SOCCUL4

Sociological Inquiry

, Vol. 79, No. 1, February 2009, 25–50 © 2008 Alpha Kappa Delta DOI: 10.1111/j.1475-682X.2008.00271.x

Blackwell Publishing IncMalden, USASOINSociological Inquiry0038-02450038-0245©2008 Alpha Kappa DeltaXXX Original ArticleFRAMING THE FAT BODYSAMANTHA KWAN

Framing the Fat Body: Contested Meanings between

Government, Activists, and Industry*

Samantha Kwan,

University of Houston

Sociologists have long recognized that social problems do not derive solely from objective conditions but from a process of collective definition. At the core of some social issues are framing competitions, struggles over the production of ideas and meanings. This article examines competing cultural meanings about the fat body. Through frame analysis of organizational materials, I map the contested field of obesity and document three cultural frames—medical frame, social justice frame, and market choice frame— as represented by the Centers for Disease Control and Prevention (CDC), the National Association to Advance Fat Acceptance (NAAFA), and the food industry group the Center for Consumer Freedom (CCF), respectively. Using the “framing matrix,” I explore each frame’s key signature elements and discuss its social and cultural significance. Notably, each frame leads to different outcomes for social equality and how society thinks about fat bodies, health, and public policy.

Introduction

The Centers for Disease Control and Prevention (CDC) warns of an obesity “epidemic” and the health risks associated with being “overweight” or “obese” including an increased risk of type 2 diabetes, heart disease, stroke, and hypertension (U.S. Department of Health and Human Services 2001). At the same time, members and allies of the fat acceptance group, the National Association to Advance Fat Acceptance (NAAFA), challenge medical data linking obesity to disease, claiming that fat bodies can still be healthy, and draw the public’s attention to size-based discrimination and the dangers of yo-yo dieting (Campos 2004; Ernsberger and Haskew 1988; Gaesser 2002; Kratina, King, and Hayes 2003; Wann 1998). Additionally, food industry represent- atives at the Center for Consumer Freedom (CCF) also question medical research linking obesity to disease, arguing that obesity’s economic toll is exag- gerated, and charge that a $40 billion a year weight-loss industry influences obesity research (CCF 2004). Both these groups, albeit in very different ways and for very different reasons, contest the CDC’s medical position.

Challenges to the dominant view of overweight and obesity are expected. Overweight and obesity are not just medical facts; they are social issues that various groups, industries, and “moral entrepreneurs” vie to define (Becker

26 SAMANTHA KWAN

1963; Sobal 1995). Sociologists have long recognized that social problems do not derive solely from objective conditions but from a process of collective definition (Blumer 1971; Hilgartner and Bosk 1988; Mauss 1977). Actors come together to define social problems and their meanings. While some groups assert the existence and/or offensiveness of some condition, others convince authorities and the public that there is a moral problem at hand (see Becker 1963; Kitsuse and Spector 1973). When meanings involve the medical profession, the medicalization of deviance and medical definitions may take precedence (Bury 1986; Conrad 1992). Thus at the core of some social problems are framing competitions—struggles over the production of ideas and meanings (Benford and Snow 2000).

For many years gender scholars have studied the fat body. Bordo (1993), Hesse-Biber (1996), and Wolf (1991) have written extensively about the oppressive effects of a thin body ideal. While these feminist contributions provide valuable insight into cultural meanings about the fat body, they focus narrowly on how beauty ideals are oppressive, particularly for women. However, in recent years, there is growing discourse in the public arena about the meanings of the fat body. It is in this cultural climate that groups such as the CDC, NAAFA, and CCF have stepped up claims-making. This article maps out their competing claims and how each group “frames” fat. What is each group’s message and how is it promulgated? Moreover, what are the cultural and social implications of each frame? As I illustrate, each frame leads to different outcomes for social equality and how one thinks about the fat body, health, and public policy.

Framing Theory and Framing Fat

Framing theory and frame analysis build on the basic tenets of social constructivism, providing a theoretical and methodological tool for the study of social problems in the public arena. As a sociological concept, framing has its roots in Goffman’s work. According to Goffman (1974:25), framing is an attempt to define “What is it that’s going on here?” As cognitive shortcuts, frames enable actors to make sense of everyday social experiences; actors can arrive at a “definition of a situation,” organize and interpret experience, and act accordingly (Goffman 1974). In other words, frames enable efficient information processing, suggesting what is at issue and a course of action. The process involves selection and salience; selecting some aspect of a perceived reality and making it salient so as to promote a particular definition of the problem (Entman 1993). It also involves diagnosing causes, making moral judgments, and suggesting policy remedies (Gamson 1992; Iyengar 1991; Ryan 1991).

Cultural frames are not just about the frames themselves and the interplay between competing or complementary frames, but they are also about the relationship between frames and agents. Frame competitors attempt to convince

FRAMING THE FAT BODY 27

others that a specific frame is the best and most accurate representation of social reality, that is, that one frame is superior. According to Snow and Benford (1988), frame credibility and relative salience determine “frame resonance,” the extent to which a frame is effective, adopted, and/or has mobilizing potential, particularly for actors in social movements. For example, the more a frame reflects personal experience and familiar cultural themes, the more likely it will be accepted as a natural way to interpret reality (Ryan 1991; Snow and Benford 1988). Addition- ally, the more a frame resonates with a “master frame” (e.g., the women’s move- ment successfully borrowed from the rights master frame), the more likely it will be effective and/or adopted. Master frames are broad in scope and function as a kind of master algorithm for other frames (see Snow and Benford 1992).

