0:49

Hello , hello , hello , it's

0:51

Sabrina . Welcome back to the show

0:53

. I am so

0:56

, so excited for today's

0:58

guest . Today I am

1:00

joined by Reagan Chastain

1:02

, who is our keynote speaker

1:05

at our Eating Disorder conference on March

1:07

1st and 2nd . More

1:09

details to follow on that

1:11

and done a previous episode on

1:13

it , but let's get to Reagan

1:16

. Reagan Chastain is a speaker

1:18

, writer , researcher , board-certified

1:20

patient advocate , multi-certified

1:23

health and fitness professional and thought

1:25

leader in weight science , weight stigma

1:27

, health and health care . Utilizing

1:29

her background in research methods and statistics

1:32

, reagan has brought her signature mix

1:34

of humor and hard facts to health

1:36

care , corporate conference and

1:38

college audiences , from Kaiser Permanente

1:40

and

1:42

the Diabetes Education Specialist National

1:44

Conference to Amazon and

1:46

Google , to Dartmouth Health , caltech

1:49

and CanFitPro . Author

1:51

of the Weight and Health Care newsletter , the

1:54

book Fat , the Owner's Manual

1:56

, co-author of Hayes Health Sheets

1:58

and editor of the anthology

2:00

the Politics of Size , reagan

2:02

is frequently featured as an expert in

2:05

print , radio , television and documentary

2:07

film . In her free time , reagan

2:09

is a national dance champion , triathlete

2:12

and marathoner who holds the Guinness

2:14

World Record for heaviest woman

2:17

to complete a marathon , and co-founder

2:19

the FitFatty's Facebook group

2:21

, which has over 11,000 members

2:23

. Reagan recently moved

2:26

to Oregon

2:28

with her fiance , julianne , and

2:30

currently enjoys fostering

2:33

dogs . In this

2:35

episode , reagan and I are chatting

2:37

about what weight stigma

2:39

is , how that shows up

2:41

in the health care setting , and

2:44

we don't dive too

2:46

nitty gritty into the weeds with it , because

2:49

that's what she's going to be sharing with

2:51

us at the Eating Disorder Conference on the first and

2:53

second . So have

2:56

a listen . Hopefully your

2:58

interest is peaked and you want more information

3:01

, or you really really want to come

3:03

to this conference so that you can hear more

3:05

about weight stigma and

3:07

what we can do , both as providers

3:09

and just as individuals

3:12

, to help combat weight stigma

3:14

. So , without further ado , let's get

3:16

to my interview with Reagan . Reagan

3:22

, I am beyond excited

3:25

to bring you on to the show and thank

3:27

you so much for agreeing to come on

3:29

. I'm really , really excited

3:32

that in two weeks I get to meet you face to face

3:34

, live in person .

3:35

Oh , right back at you . I am so excited about

3:38

today , I'm so excited about the

3:40

conference . This is going to be amazing yeah

3:42

.

3:43

Everybody at EDCI was like fan

3:45

girling when we heard that you were going to

3:47

come out and we had a meeting this morning

3:49

and they were asking about this and I'm like I'm going to play it

3:51

real cool . It's going to be one of those people

3:53

, I'm going to be cool , so I hope

3:56

I can pull that off .

3:58

I'm way less cool in person . It will be a problem

4:00

, I promise .

4:03

We'll see . We'll see . So , listeners

4:05

, you may have already heard I know I've made the announcement

4:08

of our eating disorder conference on March 1st

4:10

and 2nd and Reagan is going to

4:12

be our keynote speaker for

4:14

both of those events and

4:16

we just wanted to come on and educate a little

4:18

bit more about what the event is

4:20

going to be , educate on weight

4:23

stigma and then , if you get

4:25

really excited about this content , you

4:27

want to learn more , then please come to

4:29

the conference , because Reagan

4:31

will be there and we're just going to share the little tidbits

4:33

, teasers today . So if you want the full

4:36

meat and potatoes , you got to come to the conference

4:38

.

4:40

Definitely . I can't wait to meet everybody in person

4:42

.

4:44

You are going to hopefully love

4:46

Iowa .

4:48

I've never been . It's one of the very few states where

4:50

I've never been , so I'm super extra excited

4:52

about this .

4:53

Yeah , yeah , and Des Moines is its own little

4:55

special place in Iowa , so

4:57

we'll see that . Yeah , let's start

4:59

with what is weight stigma

5:01

, because I know some of my listeners have maybe heard

5:04

me mention it or not heard me mention it

5:06

and have no idea what this is .

5:09

Yeah , so at its base , weight stigma is essentially

5:11

the belief that a thinner

5:13

body is better than a fatter

5:16

body , whether we're talking about in terms of attractiveness

5:18

or health or on any other

5:21

axis . And there's a lot of different

5:23

ways . You can have implicit

5:25

or subconscious bias , where people have just absorbed

5:27

all the weight stigma around them , which is like

5:30

not a galloping shock , and they're operating from that

5:32

without even knowing it . We can have explicit

5:34

bias , where people are very well aware

5:36

that they have negative beliefs about

5:39

higher weight people , and other

5:41

types of biases as well . So there's a lot of different

5:43

ways that weight stigma bias can impact

5:46

both practitioners and clients

5:48

.

