His latest in the New English Review:
It hardly requires me to point out that obesity has become a greater threat to the health of the human population in most parts of the world than famine. There was a wonderful cartoon recently in the British magazine, The Oldie, which captured this perfectly. A mother is taking a plate of food away from her child, who is protesting. “Think of the obese millions!” she says to him. When I was young, of course, we were told to finish what was on our plate and to think of the starving millions. Being a precocious little brat, I used to ask how eating what I did not want would help them. Let us just say that the reply was seldom well-reasoned, either in form or content.
It has now become an almost unassailable orthodoxy, at least in medical journals, that obesity is an illness in and of itself: that is to say, it does not merely have medical consequences, but — even without those consequences — is a disease. To be fat is, ipso facto, to be ill, in the same sense as to have Parkinson’s disease is to be ill.
Nor, according to the modern orthodoxy, is obesity to be considered the natural consequence of bad or foolish individual choices, a lack of self-control. That would be to blame the victim. The fat person is in effect the vector of forces that play upon him or her, without any contribution on his or her part.
This is an idea of long gestation. Reading an old text on obesity, published in 1975, and edited by one of my medical mentors, I came across the following quote from a paper written in 1962:
I wish to propose that obesity is an inherited disorder and due to a genetically determined defect in an enzyme: in other words that people who are fat are born fat, and nothing much can be done about it.
This is like saying that addicted people are born to be addicted, and until doctors discover a technical means of stopping their addiction, they might as well make no efforts on their own behalf. No doubt the people who adhere to this view – that obesity and addiction are illnesses simpliciter – think they are being generous but in fact they are forging psychological manacles. No doubt the fat woman in the bakery was at some level trying to prove to herself that obesity was a fatality and not under any possible individual control.
But is the theory in accord with the scene I have described above? In fact, the scene might lead us to a more nuanced or less categorical view of the problem of obesity (and, by extension, of other social problems) than we might at first adopt.