Frames are important. Because frames not only define an issue but also prescribe its solution (Gamson 1992), frames have the ability to reduce or contribute to social inequality (also see Saguy and Almeling 2008; Saguy and Riley 2005). As Menashe and Siegel (1998:310) claim, “[t]he concept of framing has important implications for individuals’ opinions and attitudes.” Thus the framing of fat as an individual health problem suggests that its cause is partly genetic and/or due to a lack of restraint and discipline. This frame blames individuals for their bodies and suggests policy that encourages changes in individual lifestyle. It also endorses moral judgments of fat individuals, thus legitimizing social inequality and health disparities (see Saguy and Riley 2005). In contrast, framing obesity as a result of structural influences, such as a lack of access to nutritional knowledge or high-quality foods, suggests that individuals are less blameworthy. Here, an appropriate line of action involves addressing these structural disparities, a strategy that redirects focus from the individual. The relationship between frames and social inequality is especially important because in modern Western societies fat is a visible status characteristic that often comes with stigma and bias. Research points to widespread size-based discrimination in all areas of social life such as employment, medicine, education, and law (Puhl and Brownell 2001; Sobal 2004).

Despite these important implications, little is known about the cultural framing of fat. While sociologists have conducted frame analyses on various health issues including child sexual abuse (Beckett 1996), abortion (Rohlinger 2002), and partial birth abortion (Esacove 2004), obesity only recently appears on the framing agenda (Lawrence 2004; Martin 2002; Saguy and Riley 2005). This interest in obesity frames may be attributed to recent calls to “think sociologically about sources of obesity” (Peralta 2003:5) and to make “fat a sociological issue” (Crossley 2004:223)—attempts to broaden the understanding of obesity beyond the domain of biology and psychology. Recent debates about whether obesity is really a public health crisis or a moral panic (Campos et al. 2006; also see Rich and Evans 2005; Saguy and Almeling 2008) that might be

28 SAMANTHA KWAN

better labeled a “postmodern epidemic” (Boero 2007:42) also underscore the complexities of this social issue. It is in this contentious climate that the food industry is articulating a position on obesity, setting a timely agenda for examining framing by this new contender.

Recent Work on Fat Frames

Sociological work on defining obesity and its meanings can be traced to Sobal’s (1995) earlier writings on obesity models. According to Sobal (1995), fat shifted historically from a sign of health and wealth in traditional societies to being seen as bad, sinful, and ugly in modern societies. With the agricultural and industrial revolutions that assured more regular food sources, fat began to be viewed unfavorably. This shift provided the basis for a moral model of fatness, suggesting that fat people are responsible for their condition and should be punished as a means of social control (Sobal 1995). This moral model was prominent until the “medicalization” (Brown 1995; Conrad 1992) of obesity took place in the 1950s. More recently, NAAFA’s attempt to demedicalize obesity has led to a new political model aimed at combating discrimination and educating the public about body diversity. In sum, according to Sobal (1995), obesity models shifted from “moral deficit” to “medical disease” to “political discrimination,” although all three, and in particular the moral model, remain evident today.

Saguy and Riley’s (2005) novel study that uses a mix of secondary and original data sources, participant observation, and in-depth interviews is the first systematic examination of obesity frames. Their study examines how groups at the forefront of the obesity controversy—antiobesity researchers, antiobesity activists, fat acceptance researchers, and fat acceptance activists— talk about obesity. They observe several frames. While members of fat acceptance groups embrace a “body diversity” frame, those in the antiobesity camp frame it as an “epidemic” and “risky behavior,” that is, a life-threatening behavior such as smoking that individuals choose. At times, both camps frame obesity as illness. Their study also examines credibility struggles and the appeal by various camps to academic authority and personal experience. While their study does not systematically document frame resonance, they note some success of the body diversity frame in the medical arena, perhaps suggesting a paradigm shift in the public’s understanding of body, health, and weight.

Lawrence’s (2004) work on obesity causal claims in the news media points to a reframing of obesity over the past two decades. Causes of obesity in the news moved from “individualizing frames” that focused on individual responsibility, biology, and personal behavior toward environmental causes. Unlike individualizing frames, “systemic” frames situate individual choice in the context of environmental factors that shape eating and activity levels. Systemic frames also have a broader focus, shifting responsibility from personal moral deficit to government, business,

FRAMING THE FAT BODY 29

and social structural factors such as poverty and the abundance of inexpensive unhealthy foods.

Research on tobacco frames and the parallels between smoking and obesity (Kersh and Morone 2002) suggest that the implication of big business as a key structural influence on obesity may lead to the food industry’s articulation of a self-serving frame. Tobacco interest frames often “conjure up images of an America whose citizens are free to pursue happiness and the American dream by making their own choices in an environment of economic prosperity” (Menashe and Siegel 1998:321). While nutritionists such as Brownell and Horgen (2004) and Nestle (2002) discuss the food industry’s perspective on obesity, it has yet to be sociologically and systematically documented and analyzed. Building on this recent work, I examine how food industry representatives, along with fat acceptance activists, challenge public health claims and disseminate new meanings about fat in the public arena.

Methods

The Framing Matrix

To understand competing cultural messages about the fat body, I turned to frame analysis. According to frame analysts, frames are part of a larger unit of public discourse called a “package” (Gamson and Lasch 1983; Gamson and Modigliani 1987). Packages include key frame(s) and “signature elements”— rhetorical devices used to describe representations of an issue (Gamson and Modigliani 1987). Signature elements of a frame include “reasoning” and “framing” devices. As Gamson and Lasch (1983) describe, reasoning devices include roots (causal dynamics), appeals to principle (underlying values), and consequences (policies). Framing devices, they assert, concern an array of descriptors that facilitate frame articulation and description. These include metaphors (analogies and symbols), exemplars (events to illustrate a key point), catchphrases (theme statements, taglines, or slogans), depictions (characterizations of principal subjects), and visual images (icons and other visual images). Not all elements are necessarily present in a given package and, while frames may be unique, they can draw on similar devices. In other words, devices are not mutually exclusive within frames and across frames. Together, the package, key frame(s), and signature elements comprise the “framing matrix” or “signature matrix.” Frame analysis is about identifying and analyzing the various components of this matrix.

Cases

While there are many groups, or cultural producers, in the public arena that put forth messages about fat, my analysis focuses on three cases. I selected these three cases because they are at the forefront of public debates on obesity.

