Psychoanalysis and Psychotherapy


WWW http://www.psychoanalysis-and-therapy.com
 

Home What's New

Psychoanalytic Writings

Psychotherapy Service Email Forums and Groups

Process Press Links


 

Obesity: How Can We Understand it?

By Em Farrell

This paper looks at the unconscious group processes involved in the creation of our understanding of obesity. It attempts to expose some of the myths we have been fed about weight and size and to consider parallels to a particular understanding of racist ideology: i.e. ‘terrified consciousness’. The issue of the psychological aetiology of obesity is not explored.

Whilst waiting in a long queue at the Post Office I began to look at those ahead of me. I realised I had been labelling in them in my mind. Shortish, black, female, inward looking, neat leather cap, must feel the heat, very self contained and yet the first person I noticed (She was fourty in the queue). Large Caribbean man, (Indian) I thought, builder, painter, by his build and paint spattered clothes, big body, sensible cap, at ease with his muscle and size, not quite as wide as he was tall, but close to it -a woman with tired looking legs, sore feet, uncomfortable high shoes, looking down, struggling. A tall young black man, with a hooded top and a beautiful face - I  realised after looking at the shape of his legs from thighs downwards that he was female. A Greek, short, good looking, large earth mother woman, with a relaxed and gentle face, large breasts and so on and so on.  I was 15th in the queue.

I had not thought about my body at all, except to notice that my feet were getting hot and I wanted to get home.  I looked at the 14 ahead of me. We were all of different ethnic origins and all came in very varied sizes and shapes. We were all waiting for our turn, patiently on a hot afternoon  - and fat and the terror of obesity did not enter my mind.

Key amongst these ‘time-bombs’ are the diet-related illnesses that are increasing rapidly, including coronary heart disease, diabetes and cancers. The rate of obesity is reported to have increased by 250 percent between 1980 and 1998 (Lang, T. and Rayner, G., 2003).

I thought about the queue. There were two stocky builders, whose muscles and size would have placed them in the obese category. There were a couple of men with beer belly’s they would probably have landed up in the overweight group, the Greek lady would be obese, the black young woman not and the woman with the tired legs not. No one was eating and no one looked on the verge of collapse.

Let’s have a look at the obesity crisis as presented in the media.
Here are some facts:
More than half of the UK is either overweight or obese - in 2002 the figures stood at 70% of men and 63% of women.
Obesity in adult women nearly trebled between 1980 and 2002 from 8% to 23%.
The picture for men is even more bleak - obesity nearly quadrupled over the same period - from 6% to 22%.
The situation is not much better for children; among those aged two to four obesity almost doubled between 1989 and 1998, from 5% to 9%.
Among those aged six to 15, rates trebled from 5% in 1990 to 16% in 2001.

If the trend continues a quarter of the British population will be obese by 2010 and a third by 2020. Dame Yve Buckland, Chairwoman of the Health Development Agency said ‘Obesity is a timebomb’ (2003).

Doctors and public health specialists join in and state that the effect on public health is already showing, with obesity-related heart disease, strokes, joint problems and diabetes already taking their toll. The prevalence of overweight and obese people in the population is already estimated to cost the NHS about £0.5 billion a year, and the wider economy a total of £2 billion.

Professor Peter Kopelman, the chairman of the working party which produced the recent government report, Storing Up Problems: The medical case for a slimmer nation, said: ‘This report highlights the terrifying health consequences of the obesity epidemic that will particularly impact on our children unless coherent preventive measures are taken’(Kopelman, 2004). The fears include the collapse of the national health service and children dying before their parents.

I spoke in Brighton a couple of years ago on ‘The Psychodynamics of Obesity’ and said -  ‘It’s important not to underestimate the enormity of the problem. A 1000 people per day are moving into the obese category in this country’ (Farrell, 2003)

The common unit of weight measurement is the body mass index , which is a person’s
weight in kilogram’s  divided by their height in metres squared. If your body mass index falls within these 15 and 20 you are underweight, between 20-25 is considered healthy, up to 30 is overweight , up to 35 is obese and over 35 is super obese, over 40 is morbid obese and over 45 is super morbid obese. In fact, according to these categories only 30% of men and 37% of women in the United Kingdom are either an acceptable weight or underweight. As of December 2002 only 20% of Americans are inside desired weight levels (although some may be below)

If there is an epidemic what are we to do? Ban food advertisements aimed at children, whether subtle like the fruit-winders that texted messages to teenagers mobile phones, in order to bypass parents, or overt ones, such as Gary Lineker eating Walkers crisps

Should we make people more active? The government has been trying to encourage increased activity for the last two years. For example 80% of those who sign up for gym memberships fail to return. The government’s exercise strategy has failed and its latest attempt is to encourage us to hoover or clean in order to use up calories is worringly inane.

