Podcasts about anti fatness

We're going to talk about food and nutrition next week. But first, we need to talk about beauty.Spoiler warning: You're beautiful.Links: Amelia is doing Youtube Lives again starting this Friday @4pm eastern!(From now until the end of Murderbot.)Bob the Drag Queen⭐️ Drink Water and Mind Your Business by Dr. Donna Oriowo ⭐️(Emily loves this book and blurbed it!)Get it from:SourcebooksAmazonBook Moon BooksDr. Yaba BlayThe Whites of Our Eyes is a short documentary film that follows Dr. Yaba Blay as she returns to her familial homeland of Ghana to explore the relationships between beauty, bodies, and b/BlacknessRad Bod or Dad Bod (Youtube)The NorthmanLindsay Ellis explains The Little Mermaid (Youtube)FD Signifier explains edgelords (Youtube)Jessica Kellgren-Fozard explains ugly laws (Youtube)Wreck-it Ralph villain support group (Youtube)Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun HarrisonHealth at Every SizeGood Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and HealthWhy Diets Make Us Fat by Sandra AamodtFSP 2020 Episode 18: The New HotnessThe Body Project Turia Pitt(it looks like Amelia's episode with Turia isn't up yet.)Ubuntu Reclaiming Ugly by Vanessa Rochelle Lewis

In many ways, the health and wellness industry is killing Black people. For our audacity to exist with melanated skin, we've historically endured subjugation, political and economic disenfranchisement, and centuries-long death. And it hasn't stopped yet. In June 2023, Jay talked about it with Da'Shaun L. Harrison for season 7 of BHY. Da'Shaun is a self-described Black, fat, trans, disabled, queer abolitionist, community organizer, writer, and editor at Scalawag magazine. Their award-winning book, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, explores desirability politics, gender, policing, and the fallacies of healthiness. __________________________ Black History Year (BHY) is produced by PushBlack, the nation's largest non-profit Black media company. PushBlack exists to amplify the stories of Black history you didn't learn in school and explore pathways to liberation with people leading the way. You make PushBlack happen with your contributions at BlackHistoryYear.com — most people donate $10 a month, but every dollar makes a difference. If this episode moved you, share it with your people! Thanks for supporting the work. Hosting BHY is Jay (2020-2023) and Darren Wallace (2024). The BHY production team includes Jareyah Bradley and Brooke Brown. Our producers are Cydney Smith and Len Webb for PushBlack, and Lance John with Gifted Sounds edits and engineers the show. BHY's executive producers are Julian Walker and Lilly Workneh. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

It's NOT the most wonderful time of the year for a lot of fat folks because many will be spending time with anti-fat family and then once you survive that it's into the “New Year New You” diet culture dog shit. Ugh. Want some tactics to overcome this stressful time? Tune into this episode for the salve to all this nonsense. Don't forget: you're worthy, you always were you always will be. Episode show notes: http://www.fiercefatty.com/194 Support me on Ko-Fi and get the Size Diversity Resource Guide: https://kofi.com/fiercefatty/tiers Link to the Your Fat Friend doc: https://youtu.be/VZ61fo1SJWs?si=1iNDEc33RW7powzX Link to healthcare survey: https://forms.gle/wVhrP5EjvyEX5Atx9 Boundaries song: https://youtu.be/rZ0ZUVXqJc4 New Year, Same Body, More Love: Resisting Diet Culture and Anti-Fatness in 2025 Thursday 16th January, 2025, 12pm PST: https://fiercefatty.my.canva.site/new-year-same-body-more-love

Having a bigger body and trying to access healthcare can be a struggle at best and lead to mistreatment, misdaignosis and death at worse. I go over the 5 stages of subpar healthcare in this episode, talk about the root of the issue and share some stories. TW: mentions of death from anti-fat bias and other general anti-fat tomfuckery. Episode show notes: http://www.fiercefatty.com/193 Support me on Ko-Fi and get the Size Diversity Resource Guide: https://kofi.com/fiercefatty/tiers Link for training: https://fiercefatty.my.canva.site/boundary-boss Take the Fat in Healthcare survey: https://forms.gle/wVhrP5EjvyEX5Atx9 Five Ways Health Care Can Be Better for Fat People: https://journalofethics.ama-assn.org/article/five-ways-health-care-can-be-better-fat-people/2023-07 In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C Health Care: chrome-extension://kdpelmjpfafjppnhbloffcjpeomlnpah/https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Summary-Report.pdf Viral stories show how 'fatphobia' has life-and-death consequences— even for babies and kids: https://www.upworthy.com/viral-post-shows-how-fatphobia-has-life-and-death-consequences-even-for-babies-and-kids Opinion  Doctors have fatphobia, too — which does serious harm to patients: https://archive.md/nhRFl#selection-447.0-453.65 My sister's cancer might have been diagnosed sooner — if doctors could have seen beyond her weight: https://archive.md/CGdDf#selection-903.0-903.98 Ellen Bennett Obituary: https://www.legacy.com/ca/obituaries/timescolonist/name/ellen-bennett-obituary?id=40627610 How 'fat shaming' from doctors is leading to misdiagnoses for obese patients: https://cbc.ca/radio/thecurrent/the-current-for-august-1-2018-1.4769487/how-fat-shaming-from-doctors-is-leading-to-misdiagnoses-for-obese-patients-1.4769569 Fat shaming in the doctor's office can be mentally and physically harmful: https://www.sciencedaily.com/releases/2017/08/170803092015.htm Weighing the care: physicians' reactions to the size of a patient: https://pubmed.ncbi.nlm.nih.gov/11477511/ Take the Fat in Healthcare survey: https://forms.gle/wVhrP5EjvyEX5Atx9

