- hace 18 horas
Categoría
🛠️
Estilo de vidaTranscripción
00:06Welcome to keynotes from Cornell University. Today we'll be discussing fat phobia as a form
00:10of structural oppression, how it operates, and how we can combat it. You can join the conversation
00:15by submitting questions in the chat. Joining us in the studio is Kate Mann, our associate professor
00:22at the Sage School of Philosophy at Cornell. Kate, thank you so much for being here.
00:27Thanks so much for having me, Amanda. It's a thrill. I'm very excited. We're here to talk
00:33about your newest book, your latest book, Unshrinking, which was just released yesterday
00:37from Penguin Random House. Right. Congratulations. Thank you. Before we get into Unshrinking proper,
00:45I was thinking that it might be helpful for our audience to resituate your book a little bit more.
00:52So while they're getting ready to do that, let's share the cover of Unshrinking and also a QR code
00:59so the audience can take a look, take a peek at it on the publisher's website as we're having the
01:04conversation. And so to situate Unshrinking kind of within your work for those people who aren't
01:13familiar with your previous two works, your first book, Down Girl, which focused on the logic of
01:18misogyny became quite popular with scholars and also with people who are not specialists, right?
01:26Your second book, Untitled, picked up on similar questions and themes speaking about male privilege
01:32and how that affects women. And then for those listeners who aren't familiar, could you tell us a
01:38little bit about how the main concerns of those two books are distinct from Unshrinking and how
01:45Unshrinking compares or differs? Yeah, absolutely. So I've been interested in the topic of misogyny
01:52for a good eight years now, and it kind of grew out of my own background. I was one of
02:01three girls at
02:02an all boys school the year it integrated. And I faced a lot of misogyny and fat phobia as a
02:10then
02:10merely somewhat chubby girl, but still one whose size made me the target of a lot of bullying and
02:17belittling. So when I published two books on misogyny, where I argued that misogyny is something
02:24that girls and women face, it's a system that serves to police and enforce gendered norms and
02:30expectations by visiting women with hostile treatment. So I made that argument in these two books.
02:37And a lot of people asked me, well, how did you get interested in the topic of misogyny?
02:43And the truth is that I really couldn't tell that story without also telling a story about fat phobia.
02:50Because when I was a school girl, I was really the target of enormous amounts of bullying and teasing
02:58and weight based belittling that I think point to a larger social phenomenon. I don't think that we can
03:04fully face misogyny without also facing fat phobia. And that's what I try to do in this latest book,
03:10to really examine fat phobia as a form of oppression that intersects with others, that intersects with
03:17racism, with classism, with ableism, with transphobia, and with misogyny.
03:23I was struck by how personal Unshrinking was, and how much it draws on your own experience.
03:30In the actual writing of it, what made you decide to write the book from that more personal
03:35experience? Yeah, that's a good question. Because part of the book, of course, is really an empirical
03:41argument that there's not a lot of good evidence that people can reduce their weight through diet
03:49and exercise in a healthy way. So a lot of what I'm drawing on in the book is endless empirical
03:55studies that show the same thing, which is that people can lose a moderate amount of weight in
04:01the short term, but then the weight comes back pretty inexorably over a four to five year period.
04:06So I wanted to say that, but I think the personal aspect of it really makes vivid that this has
04:13certainly been my experience, and I am the rule, not the exception. So when I give my own experience that
04:20I think vivifies the way that diet culture really fails us, and that we're not failing
04:26our diets, it's that they're failing us. I hope that it makes vivid to the reader that I'm someone
04:32who's tried really every diet under the sun to try to shrink myself. And that in addition to it not
04:38working, I think it's a bit surprising to some readers that even as a card carrying feminist who's
04:45now written two books on misogyny, I am by no means immune from the dictates of diet culture.
04:51In fact, I've been really influenced by this toxic and harmful sense that we need to shrink ourselves
04:57or else in ways that I hope that this is a basis for really finding solidarity with one another in
05:05our struggles with body image in general and fat phobia in particular. So yeah, that personal piece
05:11that felt like an important way of putting myself out there and also releasing myself from some of
05:18the body shame that has dogged me. Because one of the things about shame that I think is really
05:24interesting as a philosopher is that shame kind of isolates us from one another. Think about the
05:30characteristic posture of shame, so head bowed, eyes lowered, wanting to disappear. That's a really
05:37powerful barrier to solidarity because we're not meeting each other's gaze almost literally. So
05:44telling my story in a way that was unashamed felt like a way of inviting my reader into a conversation
05:51that would get us beyond this place of shame and shrinking and really towards a place of solidarity
05:57with all of us who have to navigate a fat phobic world in our vulnerable human bodies.
06:04Well, and I, as a reader, I really appreciated that too. And I could feel that, that personal
06:10experience doing that work. So thank you.
06:14Despite, or maybe because the fact that this was so personal for you,
06:21even though it was so personal for you, you still write with a great deal of humor in the book.
