When 13-year-old Christina Corrigan was found dead in her bed in California, covered in bed sores and with faeces trapped in the folds of her skin, the medical examiner measured her thighs and took photographs for his personal collection. Christina was treated as a freak in death, as she was in life, because she weighed 48 stone.
This month, a Californian court will decide whether Christina's mother Marlene is guilty of child abuse.
But there's another side to the story: fat activists are arguing that Christina, whose mother brought her to the doctor 90 times before her death, was actually a victim of obesity phobia. "Prejudice against fat people has infiltrated the entire case," says Sondra Solovay, a legal consultant who specialises in weight-related issues. Locked away in her bedroom prison because she dare not face the world, it's possible that Christina died because she had no choice. Humiliation had become her life. Her doctor weighed her in a public room with people staring at her. On the bus to school, she was routinely tormented. When she walked, boys circled her on bicycles, taunting her. When she grew too heavy to climb the steep hill to school, her school refused to offer an alternative form of transport, or home tutoring, as a child disabled in any other way would get.
The blatant prejudice she suffered is not unusual - other obese children in the US have been driven to kill themselves. We're living in an age when it's better to be dead than fat. If you think that sounds extreme, consider that in survey after survey, US women say that they would rather die than continue to be overweight. And before you start blaming American faddism and extremism, consider that we're just as vulnerable in this country. "Obesity phobia is rampant in Ireland and it's a major health issue, especially for women," says Dr Mary Flynn, lecturer in nutrition at the Dublin Institute of Technology (DIT).
The huge proportion of Irish teenage girls of normal weight who engage in self-destructive behaviour such as smoking, purging, vomiting and laxative abuse in the belief that they are fat is worryingly high, according to research by Yvonne Ryan of the DIT. Three-quarters of 15-year-old transition year students are unhappy with their weight, she found. Dissatisfaction with body weight is 100 per cent among overweight girls, as you might expect, but it is also extremely high among normal and even underweight girls.
"While clinical eating disorders including anorexia and bulimia affect 1 per cent of the population, sub-clinical eating disorders are very common among Irish girls," she says. "It has been described as a `normative discontent', a normal part of adolescence, if you like."
Presented with idealised images of the asexual and undernourished teens featured in the CK One perfume ads, how can any teenage girl of normal weight feel that she is beautiful? According to one US study, Playboy models and beauty contestants are 15 per cent below normal body weight, which also happens to be one clinical definition of anorexia.
Irish research has found that this "normative discontent" with one's weight is ingrained in most children long before adolescence, especially in girls. Before they have even begun to develop the curves of adolescence, girls are already fearful of becoming fat. The womanly pear-shape is regarded with contempt by Irish girls who would prefer to be "tubular", one study found, than womanly and curvaceous. "Irish teenagers want to look slimmer than is realistic and in their attempts to become that way, many of them are smoking and don't worry about health risks like cancer. Their priority is to be slim and they carry this issue throughout adult life," says Yvonne Ryan. Nobody's afraid of being too thin, because nobody calls an anorexic stupid and lazy - and anorexics get sympathy while the obese get abuse. When was the last time you saw a media campaign to rescue a teenage girl from fatness?
In a British study, schoolchildren shown pictures of fat children described them as "ugly, lazy, stupid and selfish". A US study which followed the fortunes of overweight women for seven years found them to be blatant victims of prejudice. When compared with women of normal weight, overweight women had completed less time at school, were less likely to be married, had lower incomes and had higher rates of household poverty. These findings were independent of their baseline socio-economic status and aptitude test scores. "The socio-economic consequences of becoming overweight for women are horrendous. Such prejudice makes you wonder where the feminist movement has been all these years," says Dr Flynn.
"This is a major health issue for women. By smoking and not taking enough calcium and meat in an attempt to be thin, girls and women are setting themselves up for cancer, heart disease, anaemia and osteoporosis in later life. The inappropriate dieting and weight-loss behaviours known to accompany fear of fatness in adolescent girls may actually pose a far greater threat to their health than obesity," says Dr Flynn.
Public health campaigns may unwittingly be reinforcing obesity phobia, believes Yvonne Ryan. "There's a lot of money spent on public health education aimed at preventing obesity and on highlighting obesity as a major risk factor for disease, but I think this may be doing more harm than good because it is stigmatising obesity, while also putting more pressure on normal people to lose weight when they don't need to," she says. Increasingly, medical experts are questioning whether being merely overweight - as opposed to obese - is really as bad for us as we think. An editorial in the New England Journal Of Medicine concluded recently that "the data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary and often ambiguous". Experts now suspect that weight is regulated by more than just calorie intake and energy expended, although these remain the crucial factors. While genetics play a factor in becoming overweight, obesity is still primarily caused by eating too much and taking too little exercise, says Ryan.
"You can lose weight on a diet with the help of a nutritionist, by taking more exercise and restricting calories while still ensuring an adequate micronutrient intake. Women, in particular teenage girls and women of child-bearing age, have high nutrient requirements and dieting can compromise their nutritional status with long-term consequences for health and well-being," she says.
Evidence is gathering that dieters often gain the weight lost back - and more. Starvation dieting seems to decrease the rate at which calories are burned by the body, making it more difficult to remain slim when you have stopped dieting. Studies have also suggested that the proportion of fat to muscle in the body is more important than overall weight as a predictor of mortality. The truth may be that the fit live longer than the unfit, even if they are somewhat overweight but still eat a healthy diet.
Perhaps the public health message we really need to be hearing is that women are as likely to diet themselves to death as to eat themselves to death.