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Shauna asked “I just saw an article about the Body Roundness Index, is that as silly as I think it is?”The Body Roundness Index seems to be the weight loss industry's response to finally having to (at least begin to) admit that the Body Mass Index (BMI) is nonsense. The BMI is a ratio of weight and height that has been used to pathologize bodies based on their size alone and has its basis in racism. I talked about that in depth in this piece.Earlier this year the AMA, which takes hundreds of thousands of dollars in donations from the weight loss industry,  tried a little sleight of hand with this, admitting that there are serious issues with the BMI (which has been used as a justification for the much of the weight loss paradigm) but instead of acknowledging that simply pathologizing bodies based on shared size is an idea lacking scientific basis and merit that has done incredible harm, they instead said that we just needed more and different ways to pathologize bodies based on shared size.That brings us to the study Shauna sent me: “Body Roundness Index and All-Cause Mortality Among US Adults” published in JAMA (the Journal of the American Medical Association.)The authors reported no conflicts of interest, even though one of the authors, Qiushi Lin, MD, PhD, literally works for Sanofi Aventis which just had its weight loss drug preliminarily rejected by an FDA panel.Where the BMI is used to pathologize bodies based on weight and height, the The Body Roundness Index (BRI) uses weight and waist circumference.The specific calculation they used is “364.2 − 365.5 × √(1 − [waist circumference in centimeters / 2π]2 / [0.5 × height in meters]2)”The use of mathematical formulas tends to lend these concepts an heir of scientific validity that they do not deserve. They explain that “Due to the lack of a reference range, BRI was categorized into 5 groups according to the 20th, 40th, 60th, and 80th quantiles to explore the association with all-cause mortality.”They find a “U-shaped association between BRI and all-cause mortality. Our findings provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”By this they mean that those at the lower and higher ends of this scale have higher all-cause mortality. As I've talked about before, one of the cornerstones of research methods is that correlation does not imply causation. The U-shaped association they found might be a valid correlation. The mistake happens if the assumption is that the BRI is the REASON for the increased risk and, when it comes to weight and health (particularly those of higher-weight people) that's what typically happens. That's what I think the problem is going to be. In our culture, there is a tendency to jump at any perceived “proof,” no matter how shoddy, that being higher weight causes health issues/is a health issue. What these researchers have found is an unexplained correlation between being at lower and higher weights and higher rates of all-cause mortality. What they absolutely have not found is that being at lower and higher weight CAUSES higher rates of all cause mortality. They don't ever claim that they've found causation but then they conclude “a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies” and not, for example, that causal mechanism(s) should be identified prior to foisting this formula on the public, it gives me the sense that they are jumping the gun here. I'm not going to do a deep dive into the methodology here because the concept is so deeply flawed at its base.I'll start with those at lower BRI range. Their BRI could be due to extreme illness (including everything from cancer, to substance use disorders, to eating disorders and more )that are the actual reason for increased all cause mortality. What they may have found is that those in the lower BRI categories are more likely to be very ill which means their findings would not extrapolate to those at the lower end of the weight spectrum who are not experiencing illness. When it comes to higher-weight people, we know that experiences of weight stigma, weight cycling, and healthcare inequalities are all associated with increased all-cause mortality. People with a higher BRI are more likely to have these experiences. Not only did these study authors fail to control for these, they failed to even mention them. Without controlling for these possible confounding variables, what their findings may indicate is just that they've found even more evidence that experiences of weight stigma, weight cycling, and healthcare inequalities increase all-cause mortality.So, if the lower someone's BRI category is, the more likely it is that they are very ill and the higher someone's BRI category is, the more likely that they've experienced/experience greater weight stigma, weight cycling, and healthcare inequalities, then we would see the exact “U-shaped association between BRI and all-cause mortality” that the study authors found.I'm not saying those are definitely the reasons, I'm saying that's the research we should be doing, not more research to reinforce a questionable correlation until the weight loss industry starts claiming that if there are *that many* studies that show correlation then it *must be* causation. Besides the weight loss industry (mis-)using this concept, I am worried about what this will lead to in terms of healthcare. The weigh-ins that patients are expected/pushed to endure in order to calculate BMI already cause some patients to delay or avoid healthcare appointments. How much worse is that going to become when healthcare providers are running after patients with tape measures to get a waist circumference measurement so they can calculate BRI. If BRI is “incorporated into public health practice” as these authors suggest using simply the correlation they've found, then the mostly likely outcome is that the suggestion is to manipulate BRI to improve all-cause mortality risk. This will be another way for the weight loss industry (including Sanofi Aventis if they can get their new drug into the endzone) to continue making money hand over fist, but for patients it will be the same old thing, which makes its use instead of BMI basically a distinction without a difference. Whether it's due to profit incentive, paradigm entrenchment, or a combination of both, the people doing this research seem to be willing to do absolutely anything other than control for confounding variables or consider the evidence that focusing on supporting health directly (rather than maintaining our obsession with weight loss,) may provide more benefits with fewer risks.Driven by the weight loss industry, weight science has gone a long way down the wrong road and they would rather step on the gas then slow down, let alone turn around. A healthcare system that is committed to viewing the existence of higher-weight people as a problem to be solved will never create polices or interventions that truly support the physical or mental health of higher-weight people. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

CNN anchor shuts down interview with Trump spox, proving the whole thing is rigged. Being anti-fat is racist? Anti-Jewish protesting crossed a serious line. Justin Heap, Caroline Sunshine and Adam Kwasman join the show.

