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I'm your host, Dr. Abdul, I'll say it.

1:06

Do like me and you grew up in the eighties, nineties

1:09

or two thousands? Chances are you've been

1:11

bombarded by ads like these. Call

1:14

one eight hundred nine four Jenny today

1:17

and lose twenty pounds for twenty dollars.

1:19

Jenny Craig, you won't just lose your

1:21

win. You won't just lose your

1:25

ostensibly, they've got your best interest

1:27

at heart, promising that beauty, happiness, and

1:29

good health. Sit at the end of a workout

1:31

video or diet plan or gym membership.

1:33

But what if the ads themselves are

1:35

actually the problem? Today, we're talking

1:38

about the consequences of weight stigma and the ways

1:40

that our public conversation about weight might

1:42

be doing more harm than good. And honestly,

1:44

I have to tell you that today's subject, well,

1:46

it hits really close to home. I've struggled

1:49

with weight and body image my entire life.

1:51

As a kid, my family moved quite a bit along

1:53

with my name, my skin color, and my religion, my

1:56

weight was just another of those things.

1:58

Cool kids would latch onto and tease me for.

2:00

I didn't always want to be a doctor. I originally

2:02

wanted to be a dentist. Though I've always

2:04

had a fascination with the biological sciences

2:07

and the ways that the body functions, I

2:09

absolutely hated seeing the doctor

2:11

when I was a kid. They'd tell me I was

2:13

too heavy that I had to lose weight, that I had to play

2:15

outside more. But I played outside all

2:17

the time. Like, I loved sports. And despite

2:20

or maybe because of my size, I

2:22

was actually pretty good at them. Football, hockey,

2:24

baseball, soccer, and track wrestling. I

2:26

played all of them. My for

2:28

their part, it didn't really help.

2:30

On the one hand, I grew up in a family where

2:32

my parents rarely said, I love you.

2:35

But they showed it through their cooking. And usually those

2:37

were the greasiest, carbiest meals. I

2:39

was always willing to accept that love.

2:41

And at the same time, they constantly monitor my

2:43

eating, telling me I had to eat less. You

2:45

can imagine the cognitive dissonance here.

2:47

By the time I hit my latter years of high school

2:49

and into college, puberty and sports,

2:51

well, they did their thing. For the first time

2:53

in my life, I met society standard for male

2:55

fitness, but I still hated seeing

2:57

the doctor because at five eight and two hundred

2:59

pounds, despite being at the peak of my fitness,

3:02

I still had a BMI of thirty point four,

3:04

and I was technically, quote, obese.

3:07

I remember walking into the university health service

3:09

at my college and watching the doctor do a double

3:11

take when she walked in the room for my examination. I

3:13

was gonna tell you to lose weight, but

3:16

yeah. After my colleagues across

3:18

days ended, medical school, undid what puberty

3:20

in sports had done. Quitting a college

3:22

sport called Turkey left me with a weird relationship

3:24

to both food and exercise. I

3:27

could eat whatever I wanted in college

3:29

and I never learned how to enjoy exercising.

3:31

It was always just an instrument to a goal,

3:33

run faster, be stronger, win games, what

3:36

now? To this day, I've never really

3:38

figured out how to eat healthy. Look, I've

3:40

studied everything there is to nutrition. I just haven't

3:42

found something I'm comfortable with. I've

3:44

dieted on and off my entire adult life.

3:47

And though I've figured out how to enjoy working

3:49

out again, it took me nearly two decades

3:51

to get here. But all this has left me

3:53

thinking a lot about the way we think about weight

3:55

and the medicalized version of that, quote, obesity.

3:58

I wrote a whole ass doctor old about

4:00

obesity. About how our simplistic

4:02

statistic, body mass index, a measure

4:04

of comparing weight to leaves us measuring

4:07

different things in different people with different body

4:09

compositions. We've known for decades

4:11

that the proportion of people with a BMI over

4:13

thirty has been rising steadily, triple

4:15

now since the seventies. And we've known that people

4:17

with high BMI tend to have higher rates

4:19

of diabetes, heart disease, stroke, and

4:21

cancer. But we don't really understand as

4:23

much about why? Why is obesity

4:25

rising so fast? Why is there more chronic

4:28

illness among folks who meet obesity thresholds?

4:30

There's some strong science that has demonstrated the

4:32

ways that more fat tissue can influence our biology.

4:34

But there's also strong evidence that the way

4:36

we treat larger people can have profound impact

4:38

on their mental health, which can then shape

4:40

their physical health. And it's this

4:42

latter piece we don't really pay enough attention

4:45

to, but perhaps we should.

4:47

In all the rush to tackle obesity,

4:50

we've personalized it rather than target

4:52

the environmental factors that have driven our

4:54

behavior, things like cheap corn or urban

4:56

planning that wedges us to our cars, we

4:58

tell people that they and they alone are

5:00

responsible. Eat less, exercise

5:02

more. Never mind that companies

5:04

make billions making those things harder.

5:06

If you can't do those things, it must

5:08

mean that you're lazy or bluntness or

5:10

just don't care about your health. And

5:12

unfortunately, it certainly means that

5:14

you're deemed less beautiful, less desirable,

5:17

less seen. Our

5:19

guest today has been thinking about weight and weight

5:21

stigma for decades. Professor Harriet

5:23

Brown is a journalist. After her own experiences

5:25

with weight stigma and her daughter's experience

5:27

with Anorexia, she set out to dig

5:29

into what we know about weight. Her book,

5:31

body of truth, how science, history, and culture

5:34

drive our obsession with weight, and what we can do

5:36

about it came out in twenty sixteen.

5:38

And since it's shifted our public conversation

5:40

about weight, I can think of no one better to

5:42

help us understand the consequences of weight stigma

5:44

and how we address

5:45

them. Here's my conversation with Harriet

5:47

Brown. Can

5:48

you introduce yourself in the day? Sure.

5:51

I'm Harriet Brown, a

5:53

of magazine news and digital journalism.

5:55

At the New House School of Syracuse University

5:58

and author of a number

6:00

of non fiction books, especially

6:03

focusing on body image

6:05

and weight and health? Well,

6:07

what a cool thing to be a professor of? I

6:10

was, for some time, a professor of epidemiology

6:13

and it was decidedly less cool. We

6:15

had a buzz there at the moment during the

6:17

pandemic, but still not

6:19

as cool as what you do. I

6:21

wish we could have a whole conversation about the

6:23

future of long form

6:25

journalism and the role of podcasting in

6:28

that. Another conversation

6:30

for another day, hopefully, I

6:33

I wanted to to sit down and have a conversation

6:35

because I was really intrigued by

6:37

a book you wrote called body of truth how

6:40

science history and culture drive our obsession

6:42

with weight and what we can do about it.

6:44

There has been some time since the book has

6:46

been published, but I wanted to step

6:48

back and ask What what got

6:50

you to to want to write this book?

6:52

That is a big question. And

6:54

it really has to do with the fact

6:57

that I grew up as a woman in America

6:59

in the nineteen sixties and seventies

7:03

in a family that

7:05

was pretty obsessed with

7:07

weight issues. And

7:09

so like a lot of other

7:12

women, my age, you know, I struggled

7:14

on and off with trying to lose weight

7:16

and regaining it. I always it

7:18

was always this source

7:20

of terrible angst for me,

7:22

and it seemed like for a lot of my friends.

