Welcome to episode 421 of The Whole View. This week Stacy and Sarah revisit the conversation surrounding body image. Specifically, the hosts tackle this subject from the lens of fatphobia and weight stigma, and how these factors have contributed to America’s health challenges. For the research and discussion, tune in below!
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The Whole View, Episode 421: The Science Behind Body Image
Welcome back to the Whole View, episode 421 – also known as the best episode of our podcast ever. (0:27)
Stacy wants to preface this show by saying that she read an article called, The Racist Roots of Fighting Obesity, several months ago.
This article blew both Stacy and Sarah’s minds in the best way.
They both felt very strongly that they needed to continue to tackle the concept of body image and fatphobia.
However, they wanted to continue this discussion in a scientific way.
There is research and science out there showing how absolutely terrible dieting and fat-stigma is, and what that is feeding into this concept of America getting unhealthier over time.
Before we fully jump in, Stacy also wants to say that no matter who you are or what your health situation is there is no judgment in this show.
Regardless of who you are and what your body looks like, this show today is about just that.
This show is about how our body and our weight does not determine our worth.
It does not determine our health.
Ultimately, it is a vessel to carry us through life, which we want to be as full as joyous and wonderful as we can make it.
This is why we do this show – so that you can find ways to healthfully, sustainably, and in a positive way, bring you to your best self.
We ask of you today and are asking ourselves as well, to challenge and reframe your thinking fatphobia.
More on the Inspiration for this Discussion
This is a journey that Stacy has been on for her whole lifetime, but has been actively working on understanding fatphobia and how it leads to unhealthiness for a couple of years. (3:44)
There is still so much work for her to do, and so much for her to learn.
She is excited to share this topic with listeners today with a scientific perspective.
Finding that Scientific American article a couple of months ago had an immediate impact on Sarah when she read it.
The concept that the stigma associated with being overweight or obese is far more harmful, if not the harmful thing, about being overweight or obese.
Sarah noted that Scientific American articles are always so well cited.
Sarah shared more on Dr. Bacon and the program she created known as Health at Every Size.
She wasn’t aware of this field of research until she found Dr. Bacon’s first article.
It is really hard to separate out the impact of being overweight/obese versus weight discrimination.
Weight discrimination is experienced across the spectrum.
Sarah became really upset with the information she found because she couldn’t help but put this research into the context of her own health journey.
She did want to mention that Dr. Bacon does have two books, which you can learn more about here.
Weight discrimination is, by different ways that medical researchers measure this, is the most pervasive form of discrimination. (9:07)
Stacy noted that this is a form of discrimination that is legally allowed.
Despite Sarah’s personal experience with weight discrimination, she did not really think of it in terms of this ubiquitous experience.
This form of discrimination intersects with sexism, racism, and classism.
So an overweight woman of color is going to have the layers of discrimination on top of each other.
These are additive layers.
This medical research comes from the intersection between sociology, physiology, and psychology.
To see this written out in a scientific article written out in a scientific journal was really eye-opening for Sarah.
What is really problematic about weight discrimination is that it causes this basic chronic social stress.
Studies have shown that weight stigma is more harmful to health, above and beyond any impact from BMI.
It becomes a self-fulfilling prophecy.
People who experience weight discrimination or perceive weight discrimination, that there is a very strong link between that perception and increased weight.
There have been studies that have looked at this that have shown that people who experience weight discrimination are two and half times more likely to become obese over time, and three times as likely to remain obese and not be able to lose that weight.
It ends up becoming the problem in and of itself.
Over time weight discrimination ends up increasing weight.
This is very problematic because the discrimination is a risk factor for health that then magnifies itself.
Sarah wants to emphasize that this is a really big challenge.
Redefining the Problem
There is a stigma that if you are overweight/obese that it is a personal failure. (14:30)
Obesity can be a symptom of something that is going wrong, and this is not something that is well understood.
It means that we need to be looking at a root cause, rather than saying that obesity is itself the risk factor for the thing going wrong, the thing that is going to cause all of these other problems.
The social stress, the mental health challenges, of being discriminated against because of our weight is compounding an issue that is a root cause that we need someone to help us with.
Dr. Bacon used the analogy that it is like blaming yellow teeth for lung cancer, but it is smoking that caused both lung cancer and yellow teeth.
Sarah feels that she could never find another better analogy than that.
Instead of making it a blame game, it is very important for the medical community, health coaches, and fitness trainers, to be looking at resistance to weight loss and/or obesity as a symptom of something else going on.
Also, we need to be able to look beyond weight as being the problem.
Stacy noted, or we need to not think of weight as a problem at all.
One of the things from the research that was really powerful for Stacy was that you can actually be obese and fit.
Stacy is excited to discuss this element from the research in greater detail.
Weight gain is a symptom of numerous mental and physical health challenges.
