Abigail C. Saguy, PhD

Introduction

In recent years, public attention to obesity has grown exponentially in the United States (Saguy & Riley, 2005; Saguy & Ameling, 2005). Previous work examining news media reporting on obesity science (Saguy & Ameling, 2005) showed that such growing news media interest in obesity tends to be alarmist, evoking an “obesity epidemic,” or an impending disaster that will halt and perhaps even reverse the millennia-long trend of rising human life expectancy. We further found that American news reporting on scientific studies of obesity overwhelmingly framed obesity as evidence of individual moral failings, rather than as a product of genetics. When the food industry was also blamed for growing population weight, such blaming tended to reinforce, rather than counter, individual blame. Finally, we found that the American press was significantly more likely to blame obesity on moral laxity when reporting on ethnic minorities or the poor, suggesting that obesity may serve as a proxy to discuss morality and class. In other words, as others (Campos, 2004; Campos, et al) have argued, it may be increasingly possible to express prejudice against, say, a poor Mexican-American woman indirectly as dislike for “lazy fat people.”

In this paper, I examine French news reporting on obesity, which has also grown in recent years, and ask five main questions:

• How and to what extent does the French press dramatize the medical risks of obesity?
• To what extent does the French press present obesity as a moral issue and, if so, what sort of moral issue?
• Are discussions of obesity used to erect social boundaries against certain social groups (like the poor or minorities) or foreign nations?
• What policy responses, if any, have we seen in France?
• Have skepticism or alternative “health at every size” messages been expressed about the “obesity epidemic” in the French press or by fat acceptance organizations? If so, what are these arguments?

News reporting on health is an important object of study, as it has farreaching implications both for public policy priorities and lay understandings of health and risk. Policy makers’ priorities are shaped by news reporting, and press coverage can influence the financial support given to academic research from both the government and private industry (Nelkin, 1987). News reporting on science also informs individuals’ understandings of health and health risk, who in turn increasingly seek information about health from the news media (ibid; Schlesinger, 2002; Carlsson, 2000).

In that rates of obesity are higher in poorer populations, health policy initiatives targeting obesity may have implications for social inequality. On one hand, obesity could be used as a hook to draw attention to and relieve other problems, such as a dearth of fruits and vegetables in poorer neighborhoods, food insecurity among the poor [argued to lead to hoarding and bingeing when food is available (Adams, et al, 2003; Townsend, et al, 2001)], violence in poor neighborhoods (keeping people inside and sedentary), or even poverty (positively associated with obesity). On the other hand, discussing obesity as a problem could reinforce the social marginalization of bigger bodies. If bigger bodies are thought to be more common among the poor or minority groups, this could further stigmatize these groups as well. Moreover, if obesity is blamed on moral laxity and lack of individual responsibility, higher rates of obesity in certain groups could be seen as evidence for their social inadequacy, justifying their lower status. Thus, how obesity is framed, and not just whether it makes news, matters.

French Women Don’t Get Fat?

France provides a fruitful comparison for studying public responses to the alleged obesity epidemic. First, rates of obesity, as defined by a Body Mass Index (BMI, weight in kilograms divided by height in meters squared) are relatively low in France. One study estimates that 10.5% of French women were obese in 2003, and that the statistics are similar for men (Perez, June 8, 2005). Childhood obesity is estimated to be 12% among 5 to 12 year olds (Labbé & Recasens, 2003). Indeed, rates of obesity in France are lower than rates of obesity in the United States in the 1960s [13.4% of male and female adults (Flegal, et al, 1998)], when there was little to no domestic concern about this issue.

Despite relatively low levels of obesity, news media attention to obesity in France has grown exponentially in recent years (see Figure 1 [not included - depicts mention of obesity in article jumping from around a steady 40/year to 120/year]). What is driving this concern? Are French worries over obesity a direct outgrowth of U.S. preoccupation with this issue? Are they responding to an increasing rate or prevalence in the general population or in specific subpopulations? While only about 10% of French adults were categorized as obese in 2003, these numbers have increased over time. In 1991, only 7% of women were obese and in 1980, only 6.3% fell into this category. Likewise, rates of childhood obesity [7.3% according to one estimate (Le Figaro, August 31, 2005)] have also increased over time. Rates of obesity have been shown to be greater among the French working class and in certain geographic regions.

