In this Walrus Magazine article, NEDIC Director Merryl Bear weighs in on the so-called "obesity epidemic" and the stigmatization faced by plus-sized women. Read the full story here.
By Katheleen Ashenburg
Photography by Derek Shapton
The Walrus Magazine, January/February 2013
Writer Terry Poulton found the secret to a happy, healthy life in her plus-sized body. Will the “obesity epidemic” finally force the rest of us to confront our fear of fat?
THERE IS no point in asking Terry Poulton how much she weighs, because she has not stepped on a scale for almost twenty years. But she is, as she notes matter-of-factly, fat. She is also attractive, with short auburn hair, sculpted cheekbones, and a redhead’s penchant for green. When we meet at Ryerson University in Toronto, where she moderates a course in memoir writing, she is wearing jade rings and bracelets, and a furl of emerald glass she has looped over some beads. Soft spoken and well spoken, she does comic things with her hands, occasionally raising them to her ears and flapping them, minstrel-show style, to emphasize a point.
There is much occasion for emphasis in her poignant story. Born in 1945, she was two years old when her parents separated. Despite that, she remembers her early childhood, spent in the small Alberta towns of Calmar and Leduc, as idyllic. She was a pretty, smart, and well-loved little girl, and her mother found jobs, such as housekeeper at a nearby farm, that allowed Terry and her sister to tag along. But when Terry was around nine, Betty Poulton had to find a better-paying job. When Terry returned from school, “Mom wasn’t home, but the peanut butter was. I would sit there eating peanut butter sandwiches, and read and read and read.” As her weight ballooned, the approving faces she was used to seeing disappeared. When she was twelve and she failed to master a square dance figure, a favourite teacher called her a “bull moose.” At her school’s field day, she was relegated to the least desirable category, the “overweight, the puny, and the congenitally uncoordinated,” as she calls them. During their events, always the last of the day, the townspeople stood around making cruel remarks.
Poulton looks at her high school pictures now and notes that she didn’t look half bad: she’s wearing her poodle skirt and she has a waist, but she felt monstrous. The reinforcement for that was plentiful. When no one invited her to the graduation dance, she screwed up her courage and asked the only boy she thought might accept. He told her he would be out of town, and she spent the night at home. Later, she learned that he had gone alone.
Although her voracious reading and talent for writing should have destined her for university, after graduation she took a secretarial job at Great-West Life Assurance in Edmonton. One of the clichés of our time is that poverty makes you fat, but it may also be true that being fat makes you poor. Certainly, fat people are under-represented in higher education, top careers, and high income brackets. Poulton was fired from her first job after two months because her 160-pound weight was thirty pounds over the limit for the company’s employee life insurance.
After summoning the nerve to move to Toronto at nineteen, she worked as a secretary, eventually for the Canadian Conference of the Arts, where she began writing the organization’s newsletter. Peter Newman, then the editor of Maclean’s, noticed her work, and on the strength of that she began freelancing for Maclean’s, and then Chatelaine, Toronto Life, and others. Big-city life presented new challenges. A waiter in a well-known high-end restaurant took one look at her and offered an armless chair, which she refused. Then there was the intimate humiliation of living with a man who, on the rare occasions when she met his friends, introduced her as his tenant.
Otherwise, her twenties and early thirties were marked by a series of doomed diets. One of the most drastic involved a five-month stretch when she subsisted on nothing but liquid protein. For another, she took three buses north of the city every day for months to take injections of human chorionic gonadotropin, a hormone found in the urine of pregnant women, and ate just 500 calories a day (about a quarter of the norm for women). Soon after she came off that regime, she was cooking hamburger one night and watched herself, as she would a stranger, reach into the frying pan for some raw meat; she mimes scooping up a handful and putting it in her mouth. “And I am not a steak tartare kind of girl,” she says, still wide eyed at the bizarre behaviour driven by starvation.