7:24

So that's kind of personal

7:26

backdrop. Fast forward,

7:28

I become a journalist, I

7:30

I, you know, get married,

7:33

I have daughters, and I continue to

7:35

struggle in all of the ways that

7:37

women do often struggle

7:39

and men too, but you

7:41

know, feeling pretty

7:43

high levels of despair and

7:46

basically often feeling

7:48

like I was spending my whole life fixated

7:51

on my body, what was wrong with

7:53

it, my weight, feeling guilty

7:55

because I could be healthier, you know, I

7:57

could be doing better by

7:59

myself. And

8:01

then my oldest daughter developed

8:04

Enerxia when she was fourteen. And

8:06

our family went through a whole

8:09

number of years helping her recover,

8:12

which she did in the end. I'm happy to say,

8:14

but it was very eye opening

8:16

to me because

8:18

it highlighted a number of things for

8:21

me starting with the fact that my

8:23

own feelings about my

8:26

body were sort of not just my

8:28

personal feelings, but they were reflected in

8:31

the medical profession and

8:33

more broadly. You know, Anorexia

8:36

often presents as a fear of fatness

8:38

and a fear of eating fat, And

8:41

I found that that was sort

8:44

of supported by everyone we

8:47

encountered. My daughter's fears

8:49

were not just hers

8:52

or mine. The doctor would say

8:54

things like Well, you need to gain weight

8:56

to recover, but not too much weight.

8:58

You know, when we would a little bit

9:00

later in her recovery, when we would go out

9:02

in public, and we would be, like, in a store

9:05

shopping for high calorie

9:07

foods, which she needed to support

9:09

her recovery. You know, we would get

9:11

sometimes I felt like people were looking at me

9:13

as if I was you know,

9:16

abusing my child in some way because we

9:18

were shopping for and we would joke

9:20

about, like, what's the highest calorie

9:22

ice cream in this freezer case, you know,

9:24

that's what we need. And the

9:26

looks that we got, the comments that

9:29

people would make, when my

9:31

daughter was gone and

9:33

very sick, people would literally come up to her

9:35

on the street and tell her how gorgeous

9:37

she was. Had she ever thought about

9:39

modeling. And then as she recovered and

9:41

gained weight and looked more healthier,

9:43

I thought all of that

9:45

stopped. So it kind of gave

9:47

me this other perspective

9:49

on something I had always thought of as

9:51

my own personal nightmare,

9:54

really. And it made me as a

9:56

journalist want to start understanding,

9:59

well, what are those

10:01

relationships between weight and

10:03

health? How terrible is it to be a

10:05

fat person in America in terms of your

10:07

health? I mean, we'll sort of setting

10:09

aside the ways in

10:11

which fatness is stigmatized

10:13

and discriminated against and just sort of focused

10:15

on the health stuff because that's what I do.

10:17

And as I started to actually read

10:19

the research and talk

10:21

to folks doing that research,

10:23

it became clear to me

10:25

that it wasn't the relationship I thought it

10:27

was. You know, I think like most of us,

10:29

I think you know, gosh, if you're too

10:31

fat, you're cutting years off your life and

10:33

it's really terrible for you and it's,

10:35

you know, you're damaging your heart and you're, you

10:37

know, increasing your risk of

10:39

all these diseases. And what

10:41

I actually found was that

10:43

the research is not clear

10:45

cut. In any way, it's very nuanced,

10:47

it's very complex, and

10:50

that in fact, for some people in some

10:52

situations, fat seems to have

10:54

protective values, whereas

10:56

maybe for other people in other situations, it

10:58

can be more problematic, but

11:01

but this sort of short answer

11:03

was, hey, it's complicated. But

11:05

despite the complexity of

11:07

the research, the messages

11:10

that we get about weight and health

11:12

specifically are not

11:14

complex, and they're not nuanced,

11:16

and they're very aggressive,

11:19

and they're very prescriptive.

11:22

And so I set out to write the

11:24

book, and I'm sorry for such a long

11:26

winded answer. As a

11:28

way to sort of share with other people, some of

11:30

the things that I had found and

11:32

some of the questions that arose from me

11:34

and that I thought other people should be

11:36

aware of too. Howard Bauchner: Yeah, I

11:38

I really appreciate that. And someone

11:41

who wrote a doc oral dissertation about

11:44

overweight and obesity. One

11:47

of the things that I really appreciate and what you

11:49

just said is just how complex

11:52

it is, both

11:54

as a phenomenon and the way that

11:56

it comes to be. And

11:59

then the ways that we talk

12:01

about it and then all

12:03

of the manifestations of capitalism

12:05

that are to round it, both that help to

12:07

create it, but then also exist to

12:09

ostensibly try and fight it, but only at

12:11

the individual level. Right?

12:13

And and then all of the

12:15

ways that that interacts with our mental health

12:17

in some really paradoxical

12:19

and frustrating ways. And

12:22

I think that what I appreciated about your book is

12:25

that you brought that

12:27

nuance to the conversation. And

12:30

one of those nuance is just

12:32

how different a thing can be

12:34

at the collective level versus

12:36

the individual level. I'm writing to someone

12:38

who does do epidemiology or

12:40

did it quite a

12:42

bit. One of the things that you

12:44

start to appreciate is that what

12:47

you find around association

12:50

doesn't always equal causation. And

12:52

when it does equal causation,

12:54

what you're finding is population level,

12:57

causal effects, whose

13:00

mechanisms oftentimes you

13:02

are assuming. Rather than

13:05

actually measuring. And part of the

13:07

problem with that is because we think of

13:09

this as an individual level

13:12

condition, we assume that

13:14

the only way to fight at this individual

13:16

level even though nothing has really

13:18

changed. Now, we talk about this often on on

13:20

the podcast. But the thing that I really want

13:22

folks to understand is that nothing has

13:24

changed about human genetics over the past thirty

13:26

years. That being said, the proportion

13:28

of people meeting a particular BMI

13:30

threshold, and we'll talk about BMI as a metric

13:32

later on. But the proportion of people meeting a

13:34

particular BMI threshold that

13:36

we call obesity has tripled

13:39

over thirty years. And that is not

13:41

because all of a sudden humans have become a lot

13:43

more gluttonous. It is because

13:45

there are things about our environment that

13:47

have vastly changed to change the

13:49

way that we both

13:51

take in calories and that we

13:53

burn calories. And then the other part

13:55

of that that I think is also really important

13:57

is if you just looked at an association, aside

14:00

from these last three years, people

14:02

have never lived longer. So you could argue

14:04

just stepping all the way back that in

14:06

the time when we have become the most,

14:08

quote, obese as a society, we are

14:10

also living the longest. And yet, right,

14:13

we know that the general

14:15

association is that among people,

14:17

right, relative to people

14:19

who are less likely to meet

14:21

a particular BMI threshold, the probability

14:23

of having a whole constellation of

14:25

very common illnesses is

14:28

higher in those who who meet that threshold.

14:30

So but like all the the causal

14:32

mechanisms, all of the exact sort

14:34

of ways in which this works

14:36

is still a black box for us. And

14:38

we just we we we are still really

14:40

starting to scratch the surface. And meanwhile,

14:42

you end up having a whole bunch of

14:44

folks training like mine, yelling at a bunch of folks to

14:46

be like, well, if you if you weren't if you just ate a

14:48

little bit less or exercised a little bit

14:50

more. One of

14:52

the points that you talked about that was

14:54

was BMI. And part

14:57

of my doctoral dissertation was

14:59

about ethnic in equities, in

15:02

obesity in England. And in

15:04

England, I've my my doctoral

15:06

work. And in England, you have two

15:09

large minority populations. One is

15:11

South Asian and one is tends

15:13

to be AfroCaribbean. Right?

15:15

And Of the two, you're talking about two

15:17

populations for whom BMI tends

15:19

not to correlate as much with

15:21

actual body fat percentage

15:24

Right? And for South Asians, you tend to have a lower

15:26

BMI per unit body fat percentage.

