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Dieted: Podcast Transcript

Anita Rao
If you're a history buff, or just someone that likes a great story, I have a podcast recommendation for you. It is called Sidedoor. It's a podcast hosted by Lizzie Peabody, and she sneaks you through the Smithsonian's side door to discover stories that can't be found anywhere else. There are more than 154 million treasures that fill the Smithsonian's vaults, and each of them hides a story. You're going to hear about everything from robots that could learn to tell the stories of our ancestors, to blood sucking worms that paved the way for modern medicine, even maybe how you could get away with murder in the Arctic. You can listen to Sidedoor wherever you get your podcasts. Just search for Sidedoor, it's all one word. Or find it online at si.edu/sidedoor.

Once you know how to recognize diet culture, you'll see that it's everywhere. Weight loss is a $70 billion industry, built on the myth that a smaller number on the scale will secure your happiness and that your ideal weight is waiting for you right on the other side of fewer carbs, intermittent eating windows, an intense workout, or a few more sips of Flat Tummy Tea.

Looking back, I can see how early the messaging seeped into my own brain. The rows of SlimFast cans lining the pantries of my friends houses, the cover of my Y-M magazine sharing so called "secrets of girls who don't have to diet."

The real secret is an open one: Diets don't work. Research has shown us for decades that the overwhelming majority of attempts to lose weight fail. And many folks who diet gain back more weight than they lost. All this while more Americans are on diets today than they were 10 years ago. So how can we stop barreling toward a future in which we're spending our hard-earned cash on things that lead us to less health, not more? This is deconstructing diet culture, a special from Embodied. I'm Anita Rao.

Christy Harrison
So diet culture is this overarching system of beliefs and values. It's really endemic to Western culture at this point in history.

Anita Rao
Christy Harrison is an anti-diet registered dietitian with a master's in public health. She's also author of the book "Anti-diet: Reclaim your time, money, well being and happiness through intuitive eating."

Before we get too deep into this conversation, I want to acknowledge something: We have all heard, maybe even from our own medical provider, that it is important to manage your weight and regulate your food intake. And that weight is an important marker of health. This podcast is not a substitute for medical or health advice. But the research that we're going to be talking about challenges some of the data and assumptions that we all hold about health and our bodies. it may bring up some big questions for you. Let them simmer, and feel free to share your thoughts with us. We'll remind you how to get in touch at the end of the episode.

Okay, back to Christy Harrison, the dietitian.

Christy Harrison
So diet culture worships thinness and equates it to health and moral virtue, promotes weight loss as a means of attaining higher status — both moral status and health status — demonizes certain foods and food groups and ways of eating while elevating others, and oppresses people who don't match up with it's supposed picture of health and well being.

But it manifests in so many different ways, from overt diets that tell you to lose weight and those cover lines that say, "drop X number of pounds," to like the old-school Weight Watchers and you know, sort of having weight watching in the name, to the more sneaky manifestations like the new-school Weight Watchers where it's WW and it's all about wellness. And you know, diets calling themselves plans, programs, protocols, lifestyle changes, resets, reboots and saying: Oh, it's not a diet, this is not a diet, this is a lifestyle change, this is a way of being.

So all of that really falls under the umbrella of diet culture, because it all upholds that same system of beliefs and values that's been around for the last 150 years.

Anita Rao
Well, how did we get to this point, because one of the things that your book does is it really starts and kind of lays out this deep, long history back to ancient Greece and shows us that it was not always considered an undesirable thing to be fat. So take us back to that and help us understand that history.

Christy Harrison
Yeah, so really, for most human civilizations around the world for most of history, being fat was actually desirable. And sort of the first earliest recorded evidence that I could find of fat being demonized as a bad thing, or being sort of considered anything less than desirable, was in ancient Greece and Rome.

