98 - Unveiling Weight Stigma in Healthcare: A Quest for Fat Liberation and Equitable Treatment with Guest Ragen Chastain

Have you ever wondered about the hidden biases in healthcare that affect those of higher weights? Prepare to have your eyes opened by Ragan Chastain, a dynamic keynote speaker who joins us to unpack the prevalence of weight stigma and its deep-seated roots in racism and anti-blackness. Our conversation is a primer for Ragan's much-anticipated keynote at the upcoming Eating Disorder Conference, where she'll dive deeper into cultivating a healthcare environment free from bias and discrimination. We discuss the urgent need for education in the healthcare sector and provide a list of essential readings to arm yourself with knowledge on this critical issue.

The weight loss industry's influence on our perceptions of health comes under the microscope as we chat with Ragan. We scrutinize the troubling ethics of profit-driven research and the promotion of drug dependency for weight management, drawing parallels with Big Pharma's notorious past. Our investigation doesn't stop there; we also dissect how the industry's narratives and marketing tactics have shaped public opinion, often placing undue blame on individuals for weight regain, and the physiological responses that complicate weight loss efforts. This episode will leave you questioning the status quo and considering the ethical ramifications of a profit-over-people approach.

Wrapping up our enlightening dialogue, we reflect upon the complex relationship between weight, health, and societal attitudes. We share haunting stories like that of Ellen Maud Bennett, illustrating the fatal consequences of medical neglect due to weight stigma. The mental health ramifications of new medical interventions are also in the spotlight, as we emphasize the importance of comprehensive education for healthcare professionals.

Join us for this deep dive into weight stigma and our collective journey toward fat liberation and equitable healthcare.


Mentioned on the show:

Eating Disorder Awareness Week Provider Conference and Community Workshop.   March 1st & 2nd.  More info here

Sabrina Strings "Fearing the Black Body"
Deshawn  Harrison "The Belly of the Beast"

Where to find Ragen Chastain

Website Dances With Fat
Instagram

Transcript

Speaker 1: 0:49

Hello, hello, hello, it's Sabrina. Welcome back to the show. I am so, so excited for today's guest. Today I am joined by Reagan Chastain, who is our keynote speaker at our Eating Disorder conference on March 1st and 2nd. More details to follow on that and done a previous episode on it, but let's get to Reagan.

Speaker 1: 1:16

Reagan Chastain is a speaker, writer, researcher, board-certified patient advocate, multi-certified health and fitness professional and thought leader in weight science, weight stigma, health and health care. Utilizing her background in research methods and statistics, reagan has brought her signature mix of humor and hard facts to health care, corporate conference and college audiences, from Kaiser Permanente and the Diabetes Education Specialist National Conference to Amazon and Google, to Dartmouth Health, caltech and CanFitPro. Author of the Weight and Health Care newsletter, the book Fat, the Owner's Manual, co-author of Hayes Health Sheets and editor of the anthology the Politics of Size, reagan is frequently featured as an expert in print, radio, television and documentary film. In her free time, reagan is a national dance champion, triathlete and marathoner who holds the Guinness World Record for heaviest woman to complete a marathon, and co-founder the FitFatty's Facebook group, which has over 11,000 members. Reagan recently moved to Oregon with her fiance, julianne, and currently enjoys fostering dogs.

Speaker 1: 2:34

In this episode, reagan and I are chatting about what weight stigma is, how that shows up in the health care setting, and we don't dive too nitty gritty into the weeds with it, because that's what she's going to be sharing with us at the Eating Disorder Conference on the first and second. So have a listen. Hopefully your interest is peaked and you want more information, or you really really want to come to this conference so that you can hear more about weight stigma and what we can do, both as providers and just as individuals, to help combat weight stigma. So, without further ado, let's get to my interview with Reagan. Reagan, I am beyond excited to bring you on to the show and thank you so much for agreeing to come on. I'm really, really excited that in two weeks I get to meet you face to face, live in person.

Speaker 2: 3:35

Oh, right back at you. I am so excited about today, I'm so excited about the conference. This is going to be amazing yeah.