06:26I did find myself laughing at parts just because of your tone, right? So not that you're
06:31necessarily cracking jokes left and right, but, but there is, um, there's some humor there. So I was
06:37wondering, um, if you could speak a little bit to that, if there were, um, maybe that's just part of
06:41your style, like your writing voice, or if there was anything about humor that made, I don't know,
06:48made this, um, topic easier to deal with, or that you found humor in the writing process going through
06:54it. I'm just curious.
06:55Yeah, that's, it's such a good question because I think as people who live in larger bodies,
07:01we're so often the butt of jokes and so subverting that felt important to the overall exercise.
07:09Um, and I should say for those who are in the audience, I'm someone who has been much heavier
07:15than I am now. So I'm someone who now identifies in the parlance of fat activists as a small fat
07:22person. So I want to be clear that I also draw in the book in ways that I think of
07:28as really
07:28important on the voices of people who are larger than me and therefore face yet more acute forms of
07:35fat phobia. But that being said, yeah, fat people were so often the butt of jokes. We're so often
07:41laughed at that being a little bit wry and dry about some of the, in particular, thin splaining that
07:49occurs to us felt kind of important and apt. So for those of you who don't know the term,
07:56mansplaining is a kind of tongue in cheek term for what happens when a man who is less expert
08:02than a woman proceeds to explain something to her in a self-important way, assuming this
08:08false authority that he knows all there is to be said about the topic. For example, I can't tell you
08:13the number of times as a moral philosopher that I've been privy to the ethical theories of a man
08:19on an airplane or something, assumes he knows all there is to say about the topic and isn't really
08:26listening to what I might have to offer, but is rather proceeding to explain an area of expertise.
08:31And I think fat people face something really similar. And it's actually quite funny that there is very
08:39few, if any fat person who hasn't done a great deal to try to reduce their body size. So the
08:46idea that
08:47telling a fat person, well, have you tried diet and exercise? It, it's just funny because what am I a
08:56fat
08:56rock sheltered Martian who has never been in the world and who really needs this explained to me?
09:02Um, and yeah, it's worth saying too, that part of the reclaiming effort to be unashamed is with humor.
09:09And part of the reclaiming effort is with a term that some in the audience may be uncomfortable with.
09:14So it's worth noting that I use the term fat as a completely neutral description now of some bodies,
09:21much like terms such as short and tall fat and thin, merely described different bodies.
09:27I view it as something where, again, we're reclaiming the term in the tradition of fat activism
09:32and holding this to be something that we don't need to be ashamed about. Our bodies simply come
09:37in rather different shapes and sizes and that we can own that and be comfortable with that in a way
09:42that doesn't require a kind of euphemism like curvy or fluffy or a medicalizing, stigmatizing term
09:49like obesity. Um, so that's why I'm using that term. And yeah, it's connected with the fact that I did
09:55want to a little bit make fun of thin splainers in this book. Um, thank you for that because, um,
10:02I was wondering in the book, you're, you're very explicit about your terminology and the vocabulary
10:06you use. Um, and unshrinking is, is part of that. Um, so I was hoping you could kind of walk
10:13us through
10:14how you got to the term unshrinking for the title. Um, and then also if we could, we'll talk more
10:20about fat phobia as a term also. Wonderful. Yeah. So I love process questions and this is a question
10:27partly about process because my amazing editorial team and I must have gone through about a hundred
10:35possible titles for this book. We brainstormed endlessly. It did not come easily. And I always
10:42find that I have the decent ideas that I have such as they are in, um, a particular circumstance,
10:49which is when I'm going to sleep. Hmm. So I was just, uh, taking a nap with my now four
10:55-year-old
10:56daughter one day and it popped into my head that of course the title to this book had to be
11:00unshrinking, which sends the message that we can embrace our bodies and be unashamed and unshrinking
11:07in the world and take up space unapologetically, but also capturing the way that I had been previously
11:14shrinking from public scrutiny. So I'm someone who cares deeply about systems of oppression and their
11:22intersection. And I've been particularly focused as we got into on the ways misogyny really makes
11:29life terrible for girls and women in many different sets of circumstances. And yet when I had the chance
11:35to publicize that work and to talk about an issue that matters to me more than almost anything,
11:42I really shrunk from public scrutiny and refused to do TV appearances. I think this is the first time
11:48I've been in a situation where I'm on camera and I'm not controlling the camera angle. So this is
11:55actually a big step for me and it feels like a good moment to be unshrinking in this culture
12:01that tells girls and women to be small, meek, and quiet.
12:07And we are so happy that you're here and doing it and sharing this with us.
12:12Yeah, the image of unshrinking, I know you talk about it in the book too, so I mean, that makes
12:17sense. Falling asleep though, it's a bad time to get ideas.
12:21I will say that, yeah, having a quick way of recording your thoughts when you have those sort
12:28of little brain waves is nice. But it's to say, in terms of process, I'm a big fan of letting
12:34your
12:34brain wander. And sometimes you come up with solutions to intellectual problems when you're
12:39actually at your most relaxed. So that is my, I think, only process insight, if it can be called
12:47that, is sometimes it's when we're not trying to solve an intellectual problem that we have that
12:52little moment of seeing what the title of it had to be. And then it felt inevitable that it would
12:58be called unshrinking.