5:49

And it shows up everywhere . I know the focus

5:52

is in the healthcare realm

5:54

, but it shows up everywhere

5:56

, right ?

5:57

Absolutely , and it doesn't affect everybody

6:00

the same way , because

6:02

it's always going to have the greatest impact on people

6:04

of the highest weights and people of multiple marginalized

6:06

identities . And I do want to point out that

6:09

weight stigma in general

6:11

, pathologizing , higher weight bodies in general

6:13

, body mass index in specific these

6:15

things are rooted in an inextricable from

6:18

racism and anti-blackness and

6:20

I highly urge folks to

6:22

read Dr Sabrina Strings fearing

6:24

the black body , Deishean Harrison's belly

6:26

of the beast and other authors in this area

6:29

to understand how these things aren't just rooted

6:31

in racism and anti-blackness but

6:33

they continue to disproportionately impact those

6:35

communities today .

6:37

Yeah , Thank you for pointing those two out and I will make

6:39

sure to link those

6:41

in the show notes that people can come

6:44

back and reference them if they need to . But both

6:47

of those resources were really eye-opening to

6:49

realize . Oh

6:52

wow , I

6:54

didn't realize that it went that deep .

6:57

Yeah yeah . They're both incredible

6:59

works and there are obviously

7:02

more . Dr Joy Cox , ek Delphine there are many

7:04

people writing about this and I just

7:06

really urge people to learn

7:08

more about this .

7:11

What does weight stigma look like ?

7:16

So it can look like a lot of things . It can be very

7:18

overt right where

7:20

someone's discriminated against because of their size

7:22

, where an Airbnb

7:25

says nobody above X-weight

7:27

is allowed to stay here . Which happened , do

7:29

they ? really do that . It happened there . The

7:31

Airbnb eventually had to remove them , but it was

7:33

a protracted , a prolonged fight where

7:37

they said we , just our furniture can't

7:39

handle people of higher weight , so they just can't

7:41

stay here . And

7:44

in a lot of places it's absolutely

7:46

legal to discriminate on the basis of

7:48

weight . It's something that the campaign for size freedom , which

7:50

full disclosure I'm the legal fellow for is

7:53

working on , is creating height and weight protections

7:55

from discrimination across the country , because

7:58

in most places it's completely legal

8:01

, right

8:03

. A boss can say look , I don't want to hire you because you're fat

8:05

, and that they're allowed to do that . There

8:09

are ways to fight that . So

8:11

it's not that it's impossible to fight it , but you

8:13

have to fight it On its face

8:15

. It seemed to be legal , so that's

8:18

a weight stigma . There's

8:21

also the fact

8:23

that the world is created for

8:25

often thinner people and

8:27

then higher weight people . That

8:30

becomes our problem that we're supposed

8:32

to solve , right ? So planes are a really good

8:34

example . They make these planes with arbitrary seat sizes

8:36

, and if you happen to be bigger

8:38

than the arbitrary seat size , you have to pay twice as

8:40

much for the same service , which is a flight

8:43

from point A to point B , right

8:46

, and then that gets couches . Oh , fat people

8:48

want special things , they want extra things

8:50

, and that's not true . We just want what

8:52

, then , people already have , which is a

8:54

flight from point A to point B in a seat that accommodates

8:56

us . Yeah , and

8:58

so weight stigma is thinking that that's higher

9:01

way , people asking for something special as

9:04

, instead of thinking , well , I get a seat that accommodates

9:06

me , why doesn't everybody get that same thing

9:08

?

9:11

So weight stigma is like

9:13

the opposite of this equity

9:16

piece .

9:17

Yes , yeah

9:20

. In many ways it very much is right that

9:22

, instead of seeking equity , we're seeking to say

9:24

higher weight bodies are wrong and

9:26

higher weight people should have to change themselves in

9:28

order to receive equitable treatment

9:30

.

9:31

Or we're just not going to give them services

9:34

or treatment .

9:35

Exactly so . Basically , the idea is , if

9:38

you want equitable services or treatment , become

9:40

a thin person , and then you can have them . Yes

9:42

, the idea that oppressed

9:45

people should have to change themselves to suit their oppressors

9:47

in order to Receive

9:49

equity .

9:51

Yeah , yeah . One of the ways

9:53

that my eyes were really open

9:55

to this when I first started getting into

9:57

the health at every size field

10:00

was like looking

10:02

at the Waiting room

10:04

chairs in your doctor's office . And Now

10:08

it's like the only thing I can focus when I go into

10:10

a new provider's office and I'm like , hey , I just wanted to let

10:12

you know that your , your office

10:14

isn't very weight-inclusive Because all

10:16

of your chairs have arms on them .