I suspect the hardest thing to do about obesity is to stop and think about it. I have just read a book that has changed my mind about weight in a fundamental way. It is called ‘The Obesity Myth: Why America’s Obesssion with Weight is Hazardous to Your Health by Paul Campos (2004).

The direction I’m now going to take is very much influenced by him. He says:

This book documents how the current barrage of claim about the supposedly devastating medical and economic consequences of “excess” weight is a produce of greed, junk science and outright bigotry. It blows the whistle on a witch-hunt masquerading as a public health initiative, by exposing the invidious cultural forces that encourage us to hate our bodies if they fail to conform to an arbitrary and absurdly restrictive ideal (Campos, 2004, p.xvii).

The key assumptions of the Government’s campaign are: that being overweight is bad for you and the more overweight you are the worse it is. Your goal, to improve your health, should be to exercise and lose weight.

These things are not as true as the Government would have us believe and yet most people do not consider questioning these ideas. What I want to consider is not only how fat has become demonised (this has been the case for years) but how it seems to have taken on a life of its own, threatening children, the NHS and our economic stability. It has become an active and frighteningly out of control horror that we have to defend ourselves against if we are to survive.

Let’s consider some of the things we think about weight:

One of the current group fantasies is that eating fat makes you fatter. This is not always true. ‘Americans get 20% less of their daily caloric intake from fat than they did a generation ago, yet at the same time ingest 10% more calories per day than they did during more fat-friendly days. We are getting fatter by eating less fat.’ (Campos, 2004, p.73).

Of course we all know, MPs, psychotherapists, mothers, fathers, daughters and sons is that weight control is a simple matter. Energy in must equal energy out for us to stay the same weight. Any imbalance one way or the other and we gain or lose weight. 

The assumption is that the amount we expend is changeable and gaugeable. This isn’t true either.How our weight is determined is actually rather complicated.

In the womb we are fed by our mothers’. When all goes as it should food is eaten by mother, digested, and nutrients pass in the blood stream to the baby via the placenta and umbilical cord. If our mother is dieting or are unable to get enough nutrition in the first three months then the foetus suffers. Research makes a strong link between  babies who are low-weight because of their mothers inadequate nutrition and the later higher incidence of obesity and heart disease. A dieting mother leads to a baby who has an increased chance of becoming obese.

Givens about our weight and eating. Here are the very obvious ones:

  • How tall you are affects how much you weigh!
  • If you are a man you are likely to weigh more than a woman.
  • Muscle cells use up more calories than fat cells, so the higher your muscle-fat ratio the higher your base metabolic rate.

 

The less obvious ones:

  • The bigger your body’s surface area the higher your base metabolic rate. So if you feed two people who weigh the same the same amount of food the taller one will need more to maintain his weight.

The ratio of fat to muscle is partly inherited, affecting how quickly we metabolise our food. This is linked to our body types of ectomorph, endomorph and mesomorph’s.
The ectomorph: short upper body, long arms and legs, long narrow feet and hands, and very little fat storage. This body type has a narrow chest and narrow shoulders and long, thin muscles.
The mesomorph: large chest, long torso, solid muscle structure and very strong.
The endomorph: short musculature, round face, short neck , wide hips, and heavy fat storage.

  • Appetite can be affected by hereditary factors.
  • The amount of energy we use to metabolise our food has a genetic component.
  • Our metabolic rates vary at birth.
  • As we age our basal metabolic rate decreases. After the age of twenty it slows down by 2% per decade, and more for women with the menopause.
  • The rare cases of an underactive thyroid does slow down basal metabolic rate, and an overactive one does speed it up. Adrenaline can also speed up metabolic rate to some extent.