30 SAMANTHA KWAN

All three groups are vocal on this issue and have an interest in how fat is understood. The three groups also represent what can be considered three competing fat frames—medical frame, social justice frame, and market choice frame. It is noteworthy that the distinct separation of cultural producers is primarily for analytic purposes and to illustrate the social construction of this social issue. Indeed organizations influence one another and governmental agencies often work under the influence and/or pressure of industry. In my conclusion, I discuss the need for research that explores frame interaction.

The Centers for Disease Control and Prevention (CDC)

is a branch of the U.S. Department of Health and Human Services (USDHHS) that monitors overweight and obesity as a chronic disease. The CDC, in line with the medical community, concerns itself with a healthy population. In fact, the medical frame can be more generally referred to as a medical community or public health frame. CDC researchers conduct research and publish their findings in peer-reviewed outlets such as the

Journal of the American Medical Association (JAMA)

. State funds are also used to fund health campaigns that educate the public and encourage healthy lifestyles.

The National Association to Advance Fat Acceptance (NAAFA)

is the most prominent political fat organization in the United States. Established in 1969, it describes itself as a nonprofit human rights organization dedicated to improving the quality of life for fat people and eliminating body size discrimination.

1

NAAFA provides fat individuals with the tools for self-empowerment through public education, advocacy, and member support. Members pay fees to join the organiza- tion; there is an annual convention; and chapters are found throughout the coun- try. Special Interest Groups (SIGs) also provide programs for members who share common concerns. There are approximately 2,500 NAAFA members (Grossman 2003) who are predominantly white, female, middle-class, and in the highest weight categories (Saguy and Riley 2005; Sobal 1999). That the group comprises primarily women is, in many ways, unsurprising given the gendered nature of body discourses and their negative impact on women (Bordo 1993; Wolf 1991).

The Center for Consumer Freedom (CCF)

represents over 30,000 restaurants and taverns in America (SourceWatch 2005) and is an organization that is extremely outspoken about obesity. The CCF is the “most vocal and perhaps well-funded” (Brownell and Horgen 2004:268) public interest group representing the food industry. According to SourceWatch (2005), a project of the Center for Media and Democracy, the CCF (formerly called the “Guest Choice Network”) is a nonprofit public interest group founded in 1995 by Philip Morris, a tobacco company. Ties to tobacco remain evident as the CCF represents the restaurant industry along with the alcohol and tobacco industries. The group’s interest in obesity claims appears to be primarily economic and geared at food sales. The CCF runs major media campaigns to disseminate its message.

FRAMING THE FAT BODY 31

Sample Documents

I collected print materials from each group’s Web site.

2

While I included Web site information in the frame analysis, 42 documents formally comprise the sample. I did not generate these documents randomly, but instead selected them because, after surveying the field of public documents available, I felt that they were representative of each group’s position. They are also documents that directly

generate

the frame, that is, state the group’s perspective. This is not to say that excluded documents do not reflect the group’s frame; to the contrary, they do. But unlike sample documents, omitted documents, such as

JAMA

publications by CDC researchers, NAAFA’s quarterly newsletter, and op-ed pieces on CCF’s Web site, indirectly

support and reinforce

the frame and, as such, are frame-supporting documents, not frame-generating.

For the CDC, I included in the sample the publication

The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity

(USDHHS 2001), hereafter

The Surgeon General’s Call

, and a series of overweight and obesity fact sheets (

n

= 6). For NAAFA, I included all official NAAFA (2005) docu- ments (

n

= 14), all of NAAFA’s information brochures (

n

= 12), and Marilyn Wann’s (1998) book

Fat! So?

Wann is the current Activism Chair on the Board of Directors at NAAFA and her book is akin to a manifesto for the fat rights movement. Finally, for the CCF, I included the group’s print advertisements related to obesity and/or food consumption (

n

= 7) and their publication

An Epidemic of Obesity Myths

(CCF 2004).

Findings

Each cultural producer uses different devices to communicate its message. While I explore each frame separately, there is overlap among the signature elements of all three frames. That is, even when frames compete, they use similar devices, although they often express their own unique interpretation of a device. I present the specific elements of the framing matrix in Table 1. Whenever possible, I preserve the framer’s original words.

The Medical Frame

“America is just too darned fat.” (Secretary of Health and Human Services, Tommy Thompson, keynote speaker at the Time/ABC Obesity Summit, June 2–4, 2004)

According to the CDC’s medical frame, obesity is a “chronic disease and condition” that has reached “epidemic proportions.” An alarmist tone is present throughout government documents. If the situation is not reversed, it could wipe out gains made in areas such as heart disease, diabetes, and some forms of can- cer. At the overweight and obesity homepage, the CDC informs that 30 percent

32 S

A M

A N

T H

A K

W A

N

Table 1

Framing Matrix

Frame Medical Social justice Market choice

Cultural producer

Government officials at the Centers for Disease Control and Prevention (CDC) with the general support of the medical community

Fat acceptance activists at the National Association to Advance Fat Acceptance (NAAFA)

Food industry representatives at the Center for Consumer Freedom (CCF)

Position Medical research using the BMI shows that obesity is a growing health epidemic resulting in serious consequences. Overweight and obesity afflict two-thirds of the population and this health problem has large medical, social, and economic costs.

Fat individuals suffer social stigma, stereotyping, and discrimination because of narrow medical and cultural conceptions of health and beauty. Critical of the BMI for being a misleading indicator of health. Research shows that fat does not necessarily mean unhealthy. Weight-loss drugs, weight- loss surgery, and diets are ineffective and/or dangerous.

Individuals should be able to consume whatever they personally think is sensible. Critical of the BMI for being a misleading indicator of health. Obesity “facts” are actually myths, e.g., research shows that obesity does not have dramatic health costs; a lack of physical activity (and not overeating alone) causes obesity; individuals can be overweight and healthy; obesity is not a disease; and soda does not cause childhood obesity.

(

Continued

)

F R

A M

IN G

T H

E FA

T B

O D

Y 33

Reasoning Devices Roots Obesity is caused by many factors

such as genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences.

Obesity is caused by many factors such as genetics, metabolism, and dieting history.

Obesity is not a disease and is not caused by overeating alone. Lack of physical activity and sedentary living are (implied to be) major contributors.

