Breathing Easy
by Hillel Schwartz

I read in the July/August 1996 issue of the NAAFA Newsletter that the FDA has recently approved dexfenfluramine (dex-fen) for long-term use as a pharmaceutical to combat obesity. The problem with such an approval, according to Drs. Stuart Rich and Lucien Abenhaim, is that there are serious side effects to long-term use of this familiar diet drug, which the FDA approved long ago for short-term (maximum three months) use. When taken over the short term, dexfen in the past has been considered harmless-and for all practical long-term weight-reducing purposes, basically ineffective; when taken over the moderately long-term, dexfen is at the very most 5% effective, but within three months or a little more, it also apparently may cause primary pulmonary hypertension (PPH), a rare ailment, difficult to diagnose even over the long-term. It takes on average three years from onset to accurate diagnosis, but PPH has a fatality rate approaching 100%, and most patients die within 2.8 years of onset.

Yes, I mean that first paragraph to be confusing. The diet drug industry, like diet advertising, is filled with many such confusions about time, fat, and mortality, some of which I have addressed on an earlier occasion. The dieting industry promotes its products for their nearly instantaneous (short-term) cures to what almost every dieter has found to be a perpetual (long-term) problem. Each new diet or diet drug is like a perpetual motion machine: it appears to defy the laws of nature, it promises a new source of energy, it promises to put the dieter into the swing of things once again, but in the long run it butts up against the most fundamental principles of physics and physiology.

The problem immediately at hand is somewhat different. I quote: "One of the problems in diagnosing PPH is that its major symptom is shortness of breath. Because many fat people experience general shortness of breath, many doctors do not treat this as a serious problem and just tell the person to lose weight." This, of course, is a grimly hilarious vicious circle: the person who is taking dexfen to lose weight complains of shortness of breath, which is a symptom of being fat, which leads physicians to advise further efforts to lose weight, which assists in the promotion of long-term diet drugs such as dexfen, and so on.

This reminds me of earlier vicious circles described by researchers in the 1930s. Opposed to prescriptions of exercise for obesity, some physiologists and physicians noted that if a fat person exercised, she would get hungrier; after satisfying her hunger with a larger meal than usual, she would become heavier and less able or less inclined to exercise; the more sedate she was, the more likely she was to injure herself exercising; now cautious and stationary, she was not likely to burn off any calories and so she would become fatter and even more in need of exercise, which in turn would make her hungrier, and so on, unfortunately, forever. There was a similarly cautionary vicious circle for men: exercise led to more work for the lung and the heart muscles, which led to cardiac or pulmonary problems, which led to a distinct need for rest, which would eventuate in a more immobile life during which the fat man would wax fatter and appear to be in greater need of some exercise, which could in turn (now that he was carrying more weight and the heart and lungs had to do more work) be deadly.

But black humor is not quite the problem at hand, which is that of fat and breath. Since the time of Chaucer, if not long before, fat people have been drawn as wheezy people. Fat men huff, fat women churl, and meanwhile they bowl the house over. For generations, one standard explanation for the etiology of fatness in children has been that their fat comes in response to a "smothering mother" who feeds them because she has no other or better way of demonstrating her love and eliciting demonstrations of affection and loyalty. Because (in yet another vicious circle), smothering mothers smother as a result of their own insecurities, and because in consequence no such mother can ever be satisfied by the love her children show her, the children feel always inadequate and eat themselves into fat bodies in an endless, vain attempt to express their love adequately.

This has proved to be hogwash. Nonetheless, the figurative connection between fat and shortness of breath remains powerful, despite performances of divas with enormous reserves of breath, and despite statistics that show emphysema and asthma to be more prevalent, for example, among thin smokers than fat non-smokers.

What's going on here?

Projection, impure and not so simple. Small, narrow people project onto large, wide people a skewed version of those uncomfortable feelings which they feel in themselves on an encounter with fatness. Much of that discomfort is itself due to having accepted the values of a society that refuses to recognize any virtue in fatness. Instead, then, of straightforward acknowledgment of a feeling of awe in the presence of a large, wide person, the tendency is to turn that feeling inside out and project onto the "fat" person an emotional or psychological state of shame. (Fat persons must feel ashamed about their bodies.) Instead, then, of straightforward acknowledgment of a feeling of being diminished in the presence of a large, wide person, the tendency is to project onto that "fat" person a state of self-abasement. (Fat persons must feel guilty for their own ugliness.) Instead, then, of acknowledgement of a feeling of being breathless and overcome in the presence of a fat person, the tendency is to project onto the "fat" person a state of breathlessness and incarceration. (Fat persons must feel smothered and imprisoned within their own fat.)

It is "only natural," one would say, for a fat person to feel ashamed, guilty, and short of breath. And there follows a most deliberate series of physiological, psychological, sociological, and economic reasons why what is "only natural" is also objectively inevitable, from shortness of breath to early death, a sudden, premature expiration.

Several issues ago, I analyzed the notion of fat people as noisy. Some of that noise comes from shortness of breath, since people who do not breathe easily breathe noisily, and gasp,and may also snore. (I know; I am not large and wide but I do have asthma and I do snore.) The noisiness commonly attributed to fat people, however, is considered part of their "condition," and it must be neither the noise of defiance nor the noise of revolution. Fat people, after all, have themselves as their worst enemies; what bones do they have to pick with the rest of us?

Taking the symptomatic (projection of) shortness of breath one step further, we may come to appreciate how shortness of breath has been integrally related to the shaming of fat people as necessarily inarticulate and unholy.

The less breath one can summon, the less coherent a protest one can mount. A wheeze is not a call to arms; a whine (fat people, short of breath, whine all the time, right?) is not an oratorical flourish. It is only natural that fat people should not be able to protest the treatment of their "condition"; they must work, rather, on getting their "condition" treated.

Their "condition," in other words, renders fat people babblers and gaspers, inarticulate as babies or fools. Fat gets in the way of dynamic speech and resolute action as it gets in the way (so it is said) of speed and accuracy.

Their "condition" also and fundamentally makes fat people unworthy (of rights, of restitution), for shortness of breath implies shortness of inspiration. To be short of breath (see Genesis; see John) is to be short of spirit. Fatness hampers access to the holy as it halts access to certain high-flying rides at amusement parks and certain pews in high-falutin' churches.

It may be true for other cultures that fatness and sanctity are entirely compatible (the fat Buddha is one of Asia's favorite Buddhas), but in the United States, public suspicion of Eastern gurus is magnified once it is found that such men and women are not only deep (yogic) breathers but physically large and wide. Fatness MUST be uninspired and uninspiring.

In sum: shortness of breath is less symptomatic of the physical status of being large and wide than it is of certain prevailing attitudes toward what fat people should be, how they should act, and where, at Judgment Day, they will end up.

What would it be like to live in a world where all people of every size were expected to be able to breathe easily? What would it take to so inspire our world? ß

HILLEL SCHWARTZ received his Ph.D. in history from Yale University. He has taught history, religious studies, and dance improvisation at several universities, including the University of California at San Diego. He currently lives and writes in Encinitas, California. His book "Never Satisfied-A Cultural History of Diets, Fantasies and Fat" is regarded as a milestone in the size acceptance movement. Dr. Schwartz' deeply philosophical perusings of size issues are a treat to those who appreciate true brilliance.