12:59Yeah, that's a really good tip for all of, I was going to say all the scholars in the audience,
13:04but actually for everybody who's, you know, solving big problems.
13:08We're all problem solving all the time.
13:10So I wanted to ask you a little bit more about the topic of the book, fatphobia.
13:18Specifically, why the term fatphobia? And relatedly, why do you feel, or why did you feel
13:23that it was important to not only name it, but also to expand upon it in a book?
13:30Yeah. So this is actually a controversial choice that I've made. And some scholars working in this
13:37space, like Aubrey Gordon, for example, whose work I just revere, prefer the term anti-fat bias,
13:43which I also think is an excellent term for what we're getting at here.
13:47One reason that I like fatphobia is that it gets at a parallel with certain forms of oppression that
13:55I think liberals and leftists do tend to take appropriately seriously, like homophobia and
14:01transphobia. So fatphobia felt like it could establish a useful parallel with those forms of
14:07oppression. And while I would never say that fatphobia is the last acceptable form of
14:13bigotry, because there's never, unfortunately, a last acceptable form of bigotry as we're
14:18seeing so vividly in the world currently, I think there is a sense in which people in my,
14:24broadly speaking, political left ilk, they tend to be a bit complacent about the topic of fatphobia.
14:31So establishing this parallel with transphobia and homophobia felt helpful to me. Now, of course,
14:37there's always a risk of the term, which is why Gordon is worried about it, that that will make
14:41it sound like it's something like an actual psychological phobia that's a fear, a disproportionate
14:49fear of fat people, which is, of course, not what it is. But I think we're accustomed to thinking of
14:54phobias as also applying to these systematic forms of oppression, where it's what people face,
15:01not what people feel. So that's very much how I define fatphobia, is a system of oppression where
15:07fat people face unwarranted judgments about our bodies, assumptions about our health status that
15:13may or may not be accurate, but also forms of moral, intellectual and aesthetic bias that really
15:21deserve to be called out and disentangled. So part of what made it for me a ripe subject for a
15:27book-length
15:27exploration is I felt like it was helpful to draw out those different strands and really go in as a
15:34philosopher to say, fat people are often seen as morally blameworthy. Is that accurate? Or can we
15:40debunk that myth? And I think the argument that I made hopefully successfully is that that's really
15:46not a fair way to look at fat people's bodies, because for among other things, fat people's weight
15:54is not really under our tight long-term control. Moreover, to the extent that fatness is a health risk,
16:00and that's itself complex and controversial, thin people take all sorts of health risks all the time
16:06and are not subject to shaming and judgment on that basis. So there's a lot of moral condemnation
16:12of fat people that feels to me to be singling out a class of bodies for derision and contempt based
16:18more
16:19on aesthetic disgust than anything. And that gave rise to another chapter of the book, which is the
16:24aesthetic piece of it, the way sexual fat phobia operates, and I think is particularly harmful to
16:31girls and women, as well as non-binary people. So there's often, again, a myth that felt worth
16:38debunking here that fat people simply aren't regarded as sexually attractive. But I think that, not to put
16:45too fine a point on it, porn consumption belies that idea, because fat bodies are a very common
16:53search term in pornography. So one way of looking at it is that fat women are often sexually desired,
17:01but seen as having low status, that means that they're perhaps subject to forms of treatment that
17:08mean they have these sexual relationships that are private and are not regarded as someone who can be
17:16dated openly without shame. So that's like a really sad but prevalent aspect of fat phobia, where
17:23it's not that certain bodies are inherently undesirable, it's that they're not seen as having
17:27a sufficient status. And then finally, there's the intellectual piece of fat phobia that I really
17:33wanted to get into as a moral philosopher, because I'm someone who has so often been subject to
17:41assumptions that I think befall many women in philosophy. So for those in the audience who don't
17:47know, philosophy is the most white male dominated discipline in the academy in the humanities and
17:54is on a par, I should say, with things like so-called pure math and physics. But because of that,
18:01women are
18:02often assumed not to be philosophers. But I think fat women, it's a particularly prevalent assumption.
18:08I mean, just to give you one small anecdote, I was giving a convocation talk at a university where
18:15I was chatting casually with an audience member beforehand. And I introduced myself to him as
18:21Kate. He had come to hear Kate Mann give a talk. And he assumed that I was an audience member
18:29and not
18:29the guest speaker, even though I was all dressed up and ready to go and fairly clearly in professional
18:37mode, because I think partly of the size of my body was seen as so incompatible with intellectual
18:42authority. So often we just make assumptions that philosophers in particular and intellectuals
18:48generally have to be lean, non-disabled, cis white men, and wealthy ones too. And so I wanted to get
18:55into that and really look at the amazing talent that we might be missing out on, because we're not
19:02listening to people who happen to be in larger bodies as intellectual authorities, regardless of what
19:09they might have to say and what insights they might have to offer.
19:13It does sound like this topic gives you a lot to work with.