Speaker 1: 3:43

Everybody at EDCI was like fan girling when we heard that you were going to come out and we had a meeting this morning and they were asking about this and I'm like I'm going to play it real cool. It's going to be one of those people, I'm going to be cool, so I hope I can pull that off.

Speaker 2: 3:58

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

Speaker 1: 4:03

We'll see. We'll see. So, listeners, you may have already heard I know I've made the announcement of our eating disorder conference on March 1st and 2nd and Reagan is going to be our keynote speaker for both of those events and we just wanted to come on and educate a little bit more about what the event is going to be, educate on weight stigma and then, if you get really excited about this content, you want to learn more, then please come to the conference, because Reagan will be there and we're just going to share the little tidbits, teasers today. So if you want the full meat and potatoes, you got to come to the conference.

Speaker 2: 4:40

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

Speaker 1: 4:44

You are going to hopefully love Iowa.

Speaker 2: 4:48

I've never been. It's one of the very few states where I've never been, so I'm super extra excited about this.

Speaker 1: 4:53

Yeah, yeah, and Des Moines is its own little special place in Iowa, so we'll see that. Yeah, let's start with what is weight stigma, because I know some of my listeners have maybe heard me mention it or not heard me mention it and have no idea what this is.

Speaker 2: 5:09

Yeah, so at its base, weight stigma is essentially the belief that a thinner body is better than a fatter body, whether we're talking about in terms of attractiveness or health or on any other axis. And there's a lot of different ways. You can have implicit or subconscious bias, where people have just absorbed all the weight stigma around them, which is like not a galloping shock, and they're operating from that without even knowing it. We can have explicit bias, where people are very well aware that they have negative beliefs about higher weight people, and other types of biases as well. So there's a lot of different ways that weight stigma bias can impact both practitioners and clients.

Speaker 1: 5:49

And it shows up everywhere. I know the focus is in the healthcare realm, but it shows up everywhere, right?

Speaker 2: 5:57

Absolutely, and it doesn't affect everybody the same way, because it's always going to have the greatest impact on people of the highest weights and people of multiple marginalized identities. And I do want to point out that weight stigma in general, pathologizing, higher weight bodies in general, body mass index in specific these things are rooted in an inextricable from racism and anti-blackness and I highly urge folks to read Dr Sabrina Strings fearing the black body, Deishean Harrison's belly of the beast and other authors in this area to understand how these things aren't just rooted in racism and anti-blackness but they continue to disproportionately impact those communities today.

Speaker 1: 6:37

Yeah, Thank you for pointing those two out and I will make sure to link those in the show notes that people can come back and reference them if they need to. But both of those resources were really eye-opening to realize. Oh wow, I didn't realize that it went that deep.

Speaker 2: 6:57

Yeah yeah. They're both incredible works and there are obviously more. Dr Joy Cox, ek Delphine there are many people writing about this and I just really urge people to learn more about this.

Speaker 1: 7:11

What does weight stigma look like?

Speaker 2: 7:16

So it can look like a lot of things. It can be very overt right where someone's discriminated against because of their size, where an Airbnb says nobody above X-weight is allowed to stay here. Which happened, do they?

Speaker 2: 7:29

really do that. It happened there. The Airbnb eventually had to remove them, but it was a protracted, a prolonged fight where they said we, just our furniture can't handle people of higher weight, so they just can't stay here. And in a lot of places it's absolutely legal to discriminate on the basis of weight. It's something that the campaign for size freedom, which full disclosure I'm the legal fellow for is working on, is creating height and weight protections from discrimination across the country, because in most places it's completely legal, right. A boss can say look, I don't want to hire you because you're fat, and that they're allowed to do that.