Set Point Theory
Set point theory is a natural extension to realising that our weight is largely, although not totally, a matter of our genes, 40 of which have been discovered to have a role in hunger and weight regulation. Set point theory sounds rather magical, but is not. In its simplest form it means that all of us have a weight that our body seems to head towards and that once we have reached it, it tries it’s best to stay there, regardless of whether we overeat or under-eat. So sometimes diets don’t work when you are trying to get below your set point and the weight seems unbudgeable. The opposite is also true. You can do a serious amount of overeating and your weight can stay the same. Your body works hard to keep its equilibrium.  An individual’s set point is a product of their genetic inheritance and their experience of feeding during the first year of their lives.

This may be part of the reason why diets don’t work and when they do you might have lost the weight without trying anyway. To illustrate the point, Ethan Allen Simms took inmates of a Vermont State prison and asked them to overeat massively for 200 days. Only 20 were able to do it (fears of never being able to stop were unfounded, 180 of them simply could not do it). Those who stuck it out gained an average of 20 to 25 pounds each, but 18 of them lost the weight gained. Only two, both with a family history of obesity kept the weight on.

It all depends on your body type. Paul Ernsberger and Paul Haskew on reviewing all the literature think re calorie expenditure and intake – ‘light-boned ectomorphs  barely alter their weight despite hearty appetites while endomorphs and some mesomorphs burgeon as they age’ (quoted in Campos, 2004, p.133).

We are up against it when we ask our bodies to gain or lose more weight than they wish. So too with dieting – if we are trying to lose more weight than our body wants it simply won’t let us.  Everyone who diets stringently triggers their body’s response to perceived starvation by improving its fat storing capacities thus making it harder and harder to lose weight each time you try and easier to put it on. This is sometimes called the ‘thrifty gene’ that evolutionary psychologists see as having been a real advantage in hunter-gatherer societies where activity was high and food availability was low. Unfortunately, in a modern urban setting the capacity to preserve fat stores and have increased appetite when food is present is a distinct disadvantage.

Our set point is not entirely fixed, and we already know that our metabolism slows down as we age, suggesting perhaps that weight gain over time may be expected. Your set point can change, but it takes about three years at a new weight for your body to accept it as its norm.

The difference between individuals basal metabolic rate is high. Some people can simply eat more than others and not put on weight. This is true and not some fallacy, just as some people can put on weight extremely easily and some only with great difficulty, and all of us fit somewhere along this continuum. Dr. Eric Ravussin found the number of calories used up by a group of people doing nothing for a day varied between 1067 and 3015. A study reported in 1990 in the New England Journal of Medicine overfed ‘12 sets of identical twins 1000 extra calories per day, six days a week, while the subjects maintained substantially identical levels of physical activity. The subjects lived in dormitories, and their activities were monitored twenty-four hours per day. After just seven weeks, the resulting weight gain among these twenty-four men varied by 300%, from 9 pounds to almost 30 pounds. The variation between sets of twins was much larger than within sets, which indicates the strong role genetics plays in this matter’ (quoted in Campos, 2004, p.176).

Another study reported in 1999 in Science overfed 16 subjects 1000 calories per day for eight weeks. They increased energy expenditure.

The most striking finding that came out of this study was the radically different amounts of energy expended by the study’s subjects through what is known as ‘activity thermogenesis,’ especially non-exercise thermogenesis (NEAT). NEAT is largely determined by activities of daily living, such as fidgeting, maintaining posture, spontaneous muscle contraction, and the like – things most people do not keep track of, and often are not even aware of. The change in NEAT brought on by the overfeeding of these sixteen subjects ranged from essentially nothing to 692 calories per day.’p.177 which is the equivalent of the calories used up running a 6.2 mile race for an average runner. ‘Glen Gaesser points out, ‘with this much variation demonstrated in studies involving a handful of individuals, imagine the variation you might find among 285,000000 Americans, or the six billion members of the human race. BMI charts are much simpler. (Campos, 2004, p.177)
So having any idea that all women or men should be aiming at a certain calorific amount per day is too simplistic.
People need very different amounts of food.

Another fact we are told in myriad ways is that being overweight is dangerous in itself and the more overweight you are the more dangerous it is. As Ansel Keys a renowned obesity expert says: ‘No study has reported a direct linear relation between relative weight and mortality’ (quoted in Sanders, T. and Bazelgette P. 1994, p.102).