19:19So on that, I wanted to get into the book a little bit more. You have this wonderful close reading
19:25of
19:26a 1938 play called Gaslight in one of the chapters, and you use it to tease out some of the
19:31logic behind
19:32what we know as gaslighting today, mainly that it is, as you describe, a systematic process that works to
19:39make us feel defective in some way for the beliefs, thoughts, feelings, desires, and appetites to which
19:45we are in reality entitled. You say that gaslighting attacks a person's mental freedom, her capacity for
19:52independent thought. So this really struck me. I hadn't heard about this play before, but your phrasing of
19:59it also. So I was curious, why was the concept of gaslighting important for the work?
20:04Yeah, so I'm so glad you called attention to that, because I'm someone who has studied gaslighting in
20:11the context of misogyny for a long time, because I think that a really powerful tool of misogyny is
20:17gaslighting women to feel either guilty and ashamed or crazy and irrational for mental states like
20:26beliefs to which we're perfectly entitled in reality. And one of the observations that has been made by
20:32several scholars working in this space, including Elena Ruiz, who's an amazing philosopher, is that gaslighting
20:39can also be cultural. So in her view, there is a kind of gaslighting of people of color by white
20:47supremacist
20:48forces in Anglo-American culture to make people feel like they can't complain about mistreatment
20:55in ways that is really pernicious. So my theory in this book is that another cultural force that gaslights
21:02us is diet culture. So I look and try to establish, just as you so nicely put it, a close
21:10reading of the
21:10play Gaslight, the original Patrick Hamilton play, which is in a way subtler than either film. I mean,
21:16the film, both the UK and the US version are wonderful, but the play really establishes this
21:23interesting piece of it, which is that by making us feel ashamed of our behavior or our bodies, you can
21:30gaslight someone into not asserting her truth. And in my case, the sense that the next day it would work,
21:39this
21:39next time will be different. I'm really to blame for not having the thin body that is designated to be
21:47the one that is appropriate and desirable according to dominant patriarchal standards. That feels like an
21:53exercise in gaslighting, which also undermines something that I've come to think of as so important,
21:58which is self-trust. So the practice, the well-evidenced practice of intuitive eating,
22:05I think can be seen as pushing back against diet culture by saying we can actually learn to trust
22:11our own bodies and our own hunger and satiety or fullness cues. And it's a way of saying the fact
22:19that gaslighting has severed this cord of trust that should run between us and our appetites,
22:25that's something that we can and should combat, but it involves a lot of hard work to get beyond
22:30that gaslighting that makes us feel defective simply for having an appetite, simply for being
22:36hungry, and simply for liking tasty foods, which I think it's a normal and healthy and indeed really
22:44good part of life that we have an appetite for something that can be a deep human pleasure and
22:50source of nourishment for our bodies.
22:54And I really appreciate you bringing attention to this concept also in this context. And so we
23:01actually have an audience question that I think dovetails really nicely from Emily, and she says,
23:07I'm curious how you see fat phobia as intersecting with eating disorders where fear of changes to
23:12weight or shape may dominate behavioral choices.
23:16Yeah, that's such a great question. And I think that this has been something that
23:23we've seen a new discourse springing up around the concept of food noise recently. And I wrote about
23:30this for the New York Times a few weeks ago, where we're seeing people really feel that their own
23:39appetite and hunger and cravings are just verboten, forbidden, and they're categorizing them not as
23:49their inner voice of hunger, but as purely something that is noise that ought not be listened to.
23:56And I'm completely sympathetic with anyone who is in that space right now. I've absolutely been there
24:02myself. But my view of it, and what I've found when I've spoken to weight neutral dietitians and
24:11clinicians and psychologists and so on, is that if we let go of our internalized fat phobia, and have
24:17the idea that our bodies are actually allowed to be the size that they end up when we eat in
24:24ways that
24:24are nourishing and involve listening to our hunger and satiety cues, if we let go of that, a lot of
24:32the disordered behaviors and risk factors for eating disorders tend to reduce quite a lot. And I can
24:40talk to my own experience here. For me, fat phobia and the internalization of it as a fat woman is
24:47directly responsible for my falling into disordered eating patterns. And I was someone who had been on
24:54so many diets and was so frustrated by their becoming progressively more ineffective, that I simply
25:00stopped eating for days at a time, because I just couldn't do it anymore. I couldn't follow another
25:07diet strictly and have it fail or perceive myself as a failure. And so that led to me developing patterns
25:16of just severe fasting and disordered eating, that I think is, you know, not only harmful in my particular
25:24case, but it's a reflection of the statistic that dieting, which is often a response to these fat
25:30phobic beauty norms, places people at about a fivefold risk of an eating disorder, a full blown
25:38eating disorder. So I think the connection is really tight. It's not to say that every eating disorder can
25:43be explained by this mechanism. But I think that put it this way, if we saw an end to fat
25:50phobia,
25:50we would see a huge reduction in disordered eating and even full blown eating disorders.
