April 09, 2015
(++++) OUR BODIES, THEMSELVES
Body of Truth: How Science, History and Culture Drive Our Obsession with Weight—and What We Can Do about It. By Harriet Brown. Da Capo. $25.99.
Argumentative and determinedly one-sided, Harriet Brown’s Body of Truth is a highly useful corrective to the veritable flood of books warning people to watch their weight, change their weight, balance their weight, and pay constant attention to their weight in order to be healthy, fulfilled and happy. It is a book that will surely be read with relief, if not glee, by the legions of people who are weight-focused – including those that are, yes, obsessed – but who are nevertheless unhappy in their own skin and unconvinced that all the dieting, careful food choices, and constant attention to weight have done them any good.
Brown’s argument here comes down to a single statement: “As with pretty much every aspect of the research on weight and health, there’s no absolute consensus, and there’s a lot we still don’t know.” This is quite true, in weight-related research as in other aspects of science, but if this is the kernel of Brown’s argument, it is not the entirety of it. She points out that some research studies (she offers copious citations: the book has just over 200 pages of text plus nearly 70 of notes, references and index entries) find a certain level of correlation of health issues with a person’s weight but that this does not establish causation. And this too is quite true – indeed, the vast majority of contemporary medical/scientific research turns up associations between one thing and another without showing, or being able to show, that Thing A is the cause of Thing B. This inability to establish causation is inherent in study design and directly related both to longitudinal issues (how long it takes to do convincing studies showing causation) and to medical/scientific ethics. But dissecting research is not Brown’s purpose here. Her concern is the harm that societal weight obsession demonstrably does, on an anecdotal basis, to people who get pulled into the orbit of a social environment and medical establishment that focus, often without strong scientific justification, on the importance of weight loss.
The concerns expressed by Brown, a Syracuse University associate professor of magazine journalism, arise from personal circumstances, including 10 years she spent in therapy to try to deal with her own weight-related issues and a serious condition that affected her daughter: “A sixth-grade ‘wellness’ class kicked off both her anxiety about eating and her interest in health. Though her weight was normal, she started to worry about being fat. She cut out desserts, telling us she’d learned that sugar was unhealthy. Over the next six months or so, her restricting took on a life of its own, and eventually turned into full-blown anorexia that nearly killed her.” This situation, which Brown wrote about in a previous book, is certainly intense and frightening enough to send someone with research skills and writing ability into the world and the scientific literature in search of understanding and clarity.
It is also, however, a recipe for confirmation bias – a flaw of which Brown is as guilty as are doctors who use anecdotal reports of weight-related health issues to make generalized statements about the way things “must” be for people in general. Confirmation bias is simply the tendency to give greater significance to matters that support your thesis while ignoring or simply not seeing ones that counter it. Doctors and scientists are as prone to this as anyone else, although the scientific method is a bulwark against it when properly understood and correctly applied. It is inevitable that Brown, convinced that weight focus is vastly overdone and done on the basis of insufficient data – and that the focus does tremendous harm to people such as her daughter and herself – will find material, scientific and anecdotal, to back up her assertions. The anecdotal items, sprinkled throughout the book, will connect most strongly with readers, but anecdotes are not research: they are pieces of information that may lead to research. So it is possible to accept as truth that every single quotation and life history in Body of Truth shows that some individuals are and have been significantly harmed through weight obsession without needing to accept the notion that weight obsession is provably a bad thing.
Brown does search for such proof, but does not find it; it does not exist, any more than does certainty about the relationship between weight and disease. However, Brown does turn up some intriguing material. For example, she finds some convincing research that indicates that each individual has a normal body-weight range beyond which it is difficult to go, and that artificial goals set through Body Mass Index and other measurements are simply inappropriate. She also finds studies indicating that it is lack of exercise, not weight, that is the primary culprit in conditions usually thought of as weight-related, such as cardiovascular disease. And she comes back, again and again, to a life-changing question that her therapist posed to her: “What if you were OK with your body the way it is right now?”
This is, in fact, one heck of a good question, and its impact grows the longer one contemplates it. Body of Truth is essentially an extended argument that it is OK to be OK with the body you have. It makes its point too intensely at times: early on, describing weight obsession as an epidemic, Brown writes, “You’d be hard-pressed to find a twenty-first-century culture that didn’t struggle with it,” a statement that ignores India, Bangladesh, central Asia and most of Africa. And Brown goes off track when she shows an unfortunately all-too-typical journalistic anti-business bias, stating that the fact that much research into obesity and other areas of health is funded by businesses that make products in those fields indicates skewed study design and even skewed results. Brown worriedly notes that “pharmaceutical companies fund about 70 percent of the [drug] research in the United States; the NIH [National Institutes of Health] funds the other 30 percent.” So 70% of research is tainted, or should not be believed? Should research funding be cut 70% to get rid of the involvement of corporations and their affiliated research foundations? Or should that 70% of funding come from…where, exactly? The NIH, which means the government, which means higher taxes and trusting future health discoveries to government employees? This kneejerk dislike of research funding methods is among the book’s weakest elements, indicating a political agenda rather than a carefully thought-through attempt to make an important point about how much we know, and do not know, about the relationship between weight and health.
That point is nevertheless worth making: there is not settled scientific or medical research (no matter how funded) indicating a causative relationship between weight and a multiplicity of diseases, and there is evidence that societal and individual weight obsession can do and does do more harm than good – certainly for some individuals, and arguably for society as a whole. Body of Truth is unlikely to change Americans’ (or American doctors’ and nutritionists’) attitudes toward food, but it deserves credit not only for trying but also for offering an alternative to the way the weight-obsessed currently regard what they eat. Taking a cue from dietitian and eating specialist Ellyn Satter, Brown argues for “competent eating,” which includes a positive attitude toward eating and food, tuning in to one’s body’s hunger and fulfillment cues, being able to eat a variety of foods, and trusting oneself to manage food well. The last of these will be the most difficult for the weight-obsessed to, so to speak, swallow, but it is arguably the most important: trusting oneself around food, rather than trusting doctors or nutritionists or weight-loss programs or even one’s own family and friends, requires having a stronger sense of self and more inner fortitude than many people have. As Brown writes, “So long as we consistently look to other people and the culture to tell us we’re OK, we’re attractive, we belong, even those of us who are the most beautiful and self-confident will struggle. I think we have to learn not to look outward for that stamp of beauty approval.” This is good therapy-speak, but it is scarcely a simple (or even moderately complex) matter; and it is certainly not the sort of foundational attitudinal change that Body of Truth or any other book can provide. But at least Brown’s work can be a good first step toward it.