In 1912, the insurance industry set guidelines for themselves on who was thin, normal, too fat, and obese. Anyone, whether they exercised or not, who fell into the "too fat" or obese category, was now labeled a health risk, subject to heart attacks, diabetes, arthritis, asthma, and even homicide (Beller, p. 6). Now, it could be calculated and determined who were the "overweight" and who were not.

Along with this occurrence, Sigmund Freud was developing his theories and determined that subconscious psychological motivations could cause disturbances in normal functioning. According to researchers and psychiatrists, Glucksman, Rand, and Stunkard (1978), Freudian psychoanalysts "emphasized the notion that obese individuals have encountered a serious disturbance during the oral stage of psychosexual development…emotional deprivations or excesses in this stage of development somehow became associated with nourishment in the potentially obese individual, presumably, because the mother of the obese-prone child feeds it inappropriately in relationship to its emotional and nutritional needs. As a result, many obese children and adults fail to distinguish between hunger, satiation, and other sensations or emotions." (pp. 103,104)

Assigning this pathology to obesity served to cast aspersions, ascribe neurosis, and shift responsibility for becoming fat onto the larger members of society. It gave permission to many sectors of the culture to denigrate, reject and shame large people, especially women. In turn, large women often denigrated, rejected and shamed themselves and their bodies, which began to affect their sexual expression. It is valuable to review the development of Freud's theories and studies on obesity because of the injurious influence they have had and continue to have on women's lives through his heirs.

Long after Freud's death, many influential analysts continued to develop his theories, identifying fatness with oral sexuality, and claiming that fat people did not experience the fullness of adult genital gratification. Theorists suggested that because fat people were unable to handle mature sex, they searched, through food, for what one Freudian psychoanalyst, Sandor Rado (1926), termed the "alimentary orgasm" (p. 577). Although Rado himself became disillusioned with traditional psychoanalytic theory (Rado and Daniels, 1956, pp. 17-18), and the concept of the alimentary orgasm seems to have disappeared from psychoanalytic writings, the idea that fat people were not able to experience mature genital gratification did not disappear (Stunkard, 1976).

In the late 1950's, Harold Kaplan, a psychiatrist, and Helen Singer Kaplan, a clinical psychologist, compiled analytical theories from the first half of the 20th century on the psychosomatic concept of obesity. They wrote by way of introduction, "Almost all conceivable psychological impulses and conflicts have been accused of causing overeating, and meanings have been assigned to food" (Kaplan and Kaplan, 1957, p. 195). Some of the 90 analytic theories about overeating are:

Overeating may be:
a means of diminishing anxiety, insecurity, tension, worry, indecision.
a means of achieving pleasure, gratification, success….
a means of relieving frustration, deprivation and discouragement.
a means of expressing hostility, which hostility may be conscious, unconscious, denied, or repressed…
a means of diminishing feelings of insecurity and inferiority
a means of rewarding oneself for some task accomplished…
a means of diminishing guilt, which guilt may itself be due to overeating.
a type of defiance, rebellion against authority and control, an attempt at independence.
a means of proving inferiority and justifying self-depreciation.
a means of avoiding maturity.
a means of handling anxiety from infantile oral frustration.

Overeating may serve:
as a substitute for love and affection
for showing love and affection
for pregnancy
for protection against men and marriage.

Overeating or food may be symbolically:
a representative of pre-Oedipal mother conflict.
a type of alimentary orgasm.
expression of unsatisfied sexual craving.
expression of destructive sadistic impulses.
expression of penis envy and a wish to deprive the male of his penis.
expression of a fantasy where overeating results in impregnation.
pathologically strong oral libido being gratified in an unsublimated way.
a means of possessing a "part-object" like a penis or breast.
a defense against threatening unconscious feminine or masculine wishes.
an indication of an early disturbed mother-child relationship. (pp. 195, 196)

The Kaplans concluded that: "It is difficult to describe all the many specific psychological factors that have been proposed as being associated with obesity…it appears that the only psychopathological generalization that can be made with confidence about obese patients is that they are individuals whose life pattern is conflictual and anxiety ridden…the people affected by obesity typically have some degree of personality disturbance and/or emotional conflict which may be of any type or severity." (pp. 196- 199)

