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Obesity as an illness of metaphor

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I’ve been reading The Pain Chronicles by Melanie Thernstrom, a well-researched and fascinating book about pain viewed through the filters of history, literature, science, religion and the author’s personal experiences. Of particular interest to me was the idea that disease is sometimes seen as metaphor. For example, a common 19th century belief about consumption (a.k.a. tuberculosis) was that it was a “spiritualizing struggle between the body and the soul, in which mortal flesh was slowly consumed in a way that heightened both beauty and creativity.” This view seems sort of silly now that we know tuberculosis is caused by mycobacterium tuberculosis. Similarly, cancer was once seen as a sign of repression, and HIV was originally viewed as punishment for homosexuality, both of which have similarly been proven false after the mechanisms of the disease were discovered.

This is when it occurred to me that obesity is still seen as a disease of metaphor.

Obese people have been assigned many traits by mainstream culture. They’re weak-willed. They’re lazy. They don’t care about their bodies. They’re disgusting. The popular belief is that obesity is an expression of these poor character traits. Unfortunately, the cause of obesity is not so simple. In the last few decades it was discovered that hormones like leptin and ghrelin modulate hunger. Someone with an imbalance of these hormones will be driven to eat more than a regular person. A pilot study by the Vanderbilt Addiction Center revealed that fMRI scans of obese people showed “greater activation in response to food cues in key regions of the brain, including the insular region, the hippocampal gyrus region, and the orbitofrontal cortex.” This suggests that obese people may battle strong biological impulses to eat that naturally skinny people don’t. Other studies have shown that a diet of high-calorie foods trigger addiction-like responses in the brain and affect dopamine levels, making it more difficult for people who eat these foods to change their diets. And Brian Wansink’s food lab research has revealed that simple things like the size of your plate or bag of popcorn influence how much you’ll eat in a sitting.

All of these findings suggest that obesity is more complicated than simply lacking will power. There is undoubtedly some personal choice involved, but it is comparable to the amount of a choice a clinically depressed person has to pursue treatment. Depressed people cannot simply “cheer up.” They can take medications, exercise to stimulate endorphins, eat a diet that provides nutrients that help battle their disease, and maintain a support system of family and friends. However, they still have to fight their natural brain chemistry, and even if they do everything right they may still fall prey victim to depressive episodes that make them consider suicide or stay in bed all day.

Similarly, obese people can eat a healthy diet, exercise regularly, weigh themselves frequently, and attend support groups such as Overeaters Anonymous or Weight Watchers. But many of them still have to fight brain chemistry and societal pressures that drive them to eat more calories than they will burn.

It is unlikely that obesity will escape its perception as a metaphor until its mechanisms have been decoded and a “cure” developed that shows the public that obesity is not just an illness of character. Currently the most affective cure against obesity is gastric bypass surgery, which is commonly viewed by the public as “cheating” and “taking the easy way out.” Though if you know anything about the surgery, it is hard to see what is easy about dumping syndrome, possible hair loss, extreme pain after overeating, and the risk of complications such as abscesses, leaks in the digestive track or death. Perhaps if there were a more socially acceptable treatment for this disease, such as a vaccine, a series of injections, or a pill, the treatment would not be viewed with the same amount of scorn as the disease.

Until obesity is better understood by the public, it will likely remain a disease of metaphor. It doesn’t help that obese people are typically regarded as unattractive, and thus deemed worthy of ill regard. In a much more extreme way, diseases such as leprosy similarly made outcasts of their sufferers. Of course, once obesity is better understood, it is also more likely that there will be a cure, thus allowing those who are overweight to escape the persecution that their weight would have brought upon them. Such a reprieve is of little consolation to those today who are discriminated against or taunted because of their size. The one consolation they can take is that it’s likely that future generations will look back on the current views of obesity with incredulity and view obesity as the complicated state it is, not an illness of metaphor.

I’m aware that this post has a serious, term-paper like tone that isn’t exactly similar to my more humorous posts. I dunno why that happened. That’s just how it came out when I wrote it, so I decided to go with it.

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44 Comments

Melissa • November 10, 2010 at 8:36 am

I think part of it is that most people don’t view obesity as a disease at all. They ONLY think the obese are weak-willed, lazy, greedy, etc. and that it’s their own fault. I’m not saying that a person has no personal responsibility but now they are discovering that it’s deeper and as you say there are hormonal factors that can make things much harder.