For Merryl Bear, the director of the National Eating Disorder Information Centre (NEDIC), Poulton’s tumble into self-doubt, shame, and extreme dieting sounds all too familiar. Compared with girls medically defined as normal-weight, obese girls are 2.7 times more likely to be bullied verbally on a regular basis, and are shut out from group activities 3.4 times more often. These statistics come to life in an exercise Bear uses in her workshops for those with or at risk for eating disorders, their families, and professionals. First she asks participants to throw out adjectives inspired by the word “thin”; responses typically include fit, healthy, in control, affluent. Says the slender Bear, “I would like to be any of those things.” The word “fat,” on the other hand, invariably conjures up dirty, lazy, ugly, unhappy, depressed, no friends, out of control, and unhealthy. Although the public has become more concerned about eating disorders such as anorexia nervosa and bulimia, Bear points out that “what hasn’t changed is the stigmatization of weight.” It’s a sad irony, since this shaming contributes to clinical eating disorders as well as a wide range of abnormal eating patterns, including chronic restrained eating and habitual dieting.
Which brings us to late 1981, when two editors at Chatelaine took Poulton out to lunch and gingerly asked how she felt about being the centre of a closely monitored diet and exercise program for six months. She would be expected to lose sixty-five pounds, one-third of her 200-pound self, with her achievement culminating in a triumphal cover story in June 1982. Poulton answered, “Hot damn, yeah!”
Thirty years later, I cannot mention the series to women of a certain age without heads nodding and a chorus of “Oh, yes, I remember that.” Although women’s magazines had been absorbed with weight for a long time, this intense six-month focus was new. So was the fact that the dieter was also the writer: Poulton became an Everywoman, humorous, confessional, indomitable, despite having lost and regained 300 pounds over the years. She connected with the many normal-weight readers who lived in a constant state of weight and food preoccupation, as well as with the overweight.
The series makes painful, if irresistible, reading. The daily 1,200-calorie regime, which Poulton reduced to less than 1,000 as she panicked her way to the finish, was beyond spartan. The official exercise plan peaked at forty-five minutes, which she doubled, swimming twenty-two lengths of an Olympic pool; and since fitness centres were not on every corner in 1982, she had to travel thirty-two kilometres to Mississauga from the downtown apartment she shared with her fiancé. At one point, she moved temporarily into a Mississauga apartment furnished with a single chair and a mattress. Within weeks of her leaving, the man she considered the love of her life had replaced her.
Through it all, Poulton was writing what she calls “happy talk” about the pleasure of lengthening her stride now that she was not afraid to jiggle, or enjoying one-calorie diet colas, “which use a newly discovered sweetener called aspartame.” At first, she tried to write honestly about the difficulty, the discouragement, and the personal fallout, but Chatelaine would have none of it. She mimics the magazine’s cheerleader approach: “We’re all dieting together, ladies! We’re all happy, and we’re going to be even happier at the end!”
Once she reached her goal of 135 pounds, she should have felt like the golden girl she remembered from her earliest childhood. Instead, surrounded by admiration and congratulations, she sensed more acutely than ever how much contempt people must have had for her before she lost weight. She was angry at them and at herself, and she felt a complicated shame she would only understand years later. For women of many different sizes and shapes, that shame still carries a powerful sting.
PREDICTABLY, within a year or so Poulton gained back the weight. She did as much of her freelance work on the phone as possible, and attended any necessary meetings wearing a raincoat under a cape, which she swirled off, hoping the raincoat would hide her multitude of sins. In 1983, now a columnist for the Toronto Star and increasingly desperate, she found herself contemplating the most dramatic insult of all to her body. Out of the blue, and unrelated to the broken ankle that had brought her to his office, a doctor asked her, “Have you ever thought of getting your stomach stapled? ” Then he gave her the name of a bariatric surgeon.
Surgical intervention for obesity had existed since the ’50s, but by the ’80s its popularity was snowballing, as ideas evolved about fat and medicine’s role in treating it. (Early statistics are hard to come by, but according to the Agency for Healthcare Research and Quality the number of these surgeries performed in the United States increased ninefold from 1998 to 2004.) The most common type is the gastric bypass, in which the surgeon creates a small pouch at the top of the stomach and connects it straight to the small intestine. This alters various physiological processes, resulting in rapid, radical weight loss—or at least that’s the theory. Poulton had a version of the surgery in 1985, but it was not a success. “Well, look at me,” she says, pointing out the obvious by spreading her hands on either side of her thighs. “I’m still fat!” She is, meanwhile, left with the downside of the surgery: if she doesn’t chew every mouthful to mush, she must vomit to relieve the discomfort, sometimes as often as once a week.
