Obesity has tripled since 1970. And since, it’s spawned all sorts of trends, ostensibly to help folks eat less, exercise more, and lose weight. But what is obesity, exactly? And is all this advice actually helping — or could it be doing more harm than good? Abdul reflects on weight, weight stigma, and the weightloss industrial complex. He sits down with Prof. Harriett Brown, author of “Body of Truth,” which digs deep into the evidence about weight and health and explores the consequences of weight stigma.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: A Biden administration official sets off a firestorm over gas stoves. COVID cases, hospitalizations, and deaths begin to decline, suggesting that this winter may be the first without a major COVID surge. My second daughter, Serene El-Sayed, was born last Tuesday. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] If you’re like me and you grew up in the eighties, nineties, or 2000s, chances are you’ve been bombarded by ads like these. 

[clip of Jenny Craig commercial] 94 Jenny. Call 1-800-94-Jenny today and lose 20 pounds for $20. Jenny Craig. You won’t just lose. You’ll win. You won’t just lose you’ll win. 

Dr. Abdul El-Sayed, narrating: Ostensibly, they’ve got your best interest at heart, promising that beauty, happiness and good health sit at the end of a workout video or diet plan or gym membership. But what if the ads themselves are actually the problem? Today we’re talking about the consequences of weight, stigma and the ways that our public conversation about weight might be doing more harm than good. And honestly, I have to tell you that today’s subject, well, it hits really close to home. I’ve struggled with weight and body image my entire life. As a kid, my family moved quite a bit. Along with my name, my skin color and my religion. My weight was just another of those things cool kids would latch on to and tease me for. I didn’t always want to be a doctor. I originally wanted to be a dentist, though I’ve always had a fascination with the biological sciences and the ways that the body functions, I absolutely hated seeing the doctor when I was a kid. They’d tell me I was too heavy, that I had to lose weight, that I had to play outside more. But I played outside all the time like I loved sports. And despite or maybe because of my size, I was actually pretty good at them. Football, hockey, baseball, soccer, track, lacrosse, wrestling. I played all of them. My parents, for their part, eh didn’t really help. On the one hand, I grew up in a family where my parents rarely said, I love you, but they showed it through their cooking and usually those were the greasiest carbiest meals. I was always willing to accept that love. And at the same time, they’d constantly monitor my eating, telling me I had to eat less. You can imagine the cognitive dissonance here. By the time I hit my latter years of high school and into college, puberty and sports, well, they did their thing. For the first time in my life, I met society standard for male fitness. But I still hated seeing the doctor because at five eight and 200 pounds, despite being at the peak of my fitness, I still had a BMI of 30.4 and I was technically, quote, “obese”. I remember walking into the university health service at my college and watching the doctor do a double take when she walked in the room for my examination. I was going to tell you to lose weight, but yeah. After my college lacrosse days ended, medical school undid what puberty and sports had done, quitting a college sport cold turkey left me with a weird relationship to both food and exercise. I could eat whatever I wanted in college, and I had never learned how to enjoy exercising. It was always just an instrument to a goal. Run faster, be stronger, win games. What now? To this day, I’ve never really figured out how to eat healthy. Look, I’ve studied everything there is to nutrition. I just haven’t found something I’m comfortable with. I’ve dieted on and off my entire adult life, and though I’ve figured out how to enjoy working out again. It took me nearly two decades to get here, but all of this has left me thinking a lot about the way we think about weight and the medicalised version of that quote, “obesity”. I wrote a whole ass doctoral dissertation about obesity, about how our simplistic statistic body mass index, a measure of comparing weight to height, leaves us measuring different things in different people with different body compositions. We’ve known for decades that the proportion of people with a BMI over 30 has been rising steadily, triple now since the seventies. And we’ve known that people with high BMI tend to have higher rates of diabetes, heart disease, stroke and cancer. But we don’t really understand as much about why. Why is obesity rising so fast? Why is there more chronic illness among folks who meet obesity thresholds? There’s some strong science that has demonstrated the ways that more fat tissue can influence our biology. But there’s also strong evidence that the way we treat larger people can have profound impact on their mental health, which can then shape their physical health. And it’s this latter piece we don’t really pay enough attention to, but perhaps we should. In all the rush to quote, “tackle obesity”, we’ve personalized it rather than target the environmental factors that have driven our behavior. Things like cheap corn or urban planning that weds us to our cars. We tell people that they and they alone are responsible. Eat less, exercise more. Never mind that companies make billions, making those things harder. And if you can’t do those things, it must mean that you’re lazy or gluttonous or just don’t care about your health. And unfortunately, it certainly means that you’re deemed less beautiful, less desirable, less seen. Our guest today has been thinking about weight and weight stigma for decades. Professor Harriet Brown is a journalist. After her own experiences with weight, stigma and her daughter’s experience with anorexia. She set out to dig into what we know about weight. Her book, Body of Truth: How Science, History and Culture Drive Our Obsession with Weight and What We Can Do About It came out in 2016. And since it’s shifted our public conversation about weight, I can think of no one better to help us understand the consequences of weight stigma and how we address them. Here’s my conversation with Professor Harriet Brown. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Harriet Brown: Sure. I am Harriet Brown, um a professor of magazine, news and digital journalism at the Newhouse School at Syracuse University and author of a number of nonfiction books, especially focusing on body image and weight and health. 

