Nothing compares to the hurt caused by insensitivity on a weighty issue

THE first time, it could have been a camera angle.

The second time, it could have been the longer hair; an immediate contrast with the shaven-headed sculptured face we were used to. The third time it could not have been either a camera angle or a change of haircut. Sinead O’Connor had put on weight.

The voice was unchanged, of course. But the physical change was evident. People commented on it. According to the singer, they kept telling her.

That’s one of the things about getting fatter, if you’re in the public eye. Those members of the general public who care, make three decisions about it: they decide the celeb is too stupid to realise what has happened to her (these rules apply almost exclusively to women); they decide that, because the famous person has put on weight they are, as a direct result, less sensitive and can be insulted with impunity; they decide, arising out of the earlier decisions, that it’s incumbent upon them to tell her.

The telling can take various forms. Sometimes, total strangers will walk up to an entertainer and do it directly. Indirectly, columnists in some newspapers refer — usually contemptuously — to the star “porking up”, which in turn provokes readers of the column to leave comments under the online versions of those columns, or tweet about it.

Integrated famous people may be irritated by the comments, but they get over them. Novelist Deirdre Purcell memorably commented, in her autobiography Diamonds and Holes in my Shoes, that when she recently hit 60, she regarded herself as thereby freed from the pressure to squeeze herself into a size 12 dress again.

She seemed relieved to have reached an age where the views of others on any prospective weight gain would be irrelevant to her.

Sinead O’Connor is not in that position. The singer did not get over her the comments made about her weight gain. They upset her so much, did those comments, that she stopped taking the medication, including lithium, which had been prescribed to enable her to cope with her bipolar illness. This, in turn, according to herself, had the result of ending her eight-month marriage to a man about whom she has said not a negative word.

She is now separated, back on her medication and making sad little jokes about having more wardrobe space for her size 14 clothes following her ex-husband’s departure from her life.

Her situation will be dismissed by anybody who has never had a weight problem or a mental health problem. For them, it’s just a case of Sinead O’Connor acting out on a new self-chosen stage. However, her situation will resonate with hundreds, if not thousands of women who have to take medication which has the side-effect of increasing their weight, many of whom would — as she did — endanger their relationships and perhaps even their lives rather than get fat.

A respiratory professor recently told me that his asthmatic patients are much more compliant than they used to be. They use their puffers when they’re supposed to and take the tablets at the time he tells them to. As a result, their asthma tends to stay under better control. The secret to this new compliance? “I just threaten them with steroids,” he told me. “They’ll do anything to avoid steroids.”

Of course they will, because anybody who wheezes knows that, while a short blast of steroids delivers a relief which feels close to miraculous, it causes so rabid an increase in appetite that an enormous and rapid weight gain follows, as day follows night. A friend who got through a difficult winter with the help of several doses of steroids went into hiding, describing herself as looking like “a whale with a stroke”.

The physical change — the sudden fatness — is so horrific to asthmatics that the very threat whips them into taking care of themselves as a way of obviating a steroid prescription.

SOME patients, however, can’t avoid the medicine that keeps them alive by doing what a consultant tells them they must do.

Diabetics have to take insulin, and for some of them the result is weight gain, which in turn has been known to lead to younger patients tricking around with their dosage in what’s called “diabulimia”.

They know that failure to follow their regimen is likely to cause them severe problems down the line, yet they endanger themselves rather than put on weight.

We are, in the Western world, on the horns of a peculiar dilemma.

On the one hand we have an obesity epidemic and on the other we have a contempt for the obese woman unparalleled in any previous period of history.

Until the early 20th century when women began to work outside the home, when girls began to get fatter in hips and breasts at puberty, when their oestrogen levels rose, it was tickety-boo because it sent the message that they would be good at the reproduction task.

“As women’s opportunities in the job market improved, they embraced a different, slimmer archetype of beauty,” according to Eduardo Porter in his The Price of Everything, in which he traces how the acceptable shape of women changed radically as soon as they began to prioritise employability, rather than staying at home and having lots of babies. According to Porter, the dynamic fits patterns found in other cultures.

“One study across dozens of primitive societies found that plump women are less desirable in societies that value women’s labour, suggesting that body fat associated with higher energy storage and reproductive fitness also makes it more difficult to succeed at work,” he points out.

“Less desirable” is a neutral way to describe an attitude which effectively divides society, at least in Ireland. Because, while the ambient negativity towards fat women is general, it seems to be more effective, in the sense of delivering outcomes, among the more educated and career-driven.

Health educators know that the more educated you are and the more focused you are on your career, the more likely you are to watch your weight, take exercise and have regular health checks, because you have a greater sense of being in control of your own life, whereas the less educated and employable you are, the less your weight or fitness matters, because you have a greater sense of the random: you could be hit by a bus tomorrow, so why bother?

The fact that we have an obesity epidemic calls for effective action. There’s surprisingly little scientific evidence to suggest that effective action includes telling perfect strangers that they have such a pretty face, it’s really a shame they let themselves go.

Sometimes the “who ate all the pies?” crack ignores the possibility that the overweight person may be at the mercy of medicinal circumstances outside their control. And sometimes, the quick satisfaction of making such a crack can endanger its target. The frightening reality is that Sinead O’Connor briefly chose slimness over sanity as a result of the unkindness of strangers.