In general, as a society, we look at that and define that as not healthy or good.
Eating foods that are less healthy for us and/or moving less is not good for us.
However, calling these things out as choices that are making us gain weight does not help the root cause.
This is also creating shame and judgment and desire to want to comfort oneself with less than healthy choices.
Regardless of what weight someone is, how can we get them to enjoy movement?
And if someone is moving, how the science shows that as being the real measure that we can look at instead of weight.
It is important to find research that reframes these things in a way that can truly drive change if we are all willing to focus on that a bit.
Stacy encourages you to read the references that we will mention throughout this show.
It takes time to dive into things and reflect on them and to then process that in a way that you can impact change.
Fitness as a Metric
The studies that are trying to separate out weight stigma versus weight and the impact of that on health are really fascinating. (22:59)
This is not an easy thing to do.
It is innovative and fascinating to see the way these studies have gone about this research.
Sarah explained the paradigm between BMI and life expectancy, which was explained in further detail in this episode.
This research indicates that our entire perception of what a healthy weight is is probably not right.
Stacy’s point about fitness is 100% spot on.
There was a study published in 1999 in one of the top medical journals, and they actually took the time to separate participants out by fit and not fit categories.
They measured their cardiorespiratory fitness and were looking at all-cause mortality.
The fit people, across the weight spectrum, had the same risk of all-cause mortality.
Unfit in normal weight was still 2.2x higher risk, compared to fit in normal weight.
In overweight is was 2.5x higher, compared to fit.
And in obese it was 3x higher, compared to fit.
So it is the magnification of not being fit, with being obese, that serves as the signal.
But if you look at fitness, it is a far more important determinant of all-cause mortality in the study.
This is because healthy habits are really important, which we have talked about on this show before in the context of intuitive eating.
These habits are really important independent of weight and benefit metrics of health independent of weight.
A lot of this research has shown that by making healthy day-to-day choices, this improves things like cholesterol and blood pressure in everybody.
So when we talk about separating out the impact of weight versus weight stigma on health, it really highlights the things that we talk about on this podcast all the time as health-promoting habits being the important thing.
These studies continue to show that losing weight is not necessary for being healthy.
It is much more important to get healthy to lose weight, rather than to lose weight to get healthy.
Stacy and Sarah both shared their personal feelings and experiences with weight stigma and how they felt when they went to a gym.
There was a study looking at 25,000 men over the course of 10 years.
Based on all of their weight, cardiorespiratory fitness was as strong of an independent predictor of cardiovascular disease and all-cause mortality, compared to that of diabetes or other cardiovascular risk factors.
Where Data is Available
For Stacy, she is having all these brain explosions about the base knowledge that is put out there regarding weight and health. (33:21)
Stacy is asking, where is the data that shows that if everyone exercised and ate the exact same that we would all hit this “ideal”.
There is no data to show this, and it doesn’t exist.
It is hard for us to break this apart because it is so ingrained in the culture.
Stacy realized that our country has a problem when she lost the weight and saw how differently she was treated.
The entire body mass index was never actually developed as an individual indicator, it was never meant to be applied to one person. (35:57)
It was always meant to be used as a way of measuring entire populations.
When you average it out over a population, then you can start to tease apart some of the interesting correlations.
When you apply it to one person, it has a very high likelihood of being incorrect.
This study found that 51% of healthy people are deemed unhealthy by a BMI scale.
So why would we use something that is a coin flip?
The reason why this type of research is important in cardiometabolic disease is because of two reasons.
One, these are the conditions that have been traditionally linked to overweight and obesity.
This is where the pathologizing of obesity is derived.
It is also important because these are chronic health conditions for which we have a number to follow that we know increases risk.
We don’t necessarily have a way of quantifying risk for other conditions.
Sarah provided examples for when these markers come into play when it comes to measuring health.
Cardiovascular Disease Research
There was one study where they took a group of people and they had a control measuring blood pressure, heart rate variability, and cardiovascular stress. (40:20)
Then they had two intervention groups within the study, using presentation scenarios as the structure for the study.
The study was looking at normal-weight people and overweight people.
Sarah referred people to this source.
They’ve shown that if you are giving this video presentation where people can see you and you have experienced weight discrimination in the past then you have higher blood pressure, heart rate variability, blood sugar is less regulated, cortisol is going to be higher, and your inflammatory markers are going to be higher.
This is such a fascinating way of separating that effect.
Sarah notes how marked this data is, and why this information is so fascinating.
Again, this is why looking at cardiovascular disease and diabetes is such a great model in which to look because we have established risk factors and measurements that are quantified.
With diabetes, studies have shown that there is definitely a link between weight and blood sugar regulation. (43:23)
Sarah wants to emphasize that being overweight is not necessarily the thing that is causing more dysregulated blood sugars.
