As a Matter of Fat

A spokesperson for Southwest Airlines says the carrier will continue to charge extra if a person takes up more than one seat.

If the city's Compliance Guidelines to Prohibit Gender Identity Discrimination, authorized in 1998, are any indication of what to expect, fat jokes will be illegal by the city's size guidelines. So will thin jokes. All employers will be asked to provide employees with continuing education in height and weight discrimination. "Size harassment" will be a misdemeanor, punishable by a $500 fine and six months' imprisonment in county jail.

Educating children, teenagers, and adults about unfair discrimination is an important social undertaking. But the new law appears to be a case of using a bomb, when a can of Raid would do. And whether the city's size discrimination guidelines turn out to be draconian or less so, there is a real question about whether they are needed.

A spokesperson for the main dwarf support group in San Francisco says the little people have no problem with employment, and they are treated well in the city's restaurants. Even Wann acknowledges that restaurants are generally fat-positive and that, in fact, the city has "plenty of very cool clothing boutiques" for the fat. Major department stores set up whole floors of clothes for large folks years ago.

Talking with Wann and Solovay, though, it is impossible not to feel the rage that drove them to demand legal protection for being fat.

"I cannot get close to people who are having weight-loss surgery," says Wann. "It's too painful to me. I do not have what they need. They want a happy life, and I can't give that to them unless they are willing to be rebellious. If you go for conformity and the approval of mainstream, unthinking people, I can't help you. But I can tutor you in how to have a great fat life and have all the sex and clothes and respect that you want to have -- but you have to be a rebel."

In trying to combat weight discrimination, the city of San Francisco actually provided legal protection to the pursuit of what most medical authorities consider to be unhealthy lifestyle choices. If obesity itself is not a chronic disease, it seems to be linked to major deadly diseases. A 1998 editorial in the New England Journal of Medicine notes, "Being substantially overweight is correlated with serious health problems, including coronary disease, hypertension, diabetes, and a variety of musculoskeletal problems. ... Some who object to society's prejudice against obesity engage in overly rigid biological determinism. They assert that obesity is no more within a person's control than eye color and has nothing to do with habits ... [they still] see people in medical terms, rather than as ordinary people who happen to be heavier than average, probably from some mixture of nature, nurture, and choice."

Wann is familiar with this editorial. A "fact sheet" that she distributes features a quote from it: "[D]ata linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous." Wann promotes this seemingly authoritative statement to suggest that there is no correlation between obesity, chronic disease, and mortality. She generally neglects to point out what follows that sentence: "Nevertheless, the totality of evidence suggests that as weight increases, so does mortality, but only modestly."

Because the causes of obesity differ from individual to individual, it is hard to set precise standards for measuring it. Many people who are technically obese -- according to a formula known as the "body mass index" -- are perfectly healthy when they eat good food and exercise. When people weigh more than 30 percent above the established norm, however, they start to run major health risks, not so much because they are fat, but because they eat poorly and do not exercise. Morbid obesity, calculated at 100 percent over the norm, is considered to actually cause diseases, such as diabetes; less than 1 percent of obese people are morbidly "super-size."

A recently released report to President Clinton says there is an "unprecedented epidemic of childhood obesity," and millions of adolescents are at risk of heart disease and diabetes. The government estimates that about one-third of the adult population is obese, up from 25 percent a decade ago. The report blames physical inactivity (including television watching) and poor diet for 300,000 deaths per year.

"If weight was all caused by genetics," Ornish asks, "then why do we have a greater percentage of obese people than ever before in the population?"

The most recent advances in medical research emphasize the predominance of environmental and lifestyle factors in the formation of both excessively fat and thin people. There is, however, an important physiological component linked to body weight; it is what Joanne Ikeda, co-director of the Center for Weight and Health at the University of California at Berkeley, describes as a metabolic defect linked to obesity that makes weight loss extremely difficult.

Ikeda is referring to the existence of metabolic "set points." Under the theory, which has gained broad acceptance, the human body regulates its weight through eating habits and physical activity. When a person diets, for instance, a sudden loss of weight can trigger the body, in a sort of "famine response," to grow extra fat cells, which creates a set point above the dieter's previous weight. The minute that the diet is broken, the extra fat cells expand, and the eater balloons.