Obesity is about more than stigma, it is about exceeding one’s social space.
Diabetes foot clinic, Apia, Samoa
Looking over the shoulder of Sina, the only podiatrist in Samoa, Jessica watches as she oversees her nurses as they change the dressing of a woman’s foot. The patient recently had a transmetatarsal amputation where the front part of her foot, including her toes, were removed. The patient returned to the urban clinic each day to have her dressing changed. These kinds of appointments kept the staff busy from open until close three days a week. When Jessica asked Sina, what other kinds of injuries did she commonly treat, her answer was broken toes. Broken toes? Yes, “from being so big.” People might stand all day, at a funeral for example, and feel ashamed to need to sit. If the person wasn’t already sitting it was because they didn’t have the status to sit—as seating is most often reserved for elders, political and church leaders, and matai (titled chiefs). To sit without being provided a seat would be impolite. Wearing only slippers—that is, flip flops—didn’t help either. Why not wear different shoes? Because then the person would have to ask for help to put their shoes on, needing assistance to tie the laces of sneakers or fasten the buckle of supportive sandals. Her patients were ashamed. They didn’t want to ask for help to put on their shoes. They didn’t want to ask for a seat. So they stood through toes breaking. Sina’s patients were acutely aware that asking for help was a privilege.
Yaicel’s living room, Santiago de Cuba, Cuba
Yaicel told Hanna about her ongoing struggles with weight loss. Yaicel explained that over the past two years she gained about 30 pounds, though she lacked access a scale. She went through a difficult relationship and divorce. The stress led her to eat and spiral into a cycle of depression where she did not want to leave the house. One day, when Yaciel needed to pick up a doctor’s note to excuse her from work for psychological reasons, she tried on all of her clothes but nothing fit. She had to walk all the way to the doctor with her jeans unbuttoned and tucked in, and the bottom part of her belly hanging out because her shirt kept riding up. That moment motivated her to lose the weight again. Yaicel explained that it was not so much a question of being unattractive to others as it was about the fact that she could not fit into her clothes—once you were above a certain size you could not find fashionable clothes and so were stuck with oversized and awkwardly shaped clothing. The cost of purchasing new clothing was not something that her household budget could accommodate. Fear of having to wear unfashionable clothing or spend precious household resources motivated her to start exercising and lose about 20 pounds (again).
Sina’s patients and Yaicel experience their overweight bodies not only as a health issue, but as something to confront within their social and material lives. Fat has practical and social consequences.
Cuba and Samoa provide two vantage points from which to flesh out macro-level trends around what the World Health Organization (WHO) calls globesity because prevalence rates are different, but rapidly growing in both. Obesity prevalence in Cuba was 11.8 percent in 2002, doubling to 27.2 percent recently. In Samoa, the rapid rise is particularly striking: between 1978 and 1991 obesity increased in males by 297 percent and in females by 115 percent . Recent statistics suggest that over 66 percent of Samoans are obese. Thinking about Samoa and Cuba together can help to understand the embodied consequences related to rises in obesity and related health issues. In public health parlance, the rise of size, weight, and BMI has been cast as an obesity epidemic, which is part of a global pandemic. In the United States, obesity in popular and medicalized discourse often appears as a threat or disease to “combat” or “fight against” like a plague. In turn, in many places across the globe a “war on fat” is underway, and it has trickled down from WHO authoritative suggestions to Sina’s clinic and Yaicel’s experience in her ill-fitting pants. Reflecting these discourses, fat bodies are often stigmatized, viewed as symbols of out of control behavior, as risks to society, as costly public health problems. Most strikingly these myriad forms of stigma are globalizing, even in places historically considered “fat-positive.” Yet Sina and Yaicel’s experiences tell a slightly different story.
Sina and Yaciel’s narratives are about the practical consequences of fat and the vulnerability experienced when one’s body does not conform to particular social and material conditions. In the US, scholars such as Alex Brewis, Amber Wutich, and Sarah Trainer articulate this as felt stigma. When chairs don’t fit, for example, the physical environment reinforces stigma by publicly drawing attention to bodily excess. Felt stigma for Sina’s patients and Yaciel is derived not from an identity sullied, as in the classic Goffmanian analysis, but from exceeding one’s social space—letting the body become the social responsibility of others either through care or economic cost. These are material dimensions to the sociality of fat: situations in which the material world does not seem to be designed or created with fat bodies in mind, and those who live in fat bodies must constantly monitor and modify their lives and their movements around material barriers. Fatness in this way is about more than individualized suffering, but it’s not the whole picture. A focus on fatness and lived experience illuminates the practical considerations and barriers that are more about acting as a full person in one’s community than about aesthetics, softness, or bulge.
Ethnographic research, including our own, explores the spaces where fat resists dichotomous framing, from fat positive movements, to complex translations of nutritional knowledge, to non-health related reasons why one might not want to be fat. The unsightliness of softness or bulge in the Euro-American contexts, contrasts with the pleasures of the social achievement of creating fat (but not too fat) family members. The social life of fat—the ways the contours of the body are anticipated by people and the ways the contours of bodies shape social interactions—is about ways of experiencing a body that fails to work as needed. Both Sina’s patients and Yaciel feared the impact that their bodies would have on others. Fat bodies can inhibit people from being moral persons—that is people who can do what is expected of them in their everyday lives.
Fatness creates certain kinds of social relations—of dependence, gratitude, or debt—that fat people themselves are acutely aware of. The social relations de-centralize the individualized shame and responsibility that are salient within much obesity scholarship. To understand the social consequences of fat we must pay attention to the specifics of the taboos and stigma aligned with fat bodies. We must attend to the material and social ways that exceeding social space is lived. As Sina’s patients’ shame is not always derived from the size of their bodies, but rather more precisely from the need to ask others for help because of the ways their fatness creates limitations. The fat consequences that Yaciel nervously negotiated are both social and economic—a sartorial challenge and a potential strain on her fragile household economy. Her weight loss was motived by her strong desire to stay within the normative parameters of her social role, that is, to be able to access fashionable clothing and not place an undue financial burden on her family. She feared the consequences of bodily excess. By looking to the social, yet individual, impacts of the variations of large body size that make bodies livable and enjoyable versus uncomfortable and unmanageable, we might be able to engage discourses that foster more effective health promotion strategies.
Yaciel maintains her weight loss by taking dance classes in the evenings after her children are asleep. Sina offers tea without sugar to family members accompanying patients to their appointments and she sees only one patient at a time, to protect their privacy—small steps help to alleviate fat consequences.
Jessica Hardin is an assistant professor of anthropology at Pacific University. She received her PhD from Brandeis University in 2014. She is author of the forthcoming book, Faith and the Pursuit of Health: Cardiometabolic Disorders in Samoa.
Hanna Garth is an assistant professor of anthropology at the University of California, San Diego. She received her PhD from the University of California, Los Angeles in 2014 and an MPH from Boston University in 2006. She is completing revisions to her book manuscript on household food access in Santiago de Cuba. She is the editor of Food and Identity in the Caribbean (2003).
Feature image: Therese Banstrom/ Flickr (CC BY-NC 2.0)
Cite as: Hardin, Jessica, and Hanna Garth. 2018. “Fat Consequences.” Anthropology News website, January 24, 2018. DOI: 10.1111/AN.741