There were really conflicting ideas there, though, about what fatness "meant," because on the one hand, you had still the language of, you know, fat being associated with wealth, fertility, well being and thinness as being associated with sort of the opposite of those things. And aesthetically, the sort of medium-fat aesthetic was seen as desirable, you know, plumpness and curviness was seen as a good thing.

But on the other hand, you had ancient Greek and Roman physicians, starting to say that fatness was a bad thing. And this wasn't because of, you know, scientific evidence at the time. This was because of the belief system that ancient Greeks had about balance and moderation in all things being seen as a virtue. And so it's, you know, people who are morally correct, and doing the right thing are eating in the way that's prescribed by ancient Greek physicians, people who are not doing those things are "barbarians."

Anita Rao
I remember learning about the ancient Greeks and their beliefs in moderation back in high school, but I'm certain my textbooks didn't trace how those beliefs laid the groundwork for fatphobia as it exists today. The fall of Rome made fatness return to morally neutral ground, and anti-fatness lost traction, until it reemerged several centuries later.

Christy Harrison
Fatness became a virtue, again, or a positive thing, or at least a morally neutral thing in a lot of civilizations around the world, I would say. So the anti-fat belief system was sort of planted back then.

But then it kind of went underground for a long time, and really saw it emerge again in the 1800s in the US, when racist ideas about which ethnicities and which, you know, genders also misogynistic ideas about the value of different bodies and of different people was really in the foreground, and that started to lead to a demonization of fatness, because early evolutionary biologists who were working around that time started to point to fatness as a mark of "evolutionary inferiority," because people who had more fat on their bodies were supposedly women and people of color and groups that were being demonized at the time.

And you know, there's political reasons for that, too, right, justifying slavery, justifying misogyny and the oppression of women. So it really comes out of the systems of oppression. And the idea that fatness was bad. And so it became, you know, the ancient Greek ideas about sort of the moral correctness of thinner bodies kind of came rushing back at that time.

Anita Rao
It bears repeating: Diet culture is everywhere. But one of the places it often shows up, that may not be as obvious to folks like me with thin privilege, is the doctor's office. Body fat deemed to be in excess is considered a health risk by many health care providers. And for some people in larger bodies. routine checkups frequently result in conversations about weight loss.

At the center of these medicalized ideas about weight is the body mass index, or BMI. A ratio of someone's weight divided by their height. Health care providers use BMI as a surrogate for body fat mass to classify people as underweight or overweight. And insurance companies use it to determine whether someone is eligible for certain health procedures.

Dr. Louise Metz is an internal medicine physician who is part of a movement within healthcare and dietetics to turn away from using BMI, because of the metric's many, many pitfalls. Dr. Metz owns Mosaic Comprehensive Care in Chapel Hill, North Carolina.

Louise Metz
I think it's helpful to look back at even the history of the BMI. It was actually originally created by a Belgian astronomer in the 1830s. And he created this measure to really look at just the average size of men. And it was designed for populations, not for individuals, and was not designed to define health in any way. And then moving on later to the modern age, it was used to begin defining health somewhere in the 1900s. And then later on in the late 90s, what we found is that these arbitrary categories for BMI were suddenly changed. So the definitions of obesity and overweight are suddenly decreased. And 29 million people suddenly became "overweight" or "obese" overnight. And these changes really were not based in any research that show that there was a direct link between these BMI categories and health.

Anita Rao
So Christy, you really unpack that history and what was going on internally in the NIH at the point that these numbers in these categories got reset and can you illuminate the origin story of this idea of an obesity epidemic and what you think may be missing in the way — the conversation as we usually have about it.

Christy Harrison
Yeah, it's so fascinating this — the origins of this, because people don't know that it came out of just a couple of researchers looking at data on how average weights in the American population seemed to have increased over time, a little bit, you know, it was an average of a single digit number of pounds between the 70s and the 90s. It was a very low amount. But they were looking at this data. And by the way, the average height of Americans had also increased during that time.