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science_cyrano • November 10, 2010 at 8:50 am

I think one of the things that makes obesity and mental illnesses harder for the public (and doctors, scientists) to understand is that they don’t follow the same algorithm as purely microbial or viral diseases (Koch’s postulates). There is no ‘fat virus’ as far as we know.
It’s not just obesity: a lot of diseases that have a brain-chemistry/mental aspect to them are in the same boat. They’re harder to quantify and treat. It’s like the difference between the Napoleonic war and fighting global poverty. Like the latter, there is no one to ‘blow up’ when you’re treating depression.

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Liz Remus • November 10, 2010 at 9:01 am

This was terrific! Thanks for explaining it like this. I’ve heard all the points you’ve mentioned separately but to relate them and tie them together and relate them to HIV and leprosy really made it click. Thank you!

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Teresa • November 10, 2010 at 9:23 am

Hi PastaQueen

Thank you for this post. It was what I needed to read this morning, it was a very much needed reminder for me that I am not crazy, I have a complicated illness that needs to be treated like an illness.

A New Friend From Indy :-)

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DebraSY • November 10, 2010 at 10:02 am

Obesity is not a disease, but in some cases it can be a symptom of other issues. It has been oversimplified to a ridiculous degree.

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Beverly • November 10, 2010 at 10:15 am

My favorite post you have ever written. It is comforting to know that someday people will look back on this time and realize how far off we were.

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NoCeleryPlease • November 10, 2010 at 11:09 am

It makes me crazy when people who have never struggled a day in their life with their weight, say things like “Eat less and Exercise more”… oh yeah? I DARE you to live my weight maintenance lifestyle and then tell me how easy and simple it is!

But the vision of fat people as lazy, etc will not go away until the message that weight is not a “Simple” thing is explored, decoded, and disseminated.

I’m not holding my breath.

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leora • November 10, 2010 at 11:21 am

This is a great post. And like posters above me have said, it is just so true that people who have never struggled with food don’t understand the inner turmoil that is produced when someone wants to stick to a healthy regimen but is confronted by unhealthy or larger quantities of food. And that happens constantly. You can’t avoid it, just watching TV there will be a million commercials for the Olive Garden with it’s never ending pasta bowls, and then commercials for cakes, candies, fast food restaurants. The triggers are inescapable. And people forget that there are so many people who struggle with food who don’t struggle with obesity but still have incredibly high levels of pain and internal conflict about food.

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Jenn • November 10, 2010 at 11:31 am

Thank you for this. It could not have been more timely for me. As I once again evaluate a failed diet and try to scrape my self-esteem and willpower together to try again, it’s good to remember that I am fighting brain chemistry and not just my own laziness/lack of willpower/fill in your own negative word.

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Karen • November 10, 2010 at 11:35 am

Thank you for this post. My only wish is that it would become so widely read that the general public would understand. Again – thank you.

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Peggy • November 10, 2010 at 11:48 am

@DebraSY – You’re right! Except when you use the phrase ‘but in some cases it can be a symptom of other issues’. I don’t believe that there is a ‘some’ involved at all. I think that all cases of obesity are ‘other issues’.

Mental illness is dealt with as a disease and yet there are many causes–neurological and environmental–that are the basis of this disease. It consists of many target-specific manifestations. And yet it is all bundled into one general catetory.

Likewise with cancer. There are many triggers of cancer and many target zones in the human body (and plants) that host this awful scurge. And yet, we don’t always distinguish the cause or the location. It is known merely as ‘cancer’.

So it is with obesity. It is a collection of causes. It is a serious and often heartbreaking collection of effects. The point is, that this disease deserves the respect and attention of other diseases that have been researched and studied.

The definition of ‘disease’ according to Merriam-Webster Dictionary is: a condition of the living human animal or living plant or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms; a harmful development’.

How can ‘obesity’ not be associated with that definition? Because the root cause is elusive? Because we can’t pinpoint a genesis? Or that we haven’t been able to definitively announce the source of the problem?

In truth, it must be. In the same way that Dana Reeves, a non-smoker, died of lung cancer. In the same way that young, slender people die of heart failure.

To deny that obesity is a disease with many causes is to shut your eyes from the truth. And that is what is keeping those of us who suffer from it and struggle with this monster in the attic of society. We’re looking for the key even as those who hold it try to conceal it in their pockets.

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maxie • November 10, 2010 at 12:20 pm

Good post, but I have to take issue with “HIV seen as punishment for homosexuality.” Yes, a certain % of the population thought (and still thinks) this, but people of intelligence always knew this was caused by a virus or a germ.

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Carlene • November 10, 2010 at 1:24 pm

Thank you for this post – very much appreciate your insights and comments.