Dr. Abdul El-Sayed: Well, what a cool thing to be a professor of. Um. I was um for some time a professor of epidemiology, and it was decidedly less cool. Um. We had a we had a buzz there in the moment uh during the pandemic, but still not as cool as what you do. Um. I wish we could have a whole conversation about, you know, the future of uh longform journalism and the role of podcasting in that. Um. Another uh conversation for another day, hopefully. I wanted to sit down and have a conversation because I was really intrigued by a book you wrote called Body of Truth: How Science, History and Culture Drive Our Obsession with Weight and What We Can Do About It. And it has been some time since the book has been published, but I wanted to just step back and ask what what got you to to want to write this book? 

Harriet Brown: That is a big question um and it really has to do with um the fact that I grew up as a woman in America in the 1960s and seventies um in a family that was pretty obsessed with weight issues. Um. And so like a lot of other women my age, you know, I struggled on and off with trying to lose weight, then regaining it. I always it was always this source of terrible angst for me and it seemed like for a lot of my friends. So that’s the kind of personal backdrop. Um. Fast forward, I become a journalist. I, I, you know, get married. I have daughters, and I continue to struggle in all of the ways that women do often struggle. And men, too. But um, you know, feeling pretty high levels of despair and basically often feeling like I was spending my whole life fixated on my body. What was wrong with it, my weight, feeling guilty because I could be healthier, you know, I could be doing better by myself. Um. And then my oldest daughter developed anorexia when she was 14. And our family went through a whole number of years helping her recover, which she did in the end, I’m happy to say. But it was very eye opening to me because um it highlighted a number of things for me, starting with the fact that my own feelings about my body were sort of not just my personal feelings, but they were reflected in the medical profession. Um. And more broadly, you know, anorexia often presents as a fear of fatness and a fear of eating fat. And um I found that that was um sort of supported by everyone we encountered. My daughter’s fears were not just hers or mine. The doctor would say things like, well, you need to gain weight to recover, but not too much weight. You know, when we would a little bit later in her recovery, when we would go out in public and we would be like in a store shopping for high calorie foods, which she needed to support her recovery, you know, we would get sometimes I felt like people were looking at me as if I was, you know, abusing my child in some way because we were shopping for and we would joke about, like, what’s the highest calorie ice cream in this freezer case? You know, that’s what we need. And um the looks that we got, the comments that people would make when my daughter was gaunt and very sick, people would literally come up to her on the street and tell her how gorgeous she was. Had she ever thought about modeling? And then as she recovered and gained weight and looked more healthier, I thought all of that stopped. So it kind of gave me this other perspective on something I had always thought of as my own personal nightmare, really. And it made me, as a journalist, want to start understanding, well, what are those relationships between weight and health? How terrible is it to be a fat person in America in terms of your health? I mean, Well, sort of setting aside the ways in which fatness is stigmatized and discriminated against and just sort of focused on the health stuff, because that’s what I do. And as I started to actually read the research and talk to folks doing that research, it became clear to me that it wasn’t the relationship I thought it was. You know, I think like most of us, I think, you know, gosh, if you’re too fat, you’re cutting years off your life and it’s really terrible for you. And it’s you know, you’re damaging your heart and you’re, you know, increasing your risk of all these diseases. And what I actually found was that the research is not clear cut in any way. It’s very nuanced. It’s very complex. And that, in fact, for some people in some situations, fat seems to have protective values, whereas maybe for other people in other situations, it can be more problematic. But but the sort of short answer was, hey, it’s complicated. But despite the complexity of the research, the messages that we get about weight and health specifically are not complex and they’re not nuanced and they’re very um aggressive and they’re very um proscriptive. And so I set out to write the book, and I’m sorry for such a long winded answer um as a way to sort of share with other people some of the things that I had found and some of the questions that arose for me and that I thought other people should be aware of too. 