[This show originally broadcast on March 20th, 2024] In her latest book, Unshrinking: How to Face Fatphobia author Kate Manne uses intimate stories and sharp analysis to explain why anti-fatness […] The post Rebroadcast: Kate Manne On Anti-Fatness appeared first on WORT-FM 89.9.

Joeita speaks with Kate Mann, Associate Professor Cornell University's Sage School of Philosophy & author of "Unshrinking: How to Face Fatphobia," which draws on personal experience & rigorous research to expose how size discrimination harms everyone, and how to combat it. HighlightsThe Insidiousness of Fatphobia - Opening Remarks (00:00)Society's Fixation on Weight & the “Ideal Body” (01:07)Introducing Kate Manne, Author of “Unshrinking: How to Face Fatphobia” (01:59)Philosophical Interest in Misogyny & Fatphobia (02:22)Defining Fatphobia (04:17)Complicated Relationship Between Fatness & Health (06:03)Fatphobia in the Healthcare System (10:15)Weigh-In Process & Weight-Inclusive Physicians (12:27)Diabetes, BMI & Stigma (13:19)Intersections of Fatphobia, Race, Class, Ability & Gender (16:22)The Politics of Anti-Fatness as Anti-Blackness (18:28)Thin-Privilege (19:36)Beyond Body-Positivity (22:24)Thinsplaining - Book Excerpt (24:22)Find the Book “Unshrinking: Facing Fatphobia” (27:51)Show Close (28:33)Guest Bio - Kate Manne is an associate professor of philosophy at Cornell University, where she's been teaching since 2013. Before that, she was a junior fellow at the Harvard Society of Fellows. Manne did her graduate work in philosophy at MIT and is the author of two previous books, Down Girl and Entitled.“Unshrinking: How to Face Fatphobia” By Kate Manne from Penguin Random House“An elegant, fierce, and profound argument for fighting fat oppression in ourselves, our communities, and our culture.”—Roxane Gay, author of HungerFor as long as she can remember, Kate Manne has wanted to be smaller. She can tell you what she weighed on any significant occasion: her wedding day, the day she became a professor, the day her daughter was born. She's been bullied and belittled for her size, leading to extreme dieting. As a feminist philosopher, she wanted to believe that she was exempt from the cultural gaslighting that compels so many of us to ignore our hunger. But she was not.Blending intimate stories with the trenchant analysis that has become her signature, Manne shows why fatphobia has become a vital social justice issue. Over the last several decades, implicit bias has waned in every category, from race to sexual orientation, except one: body size. Manne examines how anti-fatness operates—how it leads us to make devastating assumptions about a person's attractiveness, fortitude, and intellect, and how it intersects with other systems of oppression. Fatphobia is responsible for wage gaps, medical neglect, and poor educational outcomes; it is a straitjacket, restricting our freedom, our movement, our potential.In this urgent call to action, Manne proposes a new politics of “body reflexivity”—a radical reevaluation of who our bodies exist in the world for: ourselves and no one else. When it comes to fatphobia, the solution is not to love our bodies more. Instead, we must dismantle the forces that control and constrain us, and remake the world to accommodate people of every size.Articles:In 'Unshrinking,' a writer discusses coming out as fat and pushing back against bias - NPR InterviewFighting Fatphobia and Embracing ‘Unshrinking': The Ms. Q&A With Kate Manne - MS Magazine Reference:Belly of the Beast The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. HarrisonTo live in a body both fat and Black is to exist at the margins of a society that creates the conditions for anti-fatness as anti-Blackness. Hyper-policed by state and society, passed over for housing and jobs, and derided and misdiagnosed by medical professionals, fat Black people in the United States are subject to sociopolitically sanctioned discrimination, abuse, condescension, and trauma.Da'Shaun Harrison—a fat, Black, disabled, and nonbinary trans writer—offers an incisive, fresh, and precise exploration of anti-fatness as anti-Blackness, foregrounding the state-sanctioned murders of fat Black men and trans and nonbinary masculine people in historical analysis. Policing, disenfranchisement, and invisibilizing of fat Black men and trans and nonbinary masculine people are pervasive, insidious ways that anti-fat anti-Blackness shows up in everyday life. Fat people can be legally fired in forty-nine states for being fat; they're more likely to be houseless. Fat people die at higher rates from misdiagnosis or nontreatment; fat women are more likely to be sexually assaulted. And at the intersections of fatness, Blackness, disability, and gender, these abuses are exacerbated.Taking on desirability politics, the limitations of gender, the connection between anti-fatness and carcerality, and the incongruity of “health” and “healthiness” for the Black fat, Harrison viscerally and vividly illustrates the myriad harms