Techniques for Winning an Argument and Losing a Voice
The anger industry is booming all over the world. Outrage seems to win arguments because many people grow tired of rage and walk away. It’s a pretty good business model for cable news right now. But it carries a risk. Anger sometimes leaves people thinking they’ve won an argument. In fact, though, they’re losing a voice in rational decision making.
Anger about Weight Bias
We have ample reasons to be angry about weight bias. It’s rampant in healthcare and routinely threatens the health and quality of life of people living with obesity.
Many health providers see nothing but a patient’s BMI if if it is high. “I could walk into my doctor’s office with an ax sticking out of my head and they’d tell me my head hurts because I’m fat.” This thought is not much of an exaggeration. And thus, outrage is an understandable response.
But with outrage, we can lose opportunities for rational problem solving. We can’t discuss the physiology of obesity and adipose tissue in some circles because “The word ‘obesity’ represents a medicalization of body weight.” Folks who have trademarked Health At Every Size® thus see that word as stigmatizing because they define obesity purely as a function of weight or BMI.
On the other side of this divide, we have clinicians and researchers who are quite serious about understanding the chronic disease of obesity – defined by adipose tissue impairing health. To some HAES activists, the science of adipose tissue disease is irrelevant. “Obesity is not the health risk it has been reported to be,” says the HAES fact sheet. That comes from assuming that weight and BMI – not adiposity – define obesity. Obesity Inc, say these activists, has “infiltrated medical practice.”
Straw-man, ad hominem, and conspiracy theory arguments get in the way of rational discourse.
Anger about Vaping
Our friend, Joe Gitchell, works on harm reduction, tobacco, and nicotine policy. He observes a similar challenge on these issues:
This behavior arises in at least some work of advocates for vaping and other noncombustible sources of nicotine as substitutes for cigarettes and other combustible tobacco products. Almost everywhere these advocates are fomenting a rebellion against the health and medical establishment, and thus can be forgiven for what can appear to be the stridency of their rhetoric. Even in the UK – where a rethinking of nicotine is only recently progressing and not yet complete – one can see this behavior at times,
It is incredibly frustrating to see advocates disrespected when they have succeeded in stopping smoking. (For a detailed and horrifying case of this, see this blog post from Clive Bates recounting events in 2014.) But advocates occasionally express vitriol that serves more to signal group allegiance than to persuade people who might be open to rethinking their ideas. We fear those advocates risk turning off the very people who might come to support their cause.
Civility Required
When we shout too long and too loud, we lose our voice. A recent ad hominem accused us of wanting to make sure that “niceness trumps actual problem solving.” As a matter of fact, we firmly believe that actual problem solving requires civility.
For an example of an ad hominem in vaping debates, click here and then here for the response.
Rage, photograph © Bart / flickr
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June 24, 2018
June 24, 2018 at 4:28 pm, Angela Meadows said:
Hi Ted,
It’s interesting that you cite that letter about the vapers, as I see a lot of what is being done by the anti-tobacco PH ‘side’ happening in the present and other blog posts.
You say, “To some HAES activists, the science of adipose tissue disease is irrelevant. “Obesity is not the health risk it has been reported to be,” says the HAES fact sheet. That comes from assuming that weight and BMI – not adiposity – define obesity. Obesity Inc, say these activists, has “infiltrated medical practice.” Straw-man, ad hominem, and conspiracy theory arguments get in the way of rational discourse.”
At least you acknowledge, “some activists”. I am an activist. I am a HAES proponent. I do believe that Obesity Inc has excessive influence on medical practice – don’t you? I also agree that being FAT is not necessarily the health risk it has been made out to be. In making these statements, we are talking to the vast majority of people who define “obesity” as a BMI >=30. You could also look at adiposity level rather than the BMI ratio and come to the same conclusion. You define obesity as a level of adiposity associated with ill health, which, as I have said before, is somewhat circular.
Nobody that has any understanding of the science (which I will admit is not all HAES proponents) would suggest that weight is un-related to health. Of course it is. We would argue the point as to 1. Why, and 2. What to do about it.
My background is in biomedical science. I, and many of the other scientifically minded HAES proponents, do indeed find the biology and physiology of adipose tissue quite interesting. For example, I’m particularly interested in how adipocytes/adipokines respond to stress signalling (e.g. constant stigma), and to the usually prescribed ‘treatment’ of fatness (dietary restriction and likely weight cycling). This is a fascinating area and no doubt has much to say about how we get fat, why we get fat, and how being fat makes us sick, when it does.
It is still entirely irrelevant in discussions of stigma, prejudice, and social justice, as I’m sure you would agree.
Finally, when faced with a doctor who does not know better than to judge a person on their BMI and send them away with instructions to just eat less and move more rather than detect and treat their actual health problem, sometimes reasoned presentation of facts is the way to go. Many people in that situation are not able to advocate adequately for themselves and we HAES advocates provide resources to help them do so (especially Linda Bacon, ASDAH, Ragen Chastain). When faced with people who are open to discussion, this is also usually the best tack. Most of us HAES advocates were once one of those people.
