The Emergence Of Obecity

The proliferation of anxiety about the obesity epidemic is in part mobilized by the experience in the United States. In the US, it is reported that 60 percent of the population is overweight, and 21 percent obese (Revill 2003). This has more than doubled in the last two decades, with obesity now rising by 5 percent per annum. This is not evenly spread through the population. There are serious health inequalities, with more than half of black women in low socio-economic groups being obese. One in five children is overweight. Obesity is estimated to account for 12 percent of health care costs, $100 billion and rising. The US has provided the emblematic marker for the rest of the western world to signify where other countries are heading and as a context to examine the causes of obesity, the problems it generates and possible solutions. In this chapter, however, we take a different turn and examine how the crisis of fat deposition has started to raise the visibility of the interconnections between the multiple metabolisms of the body, sewer and city.

In the US the concern with the rising levels of obesity of individual bodies has sparked an interesting mobilization of the problem of obesity at the urban level. At the core of this movement has been the development of city "fatness and fitness" league tables produced by Men's Fitness, a leading men's health magazine. The magazine set out "to measure, city by city the relative environmental factors that either support an active, fit lifestyle, or nudge people towards a pudgier sedentary existence" (Men's Fitness magazine website, Survey Methodology). The magazine's analysis enrolled a range of existing surveys and data and involved aggregating scores based on a multiplicity of indicators, including gyms and sporting-goods stores, health club memberships, surveys of exercise, levels of fruit-and-vegetable consumption, alcohol consumption, smoking, television watching, number of junk food outlets per 100,000 population, recreation facilities, etc. Obesity levels were scored for cities by drawing on data from the Centers for Disease Control and Prevention and the Center for Chronic Disease Prevention and Health Promotion.

Consequently cities have been jostling not to be top of the league. While New Orleans was ranked as the number one fattest city in the first year of the league in 1999, in 2000 it was Philadelphia, and then Houston took the lead for the subsequent two years. These rankings were not ignored. When Philadelphia was top of the league a headline in USA Today ran "Blame the Cheese Steak: Unfit Philly wins flab crown" (Hellmich 1999). The article reports an initial response by a spokesperson for the city saying that: "this just proves what we've been saying all along, because Philadelphia has the best restaurants of any city in America, and apparently we've got the evidence to prove it." A more considered response followed from the new Mayor, John Street, elected in 2000, who appeared on The Oprah Winfrey Show to discuss Philadelphia's new status as fat capital. The Mayor enrolled the city into a strategy of collective weight loss (Calandra 2001). His initial response was to appoint a Health and Fitness Czar (or Fat Czar as the media reported it) and to initiate a programme called "76 tons in 76 days" with the support of the professional basketball team the Philadelphia 76ers. The challenge was set for the city to lose a collective 76 tons of weight in 11 weeks. The official weight was due on 3 July 2001 and 26,000 people were reported to have lost an average of 5.3 pounds each. Strategies for collective weight loss included groups for dieting and weighing in, line dancing programmes for city employees, enrolling restaurants to provide healthier food, and free fitness programmes (Twyman 2003). The Mayor's Office of Health and Fitness now reports that since the initial strategy was adopted in January 2000 a range of actors have become enrolled into a coalition for improving the health of Philadelphia: "citizens, the Department of Health, private corporate and community organizations, institutions of higher learning, public and private schools, communities of faith, hospitals, health systems, health clubs and gyms, Pharmaceuticals, media outlets, local, state and federal government agencies, non-profit health agencies and sports teams" (City of Philadelphia, "Fit and Fun" website). And, it turns out, Philadelphia has moved down to seventh position in the league tables in 2004. All is not without controversy, however, and with the cities' growing fiscal problems, opposition politicians had urged that slimming the city's budget should include firing the health Czar (Twyman 2003).