Appeals to principle

Health is desirable to live a long productive life, where health is defined primarily in physiological terms.

Health is desirable, where health is defined in part as health-at-every-size and psychological well-being. Human rights should be protected. Fat individuals should be able to live free from stigma and discrimination.

Individual choice and right should be protected.

(

Continued

)

Frame Medical Social justice Market choice

Table 1

(

Continued

)

34 S

A M

A N

T H

A K

W A

N

Policies CARE:

Communication

with the public about the goals of a healthy public;

Action

including interventions and activities that encourage changes in behavioral (consumption and activity) patterns;

Research

and

Evaluation

into the causes, prevention, and effective treatment of obesity. Encourage efforts to maintain a healthy weight starting in childhood and continuing throughout adulthood. Dietary and physical activity recommendations.

Dispel common myths about fat persons. Educate the public about the sociological, psychological, medical, legal, medical, and physiological aspects of being fat. Advocate and sponsor responsible research. Fight size-based discrimination in all realms of social life. Include height and weight as protected legal categories.

Mobilization against government regulation of industry.

Rejection of proposed laws that would tax certain high- fat, low-nutritional value foods.

Framing Devices Metaphors The healthy body as a symbol of

accomplishment. The fat (especially female) body as a symbol of beauty and empowerment.

The evils of “big government.”

Catchphrases Obesity is a major public health problem. Obesity is an epidemic. Obesity is a personal and community responsibility.

Fat is not a four-letter word. Fat! So? Health at Every Size. Diets don’t work. War on fat.

Obesity hype. Obesity myths. Personal responsibility. Common sense. Junk science.

Frame Medical Social justice Market choice

Table 1

(

Continued

)

F R

A M

IN G

T H

E FA

T B

O D

Y 35

Depictions Opponents are (implied to be) ignorant to reject scientific studies linking obesity to death, disability, and disease.

Opponents, namely obesity researchers, have an economic conflict of interest and are individuals motivated primarily by financial gain.

Opponents, including trial lawyers who are suing food companies and obesity researchers who are funded by the weight-loss industry, are greedy and self- serving. Activists, “food cops” including the Center for Science in the Public Interest, and government bureaucrats who are proposing warning labels and taxes on certain foods are extremists, radicals, and hysterical.

Visual images

Statistical tables, including BMI tables, and graphs illustrating the prevalence and rise of obesity.

Visual images are rare although Wann (1998) uses satirical drawings of the fat body in an attempt to reclaim it.

Visual devices vary and often employ sarcasm to emphasize personal choice, responsibility, and/or to debunk obesity myths.

BMI, Body Mass Index.

Frame Medical Social justice Market choice

Table 1

(

Continued

)

36 SAMANTHA KWAN

of U.S. adults, or 60 million people, are obese. The CDC expresses concern about the growing number of obese children as the percentage of young people who are overweight has more than tripled since 1980. In their words, “[t]hese increas- ing rates raise concern because of their implications for Americans’ health.”

Repeatedly, the CDC emphasizes the health costs of obesity. CDC Web sites warn that obesity leads to an increased risk of “hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers.” The

Health Consequences

fact sheet provides in-depth information about these health consequences while the

Surgeon General’s Call

provides further evidence for the government’s health concern: “An estimated 300,000 deaths a year may be attributable to obesity. Morbidity from obesity may be as great as from poverty, smoking, or problem drinking” (USDHHS 2001:8, notes omitted).

Data used to support these medical claims rely on the Body Mass Index (BMI)—a calculation based on an individual’s weight and height, where a BMI over 30.0 indicates “obesity” and a BMI between 25.0 and 29.9 indicates “overweight.” According to the CDC, a “normal” BMI is between 20.0 and 24.9. The CDC relies on the BMI because, as it claims, “for most people, it correlates with their amount of body fat.” While the measure has been criticized as a misleading indicator of body fat, especially for very muscular individuals and pregnant or lactating women (e.g., American Obesity Association 2002; Prentice and Jebb 2001), widespread adoption of the BMI by the CDC and the medical community indicates that they consider the BMI a valid measure of health. Notably, other framers explicitly challenge the use of the BMI.

Alongside health costs, the CDC details the economic costs of obesity. Citing a national study, it claims that medical expenses attributed to both overweight and obesity reached as high as $78.5 billion in 1998. Approximately half of these costs, it points out, were paid by Medicaid and Medicare. Not surprisingly, catchphrases of the medical frame include “obesity is an epidemic,” and “obesity is a major public health problem.” For the government, it threatens both the population’s health and economy.

The CDC acknowledges that there are multiple causes of obesity. For example, the

At a Glance

fact sheet states that “[b]ehavioral and environmental factors are large contributors to overweight and obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.” At the same time, it strongly implicates behavioral variables. For example, the

Surgeon General’s Call

states that “For the

vast majority

of individuals, overweight and obesity result from excess calorie consumption and/or inadequate physical activity” (USDHHS 2001:1, emphasis added).

The medical frame rests on an appeal to medical science and health sensibility. The CDC cites medical research to support its claims and public

FRAMING THE FAT BODY 37

health message. While government documents do not expressly depict opponents, embedded in the medical frame are built-in assumptions. Those who contest the medical frame are implied to be lazy and foolish to reject “objective” scientific research linking obesity to disease and death. The CDC presents numerous statistical tables and graphs, including BMI tables, to support its frame and to illustrate that obesity is in fact a pressing public health problem that afflicts a large and growing segment of the population.