The findings of the studies compiled by the Kaplans appear today to be vague, ambiguous, and contradictory. Furthermore, all the obese people who came to the psychoanalytic authors felt a need for therapy. Obese people who did not feel a need for therapy were not taken into account in the creation of the theories -- possibly skewing the theorists' conclusions. Only one reference in the Kaplans' compilation suggests that it may be the obesity that is creating the personality disturbance. Rather than indicating that an inferiority complex, and feelings of inadequacy and shame, cause the obesity, we see the suggestion that: "Obesity results [italics added] in feelings of inferiority, inadequacy and shame. These feelings and the obesity associated with them then can be used to justify all the failures in interpersonal relationships, which the obese patient has. They may be used as a rationalization to avoid any further contact with people and threatening situations." (p. 196)

After the Kaplans' published their compilation, a number of studies emerged that countered the idea that obesity was a symptom of pathology. Albert Stunkard, who was a leading researcher and thinker contributed significantly to the changing attitudes about the psychopathology of obesity. Originally from the psychoanalytic tradition, Stunkard, in conjunction with other researchers, responded to the Kaplans' enumeration of pathology theories by trying to determine whether, in fact, obese people were more neurotic than thinner people. His first studies were of small numbers of people and showed virtually equal psychological health. Rand and Stunkard (1977) combined the findings of four different surveys, completed by 104 analysts on 147 patients. The results indicated that there was either a very small or no difference in psychopathology between obese and non-obese patients.

Then, in 1976, Goldblatt and Stunkard used a massive investigation done some years before to collect information on the lives of 1,660 people from midtown Manhattan. The investigation had collected but not correlated their weight and their psychological condition. After re-analyzing the data, the researchers found that obese people scored slightly higher on tests for "childhood anxiety, withdrawal, neurasthenia, depression, anxiety, rigidity, suspiciousness, and immaturity than the rest of the Midtowners but that the differences were not statistically significant [italics added]" (p. 145). This finding began a revolution in thinking that is evidenced by Wadden and Stunkard's (1996) later statement, "When psychopathology is observed in obese individuals, it is now seen as a consequence rather than a cause--a consequence of the prejudice and discrimination to which the overweight are subjected" (p. 163). Other studies (Crisp and McGuiness, 1976; Friedman, 1959; Weinberg and Stunkard, 1961, 1976; Wise, 1978; Wooley and Wooley, 1984) have substantiated these results.

Another example of the changes slowly taking place in attitudes toward obesity can be seen in the writings of Dr. Theodore Isaac Rubin (1967, 1970, 1978). Dr. Rubin is a well-known psychiatrist who wrote three popular psychology self-help books on losing weight. His books became best sellers and influenced many people in the late 1960's and 1970's. In Forever Thin, Rubin (1970) wrote, "Obese people almost always have sexual problems. The combination of grotesque fatness and repressed hostility are very destructive to closeness and good sexual relating. As anger dissipates in obese people and with it, fat, relations eventually improve" (p. 70). By 1978, however, Rubin was writing: "I do not believe the fat half of the population is sicker than the thin half, either physically or psychologically…. I feel that my earlier views in this regard were due largely to my own unconscious prejudice against myself and other fat people" (p. 22).

The assumption that if one is obese, one must have an underlying pathology did not and has not disappeared, however. Jungian, Marian Woodman (1980) wrote that the obese woman and her body "takes on the projection of the shadow and is experienced as evil. Sexuality therefore becomes evil. Femininity and sexuality are confused….[she] does not know physically or psychically where she begins or where she ends….[her] frustrations, aggressions, and inability to adjust to reality are expressed in craving for food. Tension in the body for whatever reason is relieved through eating." (p. 41)

Judi Hollis's point of view and recommendations may also be influenced by Freudian ideas that obesity is linked to repressed anger. In Fat and Furious, Hollis (1994) wrote, "I've never met an eating-disordered person -- either bingeing or starving -- who wasn't raging within" (p. xxvi).

Some theorists believe they have found an association between obesity and sexual trauma suffered in childhood (Blume, 1991). Other theorists conclude that compulsive eating and other addictions can result when women need to nurture themselves or suppress feelings (Woititz, 1989).

Compulsive overeating can be one of the results of sexual abuse. The act of eating, regardless of weight gain, is experienced as self-nurture. Since nurture by another cannot be trusted, and since one is so needy, the need plays out in the eating. Obesity serves a purpose. If you are obese, you usually feel sexually undesirable. If you are sexually undesirable, you don't have to deal with sexual advances made toward you. Obesity enables you to avoid the problem of having to deal with your sexuality. It is also true that if you stay fat, you don't have to deal with the terrifying truth - as you see it - that if you were thin, you'd still be undesirable because you are not worth much. (Woititz, 1989, pp. 64,65)

While many obese women did suffer sexual trauma in childhood, so did many other women who are not obese. There are also women who are obese who were not molested as children.