of anti-fat anti-Blackness. They offer strategies for dismantling denial, unlearning the cultural programming that tells us “fat is bad,” and destroying the world as we know it, so the Black fat can inhabit a place not built on their subjugation. About The PulseOn The Pulse, host Joeita Gupta brings us closer to issues impacting the disability community across Canada.Joeita Gupta has nurtured a life-long dream to work in radio! She's blind, moved to Toronto in 2004 and got her start in radio at CKLN, 88.1 FM in Toronto. A former co-host of AMI-audio's Live from Studio 5, Joeita also works full-time at a nonprofit in Toronto, specializing in housing/tenant rights. Find Joeita on X / Twitter: https://twitter.com/JoeitaGupta The Pulse airs weekly on AMI-audio. For more information, visit https://www.ami.ca/ThePulse/ About AMIAMI is a not-for-profit media company that entertains, informs and empowers Canadians who are blind or partially sighted. Operating three broadcast services, AMI-tv and AMI-audio in English and AMI-télé in French, AMI's vision is to establish and support a voice for Canadians with disabilities, representing their interests, concerns and values through inclusion, representation, accessible media, reflection, representation and portrayal. Learn more at AMI.caConnect on Twitter @AccessibleMediaOn Instagram @accessiblemediaincOn Facebook at @AccessibleMediaIncOn TikTok @accessiblemediaincEmail feedback@ami.ca

Kate Manne joins Let's Talk Memoir for a conversation about coming of age in fatphobic culture, disentangling the threads of weight, health, and diet culture, the racism at the root of anti-fatness, writing ourselves out and then back into our work, the psycho-social consequences of fatphobia on our bodies, the shame around shame, organizing our time, writing while mothering a young child, gathering and incorporating research in our work, and her new book Unshrinking: How to Face Fatphobia.   Also in this episode: -the rhetoric around dieting -becoming self-compassionate through writing -why we might not trust pleasure    Books mentioned in this episode: Fearing the Black Body by Sabrina Strings Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison Hunger by Roxanne Gay You Just Need to Lose Weight by Aubrey Gordon What We Don't Talk About When We Talk About Fat by Aubrey Gordon Fat Talk by Virginia Sole Smith   Kate Manne is an associate professor of philosophy at Cornell University, where she's been teaching since 2013. Before that, she was a junior fellow at the Harvard Society of Fellows. Manne did her graduate work in philosophy at MIT, and works in moral, social, and feminist philosophy. She is the author of three books, Down Girl: The Logic of Misogyny, Entitled: How Male Privilege Hurts Women, and Unshrinking: How to Face Fatphobia, which came out in January. You can subscribe to her substack newsletter, More to Hate, for musings on misogyny, fatphobia, their intersection, and more.  Connect with Kate: Website: http://www.katemanne.net/ Substack: https://katemanne.substack.com/ X: https://twitter.com/kate_manne, Instagram: https://www.instagram.com/kate_manne Get “Unshrinking” here: https://www.penguinrandomhouse.com/books/722318/unshrinking-by-kate-manne/   — Ronit's writing has appeared in The Atlantic, The Rumpus, The New York Times, The Iowa Review, Hippocampus, The Washington Post, Writer's Digest, American Literary Review, and elsewhere. Her memoir WHEN SHE COMES BACK about the loss of her mother to the guru Bhagwan Shree Rajneesh and their eventual reconciliation was named Finalist in the 2021 Housatonic Awards Awards, the 2021 Indie Excellence Awards, and was a 2021 Book Riot Best True Crime Book. Her short story collection HOME IS A MADE-UP PLACE won Hidden River Arts' 2020 Eludia Award and the 2023 Page Turner Awards for Short Stories. She earned an MFA in Nonfiction Writing at Pacific University, is Creative Nonfiction Editor at The Citron Review, and lives in Seattle with her family where she teaches memoir workshops and is working on her next book. More about Ronit: https://ronitplank.com Sign up for monthly podcast and writing updates: https://bit.ly/33nyTKd   Follow Ronit: https://www.instagram.com/ronitplank/ https://twitter.com/RonitPlank https://www.facebook.com/RonitPlank   Background photo credit: Photo by Patrick Tomasso on Unsplash Headshot photo credit: Sarah Anne Photography Theme music: Isaac Jo

In her latest book, Unshrinking: How to Face Fatphobia author Kate Manne uses intimate stories and sharp analysis to explain why anti-fatness has become a vital social justice issue. She […] The post Kate Manne on Anti-fatness appeared first on WORT-FM 89.9.

Philosopher Kate Manne (Down Girl, Entitled) joins Moira and Adrian to talk about the politics of anti-fatness – where fatphobia came from historically, how it intersects with racism, sexism and transphobia, and how interpreting bodies according to moralizing principles remains a right-wing idea that succeeds even in the leftiest of spaces.