But you had one researcher who sort of leading the charge on this idea that this was a problem that Americans weights were increasing. His name was William Dietz, spelled like diets with a Z, you really can't make this stuff up. But he, you know, was looking at this research. And, you know, he and many, many other researchers who are in the field of so-called obesity research, are financed and funded by the pharmaceutical industry, by the diet industry. Many of them have their own diet plans and programs that they are selling and, you know, have this financing that's coming from basically people with a vested interest in making Americans fear weight gain, and think that their body size is a problem.

Anita Rao
But there are — I just want to pause you for a second there, because the CDC does link obesity to a range of health consequences: high blood pressure, type two diabetes, coronary artery disease, osteoarthritis. So people may say that it is important to talk about weight in this context, because it is correlated with a number of diseases. Maybe Dr. Metz, you can take that question.

Louise Metz
Yeah, that's a very good question. So we do know that there are certain health conditions that are correlated with body size. But we talk a lot about how this is a correlation and not necessarily causation. So we don't have proof that it's the body size causing these health conditions. One could be cardiovascular fitness. So we have some data to show that that could be a mediator between body size and health. So there's one study that looked at this and found that in people who have low cardiovascular fitness levels, mortality rates were higher with higher BMI. But in individuals who had higher cardiovascular fitness, we found that the mortality rates evened out across body size, and that in fact, people who were "overweight" or "obese" and were active cardiovascularly had lower mortality rates than those with a "normal" BMI who were inactive. So that's that —

Anita Rao
How about the type two diabetes, which I think is one of the most common ones that comes up in this because there has been research showing that losing some weight may lessen your risk of developing type two diabetes. So people may say: Well, why not err on the side of caution? Why is it so bad to talk about weight management when we're trying to reduce things like type two diabetes?

Louise Metz
I think we're sort of asking the wrong questions, and that there are assumptions behind those questions. And that it is likely not the body size that is causing diabetes. again, but there may be other mediators like genetics, and someone might be exposed to chronic dieting and weight cycling, which we might get into more, that that as well as weight stigma are increasing risk of conditions like diabetes. And so that's another mediator that it's not their body size, but it's these other factors that are contributing to conditions like diabetes.

Anita Rao
Well, I'd love to get to that, because I know Christy, you say that: Yes, you agree that there is a correlation between higher weight and some of these conditions, but we can't draw any conclusions until we control for both weight stigma and weight cycling. So if you could kind of briefly explain both of those and how you think they cloud our picture of what we think we know about the link between weight and health.

Christy Harrison
Yeah, so weight stigma is discrimination against people in larger bodies, and sort of all the outcomes of that discrimination in healthcare and across the, the sort of culture.

And weight cycling is this repeated cycle of weight loss and regain that people undergo when they try to intentionally lose weight. And we see in the research that up to 98% of the time when people embark on weight loss efforts, they end up regaining all the weight they lost within five years, if not more. In fact, up to two thirds of people who embark on weight loss efforts may regain more weight than they lost.

And so you know, weight stigma and weight cycling are both things that are disproportionately experienced by people in larger bodies, right, people in larger bodies have weight stigma lobbed at them from every which way from the time they're children, usually.

Anita Rao
Diet culture shapes how we think about food, but also fitness. What a fit body looks like, and how folks not in thin bodies are treated in fitness spaces is something Mirna Valerio has thought a lot about. She's known affectionately as The Mirnavator. She's an ultra runner and author of the book "A Beautiful Work in Progress," which traces her experience as an athlete in a larger body.

Mirna Valerio
I'll tell you a little bit about my experience first with medical professionals, and I actually pulled up a piece that I had written in my blog a couple of years ago, my blog Fat Girl Running. And it says — it's not very eloquent, but it says: So I was at the doctor's today filling out a bunch of paperwork. Under the question anything else you would like us to know? This is what I wrote, I was in a mood: Please do not ask me to exercise or to lose weight. I'm a very, very active person. I run marathons and I work out four to six days a week. I know I'm overweight, and I've been working at slow and permanent weight loss for the past five years, please actually read my chart before you start talking about these things. I would highly appreciate it.