Vomiting aside, Poulton maintains that she is not an overeater. The two-week food diary Chatelaine had asked her to keep before she began dieting established that, left to her own devices, she ate just 2,000 calories a day. The fat woman who eats less than her skinny sister is far from rare, and scientists increasingly see obesity as a complicated, imperfectly understood condition that involves as many as 400 genes. On a scale of complexity, Mike Gibney, a professor of food and health at University College Dublin, assigns heart disease a score of one, cancer a ten, and obesity 100.
The scourge of overweight makes us so nervous that in our quest for thinness we ignore some hard truths. The hardest of all is that every body has a “set point,” a weight range within which we are healthy, and which is almost impossible to shift. As the NEDIC website says, “Your body doesn’t know the difference between a famine and a diet,” and it quickly adjusts your metabolism to preserve your set point. Within five years of losing weight, almost all dieters gain it back, and many gain more than they lost. Poulton believes that her decades of dieting permanently slowed her metabolism, as her body struggled to keep her alive through deprived conditions, but no one really knows what caused her excess weight in the first place, or exactly why the surgery didn’t work.
By 1990, she had hit rock bottom. From being the poster girl for weight loss and then a media darling with a million readers, she began retreating farther and farther from the public’s gaze. She had left the Star in 1987 and written a few screenplays. Three years later, telling her friends, “I’m running to nowhere,” she moved to Louisville, Kentucky, where her sister and nieces and nephews lived. “I felt like an outcast because I was so conflicted,” she says. “Nobody knew me or anything about me, and that’s why I went.”
She was working as a secretary, lonely in the insular town except for her family, when the Toronto literary agent Helen Heller contacted her. Noting the rise of “scolding articles” about obesity in the popular press, Heller wanted a book about what she saw as a climate of moral judgment, and she wanted Poulton to write it. No, Poulton insisted, “I will write about compost, I will write about trains, but I am not writing one more word about Terry Poulton’s body.”
But Heller had tickled the writer’s itch, and Poulton capitulated. Soon after she began her research, she had her eureka moment: the desire for slenderness, she realized, was driven by a multibillion-dollar weight loss industry in North America, from women’s magazines to doctors to the purveyors of diet pills, potions, and plans such as Weight Watchers. In this scenario, everybody wins except the woman. She loses, not pounds—or not permanently—but dollars and what little self-respect she has left. Asking for the first time, “Why be thin? ” Poulton didn’t like the answer. “We all thought it was about being slender and beautiful,” she says, “but it’s really about being obedient little consumers.”
Of course, so much money could not have been made if we did not already fear fat in ourselves and disapprove of it in others; in other words, the financial gain is both cause and effect. The aversion goes way back: it’s there, for example, in the first centuries of the Christian era, when the more you deprived yourself of food, drink, sex, and even cleanliness, the holier you were. Admittedly, monks and nuns and hermits succeeded better at this than everyday Christians, but the goal—to exalt the spirit while depriving the body—resonated. For centuries, this ascetic ideal coexisted with a folk medicine belief that fat was protective, as well as with an aesthetic preference for voluptuousness. Think of the abundant female flesh celebrated in the paintings of Rubens, Delacroix, and Ingres, among many. Or think of Anna Karenina, in which Tolstoy lavishes attention on his beautiful heroine’s “full” arms and shoulders. “In the white peignoir,” he writes admiringly in one scene, “her figure seemed especially big and wide.” Then compare that to the film adaptation released last fall, starring the waiflike Keira Knightley as the zaftig, womanly Anna. It’s not hard to imagine Tolstoy cringing at the sight of Knightley’s arms, which are as thin as a child’s.