Dr. Abdul El-Sayed: Yeah, I really um appreciate that. And as someone who wrote a doctoral dissertation about um overweight and obesity, uh one of the things that I really appreciated in what you just said is just how complex it is, um both as a phenomenon and the way that um it comes to be and then the ways that we talk about it, and then all of the manifestations of capitalism that are built around it, both that helped to create it, but then also exist to ostensibly try and fight it, but only at the individual level. Right. And um and then all of the ways that then interacts with our mental health in some really paradoxical and frustrating ways. Um. And I think that what I appreciated about your book is that you brought um that nuance to the conversation. Um. And one of those nuances is just how different a thing can be at the collective level versus the individual level. Right, and as someone who does do epidemiology or did it um uh quite a bit. Uh. One of the things that you start to appreciate is that what you find around association doesn’t always equal causation. And when it does equal causation, what you’re finding is population level causal effects, whose um mechanisms oftentimes you are assuming rather than actually measuring. And part of the problem with that is because we think of this as an individual level condition, we assume that the only way to fight it is individual level, even though nothing has really changed. And I, I we talk about this often on on the podcast, but the thing that I really want folks to understand is that nothing has changed about human genetics over the past 30 years. That being said, the proportion of people meeting a particular BMI threshold and we’ll talk about BMI as a metric later on, but the proportion of people meeting a particular BMI threshold um that we call obesity has tripled over 30 years. And that is not because all of a sudden humans have become a lot more gluttonous. It is because there are things about our environment that have vastly changed to change the way that we both take in calories and that we burn calories. And then the other part of that that I think is also really important is if you just looked at an association, um aside from these last three years, people have never lived longer. So you could argue just stepping all the way back, that in the time when we have become the most quote “obese” as a society, we are also living the longest. And yet. Right. We know that the general association is that among people, right? Relative uh to people who are um less likely to meet a particular BMI threshold, the probability of having a whole constellation of very common illnesses um is higher in those who who meet that threshold. So but like all the causal mechanisms, all of the exact sort of ways in which this works is still a black box for us. And we just we we are still really starting to scratch the surface. And meanwhile you end up having a whole bunch of folks with training like mine, yelling at a bunch of folks to be like, well, if you if you weren’t if you just ate a little bit less or exercised a little bit more. Um. One of the points that you talked about that was was BMI. And um part of my doctoral dissertation was about ethnic inequalities in uh obesity in England and in England, this is where I did my my doctoral work. And in England um you have two large minority populations. One is South Asian and one is tends to be Afro-Caribbean. Right? And of the two, you’re talking about two populations for whom BMI tends not to correlate as much with um actual uh body fat percentage. Right. And for South Asians, you tend to have a lower BMI per unit body fat percentage. And for Afro Caribbeans, um you tend to have a higher. And for me, right, my family’s Egyptian um and you know, the sort of um and I use this tongue in cheek, but also, you know, I appreciate how tough the euphemism is, as I was always said, I was big boned. Right. But I actually am really big boned. And the funny thing about it is when I was in college, I played um Lacrosse in college. And I was at my, you know, tip top shape. I had a, you know, sub uh 10% body fat percentage at some point, but I was technically obese. And I remember walking in to the clinic and having the doctor sort of look at their they were looking at their notes and then looked up at me and they were like, wait, are you the right person? So like, because technically you’re morbidly obese. And I was like, oh, I know, I know. I’ve been morbidly obese my entire life, right? But I at this point. Right. Um. I am in in pretty good health. I would say. I’m a 19 year old college Lacrosse player. Right. Who runs a sub six mile and a you know, a pretty quick 40. Um. And so uh it just that’s sort of what led to this sort of this notion of doing this work. How did we come upon this really weird um metric of body mass index? And what does that tell us? I mean, in the way that we change cut points, how has that shaped the discourse about obesity in what ways? 

Harriet Brown: Well, the BMI was um originally created as a population measure by a mathematician back in the 1830s, Adolphe Quetelet. And it’s basically a ratio of your height to your weight. Uh. There’s a complicated mathematical explanation, but it’s basically a ratio of height and weight. And um, you know, it was never intended as a individual measure of anything. Right? Um. And even researchers who have used it through the years, like Ancel Keys, a well-known epidemiological uh researcher, you know, who did the famous semi starvation study, among other things, you know, said, hey, this might be a good way to take a look at population level, but it should never be used as an individual level. Um. But at some point in the 1990s, it became a metric that was used to look at individuals, probably because it’s easy, it’s noninvasive. You can do it, apply it retroactively, right? You don’t need to like poke someone or put them through an expensive scanner. All you need is their height and weight and you can make this calculation. Um. And so people started using it in those ways. Um. But one of the really interesting things about the BMI, which I do write about in the book, is that those categories are fairly random, right, at some point there were life insurance companies that actually correlated like life expectancy with all of these measures, including height and weight and then therefore BMI. And they came up with these categories. And and there were two categories to begin, I believe, like normal and overweight. Um. And they were sort of pegged to the levels at which health issues were observed. Again, we don’t know you know what cause and effect it was, but here’s where, you know, we think life expectancy maybe starts to get wonky. And bear in mind that this was calculated by actuaries and not like medical people. Um. And then in 1997, at the end of 1997, the World Health Organization decided to change those metrics. Um. And they did it for somewhat cynical reasons. Right? So they created a third category. So now well there’s actually four categories, but we don’t typically talk about the underweight category, right? We never talk about that. So we have normal, overweight, and obese now. And they said, you know what? Like because earlier on, the BMI was like it was first of all, it was different for men and women, which makes sense because men and women’s bodies have different percentages of body fat and they work differently biologically. Um. They said, let’s just have one. It’s too hard to think about men and women and let’s make it even numbers, because I think originally you crossed from normal to overweight at something like 27.6. Right? Nah, that’s too hard for people. Let’s make it even. So they created they changed those categories to what we have now, which is normal is 18 to 25, overweight is 25 to 30, and obese is 30 and above. Even numbers easier to remember, but not actually pegged to data. So um because when we look at the data and an epidemiologist named uh Katherine Flegal, who I’m sure you’ve heard of um at the CDC, she’s retired now, she was like, hey, let’s take an epidemiological look at this and let’s actually put all this data together and see how it maps on to actual life expectancy. And again, you would expect, you know, like a line moving up into infinity, like the the heavier you are, the fatter you are for your height, the the lower your life expectancy. But what she actually found was a j-shaped curve. And so at the tops of those curves, in other words, the lowest levels of life expectancy were at the two ends of the curve. So in the underweight category and then in the, let’s say, 40 plus BMI category, the lowest point of the curve, the highest life expectancy correlates with what we call overweight. Right? So in that 25 to 30, even like 31-32. Right. That seems to be and again, it’s correlation, it’s not causation. So and she did not editorialize about this. She didn’t she just published her data and um that turned into [laugh] kind of a witch hunt um on the part of other epidemiologists who said, no, this can’t be true. You know, she’s got an agenda and it’s a story that’s still playing out. But, you know, she and others have run the data numerous times, and it seems fairly clear that that’s what we’ve got. So in other words, what is the relationship between BMI and life expectancy and health? You know, so mortality and morbidity. And again, the answer is it’s complicated. And I just want to throw one other thing into the mix, which is that, you know, you mentioned earlier that there are these associations between higher weight and incidences of certain diseases, which is true for some people in some situations. But one of the potential explanations for that that people have put forward is that we have such high levels of discrimination um and stigmatization of people in larger bodies. Um. And there’s beginning to be a literature of looking at how discrimination across the board, right. Whether it’s racial discrimination, gender discrimination, poverty, whatever, um how that affects our physical health. And again, it’s complex and our physical health is very much altered by that. So there are people who make the argument, I think, somewhat convincingly that unless you can factor out stigma and discrimination against people in higher weight bodies, you are not really seeing what the effects of being fat are on health. You know, until you can separate out the cultural and social determinants of health, then you don’t know what you’re looking at. So again, it’s not as simple as, wow, being fatter is bad for your heart. You know, you should lose weight and whatever. So uh. So, yes, it’s all very complicated. 