15:28

And for AfroCaribians, you tend

15:30

to have a higher. And for me,

15:32

right, my family is Egyptian and,

15:35

you know, the the sort of and I use

15:37

this tongue in cheek, but also, you know, the I

15:39

appreciate how tough the euphemism is,

15:41

as I always said, I was big boned. Right? But

15:43

I actually am really big boned. And the funny thing about

15:45

is when I was in college, I

15:47

played across in college, and I was

15:49

at my, you know, tip top shape. I had a, you

15:51

know, sub ten percent

15:53

body fat percentage at some point, but

15:55

I was technically obese. And I remember walking

15:57

in to the clinic and

15:59

having the doctor sort of look at their they were

16:01

looking at their notes and then looked up at

16:03

me And they were like, wait, are you the right

16:05

person? It's like, because technically,

16:07

you're morbidly obese. And I was like, oh,

16:09

I know. I know. I've been morbidly obese my

16:11

entire life. Right? But I At

16:13

this point, right, I am

16:16

in pretty good health, I would say. I'm a

16:18

nineteen year old college or cross player, right,

16:20

who runs a sub six mile and, you

16:22

know, a pretty quick forty. And so

16:24

it just that that sort of what led to

16:27

this sort of notion of doing this work.

16:29

How did we come upon this really

16:31

weird metric of body mass

16:33

index. And what

16:35

does that tell us? I mean, in the way that we change

16:37

cut points, how has that shaped the

16:39

discourse about obesity

16:41

in what ways? Well, the

16:43

BMI was originally

16:46

created as a population measure by a

16:48

mathematician back in the eighteen

16:50

thirties. At all of Kiddalay. And

16:52

it's basically a ratio of your

16:54

height, your weight. There's

16:56

a complicated mathematical explanation, but

16:58

it's basically a ratio of height and

17:01

weight. And, you know,

17:03

it was never intended as a

17:05

individual measure of anything.

17:07

Right? And even researchers

17:09

who have used it through the years like

17:11

Ancel Keys, a well known epidemiological

17:15

researcher, you know, who did the famous

17:17

semi starvation study among other

17:19

things, you know, said, hey, this might

17:21

be a good way to take a look population level, but it should

17:23

never be used as an individual level.

17:26

But at some

17:28

point in the nineteen nineties, it

17:30

became a metric

17:32

that was used to look at individuals

17:34

probably because it's easy.

17:36

It's non invasive. You can do it

17:38

apply it retroactively. Right? You don't need

17:40

to, like, poke someone or put them through

17:43

an expensive scanner. All you need is their

17:45

height and weight. And you can make

17:47

this calculation. And

17:49

so people started using

17:51

it in those ways. But

17:53

one of the really interesting

17:56

things about the BMI, which I do write

17:58

about in the book, is that those

18:00

categories are fairly random. Right?

18:02

At some point, there were life insurance

18:04

companies that actually correlated, like,

18:07

life expectancy with all of these

18:09

measures, including height and

18:11

weight, and then therefore BMI. And

18:13

they came up with these categories, and and there were two

18:16

categories to begin, I believe, like, normal

18:18

and overweight. And they were sort

18:20

of pegged to the levels

18:22

at which health

18:24

issues were observed. Again, we don't know,

18:26

you know, what cause and effect was,

18:28

but here's where, you know, we think

18:30

life expectancy maybe starts to

18:33

get long key. And bear in mind that this was

18:35

calculated by actuaries and not

18:37

like medical

18:37

people. And then in

18:40

nineteen ninety seven. At the

18:42

end of nineteen ninety seven, the World Health Organization

18:45

decided

18:45

to change those metrics,

18:48

and they did it four

18:50

somewhat cynical reasons. Right? So

18:52

they created a third category.

18:54

So now well, there's actually

18:56

four categories, but we don't typically talk about

18:58

the underweight. Category. Right? We never

19:00

talk about that. So we have normal

19:02

overweight and obese now. And

19:04

they said, you know what? Like, because

19:06

earlier on, the BMI was

19:08

like, It was first of all, it different for men and women,

19:10

which makes sense because men and women's

19:12

bodies have different percentages. So body

19:14

fat and they work differently

19:17

biologically. They said, let's

19:19

just have one. It's too hard to think

19:21

about men and women, and let's make it even

19:23

numbers because I think originally you

19:25

crossed from normal to overweight at

19:27

something like twenty seven point

19:29

six. Right? Nah, that's too hard for

19:31

people. Let's make it even. So

19:34

they created, they changed those categories

19:36

to what we have now, which is

19:38

normal as eighteen to twenty five,

19:41

overweight is twenty five to thirty and

19:43

obese is thirty and above.

19:45

Even numbers easier to remember,

19:47

but not actually pegged

19:49

to data. So

19:52

because when we look at the data and an

19:55

epidemiologist named Katherine FLEGLE, who

19:57

I'm sure you've heard of, at

19:59

the CDC. She's retired now.

20:01

She was like, hey, let's take

20:03

an epidemiological look at this, and

20:05

let's actually put all this data

20:07

together and see how it maps onto

20:10

actual life expectancy. And

20:13

again, you would expect, you

20:15

know, like a a line moving up

20:17

into infinity, like the

20:19

heavier you are, the fatter you

20:21

are for your height, the the

20:23

lower your life expectancy. But

20:25

what she actually found was a j shaped

20:27

curve. And so at the tops of those

20:29

curves, in other words, the lowest levels

20:31

of life expectancy were at the two

20:33

ends of the curve. So

20:35

in the under category and then in the, let's

20:38

say, forty plus BMI category.

20:42

The lowest point of the curve, the highest

20:44

life expectancy correlates

20:46

with what we call overweight.

20:48

Right? So in that twenty five to

20:50

thirty, even like thirty one,

20:52

thirty Right? That seems to be And

20:54

again, it's correlation. It's not causation.

20:56

So and

20:58

she did not editorialize about this, she didn't, she

21:01

just published her data, and

21:04

that turned into kind

21:07

of a witch hunt

21:09

on the part of other epidemiologists

21:11

who said, no, this can't be true.

21:13

You know, she's got an agenda

21:16

and a story that's still playing out. But, you

21:18

know, she and others have run the

21:20

data numerous times, and it seems

21:22

fairly clear that that's what we've got.

21:24

So In other words,

21:26

what is the relationship between BMI

21:29

and life expectancy and

21:31

health? You know, so mortality and

21:33

morbidity? And, again, the answer is it's

21:36

complicated. And I just want to throw one other

21:38

thing into the mix, which is

21:40

that, you know, you mentioned earlier

21:42

that there are these associations between

21:44

higher weight and incidences

21:46

of certain diseases,

21:48

which is true for some people

21:50

in some situations. But one

21:53

of the potential explanations

21:55

for that that people have put forward

21:58

is that we have such high

22:00

levels of discrimination and

22:04

stigmatization of people in larger

22:07

bodies. And there's beginning to be a

22:09

literature of looking at

22:11

how discrimination across the board. Right?

22:13

Whether it's racial discrimination, gender

22:15

discrimination, poverty,

22:18

whatever, how that affects our

22:20

physical health. And again, it's

22:22

complex and our physical health

22:24

is very much altered by that.

22:26

So there are people who make

22:28

the argument, I think somewhat convincingly

22:31

that unless you can factor

22:33

out stigma and discrimination

22:35

against people in higher weight bodies, you

22:37

are not really seeing what

22:40

the effects of being fat

22:42

are on health. You know, until you can separate out

22:45

the cultural and social determinants

22:47

of health, then you don't know

22:49

what you're looking at. So again,

22:51

it's not as simple as wow,

22:53

being fatter is bad for your heart. You know, you

22:55

should lose weight and whatever. So

22:58

so yes, it's all very complicated.

