Retrospectacle: A Neuroscience Blog

Recently, an older post I made regarding AIDS in Africa was included in a Feminism carnival. The Body Impolitic saw fit to take my assesment of the situation to task, and I feel the need to respond to what I believe is a gross mis-representation of my post. Specifically, that it was somehow derogatory to people of size.

My post was this:

As more and more women are acquiring AIDS in South Africa, a new trend is emerging: in order to not look HIV positive, women are becoming obese in large numbers. According to the Independent Online, half of all women in South Africa are overweight, and almost one-third are severely overweight. More than 5 million of South Africa’s 45 million people are infected with HIV/AIDS, and the cultural perception is that if a black woman is thin, she has AIDS.

“When being overweight is seen as a sign of health and wealth, it is extremely difficult to change this perception,” Ms Van der Merwe [of the International Association for the Study of Obesity] said. “We should be convincing black women that weight loss has a markedly helpful effect on health.”

This is really quite a disturbing trend, as women in South Africa may just be harming their health even more by becoming overweight (AIDS or not). In addition, it seems to highlight that the perception of having AIDS, of how one appear to the world, may be as important (if not more) than the actual prevention and treatment of the disease.

The Body Impolitic (TBI) responded thusly:

Under no circumstances can the dangers of fat, which in the very worst junk statistics known to humankind has been said to kill 60 or 70 percent of fat people, compare to the dangers of AIDS, a virtual death sentence without current drugs. And the current drugs are often not available in Africa. The real numbers for fat as a killer, of course, are no more than 1/10 of those inflated numbers, and would be lower still if fat people were not stigmatized by cruel and thoughtless comments like Retrospectacle’s.

At no time did I compare obesity to the dangers of AIDS, and nor would I ever do so. Although I certainly consider the health effects of obesity to be serious, and would never treat them so flippantly as TBI, the point of my post was to comment that 1) the combined effects of obesity and AIDS certainly would do these women no benefit; but most importantly 2) the prevention of the disease, rather than the MASKING of it, is what will contribute to the end of AIDS. Finding a cure for AIDS, which is certianly what I would hope for in the future, does not include bowing to cultural stigma which may mask it, and abet its spread. Also, TBI claims offers no backing as to why she disputes current statistics on obesity (in America as well as Africa). And I’m not certain how my so-called “cruel and thoughless comments” impact the numbers of people who die of obesity-related disorders.

TBI continues:

Retrospectacle says she’s opposed to appearance (of not having AIDS) being more important than reality, but this is exactly what she is promoting: She says in so many words that whether or not these women are fat (in other words, how they look) is more important than whether or not they are healthy, and then she turns around in the same sentence and disses them for caring more about how they look than about their health.

This is baffling to me, as this is the exact opposite of what I have said. I can only attribute this to TBI misunderstanding the post, which was most certainly and emphatically stating that the actual health, and actual prevention of disease, should take precedence over the perception of health and lack of disease. How they look, whether they are fat, thin, red, white, or blue makes no difference to me in the scheme of things, except that “fat” is the stigma that follows “a lack or AIDS” rather than thin, red, white, or blue. What I’m stating (and I’ll try to be clear) is that stigmas which may prevent people from receiving help, and cultural pressures which may impact a person’s recovery negatively, are always themselves negative.


I say gaining weight is a very sensible response to risk of exposure to a disease that destroys (among other things) your ability to metabolize calories. When the drugs are scarce, each extra ten pounds increases a woman’s chance of staying alive until the drugs become available. Not to mention that, in impoverished circumstances, being able to marry can be another way to save your life. If African men are looking for assurances that potential wives don’t have AIDS, gaining weight is smart on that axis as well.

Medically speaking, this doesn’t hold water. Obesity is (to some degree) a strain on the body, not an asset, and this will only increase in a disease state. A person who dies of AIDS is very likely to die of an “infection of oppertunity” which attacks the weakened immune system of the AIDS patient rather than inducing starvation. And certainly, playing into the cultural stigma by purposefully gaining weight just to catch a husband (which by no means guarantees an AIDS-free life), only perpetuates the myth of “fat and AIDS-free” rather than addressing the reality that AIDS does not discriminate.

And more….

Oh, by the way? Another thing Retrospectacle apparently doesn’t know is that by no means everyone can gain significant weight by eating more.

Another thing that I never stated—in my post I never said anything about eating more. Obesity could be attained by less exercise…..higher caloric intake…..a change in the balance of your diet…..hormones….etc.

I appreciate the sentiment behind TBI post, insofar that a person should not be discriminated against based on their size. I agree. But I also propose that the hope of reducing new cases of AIDS and treating existing cases will not be achieved by denying that one has AIDS, and the issue at the forefront is changing the behavior which might lead to AIDS (promoting safe sex, changing stigmas rather than catering to them, and increasing availability of anti-retros). I am not trying to attack TBI, but must respond when I believe that my words and sentiments are taken out of context.


  1. #1 CCP
    October 6, 2006

    oh I have to ask, being an ecological energetics kind of person:
    what the hell could it possibly mean to claim that a disease “destroys…your ability to metabolize calories”?

    reminds me of the radio ad from the Milk Board I heard once:
    “Milk! High in energy, low in calories.”

  2. #2 Shelley Batts
    October 6, 2006

    CCP, I wasn’t so sure about that either….perhaps she meant the nausea that made it hard to keep food down??

  3. #3 JaysonB
    October 6, 2006

    This sounds more like someone getting their panties in a bunch more about what they THINK they skimmed through, rather than what they actually read.

    Because i don’t see how she could have read anything that you wrote and came to her absurd conclusions. It was like she selectively read the words “fat bad aids better” and ran with it.

  4. #4 Scott Belyea
    October 6, 2006

    …people of size.