Despite our genes we do weigh more than we used to. The explicit aim of the Government is to make the nation slimmer. Dieting is seen as a good idea. The problem is that dieting is a very good way of gaining weight. What seems to be forgotten is what we all know that dieting works in the short term and in the long term makes you fatter. We know that very low calorie diets can reduce your basal metabolic rate by between 20 and 30%. This means that very low calorie diets tell your body to make better use of food when it is next available. It ensures quick weight gain and makes losing weight harder in the future. So we can make ourselves bigger in the long term by going on crash diets. 98% of people end up weighing more than they did before they started.

I remembered something from Shelley Bovey’s  The Forbidden Body, WhyBeing Fat is Not a Sin, where she wrote about a study that suggested quick weight loss followed by quick weight gain led to a higher risk of heart attack. Glen Gaesser, an obesity researcher found that more than 2 dozen studies in the last twenty years found that weight loss as minimal as 10lbs led ‘to an increased risk of premature death, sometimes by an order of several hundred percent.’

Here are a couple of the studies:  2002 a group of men and women of average age 70 ‘found as increased risk of death with a weight loss of 10 pounds or more, even in diabetics. A weight gain in underweight older people reduced mortality by about one-third. Trials of weight gain show benefits, not weight loss.

The other is an old one from the 1960s and is frightening. 200 very fat young people were placed on very restrictive diets. None had any health problems when they started. The boys lost an average of 75 lbs, and almost all of them regained the weight plus a little more. ‘In the years immediately following their participation in the study, these young men suffered a mortality rate that was up to thirteen times higher than that of equally heavy men who had not been put on any sort of diet (fifty died, which is forty-six more deaths than would have been expected among men of similar age over this time period)’ (Campos, 2004, p.220).

Paul Ernsberger and Paul Haskew comment that ‘the astronomical death rate of crash dieters than regain their lost weight (as in fact almost all do) suggests that the hazards associated with fatness may be mainly related to rapid weight loss and regain of weight, not to obesity itself’ (quoted in Campos, P.2004, p.220). Yet the above study has been quoted over 200 times as proof of how dangerous obesity is.

 ‘Dieters as a group run up to double the risk of developing cardiovascular disease and Type 2 diabetese when compared to “overweight” people who do not diet’ (Campos, 2004, p.32).

Dieting is dangerous for you and makes you fat. Visceral fat around organs tends to develop after dieting and is more dangerous than subcutaneous fat.)

What study after study does show is that when the data isn’t tampered with exercise and a good diet can help prevent diabetes, cancer and heart disease.  What causes trouble is eating unhealthy food and having a sedentary lifestyle, not weight or fat per se. ‘The Seven Country Study, which has followed nearly thirteen thousand men from around the world for more than forty years, has to this point observed that the risk of dying from cancer decreases with increasing relative weight’ (Campos, 2004, p. 24). So you get less cancer as you put on weight not more.

Heavier people have less emphysema, chronic obstructive pulmonary disease, hip fracture, vertebral fracture, tuberculosis, anemia, peptic ulcer, chronic bronchitis and much lower rates of osteoporosis. ‘In the United Kingdom more women die from osteoporosis-related hip fractures than from breast, cervical, and uterine cancer combined’ (Campos, 2004, p.25).

A study run at the University of California- Davis compared a weight loss program to a healthy eating and exercise program based on health at every size guidelines found that over two years the benefits of lowered blood pressure, LCL cholesterol, increased activity and increased self acceptance and self esteem went up in the non dieting. The benefits were short lived in the dieting group. ‘Studies of this sort suggest both that the medical profession’s traditional focus on weight loss is hazardous to physiological and psychological health, and that the key to improving the health of larger-than-average persons is to focus on appropriate lifestyle changes while promoting body acceptance, rather than continuing the futile quest to make fat people thin’ (Campos, 2004, p.179).

Being overweight is dangerous but not for our physical health. How we think about it and relate to it is. Morbid obesity in itself is not linked to increased mortality. The largest obese ethnic group in America are Afro-Americans over the age of 50. Worryingly, there are plans to try and try encourage them to hate their size so that they too can pick up the white weight neurosis.

Most white women are quite clear about their own relationship to
to their own fat.

A.. ‘I hate it and want to cut it off’
B. My stomach’s so flabby, just like my mother, how could anyone find me attractive?.
C. I sometimes punch myself, or pull and twist my fat – I hate it so much. Why can’t I get rid of it?
D. I just hate myself at this size. I don’t feel it’s me.

Joyce. 34 5.7 107.3 pounds. ‘When I gain weight, I feel fat and when I feel fat I feel worthless’ (quoted in Campos, 2004, p.157).