23:02

We'll be back

23:03

with more Prof Harriet Brown after

23:06

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25:57

to the garbage can. What

26:08

I'd like to do is sort of think a little bit

26:10

about that sort of secondary pathway,

26:13

right? There is a good

26:15

argument to make about the

26:18

potential physiological consequences

26:21

of overweight. But

26:23

there's also an equally

26:25

good argument to make about social

26:28

consequences of overweight.

26:30

And the high probability as these things

26:32

sort of turn out is that, you know, we

26:35

as epidemiologists get real

26:37

interested in perfect causation as

26:39

if the world is a silver bullet kind of place,

26:41

that there's just one thing. And

26:43

usually, it's some of a lot of things that

26:45

interact with each other in complex ways that

26:47

we can't fully actually elucidate

26:49

and understand as

26:51

hard as we try. Two places I kind of want to take

26:53

us are a, the social

26:55

circumstances of stigma. And

26:57

from my experience as someone who

26:59

has struggled with my weight,

27:02

through my childhood and even into my later

27:05

adulthood. I often find

27:07

the kind of stigma that you get at

27:10

the doctor's office to be so counterproductive.

27:12

Right? Because most of the time when

27:14

you sit down with a doctor,

27:17

and, you know, they tell you you should lose weight. Their assumption is

27:19

that you never had that idea before. You'd like never had

27:21

that thought. Like, that that never occurred to you. Right?

27:24

You're like, oh, but for this doctor

27:27

telling me with the authority of

27:29

their MD degree that I

27:31

should lose weight, I would never have happened

27:33

upon this insight, this

27:35

wisdom. And then and then it

27:37

just makes you feel bad about yourself

27:39

or whatever else you're doing And

27:41

when you feel bad, the thing that you tend

27:43

to do tends to not help

27:45

you, right, in this process of trying to lose

27:47

weight. So it's like counterproductive on its own

27:50

terms. But then the bigger context

27:53

here is that when

27:55

we perpetuate the idea,

27:58

that body weight is a

28:00

function of individual effort.

28:02

We perpetuate the idea that people

28:04

who are overweight are people who

28:07

don't have agency or unwilling

28:09

to do the things that they need to do to protect

28:11

themselves, which opens the

28:13

door to a certain level of discrimination

28:15

which basically says, if these people don't care enough about

28:17

themselves, then why should I care about them? Right? And

28:20

that's the sort of the mechanism

28:22

there. And that itself opens a

28:24

door to all kinds of

28:26

other consequences. In your

28:28

work, what was it that you found

28:30

about the impact of this

28:32

kind of discrimination and this kind of

28:34

a stigma on the

28:36

mental

28:36

wellness, but also the physical wellness

28:38

of people who inhabit bigger bodies.

28:41

Well, I think there huge consequences

28:43

across multiple layers of

28:46

experience, even if we just start with, like,

28:48

the medical setting. Right?

28:50

So what you've described.

28:52

Right? Anyone whose BMI

28:54

is over twenty five is

28:56

going to get harassed basically

28:59

to some extent or another by

29:01

medical

29:01

folks, their doctors, or

29:03

they wind up in ERs, whatever. And

29:08

basically anything that's wrong with you is going to be

29:10

blamed on your weight. Like, I have

29:12

heard many many many anecdotal

29:14

stories from people saying, I went to the

29:16

doctor with a sore throat, you

29:18

know, and was told it was because I

29:20

am fat. So or

29:22

I broke, you know, I I hurt

29:24

myself, and they blamed it on

29:26

that. But maybe more

29:28

importantly, I think if you've

29:30

ever experienced that kind of

29:32

judgment, you feel a lot of

29:34

shame. And one of the results of that

29:36

is that you might avoid going to the

29:38

doctor, for example. Right? A lot of

29:40

people don't go, which means

29:42

they don't get routine preventive

29:44

care, which means that perhaps if they

29:46

are developing some kind of disease, it might not

29:48

be caught until later. So there's that

29:51

whole layer. There's the

29:53

mistrust of the medical profession

29:55

that is really problematic.

29:57

But then there's also,

30:01

you know, that sense

30:03

of shame, which as you

30:05

pointed out, doesn't make you

30:07

want to do the things that you

30:09

might feel I need to do to be my

30:11

best self. And I think

30:13

that what you're really talking about

30:15

there is pursuing health

30:17

separate from weight loss. Right?

30:19

So, like, let's say you're a

30:21

sedentary person and you, you know, you know that you

30:23

should be exercising and you

30:25

know, you you haven't exercised and

30:28

you want to get some kind of exercise

30:30

program going. Making you feel

30:32

bad about yourself is probably

30:34

not going to in fact, we know it's not the thing

30:36

that's gonna make you able to do

30:38

that. Right? We know that

30:41

shame does not inspire people toward

30:43

positive health behaviors.

30:45

Right? What are the

30:47

things that inspire people to

30:49

pursue health. You know, it's complex. But, I

30:51

mean, I think you have to feel

30:53

good about yourself on a certain level. You

30:55

have to love the body that you're in.

30:57

You have to cherish it and wanna

30:59

do as well as you can by it.

31:01

You know? So so those

31:03

are just like couple of the ways in which

31:06

that discrimination and shame can

31:08

affect people's health. And, I mean, if you've

31:10

ever been through this on any level, you

31:12

know how terrible it

31:14

feels, to be judged in that

31:16

way, to be to be denied

31:18

medical care. Right? So

31:20

I had a knee that was, you

31:22

know, like, bone on bone arthritis. I

31:24

needed a knee replacement and I

31:26

had to basically it took me quite a

31:28

while to find a surgeon

31:30

who would operate on me because my

31:33

BMI was over a certain point, you

31:35

know, because it was in the obese range.

31:37

It was like, but I'll do get

31:39

but, you know, you get gastric bypass. That's not a

31:42

problem. So then, at that point, you're

31:44

like, so the risks of

31:46

doing surgery on my knee are too great,

31:48

but the risks of doing gastric bypass

31:50

are not. Like, I don't understand.

31:53

And that leaves you with a bad taste in

31:55

your mouth, that leaves you feeling like, can

31:57

I

31:57

trust what these people are saying? And in fact,

31:59

I did have my knee replaced and it

32:02

went well and everything is

32:03

great. I got the rehab all as well.

32:06

So

32:06

I think that's a problem in medicine

32:08

anytime you're using one med and

32:10

only one metric. And that metric has

32:12

become so widespread that

32:14

it's, like, as you say, it's

32:16

the only thing you know, the

32:19

doctor looking at you and then looking at the paper and

32:21

saying could this be you? I'll give you another

32:23

example. My husband who's not

32:25

fat, never has been fat. A

32:27

thin person, a very active person developed high

32:29

blood pressure in his fifties, went

32:31

to the doctor, and the doctor's

32:33

immediate response was lose weight, and then he

32:35

kind of caught himself and

32:36

said, oh, wait a minute.

32:38

You know, and my husband was

32:40

like, what would I lose? Like,

32:43

he's always had trouble keeping weight

32:45

on. So But it's such a knee

32:47

jerk response, you know, is kind of

32:49

the issue. Yeah. And and, you

32:51

know, first of all, I'm really sorry to hear about

32:53

that experience, that been so

32:55

harrowing for so many reasons, not only the

32:57

pain of your knee, but also just

32:59

being stigmatized by healthcare

33:01

providers you turn to and you're supposed

33:03

to trust to have your best interest at part.