Dr. Abdul El-Sayed, narrating: We’ll be back with more with Professor Harriet Brown after this break. 

[AD BREAK]

Dr. Abdul El-Sayed: What I’d like to do is sort of think a little bit about that sort of secondary pathway. Right. Um. There is a good argument to to make about the potential physiological consequences of overweight. But there’s also an equally good argument to make about the social consequences of overweight. And the high probability, as these things sort of turn out, is that, you know, we as epidemiologists get real um interested in perfect causation as if the world is a silver bullet kind of place, um that there’s just one thing. And usually it’s it’s some of a lot of things that interact with each other in complex ways that we can’t we can’t fully actually elucidate and understand um as hard as we try. Two places I kind of want to take us are A.) The social circumstances of stigma. And from my experience as someone who has um struggled with my weight uh through my childhood and even into my later adulthood, um I often find the kind of stigma that you get at the doctor’s office to be so counterproductive. Right? Because most of the time when you sit down with a doctor and, you know, they tell you you should lose weight, their assumption is that you never had that idea before. You’ve like never had that thought like that that never occurred to you, right? Um. You’re like, oh, but for this doctor telling me with the authority of their M.D. degree that I should lose weight, I would never have happened upon this insight, this wisdom. Um. And then and then it just makes you feel bad about yourself or whatever else you’re doing. And when you feel bad, the thing that you tend to do tends to not help you, right, in this process of trying to lose weight. So it’s like counterproductive on its own terms. But then the bigger context here is that when we perpetuate the idea that body weight is a function of individual effort, we perpetuate the idea that people who are overweight are people who don’t have agency or are unwilling to do the things that they need to do to protect themselves, which opens the door to a certain level of discrimination, which basically says if these people don’t care enough about themselves, then why should I care about them? Right. And that’s the that’s the sort of the mechanism there. And that itself opens the door to all kinds of other consequences. In your work, what was it that you found about the impact of this kind of discrimination and this kind of stigma on the mental wellness, but also the physical wellness of people who inhabit bigger bodies? 

Harriet Brown: Um. Well, I think there are huge consequences across multiple layers of um experience, even if we just start with like the medical setting, right. So what you’ve described, right, anyone whose BMI is over 25 is going to get harassed basically to some extent or another by medical folks, their doctors, or they wind up in ERs or whatever. Um. And basically anything that’s wrong with you is going to be blamed on your weight. Like I have heard many, many, many anecdotal stories from people saying I went to the doctor with a sore throat, you know, and was told it was because I am fat so um or I broke, you know, I hurt myself. Um. And they blamed it on that. But maybe more importantly, I think if you’ve ever experienced that kind of judgment, you feel a lot of shame. And one of the results of that is that you might avoid going to the doctor, for example. Right. A lot of people don’t go, which means they don’t get routine preventive care, which means that perhaps if they are developing some kind of disease, it might not be caught until later. So there’s that whole layer. There’s the mistrust of the medical profession that is really problematic. Um. But then there’s also, um you know, that sense of shame, which, as you pointed out, doesn’t make you want to do the things that you might feel I need to do to be my best self. And I think that what you’re really talking about there is pursuing health separate from weight loss, Right? So like, let’s say you’re a sedentary person and you you know, you know that you should be exercising and you know, you you haven’t exercised and you’re want to get some kind of exercise program going. Making you feel bad about yourself is probably not going to well in fact, we know it’s not the thing that’s going to make you able to do that, right. We know that um shame does not inspire people toward positive health behaviors. Right. Um. What are the things that inspire people to pursue health? You know, it’s complex, but I mean, I think you have to feel good about yourself on a certain level. You have to–

Dr. Abdul El-Sayed: Right. 