10:19

Yeah , thank you so much for doing that . It's a

10:21

huge issue and you know , before

10:24

you even get to , do you have a proper blood pressure cuff

10:26

? Do you have an MRI that accommodates ? Do

10:28

you have tables and beds and just

10:31

sitting down in the waiting room the most basic

10:33

function of the doctor's office

10:35

, and it's not accessible

10:37

to many people is such

10:39

a great example and again thank

10:41

you for for speaking up about that , because

10:43

the more people who do , the more change

10:45

there will be .

10:47

Yeah , and that that was one of my things when I I

10:49

recently opened a group practice and

10:51

so had to redo , got an office

10:53

again after COVID and like it

10:56

was really frustrating looking through

10:58

different manufacturers

11:01

and like weight limits on the , the waiting

11:03

room furniture , because I'm like the couches are probably okay

11:05

like they're , they're built pretty sturdy , but finding

11:07

something that accommodates more than

11:09

250 pounds Was

11:12

ridiculous , and then you have to pay like

11:14

twice as much , yeah , and

11:17

it's just yeah

11:20

, but it's a thing that we even have to think

11:22

about .

11:23

Yeah , and I

11:25

think more insidious is the way that

11:28

it gets justified instead of questions

11:30

Questioned , right . Well

11:32

, of course , if you know it

11:34

, the chair is higher weight capacity . Of course it

11:36

should be more expensive , right . But

11:38

like , why are we making chairs that don't

11:41

accommodate people ? Like , just go ahead

11:43

and make the chairs highway capacity and then we'll

11:45

all be fine . Yeah , and

11:47

it's the thing about accommodation . Typically , by

11:49

accommodating folks , you

11:51

accommodate everyone , right

11:53

. So if you accommodate a higher weight folks , folks

11:56

of all sizes , can be accommodated , right

11:58

, and this goes across things like disability

12:01

accommodation and more . Like , if we

12:03

are accommodating more people , then you

12:06

know typically that will encompass everyone

12:08

.

12:10

So that's some of the weight stigma that we might see

12:12

. Before we even get into see

12:14

our provider is is waiting

12:17

room and Just

12:19

this belief walking around . But

12:21

once we're in the room with our

12:23

provider , how does weight stigma show up ?

12:27

Weight stigma shows up in a lot of ways and again

12:29

, both consciously and subconsciously Right

12:32

. So often , providers , we live in a world that is rife with weight

12:34

stigma , so if we've internalized some of that , that's

12:36

not like a galloping shock , right . But

12:40

because it's implicit , we're

12:42

not even aware that we're doing it necessarily right . So

12:45

we make assumptions about people based on their size without doing that content

12:47

. We're not like I assume that this person does an exercise

12:49

because of their size . We

12:52

just do that subconsciously . And

12:54

so there's that piece of it where Practitioners

12:58

are treating higher-weight patients differently Because they're

13:00

Implicit

13:03

bias . There's also explicit

13:06

right where Practitioners are

13:08

Consciously

13:11

making these Beliefs

13:14

and having these beliefs and making these choices

13:16

about how to treat their higher-weight patients . And

13:19

there's something that I call practitioner weight distraction , which

13:22

is when the practitioner becomes so focused

13:25

on the patient's weight and wanting to alter

13:27

their weight that they don't listen to other things

13:29

and they don't provide the

13:31

same ethical , evidence-based recommendations that they would give

13:33

to a thinner patient . So that can be a

13:35

big piece of it as well .

13:39

And specifically , that

13:41

is more , when

13:43

a provider says yes

13:45

, I know you're coming in for your knee pain , but

13:47

that's because of your weight . We need to work on getting

13:50

the weight down . Let's move your body , let's

13:52

exercise some more , let's talk about changing

13:54

your diet . You can't move because

13:56

your knee isn't so much pain .

13:59

That's such a great example on a lot of

14:01

different axes , right ? Because

14:04

, first of all , the patient has come in with a specific complaint

14:06

and we've shifted to weight loss . Also

14:08

, people of all sizes get knee pain , so

14:11

the assumption that it must be the patient's weight

14:13

is a problem . Also , what

14:15

happens is and this is like such a great example

14:18

that you've given because a thin person is

14:20

typically going to get physical therapy

14:22

recommendations for the acute knee pain

14:24

they're having , but a higher weight person often

14:26

gets weight loss and told to eat

14:29

less and exercise more , both of which

14:31

will exacerbate an acute knee injury and

14:33

can turn it into a chronic knee injury , which

14:35

then again will be blamed on their weight . Oh well

14:37

, you have this knee injury because your higher weight , not

14:39

because we told you to go jump around

14:41

with an acute knee

14:43

injury , so that

14:45

, in all of those ways , weight stigma compromises

14:48

patient care .

14:49

I had a client that has some

14:52

pretty severe back pain and we've

14:54

been working to advocate on

14:56

other modalities

14:58

to treat it and finally she

15:00

got to a surgeon and the surgeon said I'm not going

15:03

to operate on you because you're high risk

15:05

because of your weight . Have you considered weight loss

15:07

surgery ?