But when faced with oppression and constant micro- and macro-abuse, sometimes we just need to get angry. We have all heard ‘you catch more flies with honey,’ and my husbands argument, just today, that ‘once you’ve gotten angry, you’ve lost the argument.’ But that assumes there is an argument, a debate, a discussion, to lose. Sometimes, this is not an open discussion among equals. Most of us are well versed in when a more moderate tone is required and when there is absolutely no bloody point. Being calm and moderate will not make some people turn around and say, ‘oh, gosh, i’d never thought of it that way, you’re totally right and i’ll never do that again.’
Please give us some credit and respect in managing our own response to oppression. You (the general you) do not get to mistreat us then tell us how it is appropriate for us to respond to this in order for you to even listen to our grievances. Tone policing is rife when marginalised and oppressed groups speak out. And as an ally, sometimes you just need to suck it up and let us vent.
June 24, 2018 at 7:06 pm, Ted said:
Angela, thanks for taking time to share your thoughts in such detail.
To answer your question about Obesity Inc, no I do not agree. References to Obesity Inc are ill-defined, so people can make it into whatever they want. The person who wrote those words was suggesting that I am part of a conspiracy to oppress fat people. I don’t agree with that and I don’t agree with conspiracy theories about obesity in general. If anything, there’s a conspiracy of ignorance about obesity and weight bias. Most medical practitioners think that instructing a patient to lose weight should solve any problems related to obesity and they’re totally wrong. That’s ignorance. It’s not a conspiracy.
I agree with you that the pathophysiology of obesity is largely irrelevant in discussions of bias and stigma and yes, oppression. Mixing in suppositions about the health effects of obesity creates a distraction. But of course, the health effects of stigma are highly relevant.
I’m not opposed to venting. Venting about fat shaming has brought progress in public awareness that’s quite helpful. What I really don’t like is ad hominem tactics (aka name calling), conspiracy theories, and misinformation. They hurt the cause. And I’ve witnessed these tactics hurting people who are living with obesity.
Again, thanks for your scholarship and your activism. And thanks for being a voice of reason.
June 24, 2018 at 6:30 pm, Katherine Flegal said:
The terminology changes have led to lots of confusion and room for fruitless discussions. It used to be that BMI was used to define “overweight’ which makes sense because BMI is a measure of weight adjusted for height and ‘overweight’ is weight over a weight standard of some kind. In 1995 WHO put out a technical report using BMI to define 3 grades of ‘overweight’ with cut points of 25, 30 and 40. The same report says on p. 420 that there is no agreed upon definition of obesity in terms of body fat.
Then the 1998 report on the “Global Epidemic of Obesity” from WHO used the same BMI cut points as the 1995 report but changed the terminology with no explanation, so now obesity was defined in terms of BMI suddenly. Since that, the actual definition of obesity according to national and international standards is a BMI of 30 or above. Now we have ended up with ‘obesity by definition’ based on BMI versus something else that might be called “real obesity” but that we don’t have a clear definition of.
This is fairly strange when you think about it. It’s hard to say that someone who meets a specific definition nonetheless shouldn’t be classified on the basis of that definition. This kind of approach pretty much guarantees endless arguments and confusion. If we go on using two different definitions of the same thing then it is going to be hard to agree. Actually WHO and US government agencies and HAES advocates are all defining obesity in terms of BMI, not in terms of some level of excess body fat. Even though BMI is probably not the best way to define obesity, it is the standard definition at this point and people shouldn’t necessarily be criticized for using it.
June 24, 2018 at 7:19 pm, Ted said:
Thanks, Katherine, for adding your perspective.
It’s not unusual for people to argue endlessly about cutoffs for a clinical condition. People still fight about criteria for hypertension and pre-hypertension. Criteria for dyslipidemia fuel similar debates. The same goes for diabetes and pre-diabetes. Why should obesity be any different? But I have no problem in living with two different criteria: BMI cutoffs for epidemiology and clinical assessment for a medical diagnosis.
June 24, 2018 at 7:19 pm, Angela Meadows said:
I hadn’t realised that remark was made to you specifically, Ted. I certainly do not agree with that intent! But I do feel that money often speaks loudest in many healthcare situations, and rational minds and evidence often do not prevail – that is the point I was making.
Katherine, thank you for that interesting potted history!
June 24, 2018 at 7:27 pm, Ted said:
You’re absolutely right, Angela. Rational minds and evidence often do not prevail. Thanks!
June 29, 2018 at 11:17 am, Katherine Flegal said:
Hi Ted. My point was not about cut-offs but about the whole question of whether the definition of something called “obesity” should be based on BMI or on some other measurement. It’s not just HAES activists defining obesity in terms of BMI. Actually WHO and the US government and many others are also defining obesity in terms of BMI, because this is the definition we have ended up with.
June 29, 2018 at 2:24 pm, Ted said:
From WHO (at http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight):
What are obesity and overweight?
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).