I suspect that most people’s associations to fat are negative and the desire is to be rid of it altogether, which is more about a state of mind than a state of health.

Here are a few thoughts about people’s relationship to fat outside of themselves.
 Julia ‘You just weren’t friends with ‘fat’ girls; I think on some level we were afraid it was contagious’ (Campos, 2004, p.166).

Margaret ‘I look around in the gym, everyone has a better body than me. I hate them.’ (Farrell, 2000)

Julia ‘And here we all are, stuck in his absurd hierarchy, hating the women thinner than us, and being disgusted by the women who are not as thin. It’s such a powerful weapon for alienating women from each other’ (quoted in Campos, 2004, p.167).

‘Americans think being fat is disgusting. It really is, on the most important cultural and political levels, as simple as that’ (Campos, p.67).

I was shocked when I first read Irvin Yaloms case study ‘Fat Lady’, about Betty. He says:

I have always been repelled by fat women. I find them disgusting: their absurd sidewise waddle, their absence of body contour – breasts, laps, buttocks, shoulders jawlines, cheekbones, everything,everything I like to see in a women , obscured in an avalanche of flesh. And I hate their clothes – the shapeless , baggy dresses or, worse, the stiff elephantine blue jeans with barrel thighs. How dare they impose that body on the rest of us.
   The origin of these sorry feelings. I have never thought to inquire. So deep do they run that I never considered them prejudice. (Yalom, 1991, p.88).

Campos says, ‘Fat has the power, metaphorically speaking, to make us non-white and poor – and under current cultural conditions it is much easier for an upper-class white person to become fat than it is for him or her to become poor, let alone non-white… ‘Eat fat and die. Or worse yet: Become one of them. (Campos, 2004, p.69)

So fat is dangerous. It can emotionally, physically, sexually and intellectually disenfranchises you. It parallels certain racist ideologies of the 19th and 20th centuries.  Anthony Maingot writes of the whites in the Caribbean.

Or was it perhaps the calm resignation typical of economically comfortable minority groups who look inward making up for their small numbers by finding strength in their group identity but also setting strict limits to their mental parameters and ambitions? Is this the explanation for the survival of these groups: the very existence of a sense of threat
which forces each group to close ranks? (Maingot, 1990, p.70)
That thin is the preserve of the powerful few is certainly true and they seem to possess an anorexic and restricted mind set as suggested in this quote. Yalom never really explored his own prejudice.  Robert Young write about racism, but what he says could equally well apply to fattism.
My point is that it is second nature, and there's the rub. Second nature is history, culture and personal experience disguised as first nature or biology. Indeed, as we have seen, the intellectual racist calls it biology. But it is not first nature or biology. I said above that racism cuts deep. I'd now like to change the image. It is that deeply sedimented by the culture, so deeply embedded that it is not amenable to excision, no matter how enlightened one's subsequent beliefs and practices may be (Young, 1987).
And its reverberations are all around. Anthony Maingot used the term ‘terrified consciousness’ to describe the terror whites felt both unconsciously and consciously of the potential retribution and violent upsurge of the Blacks, as had happened in the Haitian revolution..  Blacks were simultaneously, thought to be uncivilized, stupid and lazy. I want to use this concept to think about society’s fantasy relationship to fat and obesity. There seems to be a terrified consciousness in relation to fat which leads to the fear of a fat take over, the sense of fat as being out of control and inherently destructive which might lead to the destruction of the health service, an immobilized population and children dying before their parents.
There is a grain of truth in this but it is only a grain. We do weigh somewhat more than we used to. BMI’s are going up. It’s also true that our idea of what a healthy size is, is coming down making it harder and harder for anyone to fit inside it. It is also true that modern life with easilyy available dieting, low fat foods and little built in exercise contributes to the growth of our waistbands, but weighing more is not unhealthy in itself.
The fact is that no studies have ever been done on a group who has dieted and kept the weight off, because no such group exists. In 1988 the Council on Scientific Affairs of the American Medical Association said ‘if a cure for obesity is defined as a reduction to a desired weight, with maintenance at that weight for five years, then one is more likely to be cured of most forms of cancer than of obesity’ (Zerbe, 1988, pp. 2547-2551) and this was when the cure rate for most cancers was much lower than it is now.