15:10

It's one of those things that would be funnier if it wasn't horrifying

15:13

right . But this is . I'm actually a

15:15

board certified patient advocate and I work with

15:17

patients on VMI based procedure

15:19

genitals , which , let's be clear , it's

15:21

holding health care hostage for a weight loss ransom

15:23

. That's what we're doing On

15:26

some . What I can tell you is pretty shaky

15:28

evidence , right , even

15:30

ignoring evidence that shows that outcomes

15:32

are very similar between patients of different sizes

15:35

, and just sort of cherry picking

15:37

evidence that would deny surgical procedures . There's

15:39

a lot here to talk about

15:42

around the way that the healthcare system

15:44

incentivizes surgeons

15:46

to cherry pick patients who may have

15:48

the best outcomes , that kind of thing . But

15:51

yeah , it's the ridiculousness of oh

15:53

, surgery is too dangerous for you , you should

15:55

have surgery is beyond

15:58

the pale , especially given that weight

16:00

loss surgery takes a perfectly healthy organ

16:02

and creates a disease state , whereas

16:05

what the other surgery is trying to do is simply

16:07

cure an

16:09

actual health issue . So it's really problematic

16:12

on like 50 different levels .

16:14

Probably even more than that .

16:16

Probably yeah , at least 50 different levels

16:18

.

16:20

Because you've been in this fat activism role

16:23

for quite a while , I mean as long as I've been aware

16:25

of you . What are your biggest

16:27

challenges you face in

16:30

this ?

16:32

The massively

16:34

funded weight loss industry machine

16:36

and everything that they do to

16:39

create more profit Pumping

16:42

out research that would have gotten me an

16:44

F in my freshman research methods

16:46

class that gets peer reviewed and published

16:48

. All the marketing that they

16:50

do , all the misinformation , the ways that

16:53

they are currently trying very hard

16:55

to co-opt decades

16:57

of weight stigma work from people who were doing this

16:59

work before I was even born , and

17:01

turn that work and pervert it to make it be

17:04

about selling weight loss drugs . And

17:06

the ways that they've got a bunch of

17:08

doctors and researchers who they're paying

17:10

to do that work . That's the

17:13

biggest hurdle , I think , is that there's a misinformation

17:15

machine that exists to create billions of dollars

17:17

of profit and they're very good at it they

17:19

are .

17:21

It reminds me of hackers , of why can't

17:24

we just use all of your skill

17:26

set and knowledge for good , rather than

17:29

tearing people down ? Yeah

17:32

.

17:33

I mean , you look at , even the funding

17:35

for research is typically earmarked for quote

17:38

unquote obesity eradication

17:40

and prevention . So people who want

17:42

to do research that builds upon the

17:44

existing body of research that shows the

17:47

safety and efficacy of weight neutral interventions

17:49

have an incredibly

17:52

difficult time getting funded , which

17:55

is why we see research that's six weeks

17:57

long instead of these large

17:59

prospective studies , why we don't see

18:01

RCTs , because it's just not fundable

18:05

. The way that the current

18:07

industry works and

18:10

that is my area of expertise is the intersections

18:12

of weight science , weight stigma and health care . But

18:15

my sort of subspecialty , as it were , is the way

18:17

that the weight loss industry infiltrates and manipulates

18:19

the health care system , and

18:21

so I promise not to take us too far into the weeds

18:23

. But you can't talk about it for very long without

18:25

sounding like a conspiracy theorist

18:28

because it is in some very rare ways of conspiracy

18:30

without having charts and graphs and

18:32

receipts to explain like no , this is really

18:34

happening .

18:35

Yeah , there's a lot of

18:37

gatekeeping that happens , and

18:39

so the research that's being done . One

18:42

supports what fits

18:45

the diet industry , what fits the

18:48

big pharma , but

18:51

also we don't have long-term studies

18:54

. Nothing goes past 10 years

18:56

, right ? Does anything go past five ?

18:59

Most doesn't go past two . Research

19:02

that goes to five years shows that the vast majority of people

19:04

who attempt weight loss end up losing weight short-term

19:06

and regaining weight long-term , because the body changes

19:09

physiologically in response to that intentional

19:11

weight loss effort . Right , and the weight loss industry

19:13

is even language , that

19:15

is , oh , people go back to their old habits and

19:18

that's why they regain the weight , which is a really disingenuous

19:20

way to say that starvation is not sustainable

19:23

. That's really what's happening here

19:25

, right , which is not a galloping

19:27

shock . It's the same with the new GLP1

19:30

agonist drugs . Their largest , their longest

19:32

studies are two years and at the end of two years , people's

19:34

weight is starting to tick back up , even though

19:36

they're still on the drugs . But they're saying

19:39

oh yeah , if you go to offer our drugs , you

19:41

regain your weight right away , but that's okay , because what

19:43

you need to do is take these drugs for the rest

19:45

of your life and , in

19:47

addition to all the dangers and expense of that

19:49

, there's no reason to believe it will actually work .