From the 1960s onward, overeating was often classified as an addictive behavior. For many, the suggested solution to overeating was to follow the proposals of Alcoholics Anonymous (an organization whose plan for stopping compulsive drinking was reportedly successful for people who followed it rigorously). AA's recommendation was to eliminate the addictive substance and find support through meetings, other people, and the help of a "higher power." The problem with treating overeating as an addiction was that compulsive overeaters had to taste their addictive substance every day. Eating was considered an inappropriate self-nurturing coping mechanism for those who ate, not to satisfy hunger, but to handle all the feelings and moods that caused a desire to eat (Overeaters Anonymous, 1939; Twelve Steps and Twelve Traditions, 1993).

Many addiction therapists (Klausner and Hasselbring, 1990; Lasater, 1988; McFarland and Baker-Bauman, 1988; Siegel, Brisman, and Weinshel, 1989; and Wills-Brandon, 1993) claimed and continue to claim that when large women suppress their feelings inappropriately, they nurture themselves through their food. It is often suggested that the problem begins in their family dynamics, for instance, a power struggle between the child and the parent. Judi Hollis (1994) wrote that people with eating disorders use food to become who others need them to be. "…daughters with eating disorders are carrying their mother's disowned pain and anger…A mother's denied emotions are internalized by the daughter….Too often the mother-daughter wound is based on unconscious enmeshment, a blending of boundaries, a failure to see where you begin and your mother ends. This failure creates self-destructive behavior that is played out on the plate." (pp. xiv-xv)

The addiction therapists (Austin, 1987; Bradshaw, 1988; Cavanaugh, 1989; Fossum and Mason, 1986; Harper and Hoopes, 1990; Potter-Efron, 1989; McFarland, 1990) under the leadership of John Bradshaw, discovered that shame is a key component of the struggle with poor body image and sexuality. Those who deal with shame believe it may be the connection that transfers poor self-esteem into a poor body image and then into one's sexual behavior by causing women to hide their bodies, become self-conscious, retreat from assertiveness, and become exquisitely vulnerable.

Searching further for the causes of obesity, the nutritional theorists claim that our sexual lives will improve as soon as we eat a balanced diet or an appropriate diet (Katherine, 1991; Walker, 1994). Fisher (1996) guarantees that a person will have increased sexual vitality as soon as she begins Fisher's low cholesterol gourmet diet.

Heubner (1993) connects food intake and sexuality. "It has long been known that food intake and sexuality are strongly influenced by the mechanism of reward-mediated by 'reward centers' of the brain. Together with other regulatory systems, such as hormones, these reward centers primarily motivate the organism to engage in complex behavior to secure maintenance of life and survival of the species. By linking these functions to powerful brain reward mechanisms, nature insures that these essential tasks are repeated over and over again. In other words, the organism does not grow tired of them, and thus the likelihood of the survival of the species is increased." (p. 229)

Before 1985, most theorists believed that obesity was simply unattractive and therefore a sexual derogator. From that assumption, they proceeded to interpret obesity as a deliberate or unconscious attempt to avoid sexual contact. They also failed to consider, until very recently, that their theories may have contributed to the very problems they attempted to link with obesity, including sexual ones. Little notice was taken of the vast numbers of women all over the world that by western standards would be considered obese, unattractive and unconsciously attempting to avoid sexual contact, but by the standards of their own country were considered highly prized and beautiful (Ford and Beach, 1951; Brown, 1993). The theorists before 1985 also failed to account for the fact that, even in western countries, there are many men who prefer large women (Dimensions). From the literature, it appears that most theorists didn't consider the possibility that a woman could be fat, have high self-esteem, feel good about her body, experience a sensual and fulfilling sexual life, and not be a compulsive eater. It is important to keep this preconception in mind when one reviews the literature on obesity and sexuality.

Many research teams have determined that isolating the etiology of obesity is not an easy task. After a researcher or theorist would conclude that they had found the cause of obesity, doctors would treat their patients from that perspective. Diets, calorie counting, amphetamines, high protein, low fat, liquids only, whatever the remedy, one observation became obvious. Although the patient might lose weight, she would gain it back and usually gain more than she had lost. Even using the many forms of surgery that were developed to suction off or diminish the intake of food, in the end, women regained much of their weight (Berg, 1992, pp. 44-49).

Beginning circa 1980, a new group of investigators emerged, not necessarily scientific researchers, but experiential theorists. Frances M. Berg (1992) writes, "From the turmoil of widespread frustration with diets that don't work, pressures to be thin, and the crises in eating disorders that grips America, a new movement is rising. It is a paradigm shift, vigorously opposed to dieting" (p. 110).