France also provides a useful comparison in that previous work suggests that body weight is less moralized in France than in the United States. Most people recognize that body weight is heavily moralized in the United States. In many American circles, the primary meaning of “I was bad today” is “I ate high caloric food,” and fat people symbolize indulgence, gluttony, and sloth in the minds of many Americans, thin and heavy alike (Schwartz, et al, 2003). Even American children impute fatness with negative social traits as early as pre-school (Musher-Eizenmann, et al, 2004), wishing to interact with fat children less than thin peers and being more likely to assign negative adjectives such as lonely, lazy, sad, stupid, ugly, and dirty to heavier children, especially girls, than to thinner children (Turnbull, et al, 2000). Similarly, studies document clear and consistent stigmatization and discrimination against fat Americans, in employment, education, and health care (Puhl & Brownell, 2001). Currently there are no published studies testing these same hypotheses in France, but historian Peter Stearns (1997) has argued that body weight is not moralized in France as it is in the United States. Instead, the French regard obesity as a primarily aesthetic and medical issue. If this is still true today, one would not necessarily expect French news reporting on obesity to frame fatness as an indicator of individual moral laxity. While perhaps less likely to frame obesity as a product of gluttony and sloth, France’s strong traditions of socialism and critique of capitalism (Crozier, 1964; Hérault & Lapeyronnie, 1998) might make the French press more likely to frame obesity as a product of corporate greed, a distinct but nonetheless moral framework that has growing support on the left in the U.S. (Linn, 2005; Tartamella, et al, 2005; Dalton, 2004; Nestle, 2002; Brownell & Horgan, 2003).

Finally, previous work suggests that, in France, class distinctions are more salient than racial and ethnic boundaries (Brubaker, 1992; Lamont, 2000; Noriel, 1988). This has strong institutional foundations. For instance, in France, it is illegal to collect statistical data on a person’s race, although one can ask about nationality and occupational status. This makes it difficult to quantify racial or ethnic discrimination, but it also avoids reifying racial or ethnic differences. This would lead us to expect French news reports on obesity to be less likely than U.S. news reports to stress racial or ethnic differences in obesity rates but to be more likely to focus on class differences. The following discussion draws on exploratory analysis of 657 articles published in the past two years in leading French newspapers and newsmagazines, including Le Monde, Le Figaro, Le Point, and L’Express, that included “obésité” (obesity) in the full text.

The “Challenge of the Century”

Many of the French news reports on obesity dramatize the issue. As in U.S. reporting on obesity science (Saguy & Almeling, 2005), hyperbolic language is commonly used to discuss obesity. For instance, one article refers to obesity as the “challenge of the century” (Bidalon, et al, 2004). Several articles label obesity the “affliction (mal) of the century” (Perez, March 11, 2004; Petinicolas, 2005). Articles routinely refer to obesity as an epidemic or a catastrophe (fl éau) and many make frightening predictions about the future. For instance, one article quotes a deputy and doctor saying, “If we don’t react quickly, people suffering from obesity will see their life expectancies reduced by ten or so years” (Petinicolas, 2005). Another article quotes a European bureaucrat: “If we don’t do anything to contain the phenomenon, our children will have a shorter life expectancy than their parents due to this obesity” and further predicting that “almost half of Europeans will suffer from ‘fat diabetes’ (diabète gras) by 2030” (Le Figaro, May 26, 2005).

Despite the fact that the rate of overweight and obesity is relatively low in France and Europe, the French news cite French or European statistics of prevalence and increasing rate of prevalence to create a sense of alarm. For instance, the following article cites European statistics to suggest that obesity is a major problem:

In certain countries in the Union, more than one in five children is obese today… It is true that Europeans don’t stop putting on weight. A recent study by the International Obesity Task Force (IOTF) shows that obesity and overweight, long underestimated, could affect more than 200 million adults, or 45% of the population of the Union. The number of overweight children (en excès pondéral) is increasing by 400,000 each year. Fourteen million little Europeans are touched by this catastrophe (fléau), including three million by obesity… Overweight means diabetes, cardiovascular disease, hypertension, and respiratory problems… with the corollary of an increase in health costs. The Commission estimates that obesity already represents between 2 and 8% of health costs in Europe (Bonavita, 2005).