Speaker 2: 8:09

There are ways to fight that. So it's not that it's impossible to fight it, but you have to fight it On its face. It seemed to be legal, so that's a weight stigma. There's also the fact that the world is created for often thinner people and then higher weight people. That becomes our problem that we're supposed to solve, right? So planes are a really good example. They make these planes with arbitrary seat sizes, and if you happen to be bigger than the arbitrary seat size, you have to pay twice as much for the same service, which is a flight from point A to point B, right, and then that gets couches. Oh, fat people want special things, they want extra things, and that's not true. We just want what, then, people already have, which is a flight from point A to point B in a seat that accommodates us. Yeah, and so weight stigma is thinking that that's higher way, people asking for something special as, instead of thinking, well, I get a seat that accommodates me, why doesn't everybody get that same thing?

Speaker 1: 9:11

So weight stigma is like the opposite of this equity piece.

Speaker 2: 9:17

Yes, yeah. In many ways it very much is right that, instead of seeking equity, we're seeking to say higher weight bodies are wrong and higher weight people should have to change themselves in order to receive equitable treatment.

Speaker 1: 9:31

Or we're just not going to give them services or treatment.

Speaker 2: 9:35

Exactly so. Basically, the idea is, if you want equitable services or treatment, become a thin person, and then you can have them. Yes, the idea that oppressed people should have to change themselves to suit their oppressors in order to Receive equity.

Speaker 1: 9:51

Yeah, yeah. One of the ways that my eyes were really open to this when I first started getting into the health at every size field was like looking at the Waiting room chairs in your doctor's office. And Now it's like the only thing I can focus when I go into a new provider's office and I'm like, hey, I just wanted to let you know that your, your office isn't very weight-inclusive Because all of your chairs have arms on them.

Speaker 2: 10:19

Yeah, thank you so much for doing that. It's a huge issue and you know, before you even get to, do you have a proper blood pressure cuff? Do you have an MRI that accommodates? Do you have tables and beds and just sitting down in the waiting room the most basic function of the doctor's office, and it's not accessible to many people is such a great example and again thank you for for speaking up about that, because the more people who do, the more change there will be.

Speaker 1: 10:47

Yeah, and that that was one of my things when I I recently opened a group practice and so had to redo, got an office again after COVID and like it was really frustrating looking through different manufacturers and like weight limits on the, the waiting room furniture, because I'm like the couches are probably okay like they're, they're built pretty sturdy, but finding something that accommodates more than 250 pounds Was ridiculous, and then you have to pay like twice as much, yeah, and it's just yeah, but it's a thing that we even have to think about.

Speaker 2: 11:23

Yeah, and I think more insidious is the way that it gets justified instead of questions Questioned, right. Well, of course, if you know it, the chair is higher weight capacity. Of course it should be more expensive, right. But like, why are we making chairs that don't accommodate people? Like, just go ahead and make the chairs highway capacity and then we'll all be fine. Yeah, and it's the thing about accommodation. Typically, by accommodating folks, you accommodate everyone, right. So if you accommodate a higher weight folks, folks of all sizes, can be accommodated, right, and this goes across things like disability accommodation and more. Like, if we are accommodating more people, then you know typically that will encompass everyone.

Speaker 1: 12:10

So that's some of the weight stigma that we might see. Before we even get into see our provider is is waiting room and Just this belief walking around. But once we're in the room with our provider, how does weight stigma show up?

Speaker 2: 12:27

Weight stigma shows up in a lot of ways and again, both consciously and subconsciously Right. So often, providers, we live in a world that is rife with weight stigma, so if we've internalized some of that, that's not like a galloping shock, right. But because it's implicit, we're not even aware that we're doing it necessarily right. So we make assumptions about people based on their size without doing that content. We're not like I assume that this person does an exercise because of their size. We just do that subconsciously. And so there's that piece of it where Practitioners are treating higher-weight patients differently Because they're Implicit bias. There's also explicit right where Practitioners are Consciously making these Beliefs and having these beliefs and making these choices about how to treat their higher-weight patients. And there's something that I call practitioner weight distraction, which is when the practitioner becomes so focused on the patient's weight and wanting to alter their weight that they don't listen to other things and they don't provide the same ethical, evidence-based recommendations that they would give to a thinner patient. So that can be a big piece of it as well.