And so — and so because I had had so many instances where I'd walk into a doctor's office, a pulmonologist or a gynecologist, and they would immediately even though I had told them that I was I was, you know, training for a marathon and I didn't want I wanted to make sure that I didn't drop dead during the marathon, so could they check me out? Make sure I was okay. Oh, you know, well, do you exercise? I just told you, I run marathons.

Anita Rao
Experiences like this one are super common, and representative of weight stigma. Close to 60% of American adults have experienced weight stigma at some point in their life, according to a recent study from health researchers at institutions like the Rudd Center for Food Policy and Obesity. Despite changes in other societal attitudes in recent decades, weight bias remains strong.

Mirna Valerio
In the medical profession, people out on the trail, you know: Should you really be doing this? Shouldn't you just go on a diet? And the questions are always there on people's faces. The questions about whether I really do the things that I say that I do, because I'm still fat, despite the fact that I've done 14 ultra marathons and 10 marathons. Despite that I train almost every day, despite the fact that I do skyrunning and mountain running. People always have these questions.

And in fact, I was at the TCS New York City Marathon Expo, and a race director came up to me — not of that particular marathon — and asked me, you know: Well, don't you think there's something wrong or something going on with your body that causes you not to lose weight? In front of my family, actually, and it was a very distressing moment.

Anita Rao
I want to put that to Dr. Metz just to kind of answer this question about size diversity and body diversity. So when someone is active, is, you know, practicing intuitive eating and their weight lands in the way that it does, but it is still at a higher weight, ss that common? And is that okay?

Louise Metz
Yeah, good question. So yeah, so I think taking it back to that idea of size diversity, which is one of the main tenants of the Health at Every Size approach is that again, we all come in different shapes and sizes, and our behaviors are independent of that. So we can't look at someone and know what behaviors they're engaging in, or what their health status is based on their body size. And we need to really begin to kind of separate those things. And unfortunately, as she describes it, this is so common in health care. So one study showed that I think 68% of people in larger bodies experienced significant weight bias or stigma in the doctor's office. And you know, doctors really need to address that bias that we have. Because we're really harming people by by providing that that weight stigma.

Anita Rao
And it can also lead to misdiagnoses, is that right?

Louise Metz
Definitely, definitely, I think that those baseline assumptions based on someone's body size are going to lead to inaccurate diagnoses. So there's typically an assumption that if someone lives in a larger body that they must have elevated blood pressure or diabetes and and if we assume that based on body size, we will clearly misdiagnose a large percentage of people. And the same goes for someone in a smaller body. If we assume they are healthy based on that body, we will misdiagnose a high number of people who have metabolic conditions.

Anita Rao
Mirna, what do you wish that people better understood about life in a fat body in today's society rampant with diet culture?

Mirna Valerio
Well, I can really only speak to my own experience, but I'd love people to know that, guess what? I know I'm fat. You don't need to tell me. You don't need to tell me with your body language. You don't need to tell me explicitly or implicitly. I already know that. So it doesn't help me to keep pointing that out. Whether I'm out on the trail, whether I'm out on the road, whether I'm just trying to sit and be me and exist in this world as I am.

Anita Rao
Your body size is nobody else's business. Even with a doctor you do trust, ,Dr. Metz says you can set boundaries.

Louise Metz
If you're going to your doctor, one thing is that you do not have to be weighed. It is your right to decline to be weighed. The other thing is to let your provider know that you would like medical care from a Health at Every Size perspective, and that you would not want to discuss weight or weight management at your visit, that you have the right to ask for that. And another helpful quote, if the doctor is recommending weight loss for a condition that you have, and you don't think it's appropriate, you can ask: Well what would you recommend for someone in a smaller body? What testing or treatment would you recommend for someone who's thin?

