SARAH MCCAMMON, HOST:
Every year, millions of Americans go on a diet. Americans also spend billions of dollars on weight loss products. So why, despite all of this, do obesity rates in the United States continue to rise?
AUBREY GORDON: It’s an incredibly complex problem that we don’t have answers to, but we kind of continue to use the increasing levels of fat in our culture as a club to get people to lose weight.
MCCAMMON: It’s writer Aubrey Gordon. She co-hosts the “Maintenance Phase” podcast with journalist Michael Hobbes. And she says at first they wanted to focus on the big questions. That other health and fitness podcasts didn’t necessarily ask for
GORDON: It was worth having a conversation about, like, OK, well, what’s the science behind this? What are the motivations of the people who present all these fad diets, all these wellness trends? Like, what’s the story behind this?
MCCAMMON: I spoke with Aubrey Gordon and Michael Hobbes the other day, and we started off by talking about the medical consensus that obesity can lead to health problems.
GORDON: Yes, there’s a very clear correlation between weight and poor health outcomes, but weight isn’t the only thing that correlates with health. We know that poverty has a devastating effect on the health of people. Life expectancy in various counties in America can vary up to 20 years. In America’s poorest and most marginalized counties, people live to about 65 years old. And, like, I think it’s, like, Boulder, Colorado, or something, they live to be 85 years old. There are all these other health disparities that come out that we accept as correlations.
And yet, weirdly, when it comes to obesity it’s like, oh, no, no, we know obesity is the root of that, don’t we? Like, people kind of jumped at this causal explanation. And there is a very strong association, but there are very strong associations of all kinds of things with the health outcomes. The question, then, is why do we still put weight at the center of our understanding of health when there are in fact much more sophisticated ways to help people be healthy and we are not. really ?
MCCAMMON: You spend an episode examining how obesity has become not only a risk factor for certain diseases, but ultimately a disease in itself. Can you just explain to us how it happened?
GORDON: I mean, I think to talk about, in quotes, “obesity as a disease” you have to talk about BMI, which I think we now see as a hard and quick measure and a target measure. size and health. In the United States, the first type of public policy definition of overweight according to the BMI was that the top 15% of us should be considered overweight. It was unrelated to their specific health outcomes occurring at the time. That was right, we’re going to call the fattest 15% of us overweight.
Basically what happened here was that there was a public health person at the CDC who felt really passionately that our conversations about weight and weight loss were terribly simplistic. And he thought redefining obesity as a disease would lead people to understand that it’s a lot more complicated than that kind of personal accountability story like tough driving that we get.
The challenge is, as he did, a group of drug companies started supporting his efforts because if more people were defined as fat, they would have more clients for their weight loss drugs and surgery. This doesn’t mean that these products didn’t work for some people and didn’t lead to weight loss for some people, but it does mean it wasn’t a neutral medical decision that wasn’t influenced. by capital, right? Like any other industry, right? – in the food industry and in the health industry, profit motives are always in play.
MCCAMMON: I mean, isn’t the point of calling something an illness often to be more compassionate? I mean, we see that with the war on drugs – don’t we? – to consider drug addiction as a disease, which implies that it is not necessarily someone’s fault. It is something that requires treatment, not punishment, not contempt.
GORDON: Yeah. I think that was the intention of this person at the CDC. Paradoxically, and sadly, what we have seen in the years since this redefinition is a surge in prejudice against obese people. It has happened among health care providers. It happened among social workers. It’s happened among the general public in the United States that we’ve seen, you know, a dramatic increase in anti-fat stigma. So, despite the kind of better intentions behind this redefinition, it unfortunately produced the opposite.
MCCAMMON: I want to ask you both something. You know, you talk a lot about how losing weight shouldn’t be – probably shouldn’t be the goal of changing your lifestyle. You know, full disclosure, I’ll tell you my own experience. About four years ago I lost 60 pounds. I had gained weight during a stressful time in my life. It’s complex, isn’t it? A lot of things went into it. And so I had a much heavier weight than usual.
Very slowly and carefully, without, you know, any kind of extreme changes, I started making little lifestyle changes in terms of improving the quality of my food, just by taking a lot more walks. When I was heavier I was still pretty healthy, but every objective measure of health, you know, like my blood pressure looks better than it was four years ago. And I’m sharing this just to say – and you won’t offend me because I want to hear your honest opinion – is there a healthy way to think about weight loss? Is it still okay for this to be a goal?
GORDON: I don’t want to take anything away from anyone, do I? I don’t mean to tell people who, you know, are sort of looking to lose weight that this is a bad or unworthy goal for them. I want to tell people that this is a much more complicated business than we have been led to believe. The story you just told is that I changed the foods I ate. I changed the quality of the food I ate. I changed the way I moved and how much I moved. And then I lost weight. And then my health markers changed.
So you can still do all the other things. You can still produce altered health outcomes by changing your behaviors, which may or may not lead to weight loss. And it’s always a win for your health, right? I think we would all do ourselves a really big disservice by focusing only on the health markers and not the proxy for health markers, which is weight.
MICHAEL HOBBES: The thing that interests us is at the systems level. So public health, we must not aim for weight, we must aim for health. If we are talking about medical care, one really important thing is that doctors actually listen to patients. And if they want to have the conversation about weight loss, if a patient brings it up, I think that’s fine.
What we find are really cohesive stories of obese people going to the doctor with a migraine and their doctor telling them to lose weight. They come in with a car accident, their doctor tells them to lose weight. They come in with a tumor, their doctor tells them to lose weight. It’s something that is, like, really, really devastating to the health of obese people that people basically don’t listen to them.
MCCAMMON: What comments, if any, have you received from the medical community for your podcast?
HOBBES: Oh, it’s like, unbelievably – this is one of the most disappointing emails I’ve ever seen. Like, it’s like sentence by sentence. It is as if this bias does not exist. And, oh, here’s my bias. It’s fascinating to me that as a very basic thing – ask them about their diet and exercise habits before you tell them boring, boring advice like calories in, calories out. Like, there’s so much resistance to that.
GORDON: So Mike tends to get line by line, extremely overt bias emails. I tend to get emails from healthcare providers talking about things like, oh, my god I never thought about why I had to put BMI on every patient’s chart, oh, my God, we are now talking about anti-fat stigma training and eating disorder screening before making any dietary recommendations to a patient. Like, every time Mike checks his emails the message he gets is that the doctors hate us. And every time I get mine – I check mine, I tell myself that everything is changing and things are getting better.
HOBBES: I know. We have to trade someday just for the sake of morale.
GORDON: (Laughs) Really. I don’t know if I can handle it.
MCCAMMON: Michael Hobbes and Aubrey Gordon present the “Maintenance Phase” podcast.
Thank you both very much for speaking with us.
HOBBES: Thanks for having us.
GORDON: Thanks. Transcript provided by NPR, Copyright NPR.