Given its focus on health, policy logically focuses on prevention and stalling increasing obesity rates. Specifically, the goal is to reduce the prevalence of obesity to less than 15 percent by the year 2010. Solutions are said to lie with interventions at the individual, community, state, and national level. As described in the

Surgeon General’s Call

and

A Vision for the Future

fact sheet, the national government’s CARE vision combines

C

ommunication,

A

ction,

R

esearch, and

E

valuation. However, even though the

Surgeon General

encourages this range of solutions, it places strong emphasis on individual level variables such as healthy eating and regular physical activity. The

What You Can Do

fact sheet encourages individuals to “activate themselves” and to “Make fitness a priority . . . COMMIT TO IT.” The

Surgeon General’s Healthy Weight Advice for Consumers

fact sheet deals with the problem at the individual level. Imperatives such as “Aim for a healthy weight,” “Be active,” and “Eat well” are exemplary. Furthermore, the goal is for individuals to lose weight to conform not to body norms, but rather to health. The opening line of the

Health Consequences

fact sheet makes this very clear: “

The primary concern of overweight and obesity is one of health and not appearance

.” In many ways then the medical frame depicts the healthy body as a symbol

of accomplishment. Individuals who work hard exercising and practice restraint by eating healthily are perceived as victorious. Their reward is weight loss. This symbol is especially ubiquitous in Western societies with a pervasive ethos that bodies can be transformed at will with discipline, hard work, and determination alone (Brownell 1991) and where the body is a metaphor for the psyche (see Bordo 1993). In this social context, fat becomes a morally suspect identity.

The Social Justice Frame

“‘Fat’ is not a four-letter word.” (The National Association to Advance Fat Acceptance)

Unlike the medical frame, NAAFA’s message focuses less on specific health ailments and more on discrimination issues and promulgating a different under- standing of health. Indeed the frame analysis brings to light how framers, at times, make tacit and/or overt appeals to common ideals such as morality, common sense, and personal choice, but ultimately take these ideals to mean different things. For example, NAAFA activists contend that there are difficulties with diagnosing

38 SAMANTHA KWAN

obesity and weight, just as the BMI is not necessarily a direct reflection of health. So unlike the CDC that adopts “the BMI greater than twenty-five” standard as a meaningful cut-off point, activists reject what they consider to be artificially contrived meanings associated with the BMI. The BMI’s importance lies not with its ability to predict good or poor health, but instead with how others use this number and its meanings to label, stigmatize, and discriminate.

NAAFA claims that there are multiple causes of fat. Numerous factors determine a person’s body weight such as “genetics, metabolism, and dieting history” (

Dispelling Common Myths about Fat Persons

). NAAFA documents stress in part external attribution, describing weight as something partly beyond one’s control. And even if weight were controllable, weight loss is not recom- mended. The group repeatedly articulates the dangers of dieting, alongside diet failure rates, pointing especially to the claim that the National Institutes of Health (NIH) and other studies show that 98 percent of people who lose weight gain it back within 5 years (

Weight Loss: Fact and Fiction

). Similarly, the group condemns weight-loss surgery and drugs as risky and ineffective (

NAAFA Policy: Weight Loss Drugs

;

NAAFA Policy: Weight Loss Surgery

). At the same time the group discourages weight loss, it promotes health as

an attainable goal for fat individuals. Here the medical and social justice frames converge. Both frames claim that physical health is a desirable and achievable outcome. But how each group approaches health differs. In government documents, a BMI greater than 25.0 is a red flag for poor health. For NAAFA members, “just being fat does not signify poor health” (

NAAFA General Information

). Consistent with this statement is a key motto or catchphrase associated with the fat acceptance movement: “Health at Every Size.”

3

The group’s policy on physical fitness confirms this: “[I]ndividual fitness can be achieved despite a high ratio of fat-to-lean body mass . . . fitness is a desirable and attainable goal for most fat people” (

NAAFA Policy: Physical Fitness

). While promoting fitness and health as desirable goals for fat individuals,

NAAFA explains how difficult it is for fat individuals to be fit because of dis- crimination. Prejudicial medical treatment and harassment by health care pro- fessionals deter them from seeking medical assistance. Additionally, even when fat individuals receive treatment, it is inadequate. The stigma with fat also makes many fat individuals uncomfortable participating in beneficial physical activities. One of NAAFA’s goals is to expose the harms of being fat in a society that portrays fat individuals as “unhealthy, unattractive, asexual, weak-willed, lazy, and gluttonous” (

NAAFA Policy: Dieting and the Diet Industry

). The group’s preferred use of the term “fat” (instead of the terms overweight

and obese) reflects an attempt to refute prevalent social constructions. “‘Fat’ is not a four-letter word. It is an adjective, like short, tall, thin, or blonde. While society has given it a derogatory meaning, we find that identifying ourselves as

FRAMING THE FAT BODY 39

‘fat’ is an important step in casting off the shame we have been taught to feel about our bodies” (

NAAFA General Information

). Wann (1998) devotes much of her book to rejecting popular assumptions about, and portrayals of, fat people. Visual images are rare for this social justice frame, but Wann does use satirical drawings and caricatures, especially of the fat female body, to reclaim it. As text accompanying these drawings indicate: “You, Too, Can Be Flabulous!” and “What Do You Like About Being Fat?” (Wann 1998:184, 24). Notably, these statements represent a key metaphor of the social justice frame. The fat body, and in particular the fat female body, is a symbol of beauty and power that challenges hegemonic Western beauty norms.

The medical and social justice frames have another framing device in common. Both frames appeal to medical science and health sensibility. However, the research each group draws attention to and how each defines health sensibility diverge. While government officials turn to mainstream medical research link- ing obesity to health debility, NAAFA underscores medical research showing that weight-loss drugs, weight-loss surgery, and diets are not only ineffective, but harmful. NAAFA also encourages its members to avoid fixation on weight loss and instead to be sensible about health by making sensible food choices, participating in an exercise program, and getting regular doctor check-ups (

NAAFA General Information

). Just like the medical frame the goal is physiological well-being, but NAAFA activists also emphasize psychological well-being.