Anita Rao
The doctor's office isn't the only place that folks commonly experience weight stigma. Another one? The gym. In the past decade, I've spent my fair share of time in group fitness classes. And know just how rare it is to find an instructor that makes no diet culture references in an hour long class.

But long before I got into this world of more formal structured movement, I was a kid moving my body with zero forethought. I unknowingly burned calories while chasing my siblings around the backyard, riding my bike through the neighborhood, and hitting music video moves when my favorite song came on the radio. At some point, movement became less intuitive and more prescribed, which is often where the issues start.

Ilya Parker
I was, and still am, in a lot of ways triggered by hearing the word fitness, because even before you kind of get engrossed in fitness culture, you are inundated into diet culture and some of the toxic messages.

Anita Rao
Meet Ilya Parker, a physical therapist assistant, certified medical exercise specialist and founder of Decolonizing Fitness, an online educational resource for those who wish to unlearn the toxic messages of diet and fitness culture.

Ilya Parker
My first entrance into fitness was literally through my medical transition. I experienced a lot of medical gatekeeping from my primary care physicians who were literally refusing to either initiate gender-affirming care or would refuse to refer me to an endocrinologist to receive hormone replacement therapy.

So when I finally was able to find a doctor who was willing to work with me, initially, I was met with medicalized fatphobia. The doctor who was also in a larger body, a body that was much more larger than mine, which was interesting, was wanting to prescribe me diet pills, essentially, in particular appetite suppressant pills, which I adamantly refused. And they were like: Hey, if you're unwilling to take this prescription, then I'm going to need for you to lose X amount of pounds before we can initiate that.

So again, coupled with my already fear of fitness as a whole, and now I'm essentially being caused to engage in fitness because I didn't want to take the appetite suppressants. And I wanted to engage in hormone replacement therapy. So I felt like I had no choice but to immediately be forced into fitness. So I was very, very upset by that.

And then when I entered the fitness industry, I was bombarded with messages via diet culture about what in particular a "female body" should look like. And mixed with messages of why I shouldn't want to transition and modify my body in ways that affirm my gender. So I had a very, very complicated relationship with fitness early on, which essentially shaped the work that I'm doing now.

Anita Rao
The preoccupation with fitness and the constant pressure to hit the gym hasn't always been as prevalent as it is today. The history of our obsession with gym culture is a specialty of Natalia Petrzela, historian and professor at The New School.

Natalia Petrzela
Before 1950, there really wasn't a cultural pressure to go to the gym to be fit. If anything, if you're someone who wasn't an athlete, and you wanted to go to the gym and exercise regularly, it was a little subversive. Like, it was a little strange.

If you were a man, the idea that you would care so much about your body and your appearance as opposed to more serious things, or that you want to spend time in the company of like other sweaty men, that immediately made you suspicious. And like men, male gyms, were seen as places for people who were, you know, "sexually deviant."

After 1950, both with the rise of a service economy where more and more people were sedentary, and with suburbanization, were kind of white middle class folks for whom leisure was considered aspirational but also took effect on your body, you start to have the idea of like, oh, you need to exercise regularly, taking shape.

And then the last point I'll make there about the 50s as a turning point, the Presidential Council on Youth Fitness and that big TV push in the 1950s, that was huge, because it really kind of sanitized the idea of regular exercise and made it virtuous. Like if you're a good citizen, you exercise. And they spoke of this in like, unapologetically fat shame-y ways. I mean, JFK gives this big talk about the "soft American" and how an American who was physically soft is a national liability.

Anita Rao
A lot of the toxicity in diet culture can be traced back to language, how we label and classify our bodies, and the assumptions we make about the bodies around us. For Ilya, some of the most harmful examples of these assumptions have to do with gender.