Forty-five percent of overweight Europeans is presented as an alarming number, even though 45% of the U.S. population were categorized as overweight as early as 1960, which was well before obesity became a major concern in the United States (Flegal, et al, 1998). The “overweight” category (BMI > 25) is routinely evoked to increase the number of people said to weigh too much for their health, even though the scientific evidence that being categorized as overweight but not obese is associated with increased mortality or morbidity is highly contested.

Often U.S. statistics, even those that have been discredited, are used to create a sense of alarm in France. Several articles cited a 2004 study by the Center for Disease Control (CDC) purporting to show that 400,000 deaths each year can be attributed to obesity (Mokdad, et al, 2005). For instance, an article entitled, “Obesity: the affliction (mal) of the century” blasts just below the headline: “400,000 deaths each year in the United States and the figures, continually increasing, are worrisome in France” (Perez, March 11, 2004). The first paragraph repeats the CDC claims that obesity will soon overtake tobacco as the leading cause of “preventable death.” Quoting Secretary of Health Tommy Thompson, the article states: “Americans need to understand that obesity literally kills.” Revealing that these claims quickly acquired the status of fact in France, another article published less than two months later writes that “obesity will soon replace tobacco as the leading cause of mortality [in the United States]” without even citing the study (Mokdad, et al, 2005) upon which that assertion was based (Vissiere, 2004).

Moreover, the study by Mokdad and colleagues has been heavily criticized (Barnoya, & Glantz, 2004; Blair & La Monte, 2004; Flegal, et al, 2004). Responding to such critiques, a CDC investigation was conducted and ultimately determined that the study had overestimated the deaths associated with obesity due to methodological flaws (Kolata, 2004). A year later, a new CDC study reported a much lower number of deaths associated with obesity (111,909), the majority of which are associated with those in the highest 6 percentile of weight, and that overweight was not associated with increased mortality (Flegal, et al, 2005). While the French news media reported heavily on the original study, they were silent on the subsequent debate and revised statistics. Previous work has shown that the American news media have also reported disproportionately on the most alarmist obesity studies (Saguy & Almeling, 2005). This effect seems to be magnifi ed in the transatlantic translation, in which dissident U.S. voices are not heard at all.

Another way that French news reports increase alarm over obesity is by focusing on rate of increase. For instance, one article reports: “Childhood obesity… has increased by 17% in 20 years in France” (Le Figaro, August 31, 2005). As others have pointed out (Best, 2001), when rates are low, the percent of increase over time might be quite high without the actual increase being very high. In this particular case, an increase of 17% in childhood obesity could mean that the rate of obesity increased from 8.6% to 10%. This same article also reports on rates of overweight (and not just obesity) among children of workers to increase alarm: “Among children of the working class, 27.2% are overweight (7.3% obese), but only 12.8% of children of professionals (1.3% obese).”

Evil Corporations, Greedy Fat Americans, and the Ignorant Poor

The analyses suggest that, contrary to what is suggested by previous work, body weight is moralized in France. Rather than framing obesity as a product of individual gluttony and sloth, as is most commonly done in the U.S., French news reports tend to frame it as a product of corporate irresponsibility, decline of French tradition in the wake of American cultural and economic imperialism, and an injustice of poverty.

French news articles frequently blame obesity on food advertisements for high caloric and low nutrient foods. For instance, one article entitled “how marketing makes your children fat” suggests that advertisements for high caloric and low nutrient foods are to blame for childhood obesity: “These apparently innocent advertisements… of cartoon characters biting with jubilation into chocolate bars are, according to this study, a ‘silent premeditated assault.’” Another article refers to vending machines as “infernal machines,” (Le Point, April 15, 2004). Clearly the discussion of obesity in France is not morally neutral!

In that the United States provides a symbol of unchecked capitalism in France, it is not surprising that the U.S. would be presented as a counter-model in regards to obesity. According to this reasoning, the high rate of obesity in the United States demonstrates the inadequacies of American cultural and economic models. French news reports on high rates of obesity in the United States reveal both a fascination with the U.S. as “other” (“look at how fat they are!”) and a fear that the United States provides a glimpse of France’s future (“we will soon be as fat as them!”). French news reports focus not only on how fat Americans are but also how obsessed they are with dieting. For instance, an article entitled “A Bulimia of Thinness” in a special issue on the United States in the left of center L’Express (Faure, 2004) reports critically on Americans’ seeming obsession at the time with low-carbohydrate diets: “Americans don’t have a healthy relationship with themselves, nor with the food they ingurgitate.”