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Shea • November 10, 2010 at 2:37 pm

Very well said. Thanks so much for sharing this post with all of us. I hope as many people read it as possible.

I’m currently reading “The End of Overeating” by David Kessler. While much of the information isn’t new to me, it still astounds me just how much goes on inside our bodies and minds.

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Jill • November 10, 2010 at 4:35 pm

Well said!!!!!!!!!

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Dee • November 10, 2010 at 5:57 pm

I love this post more than I can express. I insatiably consume alot of what’s out there about the whys and hows of weight gain and weight loss, biochemistry, etc, from the self-help type to the scientific journals. And what I’ve noticed is a) that the whole darn thing is way more complicated than any one source every acknowledges and b) that no one out there, that I’ve read, has done a good job of acknowledging this, studying it, developing sufficiently comprehensive and individualized treatment plan ideas, etc.

Your post is the first, and it makes so much sense, you need to hook-up with someone who does scientific research and make your third (or fourth?) book about this very problem of definition, which hampers effective treatment. Your post needs to be a book. Awesome!

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Leigh • November 10, 2010 at 6:07 pm

Thank you.

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Jennifer • November 10, 2010 at 6:21 pm

Best post ever. Thank you, for both the insight, and the book recommendation.

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Deanna • November 10, 2010 at 6:44 pm

There is so much truth in this post. My own family considers obesity a character flaw, which makes sense considering besides myself no one else in the tree has more than 20 additional pounds (which is nothing). They don’t understand. Just like I don’t understand a Meth addict or someone with a compulsive shopping problem – yet, there are parallels to these problems and food addiction.

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RNegade • November 10, 2010 at 7:11 pm

Today I feel so hungry I can scarcely think of anything else. It would have been an easier day if I ate nothing at all. At least then I wouldn’t have awakened this hunger. Or that is the story I tell myself. Am I sounding like I have anorexia? Hmmm. How is it possible to feel this way when I still weigh 200 lbs? Yep, that is the nature of this battle, for me, much of the time. Not every single day. But most. Just eat less and move more. Right.

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Jaclyn • November 10, 2010 at 7:16 pm

Fascinating. Thanks for sharing this.

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Emily • November 10, 2010 at 11:26 pm

I don’t know. I find the topic interesting. I can’t seem to lose weight and keep it off, and yet I still see it as little more than a weakness in myself. Yet, the more I read, the more I know I’m fighting against all kinds of factors, and yet, I still just think I need to eat less and exercise more.

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cindy • November 10, 2010 at 11:52 pm

Obesity in and of itself is not a disease. Why are you calling it one? (I’m not interested in anyone’s answer but Jennette’s, thanks.)

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msmezzo • November 11, 2010 at 4:08 am

If this is a term paper, please write more of them. A+

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beep • November 11, 2010 at 6:46 am

Word. Great post.

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cindy • November 11, 2010 at 6:50 am

Not the same cindy as above…
I read this with a great deal of interest. I have been obese most of my adult life. I’ve struggled and lost most of the excess weight, only to re-gain half of it. As much as I want to believe this post… and as much as I live the experiences it expresses… my feelings still tell me that I am weak, impulsive, and disgusting. Maybe that’s because that’s the message society has given me my whole life. Maybe. But maybe its because its true—that its a weakness of character that makes me who I am and there is no hope for permanent success at fighting this. I just don’t know… I am my worst enemy.

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Lesley • November 11, 2010 at 7:59 am

It’s serious stuff and you don’t have to be funny all the time. I agree with your take on this serious issue and am pleased you have raised it. very thought provoking.

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dominic • November 11, 2010 at 8:43 am

Really good, thought out piece, excellent

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rah • November 11, 2010 at 8:45 am

Please write more term papers. It’s nice to have something pithy to read! And I can only echo the other comments–if only the world knew.

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Shannon • November 11, 2010 at 9:48 am

Thanks for this. It is a perfect way to look at obesity. It’s like we blame the people who are fat, rather than trying to understand what got them there in the first place.

This is worth sharing. Thanks.

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psychsarah • November 11, 2010 at 11:32 am

Fascinating take PQ. Thanks for sharing your thoughts. It certainly provided me with “food for thought”.

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Ms. PJ Geek • November 11, 2010 at 12:23 pm

In a world where a size 4 woman says “i’m fat..just look at my tummy!” and where people crow about not having eaten a donut “in years”, it would be nice if this kind of thoughtful editorial were required reading for all. So says a recovering food addict who after years of therapy and exercise and effort to lose / maintain a +100 lbs wt loss still ate 3 donuts from Dunkin Donuts on Sunday because she was stressed out and wanted comfort. It was comforting and yet it wasn’t.

