XXL: Obesity and the Limits of Shame

XXL: Obesity and the Limits of Shame is a book that directly challenges the public health sector in North America and around the world for its failure to address the crisis of obesity meaningfully. The authors argue that the public health sector has made the problem worse by failing to emphasize how intensely difficult it is for individuals to lose weight and by proposing marginal and ineffective lifestyle changes. Around the globe, the traditional public health solution has been to throw extraordinary amounts of tax dollars at shame-inducing policies that encourage people to eat right and exercise. This generic approach has failed. A shaming mentality is metastasizing throughout the anti-obesity public health movement and across popular culture. The book begins with an account of a futuristic world in which we might live if shame-laden policies accelerate. The authors argue that shaming policies (singling out fat children in gym classes for “re-education”) and mass “carpet-bombing messages” (“eat your fruits and veggies or else!”) carry deep social costs. In some cases being threats to fundamental freedoms, and in other cases being expensive showpieces to justify government bureaucrats' existence, such shaming policies do little to confront the personal, genetic and cultural challenges of obesity. No one program works for everyone. But the one-size-fits-all public health approach dooms it to failure. This book is not about how to lose weight or how to eat less. XXL is a public policy document of how to implement policies that might more realistically work to decrease the health crisis caused by high calorie consumption. And the evidence of poor diet is everywhere from a dramatic increase in childhood diabetes, to doctors' offices and weight-loss centers that have furnished waiting rooms and diagnostic machines with extra-wide, heavily reinforced chairs known as “bariatric chairs.” Obesity is not only a public health problem, but an ethically fraught psychological and bio-social-cultural-genetic problem. This book realigns the debate on obesity: Governments must admit to the utter futility of their top-down planning solutions and enable bottom-up innovations to flourish.