When reporting on France, the French press presents the poor and working class as most vulnerable to the market. “The cheapest foods are also the highest in calories,” reports one typical article (Gazeau, 2004). Similarly, another article reports “the fat calorie costs infi nitely less than the calorie from fruits and vegetables. The price of fruits and vegetables is increasing, while that of fat is decreasing… If the public authorities want to undertake a real nutritional policy, they will have to convey medical messages as well as take economic actions” (Perez, June 8, 2005). Unlike the American press, the French press does not discuss difference in weight or eating by race and ethnicity. French political laws that prohibit collecting data on these attributes, which subsequently makes it difficult to comment on them, can explain the lack of attention to race and ethnicity. French reporting also discusses regional differences in weight distribution. For instance, rates of obesity are higher in certain regions, notably the Northeast, Normandy, and the Center, and lower in others like Brittany, Ile-de-France, and the Great West (Perez, June 8, 2005).

Despite generally seeing poor French people as victims of greedy corporations, several news reports also suggest that poorer families need nutritional education, implying that they lack the knowledge to make healthy decisions. For instance, the following article quotes a dietitian suggesting that working-class parents often make bad choices for their children: “In these families, the parents take advantage of discounts that favor snacking. They neglect snacks at fixed hours and prefer pre-cooked meals” (Gazeau, 2004). Most often, several factors are targeted at once. So, for instance, the passage cited above that stressed the need for economic reform also urged for “a true nutritional education” (Perez, June 8, 2005), thus implying that ignorance is at the root of obesity.

In sum, obesity is moralized in France, although in a different way than is typical in the United States. While, obesity is primarily framed as a product of gluttony and sloth and individual responsibility in the United States, especially on the political right, in France, where critiques of capitalism are stronger, leftist critiques of the food industry have particular resonance. Obesity has been framed as a product of personal over-consumption and corporate greed in the U.S. as in France. But in France, this framing allows obesity to become a lightning rod for deep-seated fears of American imperialism, in which American values and economic arrangements are seen to be displacing those of France. In this climate, it is not hard to imagine how obesity could be seen as an issue of national identity, thus making it a more urgent political matter than might otherwise be the case. When a public health issue is regarded as urgent, it is particularly difficult for moderate or skeptical voices to be heard, as including such perspectives necessarily means delays in taking public health action.

A striking and unexpected finding was that the words “obesity” and “obese” are now used in the French press as metaphor of waste, particularly of public resources in social programs. Thus one reads that “the excess of centralization… leads to obesity of the State and the asphyxiating heaviness of the administrative machine” (Duhamel, 2004, emphasis added). Similarly, another article opines that “this imperious French State finds itself today diminished by its obesity, by the liberalities of its ‘providence’” (Imbert, October 31, 2003), and a third evokes the “obesity of the welfare state” (Imbert, April 1, 2004). So it seems that obesity offers a language for discussing both the social risks of unchecked capitalism, on the left, and the economic risks of social welfare programs, on the right. Obesity similarly speaks to people across the political spectrum in the United States, as either a matter of personal or corporate responsibility. In both countries, concerns about obesity are not only about physical bodies but about the social body as well.

Policy Responses

Such media reports are arguably contributing to policy initiatives to slow or reverse population weight gain. Recent initiatives include removing vending machines in all public schools (Le Figaro, August 31, 2005), eliminating the 10 am snack at schools (Cousin, May 31 2004), regulating food advertisements that target children (Perez, June 6, 2005; Labbé & Recasens, 2003), weighing children on the assumption that “at first you can’t see it [obesity]” (Perez, June 6, 2005), and educating children in the benefi ts of fruits and vegetables (Singer, 2004).

Health at Every Size?