Send us a Text Message.Simone Samuels, B.A. (Hons.), J.D., B.C.L. is a consultant in equity, diversity and inclusion and a weight-neutral personal trainer/group fitness instructor.  A lawyer by training and a fitness professional, she has consulted for fitness organizations in Canada, US and the UK and has delivered courses on weight stigma, fatphobia, anti-racism, allyship and anti-oppression.Simone is a tireless advocate for making the fitness and wider world a more inclusive place.I was SO excited to chat with Simone and knew it would be a confronting and very important conversation. She was incredibly generous with her time and I know you will very much enjoy this meaty conversation.We chatted about:How white female Fitpros can actually be inclusive in the fitness space?The racist roots of the BMI and diet culture.  Simone recommends some must-read books for those serious about doing the work.According to the BMI the ROCK (Dwayne Johnson) is morbidly ob*se. It was never meant to be used at a population level.Overcoming fatphobia in fitness spaces.  How we can get informed.Finding real joy in movement in this hustle culture and untangling weight loss and exercise.We chat about Aqua Zumba and ask why aqua is always associated with an older demographic.What a chat!  I was truly buzzing afterwards and cannot wait to get Simone back for part 2.  Recommended Reading for Fitpros or anyone engaged in the fitness industry:Sabrina Strings - Fearing the Black Body. The Racist Origins of FatphobiaDa'Shaun L. Harrison - The Belly of the Beast: The Politics of Anti-Fatness as Anti-BlacknessIbram X Kendi: Stamped From The Beginning: A Graphic History of Racist Ideas in AmericaIf you'd like to know more about  Simone, find her on Instagram or have a look at her website, where she has lots of different options to work Are you feeling stuck in the 'earn and burn' cycle with your exercise routine, or as summer approaches, are you feeling self-conscious about wearing a swimsuit on the beach? Maybe you just want to stop worrying so much about food or how your body looks.You are not alone and your body is NOT the problem Please reach out if you would like some support. We both have limited slots for Intuitive Eating Coaching, so get in touch with Christine or with Ela.AND if you enjoyed this episode, please share and follow the 'Find Your Strong podcast' and if you have time, write us a short review. It would honestly mean the world. Love to you all, Ela & Christine x

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!This is the final in a three-part series about Tirzepatide (Brand name Mounjaro for Type 2 diabetes and Zepbound for Weight Loss.) In part one we discussed the basics of the drug, in part 2 we discussed the authors of this study and finally, in part three we'll finish discussing the most recent study on Zepbound - SURMOUNT -4.(the text in italics is from the study itself.)SURMOUNT-4 was designed to find out what happens when higher-weight people (without type 2 diabetes) go on the drug for a while and then go off of it. The study was divided into two periods In the first 36 weeks all of the participants took Tirzepatide. Then there was a 52-week period during which subjects were randomly assigned to receive either tirzepatide, or a placebo.The basic findings, per the study:After 36 weeks of open-label maximum tolerated dose of tirzepatide (10 or 15 mg), adults (n = 670) with obesity or overweight (without diabetes) experienced a mean weight reduction of 20.9%. From randomization (at week 36), those switched to placebo experienced a 14% weight regain and those continuing tirzepatide experienced an additional 5.5% weight reduction during the 52-week double-blind period.Here's a graph that shows the average results:Some things to note:First, the graph clearly shows that people who go off the drug rapidly start regaining the weight they lost, and their weight was trending up when follow-up ended, suggesting that the weight regain will continue (as we've seen in about a century of research and in the history of weight loss drugs.) In addition to being exposed to the side effects of these drugs (some of which can be fatal) these people will also be subjected to the risks that come from weight cycling which include everything from increased risk of type 2 diabetes and hypertension to increased cardiovascular disease and overall mortality. This is important since there are any number of reasons why someone would have to go off the drug, from side effects, to expense, to availability.For those who remained on the drug, weight loss slowed considerably and by the end, had started to rise slightly, which means that the claim that weight loss will be permanent as long as people stay on the drug is not supported by the evidence.Let's go beyond average results and get into some specifics - 783 participants were enrolled in the initial 36-week study in which all participants took Tirzepatide, but 113 discontinued the study drug before the 36-week stage even ended, most commonly due to an adverse event or participant withdrawal. So a little over 14% didn't even make it 9 months on the drug, and that's including the fact that the drug was started at a minimal 2.5mg dose and then increased by 2.5 mg every 4 weeks until a maximum tolerated dose of 10 or 15 mg was achieved.300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in periodDid you catch that? First, 10.5% of the group who were still taking the drug during the one-year follow-up had already gained back more than 20% of the weight they lost in the first 36 weeks- again even though they were Still. Taking. The. Drug. As for the rest, they could well have been regaining the weight because of the way the study defined “maintaining.” For the purposes of this study, “maintaining” weight loss doesn't mean that people lost weight and kept it off (as the word would be used in any reasonable context.) For this study, “maintained” just meant that they were regaining the lost weight slowly enough that by 52 weeks these participants hadn't regained 20% of the weight that they lost in the first 32 weeks…yet. (This is one of those examples of words having different meanings in weight loss research.)Let's take a look at side effects:A total of 81.0% of participants reported at least 1 treatment-emergent adverse event during the tirzepatide lead-in treatment period, with the most frequent events being gastrointestinal (nausea [35.5%], diarrhea, [21.1%], constipation [20.7%], and vomiting [16.3%]… [During the follow up period] Gastrointestinal events were more common in the tirzepatide group than in the placebo group (diarrhea, 10.7% vs 4.8%; nausea, 8.1% vs 2.7%; and vomiting, 5.7% vs 1.2%)Of course, the trial wasn't long enough to determine long-term impacts. They also say :A significantly greater percentage of participants continuing tirzepatide vs placebo met the weight reduction thresholds of at least 5% (97.3% vs 70.3%), at least 10% (92.1% vs 46.2%), at least 15% (84.1% vs 25.9%), and at least 20% (69.5% vs 12.6%) from week 0 to week 88Let's say the above another way: 2.7% of people who took Tirzepatide for 88 weeks, opening themselves up to side effects and unknown long-term consequences failed to lose even 5% of their body weight, 7.9% failed to lose even 10%, 15.9% failed to lose 15% and 30.5% failed to lose 20%. This is important since they are touting the mean weight loss as 25.3% in their results section. That's the kind of thing that healthcare providers should include in an informed consent conversation.The study group is also problematic in terms of extrapolation. Study findings can only be reliably applied to people in the demographics that were studied. In this case, the randomized participants were 70.6% cis women and there was no trans or non-binary representation. The mean age was 48 and the participants were 80.1% white despite having study sites at “70 sites in Argentina, Brazil, Taiwan, and the US.” In fact, the study states “The study was not designed to represent the racial diversity of each of the participating countries.” This, to me, is unconscionable – if you can't get a more representative sample than this, then just don't proceed with the study until you can.The lack of a weight-neutral comparator group is also an issue. Research suggests that weight-neutral, health-supporting behaviors can have more health benefits with far less risk than intentional weight loss, including with diet drugs. By comparing their drug to a “placebo group” that is still attempting intentional weight loss, just without pharmaceutical support, they are stacking the deck, taking advantage of the fact that they KNOW that behavioral weight loss interventions don't work long-term (they literally admit that in their introduction.)  It also allows them to avoid a comparison of the actual health impacts of their drugs against the health impacts of a weight-neutral health intervention – including the difference in risk.So, does the conclusion say that about 10% of people who take the drug can expect to lose weight over the first 36 weeks and then regain more than 20% in the next 52 weeks? Does it say how many others were slowly regaining weight, though they hadn't (yet) regained 20% after a year?No.They conclude:“In participants with ob*sity or over*eight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction.”That, I would suggest, is what happens when Eli Lilly and Company are involved in the study design and conduct; data collection, management, analyses, and interpretation of the data; preparation, review, approval of the manuscript; and decision to submit the manuscript for publication, and almost every listed author is either taking money from them, or is directly employed by them.Let me offer an alternative suggestion as to what may have happened here: Participants joined this study, ostensibly, because they wanted to lose weight. They took a drug for 36 weeks that disrupted their natural sense of hunger and satiety and their natural digestive processes while (if we take their claims at face value) eating 500 calories a day less than their bodies need to properly function while exercising 150 minutes or more per week.At 36 weeks, the drug is withdrawn from some participants whose bodies then return to their normal function and try desperately to return to stasis (which is a process that we see in non-drug induced weight loss from behavioral interventions when, after about a year of weight loss people begin to regain weight, with the vast majority regaining all of the weight they lost.)Remember, too, that they know they are part of a trial and that they may continue getting the trial drug, or they may be getting a placebo. As almost anyone who has attempted behavior-based intentional weight loss (aka dieting) can tell you: trying to exercise while restricting food is very unpleasant, more so for this group now that their natural sense of hunger is not experiencing drug-induced interference. The fact that they no longer feel sick after their injection and/or that they can once again experience natural hunger means that they are likely aware that they are in the placebo group. They regain the weight they lost rapidly because of their body's natural reaction to being under-nourished (changing physiologically to become a weight regaining/weight maintaining machine) and the fact that their digestion is no longer impaired and their hunger is no longer suppressed.Meanwhile, another group is kept on the hunger and digestion-disrupting drug. Their weight loss slows dramatically at 52 weeks and, for many, begins to reverse by the end of 72 weeks. This is perhaps their body finally being able to overcome the drug-induced food deprivation they've been experiencing. There is no reason not to expect continued weight gain if these patients are tracked beyond 72 weeks (which, since the company funding the research is the company that wants people to take the drug, seems unlikely to me.)Again, everything about this study is designed to overstate the drug's effectiveness, and that's not surprising given the drug manufacturer's deep participation in every aspect of the study which is why, with weight loss interventions, it's always buyer beware.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Health, nutrition, and food are spaces that can be fraught with harmful and perpetual misconceptions of the body, to the point where many people of the global majority may not always feel safe or heard. My guest this week, Patrilie Hernandez, is someone who works to create more weight-inclusive and nutritionally holistic practices at the forefront of these spaces. Patrilie (they/she) has over 14 years of professional experience working in the health and nutrition sector as an educator, advocate, project manager, and policy analyst. They combine their academic background in culinary arts, anthropology, nutrition and health with lived experience a sa large-bodied, neuroatypical, queer, multiracial femme of the Puerto Rican diaspore to disrupt the status quo of the local nutrition and wellness community, where they advocate for a weight-inclusive paradigm centring on the social determinants of health. Patrilile is the founder of Embody Lib and partners with nutrition, medical, health, and wellness providers to integrate weight-inclusive strategies that can help improve the health and wellbeing of historically marginalized communities. In today's conversation, we explore how her exceptional background informs her multi-dimensional approach to nutrition and food, unpack colonial and white supremacist lenses that have long-informed nutritional and food spheres while still looking at the value of science and health, and how their Embody Lib work platform helps people of the global majority reclaim their health and wellbeing. Learn More About Patrilie! Website: https://www.embodylib.com/ The Body Liberation Learning Platform Follow Patrilie on Instagram: @the_bodylib_advocate  

