Introduction to the special issue: public health, healthism, and fatness

Abstract

One of the most pervasive elements of fat phobia is the equation of body fat and poor health. Health effectively serves as the weapon of last resort when every other argument against fatness has failed to convince. Because of the “reductive collapse between weight and health” (LeBesco 2010, 154) and because health seems to be such an unequivocally positive and indisputable goal, this justifies the notion that fatness cannot in good conscience be embraced as part of human diversity. Public health, typically defined as “the science and art of preventing disease, prolonging life, and promoting physical and mental health” (Winslow 1920, 23), is shaped by an understanding of fatness as one of the main causes for chronic diseases and one of the major health problems the world is currently facing. The field defines itself in large part as prevention in contrast to medicine with its focus on intervention. This attitude is most eloquently expressed in the parable of the lethal river. In this tale, medicine is constantly rescuing drowning people out of the wild water without time to analyze the underlying causes. Public health on the other hand sees its role in preventing loss of lives by installing safety precautions upstream and, better yet, by teaching people how to swim (McKinlay 1979). This model worked well historically and had its most obvious success in the nineteenth century, when hygienic arrangements saved many people from infectious diseases well before the exact causes of these diseases were known, and long before a medical solution was readily available. The model became harder to repeat when, in the second half of the twentieth century, the prevention of non-communicable diseases (NCDs) became the central focus of health interventions in western societies. With the popularization of the “risk factor model” – that is, the identification of risks for illnesses such as diabetes and cardiovascular diseases – it turned out to be increasingly difficult to pin down decisive risk factors with the required accuracy (Barnes and Parkhurst 2014). Since then, the solutions public health proposes against the risk factors of chronic diseases tend to address the