” centre around people’s ability to work – in other words, how able they are to serve capital. We can see this in the medical examinations that form part of the “Work Capability Assessment”. The idea that health is little more than the ability to work is to be rejected.

Much of what is defined as 'ill health' is the result of how society is materially arranged — for example, living near industrial areas results in worse air and water quality. Working class people and those living in areas of greater deprivation face higher rates of illness and disability and have lower life expectancy.

Rejecting the bourgeois definition of health means rejecting the idea that people’s ability to work correlates to their health. To equate “health” with ability to work is fundamentally ableist.

Boris Johnson and His History with Fatphobia

This is not the first time anti-fat bias has been wielded to distract from the government’s deadly negligence. Back in 2020, as the pandemic was in full swing, it came in the form of the launch of the ‘Let’s Do This’ campaign, along with media coverage of Boris Johnson’s diet.

Fatphobia makes for a particularly useful distraction from the disastrous handling of the pandemic. Invoking it inevitably triggers powerful emotions. It brings forth entitlement in heterosexual white men, who have been given ownership over the bodies of exploited and oppressed people (particularly women) under patriarchal racial capitalism. This can bring out resentment in oppressed men who feel that the issue is their lack of access to this ownership, along with privileged men who perceive the slightest threat to it. It causes a complicated mix of shame, pride, and comparison for all oppressed and exploited people. White women are promised protection and domination over more oppressed groups if they conform to the white, cishet, able-bodied, bourgeois norm; all other women and people of oppressed genders are offered the illusion of easing their own oppression and exploitation the closer they get to it. The government cleverly wields the biases many of us hold in a capitalist society when they invoke fatphobia: disgust, disableism, and disdain for fat people, are things not even fat people are immune to. Instead of this individualised competition, we need to dismantle the entire system, being aware of our own positionality and power (or lack of) within it.

While fat white men do experience anti-fat oppression and related disableism, white men's bodies are not subject to the same policing or ownership. This is reflected in the fact that pints — heavily associated with white, working-class men — were initially included in the list of products that must be labelled, but were later removed.

The Racist History of Anti-Fatness

Fatphobia has always been linked to anti-Blackness and misogyn/y/oir. Fatness was one of the characteristics proto-eugenicists linked to ‘less evolved’ societies, in their attempt to justify white supremacy, colonialism, and slavery. They lauded European societies as the most advanced and evolved, and depicted Black and colonised peoples as inferior. That fatness was deemed to be one of these characteristics gives us some idea of how and why distaste towards fatness began to develop among the white bourgeoisie.

In the most detailed history of the racist origins of fatphobia so far, Sabrina Strings traces the history of anti-Blackness and fatphobia by following the shift from using Black models as an aesthetic counterpart to white women in European art, to using Black people as a counterpoint: an opposite that defined what beauty was not. The idea of what constituted beauty transformed as the slave trade meant Black people’s bodies came to represent a kind of non-humanity that was objectified, commodified, and designated as property. Proto-eugenicists developing the idea of ‘race’ (including Louis Bernier) began to focus on the difference between white and Black women’s bodies to distinguish between European and African people as a whole. Buffon defined Black people by their skin colour & their size, and linked fatness to laziness and a lack of intelligence. Fatness and overeating was condemned in general by intellectuals of the time, who encouraged periods of fasting to supposedly increase mental perspicuity. Disturbingly, there has been a huge resurgence in this lately: bourgeois intellectuals and entrepreneurs promote “intermittent fasting” as a way to improve yourself and ‘become like them’.

Strings writes about how the white bourgeoisie in the US sought ways to ‘prove’ their ‘racial superiority’. Slenderness, already linked to rationality, self-control, and self-restraint, was such proofs they offered. These associations were in part due to the ascetic movement in England, in which figures such as George Cheyne - building on the pro-temperance works of Thomas Muffet - promoted reduced eating to improve the intellect and avoid overindulgence, once again linking fatness with moral failings and slenderness with decency. The white bourgeoisie also began to distinguish between ‘gradations’ in whiteness - the European populations who might be aligned with people of colour and thus deemed inferior — and, of course, one of the characteristics that purportedly showed this, was fatness.