25:56And the final piece of the picture is the parenting piece of it. We know that the biggest risk factor
26:02for girls developing an eating disorder is being perceived as overweight by her parents. And the
26:08other one is being put on a diet. So that suggests that the connection, while not one to one, is
26:16a really
26:16tight connection. And that parents who perhaps, while meaningly, oftentimes with the best of
26:23intentions, do try to control their children's weight, really do place them at a higher risk for
26:29something which is demonstrably unhealthy, namely disordered eating, or again, full blown eating
26:34disorders that have, after all, one of the highest mortality rates of any mental illness, at least when
26:41it comes to anorexia. Wow. That actually answers, or kind of gets to another audience question we have
26:47from Andrea about specifically parenting and suggestions for preventing children from developing
26:54kind of that internalized fat phobia. Yeah. And so you spoke about it just now a little bit about
27:00parents not, maybe, are there other suggestions that you might have as a parent yourself also,
27:08that you've mentioned before? Yes. Well, I love that question, Andrea. One book that I think is
27:13really brilliant on this topic is my friend Virginia Sol Smith's book, Fat Talk, Parenting in the Age of
27:19Diet Culture. So I think that's a really wonderful read, because it suggests that one approach that she
27:27is a fan of, and has talked about a lot, both in the book and in her work as a
27:34podcaster and health
27:35reporter, is what's called division of responsibility at the dinner table. So the idea is parents provide
27:43nutritious, tasty meals, including regular access to treats and desserts and so on. No food is forbidden,
27:51but you provide well-balanced meals, and then the child is fully responsible for what they eat of what's
27:57on offer at mealtimes, and how much they eat of those foods that are offered. So what Virginia argues,
28:04and what many clinicians in this framework have argued, is that's a way of cultivating an atmosphere
28:10of autonomy and bodily self-trust at the dinner table. So there's structure, there's a framework,
28:15but that is a way to think about the family dinner table as a place for connection and a place
28:22for
28:24curiosity and low pressure around not having to finish a certain number of bites of broccoli to get
28:29the reward of a cookie, which is actually very clearly going to make the broccoli less appealing.
28:36So many studies show that if you make a child finish their vegetable soup before they can have
28:41dessert, they rate the vegetable soup as less tasty. So if we just present these foods somewhat
28:47neutrally, we don't have this categorization of good foods versus bad foods, there's just an attitude,
28:53here is dinner, and let's have a conversation. That can be a way of really taking the pressure off
28:58and cultivating this atmosphere of bodily autonomy and self-trust. So that's one piece of it.
29:04I also think it is valuable to have a lot of representation of body diversity of all kinds
29:13in the children's books that you read. So I'm a big fan of having just a very healthy, robust sense
29:20in a household that we all come in different shapes and sizes, different skin tones, different hair
29:25textures. Some of us use a wheelchair, some of us may have limb differences or facial differences,
29:31and that that is a normal, beautiful part of human diversity, and we are all equal. So a book like,
29:38just to name one example, Tyler Fetter's Bodies Are Cool, is just a beautiful exercise in representation
29:45and just looking at body diversity as valuable and interesting rather than trying to shut down
29:55conversations that might involve healthy curiosity about bodily differences between people.
30:00I think it's nice to say, oh, look, here's someone who has a prosthetic leg, or here's someone who's in
30:08a
30:08larger body, and our bodies are different from one another. And that is actually a cool thing,
30:13not something to hide from children. So that's certainly two pieces of it. And you can tell I've
30:21put a lot of thought into this topic, so I could go on and on. But yeah, those, I think,
30:26are really
30:26valuable starting points, as well as finally, I should say, to have a conversation that's ongoing
30:32about just as I think white parents are responsible for introducing their child to the topic of racism and
30:39saying, look, we have to be conscious of white privilege. I think it's also really valuable to
30:45have conversations early on in an ongoing way about fat stigma and fat shaming, and really make
30:52it clear to children that no matter what our body size, we are all responsible for making it a just,
30:58kind, inclusive world. It is never okay to exclude someone based on her body size. And that's another
31:04important piece of it. Thank you so much. I think those are, yeah, like you said, great starting
31:10points for parents. So something I really, something else I really appreciated about you
31:17tackling in the book is the relationship between fatness and health. Because I think this is a
31:22real big stumbling block for many well-intentioned people, too. And as you point out, medical professionals
31:27at times as well. So you say, we must find a way to have a conversation that recognizes the complicated
31:35relationship between fatness and health, highlighting that fat bodies can be healthy without insisting that
31:40fat people must be healthy in order to be valid. And so I think this statement speaks to your point
31:48about how fat phobia and healthcare intersect in negative ways due to a stigma around fatness that
31:54we've been talking about. So I wanted to ask you this. Can you say a little bit more about this
32:00idea and about how you personally think about reframing that relationship between fatness and
32:05healthcare? Yeah. Yeah, I'd love to. So I think one thing to get out of the way right at the
32:14beginning is
32:15whatever you think about the relationship between fatness and health, let's be clear, everyone,
32:20regardless of her body size deserves adequate healthcare and compassion and good treatment
32:25and kindness. So even if everyone rejects all of what I say in the book about this actually being a
32:32really complicated and interestingly complicated empirical picture, I think we can agree or I hope
32:39we can agree that fat shaming needs to end and weight stigma needs to end. And that's a piece of
32:45the
32:45book that is really important to me is looking at the way weight stigma is actually really damaging
32:51the health of fat people. So study after study shows that in particular, people are getting inadequate
32:57healthcare when they're at a higher weight. So this isn't just implicit bias, this is explicit bias.