The campaign aimed at getting people to lose weight is bound to fail. It is misdirected. It is almost as daft as trying to get people to change their skin colour or their height. I want to think about the psychological and emotional toll that the hatred of fat has not on society as a whole but on individuals.

Fat is not only hated, but also seen as doing physical damage to the individual. Frantz Fanon talked of the internalised racist where the ideology of whites was internalised by Blacks. So that Blacks too associated being Black with failing, being lazy, being less, being stupid and being white meant having power, being successful and being pure! The black man or woman idealised the system of white hierarchy and held it in their own mind as a model. The same is true for people who believe themselves to be fat. They believe the propaganda that thin is better, not only in terms of health, but that is will make them a better and happier person with a higher status and so they hate who they are.

Paul Campos says of fat: ‘for many people, this was the single most important issue in their lives; and that, further, the issue had become nearly all-consuming in part because of a general taboo against admitting how important it can be’ (Campos, 2004, p.154).

Fat usually has horrible associations. As Cynthia says: ‘The unspoken assumption is that fat people are undisciplined, lazy, smelly and stupid’ (Campos, 2004, p.171).

I want to make this it a bit more textured by just describing a few of the difficulties of being bigger than normal and unfit. There is the everyday pain and humiliation that accompanies increasing size. As weight increases past a certain point so too do the physical difficulties. Getting dressed becomes difficult; putting on socks and shoes a near impossibility without help. You might get chapped skin from skin rubbing against skin or fungal infections as sweat and moisture get trapped between skin folds. Picking things up is hard, as is going to the loo; wiping  yourself becomes difficult, as does fitting on the loo seat, into the aeroplane seat, the train seat and even the car seat. I have a  thin  and elegant sister who when flying up to Scotland attempted to push impatiently past Robbie Coltrane (who plays Hagrid in the Harry Potter films and is obese) as he was struggling to get into his seat. He said to her ‘Why don’t you go and pick on someone your own size?’ A good point.

Margaret, a very large woman spoke to me about how she isn’t able to deal with the shame and shyness she feels in social situations:

Margaret: You know they say don’t judge people by the way they look but I guess loads of people do and until people get to know you they talk over you a lot and plus you give people that impression because you intend to stand back and you don’t push yourself up front so then they start thinking  “ooh, she’s sitting there all quiet – is she a bit funny”?

So its part of the vibe that you aren’t confident enough to get in there and say “oh hello”, you know, really get up-front like everybody else, so in a group you often get noticed for that anyway, for being big and silent, which draws attention to you anyway.

Em. You’re trying not to draw attention to yourself

M. But that’s why you’re in there at the back not saying a word, because you don’t want the attention, but you really are drawing the attention to yourself, but you haven’t got the confidence to get in there - up front - where you should be, to take the edge off it and say ah here I am, I’m normal, I’m fine, but just you can’t get up front and do that. (Farrell, 2003)

Even books apparently trying to challenge these assumptions end up joining in. Like Fat is a Feminist Issue, with its non-ironic title of The Anti-diet Guide to Permanent Weight Loss and the lovely Overcoming Overeating implicitly or explicitly make the question of eating an apparently simple one. To get it right, all we have to do is to respond to our physiological hunger. The assumption is that our bodies know how to regulate our weight. All we need to do is to retrain ourselves, so that we ignore external and emotional triggers that prompt us to eat and instead learn to recognise and respond to our internal hunger signals. The implication is that we will end up with a body size we are happy with.

These books tend to ignore how complicated a matter eating is, and they assume wrongly that following our physiological hunger will work as a diet in itself, just as the sub-title to Fat is a Feminist Issue suggests.  This is not true but also asks for the impossible – the separation of eating from self.  Carol Munter and Jane Hirschorn’s later books and workshops have a much more tolerant and complex understanding which puts them firmly in the camp of Health at Every Size advocates. They have a useful website: www.overcomingovereating.com.

We will not all end up with the body we want: ‘the body you have been acculturated to want is not genetically available to at least 99% of the people who want it’ (Campos, 2004, p.78).
As Helen Johnston editor of Bliss, a young girls magazine says:
It's tragic even girls of normal weight want to be skinny. They are driving themselves mad trying to achieve unrealistic bodies that even supermodels won't lay claim to.’
Perhaps the fear of obesity exacerbates what is already a difficult situation for the thin, not the naturally thin, but those who have to permanently restrain their eating. For they have to deal not only with their feelings of hatred about fat and all that it stands for but they have also to deal with the cost of being thin. The thin person’s feeling of superiority dehumanises them as it based on a hatred of hunger and appetite in others, and vicious self-hatred of any weight gain in themselves (Johnston, 2004).