NAAFA’s social justice frame appeals to human rights. Established in 1969 as a human rights organization, the group combats size-based discrimination and seeks equal treatment for fat people. Its

Declaration of Health Rights for Fat People

declares nine rights pertaining to the administration of health care. For example, the document asserts the right to nondiscriminatory quality health care, to refuse participation in weight-loss programs of all kinds, and to be free from ridicule, coercion, and harassment from all care givers. The declaration is a direct response to what the group feels is a lack of sensitivity by health care providers (

NAAFA Guidelines for Health Care Providers in Dealing with Patients

). The appeal to human rights is also evident in their campaign to have height and weight included as protected legal categories in existing local, state, and federal civil rights statutes (

NAAFA Policy: Size-Related Legislation

). The assumption is that, just like other historically disadvantaged groups, fat people need equal protection. The group’s adoption of the term “fat” is, in many ways, reminiscent of how gay, lesbian, bisexual, and transgender/transsexual (GLBT) activists adopted the term “queer” as a mobilization strategy. NAAFA also references other disadvantaged groups. For instance, it maintains that health research affecting disenfranchised groups such as African Americans, Latinos, and women often involves consultation with these groups. Yet despite offers of assistance, NIH or other obesity researchers rarely consult advocates for the fat community.

40 SAMANTHA KWAN

Unlike the medical frame that does not explicitly mention its opponents, NAAFA’s depictions of its enemies are explicit. Of their major opponent, obesity researchers, NAAFA writes:

Obesity researchers’ hypotheses often incorporate personal or cultural biases against fat people. Unproven assumptions about fatness frequently invalidate the basic premise of research studies . . . mainstream obesity researchers never study alternatives to weight loss [such as exercise] in improving comorbidity factors . . . the obesity research community has refused to see that fatness is not only a health issue, but a psychological, cultural, and polit- ical issue. (NAAFA Policy: Obesity Research)

NAAFA considers its opponents to be narrow-minded, biased, and essentially bad researchers who do not conduct objective research. The group makes clear what they believe is the motivation for this bias. Wann’s (1998) discussion of obesity is representative of NAAFA’s overall perspective. She (Wann 1998:19) writes: “Obese. This is a doctor’s fancy way of saying, ‘I’m looking at you, and I find you disgusting. Would you like this ineffective but wildly expensive weight-loss treatment? If you don’t, you could die. Besides, my country club membership fees are due.” According to NAAFA, “[m]ost obesity researchers experience a profound economic conflict of interest” (NAAFA Policy: Obesity Research). Opponents, like Wann’s doctor, are perceived as self-serving. NAAFA’s position is especially evident when the organization discusses the 1985 NIH consensus conference that proclaimed obesity to be a “killer disease.” The conference led to a redefinition and call for treatment that “translated into billions of additional dollars of research money, commercial weight loss industry profits, and physician’s revenues” (NAAFA Policy: Obesity Research). As such, NAAFA advocates and sponsors “responsible research” (NAAFA General Information).

The Market Choice Frame

“Everyone should have the right to make their own choices about what to eat and drink . . .” (Center for Consumer Freedom)

Like NAAFA, the CCF challenges the medical frame promoted by the medical community. For the CCF, however, the central issue is freedom of choice. In a capitalist democracy, individuals should have the right to consume whatever they want. Responsibility is a personal matter and the main authority over consumption should be the individual. Interestingly, like the CDC, the CCF, too, adopts an alarmist tone. Yet, unlike the CDC’s health warnings, the CCF warns of government control and a loss of individual autonomy. The themes of individual choice, common sense, and responsibility permeate their print advertisements:

Some government officials want warning labels on food. Warning labels on food to “protect” us? At the Center for Consumer Freedom, we think adults are smart enough to choose what to eat and when to move. The only warnings you really need are about food cops, bureaucrats, and scheming trial lawyers.

FRAMING THE FAT BODY 41

Did you hear the one about the fat guy suing the restaurants? It’s no joke. He claims the food was too cheap so he ate too much! Learn more about the erosion of personal responsibility and common sense. Go to: ConsumerFreedom.com.

YOU ARE TOO STUPID . . . to make your own food choices. At least according to the food police and government bureaucrats who have proposed “fat taxes” on foods they don’t want you to eat.

The CCF does not articulate what it thinks are the causes of obesity. Instead, it openly states what are not causes. As the group maintains, obesity is not a disease and is not caused primarily by overeating. CCF documents cite specific research to back these claims. For example, citing the American Journal of Clinical Nutrition, the CCF (2004:14) writes: “Energy intakes per person were [about] 7 percent lower in 1994 than in 1977–78.” Moreover, the CCF indirectly implicates smoking and a lack of physical activity as possible correlates of weight gain. An Epidemic of Obesity Myths details the decline of physical activity in the United States showing, for example, that only one-half of young people regularly participate in vigorous activity and that a quarter of the population reports no vigorous physical activity.

Like fat acceptance activists, the CCF rejects the myth that “you can’t be overweight and healthy.” Again citing research, it shows that fat in and of itself does not mean unhealthy. Specifically, the CCF (2004:7) cites the Harvard Health Policy Review and The President’s Council on Physical Fitness and Sports that claim, respectively: “[A] fit man carrying 50 pounds of body fat had a death rate less than one-half that of an unfit man with only 25 pounds of body fat” and “Active obese individuals actually have lower morbidity and mortality than normal weight individuals who are sedentary.” And like NAAFA, the CCF rejects the BMI as a valid measure of health. One ad, demonstrating the signature sarcasm present in most CCF ads, makes clear the group’s position on the BMI:

Actor. Governor. Fatso? According to the U.S. government, Arnold Schwarzenegger, Tom Cruise, and Sammy Sosa are all obese!

Subsequently, the group rejects claims based on the BMI. The CCF outlines and refutes a total of seven myths (primarily with the use of counter-research) in An Epidemic of Obesity Myths such as Obesity kills 400,000 Americans a year; You can’t be overweight and healthy; Overeating is a primary cause of obesity; and Soda causes childhood obesity. Most of these myths, the group says, are government-generated hype that stem from “junk science” fueled by a $40 billion weight-loss industry—a particularly interesting charge since annual revenues in 2006 from the restaurant industry alone (both dine-in and take-out foods) were $511 billion (Plunkett 2007).

To a large extent, NAAFA’s and the CCF’s opponents overlap. The CCF (2004:12–13), however, goes so far as to target specific obesity researchers:

42 SAMANTHA KWAN

[Dr.] Pi-Sunyer reclassified millions of Americans as “overweight,” published a study that insists obesity is tremendously costly, and played a crucial role in funding, supervising, reviewing, and editing a wealth of obesity-related research—all while he was working for Weight Watchers.