Speaker 1: 13:39

And specifically, that is more, when a provider says yes, I know you're coming in for your knee pain, but that's because of your weight. We need to work on getting the weight down. Let's move your body, let's exercise some more, let's talk about changing your diet. You can't move because your knee isn't so much pain.

Speaker 2: 13:59

That's such a great example on a lot of different axes, right? Because, first of all, the patient has come in with a specific complaint and we've shifted to weight loss. Also, people of all sizes get knee pain, so the assumption that it must be the patient's weight is a problem. Also, what happens is and this is like such a great example that you've given because a thin person is typically going to get physical therapy recommendations for the acute knee pain they're having, but a higher weight person often gets weight loss and told to eat less and exercise more, both of which will exacerbate an acute knee injury and can turn it into a chronic knee injury, which then again will be blamed on their weight. Oh well, you have this knee injury because your higher weight, not because we told you to go jump around with an acute knee injury, so that, in all of those ways, weight stigma compromises patient care.

Speaker 1: 14:49

I had a client that has some pretty severe back pain and we've been working to advocate on other modalities to treat it and finally she got to a surgeon and the surgeon said I'm not going to operate on you because you're high risk because of your weight. Have you considered weight loss surgery?

Speaker 2: 15:10

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

Speaker 2: 15:13

But this is. I'm actually a board certified patient advocate and I work with patients on VMI based procedure genitals, which, let's be clear, it's holding health care hostage for a weight loss ransom. That's what we're doing On some. What I can tell you is pretty shaky evidence, right, even ignoring evidence that shows that outcomes are very similar between patients of different sizes, and just sort of cherry picking evidence that would deny surgical procedures. There's a lot here to talk about around the way that the healthcare system incentivizes surgeons to cherry pick patients who may have the best outcomes, that kind of thing. But yeah, it's the ridiculousness of oh, surgery is too dangerous for you, you should have surgery is beyond the pale, especially given that weight loss surgery takes a perfectly healthy organ and creates a disease state, whereas what the other surgery is trying to do is simply cure an actual health issue. So it's really problematic on like 50 different levels.

Speaker 1: 16:14

Probably even more than that.

Speaker 2: 16:16

Probably yeah, at least 50 different levels.

Speaker 1: 16:20

Because you've been in this fat activism role for quite a while, I mean as long as I've been aware of you. What are your biggest challenges you face in this?

Speaker 2: 16:32

The massively funded weight loss industry machine and everything that they do to create more profit Pumping out research that would have gotten me an F in my freshman research methods class that gets peer reviewed and published. All the marketing that they do, all the misinformation, the ways that they are currently trying very hard to co-opt decades of weight stigma work from people who were doing this work before I was even born, and turn that work and pervert it to make it be about selling weight loss drugs. And the ways that they've got a bunch of doctors and researchers who they're paying to do that work. That's the biggest hurdle, I think, is that there's a misinformation machine that exists to create billions of dollars of profit and they're very good at it they are.

Speaker 1: 17:21

It reminds me of hackers, of why can't we just use all of your skill set and knowledge for good, rather than tearing people down? Yeah.

Speaker 2: 17:33

I mean, you look at, even the funding for research is typically earmarked for quote unquote obesity eradication and prevention. So people who want to do research that builds upon the existing body of research that shows the safety and efficacy of weight neutral interventions have an incredibly difficult time getting funded, which is why we see research that's six weeks long instead of these large prospective studies, why we don't see RCTs, because it's just not fundable. The way that the current industry works and that is my area of expertise is the intersections of weight science, weight stigma and health care. But my sort of subspecialty, as it were, is the way that the weight loss industry infiltrates and manipulates the health care system, and so I promise not to take us too far into the weeds. But you can't talk about it for very long without sounding like a conspiracy theorist because it is in some very rare ways of conspiracy without having charts and graphs and receipts to explain like no, this is really happening.

Speaker 1: 18:35

Yeah, there's a lot of gatekeeping that happens, and so the research that's being done. One supports what fits the diet industry, what fits the big pharma, but also we don't have long-term studies. Nothing goes past 10 years, right? Does anything go past five?