Knightley’s slimness is the angular, utterly modern look that was born in the ’20s and is now inextricably linked to our culture’s self-restraining, take-charge values. This is the ideal Poulton repeatedly failed to live up to (she calls it the eleventh commandment, “Thou shalt not be fat”) and, in the case of the Chatelaine series, the tarnished brass ring she dangled before thousands of women. Now, with her epiphany about the weight loss industry, everything clicked into place: intellectually and emotionally, she was done with shame. “I would still love to be slender,” she says. “Who wouldn’t? The clothes alone! But the shame can’t come back.” As she explained in a television interview with TVO personality Allan Gregg, “Now I want to do the right thing by this aging body. Stepping on a scale destroys your spirit. This really does feel like being free.” Rather than weighing herself, she exercised when it suited her schedule and ate a wide variety of foods, including the occasional dessert, over which she no longer felt guilty.
She realized, too, that she could not avoid writing herself into the book: “I needed a fat chick to hang this on, and she’s me.” No Fat Chicks: How Women Are Brainwashed to Hate Their Bodies and Spend Their Money was published in 1996, and as she told Gregg, she really thought that “the jig is up”: once women saw the man behind the curtain, they would throw off the trammels of weight worry and live healthily, at whatever size nature had intended. But while the book enjoyed a modest success and Poulton continued to live happily and healthily in her own body, her dream of a revolution slowly melted away.
By 2000, when she returned to Canada, the average American woman weighed about 155 pounds, while supermodels like Kate Moss spread the cult of size zero. Concerns about body image and chronic dieting have become so common that they are statistically normal for Canadian women, and men are not far behind. Still going strong, with 7.2 million viewers in its 2012 season, the reality show The Biggest Loser has been following its frenetic, medically irresponsible path since 2004. (Competitors drop ten pounds or more weekly, while doctors recommend losing one or two.) Not surprisingly, a younger generation is now drinking the low-cal Kool-Aid: in the 2009 Canadian Community Health Survey, a quarter of grade six girls and boys describe themselves as too fat; for girls, that number rises to 40 percent by grade ten, despite the fact that only 15 percent were overweight or obese, based on their self-reported height and weight. Pro-anorexia websites now proliferate, encouraging visitors to engage in compulsive behaviour that carries a 10 percent death rate over a ten-year period, making it the most dangerous of all psychiatric disorders. Meanwhile, the medical establishment and the culture at large seem increasingly preoccupied with the so-called obesity epidemic.
THE TURN of the millennium saw fat emerge as a plus-sized health emergency, implicated in a raft of illnesses from type two diabetes to high blood pressure to heart disease. “Almost overnight,” writes Michael Gard, an academic specializing in health issues, “obesity joined the ranks of famous infectious contagions and was transformed from a slow-moving inconvenience into an agile killer.” Encouraged by a delighted mass media, stories proliferated about 300,000 (or 400,000—accounts varied) Americans being killed every year by obesity. Fat people were no longer just eyesores; they were making themselves seriously ill, and potentially compromising the health care system. In 2003, the World Health Organization declared obesity a crisis.
“I would say the cultural conversation has shifted,” agrees Jenny Ellison, “to the idea that obese people are a societal burden.” A historian at Mount Allison University whose special interest is fat activism in Canada, she notes that before 2000, people typically wanted to lose weight to look better. Now it’s “I just want to be healthy.” The medicalization of weight has some obvious origins, including a beleaguered health care system, and higher expectations that individuals assume responsibility for their own health. But it may also function as a more politically correct smokescreen behind which doctors and lay people can express their disgust about fat. It’s more civilized to say of a friend, “I’m concerned about her health,” than to ask, “Doesn’t she look dreadful since she gained weight? ”
Not everyone sees fat people as gobbling up our health dollars while they kill themselves with calories. In the new field of critical obesity studies, Glenn Gaesser (Big Fat Lies), J. Eric Oliver (Fat Politics), Paul Campos (The Obesity Myth), and Michael Gard (The Obesity Epidemic, with Jan Wright, and The End of the Obesity Epidemic), among others, underscore the complexity of obesity and challenge its so-called health dangers. Many of their points are plausible: too much anti-obesity medical research has been funded by pharmaceutical companies and other vested interests; the standard measure of weight, the body mass index, is too blunt an instrument to yield much valuable information; and, despite the scary headlines, obesity rates have already peaked and may even be decreasing.