Harriet Brown: –love the body that you’re in. You have to cherish it and want to do as well as you can by it, you know, so um so those are just like a couple of the ways in which that discrimination and shame can affect people’s health. And I mean, if you’ve ever been through this on any level, you know how terrible it feels um to be judged in that way to be to be denied medical care. Right. So I had a knee that was, you know, like bone on bone arthritis. I needed a knee replacement and I had to basically it took me quite a while to find a surgeon who would operate on me because my BMI was over a certain point, you know, because it was in the obese range. It was like, but I’ll do get but, you know, you could get gastric bypass. That’s not a problem. So then at that point you’re like, hmm, so the risks of doing surgery on my knee are too great, but the risks of doing gastric bypass are not like, I don’t understand. And that leaves you with a bad taste in your mouth and leaves you feeling like, can I trust what these people are saying? And in fact, I did have my knee replaced and it went well and everything is great. I got through rehab, all is well. So I think that’s a problem in medicine. Anytime you’re using one metric and only one metric and that metric has become so widespread that it’s like, as you say, it’s the only thing you know, the doctor looking at you and then looking at the paper and saying, could this be you? I’ll give you another example. My husband, who’s not fat, never has been fat. A thin person, a very active person, developed high blood pressure in his fifties, went to the doctor, and the doctor’s immediate response was lose weight. And then he kind of caught himself and said, Oh, wait a minute. You know, and my husband was like, what would I lose? Like he’s always had trouble keeping weight on. So but it’s such a knee jerk response, you know, it’s kind of the issue. 

Dr. Abdul El-Sayed: Yeah. And, you know, first off, I’m really sorry to hear about that experience. That must have been so harrowing for so many reasons. Not only the the pain of your knee, but also just being stigmatized by health care providers you turn to um and you’re supposed to trust to have your best interest at heart. You know, I remember uh sitting with a um a group of clinicians uh when I was in medical school, and, you know, I’d just finished a Ph.D. on obesity and uh we were having this discussion and they were talking about, well, you know, if all these people just lost some weight, I was like, well, you know, when you talk about weight, what you’re actually talking about is BMI. Like, that’s how you measure that, right? You’re not actually talking about weight. Right. So we should be specific. And so, you know, because they thought I was being a tongue in cheek, pedantic medical student, they’re like, well, okay, fine. They should lower their BMI. I was like, well, you know, one way to do that is we could just cut off everyone’s arm, like if we did that, um or maybe even better, like we could cut off their leg, which is like, you know, 20% of their weight and they would all have a quote, “healthy BMI”. Right. And but I think you would agree that we probably would not have done these folks a service um by doing this. So, you know, there is a sort of way that we get very literal about bigger picture questions rather than asking how do you optimize your health? The other part of this conversation that I think um I get really frustrated about is because so much of the way that we think about weight is as a matter of individual choices, right? You’re drilled um in medical school, right? Calories in, calories out. That’s all this is. This is just a thermodynamics equation. I’m like, well, I don’t know that that’s that simple, right? Because what we’re also doing is we’re giving a pass to a whole system of corporations that have figured out how to truck artificially cheap sweeteners into our food um change the very food dynamics about who gets what food, where, what is, what is considered good, palatable food, what children are taught to enjoy when they’re having lunch at school, and then an automotive industry that lobbied to fundamentally change the ways that we got around to the places that we needed to go. So rather than, you know, walk the 20 minutes to to work, most people have to drive in a solitary car, which, by the way, destroys the environment. And that’s a whole different question. But um it gives a pass to those folks. And what we all ought to do is just try harder. And the challenges that obesity is actually probably more about, um less about individual choices and more about the degree to which someone is is sensitive to an environmental condition. Right. And um we don’t think about that. I wanted to ask you, you know in your work, how often did the experts that you talked to talk about this environmental issue um and, you know, what would it take for us to start holding the purveyors of these these circumstances accountable for the consequences that that then fall upon individuals? 

Harriet Brown: What a great question, because the answer is um no one ever wants to talk about this, because in America, in capitalist America, we are very, very invested in the idea of personal responsibility. Right? It’s sort of baked into our national DNA. Like we like to think of ourselves as scrappy people who can overcome any kind of obstacle and challenge if we just put our mind to it, pull ourselves up by our bootstraps, blah, blah, blah. And so, you know, I think the notion that, as you say and I think that’s a very elegant way to put it, that people respond differently, people’s bodies and minds respond differently to the environment that they’re in. I think that there are people, especially in certain parts of the political spectrum, who see that as a cop out, who see that as, you know, wait you want government to do something for you, you know, like whether it’s regulating, you know, food advertising to kids or, you know, whatever form. Um. And I just think that [laugh] what would we have to do to shift that? Maybe head for a political system that’s closer to what they have in Scandinavia, you know, social democracy rather than like, you know, or social capitalism rather than– 

Dr. Abdul El-Sayed: Some of us have been trying. 

Harriet Brown: [laughter] We have unfettered capitalism here. So, you know, I don’t see that changing any time soon, you know, And I think that um when people question it, they’re often vilified in one way or another, which is unfortunate because, you know, if we can’t actually even just ask the question, for example, in terms of environmental stuff, there’s there are people who who hypothesize that our exposure to certain environmental toxins, even in tiny amounts over time, you know, is responsible for shifting our metabolic you know rates. And that that could be part of what’s playing into the fact that we are fatter now than we were before, you know, trace elements building up in our you know, and the fat in our body is stored permanently. You know, and I just I don’t think we have enough evidence to know one way or another. But wow, is that an unpopular line of thinking? Which puzzles me, You know, like when I wrote this book and when it was published, I had this idea that people would respond to it by saying, Wow, this is great news. Like this situ– the relationship between weight and health might be more complicated than I thought. That’s really good news. But actually, I learned that people got very angry. People across the weight spectrum and across like many different occupations were enraged by the idea that it might not be as simple as they thought. And what what I kind of got from that is, oh, so we want to think it’s simple. We want to think that we can overcome these things. And even if that lands us in a situation of like beating our head against a brick wall, being, you know, feeling stigmatized whatever, we’ll take that over acknowledging the complexities and trying to address them in a broader way. And wow, [laughing] that was very eye opening for me. I don’t know if you’ve encountered that kind of attitude at all. 