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Kelli • November 11, 2010 at 2:18 pm

Thank you for your insight. Lately, more often than not, I wish I had a drug addiction. Or that I were an alcoholic. It would make my cravings much easier. I could avoid those. How do I avoid food? “Sorry, Kids. No more food. If you’re hungry have a crayon”. At least fat clothes are cooler now than when I was a kid.

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DebraSY • November 11, 2010 at 4:23 pm

@Peggy – Thanks for your thoughtful response, but I think we may need to agree to disagree for today, or we could end up taking up all of PQ’s comment space. In short, if we were to really get into it, I think we’d need to define terms and then talk. And even then, I think we’d find that we are more similar in our views than we are different. With regards to definitions, for example, a BMI of 30 is clinically defined as obesity. Many people with BMIs in the low 30s, and even higher, live long lives displaying beautiful blood panels, normal blood pressure and with no other complications in their lives beyond those inflicted by a culture of fat-phobia. People in the upper 20s, however, if their fat is misplaced in the midsection, may have medical issues.

I’m starting to go down a complicated path that is inappropriate in a blog comment. Suffice it here that I don’t think you and I disagree on the complexities of fat as both a medical and social issue. I just don’t like the “disease” language, and I think it’s at least imprecise, if not wholly inaccurate. Moreover, it hasn’t helped people, in my opinion.

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PastaQueen • November 11, 2010 at 6:02 pm

Regarding the question of whether obesity should be referred to as a “disease,” the reason I used that terminology was because of a concept in Thernstrom’s book, in turn based on Susan Sontag’s Illness as Metaphor. As Thernstrom says, that book “describes the transformation of consumption into tuberculosis as an archetypal example of a process by which diseases are understood metaphorically until their pathology becomes clear.” The disease/illness/medical condition was called “consumption” because you were consumed in a spiritual battle. It was later called “tuberculosis” because of the name of the bacteria that caused it. The change of name reflected the changing way people viewed that disease/illness/medical condition.

Essentially, when a disease/illness/medical condition is still viewed metaphorically, it’s typically described as an illness (not a disease). When we start to view it more scientifically, it’s typically described as a disease (not an illness). So, since I was talking about obesity viewed as a scientifically-based condition and not a result of a set of personality flaws, I used the word “disease.” Whether you consider it a disease or not is debatable, but that’s why I used that word. It’s also why the title uses the phrase “illness of metaphor” and not “disease of metaphor.”

If you want to further down this line of thought, Thernstom also says that philosopher Michel Foucault postulates “that modern medicine began when doctors stopped asking patients, ‘What is the matter with you?’—a question that invited a complex personal response—and began asking, ‘Where does it hurt?’ instead, a question focuses solely on biology. The word “illness” connotes the first approach, and the word “disease ” connotes the latter.

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cindy • November 12, 2010 at 12:25 am

@PastaQueen – Thank you for answering.

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Kristen • November 12, 2010 at 12:54 pm

What an interesting post. I am not sure where I stand on the “obesity is a disease” debate, but I do agree morbid obesity is not caused by laziness or stupidy. I think morbid obesity is a consequence of poor choices made in an attempt to handle stress, depression and life in general. People deal with the stresses of life in many different ways, alot of which are unfortunately destructive. I think morbid obesity should be seen in the same light as anorexia/bulmia and it needs to be treated from a mental standpoint first, physical second.

Nobody dreams of being morbidly obese or an alcholic or an addict etc. I do not have sympathy for anyone who ends up in these categories as I believe they are consequences of your choices. But, I do have empathy for anyone dealing with these issues.

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Lin • November 13, 2010 at 1:43 pm

It’s fascinating to read othes opinions about obesity and the latest research. I enjoyed reading your post and hope you will discuss in future posts more of your thoughts and personal feelings about different aspects of obesity (maybe emotional eating).

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Bright Angel • November 14, 2010 at 5:46 pm

In the same vein……..
Anyone who hasn’t watched the amusing documentary DVD movie – “FatHead”,
should watch the 5 part Lecture by that DVD’s producer on YouTube, which covers much of the material in the documentary.
I don’t know if I can link them here in this comment section, but Here are the addresses.