Speaker 2: 18:59

Most doesn't go past two. Research that goes to five years shows that the vast majority of people who attempt weight loss end up losing weight short-term and regaining weight long-term, because the body changes physiologically in response to that intentional weight loss effort. Right, and the weight loss industry is even language, that is, oh, people go back to their old habits and that's why they regain the weight, which is a really disingenuous way to say that starvation is not sustainable. That's really what's happening here, right, which is not a galloping shock. It's the same with the new GLP1 agonist drugs. Their largest, their longest studies are two years and at the end of two years, people's weight is starting to tick back up, even though they're still on the drugs. But they're saying oh yeah, if you go to offer our drugs, you regain your weight right away, but that's okay, because what you need to do is take these drugs for the rest of your life and, in addition to all the dangers and expense of that, there's no reason to believe it will actually work.

Speaker 1: 19:54

Speaking of those meds, because you brought them up, have you seen any shifts in your work since this has become highly marketed and promoted?

Speaker 2: 20:04

Yeah, so this is where the weight loss industry and in many ways they're following the Purdue Pharma playbook by which they marketed Oxycontin right? There's a lot of parallels there, but they're working really hard. So we're seeing now you'll see this phrase everywhere that quote obesity is a chronic, relapsing, progressive disease. All of that is nonsense. It is 100% junk science. But it's what they're using to justify the idea that we have to take this drug for the rest of our lives if we want it to work. And again, the research doesn't even support that. But like that's the big march, right now They've got themselves to say you know what intentional behavior-based weight loss doesn't work long-term, which, like for again, activists and weight-neutral health providers have been screaming this from the rooftop for decades.

Speaker 2: 20:55

It's like when big tobacco finally figured out that nicotine is addictive. Holy cow, really. Like they knew the whole time. Right, these folks knew the whole time. It's what they based their model on. They took credit for the first part of the biological response where people lose weight. They blamed people for the second part of the same biological response, where they gained them back and where they gained the weight back, and then they had them come back and do another intentional weight loss attempt, right, and so they knew the whole time.

Speaker 2: 21:21

But now, because these drugs are massively profitable to sell to people for their whole lives, we're like oh no, it's a chronic, relaxing, progressive quote disease to simply exist in a higher weight body, right, which, again, what we're doing is pathologizing bodies based on shared size, rather than shared symptomatology or cardiometabolic profile, like you would with a true disease. So the change in my work is that this is really, I think, a critical tipping point where we have to push back with everything that we have to stop them. Like Novo Nordisk, when they launched Wagovii, also launched their it's Bigger Than Me campaign, which is supposedly an anti-weight stigma campaign. And I'm like it's bigger than like, get it, because fat people are big.

Speaker 2: 22:06

Like, if your anti-weight stigma campaign sounds like it was named by a sixth grade schoolyard bully, you probably aren't an expert in anti-weight stigma, but what they're doing is co-opting it and trying to say oh no, the real stigma is that people don't have enough access to our drugs and the cure to weight stigma is to have access to our drugs and, in particular, people of color and older people. Like. The real racism is that people don't have enough access to our drugs. However, in their research, they vastly underrepresented people of color and older people, so they're basically targeting these communities for experimental medicine because they didn't bother to include them in their studies, but now they want to use them as oh, this is the real stigma and the real racism within weight stigma, and so, again, it's co-opting a lot of really important work and it's an incredibly dangerous thing, and so that for the change in my work is that I have to write and speak about this a lot.

Speaker 1: 22:59

I see it, co-opting and diet culture is great at doing that, like we've seen this whole intuitive fasting that a celebrity has recently endorsed. But it's also this idea of putting back the blame on the patient, on the individual of yes, you need to stay on these drugs for the rest of your life because you can't be trusted to manage without them.

Speaker 2: 23:30

Yeah, the idea is, you know in, the only path to health for higher weight people is thinness, and so these drugs risk the approval process. On the risk benefit analysis for interventions for weight loss is basically a belief that it's worth risking higher weight people's lives and quality of life in attempts to make them thin. And that's not fully understood. When people see these drugs or FDA approved, what they hear is these drugs are safe. And I take a really firm view of bodily autonomy. It does not surprise me that people want to lose weight in a society where there's a tremendous amount of fat phobia and I think people are allowed to do what they want to do with their bodies.

