In all honesty, I am not really sure how to approach this review. Perhaps the clearest theme that presented itself to me was one that actually arose before we even entered the main conference room to hear our first keynote speaker, Abigail Saguy, speak. It is the theme of privilege.
I was conversing with Abigail Saguy, Harriet Brown and Caitlin O’Reilly in the reception area outside our conference room on the morning of day one. The topic turned to the fallout of presenting the facts of obesity within a medical industrial complex dependent upon the fallacies of obesity as a source of sustenance.
Caitlin O’Reilly is actually a fellow Vancouverite, although neither of us knew of the existence of the other until we met in Iceland! Caitlin works in the field of eating disorders as well as health care and weight stigma within our geographic locale, whereas I am clearly not very connected to the advocacy community in Vancouver at all.
Caitlin mentioned the current Provincial Health Services Authority (PHSA) initiative to reduce weight stigma within health care delivery services in British Columbia. She is a PhD student and current consultant involved in this PHSA initiative.
Caitlin was mentioning how it became necessary to reinforce “a balanced view” of obesity within the PHSA initiative because reflecting the fact that obesity is not a health issue generated too much resistance from health care practitioners and medical advisers involved in the program development and production.
Abigail then confirmed that she has been rejected for tenure twice and was advised to offer up a more “balanced view” should she wish to be a successful tenure applicant in future as representatives from the medical faculty took great issue with her current stance on obesity.
In response I said “I am so glad that I live completely outside your worlds and that I am not forced to obscure facts and data. But as Upton Sinclair once said (something along the lines of) “It’s difficult to get a man to understand something, when his income depends upon his not understanding it.””
At the end of the two days I was actually very disheartened. It was my husband who reframed much of what I saw as the pointlessness of trying to change such pervasive and institutionalized hatred, as being a necessary, steady and ultimately perhaps successful erosion of what looks today to be an insurmountable monolithic slab of discrimination.
I expect to have more to share on the details of the conference over the next few weeks, but for now I want to relay what I found most insightful on this theme of privilege…
Abigail Saguy covered off some highlights of her book What’s Wrong With Fat? (that I now must read). Many of you will be familiar with the data, having read the various blog posts on obesity and fat here on Your Eatopia. However, Abigail Saguy’s presentation of the material is far more methodical and organized than my scattershot blog posts of course. But for those who have felt that the material on Your Eatopia seems to be found nowhere else, look out Abigail’s book for corroboration.
Ragen Chastain is a brilliant speaker, not to mention an exceptional human being. Some of her first-person accounts of discrimination were tragi-comedic train wrecks. As just one example, she once broke her toe and it was at a right angle to the rest of her toes, yet the emergency room physician informed her that he would not fix her toe until she at least agreed to attend a seminar on bariatric surgery. It was resolved by her receiving appropriate care from another physician in the ER. I am in absolute awe of Ragen that she navigates such a disgusting level of discrimination, abuse and hatred with an unwavering commitment to her innate value as a human being. I think in the face of such extreme prejudice I would promptly deflate and meekly accept the seminar-for-proper-care injustice.
Daniel S. Goldberg was our third keynote speaker on day two. I knew nothing of him prior to this conference. He is a professor of bioethics at the Brody School of Medicine at East Carolina University. He’s an attorney, historian and public health ethicist and I’m a serious fan after sitting through his presentation.
I am now working my way through his published works that can be found here. And I highly recommend Fatness, Medicalization, and Stigma: On the Need to Do Better.
He does not define himself as an ally to the fat community pursuing social justice. As he clarified, he can pretty much check off every category of privilege that exists: white, male, thin, educated and from an affluent and industrialized nation. And so he sees his role as one of listening and supporting the cause as directed by those without status or privilege.
Of course, as he pointed out, we are all members of various groups in society and not all are universally with or without privilege. However for many, an out-group status is a compounding one: someone who is fat suffers sufficient discrimination that she is less likely to receive post-secondary education; more likely to be underpaid relative to her thin counterparts; and more likely to become ill and disabled as a direct result of how systemic discrimination impacts a person’s health and longevity.
Abigail, Ragen and Dan are out there directly countering pervasive fattism within the medical community and beyond. What struck me is that their need to refine their stance when communicating directly with the medical community is not because the facts about fatness are equivocal or really have two-sides that must be “balanced out”; and it’s not that Upton Sinclair’s observation that men will refuse to understand anything that might jeopardize their incomes is or is not valid; it’s actually that woven into the status any one of us might enjoy, is the discrimination of other upon which our status depends. In other words, inherent to the revered status conferred upon a medical doctor is the otherness, or out-group, of the sick.
“It is difficult to believe that the AMA [American Medical Association] is unaware that the concept of disease is a social construction, and that simply declaring a risk factor—itself a fraught concept (Greene, 2008; Rothstein, 2008)—a disease by ﬁat neither decides the matter nor avoids any of the complexities and ambiguities that obtain in framing disease (Rosenberg & Golden, 1992)” i
The AMA was hoping to help those with obesity by classifying the presence of fatness as a disease state. And as Dr. Goldberg pointed out, even if we give the AMA absolute benefit-of-the-doubt and assume that the goal was to help, the classification of sickness can only relegate the group to otherness.
The more groups that can be relegated to sickness and otherness, the more the special status of the medical community is heightened and reinforced. And perhaps that is the most insidious kind of status that human cultures can and do devise: a status that ostensibly ministers to the disenfranchised and marginalized all while reinforcing its privilege relative to those groups.
The privilege of these communities that rejects tenure and demands “balanced views”, wields tremendous power— the power to clearly make or break careers as well as the power to obliterate facts and reinforce outright falsehoods. And yet, it is clear that this privilege is also exceedingly brittle. It is too fragile to accommodate facts. It cannot even step down a notch so that others might be raised up a notch. Like a cornered animal it is most certainly dangerous, but it is cornered nonetheless.
I think it is for all of us, whether within the system or outside of it, to stand our ground. By all means, choose to stay put watching the animal closely, but don’t back away and give it room to attack either.
In the next installment on this review I will talk about the breakout sessions offered by Carmen Cool as well as Andrea LaMarre and Jen Rinaldi—I found these to be moving and inspirational.
i Goldberg, D. S. (2014). Fatness, Medicalization, and Stigma: On the Need to Do Better. Narrative inquiry in bioethics, 4(2), 117-123.