Similarly, the group accuses Dr. Allison, a lead author of a JAMA study reporting that obesity causes 300,000 deaths a year, of a conflict of interest by conducting obesity research while simultaneously working as a consultant to at least nine pharmaceutical companies that make obesity drugs. Their portrayals go beyond money-hungry researchers. They also depict “food cops” and government bureaucrats that propose food taxes as extremists. The CCF uses adjectives such as “radicals,” “hype,” and “self-righteous” to describe opponents of their frame. Indeed this frame embraces the metaphor of evil “big government” and views the state as an entity to be feared.

The market choice frame endorses a laissez-faire philosophy, demanding minimal government intervention and promoting economic autonomy. Like other industry actors, the group readily mobilizes and canvases to weaken and eliminate government regulation. Individuals, the group argues, as responsible adults, are able to make their own decisions about consumption. The CCF thus protests food taxes and what the group feels is excessive regulation of industry. Supply and demand should regulate the free market and consumers should make their own choices in a capitalist, consumer-driven society.

Interestingly, none of the frames explicitly employ an exemplar—a specific event used to illustrate a frame’s key point. However, there may be one turning- point akin to an exemplar that bolstered both the claims of the social justice and market choice frames. Shortly after the release of a study by Mokdad and colleagues (2004) attributing 400,000 annual deaths due to excess weight, the methodology and findings of this study were called into question by both CDC officials and public health critics (see McHugh 2006). This criticism eventually led to new research on the relationship between obesity and mortality, along with a JAMA publication of a significantly reduced figure (see Flegal et al. 2005). The controversy supports the CCF’s and NAAFA’s claim that the medical position is problematic or, at the very least, exaggerated.

Discussion

All three cultural frames have important implications for how one thinks about the fat body. Because the medical frame constructs health narrowly, that is, a healthy individual possesses a “normal” BMI between 20.0 and 24.9, the frame has the potential to legitimize social inequality. Because weight loss and a thin body (although not too thin, the government also warns of the dangers of anorexia) are desired goals, the frame pressures fat individuals to lose weight. As Saguy and Riley (2005:873) put it, “framing fatness as a preventable health risk or illness in and of itself suggests that less tolerance and more public vigilance

FRAMING THE FAT BODY 43

is needed.” Moreover, fat individuals are seen as blameworthy and morally culpable. They are, as NAAFA describes, depicted as “weak-willed, lazy, and gluttonous.” Although government documents claim that obesity is a national, state, community, and individual problem, the CDC admits that much intervention can take place at the individual level. In other words, the medical frame legitimizes, even if unintentionally, moral judgments of fat individuals because these individuals are seen as largely responsible for their “deviant” fat bodies. In this way, the medical frame has the ability to contribute to a form of “health fascism” that focuses on controlling “people’s health sins . . . rather than examining and perhaps modifying the societal conditions of ill-health” (Edgley and Brissett 1990:260). That is, the frame’s focus on individual behavior detracts from larger structural efforts that encourage healthier living such as increased access to safe and affordable public recreational facilities; increased availability of inexpensive, fresh, and healthy foods; and greater regulation of the food industry.

The medical frame also supports existing beauty ideals about body size. While public health documents do not engage debates about beauty standards and state explicitly that it is not about appearance but health, their message nevertheless reinforces hegemonic cultural ideals. That is, the medical commu- nity indirectly promotes a thin body type. Its message is not that one should make oneself thin to possess a beautiful body. Rather, because fat is medically bad, not-fat is necessarily good. So even when public health officials think they promote the medical frame neutrally in the name of health, the frame can be used to support a narrow conception of the acceptable body, affecting the self-esteem of those, particularly women, who cannot attain the thin ideal (see, for example, Cash and Roy 1999). Moreover, it also encourages a narrow understanding of health where thin is tantamount to healthy, when in fact “metabolic fitness”—gained through healthy eating and regular physical activity— can also lead to positive health outcomes for individuals of all sizes (see, for example, Gaesser 2002).

In contrast is NAAFA’s social justice frame, an example of a collective action frame that expresses moral indignation, a consciousness that it is possi- ble to alter conditions through action, and a collective identity (Gamson 1992). Because NAAFA activists consider weight partly beyond an individual’s control, moral judgments, they believe, should not be placed on fat bodies. NAAFA’s focus on external causes of fat, such as an individual’s genetic predis- position, has important implications for social justice. Attribution theory informs that when fat individuals are seen as responsible for their condition, they are more likely to be evaluated negatively (DeJong 1980; Weiner, Perry, and Magnusson 1988). This is especially the case with obesity—an attribute often assumed to be under an individual’s control and due to laziness or lack of restraint. This is a key myth activists hope to debunk.

44 SAMANTHA KWAN

At a time when size-based discrimination is widespread, resonance of NAAFA’s frame, especially through public education, may result in greater tolerance and understanding of fat individuals. This is one of NAAFA’s central goals. This collective action frame challenges Western culture’s negative depiction and treatment of fat individuals. Wann’s (1998) manifesto is, at bottom, about reclaiming the fat body and rejecting pervasive fat myths. Moreover, NAAFA’s expanded definition of health encourages health for everyone. Thus this frame suggests a response that is quite different from the medical frame. Instead of encouraging conformity through weight loss, NAAFA’s frame beseeches the public to rethink what healthy means and to consider the possibility that fat does not necessarily immediately signify unhealthy.

Finally, while the market choice frame challenges the medical frame, it poses few challenges to current social and cultural structures. Just like Big Tobacco and its response to smoking related litigation, the market choice frame emphasizes responsibility and stresses neoliberal rhetoric. The market choice frame works within, and is an integral part of, the capitalist economic system. The CCF proffers no critique of prevailing body norms. These norms are seemingly outside and irrelevant to the frame and its promoters. At bottom, the market choice frame is morally ambivalent when it comes to bodies. It makes no claims about what bodies are right or wrong, beautiful or ugly. All bodies are tolerated, so long as they consume.