19:54

Speaking of those meds , because you brought them up , have

19:57

you seen any shifts in your

19:59

work since this has become

20:02

highly marketed and promoted

20:04

?

20:04

Yeah , so this

20:06

is where the weight loss industry and in many

20:09

ways they're following the Purdue

20:11

Pharma playbook by which they marketed Oxycontin

20:13

right ? There's a lot of parallels

20:16

there , but they're working really

20:18

hard . So we're seeing now you'll see this phrase

20:20

everywhere that quote obesity

20:22

is a chronic , relapsing

20:25

, progressive disease . All of that

20:27

is nonsense . It is 100%

20:29

junk science . But it's what they're

20:32

using to justify the idea that we

20:34

have to take this drug for the rest of our

20:36

lives if we want it to work

20:38

. And again , the research doesn't even support

20:40

that . But like that's the big march

20:42

, right now They've got themselves to say you know

20:44

what intentional behavior-based weight loss

20:46

doesn't work long-term , which , like

20:49

for again , activists

20:51

and weight-neutral health providers have been screaming

20:53

this from the rooftop for decades . It's

20:55

like when big tobacco finally figured out that nicotine

20:58

is addictive . Holy cow , really . Like they

21:00

knew the whole time . Right

21:02

, these folks knew the whole time . It's what they based their

21:04

model on . They took

21:07

credit for the first part of the biological response

21:09

where people lose weight . They blamed people

21:11

for the second part of the same biological response , where

21:13

they gained them back and where they gained the weight back , and

21:15

then they had them come back and do

21:17

another intentional weight loss attempt , right

21:20

, and so they knew the whole time . But now , because

21:22

these drugs are massively

21:24

profitable to sell to people for their whole lives

21:26

, we're like oh no , it's a chronic

21:28

, relaxing , progressive

21:31

quote disease to simply exist in a higher

21:33

weight body , right , which , again

21:35

, what we're doing is pathologizing bodies based on

21:37

shared size , rather than shared symptomatology

21:40

or cardiometabolic profile , like you would with a true

21:42

disease . So the change

21:44

in my work is that this is really , I think , a

21:46

critical tipping point where we

21:49

have to push back with everything that we have

21:51

to stop them . Like Novo Nordisk

21:53

, when they launched Wagovii , also

21:55

launched their it's Bigger Than Me campaign

21:58

, which is supposedly an anti-weight

22:00

stigma campaign . And

22:02

I'm like it's bigger than like , get it , because

22:04

fat people are big . Like , if your anti-weight

22:07

stigma campaign sounds like it was named by a sixth

22:09

grade schoolyard bully , you probably aren't an expert

22:11

in anti-weight stigma , but what they're doing

22:13

is co-opting it and trying to say oh no , the

22:17

real stigma is that people don't have enough

22:19

access to our drugs and

22:21

the cure to weight stigma is to have

22:23

access to our drugs and , in particular , people

22:26

of color and older people . Like . The

22:28

real racism is that people don't have enough access

22:30

to our drugs . However , in their research

22:33

, they vastly underrepresented

22:35

people of color and older people , so they're

22:37

basically targeting these communities

22:39

for experimental medicine because they didn't bother

22:41

to include them in their studies , but

22:43

now they want to use them as oh

22:46

, this is the real stigma and the real

22:48

racism within weight stigma , and

22:50

so , again , it's co-opting a lot of really important work and it's

22:52

an incredibly dangerous thing , and

22:54

so that for the change in my work is that I

22:56

have to write and speak about this a lot .

22:59

I see it , co-opting and diet culture

23:02

is great at doing that , like we've seen this

23:04

whole intuitive fasting

23:06

that a celebrity

23:08

has recently endorsed

23:11

. But it's also

23:13

this idea

23:15

of putting back

23:17

the blame on the patient

23:20

, on the individual of yes

23:22

, you need to stay on these drugs for the rest of your life

23:24

because you can't be

23:26

trusted to manage without them .

23:30

Yeah , the idea is , you know in

23:34

, the only path to health for higher

23:36

weight people is thinness , and

23:38

so these drugs risk the

23:40

approval process . On the risk benefit analysis

23:42

for interventions for weight loss

23:44

is basically

23:47

a belief that it's worth risking higher weight

23:49

people's lives and quality of life in attempts to

23:51

make them thin . And that's

23:53

not fully understood . When people see these drugs or FDA

23:55

approved , what they hear is these drugs are safe . And

23:59

I take a really firm view of bodily autonomy

24:01

. It does not surprise me that people want to lose weight in

24:03

a society where there's a tremendous amount of fat phobia

24:05

and I think people are allowed to do what they want to do with

24:07

their bodies . I also take a very firm view

24:09

of what constitutes the ethical , evidence-based practice

24:11

of medicine . And that is where I get into trouble

24:14

with these drugs and with the FDA approval process

24:16

, because they take a big mountain of

24:18

terrible shoddy research that just

24:20

correlates being higher weight with health issues , without

24:22

exploring confounding variables , and they say , see

24:24

, it's so dangerous to exist in a higher weight

24:26

body , it's worth risking their lives and

24:28

quality of life to be on this drug forever . And

24:30

the FDA says , yes , we agree with that , and then it

24:32

gets approved and that's the situation

24:35

we're in . And so it's not

24:37

just this co-opting

24:39

though that's a huge part of it but

24:41

it's also this inherent belief that

24:45

they want us thinner dead and they don't care

24:48

much , which necessarily Because

24:51

it's such a high profit model , and

24:53

that is what's really scary to me and

24:56

that's at the extreme right , but that's what's

24:58

very scary to me in terms of the way that this

25:00

industry works .