Big Fat Fiasco part 1 –

http://www.youtube.com/watch?v=exi7O1li_wA&feature=related

Big Fat Fiasco part 2 –

http://www.youtube.com/watch?v=cmwNpUJUjPg&feature=related

Big Fat Fiasco part 3 –

http://www.youtube.com/watch?v=TuxDuLKz39c&feature=related

Big Fat Fiasco part 4 –

http://www.youtube.com/watch?v=Z9mQ-QZkZpk&feature=related

Big Fat Fiasco part 5 –

http://www.youtube.com/watch?v=cEayi6IBjZw&feature=related

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Shane • November 15, 2010 at 10:17 am

I couldn’t agree more. I hate it when people assume obesity is an issue with willpower. It’s way more complicated than that and it’s plain ignorance to think that everybody who is obese got there simply because they’re lazy and undisciplined. Nobody is really talking about this and I’m glad you blogged about it. I’m definitely going to bookmark and be back. Thanks a bunch- Shane

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Dana • November 19, 2010 at 11:42 pm

Wait wait wait wait wait.

It’s easy for you to believe stuff like this:

“…obese people may battle strong biological impulses to eat that naturally skinny people don’t.”

…because you have struggled with obesity all your life, so it is very easy for you to fall for the myth that there are two camps of people, “the obese” and “the naturally skinny.”

What about those of us who’ve been both?

Before I went on the Pill in 1995, I was one of The Naturally Skinny. I was not *rail*-thin, but only because I had wide hips. But if you look at the rare example of an old photo of my ass, you will see it was a rather nice one. I am not making this up to feel better about myself. 5’6″ and 130 pounds is well within normal BMI–even, dare I say it, a relatively healthy weight.

Ever since 1995, and particularly 1996 after I had my first child, I’ve been one of The Obese. And I can’t say that my appetite and habits were markedly different from when I was The Naturally Skinny, except I was about fifty pounds heavier.

Now this is not to say I didn’t have odd eating habits and the occasional craving for something like a whole bag of Ruffles chips and a can of Frito-Lay French onion dip. (I don’t even like onions. Explain this to me because I still don’t get it. Haha.) But something about me being The Naturally Skinny allowed me to shrug off these insults to my body like they were nothing. I wasn’t even a proper athlete, despite being in the Army for two and a half years of my Natural Skinniness. I hated exercise and avoided it whenever I could.

The hormone changes were when the weight changed. Small change with the Pill, big change with each of two babies.

I don’t buy that it is calories. I’ve been down that road, complete with a raging soda addiction and all I seemed to do pre-Pill was rot one of my molars from the inside out. I should have been a good 180-200 pounds pre-Pill if it was just calories.

I don’t doubt that some obese people have severe hunger issues. But I don’t think they got extra hungry before they got fat and that is why they are fat now. I think something else is going on and, furthermore, nobody really knows what that something is–it’s essentially the blind men feeling up the elephant. Don’t describe the elephant as short, thin, and dangling in midair with bristles on one end and a funny smell lingering about. That’s not the whole story.

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Cameron • November 23, 2010 at 3:53 pm

Everyone wants to eat delicious calorie packed food, when their sadd, eat when their happy blah blah blah….we’re human we eat! What i dont understand is how we can all sit here and agree with comparing obesity to TB and HIV. Obesity does not exist purely because it was a matured disease that spread fast through unsanitary and unhealthy conditions. Obesity has built up over time, that is why the percent of obese Americans rises every year. Please also remember “skinny” people are not exactly “healthy” people. America itself should stop making excuses for its poor diet in general and do something about it.

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Cristina • December 1, 2010 at 5:11 pm

This is one of my favourite PQ posts, but what has happened to the “Best Entries” section of your blog?? It has nothing from this year, and come on, you have very nice posts you could put there. It would be nice if you updated this section.

I’m a long time PQ fan and reader

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Ann • January 18, 2011 at 12:06 pm

Thanks PQ for this post. It’s so refreshing and reassuring to read a post that defends those dealing with obesity. I am a nurse and do believe that it is a disease, similar to alcoholism, only with the even more complicating factor that you cannot quit eating food like you might be able to quit drinking alcohol.

On a sad note, I recently completed a half-marathon in a little over 3 hours (which I was incredibly proud of!), but even though I am not classified as morbidly obese, I still got disparaging looks and comments from a couple of workers at the booths afterwards. It was a disappointing way to finish, when lots of people were so supportive along the way, to feel self conscious at the finish. I hope that in the future people do look back on obesity with more compassion as your post so eloquently explained.

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Comments are now closed on all PastaQueen entries. The blog is an archive only so I don't have to deal with spammers. For fresh discussions please visit my new blog JenFul.

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Jennette Fulda tells stories to the Internet about her life as a smartass, writer, weight-loss inspiration, chronic headache sufferer, and overall nice person (who is silently judging you). She does this at JenFul now, but you can still have fun perusing her past here.

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