Speaker 2: 24:08

I also take a very firm view of what constitutes the ethical, evidence-based practice of medicine. And that is where I get into trouble with these drugs and with the FDA approval process, because they take a big mountain of terrible shoddy research that just correlates being higher weight with health issues, without exploring confounding variables, and they say, see, it's so dangerous to exist in a higher weight body, it's worth risking their lives and quality of life to be on this drug forever. And the FDA says, yes, we agree with that, and then it gets approved and that's the situation we're in. And so it's not just this co-opting though that's a huge part of it but it's also this inherent belief that they want us thinner dead and they don't care much, which necessarily Because it's such a high profit model, and that is what's really scary to me and that's at the extreme right, but that's what's very scary to me in terms of the way that this industry works.

Speaker 1: 25:02

When it perpetuates the weight loss, weight gain cycle, that yo-yo dieting, which is so much worse for us any of us than if we had stayed whatever weight we were at before we started dieting.

Speaker 2: 25:17

Yeah, research shows that weight cycling is linked to basically the same things that being higher weight are everything from hypertension and type 2 diabetes, cardiovascular disease and higher overall mortality, and so that's really dangerous. Like that, we're perpetuating something that we know great disease health issues. But it's also again a problem, because what we call weight related health conditions may very well be weight cycling related health conditions or weight stigma related health conditions or health care inequality related health conditions, but we do these things to higher weight people and then we blame their bodies for the negative results.

Speaker 1: 25:55

Yeah, Thank you for saying that, especially this idea that if people of higher weight are not receiving the care that they are wanting and needing, they're less likely to continue to go to see their doctor. Because if they go to their doctor and every time they go all they are talked to about is losing weight you stop going, which then means we're not catching things, we're not doing any sort of prevention and things that are going to escalate and get worse.

Speaker 2: 26:27

Yeah, weight stigma and care drives so much patient disengagement from care and we know that folks, as you said, they miss early screenings, they miss early detection and sometimes that combines with weight stigma where a practitioner doesn't explore somebody's symptoms because they assume that weight loss will solve them. But I think of the case of Ellen Mod Bennett, who went to multiple doctors and said there's something very wrong, and they all had said, nope, this will be cured by weight loss. And so when they eventually did diagnose her cancer, she had literally days to live and that was unnecessary and she put in her obituary that she wanted her death to be assigned to other higher weight people to seek health care and to push for health care, which is why it's important to me that I tell her story but understand the impacts of weight stigma can be fatal.

Speaker 1: 27:18

Yeah, for lots of reasons, whether it's preventing access to care. But then we also have the people just get depressed and they have nowhere else to go, and then we have people who are taking their own lives because there's nowhere else for them to go. It's not just about lack of access to care.

Speaker 2: 27:39

Yeah, and it's worth mentioning that suicidal behaviors and ideations are a side effect of the new GLP1 agonist drugs as well.

Speaker 1: 27:47

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

Speaker 2: 27:50

a lot. No, there's more studies going on that I know about right now in the UK, but it's listed under the known side effects.

Speaker 1: 28:00

In the very fine print because, yeah, they're not putting that on the commercials on. I didn't even watch Super Bowl. I'm assuming there was one on the Super Bowl.

Speaker 2: 28:08

I didn't watch either. I can't watch, but yeah, it's a real issue.

Speaker 2: 28:16

And what's sad is that a lot of the training and again, this is part of that whole weight loss industry but a lot of the training that health care practitioners get continuing medical education is coming from the weight loss industry. So very well-intentioned people are getting this training, whether it's about prescribing drugs or using person-first language as anti-stigma language, which is ridiculous. But they want to do the right thing and they're not given the tools to do the right thing and they're not given the information to do the right thing. And so that's what my work is about. Like, let's just talk about what the research says and then you can move forward, you can draw conclusions, you can dig more, you can email me and I'll talk about it. But like, let's actually look at the research here and let's get a base understanding of what's going on.