However, there is a strong association.
The heavier you are, the more likely it is to have dysregulated blood sugars, but the studies show that that is dramatically exacerbated by weight discrimination.
Sarah is not trying to say that having a high body fat percentage is harmless.
What she is trying to say is that the stigma and the weight discrimination on top of that is the bigger effect, or equally problematic effect, as shown by the research.
This makes the intervention point clear.
The intervention point is not to get that person on a diet to lose weight but is instead to get rid of the weight discrimination.
This allows us to break the vicious cycle.
And this is not how this is viewed medically or socially, and this really needs to change.
Sarah referenced this article.
There have also been studies that have looked at all-cause mortality and increase mortality risk. (45:46)
One of the studies was called the Health & Retirement Study and the other was called the Midlife in the United States study.
In both of these populations, it was shown that weight discrimination was associated with a nearly 60% increased mortality risk.
It was the stronger predictor of mortality than any of the other things that they could correct for.
In addition, the association between weight discrimination and mortality was stronger than for other types of discrimination.
These studies that are trying to separate out the impact of weight versus the mental health challenges that come with weight discrimination are far and few between.
However, there are enough to have some systematic reviews and some metanalysis.
They show over and over again that the far more important thing to be focusing on is not the weight itself, but looking at weight as a symptom and looking at it as a root cause.
Studies have shown that things like healthy eating and activity, these behaviors, really only account for about 25% of the difference in health outcomes.
The other 75% are things like socioeconomic status, exposure to environmental toxins, etc.
These elements are stronger predictors and emphasize that the focus on weight loss as a primary focus is not the right way to go about addressing the public health challenges that are these chronic illnesses.
The USDA dietary guidelines and the dietary industry, which is worth 80 billion dollars a year have magnified fat discrimination, fat-phobia, and fat-shaming when the problem is not the weight itself.
The weight may be a symptom of so many other factors, which serve as the intervention points.
Healthy at Every/Any Size
The idea behind ‘health at every size’ or ‘health at any size’ is that the things that matter are not necessarily going to result in weight loss and that is ok. (49:57)
It is about really looking at the mental health piece, because that mental health piece of body shame is really damaging, and combining that with a healthy diet, movement, sleep, and stress management.
Healthy living requires a comprehensive approach that is looking at day to day choices and healthy diet and lifestyle as a point of self-care in an environment where there is no shame associated with overweight and obesity because that is associated with a symptom and not a personal failure.
Stacy took a minute to circle back to this and encourages listeners to please take the time to read this article.
She also talked about how pervasive diet culture is and how it impacts us.
The judgment and discrimination that comes from fat-phobia contribute to factors that reduce health.
It is a big deal that we have science for this.
The research shows that a weight inclusive approach translates to better long-term behavior changes.
These people are maintaining a more active lifestyle, they are eating more whole foods, they are making more lasting positive change in their day to day choices.
This is because these people are focusing on health and not weight loss.
Sarah feels that this is the big takehome here.
Taking weight loss out of the equation is beneficial.
That doesn’t mean that someone who makes all of these changes won’t lose weight, it just means that weight loss is not the goal.
Health is the goal.
Weightloss might go with it, and it might not.
It doesn’t matter if it doesn’t because health is the goal.
None of this discussion is to take away from the importance of a nutrient-dense, anti-inflammatory diet, or getting enough sleep, or living an active lifestyle, or managing stress, etc.
All of these things are still true.
However, instead of implementing these things to lose weight, we are implementing them for the sake of improving health.
Reframing Our Thinking
The thing that has really helped Stacy was reframing her thinking. (58:34)
Getting out and being active is enjoyable.
Part of our problem as a society is the way we frame so many healthy choices as being done for weight loss that it can carry a negative, ‘this is work’ mindset with it.
We lose the ability to enjoy activities.
As a society, we have come to view exercise as an activity, and we view it as a requirement in a negative way.
For everyone in our life, Stacy wants us to reframe (for everybody in our lives, ourselves included), look for the things that bring you joy, and find ways to do more of them.
The more that we can tell ourselves that, the more we will move away from diet culture.
Stacy feels that it takes a long time to lose away from the ‘weight loss is the goal’ mentality.
It is so ingrained in us that we have to question it and be acutely aware of it.
When you look to simply find enjoyment in what you are doing, it helps to create awareness and bring you back to the moment.
Even though Sarah has talked about health as being the priority instead of weight loss that doesn’t mean that Sarah isn’t someone who wants to lose some weight. (1:03:12)
Sarah has thirty to thirty-five years of body image to undo in her own head.
She needs to figure out how to drop this and let it go, and not have weight loss as a goal, not have it as a thing.
Sarah puts a lot of effort into a healthy lifestyle and it makes her feel good.
