As a Matter of Fat

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.

Exercise has been shown to lower the set point, hence lowering weight. Eating saturated fat has been shown to raise the set point and weight.

Obese people often suffer from set point imbalance. The good news is that people can gradually regulate their weight by manipulating the set point with a nutritious diet and regular exercise.

The bad news, at least for those who support a weight discrimination ordinance, is that the vast majority of the medical establishment does not consider obesity to be immutable. And to the extent that obesity is now seen, in a scientific sense, to be changeable, the arguments for protecting obesity with a strongly enforceable discrimination law are seriously undermined, and the argument that San Francisco's law is an endorsement of unhealthiness seems ever more persuasive.

Krissy Keefer's latest modern dance composition, Cavewoman, is impressive. In a performance at the Dance Mission studio, her troupe of beautiful, athletic, short, tall, plump, and rawly feminist women danced a thumping ballet of ritual sex, murder, and rebirth, to the cadence of taiko drums that they beat with fury and joy.

So why is Keefer battling to send her daughter into the jaws of what would seem to be the enemy of her aesthetic, the taskmeisters of classical ballet?

She says she wants her daughter to go to the San Francisco Ballet because its school has the best facilities in town. But Fredrika, who danced on the same bill as Cavewoman, seemed able to perform with great gusto and freedom in her mother's wonderful dance space, which spreads over several thousand square feet. The only apparent problems with Dance Mission seem to be easily fixable, if enough money is available. All the studio needs is a few broader chairs, a wider bathroom, taller doors, a shorter refreshment counter, and some disability handrails that heavy people could use while climbing the building's long flight of steep stairs.

Oh. An elevator might be nice, too.