    Hmmm. I could have sworn that everyone I’d ever seen had “size.” I’ll have to start looking more closely. Mind you, if someone isn’t a “person of size,” then she or he is probably easy to miss.

    Are basketball players “people of height”? Just asking … :-)

  5. #5 Shelley Batts
    October 6, 2006

    Well, I agree with ya Scott…..I just wasn’t sure how to say what I meant in a delicate, non-offensive way.

    Any suggestions?

  6. #6 afterthought
    October 6, 2006

    It is hard to be sure, but it sure seems like TBI is being intentionally obtuse, though “skimming” could be the problem I suppose.

  7. #7 bernarda
    October 7, 2006

    Here is a Monty Python take on the Catholic Church and birth control.

  8. #8 Bram
    October 7, 2006

    I would argue that she didn’t take what you said ‘out of context’, because she quoted plenty enough for it to be entirely clear what you meant, and she was simply incapable of parsing it to mean anything which isn’t on her short list of opinions which some people have

  9. #9 Debbie Notkin
    October 10, 2006

    It’s clear that you put a lot of time and energy into responding to my response to your piece on African women gaining weight.

    We are in significant disagreement around many of the facts in this issue. My “flippant” treatment of the AIDS mortality statistics (which I should probably have backed up) is based on 20 years of research and social awareness, but perhaps the single biggest factor was last year’s enormous policy change by the U.S. CDC, which downgraded obesity from causing an estimated 400,000 deaths per year to causing an estimated 25,000. This puts it below septicemia, just to give us one comparison.

    The recent studies, especially the larger ones, repeatedly show that a body mass index in the “overweight” range actually increases life expectancy, and one in the “obese” range does not predict a significant decrease. Here’s one analysis. Countervailingly, and especially important in this conversation, are the dangers of a low BMI, almost never discussed in the popular literature. Perhaps the most important one, again especially in this context, is that low BMI is the best indicator of dying in the hospital.

    Perhaps those resources will help you understand my position, when I say I don’t believe the women in question are risking their health.

    For the rest of it, I’m guessing that you weren’t around when the AIDS epidemic was strong in the United States, before the advent of the protease inhibitors. You and your commenters are, of course, correct that the disease does not prevent one from “metabolizing calories.” That was written too quickly and should have been edited. It does, however, prevent ingestion and digestion. It is a wasting disease, and a very ugly and sad one; no one who has lost friends, lovers, or family to AIDS ever forgets the skeletal thin-ness of the dying. The Africans don’t call the disease “the slims” for nothing.

    If they are in fact gaining weight to avoid the appearance of having AIDS, which is not as easy as it sounds (despite your list of alternatives to eating more), African women are achieving at least three goals: 1) they are increasing their odds of living long enough to get treatment if they do contract AIDS; 2) they are protecting themselves as well as the people around them from the all-too-common painful visuals of a continent with a 25% adult AIDS rate; and 3) they are perhaps improving their odds in the marriage market. You are again, of course, correct that getting married is no guarantee against contracting AIDS. What it is, for women in most cultures, is a way to improve one’s income, social status, and governmental protections–all desperately needed in a continent under siege.

    P.S. I can’t check links in your preview set-up, so if any of the above links don’t work, please let me know.

  10. #10 kemibe
    October 11, 2006

    “…perhaps the single biggest factor was last year’s enormous policy change by the U.S. CDC, which downgraded obesity from causing an estimated 400,000 deaths per year to causing an estimated 25,000.”

    The CDC freely admits that owing to a slew of confounding factors, it’s difficult to precisely pin down the number of deaths directly attributable to obesity. But this in no way undermines the vast array of literature driving the conclusion that obesity carries a variety of health risks, which I need not enumerate. It is as spurious to use this numerical discrepancy to deny these risks as it is for creationists to point to disagreements among biologists about mechanisms of evolution as evidence that common descent, natural selection and transitional fossils are bogus constructs.

    “The recent studies, especially the larger ones, repeatedly show that a body mass index in the ‘overweight’ range actually increases life expectancy, and one in the ‘obese’ range does not predict a significant decrease. Here’s one analysis.”

    What studies are these that “repeatedly” establish a positive correlation between life expectancy and overweight in the general population? Similarly, which ones suggest that obesity is not “significantly” correlated with a lower life expectancy?

    Also, if you’re going to enlcose “overweight” and “obese” in quotes, you might have done the same with “analysis,” considering that the source is a law professor with an axe to grind in an opinion column and a trade book (The Obesity Myth) to promote — a demagogue whose distorted interpretations of various studies have been repeatedly thwarted by Harvard School of Public Health researchers. Here is what those researchers have to say about the Flegal study Paul Campos — rowdily convinced, as always, that docs have an inherent (but conspicuously unexplained) need to inflate obesity-related mortality statistics — rails about.

    “Countervailingly, and especially important in this conversation, are the dangers of a low BMI, almost never discussed in the popular literature.”

    This is a red herring and fails on its face. Claiming that being overweight represents an established health risk is not tantamount to claiming that lighter is uniformly healthier. Your statement is akin to the hypothetical assertion that because SSRIs appear to create a higher suicide risk in certain adolescents, depression itself is nothing to worry about.

    “Perhaps the most important one, again especially in this context, is that low BMI is the best indicator of dying in the hospital.”

    Since you again provided no external support for this claim, it’s difficult to directly dispute it, but might this finding (assuming it’s even true) be related to the fact that a wide variety of terminal illnesses (e.g., cancer, COPD, CHF) include wasting and cachexia as prominent features? This, by the way, applies to formerly heavy patients whose disease processes are strongly linked to overweight and obesity who then lose weight owing solely to their pathology before expiring, as the Harvard release explains.