33:04Doctors who actually tick the box on the form that says, for a fat patient, this patient is more likely
33:10to annoy me, this patient feels like a waste of my time. And this patient is someone who they will
33:17rush
33:18through an appointment and not spend as much time with. So this is really explicit bias that means that fat
33:24people are often not getting the healthcare that they deserve, and are also so subject to weight shaming
33:30at the doctor's office, that they avoid seeking preventative care, such as cancer screenings, which means
33:36that tragically, we have people who are dying, or at least suffering from really severe health problems,
33:43because they feel too ashamed and too unhealthy to get the healthcare that they deserve access to.
33:52So that's a piece of it that weight stigma, no matter what someone's weight can be deadly,
33:58it can really prevent someone from getting adequate healthcare. And that I think deserves emphasis
34:05in this conversation. And I think another part of the conversation that is important draws on
34:11research by the award-winning CDC epidemiologist, Catherine Flegel, to show that, yeah, this is quite
34:19a complicated relationship between fatness and health. So the relationship between the two can be
34:24pictured as a U-shaped curve, where people who are at the bottom part of the curve have the lowest
34:33mortality statistics in terms of how likely they are to suffer premature death. And that lowest point
34:41in the curve is actually for overweight people. People who are classified as overweight, according to the
34:46BMI charts, have the lowest mortality risk, statistically speaking. So despite the fact that people who are
34:52overweight are often told to lose weight, that is in fact, statistically, again, the healthiest place
34:59of that U-shaped curve to be. And while we know that, I should say too, a piece of it
35:05is that
35:06people who are so-called normal weight and people who are even moderately obese, terms I don't love,
35:12but I'll use for the purposes of just framing this medical finding, they have the same statistical risk
35:19of mortality. So even being in the obese category with a BMI of between 30 and 35 is not associated
35:27with
35:27elevated health risks in general. Now it is true that both very thin and very fat people are subject
35:35to greater health risks in terms of the correlation between being those weights that are on either end
35:41of the spectrum and having greater health risks. But there are important questions to be asked.
35:47Is that causation? Is someone's health problem caused by their weight? Or are they, for example,
35:53subject to so much weight stigma that they're suffering health problems because they're not
35:58getting adequate care? So I think it's still an open question whether weight of a very high kind is
36:05the cause of health problems. But again, even if the answer to that question turns out to be yes,
36:11people in that category still deserve to be treated like human beings.
36:14Of course. Yeah. Um, that actually speaks to, um, a couple more audience questions we have around
36:21this. Um, so specifically around BMI, um, so from two different perspectives, um, so we have Carly's
36:29asking, I'd love to hear Dr. Mann's thoughts on the interplay between changing cultural norms,
36:34fat phobia specifically, um, and improvement of institutional fat phobia. And, um, they say I'm,
36:41I'm perpetually shocked by how BMI creates actual barriers to access, that's what you're speaking
36:47about, um, to healthcare, particularly for women and, um, and when this will be seen as an equal
36:53access issue. Um, so that's part, part one. And then we have a second question that's related,
36:58um, from Allison who was working in the medical field. Do you have any suggestions surrounding BMI and
37:05how to address this as a, as a provider? Yeah. So I think there are doctors, including
37:11Dr. Mara Gordon, who is a weight neutral and inclusive physician working in this space,
37:17who really don't see BMI as a particularly useful metric anymore. And one of the reasons for that is
37:24the BMI is based on ultimately the measurements of, um, Adolphe Cadillet, who was a 19th century
37:33Belgian astronomer, and who made this assumption that the average body was the ideal body.
37:39And his average body was that of 19th century Belgian military men. So why we should be
37:48regarding that as the gold standard for human beings right now, there is no good answer to
37:55that question. Um, these are again, very arbitrary standards rooted in really a quite sordid and
38:01racist history that, uh, Aubrey Gordon has done brilliant work exposing. So I'd encourage people
38:07to look into that too. So I think it's possible to think about the BMI as a very unreliable proxy
38:14for
38:15things that can be measured directly, um, people's blood work, people's blood pressure, um, symptoms
38:21that they actually have. And I think there is an argument made by people who are working in this space
38:27that BMI isn't terribly useful. Now, of course, I'm not a doctor, I'm not a medical researcher,
38:32I'm not an epidemiologist. So that is a controversial view and something which I, um,
38:40wouldn't, uh, regard myself as in any way the authority on, but it's just a point to the fact
38:45that there are people who are working in this space and thinking of themselves now as weight
38:50neutral clinicians who will do things like, for example, not weighing a patient when they come into
38:55the doctor's office, because usually we don't need to know what someone's exact weight is in order to,
39:01um, give them appropriate medical care. There are, of course, exceptions to that rule for the dosage
39:06of a medication, for example, um, or to assess a child's growth rate. So I'm not saying no one should
39:12ever be weighed, but there are certainly people who are pushing back against the idea that you need to
39:17be weighed the second you get to the doctor's office, even if you're there to seek, for example,
39:22treatment for migraine, which is, um, according to most people, not associated with your BMI.