Dr. Abdul El-Sayed: Ultimate agency is a very seductive idea. The notion that we are the captains of our own destiny and that nothing that happens in the literal air we breathe or the water we drink or the human sea in which we swim will actually affect what happens to us. It’s a very seductive idea, and it’s particularly seductive here in America. And you like kind of can see how we’ve built that world or attempted to build that world for ourselves. Um. You know, the kind of just ever growing cars that we drive or the kinds of sort of gated neighborhoods that we live in. Everyone kind of wants to have a castle, you know, for themselves and believe that, you know, they are the only one who gets to decide what happens in the castle. And it leaves us, um I think, ignoring the kind of collective agency that we actually can pursue that does change the air we breathe, the water we drink, the human sea in which we swim. Um. And it also leaves us in a situation where we’re fragile to the world reminding us that we really are, right, our destinies really are um a some some portion of what we do and what others and society and the world does around us. And, you know, it’s like you always have this image of folks in Florida who, you know, I sort of vote a certain way and then the hurricane comes and like, we couldn’t have seen this coming. And like y’all, we’ve been talking about climate change for some time now. And you moved into literal hurricane alley and now you’re surprised that a hurricane came and swept your house and don’t get me wrong, we got it we owe you every responsibility to protect you. And look, you know, we are going to to to provide the services that we can. But like, don’t be so surprised when somehow you actually aren’t the only one who controls your destiny. That actually the things that we have been doing and that we continue to do have consequences for you and for us um. And maybe we should all come together and do the thing that we can do about it. And um, and so I just really appreciate that point. One of the things that I found in my personal life about um about the impact of weight stigma and the weight discussion has been the way that it shapes my understanding of food. And I just, you know, to get real vulnerable um and personal. You know, for me, my parents got divorced when I was really young, and both my parents have the penchant for showing their love in food. And um, you know, as someone who uh grew up between a bunch of different cultures, there were always those special foods that, you know, you looked forward to eating. And over time, the complication of right the mixed signals of we love you, we made you this really lovely dish, but don’t eat so much of it, right? Don’t don’t, don’t consume so much of our love. You have to see the love and leave it there on your plate. Right. Um. That that always fundamentally changed the way that I understood uh so much of like just the joy of food unto itself, but also the way that we communicate um across cultures, that we love each other and that we care about each other because food is, you know, broader than just nourishment. It’s not just calories in, it it has so much to do with every ritual that uh we partake in, every custom uh that exists. Every culture has its dish that it that that you know it venerates. Um. And so it, it you know it really I think has deeply complicated in a really tragic way uh my understanding of this thing that I truly and deeply enjoy, um but also, you know, have now found so much frustration and stigma around, right. In writing this book and reporting this book and also previous books about anorexia, how do you feel like our discussion about obesity has bled into our discussion about food? 

Harriet Brown: Um. Well, it has tainted it 100%. And I don’t have to go any further than my own classrooms to see that in action. Right. I teach in a university. Um. Many I would say two thirds of my students are young women, so they’re between 18 and 22 typically. I teach classes where we wind up talking about this stuff um and the things that they tell me, um the things that I have observed. Their relationships with food are unbelievably dysfunctional. Now, there, you know, um perhaps a more affluent section of you know the population. They all of the sorts of expectations of class and race that come with, you know, being fairly privileged in this culture. Um. But the stories that they tell me about how their parents like, denied them food and the rituals that they go through. They only allow themselves to eat one meal a day. They, you know, are constantly you know, some of them have diagnosable clinical eating disorders, but most of them just have unbelievably disordered eating. And I once in a class asked the question like, so, so what is normal eating? And nobody could answer it. And I think that that’s very much the case across the board. You know, I would say that what is normal eating? We don’t even know. You know, and when I say to especially my students, like younger people, well, you know, I think it has to do with eating until you’re full and satisfied and then stopping and being able to sort of regulate your your eating by your own cues of satiety and hunger. And they look at me like I’m nuts, because that’s not how they eat. That’s not how they’ve been taught to eat. I know that, you know, when my own daughters went through middle school and they went through like the middle school health class, um that was one of the triggers for my daughter developing anorexia, not a cause. I’m not going to say it was a cause, but like, you know, I remember her coming home from that class and saying all sugar is bad. We shouldn’t be eating sugar at all. You know, she she got a lot of support and encouragement in cutting out like whole food groups and sort of regulating her relationship with food based on these external ideas. And I think that that’s really, really problematic for a lot of reasons. So um I think it’s incredibly sad what has happened to disrupt our relationship with food. And it’s such a primal relationship, you know, both in terms of our own bodies and also, as you said, like the culture, like so many of our social interactions have to do with sharing of food and enjoying food together and preparing and cleaning up and all of that. And, you know, I think much of that has been rendered dysfunctional. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Abdul El-Sayed, narrating: We’ll be back with more with Professor Harriet Brown after this break. 

[AD BREAK] 

Dr. Abdul El-Sayed: I uh appreciate how you said primal, because, of course, the other primal need for humans is um to be desired. Right. And and sex and sexuality and the conversation about who is desirable and who is not is, I think, so fundamentally patterned by body size and body habitus. Um. How do you think about the connection between body size, food, sexuality, desirability, youth? How does that aspect of it sort of undergird so much of um the broader sort of consequences and the stigma of uh obesity? 

