Your Playstation Made You Fat, and other reductive narratives: Our problem with public health

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Reading my RSS feeds yesterday, I ran across a post on Kotaku — of all places — about the winner of a design contest by Let’s Move, Michelle Obama’s campaign against “childhood obesity”. The challenge was to design an infographic enumerating the — oh, I don’t know y’all, I guess some of the stuff that’s happened at the same time that childhood obesity rates have gone up, along with some of the stuff being done to make those rates go back down again. Kotaku picked up on it because one of the things that happened, and which is noted on the chart, was the release of the Sony Playstation. The design of the graphic is pretty swell, I’ll admit, but I’m a little amused at how some events are linked to the enfattening of the childrens while others are not. Why isn’t the purple-tinged rise to power of Barney the fat purple dinosaur included? Barney totally promotes obesity — have you seen his rear end? — and kids love him. The first “successful” mall food court is worth noting on the chart, but the disappearance of the Pogo Ball, a popular 1980s child-torture device, from toy store shelves nationwide is not. Possibly most egregiously, why does the Playstation get a mention but the original Nintendo Entertainment System does not? While the Playstation was a worthy landmark in the evolution of video games as a legitimate form of media — pardon me, I mean as THE SCOURGE OF HUMANITY — I tend to think the NES was really the beginning of widespread home video-gaming.*

I digress.

I know it’s just a pithy representation of information that most folks couldn’t be arsed to read without some graphical interest to draw their attention, and of course it’d focus on the favored scapegoats of soda, television, and video games as causing the downfall of our great civilization. But what I really want to discuss here is not the legitimacy of the cultural landmarks that may or may not have anything to do with anything. Rather, I want to discuss our often-inappropriate use of public health information to condemn individuals.

To begin, let’s define our terms: public health, as used here and in lots of other places, refers to the study and analysis of statistical trends across populations, and the creation of social solutions to large-scale problems. For example, the now-discontinued use of lead paint in residential households was a public health issue. Once it was discovered that the lead in this paint could be ingested by children and cause serious health consequences, there was an institutional response which included education of the public (which is why we all know lead paint is bad today) and consumer regulation (which is why lead paint is no longer used on toys, furniture, or for other household purposes).

I’ve intentionally used the lead-paint example because it lacks a moral component, as many other public health issues are prone to do, while illustrating how public health initiatives are supposed to work. A problem is discovered, researched, and addressed, all on a macro scale. Lead paint was nobody’s responsibility and nobody’s fault, the many decades of lawsuits against the lead industry notwithstanding; it was rather an unfortunate outcome of a lack of knowledge about the health effects of the substance.

That said, when we apply public health to issues that do have established social and moral aspects, things get murkier. It is — and this should come as a surprise to no one — remarkably difficult to constructively discuss broad generalizations of statistical trends without also, intentionally or not, imposing those trends on one’s personal lived experience, where they may not actually be true or appropriate. For example: along with the Playstation, the graphic above places emphasis on soda consumption as a cause of fatness. Have some fat kids played video games and imbibed Coca-Cola? Certainly. Have they all? Absolutely not. Just like your one “overweight” friend is not representative of “the obesity epidemic”, one fat child is not representative of every single social trend that may be contributing to increased rates of childhood obesity.

Public health must be studied and addressed; work in this field is why such tremendous life-saving advances like vaccination programs and sewage systems exist. The problem is that, culturally, we have somehow lost the plot that public health does not attempt to address individual health issues, but looks at the population as a whole for the purposes of developing preventative measures — like vaccines and sewage-free water and uncontaminated food supplies — to curtail the spread of disease. Generalizations and categorizations are fine with when discussing the lives and habits of millions of people, but often fail when applied to individuals, because that is not what they’re for.

Furthermore, when public health approaches run up against the prevailing conventional wisdom that the “disease” in question is the personal responsibility of the person enduring it — unlike polio or cholera or cancer — then the conversation, and the cultural response, takes a darker turn. We have seen this before; public health warnings can easily stir up hysteria over the issue at hand and create or worsen existing cultural loathing of their sufferers. When HIV/AIDS was first identified as a public health issue in the early 1980s, it seemed to be primarily affecting men who had been involved in homosexual relationships, which led to its originally being called GRID, which stood for “Gay-related immune deficiency” — as though there were some measurable physical difference between people engaging in gay sex that would make them susceptible to a disease to which straight folk were immune. Because the identifiable trend was amongst gay men, two ideas emerged in the cultural consciousness: one, that it could only affect gay men, and two, that all gay men were potential vectors of the disease. These assumptions led to a lot of extreme homophobia that persists to this day, even in light of conclusive evidence that casual contact cannot result in infection, and that HIV/AIDS can, in fact, affect people who are not gay. Anecdotally, I was a kid during the HIV/AIDS hysteria, and I vividly remember feeling a little afraid of gay people, while also being hammered — too little, too late? — with the fact that touching, hugging, kissing, dirty toilet seats, etc., could not infect me.