33:06

I remember

33:08

sitting with a group

33:11

of clinicians when

33:13

I was in medical school and, you know,

33:15

I just finished a PhD

33:17

on obesity. And

33:20

we were having this discussion and they

33:22

were talking about, well, you know, if all these people

33:24

just lost some weight. I was like, well, you know, when you

33:26

talk about weight, what you're actually talking about is BMI. Like,

33:28

that's how you measure Right? You're not actually

33:30

talking about weight. Right? So we should

33:32

be specific. And so, you know,

33:35

because they thought I was being a

33:37

tongue and cheek pedantic medical student, they're like, well, okay, fine. They

33:39

should lower their BMI. I was like, well, you know, one way to do that is

33:41

we could just cut off everyone's arm. Like, we

33:43

if we did that or maybe even

33:46

better, like, we could cut off their leg, which

33:48

is like, you know, twenty percent of their

33:50

weight. And they would all have a

33:52

quote healthy BMI. Right? And but I

33:54

think you you would agree that we probably not have

33:56

done these folks a

33:58

service by doing

33:58

this. So, you know, there is

34:01

a sort of way that we get very

34:03

literal about bigger picture questions

34:05

rather than asking how do you optimize

34:07

your health? The the other part of

34:09

this conversation that I think I

34:11

get really frustrated about is because so much

34:13

of the way that we think about weight

34:15

is as a matter of individual choices.

34:18

Right? You're drilled in medical school,

34:20

right, calories in calories out. That's all this is.

34:22

This is just a thermodynamics

34:24

equation. I'm like, well, I don't know that

34:26

that's that's simple. Right? Because what we're

34:28

also doing is we're giving a

34:30

pass to a whole system of

34:32

corporations that have figured out

34:34

how to track

34:36

artificially cheap sweeteners into our food,

34:38

change the very food dynamics about

34:40

who gets what food, where,

34:42

what is

34:44

considered good palatable food,

34:46

what children are taught to enjoy when they're

34:48

having lunch at school. And then

34:50

an automotive industry that lobbied to

34:52

fundamentally change the ways that we got around to the places that we needed

34:54

to go. So rather than, you know, walk the

34:57

twenty minutes to to work, most

34:59

people have to drive in a

35:02

solitary car, which by the way destroys the environment,

35:04

and that's a whole different question.

35:06

But it gives a pass

35:08

to those folks, and what we all ought to do is

35:10

just try harder. And the challenge is that obesity is actually probably

35:12

more about less about

35:14

individual choices and

35:16

more about the

35:18

degree to which someone is sensitive

35:20

to an environmental condition. Right?

35:24

And we don't think

35:26

about that. I wanted to ask you, you

35:28

know, in your work, how often did the experts that you talked to talk about this

35:31

environmental issue? And, you

35:33

know, what would it

35:35

take for us? To start holding

35:37

the purveyors of these these

35:40

circumstances accountable for

35:42

the consequences that that then fall upon

35:45

individuals. What a great question because the answer

35:48

is no one ever wants to talk

35:50

about this because in America,

35:52

in Capitalist

35:54

America, we are very, very

35:56

invested in the idea of personal

35:58

responsibility. Right? It's sort of

36:00

baked into our national DNA. Like,

36:03

we like to think of our selves as

36:05

scrappy people who can overcome any kind

36:07

of obstacle and challenge. If we just put

36:09

our mind to it, pull ourselves up by

36:11

our bootstraps, blah blah

36:14

blah. And so, you know, I think the

36:16

notion that as you say and I think

36:18

that's a very elegant way to put it that

36:21

people respond differently. People's bodies

36:24

and minds respond differently

36:26

to the environment that

36:28

they're in. I think that there are people,

36:30

especially in certain parts of the political

36:32

spectrum, who see that as a cop out,

36:34

who see that as,

36:36

you know, wait, you

36:38

want government to do something for

36:40

you, you know, like whether it's

36:42

regulating, you know, food

36:44

advertising to kids or, you know,

36:46

whatever form And I just think

36:48

that what would we have to do to

36:50

shift that maybe

36:52

head for a political

36:56

system closer to what they have in Scandinavia, you know, social

36:58

democracy, rather than like, you know,

37:00

our social capitalism rather than Some of

37:02

us have been trying. We have

37:04

unfettered capital alism here.

37:06

So, you know, I don't see that

37:08

changing anytime soon, you know. And I

37:10

think that

37:13

when people question

37:14

it, they're often vilified in one

37:17

way or another, which is

37:20

unfortunate because

37:20

you know, if we can't actually even just ask the question. For

37:23

example, in terms of

37:25

environmental stuff, there's there

37:28

are people who who hypothesize that are

37:30

exposure to certain environmental toxins,

37:33

even in tiny amounts, over

37:36

time is responsible for

37:38

shifting our metabolic, you

37:41

know, rates and that

37:43

that could be part of what's playing

37:46

into the fact that we are fatter

37:48

now than we were before. You know,

37:50

trace elements building up

37:52

in our you know, in the fat and our body is stored

37:54

permanently. You know? And I just I don't think we have

37:56

enough evidence to know one way or

37:58

another, but Why

38:00

is that an unpopular line of thinking?

38:02

Which puzzles me? You

38:05

know,

38:05

like, when I wrote this book and

38:07

when it was published,

38:09

I had this idea that people

38:12

would respond to it by saying, wow, this is

38:14

great news. Like, the

38:16

relationship between weight and health might be

38:18

more complicated. Than I thought. That's really

38:21

good news. But actually, I

38:23

learned that people got very

38:26

angry. People across

38:28

the weight spectrum and across, like,

38:30

many different occupations were

38:32

enraged by the idea

38:34

that it might not be as simple

38:37

as they thought. And what what I kind of got from that is,

38:39

oh, so we want to think it's

38:41

simple. We want to think that we can

38:43

overcome these things And

38:46

even if that lands us in a situation of like beating

38:48

our head against a brick wall, being,

38:50

you know, feeling stigmatized, whatever,

38:54

We'll take that over acknowledging the complexities

38:56

and trying to address them in a

38:58

broader way. And wow, That

39:02

was very eye opening for me. I

39:04

don't know if you've encountered that kind

39:06

of attitude at all.

39:08

Ultimate agency is a very seductive idea.

39:11

The notion that we are the captains of

39:13

our own destiny and

39:16

that nothing that happens

39:18

in the literal air we breathe or the water

39:20

we drink or the human sea

39:23

in which we swim will actually

39:25

affect what happens to us. It's a very

39:27

seductive idea and it's particularly seductive here in

39:29

America and you like kinda can see

39:31

how we've built that world or attempted to build that

39:33

world for ourselves. You know,

39:36

the the

39:38

kind of just ever growing cars that we drive or

39:40

the kinds of sort of gated neighborhoods that we

39:42

live in, everyone kind of wants to

39:44

have a castle, you know, for themselves and

39:46

believe that they are the only

39:48

one who gets to decide what happens at a castle

39:50

and it leaves us,

39:52

I think, ignoring the kind of collective

39:54

agency that we actually can pursue.

39:57

That does change the air we breathe,

39:59

the water we drink, the human sea in

40:01

which we swim. And it

40:03

also leaves us in a situation

40:05

where we're fragile. To the world reminding

40:07

us that we really are. Right? Our

40:10

destinies really are. Some

40:12

portion of what we do and what

40:16

others and society and the world does around us. And,

40:18

you know, it's like you always have

40:20

this image of a folks in

40:22

Florida who I

40:24

sort of vote a certain way and then the hurricane comes and, like, we couldn't have

40:26

seen this coming and, like, yeah, we've been talking about

40:28

climate change for some time now.

