It is not always the case that in order to solve a particular problem a precise understanding of its cause or causes is needed. A number of scholars have pointed out that the European health reformers of the nineteenth century had very little knowledge about the medical aetiology of the major health problems that afflicted the urban poor. Dubos (1971) argues that these reformist campaigns, which agitated for cleaner food, water and air, were motivated mostly by humanitarian rather than scientific impulses. It would be some years before the microbial origins of these diseases were discovered and there are those who seriously question whether these later scientific discoveries contributed significantly to improvements in public health (McKeown 1979).
So far in this book we have raised questions about the legitimacy of describing overweight and obesity as diseases and as a looming health disaster. But if we leave these issues to one side and engage with the 'obesity epidemic' on its own terms, what can we say about the most popular causal explanations, particularly the idea that 'Western lifestyles' are responsible? Our argument will be that, first, this claim is extremely difficult to justify given the available evidence and second, that it is, in reality, quite meaningless, misleading and decidedly unhelpful. Unlike many who claim expertise in this area, we think that the reasons for changes in the levels of overweight and obesity in Western countries remain largely mysterious and that scientific research has done little to clarify the current situation.
It is hardly an original insight on our part to point out that, faced with mystery, humans have historically resorted to telling stories as a way of making sense of their world. But we should never forget also that stories are rarely disinterested, neutral accounts of the way things are. Either wittingly or unwittingly, they present partial and partisan accounts of how the world works and how it should be. Therefore, our argument is not only that existing causational explanations of the 'obesity epidemic' rest on largely unsubstantiated claims, but that they also avoid and obscure other ways of interpreting obesity statistics and thinking about body weight.
Our purpose in all of this is not to suggest that these other ways of thinking are ideologically neutral or that we have offered the last word about the science of overweight and obesity. Despite our collective air of certainty and claims to 'expertise', all of us - epidemiologists, exercise scientists, sociologists, medical practitioners and physical educators - work in a context of profound uncertainty. What is interesting is not so much that people cling to a story in order to manage this uncertainty, but that so many cling to the same story.