25:02

When it perpetuates the weight

25:05

loss , weight gain cycle

25:07

, that yo-yo dieting , which

25:10

is so much worse for us any

25:12

of us than if we had stayed whatever

25:14

weight we were at before we started dieting .

25:17

Yeah , research shows that weight cycling

25:19

is linked to basically the same things that being

25:21

higher weight are everything from hypertension and type

25:23

2 diabetes , cardiovascular disease

25:25

and higher overall mortality , and

25:28

so that's really dangerous

25:30

. Like that , we're perpetuating something

25:32

that we know great disease health issues

25:35

. But it's also again a problem

25:37

, because what we call weight

25:39

related health conditions may

25:41

very well be weight cycling related

25:43

health conditions or weight stigma related health

25:45

conditions or health care inequality related health

25:48

conditions , but we do these things

25:50

to higher weight people and then we blame

25:52

their bodies for the negative results .

25:55

Yeah , Thank you for saying

25:57

that , especially this

25:59

idea that

26:02

if people of higher

26:04

weight are not receiving the care

26:06

that they are wanting and needing , they're

26:09

less likely to continue to go

26:11

to see their doctor . Because if they go to

26:13

their doctor and every time they go all

26:15

they are talked to about is losing

26:17

weight you stop going , which

26:19

then means we're not catching things

26:21

, we're not doing any sort of prevention and

26:24

things that are going to escalate and get worse .

26:27

Yeah , weight stigma and care drives so

26:29

much patient disengagement from care and

26:31

we know that folks , as you said , they miss early

26:34

screenings , they miss early detection and

26:36

sometimes that combines with weight stigma where

26:38

a practitioner doesn't explore

26:41

somebody's symptoms because they assume that weight

26:43

loss will solve them . But I think

26:45

of the case of Ellen Mod Bennett , who

26:47

went to multiple doctors and said there's something

26:49

very wrong , and they all had said , nope , this will

26:51

be cured by weight loss . And

26:53

so when they eventually did diagnose her cancer

26:56

, she had literally days to live and

26:58

that was unnecessary and she put in her obituary

27:01

that she wanted her death to be

27:03

assigned to other higher weight people to

27:05

seek health care and to push for health care , which is why

27:07

it's important to me that I tell her story but

27:10

understand the impacts

27:12

of weight stigma can

27:14

be fatal .

27:18

Yeah , for lots of reasons , whether it's preventing

27:22

access to care . But then we

27:24

also have the people

27:27

just get depressed

27:29

and they have nowhere else to go , and

27:31

then we have people who are taking

27:33

their own lives because there's nowhere

27:35

else for them to go . It's not just about lack

27:38

of access to care .

27:39

Yeah , and it's worth mentioning

27:41

that suicidal behaviors and ideations

27:43

are a side effect of the new GLP1 agonist

27:45

drugs as well .

27:47

Oh , that's not talked about , is it Not ?

27:50

a lot . No , there's more studies

27:52

going on that I know about right now in

27:54

the UK , but it's listed under

27:56

the known side effects .

28:00

In the very fine print because , yeah , they're not putting

28:02

that on the commercials on

28:04

. I didn't even watch Super Bowl . I'm

28:06

assuming there was one on the Super Bowl .

28:08

I didn't watch either . I can't watch , but

28:11

yeah , it's a real issue . And

28:16

what's sad is that a lot

28:19

of the training and

28:21

again , this is part of that whole

28:23

weight loss industry but a lot of the training that

28:26

health care practitioners get continuing medical education

28:28

is coming from the weight loss industry . So

28:30

very well-intentioned people are getting

28:33

this training , whether it's about prescribing

28:35

drugs or using person-first language

28:37

as anti-stigma language , which is ridiculous . But

28:41

they want to do the right thing and they're

28:43

not given the tools to do the right thing and they're

28:45

not given the information to do the right thing . And so that's what

28:47

my work is about . Like , let's just talk about what

28:49

the research says and then you can

28:51

move forward , you can draw conclusions , you can dig

28:54

more , you can email me and I'll talk about it . But like , let's

28:56

actually look at the

28:58

research here and let's get a base

29:00

understanding of what's going on .

29:04

Shaking things up a bit of

29:06

. We can't change things right

29:09

now at a systemic level . We

29:11

can't go in and teach different classes at med school

29:13

. We can't go in and change the weight loss industry

29:15

and all of the funding that they get . But

29:18

we can start to poke

29:20

holes in things and we can start to look

29:23

at research that isn't just

29:25

funded by weight loss industries .