40:31

And you moved into literal hurricane Ali,

40:33

and now you're surprised that a hurricane came and swept

40:35

your house and don't get me wrong. We got it.

40:37

We owe you every responsibility protect you and

40:39

look, you know, we are going to to provide the services that

40:41

we can, but, like, don't be so

40:43

surprised when somehow

40:46

you actually aren't the only one who controls your destiny that actually

40:48

the things that we have been doing and

40:50

that we continue to do have consequences

40:52

for you. And for us,

40:55

and maybe we should all come together and do the thing that we can do about it.

40:58

And and so I I just really

41:00

appreciate that point. One of the

41:02

things that I found in

41:04

in my personal life about about the impact of weight

41:06

stigma and the weight discussion

41:10

has been the way that it shapes my understanding of

41:12

food. And I just, you know, to to get real

41:14

vulnerable and personal, you

41:18

know, for me, my parents got divorced when I was real young, and both of my parents

41:20

have the pension for showing their love

41:22

in food. And, you know,

41:24

as someone who grew up between a

41:27

bunch of cultures, there are always those special

41:29

foods that, you know, you looked

41:31

forward to eating. And over

41:34

time, the complication of, right, the mixed

41:36

signals of we love you. We

41:38

made you this really lovely

41:40

dish, but don't eat so much of it.

41:42

Right? Don't don't consume

41:44

so much of our love. You have to see

41:46

the love. And leave it

41:48

there on your plate. Right? That that always fundamentally changed the

41:50

way that I understood so

41:55

much of like just the joy of food unto

41:58

itself, but also the way that we

42:00

communicate across

42:02

cultures that we love each other and

42:04

that we care about each other. Because food is,

42:06

you know, broader than just nourishment. It's not

42:08

just calories in. It it has so much

42:10

to do with every ritual that

42:12

we partake in, every custom

42:15

that exists, every culture has its

42:17

dish that it that, you know,

42:19

it venerates. And so it really, I

42:21

think, has deeply complicated in a

42:23

really tragic way my

42:26

understanding of this thing that I I truly and

42:28

deeply enjoy but

42:30

also, you know, have now found

42:32

so much frustration in

42:35

stigma around. Right? In in writing this book and reporting this book

42:37

and and also previous books about Anorexia,

42:40

how do you feel like our

42:42

discussion

42:43

about obesity has bled

42:46

into our discussion about

42:48

food? Well, it has

42:50

tainted it one hundred percent and

42:53

I don't have to go any further than my own

42:55

classrooms to see that in action. Right?

42:57

I teach any

43:00

university many, I would say, two thirds of my students are young women,

43:02

so they're between eighteen and twenty

43:04

two, typically. I teach classes

43:06

where we wind up talking about this stuff.

43:10

And the things that

43:12

they tell me, the

43:14

things that I've observed, their

43:16

relationships with

43:18

food are unbelievably

43:22

dysfunctional. Now they're, you

43:24

know, perhaps a more

43:27

affluent section of you know,

43:30

the population, they

43:32

all of the sorts of expectations

43:34

of class and race that come

43:36

with you know, being fairly privileged

43:39

in this culture. But

43:42

the stories that they tell me

43:44

about how their

43:46

parents like denied them

43:48

food and and the the rituals that

43:50

they go through. They only allow

43:52

themselves to eat one meal a day. They,

43:54

you know,

43:56

are constantly you know, some of them

43:58

have diagnosable clinical eating disorders, but most of them just have

44:00

unbelievably disordered eating. And

44:04

I once in a class asked the question

44:06

like, so so what is normal eating? And

44:09

nobody could answer it. And

44:11

I think that that's very

44:14

much the case across the

44:15

board. You know, I

44:18

would

44:18

say, that what

44:20

is normal eating? We don't even know.

44:22

You know? And when I say to

44:24

especially my students, like younger people,

44:26

Well, you know, I think it has to do with eating

44:29

until you're full and satisfied and then stopping and being able

44:31

to sort of regulate your

44:34

your eating by

44:36

your own cues of satiety and

44:38

hunger. And they look at me like

44:41

I'm nuts because That's not how they eat. That's not how they've been

44:43

taught to eat. I know that, you know, when my

44:45

own daughters went through middle school and they went

44:47

through, like, the middle school

44:50

health class, That was one

44:52

of the triggers for my

44:54

daughter developing anorexia. Not a cause. I'm

44:56

not gonna say it was a cause, but, like, you

44:58

know, I remember her coming home from that class. He's saying,

45:00

all sugar is bad. We shouldn't

45:02

be eating sugar at all. You

45:06

know, she got a lot of support and encouragement in cutting like,

45:08

whole food groups and sort of

45:10

regulating her relationship with food based

45:13

on these external ideas. And

45:15

I think that that's really, really problematic for

45:18

a lot of reasons.

45:20

So I think it's incredibly

45:22

sad what has happened to disrupt our

45:24

relationship with food. And it's such a

45:26

primal relationship, you know, both

45:28

in terms of our own bodies and

45:30

also, as you said, like the

45:32

culture, like so many of our social interactions have to

45:34

do with sharing of food

45:36

and enjoying food together and

45:38

preparing and cleaning up and all of

45:40

that and

45:42

you know, I

45:43

think much of that has been rendered dysfunctional. Yeah.

45:46

We'll be back with more with professor Harriet

45:48

Brown after this break. Support

46:00

for this podcast comes from Marguerite Casey Foundation. Marguerite Casey

46:03

Foundation imagines a world where all communities

46:05

are represented in our economy and

46:08

democracy. Foundation is proud to announce the

46:10

newest Freedom scholars. The MCF Freedom scholars compile research that provides critical

46:12

insight on how we can radically improve

46:14

our democracy, economy, and society. Twenty

46:18

twenty two recipients include renowned philosopher and Georgetown professor, Loufame

46:21

O'Taiwo, founding director of the Smart Cities

46:23

Research Lab at Trinity College,

46:25

DaVarian El Baldwin, and prison abolitionist professor and

46:27

author, Sarah Haley. To learn more about them and to see the full list

46:29

of freedom scholars, visit casey grants dot org

46:32

and follow at casey grants on all

46:34

social media. American

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your first purchase of a hundred dollars

47:54

or more. I

48:06

appreciate how you said primal. Because

48:08

of course, the other primal need for

48:10

humans is to be

48:12

desired. Right? And and sex and sexuality. And

48:16

the conversation about who is desirable

48:18

and who is not is I

48:21

think so fundamentally patterned by body

48:24

size and body happiness.

48:26

How do you think about

48:29

the connection between body size,

48:32

food, sexuality, desirability,

48:34

youth. How does that aspect of

48:36

it sort of undergird so much of

48:40

the broader sort of consequences in the stigma

48:43

of obesity? Wow,

48:45

that's a complicated

48:47

question. I mean, it's part

48:49

of everything. Right? So, like, a lot of

48:52

our a lot of our

48:54

discourse around obesity often

48:56

focuses on

48:56

health. Right? And I think it's because

49:00

it's easier and we

49:01

feel like on some level it's more

49:03

virtuous to talk about, well, this is bad for

49:05

your health. This is good for your health.

49:07

Obviously we all want to

49:10

be desired, as you said, and seen,

49:12

and loved, and

49:14

appreciated, and I mean, I think we're taught that you cannot be any

49:16

of those things if your body

49:18

does not conform in these

49:20

particular ways to these cultural norms. You

49:22

know? So

49:24

And I think in some settings, like, again, I think about the things

49:26

I hear from my students, you know, where they talk about,

49:28

like, the comments that boys

49:32

in bars will say,

49:34

you know, to the girls who

49:37

aren't stick thin. You know,

49:39

that there's real consequences, social consequences

49:41

for them. But I think

49:44

that that message that, you know, you

49:46

have to fit only this one norm

49:48

or you're

49:50

not is BS, and it's basically

49:52

another week to blame that on capitalism

49:54

too, you know, because I think in reality,

49:57

all kinds of humans are attracted to all kinds

49:59

of other humans who come in

50:02

all kinds of bodies. Right?