In 1984, researchers finally, openly admitted that ascribing psychopathology to obesity and treating it, appeared to intensify fat phobia and exacerbate not only the problem of compulsive eating, but other forms of eating disorders as well (Wooley, 1984).

Starting with Susie Orbach's Fat is a Feminist Issue (1979), Marcia Millman's Such a Pretty Face (1980), and Kim Chernin's The Obsession: Reflections on the Tyranny of Slenderness (1981), the attitudes about obesity began to change. Slowly women began to get angry about what had been "done" to their self-esteem, their bodies, and their spirits in the name of thinness and beauty.

One assemblage that was very incensed was the feminists. This group found society at fault for fat phobia, especially the males, the controlling half of the society. Some feminists suggest that the reason responsible for fat phobia and body obsession is that the new power and assertiveness that women were beginning to project threatened men in our culture. Men want women to stay tiny, dainty, and manageable. By linking success to adolescent style bodies, the patriarchal males create an impossible ideal that almost no one can attain. The struggle to be adolescent thin, which mature women can rarely be, may cripple women's energy, assertiveness, self-esteem, and self-confidence. When women accept and succumb to this male dominated system, they disempower themselves sexually and in numerous other ways, and keep themselves under paternalistic dominance.Should a woman break the rules of our paternalistic society, she will be made to feel guilty about and displeased with herself (Orbach, 1978; Woodman, 1980; Chernin, 1981; Bordo, 1993; Fallon et al., 1994). In The Beauty Myth, Naomi Wolf (1996) describes this dynamic as an attempt to undermine the new power of women that developed when women got the vote, birth control and began working outside the home (p. 12).

Much has been written about the influence of capitalist pressure on women to buy goods that improve their looks. Capitalism fuels and then profits from women's fears about failing to attract a partner. Women spend $33 billion a year on diets, $20 billion on cosmetics, and $300 million on cosmetic surgery (Wolf, 1991). Business interests that profit from women's insecurities continue to offer warnings about women's health, fading beauty, deteriorating bodies, and passing opportunities to attract a partner. The entire diet industry is supported by women's fat phobia and the obsession with making one's appearance finally "good enough" (Epstein, et al., 1994, and Wolf, 1991).

Capitalists' and men's interests intersect in patriarchal Capitalism. It is mostly men who own and control capital; it is men who receive higher wages - and it is women who do most of the work. The benefits of capital accumulation accrue mostly to men, and to women only through men. This is what female supplication to catch the right man is based on… (Szekely, 1988, p. 193)

Naomi Wolf (1991) combines feminist theory with economic theory: "The sexual revolution promoted the discovery of female sexuality; "beauty pornography" - which for the first time in women's history artificially links a commodified "beauty" directly and explicitly to sexuality - invaded the mainstream to undermine women's new and vulnerable sense of sexual self-worth….The weight of fashion models plummeted to 23 % below that of ordinary women, eating disorders rose exponentially, and a mass neurosis was promoted that used food and weight to strip women of that sense of control. Women insisted on politicizing health; new technologies of invasive, potentially deadly "cosmetic" surgeries developed apace to re-exert old forms of medical control over women." (p. 11)

Fraser (1998) conducted an exhaustive study of the diet industry and discovered that at present the obesity researchers fall into two camps: medical researchers, who believe that losing weight in any way, including surgery, is beneficial, even if people gain the weight back, and anti-diet eating disorders researchers who point out that dieting and regaining weight is doing more harm to the body and to the psyche than good (pp. 212-214).

Medical researchers study the etiology of obesity from a medical/physiological perspective and there are researchers and medical personnel who believe that the source of obesity is in the genes, or the endorphins, or the synapses, or the uptakers. These persons recommend medical intervention such as drugs that curb appetites (Hudson, Pope, and Jonas, 1984), doing intestinal or ileal bypass surgery (Mason and Doherty, 1993), readjusting metabolism (Keesey and Corbett, 1984), and eliminating hunger sensors (Fischer, 1996; Walker, 1994). There have been technical advances in the understanding of the neurotransmitters and receptors that play crucial roles in feeding and weight regulation (Blundell and Lawton, 1993). It may be worth noting that there is significant financial support for many of these investigations from drug companies that make profits from the fat-phobic public (Fraser, 1998).

The eating disorders researchers and activists found that dieting was having a disastrous after-effect on the participants and asked, "Should Obesity Be Treated At All?" (Wooley, 1984) They stressed that physicians didn't take the psychological and physiological risks of dieting seriously. By treating obesity as a disease, rather than acknowledging it as a natural human variation, the medical establishment was contributing to the overwhelming cultural prejudice against fatness.