Speaker 1: 29:04

Shaking things up a bit of. We can't change things right now at a systemic level. We can't go in and teach different classes at med school. We can't go in and change the weight loss industry and all of the funding that they get. But we can start to poke holes in things and we can start to look at research that isn't just funded by weight loss industries.

Speaker 2: 29:27

Yeah, and we can start to change our world, which eventually does change the world.

Speaker 1: 29:32

Yeah, yeah. Speaking of our world and what we can do right now, what would you like people to understand about the relationship between body size and health?

Speaker 2: 29:46

It's much less clear than what you've probably been taught. We get taught that it's very like higher weight equals unhealthy, losing weight equals increasing health, and that is far. It's far more complex than that. That. It is far less clear than that and again, there's a lot of misinformation that floats out there about that and it's very profitable misinformation. But the relationship between weight and health is much less clear than what most people have been told or taught.

Speaker 1: 30:17

Yeah, it's more of that correlation. It's dots on a graph, but that doesn't mean that it is caused, and I think you've talked about this a lot before. But one other thing that I think a lot about is that a lot of times if we've gained weight let's say we were in a smaller body and we've gained weight and we get a lot of guilt and shame for that I'm noticing that it's more of whatever condition is going on is causing some of that weight gain rather than the weight gain causing the condition.

Speaker 2: 30:49

Yeah, that's a serious issue, that a lot of conditions, a lot of medications that people take now can cause weight gain, but we just assume that it's food or exercise right. There's a lot of that. The number of healthcare practitioners who have told me to eat less and exercise more, who had no information about how much I ate or how much I exercised, is staggering, and these are well-meaning people. This is what they were taught to say to me to look at me and say you obviously need to eat less and exercise more, right? Without exploring anything like do you perhaps have PCOS? That would cause weight gain, that kind of thing. And so it is really problematic that the way that we make assumptions, the way that we see higher weight equals bad, losing weight equals good, and that's just like the paradigm of healthcare that a lot of people are working from and again, really well-intentioned people who are accidentally doing a lot of harm.

Speaker 1: 31:44

I really appreciate that. You mentioned that like well-meaning people. So not all these providers out here are the Wicked Witch of the West and trying to intentionally harm people. It's that they haven't been educated otherwise.

Speaker 2: 31:56

Yeah, and of course, impact is always greater than intent, but I think it matters, you know, because of the work I do. People are like do you just hate all healthcare providers? I'm like, no, not at all. I think like they are heroic in a lot of ways, and not like pizza in the break room way, but like should be paid more and their you know their work should be made better and easier and fully staffed, like. There's a lot of issues within the healthcare industry that make things hard for healthcare providers, but also the impact of buying into the weight loss paradigm is a tremendous amount of harm to their patients, and so, as much as I care for providers, my main concern has to be the patients who are being harmed, and so that's why I do this work. That's what is important to me that well-intentioned people be given the tools they need to give their clients and patients the best care, the most ethical, evidence-based care that they possibly can.

Speaker 1: 32:54

Yeah, is there anything that we haven't touched on yet that you really want to make sure the listeners hear?

Speaker 2: 33:03

I think it's important to understand like reasonable people can disagree about the evidence. But higher weight people have the right to exist without shame, bullying, stigma or oppression Period. It doesn't matter why they're fat, it doesn't matter if their health impacts of their weight, it doesn't matter if they could or even want to become thinner. Higher weight people have the right to exist in peace and without shame, stigma, bullying or oppression. And that's really important because I talk a lot about the health you know, research and healthcare and that's important work. But overall stigma is wrong Period.

Speaker 1: 33:36

In any in any form. Yeah, yeah, Speaking of that, where do you see your work going in the next decade, or even just the fat liberation movement?

