Philip Alcabes discusses myths of health, disease and risk.

The Anti-Obesity Crusade Invades Academia

The Chronicle of Higher Education reports that students at Lincoln U. in Pennsylvania can now be required to take a physical exercise course (“Fitness for Life”) if they have a body-mass index above 30.  The chairman of the college’s Department of Health, Physical Education, and Recreation pointed out that he sees a responsibility to address the “obesity epidemic.”

Nutty, but not so terrible, perhaps.  The policy is a transparent attempt by a not-so-wealthy university to seem au courant and curry favor with donors, who might like the idea that the school is addressing obesity — which the public health industry keeps insisting is a terrible problem facing young people.

Really, the obese-student policy at Lincoln doesn’t demand much.  Some students have to work out for a few hours a week (it’s a 1-credit course).  Not how they want to spend their time, probably pointless in terms of their health, but not the end of the world.

But pay attention to the commentary.

The director of another university’s center on higher-education law and policy voices concern — not over Lincoln’s feeble gesture at controlling fatness , but over medical confidentiality.  “Being put in a class with other ‘at-risk’ BMI’s walks a little close to disclosure,” he told the Chronicle.

The implication here is that obesity is an illness, and therefore only a physician should be allowed to know that you have it.  Certainly, your classmates shouldn’t.

How can obesity, of all things, be thought of as a secret that would only be revealed if you got into gym shorts and showed up on the treadmill in the fat-students’ class?

There’s a clue in the use of the term “at risk”:  obesity is like sleeping around without using condoms, driving drunk, or smoking near your kids  — it’s supposed to be both dangerous and shameful.  You would only admit being “at risk” to your doctor (who would, we have to assume, dutifully dissuade you from following your naughty instincts).

At the NYT blog The Choice, Rebecca Ruiz notes that the Lincoln faculty will be discussing the problem tomorrow.  So far, there’s been plenty of skepticism there, but a few defenders of the fat-class policy.  And most of the comments responding to Ruiz have been supportive of the idea that a university might require physical exercise.

What isn’t getting mentioned is race.  Is the policy popular because Lincoln is one of only two HBCUs in Pennsylvania, and some of the much-discussed “adverse outcomes” of obesity are conditions that are common among African Americans?  Do people feel  relieved that a predominantly African-American university is addressing a problem that seems somehow racial?  Do we feel reassured that a college that  doesn’t serve America’s traditional wealthy elite is taking on a problem that seems to be a threat to the elite — and a threat that seems born of the bad habits of the poor, especially the dark-and-poor?

Obesity is more common among people who identify themselves as African Americans — even at colleges, as a recently published study showed.  Here, and worldwide, obesity is mostly a problem of poverty.

Doesn’t obesity’s taint stem, at least partly, from the way it reminds Americans of poor people — and the dark-skinned poor in particular?

Public Health and Purity

A week ago, we rode by bus nearly the full length of the old land of Galicia, from L’viv in Ukraine to Kraków, Poland.  Our one long stop was at Belzec, where a moving memorial, the creation of historians and artists, speaks to a double disaster:  the murder of nearly half a million people, predominantly Jews, who were gassed there in 1942 and ’43; and the so-called purification of the region by virtually erasing part (the Jewish part) of a historically complex culture.

The visit spoke to a modern concern, too:  the connections between purity and public health.

The commandant at Belzec, Christian Wirth, had been one of the directors of the Nazi euthansia program, nicknamed T4.  Between 1939 and 1941, T4 killed over 70,000 Germans — mostly full-blooded “Aryans” — who had psychiatric or developmental problems, or congenital conditions, and who were therefore lebensunwerten, unworthy of life.

The T4 program, in its turn, grew out of the Nazi doctrine of racial hygiene — an effort to improve the public’s health by control of breeding.  Racial hygiene was based on eugenics, and led to public health endeavors such as screening for congenital conditions, mandatory sterilization of sexual transgressors and disease carriers, and selective breeding.  The Nazi public health program was much applauded by American public health experts, at least in its first few years.

Once the decision was made to eliminate Jews from Nazi-occupied regions, the experience that Wirth and colleagues acquired through killing the lebensunwerten in T4 was invaluable.  Going from exterminating tens of thousands of mentally ill or developmentally disabled people to eradicating a few million Jews, Gypsies, and other polluters of Aryan health was just a matter of making the process more efficient.

It’s striking how thin the line is between laudable public health goals, like limiting congenital disease through screening, and implementing the concept of race purity.