Nortin Hadler, a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, has been swimming against the tide for decades. His latest book, Rethinking Aging: Growing Old and Living Well in an Overtreated Society, makes use of two important studies, one Canadian, published in 2009, and the other Australian, published in 2010, that overturn the prevailing belief about obesity and health. The Canadian study, which followed 11,000 subjects over eleven years, established that overweight and even obese people have no more, and perhaps less, risk of mortality than normal-weight people. Only those at the extremes, the very thin and the morbidly obese, showed a decrease in expected longevity. (The body mass index, or BMI, which relates weight to height, defines, for example, a five-foot-six woman between roughly 114 to 154 pounds as normal weight, from 155 to 185 pounds as overweight, from 186 to 216 pounds as obese, and above that as morbidly obese.) The Australian study—more nuanced than the Canadian one in isolating weight from other factors such as exercise, alcohol, and tobacco consumption, in a population aged seventy to seventy-five—produced even more striking findings: people considered overweight had a 13 percent lower risk of death than those of normal weight. Probably erring on the side of caution, Hadler summarizes the research: “It suggests that being a bit chunky is not such a bad thing. In fact, if there’s a trend, it’s toward the good effects and not the bad.”
In this ongoing debate, the most surprising development, known as the obesity paradox, also points to fat’s protectiveness—in this case, from certain diseases. A series of independent studies done over the past decade shows that when a normal-weight person has diabetes, heart disease, heart failure, kidney disease, high blood pressure, or a stroke, he or she often has a significantly poorer outcome than one who is overweight or obese. In the case of diabetes, normal-weight patients are more than twice as likely to die than those who are overweight or obese. In a study of coronary heart disease, obese people also did better than their thinner counterparts. In 2002, when Carl Lavie, the medical director of cardiac rehabilitation at the John Ochsner Heart and Vascular Institute in New Orleans, produced one of the earliest demonstrations of the obesity paradox, about heart failure, it took him almost two years to find a journal willing to publish his research. He told the New York Times, “People thought there was something wrong with the data. They said, ‘If obesity is bad for heart disease, how could this possibly be true? ’”
The answers, all speculative at this stage, vary. Some think that normal-weight people with chronic diseases may have gene variants that make them more vulnerable. Others suggest that a body with a chronic disease needs higher caloric reserves; without them, even a normal-weight person may be malnourished. To the doctors and lay people convinced of the evils of fat, this seems deeply counterintuitive, but it is worth remembering the much older folk medicine idea of health with some extra padding, or, as Poulton puts it, “nature’s insurance plan.” Making a more obvious connection, perhaps, critics are wondering if a focus on weight distracts researchers from other, more significant factors, such as cardiovascular fitness. Lavie, for his part, maintains that if one had to choose, “it looks as if it’s more important to maintain your fitness than your leanness.”
Merryl Bear, who grapples every day at NEDIC with the stigma attached to fat, is deeply concerned about the quick and “sometimes very spurious” links made between health and overweight, and of downloading responsibility onto individuals. “It sets up a straw dog,” she says wearily of the anti-obesity campaign, “and it’s much easier to battle this single entity than to tease out the complexities that lead to ill health and do something about the causative factors.” With the earnest patience of someone who has said the same thing hundreds of times, she notes that weight cycling, or yo-yo dieting, is more dangerous to your health than being on the wrong side of the body mass index. Poulton serves as a case in point, having lost her gallbladder, which is essential to fat digestion, in her early thirties.
The most sensible, compassionate assessment of this whole freighted issue comes from Jenny Ellison. Describing herself as an agnostic about the health or unhealthiness of overweight, she makes two points. Even if being overweight is unhealthy, it does not justify the stigma and bad feelings we foist on fat people. And, since losing weight remains an unsolved mystery, telling people to do it—what Poulton calls the “lose fifty pounds and call me in the morning” syndrome—is not only pointless but cruel.