50:04

And, you know, so I

50:06

think that there's this narrative, but then there's the

50:08

reality. And I wish we did a

50:10

better job of separating them, but I

50:12

think that would be more helpful to say,

50:14

you know, Yeah.

50:16

Okay. So, like, person a might not be attracted to person b

50:18

for whatever reason, but there's like a

50:20

person g down the line who maybe

50:23

will be. Like like, but that's always been

50:26

true. Right? Like, that's but

50:28

but somehow we've narrowed this conversation.

50:31

You know, very much, especially for younger

50:33

people, I think, so that it's really

50:35

only its main focus

50:38

seems to be like on weight

50:40

and as a sort of metric

50:42

of

50:42

attractiveness. And that's that's just

50:44

not true. Right? That's not how humans

50:47

work. I wanna go back to where we started,

50:49

which is on the the question

50:51

of relationship to health. You know,

50:53

it's interesting that you talked about

50:55

the association that we find

50:58

is not as cut and dry

51:00

as we'd expected based on what, you know, the

51:02

paper you cited by

51:04

Legal. But it's also a bit of

51:06

a black We don't actually understand causation. And what's really

51:08

interesting is that

51:10

if you go back in the past,

51:13

the desirable body

51:16

happiness. Right? Was what we, in

51:18

this moment, would identify as

51:20

being overweight. And the interesting aspect of

51:22

this is that in a

51:24

time when more people died of

51:26

infectious disease,

51:29

being heavier meant that

51:31

you usually had a more

51:33

nutrition and b for

51:36

that reason a healthier

51:38

immune system. And in a world where more

51:40

people died of more infectious diseases

51:42

because public health wasn't actively

51:44

fighting them

51:46

for you, that was a real survivability advantage. It was

51:48

healthier, right, objectively.

51:50

And what's interesting now is

51:53

that we are the

51:56

last three years aside, less likely to die

51:58

of infectious diseases than

52:00

our counterparts in the past, and

52:02

more likely to

52:04

die of these chronic diseases, things like diabetes,

52:06

heart disease, stroke, cancer.

52:08

And so the sort of – that link

52:10

between health

52:12

and then what is socially desirable has

52:14

sort of transmuted with the epidemiology

52:16

of the time. And What

52:19

I think this historical

52:22

anecdote paints is

52:24

the notion that these things are not fixed

52:26

with time. And even what is healthy

52:28

is not fixed with time. It's more a function

52:30

of the environment around you. And I

52:32

guess as we think about where we want

52:34

to go, Right. We talked about all the

52:37

ills of the obesity discourse

52:39

as it stands. Where do

52:41

we want to go? What is

52:43

a healthy public conversation about

52:46

body body size

52:48

that maximizes, you know, everyone's opportunity

52:50

to live their longest, healthiest lives.

52:53

And also the mental

52:55

health of all of us

52:57

and the social health of all of

52:59

us around the idea of being

53:01

both desirable and able to commune with your food in

53:04

a in a way that makes you feel

53:06

whole. What does that discourse

53:08

look like?

53:08

I think that a primary aspect of that

53:11

discourse is in separating

53:14

these ideas of weight and health.

53:18

Like like sort of putting aside the questions

53:20

of what are the causal, you

53:22

know, and what are the sort of associative

53:26

connections? Because we don't fully understand it. It is a black box, as

53:28

you said. So but

53:30

because of the way that weight

53:32

drives the health discourse, I

53:36

think that what happens is if you separate them, right? If

53:38

you say, okay, I wanna improve my

53:41

health, you know. What

53:43

does that mean? Our knee

53:46

jerk reaction and the knee jerk

53:48

recommendation most of us are gonna get from

53:50

the medical profession is gonna start

53:52

with lose weight. But what

53:54

if it took into account

53:56

the idea that health is

53:58

basically more individual. Right? It's

54:00

not There's not a one size

54:02

fits all, and it changes through your life. Like,

54:04

as you were talking about the

54:06

protective aspects of having

54:08

more flesh on your body, you know, in an

54:10

earlier time, I was

54:12

thinking about the fact that as we age, it's also better for you

54:14

to have more weight. Right? Like

54:16

that one of the big risk

54:18

factors for premature death as you get older

54:20

is frailty.

54:22

So we don't want to see older people losing weight. So

54:24

what if we again just said,

54:26

what does improving my health look

54:30

for for me right now in this part of my life, you know?

54:32

And then we could look at actual

54:34

behaviors. We could look at things

54:37

like exercise because There's

54:40

a huge body of evidence suggesting that fitness

54:43

plays an enormous role in

54:45

one's overall health

54:47

and life expectancy. Separate from

54:50

weight status. So what if we said fine?

54:52

Like, how can you incorporate

54:54

more happy,

54:56

joyful positive movement in your life, whether you lose weight from that

54:58

or not, you know, or what

55:00

would it mean to eat in a more nutritious

55:03

way. Again, whether weight loss comes with that or not,

55:05

you know. I once interviewed a woman who

55:08

was in like she'd been diagnosed with

55:10

diabetes and she was

55:12

in like like a diabetes program, you know,

55:14

designed to help you change your habits to

55:16

more healthy ones for the

55:18

fact that you have diabetes. And she was so

55:20

frustrated because

55:22

she said like, I've made a lot of changes in the way

55:24

I eat. I've actually think

55:26

I've improved my sugar and

55:28

everything, but I haven't lost weight.

55:31

And the program basically considers me a

55:34

failure. So if we could separate

55:36

those things

55:38

and focus more on actual health and things that we

55:40

do and things that we have control

55:42

over, I think that would be better

55:44

for everybody. I

55:47

agree with you. I think so much

55:49

of our discourse tries

55:51

to optimize to one

55:53

size fits all I think

55:55

if we were able to

55:58

identify that it's probably

56:00

more about finding a space

56:03

of comfort and joy and

56:05

positive engagement with a set

56:07

of things that are

56:10

also health fortifying

56:12

and improving. We'd be in a much better

56:14

place than focusing on a particular endpoint. That

56:16

is gonna be different for different groups of

56:18

people and different for different

56:20

individuals. And I think a lot

56:22

about the interactions I had in medical

56:24

school around this question

56:26

and I just

56:28

wish that some of the

56:30

folks who were offering medical

56:32

advice who'd never actually dealt with the challenge

56:34

themselves, understood how they

56:36

were being perceived. Right? Because I do think that conversation with doctor be

56:38

a powerful thing, but you get a choice

56:40

about whether or not you're gonna turn on

56:43

the light switch or turn it off. And

56:45

I think the minute you walk in and you assume a set of things about your patient,

56:48

you turn that light switch off. And you you take

56:50

that interaction from being a

56:52

potentially fortifying and

56:54

trust building one to being a really damaging one,

56:57

and one that, you know, can shape

56:59

a set of health behaviors over the long

57:01

term that really, really are quite

57:04

damaging. But I really appreciate you shedding

57:06

light on this issue joining us to talk

57:08

about it and to share your perspective

57:10

and share your work. Our guest

57:12

today is Professor Harriet Brown. She's the

57:14

author of body of

57:16

truth, how science history and culture drive our

57:18

obsession with weight, and what we can do

57:20

about it. Thank you so much for joining us today and taking the

57:22

time. Thank you for having me. This is actually

57:24

I've done a lot of podcast and things, and this

57:26

is perhaps

57:28

been the best conversation I've ever had in this setting. So

57:30

thank you. I really appreciate how thoughtful you

57:32

are and Well, I I

57:34

appreciate how thoughtful you've been and

57:36

and sharing your wisdom with us. So thank you. As

57:47

usual, here's what I'm watching right now. Right wing

57:49

media had a total meltdown

57:51

this week over cast

57:54

oves. That's right. Take a listen. Consumer

57:56

Product Safety Commission is

57:58

deciding on whether to ban gas

58:00

oves totally. Because of

58:02

safety. Safety.