This is an example of how public health information can go terribly wrong, particularly when it is disseminated by and through outlets that are more prone to paranoia and fear than rational conversation, and particularly when it relates to a group of people already under the boot of social oppression. But let’s return to the current story that your Playstation made you fat, and the personal accountability of modern public health narratives about fat people.

The problem with such narratives is also their purpose: they are necessarily reductive, as their purpose is to identify broad trends that might be addressed through public information projects (such as anti-drug PSA) or institutional regulation or reform (such as banning smoking in public places) and not to finger-point individuals. The inevitable finger-pointing that happens is primarily owing to the news media that have no compunction against inappropriately twisting the vastness of public health information into a narrow barb with which to provoke individual terror and guilt. Media reports use public health info to stir individual panic — and to incite a sense of personal responsibility to “fix” it — when the measures actually taken to address public health are usually long-term and not individually-dependent at all. This is how a study that finds correlation (if not causation) between soda consumption and childhood obesity is translated, by said media, into the message that an individual parent allowing his individual child to consume soda on occasion makes that parent an irresponsible or even dangerous caretaker. This is how studies that find fatness to be beneficial in certain circumstances are either ignored by news media entirely, or are magically perverted into fat-negative articles that report that this evidence seems to exist but is obviously wrong because fat people are still going to die, fatty fat fat, death die die, and nobody else is going to die. No, wait, everyone dies. I mean, some people will die while fat and some won’t.

I’ve discussed both childhood obesity and my problems with the Let’s Move campaign elsewhere, so I won’t repeat myself here. My beef is not with the movement to study these trends, or what may be causing them, but with what we do with that information. Most current public health initiatives cast obesity as a disease at best, and a menace to the American way of life at worst, and unflinchingly place the responsibility upon the shoulders of each individual to police fatness. The fat are encouraged to punish themselves, and the non-fat are encouraged to punish them too. Portraying fatness-as-disease also carries the possibilities of cure and contagion. The cure has yet to be reliably determined — not for lack of trying and economic investment — and the idea of fat contagion continues to be studied and discussed. Seriously, even. If the plan is to isolate and ostracize fat people from society as a whole, then the groundwork is well-laid indeed.

Is there a better solution? I’d propose dropping the idea of fatness as a disease, to start. Even setting aside the debate about whether fatness is universally sick-making, even leaving the assumption that increases in childhood obesity rates are both legitimate and a problem, there are better ways of addressing these trends rather than simply emphasizing the Playstation as the Devil’s Enfattener and inspiring people to banish video games from their homes (everything in moderation, y’all). If poor nutrition and a lack of adequate physical activity are negative drains on the health of Americans, these are environmental factors that can be promoted across the entire population, because it’s not only fat people who would benefit from a better understanding of food science and more opportunities to be active, and withdrawing the laser-like focus on fat people (because everyone else is automatically and completely healthy!) would not fan the flames of cultural anti-fat stigma (the same stigma that makes it difficult for fat people to exercise in public, or, in some cases, go out in public at all) in the way that Let’s Move does. Simply living in certain US cities is associated with greater risk of certain health problems, but the solution is not to remove every individual from that city; the solution is to identify the environmental factors that are having a negative influence, and to improve the circumstances in which those people live, thereby improving their lives entire.

Likewise, the solution to improving the health of fat people is not necessarily to remove them from their bodies, but to give them the opportunity to live in a world and a culture that is healthful and positive for all bodies, according to individual ability and circumstance, whether they are fat or not. You cannot make people healthy by coercion, shame, or stress. Good health is private and subjective, and stems from having options in an environment supportive of and conducive to knowing one’s body. If public health “obesity” initiatives — and the people behind them — really want to improve the health of the nation, they will remove the focus on fat scapegoats and use that energy to build parks and farmer’s markets and to give folks the time necessary to cook and go outdoors and play with their fat kids in the fucking sunshine.

It’s much more difficult to take this road, for sure. But our long-term health, both mental and physical, of all of us depends upon it.

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* Yes, there was Atari, and other long-forgotten platforms prior to the NES, but their downright abstract graphics, lack of character-focused games, and relative expense kept them from proliferating in the way the NES would. My dad bought me an Atari 5200 when I was seven years old, a superior 2600 upgrade which was sadly a market failure. I loved that thing. Oddly, while I don’t remember receiving my first NES — and I did have one fairly early on — I vividly remember the Atari 5200, right down to the box it came in.
Damn, can someone point me to a Super Breakout emulator? I want to play it right now.

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