Harriet Brown: Wow, that’s a complicated question. I mean, it’s part of everything, right? So like a lot of our um a lot of our discourse around obesity often focuses on health. Right. And I think it’s because it’s easier. And we feel like on some level, it’s more virtuous to talk about, well, this is bad for your health. This is good for your health. But obviously, we all want to be desired, as you said, and seen and loved and appreciated. And I mean, I think we’re taught that you cannot be any of those things if your body does not conform in these particular ways to these cultural norms. You know, so and I think in some settings, like again, I think about the things I hear from my students, you know, where they talk about like the comments that uh boys in bars will say, you know, to the girls who aren’t stick thin, um you know, that there’s real consequences, social consequences for them. But I think that that that message that, you know, you have to fit only this one, norm or you’re not desirable is B.S. And it’s basically another [laughing] we can blame that on capitalism, too, you know, because I think in reality, all kinds of humans are attracted to all kinds of other humans. [?] come in all kinds of bodies. Right. And, you know, so I think that there’s this narrative, but then there’s the reality. And I wish we did a better job of separating them. But I think that would be more helpful to say, you know, yeah, okay, so like, person A might not be attracted to person B for whatever reason, but there’s like a person G down the line who maybe will be like like, but that’s always been true, right? Like, that’s but, but somehow we’ve narrowed this conversation, you know, very much, especially for younger people, I think. So that it’s really only it’s main focus seems to be like on weight and as a sort of metric of attractiveness. And that’s that’s just not true. Right? That’s not how humans work. 

Dr. Abdul El-Sayed: I want to go back to where we started, which is on the question of relationship to health. You know, it’s interesting because you talked about the association that we find is not as cut and dry as we had expected based on what you know the paper you cited by Flegal, um but it’s also a bit of a black box. We don’t actually understand causation. And what’s really interesting is that um if you go back in the past, the desirable body habitus, right, was what we in this moment would identify as being overweight. And the interesting aspect of this is that in a time when more people died of infectious disease being heavier meant that you usually had A.) More nutrition and B.), for that reason, a um a healthier immune system. And in a world where more people died of more infectious diseases because public health wasn’t actively fighting them for you, um that was a real survivability advantage. It was healthier, right? Um. Objectively. And what’s interesting now is that um we are well the last three years aside less likely to die of infectious diseases than our counterparts in the past and more likely to die of these chronic diseases, things like um diabetes, heart disease, stroke, cancer. And so the sort of that that link between health and then what is socially desirable um has sort of transmuted with the epidemiology of the time. And what I think um this historical anecdote paints is the notion that these things are not fixed with time and even what is healthy is not fixed with time. It’s more a function of the environment around you. And I guess as we think about where we want to go, right, we talked about all the ills of the obesity discourse as it stands, where do we want to go? What is a healthy public conversation about body body size um that maximizes, you know, everyone’s opportunity to live their longest, healthiest lives and also the mental health of all of us and the social health of all of us around the idea of being both desirable and able to commune with your food in a in a way that um makes you feel whole. What does that discourse look like? 

Harriet Brown: I think that a primary aspect of that discourse is in, you know, separating these ideas of weight and health. Like, like sort of putting aside the questions of what are the causal, you know, and what are the sort of associative connections, because we don’t fully understand it. It is a black box, as you said. So but because of the way that weight derives the health discourse, I think that what happens is if you separate them, right, if you say, okay, I want to improve my health, you know, what does that mean? Our knee jerk reaction and the knee jerk recommendation most of us are going to get from the medical profession is going to start with lose weight. But what if it took into account the idea that health is basically more individual? Right. It’s not there’s not a one size fits all and it changes through your life. Like as you were talking about the protective aspects of having more flesh on your body. You know, in an earlier time, I was thinking about the fact that as we age, it’s also better for you to have more weight, right, Like that one of the big risk factors for premature death as you get older is frailty. So we don’t want to see older people losing weight. So what if we again just said, what does improving my health look for for me right now in this part of my life? You know, and then we could look at actual behaviors. We could look at things like exercise, because there’s a huge body of evidence suggesting that fitness plays an enormous role in one’s overall health and life expectancy, separate from weight status. So what if we said, fine, like, how can you incorporate more happy, joyful, positive movement in your life, whether you lose weight from that or not, you know? Or what would it mean to eat in a more nutritious way. Again, whether weight loss comes with that or not. You know, I once interviewed a woman who was in like a she had been diagnosed with diabetes and she was in like like a diabetes program, you know, designed to help you change your habits to more healthy ones for the fact that you have diabetes. And she was so frustrated because she said, like, I’ve made a lot of changes in the way I eat. I’ve actually think I’ve improved my sugar and everything, but I haven’t lost weight. And the program basically considers me a failure. So if we could separate those things and focus more on actual health and things that we do and things that we have control over, I think that would be better for everybody. 