39:28So that's part of it. Um, in terms of the institutional, uh, connection here, I think
39:34that's really crucial. So in the book, what I talk about and the way that I try to frame this
39:40is that
39:41fat phobia is really a straitjacket restricting people's movement, their freedom, their potential.
39:47So I think it has constraints for all of us who have a human body. It tells almost everyone not
39:53to get any fatter or else, but it tells in particular fat people that they don't fit the
39:58world. And it is a way of constraining us in ways that are literally physically painful and are also
40:05stigmatizing. So I wanted some of that imagery of the white, um, straitjacket that is used to mark
40:11someone as undeserving of care. And we see this show up in so many institutional settings. We see
40:18it in healthcare, as I've adverted to, we see it in employment where fat people, particularly fat
40:24women are subject to really widespread discrimination. And we see it in education where fat children are
40:31stereotyped as less able and less brilliant and less competent in ways that don't reflect their actual
40:38test scores or performance. So if a child gains weight, they will be perceived as less able,
40:44even though nothing has changed objectively about their test scores and performance.
40:48So, um, those general results hold, but I think it's also really important to look at how vulnerable
40:55communities are affected by fat phobia that restricts their access to the medical system
41:01in ways that are especially pernicious. So for example, for trans patients who seek gender
41:07affirming care, large studies at Mount Sinai in New York have shown that a large portion of those
41:13patients are denied gender affirming care on the basis of their BMIs, even though there's often a
41:20lack of evidence or even hard evidence against the proposition that it would be risky to operate on
41:26someone with a higher BMI. So for example, top surgery for someone who is seeking gender affirming care
41:32as a trans man has been recently shown not to be more risky for patients who are of a heavier
41:38weight.
41:38And yet there's a lot of gatekeeping of that really life-saving gender affirming care,
41:44which can protect people from a huge risk of mental health issues and even suicide
41:50because they happen to be a fat trans person. So yeah, I really think it is an issue of equity
41:57and access.
41:58And we see some of the hypocrisy of those policies in the fact that often those fat patients would be
42:04allowed to have weight loss surgery, but they're not allowed to have gender affirming care or knee
42:09surgery or whatever else it is. So there are no reasons why we shouldn't be treating people with the
42:18bodies that they have rather than requiring them to do something which is often just not on the cards
42:25for a particular patient, given how difficult weight loss is for many people.
42:30Thank you for that. We have some questions coming in around A1C blood test indicators.
42:38It's supposed to be something you could speak to.
42:41I'll try my bet again. Not a doctor.
42:43Right.
42:43Not that kind of doctor.
42:44But your perspective, you know, I think the audience is interested in your perspective on this
42:48because you've obviously thought about, you know, this subject a lot.
42:51So some questions are, there's a push to lower the A1C in moderately overweight patients.
42:59At what point should we draw the line?
43:02Yeah, yeah.
43:02And then just more generally, if you have other thoughts on this kind of push around these indicators.
43:10Yeah. So this is interesting because this overlaps at least with an area of care for patients with
43:19so-called pre-diabetes that is rather controversial. And again, I certainly don't regard myself as the
43:25authority in this space. But psychologists and endocrinologists who are working in a weight
43:33inclusive and weight neutral paradigm have been critical of the diagnosis of pre-diabetes on the
43:39grounds that fewer than 2% of people diagnosed with pre-diabetes actually go on to develop diabetes
43:47annually. So there is a worry that we're setting the threshold for what someone's blood sugar levels
43:53should be. And A1C, for those of you who don't know, is a measure of the history of someone's blood
43:58glucose levels over a several month period. There's a worry that there's something a bit too alarmist
44:05about setting the standards where they currently are, and that people are assuming they're headed on a
44:10surefire course towards being a type 2 diabetic, when in fact the risk is still rather low.
44:16So that's certainly a debate that's playing out in this space. And yeah, regardless of what the outcome is,
44:23I do think we see a long history of the expansion of certain categories of medical diagnosis,
44:30which is in part pushed by drug companies who are ultimately profiteering in this space.
44:36Certainly we see the push to consider obesity, so-called obesity, just fatness in itself a disease,
44:44was arguably partly the result of the advent of new weight loss drugs that were coming to market,
44:49and drug companies were really hopeful that they would get more health insurance coverage
44:54if you could define obesity as in and of itself a disease, rather than an unreliable proxy for disease
45:01risk factors. And this kind of expansion is really not unique to this area. We see it in so-called
45:10condition branding for things like hyposexual desire disorder for women. So as soon as you have a
45:17treatment for women's supposedly low libido, that becomes a medical disorder rather than a normal
45:23human variation where some people might be on the asexual spectrum or on it at a certain point in
45:29life. We also see things like testosterone deficiency becoming this huge boom in diagnoses because
45:41medical, because drug companies had testosterone treatments that they were pushing. We see this
45:47too in the history of human growth hormone. When that came to be available, idiopathic short stature
45:53became a medical diagnosis, which just means being short for no particular reason. So again, we have to be a
46:00little bit careful about the way this isn't about entirely neutral and well-meaning attempts to regulate
46:09people's health and help them live the best health, happiest, healthiest lives we can. It's often partly
46:15about what's profitable for drug companies that have something to sell. And if they brand a medical
46:23condition like prediabetes, then the treatments they have available for those conditions will be more
46:28marketable. So that's certainly a factor to at least keep in the back of our minds as a process
46:34historically and culturally that we should be worried about in this space.
