Public health vs. personal freedom

How can we discourage obesity without contributing to negative social stigmas of fat people?

Maryann Bodolay heads the National Association for the Advancement of Fat Americans.

Maryann Bodolay heads the National Association for the Advancement of Fat Americans.

Photo by Larry Dalton

Maryann Bodolay is a mother, a professional and an activist. The Sacramento resident is an intelligent and passionate advocate for equal rights and acceptance of all persons, one who speaks frankly and with a candor that immediately makes people feel at ease.

Tipping the scales at well over 300 pounds, and having some health problems related to her size, Bodolay also embodies the central paradox of an expanding effort by public health officials to combat obesity: how does society discourage obesity without denigrating fat people?

As executive administrator of the Sacramento-based National Association for the Advancement of Fat Americans (NAAFA)—which was founded in 1969 and now has 50 chapters across the country—Bodolay has worked for years to combat social stigmas of obesity.

Even the use of the pejorative-sounding term “fat” was intentionally chosen by NAAFA to neutralize its negative connotations, and to diminish the shame that some obese persons have learned to associate with their bodies. The organization dedicated itself to shedding light on the issues of discrimination and mistreatment of fat people.

The idea was to convey the message: It’s OK to be overweight. And through most of its history, that mission seemed to make sense, especially during a period in which popular concerns about body image focused on the dangers of anorexia and bulimia, in which people were literally dying to be skinny.

But in recent years, the paradigm has shifted, as the public health community sounds the alarm that our fast-food culture is creating a new kind of health crisis. Beginning last year with a groundbreaking report on obesity by the U.S. Surgeon General, and continuing through currently proposed legislation to tax soda pop to fund anti-obesity campaigns, the idea that “it’s OK to be overweight” is being challenged.

It’s a trend that has made Bodolay’s job tougher than ever, and raised difficult questions about just what it means to be fat in America.

The Surgeon General’s report on obesity and overweight detailed specific risks associated with obesity, citing that “approximately 300,000 deaths a year in this country are currently associated with overweight and obesity.” Some of the health risks include an increased risk for coronary heart disease, diabetes, strokes, asthma, several types of cancer and certain musculoskeletal disorders such as osteoarthritis.

“Individuals who are obese,” the report states, “have a 50 to 100 percent increased risk of premature death from all causes compared to individuals with a BMI (body mass index) in a normal range.”

The report follows a tradition of shedding light on public health concerns and bringing attention to issues affecting the quality of life of Americans, particularly issues with great financial and human costs to the country. Past reports have publicized the perils of smoking, drug use and irresponsible sexual practices. The fact that obesity has been placed in the same category by such a powerful agency indicates the acute dangers of being overweight.

And like past reports, this one has triggered follow-up measures to address the problem. The latest comes from Senator Deborah Ortiz of Sacramento. Dubbed the “soda-pop bill,” Senate Bill 1520 aims to curb obesity and promote fitness among school-age children by implementing a surtax on soft-drink syrups and other soda-related drink products.

The revenues collected from this surtax would be deposited in the California Child Health Achievement Fund, which the bill proposes to create, for the implementation of programs designed to treat and prevent obesity. School districts that cease selling soda would receive some of that funding.

The approach is similar to the state’s practice of taxing tobacco products and using the money to fund anti-smoking campaigns. In both cases, opponents claim that it’s a matter of personal freedom, and that government shouldn’t be dictating to people what to put in their bodies, while proponents claim that promoting a healthy populace is a legitimate function of government.

Yet Bodolay also brings a new dimension to the debate. Not only does she believe that campaigns against obesity hurt the self-esteem of fat people and legitimize discrimination against them, but she also believes the message is flat-out wrong. Being obese, she said, is not the same as being unhealthy.

Bodolay said society’s idea of what is in fact healthy often leads to a skewed sense of truth. She explains how in our culture, a healthy body is determined almost completely by appearance alone, with little regard to actual physical fitness.

