This week a Boston-area doctor revealed she will no longer accept patients who weigh more than 200 pounds, because fat people are dangerous deviants who should go to “obesity centers” to get treated for their “disease.” Earlier this summer, a gay man accused a New Jersey doctor of refusing to treat him because, allegedly, she attributed his need for medical care to “going against God’s will.”
“Homosexuality” and “obesity” are both diseases invented around the turn of the previous century. Prior to that time, being sexually attracted to someone of the same gender or having a larger than average body were, to the extent they were thought of as social problems, considered moral rather than medical issues: That is, they were seen as manifestations of morally problematic appetites, rather than disease states.
The same medical establishment that pathologized same-sex sexual attraction and larger bodies also offered up cures for these newly discovered diseases. Those who deviated from social norms were assured that, with the help of medical science, homosexuals and the obese could become “normal,” that is, heterosexual and thin.
In the latter half of the 20th century these frames were challenged by gay rights and fat rights advocates. Within these movements, the words "gay" and "fat" had similar purposes. They were intended to depathologize what medicine called “homosexuality” and “obesity,” by asserting that different sexual orientations and body sizes were both inevitable and largely unalterable, and that being gay or fat was not a disease.
Over the past few decades, gay rights activists have had great success challenging what 50 years ago was the standard medical view that “homosexuality” constituted a disease. By contrast, fat rights activists still deal with a public health establishment that continues to reflect and replicate profound cultural prejudices when it advocates ineffective cures for an imaginary illness.
The extent to which the construction of “obesity” as a social problem has paralleled the history of the medical establishment’s construction of the concept of “homosexuality” can be seen by comparing the cures put forth for these purported diseases.
To a remarkable degree, attempts to cure obesity resemble attempted cures for homosexuality, with the key difference being that while our public health authorities have come to denounce the latter as ineffective, unnecessary and ultimately harmful, they continue to employ the most extreme rhetoric in regard to the former. For example, the goal of Michelle Obama’s Let’s Move! campaign is no less than to “end childhood obesity within a generation,” that is, to create an America with no fat children in it.
Consider the many parallels between the treatments advocated by those who claim being gay is a disease, and those being pushed by our public health establishment to “cure” fat children and adults of their supposedly pathological state.
The advocates of so-called conversion or reparative therapy believe that “homosexuality” is a curable condition, and that a key to successful treatment is that patients must want to be cured, which is to say they consider same-sex sexual orientation volitional. These beliefs mirror precisely those of the obesity establishment, which claims to offer the means by which fat people who want to choose to stop being fat can successfully make that choice.
Those who seek to cure homosexuality and obesity have tended to react to the failure of their attempts by demanding ever more radical interventions. For example, in the 1950s Edmund Bergler, the most influential psychoanalytical theorist of homosexuality of his era, bullied and berated his clients, violated patient confidentiality and renounced his earlier, more tolerant attitude toward gay people as a form of enabling. Meanwhile, earlier this year a Harvard biology professor declared in a public lecture that Mrs. Obama’s call for voluntary lifestyle changes on the part of the obese constituted an insufficient response to the supposed public health calamity overwhelming the nation, and that the government should legally require fat people to exercise.
Anti-gay and anti-fat zealots both try to build support for their initiatives by defining success down: Advocates of conversion therapy claim their treatments “work” if patients are able to achieve sexual potency in a heterosexual encounter, or are able to avoid same-sex sexual contact for a period of weeks or months, even if they experience no lessening of desire for such contact. This lowering of the bar for what constitutes a cure is mirrored by public health authorities touting short-term weight loss or small losses of body weight as evidence for the success of anti-obesity programs.
Indeed, the most striking parallel between attempts to turn gay people into straight people and efforts to turn fat people into thin people is that both almost invariably fail. The long-term success rate of such attempts is extremely low. When it comes to the various forms of conversion therapy, the medical establishment now acknowledges this. This acknowledgment, in turn, has helped medical authorities recognize that it does not make sense to label “homosexuality” a disease, and that therapy for same-sex sexual attraction is both unnecessary and more likely to do harm than good.
But when it comes to fat, the fear and disgust elicited in this culture by fat bodies (reminiscent of the reactions elicited traditionally by same-sex sexual relations) prevents the public health establishment from recognizing that the various “cures” it advocates for “obesity” have been demonstrated again and again to be every bit as ineffective as conversion therapy has been shown to be for “homosexuality.”
The pathologizing of gay and fat bodies springs ultimately from the same cultural source: the desire to ground moral and aesthetic disapproval in the supposedly objective discourse of science and health. It is true that fat people are at a higher risk for certain diseases (although the extent to which higher weight correlates with increased mortality and morbidity is greatly exaggerated). But trying to, for example, lessen the prevalence of diabetes by eliminating “obesity” makes no more sense than trying to lessen the prevalence of HIV infection by eliminating “homosexuality.”
The extent to which either one’s sexual orientation or one’s weight are chosen states is minimal. With rare exceptions, people cannot intentionally alter either their sexual orientation or their weight in a long-term way. Given all this, to label same-sex orientation or higher than average body weight as diseases stigmatizes those who are so labeled to no purpose, other than to express disapproval of deviance from social norms to which the stigmatized cannot adhere.
Telling fat people they ought to be thin is about as helpful as telling gay people they should be straight. It took many decades for the medical establishment to recognize that its “cures” for “homosexuality” did far more damage than the imaginary disease to which they were addressed, and that the biggest favor it could do for gay people was to stop harassing them. Fat people are still waiting for the same favor.