As Campos says ’power and privilege in all its forms are associated with thinness.’ (Campos, 2004, p.65) suggesting the opposite is also true.
There are serious physical and emotional costs to under-eating. The effects of starvation do depend on the individual, but some of these side effects are experienced by the 50% of women who are currently dieting in the U.K, and the 80% of who have sub clinical eating disorders. These are the yoyo dieters like Elizabeth Kemp:
‘I am a prisoner of food. I seem to have two systems: One where I am in jail and one where I’m out of jail.
            ...Being back in jail has its advantages after all you see.
   In jail, at least, I know once again I will have some control.’ (quoted in Jaglom, p.146-147)

Men are also catching up. The side effects include intense preoccupation with food, dreaming about it and fantasizing about it, as well as with the body itself, as it is scrutinized for signs of weight loss and change. Emotional changes can include apathy, irritability and inability to concentrate. There are wider emotional consequences as the in and out of prison cycle has its own mini version of manic depression where the high hopes and euphoria of dieting slowly recede and are replaced by the despair of weight gain, which is then potentially alleviated by a new found diet. So women who diet lose some of their intellectual, physical and emotional capacities to relate to others and the world around them. They may also be doing themselves damage as being too thin is associated with an increased mortality risk. For example, The Cooper Institute Study published in the Journal of the American Medical Association. Found that ’middle-aged fit women of average height weighing 146 pounds or more had almost half the mortality rate of equally fit women of the same height who weighed 115 pounds or less’ (Campos, 2004 p.36). Being too thin is dangerous.

Those who succeed in remaining thin, by will, risk their health and live in a state of terrified consciousness about their fat, which limits their intellectual and emotional capacities even more.

I don’t want to demonise being thin. Being any size is fine as long as you are fit and not suffering from an eating disorder. Eating fat doesn’t make you fat. People may use/ misuse food at any weight. What they look like will not necessarily tell you about their relationship with food. Weight loss is close to impossible to achieve. One way of gaining weight is to diet. This type of weight gain is dangerous for your health. Exercise and eating well is good for you and helps reduce the risk of getting cancer, heart disease, high blood pressure and diabetes.

This means in the consulting room we must stop assuming the overweight individual necessarily has a problem with food, just as we may wrongly assume the normal size person does not. So, too, with very large people we see we need to understand how they come to be how they are. We should not aim to have weight loss as a desired outcome.

What I would say it that almost all the men and women I see in my consulting room are preoccupied with how they look, their sexuality, their relationship to their body and food, and only a handful of them have eating disorders.

I would say that:

Whatever age we are, whenever we eat:
We are making a connection to our own beginnings and history, usually without being aware of it.
Whatever age we are, whenever we eat:
We are making a connection to our own body and feelings in the present, usually without being aware of it.
Whatever age we are, whenever we eat:
We are making a statement about our position in the world, our families, and ourselves.

We have to consider how food is used.

I remember having boiled egg and soldiers mashed up, in a bowl with teddy bears around the edge. I remember the jewel-like yellow specks of yolk and the almost lost crunchiness of the white toast. I remember the coolness, the hardness of the silver teaspoon, and the encouraging smile of Nanny, who’d prepared it.  I remember the sense of her expectation that it would be good and her wish that it were so. I remember her smile, as I liked the taste, and my own relief when I did.
                                                                           Marjorie (Farrell, 2004)

 

Every patient’s relationship to food and their body needs to be explored.
The meaning an individual give to their body and their experience of it is what matters. One of most helpful ways is to understand the interplay between society and the individual and then to move into the arena of the object relations of the patient themselves. So that their self-hatred can diminish. Rachel, a 34 years old, 5.3 female 113 pounds, Law professor said: ‘

For me, putting the issue in a political and cultural context was enormously important. Finally, getting more involved in various forms of physical activity in the outdoor helped too. Nature’s a great antidote to culturally inspired neurosis…My biggest regret in life, …is that I lost so much time, so much energy, having this corrosive, destructive disease. I look back on pictures of when I was young now, and think, gee, what a cute kid. I never saw that then. And not seeing that somehow stopped me from doing so many other things in life that are wholly unrelated to how one looks. It’s crazy (Campos, 2004, p.156).