Houston, by contrast, has been faced with the opposite problem to Philadelphia, captured by the ABC news headline, "Houston you have a problem: a big, fat problem" (Reynolds 2002a). Houston took the lead from Philadelphia and for 2002 and 2003 was at the top of the league table. This identity is provocative, not something the Mayor, Lee Brown, wanted "as a distinction of our city" (Reynolds 2002a). Houston's response was to get advice from Philadelphia. A fitness Czar was appointed, Lee Labrada, a former Mr Universe, who began a "Get Lean Houston" campaign. This included a Fat Drive in which participants pledged to lose weight, resulting in 17,000 pounds being lost by 2,000 participants by 2003. Again a range of different agencies was enrolled. Most notable was McDonald's as Official Restaurant Sponsor rolling out a menu of "Salad and More" across all 253 restaurants in Houston. By 2004, Houston was able to boast "Houston: We did it! We are officially no longer the Fattest City in America. Dropping to #2 behind Detroit, MI" ("Get lean Houston" website). This, according to Men's Fitness was the result of better scores for increased sports participation, decreased alcohol consumption and improved nutrition (Men's Fitness website, Houston). So pleased are "Get lean Houston" with the success that they now claim to have rolled out the campaign nationally with the launch of "Get lean America" ("Get lean Houston" website).

The mobilization by Men's Fitness of the metaphor Fat City has provoked a renewed interest in the relationship between bodies and urban form (Sui 2003). Papers published in The American Journal of Health Promotion (Killingsworth et al. 2003) and American Journal of Public Health (Jackson 2003) reported a series of studies that "are among the first to link shopping centres, lack of sidewalks and bike-trails and other features of urban sprawl to deadly health problems" (Fackelmann 2003). One report shows how "people who live in sprawling neighbourhoods walked less and had less chance to stay fit...people living in sprawling neighbourhoods weighed 6 pounds more on average than the folks living in compact neighbourhoods where sidewalks are plentiful and stores and shops are close to residential areas" (Fackelmann 2003). And, in such areas, obesity is reported as more prevalent.

Sui argues this literal uptake of the fat metaphor can be illuminated through debates about the body and the city:

Fat City depends on the fatness of the body since this is the body of a coordinator: a data processor, business person, real estate agents, or urban planner.And the fatness of the body depends on the fatness of the city, since it develops as a result of the automobile dependent, privatized spaces of the fat city. The excess circulation of the city (roads) allows isolation of the person, which transforms again into excess circulation (blood vessels to the fat tissue). If the fat body becomes an obsession for health reasons and narcissism alike, it cannot be returned to a more sustainable size and shape as long as the city remains outside of theories of health.

Raising analysis of the relationship between the body and the city in this way is important. However, the emphasis on the direct linkages between fat bodies and urban sprawl neglects the subtleties and multiplicities in the work done by Men's Fitness magazine. The Men's Fitness league tables have significantly raised the visibility of fat issues in US cities. It has mobilized in the USA the classic debate between nature versus nurture by arguing that the rapid rise in obesity in the last century could not simply be explained by genetics and must therefore be a consequence of changing environmental circumstances. In explaining their rationale for this they use the imaginary example of two identical twins living in different cities to argue that the twin living in a poor city environment—in which finding healthy food is difficult, there are few places to exercise, the weather is not conducive to exercise, where people smoke freely, commuting is a hassle, there is poor access to gyms, and health care is poor and where junk food is easy to hand—is more likely to be fat. With this simple analogy to demonstrate the issue, the magazine develops a sophisticated methodology upon which the league tables are based. The magazine displaces methodology based on simple measures of obesity prevalence based on Body Mass Index with a range of indicators that move beyond individual bodies to the wider city ecology. This is clear when one considers that, based on BMI alone, the league tables would look different. For example, in 2003, Memphis, Tennessee had the highest percentage of overweight and obese adults and yet was placed 21st position in the league tables. The effect is to move from measuring the state of obesity in a city to highlighting the processes that lead to obesity.

This identification of the "fat city", as we have seen with the examples of Philadelphia and Houston, can lead to the mobilization of representations of the city to collectively remobilise fat with the enrolment of a range of diverse actors into strategies to reshape the metabolism of bodies and the city. The emergence of the representation of fat cities has involved a significant move in making visible the dynamics between bodies and the city as an environment and in doing so has opened up new discourses and forms of activity around the city as a collective metabolism. While Men's Fitness magazine presents a sophisticated account of the relationship between fat bodies and the fat city, understanding the circulation and deposition of fat requires looking beyond the dichotomy of body and city. To look at the multiple mediations of fat embedded within other less visible urban metabolisms we need to recognize the complexities and multiplicities of the relationship between bodies and cities that includes the role of social-technical infrastructure in the distribution of fat.

Beat The Battle With The Bottle

Beat The Battle With The Bottle

Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.

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