Happy 2024! I am ready for another year of writing about the intersections of weight science, weight stigma, and healthcare and I'm glad you are here reading! This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I received the following question from reader Lisa:I notice that when you write about things that can hurt larger people's health you usually mention weight cycling, weight stigma, and healthcare inequalities. I've read your posts for the first two – is there a post that describes the third one?Thanks for asking Lisa, I've been meaning to write this and you've given me the perfect gentle push! For the record the piece for the harm of weight cycling is here and the one on the harm of weight stigma is here.The idea of healthcare inequalities is difficult to quantify because it's such a vast category. In terms of a definition, the one I'm going to use here is any way in which higher-weight people's healthcare experiences differ from those of thin people to the detriment of higher-weight people.It's always important to remember that when we discuss these inequalities we are clear that they don't impact everyone equally, as people's weight becomes higher their experience of inequality typically increases as well and, utilizing Kimberlé Crenshaw's framework of intersectionality, those who have multiple marginalized identities will also face greater inequality in their individual marginalizations and at the intersections of them.Finally, I want to point out that thin people can face healthcare disparities as well based on things like marginalized identities and socioeconomic status. The comparisons I'm drawing here are about the typical experience of thin people and are not meant to indicate that thin people never face issues in accessing healthcare, just that as a group thin people are not systematically marginalized within the healthcare system because of their size.I also want to be clear that this is not an exhaustive list and I welcome you to add other examples in the comment section. I'm going to divide these up into groups to help give this conversation some structure.Practitioner BiasThis includes a lot of different things. Before I get into it, I want to point out that providers aren't necessarily bad actors who just hate fat people (though, sadly, some absolutely are.) Many are simply a product of a healthcare system (including healthcare education) that is deeply rooted in weight stigma. Regardless of how they got to this place, these practitioners are responsible for the harm that they do.Some practitioners are operating out of implicit bias, which is to say that the bias is subconscious. Others are operating from explicit bias, they are fully aware of their negative beliefs and stereotypes about higher-weight people and they are working with higher-weight patients based on those beliefs and feelings. This can lead to a lot of negative impacts. Some examples:There is the classic (and far too prevalent) example of a practitioner who offers ethical, evidence-based treatments to thin patients for health issues, but sends higher-weight patients with the same symptoms/diagnoses/complaints away with a diet.There's the “Occam's razor” mistake. Occam's Razor states “plurality should not be posited without necessity.”  Said another way, when choosing between theories, the simplest one is usually correct. This gets applied to the care of higher-weight patients when providers don't address individual health issues/symptoms/diagnoses/complaints for fat patients because they assume weight loss will solve them all (and/or they want to see what weight loss solves before attempting the ethical, evidence-based treatments that thin people would typically get for the same issues/symptoms/diagnoses/complaints.)Some practitioners assume that fat patients are lying if what they are telling the provider doesn't match up with the provider's stereotypes of people their size. These practitioners base decisions and recommendations on their stereotypes rather than what the patient is telling them.There are practitioners who, consciously or subconsciously, are reluctant to touch fat patients or manipulate their bodies which can impact everything from examinations to post-operative care.There are practitioners who think it's worth risking fat people's lives and quality of life in attempts to make them thin. Some of these practitioners take this further by deciding that they know better than fat people and so try to manipulate/trick/bully fat people into weight loss interventions (including dangerous drugs and surgeries) by almost any means necessary including intentionally failing to give a thorough informed consent conversation – blowing patients off with phrases like “all drugs have side effects” or “it's nothing to worry about” rather than being honest about the risks and/or making threats about the patient's health and life expectancy that are not supported by evidence. These inequalities can lead to many harms. First of all, we know from a century of data that weight loss almost never works and typically results in weight cycling which is independently linked to a number of harms. It can also delay care – when a thin person gets an intervention at their first appointment but a fat person with the same symptoms/diagnosis gets sent away with a recommendation to lose weight the higher-weight patient's actual care is delayed.The “Occam's Razor” mistake creates similar problems. It must be remembered that Occam (actually, it seems, Ockham but that's a whole other thing) was a philosopher, not