Our fantasised fat can become the storage room for anxieties galore about ourselves and a misplaced idea that there is a weight at which we will be happy. Paul Campos says that ‘for the vast majority of people , reconnecting with their bodies in a beneficial way requires  accepting the simple truth that there is actually nothing wrong with their bodies in the first place’( Campos, 2004, p.211). If only things were so simple. Ferenczi found that some psychosis was triggered by intentional weight loss. Unexpected weight gain or loss is often a response to trauma.

So how can we understand obesity? It is not what we are told it is day in and day out in the press. It will not kill us – unless it is a product of yoyo dieting and unless it is combined with a sedentary lifestyle and unhealthy eating habits. In this case it is dangerous. But if you are fit and are eating healthily increased prolongs life until you reach physically totally immobilizing weights. Eating more fibre, fruit and vegetables does help.

However, remember our weight is not linked in a straightforward way to calorie consumption. It is just about impossible to lose weight permanently. Dieting is the effective of gaining it. Weight needs to thought of as a fact, not a moral failing.

All of us have issues with fat. We are part of a society which hates fat and we need to be aware of own terrified consciousness and our own hatred before we can help others address it.

Yalom with his wonderfully honest self-appraisal talks about his embarrassment of his prejudice being spotted and says to his fat lady that  he wasn’t comfortable working with obesity.

Betty replied: ‘Ho! Ho! Ho! “Didn’t feel comfortable! That’s putting it mildy”. Do you know that for the first six months you hardly ever looked at me? And in a whole year and a half you never – not once - touched me? Not even for a handshake?’ (Yalom, 1991, p.115).

And why did Betty stay with him? Because she hated fat people too.

 

REFERENCES

Bovey, S. (1994) The Forbidden Body. Why Being Fat is Not a Sin.  New York: Harper Collins.
Buckland, Y. (2003) quote from www.telegraph.co.uk/news/main.jhtml?xml=/ news/2003/10/08/nfat08.xml.
Campos, P. (2004) The Obesity Myth: Why America’s Obesssion with Weight is Hazardous to Your Health. Gotham Books: New York.
Farrell, M.E.M. (2002) Personal communication.
Farrell, M.E.M. (2002) ‘The Psychodynamics of Obesity’ unpublished talk given to the University of Sussex Counsellors Association.
Farrell, M.E.M. (2003) Interview with Margaret.
Farrell, M.E.M. (2004) Personal communication.
Jaglom, H. (1990) Eating: A Very Serious Comedy About Women and Food.  Hollywood: Rainbow Filmbooks.
Johnston, H. (2004) observer.guardian.co.uk/Society/ publichealth/story/0,11098,1116982,00.html - 30k
Kopelman, P. (2004) launch of ‘Storing Up Problems: The Medical Case for a Slimmer Nation’, Royal College Physicians News, http://www.rcplondon.ac.uk/news/news.asp?PR_id=201
Lang, T. and Rayner, G. (2003) ‘Food and Health Strategy in the UK: A Policy Impact Analysis’, Political Quarterly, 74:66-75.
Maingot, A. P. (1996) ‘Haiti and the Terrified Consciousness of the Caribbean’ in
Oostindie, Gert (ed.), Ethnicity in the Caribbean: Essays in Honour of Harry Hoetink. London: Macmillan, pp. 53-80. 
Munter, C. and Hirschorn, J. (1989) Overcoming Overeating. New York: Ballantine Books.
Orbach, S. (1978) Fat is a Feminist Issue: The Anti-Diet Guide to Permanent Weight Loss.   London: Paddington Press.
Sander, T. and Bazelgette P. (1994) You Don’t Have to Diet. New York: Bantam Press.
Yalom, I.D.(1991) (1989) Love’s Executioner and Other Tales of Psychotherapy.  London: Penguin.
Young, R. (1987) ‘Psychoanalysis and Racism: A Loud Silence’ www.human-nature.com/rmyoung/papers.

Zerbe, K.J., (1988) The Body Betrayed: A Deeper Understanding of Women, Eating Disorders and Treatment. Carlsbad: Gürze Books.


 

 

 

 

 

| Home | What's new | | Psychoanalytic Writings | Psychotherapy Service | Email Forums and Groups | Process Press | Links