Through diet and lifestyle and functional medicine, she has been able to manage four autoimmune conditions.
These are the things that are important: how she feels, how much energy she has, what her mood is like, etc.
Sarah knows that it is going to be tuff to avoid sliding into the mindset of, “maybe I will lose a few pounds”.
However, she wants to find out how to make that thought process change.
Sarah wants to acknowledge that for anybody who has had a health journey that has included weight loss or weight-loss diets, there is a mindset that is drilled into us.
This mindset is not an easy one to shake.
Sarah wants to wrap up with this science with compassion.
She wants to emphasize compassion for herself, compassion for other people who are hearing this and feeling stuck on how to make that mental shift to find body acceptance.
Sarah doesn’t have all the answers on how to do this, but she is working on it too.
This process takes a lot of positive self talk to outweigh all of the years of negative self-talk, and this is Sarah’s primary self-focus.
Stacy noted that this negative self-talk compiles onto those negative health factors and potentially gaining weight.
Yes, this is a three times higher risk Sarah points out.
Every time we think about weight as it relates to how our clothes are fitting or whatever justification you’re are telling yourself is the alternative to weight loss – remind yourself what you are actually doing. (1:07:21)
You are increasing your likelihood to gain weight that will result in a negative health effect.
This is a good way to stop yourself from justifying that self-imposed diet-talk.
Stacy really likes Lindo Bacon’s phrasing of being weight neutral.
So the concept of ‘health at every size’ or ‘health at any size’ and being positive are sometimes a little far-reaching, or there is judgment associated with them.
Stacy also feels that it sometimes feeds into this new marketing schtick by people of finding another way of this diet culture to reach you.
Focus on healthy habits.
Focus on the healthy exercise options that you can sustainably do regularly.
Ask yourself how you can improve the nutrient density of the food you are eating and reduce things that cause inflammation or don’t make you feel your best.
What can we do to be weight neutral?
To just focus on those things that make us feel good that we know are indicators of health and promote healthy living.
Sarah notes that one of the things she sees is cliques of the health at every size/healthy at any size movement as being a license for people to let go.
However, this is not at all what the movement is about, it is about focusing on these things that are important for health, rather than weight.
The science really does show that weight is not a very good indicator of health.
While we didn’t have time to dig into this data in this episode, there is data that shows that if you look at cardiovascular disease risk factors, that there is a large number of “normal weight people” who are not diagnosed.
This is because there is an assumption that if you are a normal weight, you obviously have a healthy diet and lifestyle.
And this is a terrible assumption!
This data shows that we have problems from both sides of the spectrum.
Your weight is not a check box to check.
Stacy is so excited to dive into the medical discrimination factor over on Patreon. (1:13:59)
She has seen this play out both personally and within this community.
The education that health professionals are taught is based on weight being such an indicator, and assumptions to make around it.
Sarah makes such a great point that it is not just about misdiagnosis, that it touches on the other side for people who would not be given the proper medical care that they need because a medical assumption is made that they are healthy based on their shape and size.
This is really a problem, and we are doing a disservice to our entire community and where we are right now.
Stacy thinks this has played into this shift since our great-grandparents when we have begun to see so much change in health.
What was viewed as a healthy body for our great-grandmothers has also changed quite a bit.
Judgment and weight discrimination about bodies have increased as people have more metrics for comparison (video, photos, social media, etc.).
Stacy wonders how these changes have played into our society’s overall health.
The more judgments and assumptions are made, the more diet culture is built into billions of dollars industry.
It is not a coincidence that the problem is getting bigger and bigger as the diet industry grows.
We all see it in the science.
This is something Stacy has known for a long time but never knew that there was hard data to support the details.
It really does make you need to step back and rethink things.
We have to be vigilant with our thoughts on weight loss because it is so ingrained, and it is hard to shift your thoughts away.
For Stacy and Sarah, their favorite episodes are the ones that break some barriers in their own minds.
They love the episodes that lead them personally to make some kind of change.
This has been one of those episodes for Sarah.
Once she learned these details, she can’t unlearn them.
Now that she knows that this has been a field of research to understand that weight is more a problem from a mental health perspective because of weight discrimination than for the weight itself.
Sarah sees the data clearly that highlights the mental health challenges that come with being the recipient of weight discrimination.
She understands that this is the thing that is harmful and can lead to more challenges that can last a lifetime.
Sarah feels that she needs to reevaluate how she talks to herself about weight, and look at how she broadly talks about weight as well.
This is really important information.
She wants to emphasize to our listeners that she doesn’t expect this shift to be easy personally.
This is merely being added to the list of internal work that Sarah has to do in a year that has revealed a lot of need for internal work.
Listeners, thank you for sticking to the end.
If you want to hear Stacy and Sarah’s real thoughts on this, be sure to hop over to Patreon to check it out.
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