29:27

Yeah , and we can start to change our world

29:29

, which eventually does change the world

29:31

.

29:32

Yeah , yeah . Speaking

29:36

of our world and what we can do right

29:38

now , what would you like

29:40

people to understand about the relationship

29:43

between body size and health ?

29:46

It's much less clear than

29:48

what you've probably been taught . We

29:52

get taught that it's very like higher weight equals unhealthy

29:54

, losing weight equals increasing

29:57

health , and that is far

29:59

. It's far more complex than that . That . It

30:01

is far less clear than that and

30:03

again , there's a lot of misinformation

30:06

that floats out there about that and it's very profitable

30:08

misinformation . But the

30:11

relationship between weight and health is much

30:13

less clear than what most people have been told or

30:15

taught .

30:17

Yeah , it's more of that correlation

30:20

. It's dots on

30:22

a graph , but that doesn't mean that

30:25

it is caused , and I

30:28

think you've talked about this a lot before

30:30

. But one other thing that I think a lot about is

30:32

that a lot of times if

30:34

we've gained weight let's say we were in a smaller

30:36

body and we've gained weight and we get a lot of guilt

30:39

and shame for that I'm

30:41

noticing that it's more of whatever condition

30:43

is going on is causing some of

30:45

that weight gain rather than the weight gain

30:47

causing the condition .

30:49

Yeah , that's a serious issue

30:51

, that a lot of conditions , a lot of medications

30:54

that people take now can cause weight gain , but

30:57

we just assume that

30:59

it's food or exercise right . There's

31:01

a lot of that . The number of healthcare practitioners

31:03

who have told me to eat less and exercise more

31:05

, who had no information about how much

31:07

I ate or how much I exercised , is staggering , and

31:11

these are well-meaning people . This is what they were

31:13

taught to say to me to look at me and

31:15

say you obviously need to eat less and exercise

31:17

more , right ? Without exploring

31:19

anything like do you perhaps have PCOS

31:21

? That would cause weight gain , that kind of thing . And

31:24

so it is really problematic

31:26

that the way that we make assumptions

31:29

, the way that we see higher weight equals bad

31:31

, losing weight equals good , and that's

31:33

just like the paradigm of healthcare that

31:35

a lot of people are working from and again

31:37

, really well-intentioned people who are

31:40

accidentally doing a lot of harm .

31:44

I really appreciate that . You mentioned that like

31:46

well-meaning people . So not all

31:48

these providers out here are the

31:50

Wicked Witch of the West and trying to intentionally

31:53

harm people . It's that they haven't

31:55

been educated otherwise .

31:56

Yeah , and of course , impact is always greater

31:59

than intent , but I think it matters

32:01

, you know , because of the work I do . People are like do you just hate all healthcare

32:03

providers ? I'm like , no , not at all

32:05

. I think like they are

32:07

heroic in a lot of ways , and

32:09

not like pizza in the break room way , but

32:11

like should be paid more and their you

32:14

know their work should be made

32:16

better and easier and fully staffed , like . There's

32:18

a lot of issues within the healthcare industry that

32:20

make things hard for healthcare providers

32:22

, but also

32:24

the impact of

32:26

buying into the weight loss paradigm

32:28

is a tremendous amount of harm to their patients

32:31

, and so , as much as I

32:33

care for providers , my

32:35

main concern has to be the

32:38

patients who are being harmed , and so that's why I

32:40

do this work . That's what is important to me

32:42

that well-intentioned people be given the

32:44

tools they need to give

32:47

their clients and patients the best

32:49

care , the most ethical , evidence-based

32:51

care that they possibly can .

32:54

Yeah , is there

32:56

anything that we haven't touched on yet

32:58

that you really want to make sure the listeners

33:00

hear ?

33:03

I think it's important to understand

33:05

like reasonable people can disagree about the evidence

33:07

. But higher weight people have

33:10

the right to exist without shame , bullying

33:12

, stigma or oppression Period

33:14

. It doesn't matter why

33:16

they're fat , it doesn't matter if their health impacts

33:18

of their weight , it doesn't matter if they could or even want

33:20

to become thinner . Higher weight people have

33:22

the right to exist in peace and without shame

33:25

, stigma , bullying or oppression . And that's

33:27

really important because I talk a lot about the

33:29

health you know , research and healthcare and that's important

33:31

work . But overall stigma is wrong

33:33

Period .

33:36

In any in any form . Yeah , yeah

33:41

, Speaking of

33:43

that , where do you see your work going

33:45

in the next decade , or even just the fat

33:47

liberation movement ?