46:40Oh, thank you. Before we move on to kind of our final question, we have one more that kind of
46:46loops
46:46us back to what we were talking about regarding within the healthcare and within the healthcare field,
46:55but particularly around children. So Katie, I'm interested to hear your thoughts on how to
47:02successfully navigate the medical system as a parent of an overweight child. They say they've consistently
47:09run into bias, even though she's a registered RD. And so what thoughts do you have for maybe educating those
47:18who care for our children regarding size inclusivity?
47:21Yeah, that's such a great question. And Katie, I'm so sorry you're dealing with that. That
47:25really resonates as a problem that many parents face. I think that one very practical strategy that
47:34some people have practiced and that I think is useful is to talk to a doctor or nurse practitioner or
47:41provider of any kind before the child is in the room for the consultation and say,
47:46we are a weight inclusive or body neutral or whatever term you want to use family. And a direct
47:57discussion of my child's weight is something that I regard based on the evidence as putting her at
48:01higher risk for eating disorders. By the way, a lot of research shows that the triggering event
48:06for a child developing disordered eating was a visit to the doctor and a patronizing conversation
48:12about their weight. A lot of people who are larger can tell you about that experience as having been
48:18formative in their feeling their bodies were just wrong. So to go into a physician's office and say,
48:24look, I don't want you to mention anything about the child's weight. We can talk about exercise.
48:30We can talk about nutrition. Although if she's an RD, then there is no need to add that piece of
48:36it to
48:37the conversation. But we can talk about health stuff that is something that we can practice as a family
48:43in terms of healthy behaviors, but we don't need to control, analyze, and scrutinize a child's weight
48:49directly. So that's, I think, a useful piece of education to just say, this is what we require as a
48:59family to take weight as a piece of it out of the conversation. But I also think that books like
49:06Fat Talk are really excellent to share with physicians who are interested in practicing
49:13something which would be more inclusive to children in a variety of body sizes.
49:18So yeah, it has a lot of interviews with pediatricians, with doctors, and with parents of larger children
49:26that I think make it very clear how stigmatizing those, again, well-meaning conversations about a
49:33child's weight can really be. Wonderful. Thank you. So before we go, towards the end of the book,
49:40you develop a new approach or perspective that you call body reflexivity. So I wanted to ask you,
49:46what do you mean by body reflexivity? And how is it different? Or how does it fit in between body
49:51positivity or body neutrality? Yeah, thank you. I found myself, because of course, part of what
49:59I'm doing in this book is navigating my journey with my own body. And the thought that helped me
50:04the most in navigating it was the thought that my body is for me. Your body is for you, and
50:10likewise
50:10for any person listening. So there was this sense that I had that body positivity was not terribly useful
50:20to me. I don't think that maintaining a monolithically positive attitude towards our own
50:28bodies is particularly realistic in such a fat phobic society. I mean, good for someone if they
50:34manage it, but there's an element of the advice that feels a little bit like toxic positivity.
50:40You must be positive or else. It feels a bit too prescriptive. And by the same token,
50:46body neutrality feels a little bit lackluster, like even maintaining a purely neutral attitude about
50:53our own bodies feels both a bit dispiriting and also very hard to achieve in the society we actually
51:00have. So I began to think, well, why are we assessing and to some extent comparing bodies at all?
51:08Why are we saying, well, we need to award our bodies like a positive number or a neutral number like
51:16a
51:16zero instead of a negative number? We should be just throwing out the whole scale and not assessing
51:21bodies whatsoever. So the idea of body reflexivity, the idea that my body is for me, is really meant to
51:30make good on that idea that our bodies are not something for assessment or consumption or correction or
51:38colonization. Rather, everyone's body is for them and no one else. And her perspective on her own body
51:45will be variable. And it's the only one that matters. So I find that my self criticisms and
51:51insecurities not completely resolved, but really fall away when I reflect that my body is my home. It's
51:59what I have to work with. It has helped me love and grow and nurture and think and move and
52:09breathe
52:09in a world that is often hostile to people in larger bodies. So instead of thinking about ways in
52:16which my body could be improved, the idea that my body is for me has allowed me to think of
52:21my body
52:22as something which has weathered a lot of storms, and for which I'm ultimately incredibly grateful.
52:29Well, Kate Mann, thank you so much. Thank you for being with us. Thank you for this book.
52:34And audience, thank you so much for your questions. And we'll see you next time on Keynotes.
52:38Thank you for this great conversation, Amanda. And thank you all for being here.
Comentarios