We found little skepticism in the mainstream press regarding the alleged obesity epidemic, although a few news articles point to how lack of appropriate medical equipment compromises fat people’s health care. For instance, an article published in May of 2004 in Le Point notes that while weight loss surgery is becoming increasingly common, French hospitals lack adequate accommodations, such as Magnetic Resonance Imaging (MRI) machines, necessary to provide basic preventive care for people over a certain size: “Without adequate equipment in French hospitals, some obese people were sent to the national veterinarian school of Maisons-Alfort to use an MRI machine, in between two big animals” (Houdart, et al, 2004). This same article notes that, while gastric-bypass surgery has exploded in France, quality of care in these procedures is often inadequate: “Half of patients do not benefit from followup medical and dietetic care for at least six months after the intervention, 45% do not receive a pre-operative multidisciplinary overview, 53% are not properly followed after the operation, and in 16% of patients the operation was contraindicated.

Allegro Fortisimo, the French chapter of the International Alliance for Size Acceptance (IASA), was not quoted in our news sample. However, a visit to their website (http://www.allegrofortissimo.com/index.html) shows that they are skeptical about the dominant discourse on obesity. For instance, the website points out that the figures presented in the Mokdad (2005) study were ultimately determined to have been inflated (http://www.allegrofortissimo. com/breve27.htm) and, quoting Paul Campos’ Obesity Myth (2004), argue that there is no medical evidence that having a BMI between 25 and 30 poses any health risk and that it is better to be “fat and fi t than skinny and sedentary” (http://www.allegrofortissimo.com/breve13.htm). This group is critical of recent efforts to eliminate sweets in school, arguing that this serves to “demonize” sweets, thus making them more alluring (http://www.allegrofortissimo.com/breve20.htm). It also expresses concerns about recent requirements that food advertisements be accompanied by “approved health messages”: “show an ad and then say that gaining weight is dangerous for your health perpetuates contradictory messages and food restrictions.” The association argues that such measures be accompanied by education about size discrimination. Despite criticisms about current policy approaches, however, Allegro Fortisimo supports “holding accountable the food industry.”

The President, a doctor and nutritionist, and Vice President, a psychiatrist, of the association, Le Gros denounce a recent public health campaign (République Française, 2005) entitled “Eat fewer fatty and sugary foods and protect your health:”

If it is true that certain eating habits are less healthy, the question of how to influence them in a positive way has still not been resolved. At the moment, we have no proof of the efficacy of these nutritional information campaigns. We have no proof, for that matter, that consuming more sugar is responsible for obesity and no proof that reducing such consumption will allow for weight loss… It is irresponsible for the public authorities and medical institutions to create a climate of panic… And especially as the sugar industry, feeling attacked by this public health campaign, is responding with another defensive campaign, entitled, “who wants a world where sugar is prohibited?” As usual, the eater finds himself at the center of a struggle between food Puritanism and consumer frenzy. This struggle echoes that which daily tears apart so many eaters, and which leads them to alternate between dietetic eating and food debauchery without being able to control themselves.

Rather than act before having all the facts, this organization thus urges the French government to be more cautious in obesity policy.

Conclusion

In sum, obesity has emerged as a major health concern in France in the past couple of years, despite relatively low rates of obesity in this country. This raises interesting questions about how and why certain issues emerge as public health concerns when they do, as well as how national context shapes the ultimate form they take. Our exploratory analyses suggest that the French preoccupation with body weight is indeed informed by American news reporting, American scientific research, and American or international organizations like the IOTF. Yet, it also takes a specific French form, in which corporations are more likely to be demonized than individuals and in which moral boundaries (Lamont, 1992) are drawn around nationality and class, but not race or ethnicity. While they seem like David against Goliath, fat acceptance movements in France offer alternative perspectives to the “fat panic.”

Abigail Saguy is an Assistant Professor, UCLA Department of Sociology. This research is part of a larger project that has been funded by a postdoctoral fellowship from the Robert Wood Johnson Foundation Program in Health Policy Research, the Fund for the Advancement of the Discipline (run jointly by American Sociological Association and the National Science Foundation), the UCLA Sociology Department, and three UCLA Senate Grants. Isabelle Huguet and Jeanine Yang provided research assistance. Thanks to the showmethedata listserv for stimulating discussions of obesity research and to Paul Campos very helpful comments on a previous draft.

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This article is from the Health at Every Size Journal and can be cited as Abigail C. Saguy, “French Women Don’t Get Fat? French News Reporting on Obesity” from Health At Every Size 19:4 (Winter 2006).