58:04

We've had these stuff for over a hundred years.

58:06

It's totally fine to get fentanyl to addicts,

58:08

but a gas stove is a threat to your life.

58:11

All this happened after Richard Trumpa junior. A commissioner

58:13

at the Consumer Product Safety

58:15

Commission proposed a ban on new gas

58:17

stoves given emerging research about

58:20

the consequences of pollutants that can result from the burn off. To be sure, this

58:22

wasn't a statement of the administration's

58:24

policy. It was one

58:26

commissioner's recognition of new

58:28

research about the risks that indoor air pollution

58:30

resulting from burning gas inside your house

58:32

actually poses. Look, this kinda makes

58:34

sense. If you burn a bunch of gas in your house to

58:36

eat your food, Where do you think the

58:38

burn off goes? To

58:40

the person literally standing

58:42

right there breathing the fumes. Look,

58:44

given all the backlash, the administration isn't likely

58:46

to move on this anytime soon.

58:48

But the inflation reduction act does

58:51

offer incentives to upgrade from gas stoves to more

58:54

efficient electric and induction

58:56

cooktops. Look, but this hub up probably did more

58:58

good than harm. Raising awareness

59:00

of just how dangerous indoor air pollution

59:02

really can be. Gastaut views has been

59:04

linked to both asthma and children and dementia

59:06

and older adults. Makes sense? You can

59:08

literally burning gas in an open fire inside your

59:10

home. And, well, we kid ourselves to think

59:12

that natural gas burns clean.

59:14

In fact, like so much else

59:16

that harms our health. Our sense that gas stopes are somehow more effective was pushed by?

59:18

Well, you guessed it. Industry.

59:23

It makes sense that an industry that sells you gas

59:25

would want you to buy appliances that

59:27

use more gas. But even since

59:29

this whole controversy started, The American Gas Association, a lobbying

59:31

group on behalf of big gas, has been twisting the signs

59:33

to argue that gas stoves are perfectly

59:36

safe. Can't make the

59:38

stuff up. I have a gas stove and

59:40

miles, and you'd better believe I've been

59:42

researching new induction stopes, which

59:44

both can reduce burn accidents and

59:46

improve air quality. And apparently they like

59:48

boil water in two

59:48

minutes, which is pretty awesome. Though COVID cases hospitalizations

59:50

and deaths remain unacceptably high,

59:54

they have begun to decline again last week, and good news. Suggest that

59:57

this may be the first winter since the

59:59

pandemic started where we won't see a

1:00:01

massive spike in COVID transmission. Remember,

1:00:04

last winter saw the first Omecon wave, which killed more Americans than

1:00:06

the entire rest of the pandemic before it.

1:00:08

And at the same time, we've got

1:00:10

to be clear about something. If four

1:00:13

hundred deaths a day is our new normal, we've got to start asking ourselves the

1:00:15

bigger picture questions about how the pandemic

1:00:17

has twisted our sense of what

1:00:19

normal should be. In

1:00:21

part, that's because we've shifted the onus of code prevention

1:00:24

entirely onto individuals. Individuals

1:00:26

wearing masks, individuals getting vaccinated.

1:00:28

Don't get me wrong. Individuals should certainly do those things, but there's so

1:00:30

much more we've learned about infectious disease prevention that

1:00:33

we're not putting into practice.

1:00:36

For example, while we're talking about gas stoves, why haven't we

1:00:38

made a full scale society wide reinvestment in

1:00:40

indoor air quality more generally? Why

1:00:43

are we equipping every new HVAC system with built in

1:00:46

air purifiers and retrofitting schools and

1:00:48

community centers with air

1:00:50

purification systems? It's not just COVID we'd be protecting ourselves from, but

1:00:52

flu, RSV, and all the other run of the

1:00:54

mill cold viruses that seem to have hit us

1:00:56

all at

1:00:58

once too. And I gotta tell

1:01:00

you, I've been thinking a lot about this

1:01:02

because well once again, my stake in the

1:01:04

future of our species just took a big

1:01:06

leap forward. That's because Serena Elseyid. My second daughter was born last

1:01:08

Tuesday at ten thirty six AM.

1:01:10

She's strong, beautiful, and true to

1:01:12

her name. Sara,

1:01:14

always the real MVP is feeling good. Both are

1:01:16

healthy, happy, and at home. Someone who

1:01:18

spends a lot of my time concerned with

1:01:20

the world as it could be, fatherhood

1:01:23

has taught me a lot about my own relationship to

1:01:25

the future. We don't, we can't

1:01:28

control who our children will become. You

1:01:30

hope and pray that they'll love and

1:01:32

be loved. Care and be cared for and leave a positive influence on the

1:01:34

world. What we have is

1:01:36

now, the moments we spend

1:01:38

with them. Where we show them

1:01:40

enough love, enough care, enough of

1:01:42

our attention, to remind them that

1:01:44

they too can do the same in the world,

1:01:46

they'll inhabit. And if they

1:01:48

do, they'll have agency in that world.

1:01:50

They can leave their mark in it.

1:01:52

They're not going to live in the world as

1:01:54

it is. Instead, they're gonna live in a world that we can't even know

1:01:56

yet. So at the same time, beyond our

1:01:58

own Progyny, we have to invest in the world,

1:02:00

they'll inhabit

1:02:02

too. To show the world love and care and presence.

1:02:04

I hope that this space we share together every

1:02:06

week is a bit of that, a place where we

1:02:08

share ideas and insights on the world

1:02:10

we can make together. The

1:02:13

world that kids like Emily and Sabine so many others will

1:02:15

inherit and share. Thanks for

1:02:17

being here. And that's

1:02:19

it for today. On your way

1:02:22

out, please don't forget to rate and review.

1:02:24

Also, if you love the show and wanna wrap us,

1:02:26

I'll drop by the crooked store for some America

1:02:28

merch. American

1:02:36

Decectored is a product of crooked media. Our producer

1:02:38

is Austin Fisher. Our associate producers are

1:02:40

Tereotrustra and Emma Alek Frank. A

1:02:42

Sealy's Autopsies mixes them masters the

1:02:45

show. Production support from Ari Schwartz and in Asmanpa. Our

1:02:47

theme song is by Takah Suzuki and

1:02:49

Alex Sugira. Our executive producers are Leo

1:02:52

Duran, Cerro Geismar, Michael

1:02:54

Martinez, and me. I'll try Google I'll say

1:02:56

it. Your host. Thanks

1:02:58

for listening. This

1:03:03

show was for general information and entertainment purposes It's not intended to provide

1:03:05

specific health care or medical advice and should not

1:03:07

be construed as providing health care

1:03:09

or medical advice. Please consult your

1:03:12

physician with any questions related to your own health. The

1:03:14

views expressed in this podcast reflect those of the

1:03:16

host and his guests, do not necessarily represent the view and opinion of Michigan

1:03:18

or its Department of Health, Human, and Veterans

1:03:22

Services.