Speaker 2: 33:49

I think that it's a growing movement. It's a movement that's getting more resources. I think that you know there's incredible work being done by so many people and I'm just honored to be part of that group, and I think that more and more, when I, for my own work, I see the difference between I started giving these talks to providers in 2009. And at that time, the audiences in the Q&A's were straight up hostile. Right, it was like I basically my presentation was here's an hour and a half of research, and then the Q&A was just like fight me, Right, Like it was. So there was so little knowledge about this. There was so much sort of scoffing and anger about it and defensiveness. And that makes sense. Right, when you're, the paradigm you've been working from is questioned. I certainly. When I started 20 years ago to study this incredulousness, defensiveness, anger I certainly felt all of those upon doing my big literature review and realizing that there wasn't a single weight loss study where more than a tiny fraction of people were successful. Right, I had all of those emotions. So I get that. But now, as you know, having moved along between 2009 and now, more people are aware of this. People are asking for this information. You know people are voluntarily showing up at these talks rather than being told to come there, and the fact that you know to be able to keynote a conference like this and have providers come and be interested in listening to this information Like that I see progress there.

Speaker 2: 35:14

It's too slow, it's too painful, it leaves too many people behind. The people at harms are again the most marginalized people, those with multiple marginalized identities. Those are the highest weights. But I do see progress and I think we're going to continue to see progress, and I think a lot of my work right now is about talking about the research and also again exposing the ways that the weight loss industry is really infiltrating and manipulating healthcare in very dangerous and, frankly, very profitable ways.

Speaker 1: 35:43

Yeah, and that's why you're out there fighting the good fight, doing what you do.

Speaker 2: 35:46

One of many.

Speaker 1: 35:50

All right, well, let's let's move into a quick lightning round before we wrap up, because I really am curious about some of these questions. So first, what are what are you most excited about coming to Iowa for? Or what are you most excited to see experience?

Speaker 2: 36:10

I'm most excited to meet in person all of the amazing people I've actually gotten to work with as we were prepping for this conference. That I'm super excited about that. I just with COVID and remote talks, you know just haven't been getting to see people in person, and so I'm really excited about that. Getting to really interact with folks in person will be really fun.

Speaker 1: 36:29

We're excited to have you. Hey, what are you currently reading?

Speaker 2: 36:37

I'm currently reading On Fat and Faith by EK Delfine for the second time. I read almost no fiction, so all of my stuff. I'm also re-listening to Empire of Pain, which is an incredible book about the Sackler family and the opioid epidemic, and it's intense. The audiobook is 19 hours long. Oh boy, incredibly informative, and so I'm re-listening to that as well.

Speaker 1: 37:06

Are there any other podcasts or other resources that you're listening to?

Speaker 2: 37:14

I listened to so many. I think Unsolicited. Fatty's Talk Back is one of my favorite podcasts. They do incredible work. But they're just so many really excellent podcasts and I'm reticent to start naming them because then I'll start forgetting them and then I'll feel terrible.

Speaker 1: 37:27

I feel bad for them leaving people out. Okay, and what is bringing you the most joy right now?

Speaker 2: 37:38

It is today's, my partner's birthday, my fiance's birthday, and so I have planned a surprise party and I also was able to secretly like in times when they happen to be sleeping and I wasn't we had. We moved to Oregon to be near to my family and our place has a screened in porch, but it was just filled with crap from the move and so I was able to clean it out and make like a little space. It's been her dream to be able to like go out in the cold and have coffee outside, because we moved here from LA and we are loving the cold and the rain. So I surprised her with that yesterday morning for a Valentine's slash birthday present and that I was really had a lot of fun with that.

Speaker 1: 38:19

That is lovely, Reagan. Thank you for sharing. So thank you for taking time out of your partner's birthday to chat with me.

Speaker 2: 38:27

No worries, we both work for ourselves, so she is also working right now, so birthday will come later.

Speaker 1: 38:34

Awesome, awesome, okay. So, as we wrap up, I just want to say thank you so much for coming on the show and telling us more about weight stigma, and thank you so much for agreeing to come to Iowa, and I really look forward to seeing you in two weeks in person.

Speaker 2: 38:47

Thanks for having me and I look forward to seeing everybody there. Thank you so much.

Speaker 1: 38:52

Yeah.

Speaker 2: 38:53

Thank you.