When claims-making, all three frames appeal to research and subsequent action, however uniquely defined. So while Saguy and Riley (2005) observe that antiobesity activists rely on personal experiences, I found that they also rely on scientific claims—claims that are generally considered to be legitimate. However, unlike the CDC that extensively details scientific research and the BMI as an indicator of health (for a discussion of health quantification, see Jutel 2001), because NAAFA’s overall appeal is to human rights and social justice, they do not delve into scientific specifics. They leave this task to fat acceptance researchers in their camp (see Saguy and Riley 2005). As such, even when scientific studies are referenced, they are ancillary. The reliance on science, by all three frames, however, reinforces its centrality as a legitimate claims- making device.

Despite the reliance on scientific evidence by all three groups, cultural discourse, in many ways, remains dominated by the medical frame. The authority of medicine is generally well established, along with the role of the medical profession in medicalizing obesity (Conrad 1992; Sobal 1995). Medical knowledge is often thought of as “authoritative knowledge” (Jordan 1997). It is authoritative because it is “knowledge the participants agree counts in a particular situation, that they see as consequential, on the basis of which they make decisions and provide justifications for the courses of action” (Jordan 1997:58). In other words,

FRAMING THE FAT BODY 45

there is some consensus within and outside the medical community that being obese is unhealthy, has real medical consequences, and should be the basis for healthful action. The concept of authoritative knowledge illustrates that despite competing knowledge systems, some systems carry more weight than others. So even when fat acceptance activists point out that individuals can still be healthy and fat, or when the food industry lobbyists say that it is not overeating alone that leads to obesity (and both rely on scientific evidence), there is a sense that this counters one’s natural beliefs, even though these beliefs are culturally constructed. Often when one kind of knowledge establishes legitimacy, alternative knowledge systems are dismissed and seen as ignorant. Similar to a master frame, authoritative knowledge comes to be seen as part of a natural order, the way things are and ought to be.

The ideology of American individualism also provides a powerful master frame upon which the medical frame draws. The belief that just by pulling ourselves up by our bootstraps we can achieve infinite goals, including redesigning our bodies, is widespread. Interestingly, the market choice frame also draws on this master frame. However, while the individualism of the medical frame encourages healthy lifestyles for a person’s own good, the individualism of the consumerist frame is presented as libertarian rhetoric. That is, the market choice frame argues that individuals should be empowered to make whatever choices, good or bad, they wish to make. It is entirely up to the individual whether he or she wants to lead a healthy lifestyle. Indeed it is plausible that industry’s alignment with this larger master frame may help it challenge public health messages.

Finally, although membership rates at NAAFA remain relatively low and studies continue to show the prevalence of size-based discrimination and the need for public policy to combat weight bias (Puhl and Brownell 2001; Rudd Center for Food Policy and Obesity 2008), challenges to the medical frame are becoming more visible. Authors such as Campos (2004), Gaesser (2002), Gard and Wright (2005), and Oliver (2006), along with bloggers and ally organizations, for example, the Association for Size Diversity and Health, are making headway. The development of “fat studies,” an interdisciplinary field that critically examines the cultural and social forces around fatness, is also increasing awareness about size-based oppression. Competing frames may face difficulty dismantling the epistemological stronghold of the medical frame, but it is not impossible to do so.

Conclusion

Obesity is not an unambiguous medical fact. It is a social fact that various cultural producers vie to define. Little is known about fat frames and my frame analysis presents a basic understanding of them and their social and cultural significance. While my analysis provides an important starting point for problematizing the socially constructed fat body, some questions remain

46 SAMANTHA KWAN

unaddressed. First, while I consider three key frames, other frames or subframes exist. For example, within the medical frame, and in light of the medicalization of obesity, how do pharmaceutical companies or bariatric surgeon frames complicate the field? Second, given that frames are interactive, dynamic, and dialogical (Esacove 2004), what is the relationship between competing frames? This is particularly important in light of the proximity and interrelationship between industry and government. Here, my primary objective is categorization and comparison, yet the study of frame interactions may illuminate important social processes. Third, my study is a content analysis with findings based solely on documents analysis. While my discussion, to a large extent, confirms Saguy and Riley’s (2005) findings about NAAFA activists and antiobesity researchers, a comprehensive picture would require more than document analysis, especially of the food industry’s position. The documents I analyzed are publicly available and an analysis of “backstage” documents and discourses may illuminate new processes. Future research should also draw on methods such as surveys and in- depth interviews to seek a direct understanding of the industry’s role in shaping public meanings about the fat body. Finally, given the importance of frame resonance for social equality, future research should examine the relationship between frames and agents. If cultural sociology is about meaning-making, then what are the meanings of these frames for cultural consumers? That is, how do frames resonate among individuals and other social movements? For example, what is the role of the medical frame in shaping the growing national movement for healthy food and health labeling? And, as tools in one’s “tool kit” or “cultural repertoire,” when, where, why, and how are certain frames drawn upon by individuals to inform the self and “strategies of action” (Swidler 1986, 2001)? Moreover, given that children and adults are different kinds of social actors, how does symbolic resonance of frames differ for these groups? Culture is an elusive concept that does not parcel out neatly for empirical study. However, as identifiable and measurable elements of culture, cultural frames provide one avenue for understanding cultural meanings—an understanding that may lead to sound public health policy and to greater social equality.

ENDNOTES

*I am grateful to the editor and anonymous reviewers of Sociological Inquiry for their helpful comments. I also wish to thank Scott Savage for helping me conceptualize ideas and Matthew Brashears, Jeff Larson, Steve Nelson, Louise Roth, and Claude Rubinson for their valuable input on earlier drafts of this article.

1However, Gimlin’s (2002) ethnographic work on NAAFA documents few politically oriented group activities.

FRAMING THE FAT BODY 47

2http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm; http://www.naafa.org/; and http://www. consumerfreedom.com/.

3NAAFA activists and allies of the Health at Every Size (HAES) movement (see Kratina, King, and Hayes 2003) share similar views (also see Saguy and Riley 2005).

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