It has been said that a definition of insanity is to do the same thing over and over again and expect different results. Since I am a sociologist writing my first blog entry on a psychology website, I will not begin by defining what is and is not "insane." However, I do believe Sociology offers an excellent set of tools to help us understand this annual January ritual and it's failures.
A $58-billion-a-year weight-loss industry (Marketdata Enterprises: The U.S. Weight Loss & Diet Control Market, 10th Ed. Lynbrook; 2009.) heavily promotes the new year's resolution of weight-loss for health and beauty (mostly beauty in the guise of health, but that will be a later blog post). Long-term and permanent weight-loss remains elusive, however, and most people who started this year out like last year, have probably already failed. Those who persist will most likely gain that weight back within 5 years. When I say most-likely, the estimates are about 90-95%, though no one really knows because most weight loss companies and products do not either keep such stats or make them public.
Why do consumers keep buying into an industry that clearly fails to deliver on its promises? Weight-loss is a capitalist's wet dream. I am hard press to think of another product or service that fails on such a regular basis but gets repeat customers. If only one out of every 10 cars produced by a company worked with customers having to trade-in or return their cars 90% of the time, no one would buy a car from that company. But dieters keep coming back.
The key is that the consumer blames herself for the failure. The diet didn't fail. The product didn't fail. The consumer failed. The weight-loss industry has an ally that few consumer products and services have. They have a culturally based moral panic that feeds their coffers.
A moral panic
is a sociological phenomenon whereby a group, usually a stigmatized or minority group, is identified as posing a danger to the general society. The current rhetoric in the "War on Obesity" in which the fattening of America is blamed for everything from rising health costs, over consumption of fuel, to undermining the war on terrorism, has all the earmarks of a moral panic
. We hear something bad about being "overweight" and/or "obese" almost every moment of the day that we consume media. Watch television or listen to the radio for more than 5 minutes and either a commercial or an expert or a character is talking about the evils of body fat.
A moral panic in social discourse usually serves to create a scapegoat or a diversion from issues. Moral panics gain social credibility because they serve the purposes of those who can provide forums for the spread of the panic. It is not easy to dissect the exact reasons for the creation of a moral panic because these things are not planned by some cartel of power-brokers in a backroom.
So the question to ask when analyzing a moral panic is who benefits from the spread of such ideas?
Here are some possibilities to consider in looking at the "War on Obesity":
- The most obvious is the weight-loss industry that makes direct money from these fears. Not only do these company make money from persons who are marked as being the deviant, but they also make money from those who fear they could become one of the deviants.
- The second group are obesity and bariatric researchers who have spent long careers studying these questions and have yet to find an answer to the question of long-term weight-loss. There are strong economic incentives not to follow the data that suggests what they are doing is failing but rather to blame the subjects of their study for the failures. Even those who are sincerely trying to help can get caught up in the moral panic because it protects them from rethinking their investment of time and effort.
- Public health officials and policy-makers. This may not seem as obvious as the first two, but in an age where spending on public health has dwindled considerably, more expensive programs that help improve health such as addressing health care access, environmental issues, air and water pollution clean-up and socioeconomic factors to the relatively cheaper "education programs" that promote individual responsibility for health with an emphasis on "life-styles."
- Failure of universal health care efforts. It is interesting to note that the two biggest "obesity" programs - Shape Up America in 1994 and Let's Move in 2010 - occurred immediately after the failure of a president to deliver on the promise of universal health care (Clinton and Obama - It is also interesting that it was their wives who spearheaded these efforts, but I will save that thought for another entry).
It is this last bullet that has interested me most as a Medical Sociologist. America's failure (some might say, "refusal") to follow the lead of most of the industrialized world into a concept of medicine as a human right rather than a commodity begs for sociological analysis.
Americans speak of freedom and, specifically, the "free market" along with a long-standing fear of "socialism" and "communism." Opponents to universal health care have consistently characterized universal access as "socialized medicine" and that characterization, with its strong cultural baggage, has worked every time to date.
Thus, it serves those who oppose a social concept of health care and health care delivery to promote a life-style view of health over a public view of health. Collective factors, such as socioeconomic levels, housing quality, air quality, water quality and availability of preventive techniques such as vaccines and early detection screening are strong predictors of both individual and population health. But such collective factors beg for collective action. An individual might be able to drink bottled water and put an ionizer in one's home, but it takes the community to address widespread water and air pollution. Collective action undermines the for-profit, personal-responsibility concept of health as commodity.
The belief that one can assess the health and life-style practices of a person by looking at their size becomes a perfect companion to this effort. We cannot have collective health care because some of "us" are "deviant" and will "drag down" the rest of "us." Only by holding each person responsible for her or his own health can we justify ignoring the collective and public aspects of health rather than creating a strong public or universal health system.
What if, however, the belief that weight equals health is wrong? What if people with "good" life-styles still get fat, still get sick, still suffer injury? Then such public policies based upon these beliefs will fail.
The government and industry-based programs that seek to address these so-called concerns only serve to increase the moral panic of a non-existent epidemic and to expand the riches of large companies while stigmatizing people, something that has real consequences on the health and well-being of those persons. It also covers for the decrease in the quality of public health programs and serves to blame the victims of the lack of addressing real social issues such as poverty, pollution and access to good prevention.
Perhaps, it is time not only for those who try to lose weight every year to seek a better way to live their lives personally, but also for public policy-makers to stop the insanity of failed public programs as well. Moral panic hurts everyone's well-being in the long-run.