Ilya Parker
It's countless group classes that I've been in where language was so important, especially when you're like: Hey, guys can only do this exercise, ladies can only do this exercise. And then also making the assumption that you know who's in the room by gendering the entire room by saying: Hey, hey, ladies, let's have a great session.

And so I think it's important to really — first, I really want to say trainers who need to recognize that our curriculums and fitness have limited us in a lot of ways. And there's a whole bunch of education that needs to happen outside of your certificate. So it's important to do a lot of learning and unlearning when you enter into fitness culture, and it is as simple as making sure you're mindful of what you don't know, asking questions and doing the research. So you can show up a better way.

Anita Rao
And I mean, when we think about power, and who wields power in these spaces, someone that comes — or I mean, a group of people that come to mind to me are the fitness instructors themselves. And I know Natalia, you've thought about this. And it's something I've thought about so often when taking a group fitness class is being really kind of captivated and entranced in this world that the particular instructor creates, and the language that they use in that class, can really get into your head in such a specific way.

I'd love for you to talk more about that, and kind of how we can prevent these potential abuses of power that people in fitness spaces can, can exert.

Natalia Petrzela
Yeah, so I've definitely ranted about this as kind of a scholar, right, thinking about how the fitness instructor as a figure has come to gain kind of more and more cultural power, right? Or, they're my guru, my therapist, or my DJ, they're a sex symbol.

But actually, we don't really have a robust conversation or set of like professional norms that govern the nature of that role. So when you know, some people are going and seeing a fitness instructor more than they're seeing their therapist, or like, more regularly than they're seeing people in their family. And that's a lot of power to wield, and not just: Oh, we need to, like, make fitness culture more equitable and accessible, or like, have more people have access to what's largely a privatized space.

But like, what's going on in that space to actually want more people to be involved and invest in a world that's perpetuating some really damaging things? Probably not. So why don't we think about what the best of it is, and try to amplify that and build out those kind of pedagogies and take them seriously as pedagogy not just like, this is a little leisure thing that you do, oh, it's just fitness, you know, it's just the instructor, but rather think these are sites where really, you know, powerful relationships are forged. And we all have a responsibility to think about how that power operates.

Anita Rao
As a personal trainer's assistant, Ilya spends a lot of time thinking about this idea of power in fitness spaces. Especially as someone whose role it is to shape how other people think about movement.

Ilya Parker
Yeah, when I — when I really began to disconnect from this myth, this standard that's set in fitness where you have to be this walking aesthetic billboard of your services and your knowledge and your value. And when I really started peeling back from that and saying: Hey, I'm knowledgeable in my lived experience in my body, and I'm okay to share those things with other people.

And if they believe and if they want to learn with me, we can take this journey together and we can also create a co-learning environment. That's what I'm really trying to, to work through, we're creating a culture of vulnerability and openness and willingness to grow and learn together.

Anita Rao
Embodied is a production of North Carolina public radio WUNC, a listener supported station. If you want to lend your support to this podcast and WUNC's other shows on demand, consider a contribution at wunc.org now. Incredible storytelling like you hear on Embodied is only possible because of listeners like you.

Josie Taris, Kaia Findlay and Charlie Shelton-Ormond produced this show, with editorial help from Audrey Smith and Amanda Magnus. Jenny Lawson is our sound engineer, and Quilla wrote our theme music. And as promised, if you'd like to get in touch with us, please send us an email. We're at embodied@wunc.org. We're also on Instagram and Twitter under the handle @embodiedwunc.

And a reminder that this is part one of our three-part anti-diet New Year's series called "Resolved." You can learn more about the whole series at our website. Make sure to stay tuned for our two future episodes.

The show is supported by Weaver Street Market, a worker and consumer-owned cooperative selling organic and local food at four Triangle locations in North Carolina. Now featuring online shopping with next-day pickup. Weaverstreetmarket.coop.

Until next time, I'm Anita Rao, taking on the taboo with you.

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