WE ARE sitting over tea and a plate of thin ginger cookies in Poulton’s cozy third-floor walk-up, in Toronto’s Beach neighbourhood. An electric flame flickers in her tiny white fireplace, and the apartment is full of warm colour (terracotta in the office, robin’s egg blue in the living room), with European scenes framed on the walls. Just down the street are Lake Ontario and the boardwalk where she frequently walks and rides her bike. When I’ve asked about her health, she has says her only problem is high blood pressure, which is well controlled by medication. But, of course, her body continues to be scrutinized. “People tell me things that don’t resonate with me,” she says. “Shouldn’t I have diabetes by now? At sixty-seven, shouldn’t I have heart disease by now? ” She taps the table. “I’m healthy as a horse.”
She still feels conflicted about food: “It was my enemy for so many years that it makes me nervous.” Living alone, she does not eat as well as she should, and does not cook much, although she enjoys preparing meals for guests. When she has high-calorie foods in the house (“I don’t want to say ‘bad’ anymore”), she wants “to disappear it—it’s got to go. I am a butter abuser, and if I have butter here I will put it on everything. I buy it maybe four times a year.” Food just isn’t that important to her.
Her chief regret, and it is a bitter one, is that she never had children, having deferred motherhood until she got thin. But she seems content, taking a current events course, moderating the memoir course, and this fall releasing No Fat Chicks as an ebook. After conceding defeat more than a decade ago, why would she want to give her book another life now? She says simply that she hopes to make a little money, not seeming to realize that this might be an excellent moment to reissue the book. She wrote it alone, with little connection to others, and she is unaware that it has been important in the thinking of a new generation of activists.
Fat activism has existed in some form in Canada for thirty years, from, as Ellison says, “the feminist-liberation approach of the ’70s, to a body acceptance/self-esteem approach in the ’80s, to the queering/performance focus of the ’90s and 2000s.” (Activists deliberately use the word “fat” to take the sting out of it, and because they reject “obese” as too medicalized.) Of the performance groups, Toronto’s Pretty, Porky, and Pissed Off, co-founded by Allyson Mitchell in 1997, is perhaps the best known. In one piece, mounted at several different public events, four fat women in full leotards would sit on cakes, then shake their be-caked bottoms at the audience. Like most fat activist groups, Ellison explains, it sprang up independently, flourished for a while, then disappeared. Part of the problem is that fat stigma keeps taking on new forms. Most recently, in response to our obesity obsession, activists have been promoting Healthy at Every Size, a concept of wellness that is based on more than just weight. Lenora Le Noire’s blog, Fat and Glamorous in the Kitchen, out of Moncton, is a good example, folding a message of self-acceptance into recipes for the likes of gluten-free chocolate-mint muffins and vegan lasagna (“First, take the bread away from the fat girl… then, the cheese? Bread and cheese is the staple diet of the fat girl. However will I survive!? ”). The accessibility of the online world no doubt contributes to some wider recognition of these ideas.
Poulton and I talk about Jennifer Livingston, a CBS TV anchor in Wisconsin who received a rebuking email telling her that she had a “community responsibility” to lose weight and be an example to the young. She responded with an eloquent request for kindness and respect, watched on YouTube by 10 million viewers at current count. The New York Times has covered the topic diligently, and not just on its health pages; television critic Alessandra Stanley wrote an article last fall about the new generation of female comedians and actors who are unabashedly, unselfconsciously overweight. Their nonchalance is exemplified by the character Hannah, played by Lena Dunham on Girls. She tells a boy who remarks on her flabby stomach, “No, I have not tried a lot to lose weight, because I decided I was going to have some other concerns in my life.” When CBC Radio’s The Sunday Edition devoted almost an hour in last October to “The Great Weight Debate,” about the fat-versus-fit controversy, the response was strong enough to warrant coverage on a subsequent episode.
However, if we are to reach a true Gladwellian tipping point, then we will need activists and spokespeople with broad social networks and the “ability to span different worlds.” Only when that happens will we realize Merryl Bear’s modest hope that we could see health and ill health as more complex than a BMI number, or Jenny Ellison’s wish that “we could shift the needle a bit so there is less stigmatization.”
I tell Poulton about Ellison’s remark that fat activists tend to be lone wolves. This takes her by surprise, and she needs to think about it for a minute. Then she says, “Well, it’s not a dignified cause.” It takes courage, she adds, to stand up and be counted as a fat person. Raising her teacup and looking into the middle distance, she wonders, “Can you be Joan of Arc for fat people? ”