“I know several fat people who exercise daily, eat a healthy diet and are very fit,” she said. “I also know average-sized people who smoke, drink huge amounts of coffee, do not exercise and are terribly unhealthy. Yet if you were to show a picture of each to the average American and ask them who is healthier I will guarantee that they will pick the average-size person.”

She says lifestyle, not a number on the scale, is the problem. While the proposed campaigns against obesity do focus more on behaviors than on appearance, public health officials say that obesity itself can be unhealthy, and it certainly can indicate whether someone is leading a healthy lifestyle.

Claudia Bays, a retired nursing professor at CSU Sacramento specializing in obesity, advocates what she calls the “eyeball test,” arguing that people who look fat are probably at risk for many of the health problems associated with obesity.

“If one looks fat,” she said, “maybe he or she is. A measure is fitness, strength and endurance.”

Yet Bodolay said such simplistic views of obesity lead to discrimination against overweight people, a problem that hinders not just social acceptance, but also proper medical care, she insists.

“Doctors have preconceived ideas concerning fat people,” she said. “Anything that’s wrong is attributed to being fat. Fat healthy people—and there are many of us—don’t get preventative checkups until something is really wrong.”

Bodolay feels that when a fat person finally goes to see a doctor it is because they are experiencing adverse health symptoms and, unfortunately, it may be too late to prevent serious consequences. She speaks of a close friend of hers that recently died from cancer because she was “underdiagnosed and mistreated.” She pauses thoughtfully and continues, “It makes me so mad, it was such a waste and so unnecessary.”

When asked if she considers herself healthy at her large size, Bodolay says, “Obviously I am not as healthy or fit as someone half my size, but my focus is on being the healthiest me I can be.”

As if to undercut her point, Bodolay began to wheeze at one point during the interview, and seemed to have a hard time bringing the spell under control. She was recently diagnosed with asthma, she explained, and sometimes has trouble breathing.

“What I am sick of is being treated like I am lazy and stupid,” she continued. “It’s not like I lay around on the couch all day eating potato chips and watching TV.”

Combating obesity through public information campaigns can be difficult, and if not done carefully, can contribute to the problems outlined by Bodolay. Even the Surgeon General’s report warned “obese individuals also may suffer from social stigmatization, discrimination, and poor body image.”

Paul Ernsberger, a nutrition expert with the Case Western Reserve School of Medicine in Cleveland, said “extra body fat itself does not cause diseases. It is true that eating the wrong diet and not getting enough exercise is unhealthy, and people who do these unhealthy things often weigh more.” He concludes by stating, “It may make more sense to have a healthier lifestyle at a high weight than to try and lose weight through unhealthy means.”

Bays agrees with Ernsberger on this point, yet she is quite a bit more adamant in her assertion that being obese is unhealthy, rattling off the same long laundry list of obesity-related health problems cited in the Surgeon General’s report.

Bodolay and Bays do agree, however, that it is imperative that we foster positive environments for our kids so they grow up fit and healthy. Bodolay feels that early education of children should focus on self-esteem and non-discriminatory attitudes and promote overall health and fitness, while Bays said adults should model behaviors that will empower children to make healthy choices through their lives and encourage the maintenance of a healthy weight and a fit body.

Both women feel that the yo-yo dieting trends discussed by Ernsberger are harmful and extremely unhealthy, they just disagree on what it means to be healthy. Is there a middle ground between stigmatizing obese persons and enforcing the concept of just how unhealthy being overweight is?

Clearly this is an emotionally charged issue and there is a great deal of debate among Americans surrounding the issues of obesity, discrimination, the role of government and the concept of what being healthy truly entails. Advocates at every corner of the issue are passionate in their beliefs and weight-related issues continue to permeate our sense of social and individual consciousness.

Yet for Bodolay, acceptance is the most important issue: “It’s sad how fat people are treated. We’re not freaks, we’re just fat. Deal with it.”