By the middle 1980's a few women began to agree that all the anti-fat theories might have actually hurt them, inducing them to disassociate from their hunger, their feelings, their bodies, and from their sexuality. These Fat-Activists recommended giving up on the diets and self-rejection. They suggested that women need to get back in touch with their true hunger, their own bodies, their actual needs (Wooley and Wooley, 1980; Roth, 1983, 1984, 1991, 1996; Hirschman and Munter, 1988, 1995; Fraser, 1998; Normandi and Roark, 1998).

In 1984, Wooley and Wooley wrote: "Many treatment successes are in fact condemned to a life of weight obsession, semi-starvation, and all the symptoms produced by chronic hunger. We have encountered and have recently begun studying successful maintainers from commercial weight loss programs and have been more impressed by their fortitude than the quality of their life. …some consume as few as 800 calories per day… Perceptible beneath the visible pride is often an unmistakable bitterness over the price they pay to have a socially acceptable body." (p. 187)

Polivy and Herman (1983) found in their extensive research that dieting disrupted people's physical sense of when and how much to eat and led to overeating. Dieting also taught people to ignore other feelings as well. Dieters stopped being able to handle other emotions -- anxiety, disappointment, fear, stress -- in a normal way, and used food instead to express their feelings.

By 1993, the concept of eating disorders which had been applied only to anorexia and bulimia now began to be applied to all those who had eating problems due to dieting, including bingeing, and compulsive overeating (Stunkard and Wadden, 1993). All had one factor in common: fear of fat. Smolak and Levine and Striegel-Moore (1996) stated that programs for the primary prevention of eating disorders of adolescents fail, even when such programs are implemented and evaluated by experts in prevention. The failures are seen as "reflecting the monstrous impact of monolithic socio-cultural factors such as the media" (p. 252).

In summary, women who had dieted for many years began to question the wisdom of so much rejection of their large bodies. They saw the disastrous consequences of their repeated dieting, obsessing and self-reproach on their sexual lives. Normandi and Roark (1998) write: "The cultural pressures to be 'superwomen,' and to look beautiful while doing it, creates women who are not only afraid of their own sexuality but many times they are actually repulsed by sex. How can a woman relax and enjoy intimate relationships while she is holding her stomach in? How can a woman enjoy sensual pleasure with her mate if she is constantly worried about her cellulite? How many times does a woman go to bed and have sex simply because it is expected of her? And if she said no, would she ever be asked again, especially if she thinks she is overweight, old, ugly or somehow not 'sexy'? How often do women simply stop eating because they don't want to have hips or thighs - the very parts that make us women? How many women starve themselves in order to look unwomanly and thus asexual? How often do women throw up their suppers because they do not want their lovers to see their fat stomachs when they get into bed? How often do women put weight on to insulate themselves from sexual attention, attraction, feelings? How often do women keep weight on in order to make themselves unattractive to the opposite sex, so that they will 'stay out of trouble,' or so that they won't be wounded again? All are ways of disappearing, of hiding." (p. 7)

The extreme fat phobia of present U.S. society has resulted in a backlash, the creation of the size/fat acceptance movement. This group says that they don't care what caused them to be fat. They are. They are tired of trying to change themselves. They believe that many of the problems in their lives and in their sexuality are related to accepting one or more of the fat-phobic theories, dieting, obsessing, and rejecting themselves. They want to live, be sexual, attract people who are attracted to them, assert their desires, say "no" if they don't feel attracted, use their bodies for fun, fitness, and pleasure. They want to celebrate their sexuality like other women. Among the many spokeswomen for this point-of-view are: Wooley, Summer, Berg, Wann, Hirschmann, Munter, Gaesser, Glenn, Hall, Lindsey, Roth, Blank and Freedman. This movement is growing and is beginning to influence both professionals and the society at large. The organization that is leading this movement is the National Association for the Advancement of Fat Acceptance. Susan Dubin, a member of NAAFA, writes to her fellow members: "Let me explain a little about what fat activism means to me. Previously, being fat for me meant being an invalid sexually, professionally and personally. NAAFA is the greatest revolution in my life. I date interesting men and I am beginning to be comfortable in a swim suit. I am taking Yoga and belly dancing classes. Being an activist in NAAFA means a total, rewarding commitment to personal change and fulfillment. Realization of your own potential and beauty awaits you. Are you ready?" (in Smith, 1995, pp. 32,33)

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