Strings also notes the moral dimension of anti-fatness, with fatness linked to gluttony and laziness. All of this added fuel to the eugenicist fires in their denigration of colonised countries, and supported eugenicist Protestants in the US in their justification of white supremacy and US exceptionalism. The Christian movement was initially more concerned with stigmatising illness and disability than fatness, focusing on ‘underweight [sic]’ and general ill health as indicative of sin. However, its fixation on disciplining white women and avoiding excess in food or sexuality (in order to ‘preserve the race’) would eventually align with the new medical aversion to fatness (partly linked with the desire of the US white bourgeoisie to separate themselves from Irish, Jewish, and Italian immigrants and the lower classes) to create the idea of white thinness as moral. This in itself would join with beliefs that Black and other colonised peoples had excessive appetites and inferior bodies, to create the modern form of anti-Black fatphobia.

Medical Fatphobia

The treatment by the medical profession of fatness as a disease is a cover for advancing anti-fat rhetoric and fat-bias.

Doctors systematically fail to take fat people seriously, only prescribing weight loss as treatment. Doctors routinely misdiagnose cancer and other serious illnesses as “being fat”, and this late diagnosis leads to a worse prognosis. Studies have also shown that doctors spend less time with fat patients. This inevitably alienates fat patients and makes them less likely to seek healthcare.

Taking this in combination with the well-documented medical racism that exists to prevent Black people, especially Black women, from receiving timely and appropriate healthcare, results in this effect disproportionately impacting fat Black people. Medicine under capitalism, as it exists to keep the workforce in work, is also known for its ableist attitudes. We also acknowledge the work of Kivan Bay, on the intersection of anti-fat and anti-trans bias. It's clear that people who face multiple oppressions will experience medical fatphobia in a more damaging way.

The medical “treatments” for fatness are deadly. Bariatric surgery is a very dangerous surgery (weight is used as a basis for gatekeeping most other surgeries, yet surgeons are happy to perform weight loss surgery because they see any risks of surgery as far less than remaining fat). Weight loss drugs such as fenfluramine/phentermine (commonly known as fen-phen) caused fatal pulmonary hypertension and heart valve problems. These risks were known, but discounted, as weight loss was seen as more important.

Medical machines are not built for fat people. MRI machines in particular are known for not accommodating fat bodies. Drug doses are not adapted for fat people, such as the morning-after pill: not all brands are effective in fat people.

We would argue that it is medical fatphobia that results in fatness being correlated with cancer and other diseases. Indeed, as a study into weight and the H1N1 virus, when adjusted for early treatment, there was no relationship between fatness and poor outcomes. It is not that fat people are inherently more “unhealthy”, but that they are systemically given worse healthcare.

Medical fatphobia also influences the way research into fatness is conducted. Katherine Flegal, a senior scientist at the Centres for Disease Control and Prevention in America, recently wrote an article detailing the personal and professional attacks she faced after publishing research that was critical of the established narrative around fatness. She says: "The controversy was something deliberately manufactured, and the attacks primarily consisted of repeated assertions of preconceived opinions." In other words, unless you do science that says that being fat is bad, you aren't allowed to do science.

Fatphobia is useful to the state, especially during a pandemic in which they engaged in eugenics. It shifts the burden from the state and its systems, which refuse entirely to protect the masses while enshrining the right to make profit from suffering, onto the individual. The familiar idea that fat people are a strain on the NHS raises its head once more, ignoring not only the science regarding weight and the failure of diets, but also obscuring the actual causes of strain. It is important to note that as communists we do not condone the colonialist, imperialist funding of the NHS — nationalised healthcare in capitalist and particularly imperialist countries is always funded by abhorrent means and serves the aims of maintaining a healthy workforce and/or army. However, we acknowledge that the cause of strain on the NHS is not its patients, but the way it has been sold for profit since the days of Blair. The claim that any group is a ‘burden’ is eugenics - claiming people do not deserve healthcare because the cost outweighs their lives in value.

Who will be harmed?

Calorie counts are hardly going to help the rising numbers of those with eating disorders, and many campaigners have written on this issue. Weighing fat children will not help children's health - it will only lead to stigma. It ignores that food insecurity will inevitably lead to shifting weights, disregards the impact on fat children and children vulnerable to eating disorders, and thinks only of more ways to distract the country from the biggest threat to our health: capitalism.