Dr. Abdul El-Sayed: I agree with you. Um. I think so much of our discourse um tries to optimize to one size fits all. I think if we were able to identify um that it’s probably more about finding a space of comfort and joy and positive engagement with a set of things um that are also health fortifying and improving, we’d be in a much better place than focusing on a particular end point that is going to be different for different groups of people um and different for different individuals. And um, you know, I think a lot about the interactions I had in medical school around this question, and I just wish that some of the folks um who are offering medical advice, who’ve never actually dealt with the challenge themselves, understood how they were being perceived. Right. Because I do think that a conversation with a doctor can be a powerful thing. But you get a choice about whether or not you’re going to turn on the light switch or turn it off. And I think the minute you walk in and you assume a set of things about your patient, you turn that light switch off and you take that interaction from being a potentially fortifying and trust building one to being um uh a really damaging one uh and one that, you know, can shape a set of health behaviors over the long term that really, really are quite damaging. Um. But I really appreciate you shedding light on this issue, joining us to talk about it, uh and to share your perspective and share your work, our guest today is Professor Harriet Brown. She’s the author of Body of Truth: How Science, History and Culture Drive Our Obsession with Weight and What We Can Do About It. Thank you so much uh for joining us today and taking the time. 

Harriet Brown: Thank you for having me. This is actually I’ve done a lot of podcasts and things, and this is perhaps been the best conversation I’ve ever had in this setting. So thank you. I really– 

Dr. Abdul El-Sayed: That’s so kind. 

Harriet Brown: –appreciate how thoughtful you are and– 

Dr. Abdul El-Sayed: Well I, I appreciate how thoughtful you’ve been in um and sharing your wisdom with us. So thank you. [music break]

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Right wing media had a total meltdown this week over gas stoves? That’s right. Take a listen. 

[clip of Tucker Carlson] Consumer Product Safety Commission is deciding on whether to ban gas stoves totally because of safety. Safety? [laughing] We’ve had these stoves for over a hundred years. It’s totally fine to give Fentanyl to addicts, but a gas stove is a threat to your life? 

Dr. Abdul El-Sayed, narrating: All this happened after Richard Trumka, Jr, a commissioner at the Consumer Product Safety Commission, proposed a ban on new gas stoves given emerging research about the consequences of pollutants that can result from the burn off. To be sure, this wasn’t a statement of the administration’s policy. It was one commissioners recognition of new research about the risks that indoor air pollution resulting from burning gas inside your house actually poses. Look, this kind of makes sense. If you burn a bunch of gas in your house to heat your food, where do you think the burn off goes? Hmm. To the person literally standing right there, breathing the fumes. Look, given all the backlash, the administration isn’t likely to move on this anytime soon. But the Inflation Reduction Act does offer incentives to upgrade from gas stoves to more efficient electric and induction cooktops. Look, but this hubbub probably did more good than harm, raising awareness of just how dangerous indoor air pollution really can be. Gas stove use has been linked to both asthma in children and dementia in older adults. Makes sense, you’re literally burning gas in an open fire inside your home. And well, we kid ourselves to think that natural gas burns clean. In fact, like so much else that harms our health, our sense that gas stoves are somehow more effective was pushed by, well, you guessed it, industry. It makes sense that an industry that sells you gas would want you to buy appliances that use more gas. But even since this whole controversy started, the American Gas Association, a lobbying group on behalf of big gas, has been twisting the science to argue that gas stoves are perfectly safe. Can’t make this stuff up. I have a gas stove in my house, and you’d better believe I’ve been researching new induction stoves, which both can reduce burn accidents and improve air quality. And apparently they like boil water in 2 minutes, which is pretty awesome. Though COVID cases, hospitalizations, and deaths remain unacceptably high, they have begun to decline again last week. And that’s really good news, suggests that this may be the first winter since the pandemic started where we won’t see a massive spike in COVID transmission. Remember last winter saw the first Omicron wave which killed more Americans than the entire rest of the pandemic before it. And at the same time, we’ve got to be clear about something. If 400 deaths a day is our new normal, we’ve got to start asking ourselves the bigger picture questions about how the pandemic has twisted our sense of what normal should be. In part, that’s because we’ve shifted the onus of COVID prevention entirely onto individuals, individuals wearing masks, individuals getting vaccinated. Don’t get me wrong, individuals should certainly do those things. But there’s so much more we’ve learned about infectious disease prevention that we’re not putting into practice. For example, while we’re talking about gas stoves. Why haven’t we made a full scale society wide reinvestment in indoor air quality more generally? Why aren’t we equipping every new HVAC system with built in air purifiers and retrofitting schools and community centers with air purification systems? It’s not just COVID we’d be protecting ourselves from. The flu, RSV, and all the other run of the mill cold viruses that seem to have hit us all at once, too. And I got to tell you, I’ve been thinking a lot about this because, well, once again, my stake in the future of our species just took a big leap forward. That’s because Serene El-Sayed, my second daughter was born last Tuesday at 10:36 a.m.. She’s strong, beautiful, and true to her name. Sarah, always the real MVP, is feeling good. Both are healthy, happy, and at home. Someone who spends a lot of my time concerned with the world as it could be. Fatherhood has taught me a lot about my own relationship to the future. We don’t we can’t control who our children will become. You hope and pray that they’ll love and be loved, care and be cared for and leave a positive influence on the world. What we have is now. The moments we spend with them, where we show them enough love, enough care, enough of our attention to remind them that they too, can do the same in the world they’ll inhabit. And if they do, they’ll have agency in that world. They can leave their mark in it, but they’re not going to live in the world as it is. Instead, they’re going to live in a world we can’t even know yet. So at the same time, beyond our own progeny, we have to invest in the world they’ll inhabit, too, to show the world love and care and presence. I hope that this space we share together every week is a bit of that. A place where we share ideas and insights on the world we can make together. The world that kids like Emmalee and Serene and so many others will inherit and share. Thanks for being here. And that’s it for today. On your way out, please don’t forget to rate and review. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed. Your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.