33:49

I think that it's a growing

33:51

movement . It's a movement that's getting more resources

33:53

. I think that you know there's

33:55

incredible work being done by so many people

33:58

and I'm just honored to be part of that group

34:00

, and I think that more and more , when I , for

34:02

my own work , I see the difference between I started

34:05

giving these talks to providers in 2009 . And

34:07

at that time , the

34:09

audiences in the Q&A's were straight

34:12

up hostile . Right , it was

34:14

like I basically my

34:16

presentation was here's an hour and a half of research

34:18

, and then the Q&A was just like fight

34:20

me , Right , Like it was . So there

34:23

was so little knowledge about this . There was

34:25

so much sort of scoffing and anger

34:27

about it and defensiveness . And that makes

34:29

sense . Right , when you're , the paradigm

34:31

you've been working from is questioned . I certainly

34:33

. When I started 20 years ago to study this incredulousness

34:36

, defensiveness , anger I certainly felt all of

34:38

those upon doing my

34:40

big literature review and realizing that

34:42

there wasn't a single weight loss study where more than

34:44

a tiny fraction of people were successful . Right

34:47

, I had all of those emotions . So I get that . But

34:49

now , as you know , having moved

34:51

along between 2009

34:53

and now , more people are aware of this

34:55

. People are asking for this information

34:57

. You know people are voluntarily

35:00

showing up at these talks rather than being

35:02

told to come there , and the fact that

35:04

you know to be able to keynote a conference

35:06

like this and have

35:08

providers come and be interested in listening to this information Like

35:12

that I see progress there . It's

35:14

too slow , it's too painful , it leaves

35:16

too many people behind . The people at harms are

35:19

again the most marginalized

35:21

people , those with multiple marginalized

35:23

identities . Those are the highest weights . But I do see

35:25

progress and I think we're going to continue to see progress

35:27

, and I think a lot of my

35:29

work right now is about talking

35:32

about the research and also again exposing the ways

35:35

that the weight loss industry is really infiltrating

35:37

and manipulating healthcare in very dangerous

35:40

and , frankly , very profitable ways .

35:43

Yeah , and that's why you're out there fighting

35:45

the good fight , doing what you do .

35:46

One of many .

35:50

All right , well , let's let's move into a quick

35:52

lightning round before we wrap up

35:54

, because I really

35:57

am curious about some of these questions . So

36:01

first , what are what are you most

36:03

excited about coming to Iowa

36:05

for ? Or what are you most excited to see

36:07

experience ?

36:10

I'm most excited to meet in person all

36:12

of the amazing people I've actually gotten to work with as

36:14

we were prepping for this conference . That

36:16

I'm super excited about that . I just with

36:18

COVID and remote talks , you know just

36:20

haven't been getting to see people in

36:23

person , and so I'm really excited about that . Getting

36:25

to really interact with folks in

36:27

person will be really fun .

36:29

We're excited to have you . Hey , what

36:33

are you currently reading ?

36:37

I'm currently reading On Fat and Faith by EK

36:39

Delfine for the second time . I

36:43

read almost no fiction

36:45

, so all of my stuff . I'm also re-listening

36:48

to Empire of Pain , which

36:50

is an incredible book about the Sackler

36:53

family and the opioid epidemic , and

36:56

it's intense . The

36:58

audiobook is 19 hours long . Oh

37:01

boy , incredibly informative , and

37:03

so I'm re-listening to that as well .

37:06

Are there any other podcasts or other

37:08

resources that you're listening to ?

37:14

I listened to so many . I think

37:16

Unsolicited . Fatty's Talk Back is

37:19

one of my favorite podcasts . They do incredible work . But

37:21

they're just so many really excellent podcasts and I'm

37:23

reticent to start naming them because then I'll start

37:25

forgetting them and then I'll feel terrible .

37:27

I feel bad for them leaving people out . Okay

37:30

, and what is bringing you

37:33

the most joy right now ?

37:38

It is today's , my partner's birthday , my

37:40

fiance's birthday , and

37:43

so I have planned a surprise party

37:45

and I also was

37:47

able to secretly like in times

37:49

when they happen to be sleeping and I wasn't we had . We

37:52

moved to Oregon to be near

37:54

to my family and our

37:57

place has a screened in porch , but it was just

38:00

filled with crap from the move and so I was able to clean

38:02

it out and make like a little space . It's been her dream

38:04

to be able to like go out in the cold and

38:06

have coffee outside , because we moved

38:08

here from LA and we are loving the cold and the rain

38:10

. So I surprised

38:12

her with that yesterday morning for a Valentine's

38:14

slash birthday present and that I

38:17

was really had a lot of fun with that .

38:19

That is lovely , Reagan . Thank you for sharing . So

38:22

thank you for taking time out of your

38:24

partner's birthday to chat

38:26

with me .

38:27

No worries , we both work

38:29

for ourselves , so she is also working right now , so

38:31

birthday will come later .

38:34

Awesome , awesome , okay . So

38:36

, as we wrap up , I just want to say thank you so much for

38:38

coming on the show and telling us more

38:40

about weight stigma , and thank you so

38:43

much for agreeing to come to Iowa , and I

38:45

really look forward to seeing you in two weeks in person

38:47

.

38:47

Thanks for having me and I look forward to seeing

38:49

everybody there . Thank you so much .

38:52

Yeah .

38:53

Thank you .