Studies have shown that fat people are at risk of eating disorders, and that their symptoms go underdiagnosed (indeed, to the point of medical professionals encouraging disordered eating that results in weight loss). In an anti-fat society where inhabiting a fat body is considered a moral failing, it is understandable that people would try any means to lose weight. This is reinforced by diagnostic criteria including “low” body weight and by fat people being targeted for weight loss “interventions” while thin people are targeted for eating disorder interventions and preventions.

A fatphobic society sets up profound barriers to recovery from eating disorders: to remain genuinely unworried about body fat is extraordinarily difficult. All those with disordered eating patterns are harmed by anti-fat society, because it makes fatness into something worth fearing. If society punishes fat people, it is only reasonable to fear fatness. If those who are “treating” eating disorders fear the same things as those they claim to be helping, any treatment will harm more than it helps.

Who will it help?

Some might claim the issue is that calorie counts don't work against 'obesity'. But we say that 'obesity' is not a problem, nor even a health issue — it is simply a heavily stigmatised term that medicalises the existence of fat people. People may be fat because of conditions that cause weight gain (heart disease, type 2 diabetes), because of medication, because that is simply their genetic predisposition, and, yes, even because of diet or exercise. None of these constitutes a health problem (even the latter is not automatically a problem or something that requires government policy to address — it's just a choice).

While cheaper, healthy food are needed, we must take into account several other factors. People experiencing food insecurity need the most calories for the lowest price. Healthy food is often used synonymously with low calorie food — sometimes because those foods contain high amounts of micronutrients and vitamins (for example, fruit and vegetables), and other times because that's the way health is conceptualised in a fatphobic culture. Nutrients become entirely irrelevant if one is not eating enough. It's also important to note that by making this an attempt to solve 'obesity', the government has not framed this as an issue around people's diets or health, but around their bodies. Focusing on the issue of diet might bring up food insecurity and pricing, and could lead to analysis of the issue as a systemic one, rather than an individual failure to 'get thin'. Even then, it must be acknowledged that diet is one of many factors influencing health, including environment (pollution, more common for poorer people, disproportionately people of colour), access to suitable shelter and hygiene, and stress (with racism and/or misogynoir being a key stress factor).

Secondly, the construct of 'health' itself is one we should be wary of accepting as a definite good. Health within a capitalist and imperialist society is often defined as that which creates a productive workforce and strong military. (Any threats to health that support capitalism - pollution, overwork, stress caused by oppression leading to heart disease and other health problems — will assuredly be ignored). Both within this framework and within the moralisation of health, the first people to lose out are disabled people, viewed as either lacking sufficient’ virtue’ to be healthy or failing to 'contribute' to capitalist society.

Obesity is a health 'problem' created by the diet industry, which can then offer itself as the solution, to great profit. We must reject this construct wherever we see it and offer our unconditional support towards fat liberation. We need to stand against the oppression and exploitation of all bodies, and against a health system that pushes diets and dangerous surgeries while ignoring fat people's actual health problems and concerns. We need to stand for genuine provision that strengthens people's health and takes steps towards dismantling fatphobia, including accessibility to all spaces, and examining our own prejudices against fat people (even when those fat people are ourselves). True liberation, however, cannot happen under racial capitalism, and therefore we must work towards its end. We must move towards a society where there is an end to weight-based stigma and discrimination, while people have access to time off, suitable spaces for movement and play, and cheap, nutritious and appropriate food.

Only under socialism can we remove the causes of much ill health: our material conditions, including all forms of oppression and conditions at work. Stress, alienation, and other in-work conditions can be fully met once the needs of workers are centred, rather than the needs of capital. Bourgeois understandings of health also rest on ableism. Under socialism we can address the fundamentally disabling structures of capitalism, both in terms of physical structures and a society structured around competition, individualism, and violent oppression. Even the doctor-'patient' relationship could look different under socialism, with an approach more like that of Paulo Freire's pedagogy, with the opinions of the person receiving the treatment being taken into account rather than a fixation on the doctor's superior status as the holder of knowledge.

Everyone has a right to genuine and non-coerced health, and to be free to pursue or not pursue health to whatever extent they see fit, without damaging material consequences. One day, we will be - and we must work towards this future with everything we have.