a physician. Deciding to treat something as complex as the human body by going for the simplest strategy is problematic on its face, even before we add the ways that weight stigma impacts providers' beliefs around and treatment of higher-weight patients.And there is another layer of harm here. As we'll see over and over, the harm from healthcare inequalities is intensified when the results of the harm are blamed on fat bodies. For example, higher-weight patients follow practitioners' advice to attempt weight loss. They lose weight short term and gain it back long term (which is exactly what all the research we have says will happen.) Their doctors tell them to try again, they weight cycle again. This happens repeatedly across their entire lives. Eventually these patient are diagnosed with cardiovascular disease (CVD). The fact that CVD is strongly linked to weight cycling is completely ignored and research (often created by/for the weight loss industry) blames “ob*sity” for the CVD and uses these higher rates of CVD to lobby for greater insurance coverage of weight loss treatments and the cycle of harm continues unabated.Structural InequalitiesThis occurs when the things that higher-weight patients need in order to access healthcare don't accommodate them. This can be because the things don't exist or because the healthcare facility that the patient is visiting doesn't have them.Again, there are too many examples here to name. One very common example is chairs. Having sturdy armless chairs in the waiting room, treatment rooms, and anywhere a patient may need to sit is the absolute least a facility can do and it's deeply disturbing how many facilities don't even get this right.Then there are the absolute basics of care – when the practice doesn't have (or can't find) properly sized/accommodating blood pressure cuffs, proper length vaccine needles, gowns, scales (for medically necessary weigh-ins like those to dose medications or check for edema from a heart condition). These are all things that thin patients can typically expect to be available.Durable medical equipment is another area where structural inequalities can compromise care – crutches, braces, walkers, wheelchairs, prosthetics.  Even when these things are available, they are often exponentially more expensive even when they don't have to be custom made.Then there are more specialized tools like operating tables and surgical instruments. Often the only place these instruments can be reliably found is in centers that focus on weight loss surgeries, meaning that higher-weight patients are excluded from the kind of surgical care that is routine for thinner patients.Next is imaging -   MRI and CT scanners that have high-weight rated tables and large enough bore sizes, ultrasounds that can appropriately view through adipose tissue, x-ray tables and spaces that are accommodating and more. Harm is added here when energy from those in the healthcare system is wasted on complaining that higher-weight people exist or justifying the lack of care, rather than focusing on solutions and working from the basis that healthcare should fit bodies, bodies shouldn't have to be changed to fit healthcare.As an example of this, let's look at the ways that a single MRI appointment can create healthcare inequalities. A patient is referred for an MRI of their knee with contrast. First, the patient goes to the facility to which their doctor referred them but is turned away because the MRI is too small. They call the referring doctor, who isn't aware of any other option and tells them to call around. After hours of research they find an MRI with a 550 pound weight limit and a bore size that will accommodate them, but unlike the first facility this one has a backlog so they'll have to wait three more weeks. When they arrive for their appointment the MRI tech is using a Gadolinium-based contrast agent (GBCA). The dosage table the tech has stops at 300 pounds and the patient says that they weigh more than that. So the tech decides to use a GBCA calculator, using the formula of the recommended dose (mmol/kg) multiplied by weight (kg) and divided by concentration (mmol/mL). Except the scale in the MRI facility has a limit of 400 pounds which is less than this patient weighs. The tech explains the risk of incorrect dosage and tells the patient that they can either cancel the MRI or give the tech their best guess of their weight. The patient offers their best guess. The patient is given a gown to change into, but it's way too small. The patient is told that they don't have gowns that are any bigger. The patient offers to wear their own clothes, explaining that they have worn 100% cotton clothes for exactly this reason. They are told that it's against policy and that the tech will have to ask their boss. The boss is off today so the patient can be rescheduled in 3 weeks and the tech says he will “try to remember” to ask his boss about the patient wearing their own clothes but suggests that the patient keep calling to try to verify and also that the patient find a scale that works for them so that they can give the tech an accurate weight. The patient comes back in three weeks with an accurate weight and having confirmed that they can wear their own clothes. They lay down on the MRI table and the tech tries to put the knee in the dedicated knee coil that allows the MRI to view the knee structure. It is too small for the patient's leg. The patient is told that there is no way to get an MRI of their knee.This is just one scan for one patient, and this is based on a true story. The failure of the healthcare system to accommodate higher-weight patients has the potential for a massive amount of harm, most of which goes uncaptured or, worse, is blamed on “ob*sity.”Research BiasThis also happens in multiple ways. It can include higher-weight people being left out of research. For example, it is well known that clearance rates of some anesthesia drugs can vary based on the amount of adipose-tissue a patient has, but higher-weight patients have traditionally been excluded from the trials for anesthesia medications so there isn't good data on this.Here harm is also increased when naming the inequality is seen as sufficient remedy. I recently spoke at the combined conference for the Washington State Society of Anesthesiologists and British Columbia Anesthesiologists' Society (which was an absolute delight! I gave a keynote and then had the honor of being on a panel with Dr. Lisa Erlanger and Dr. Sandi Pitfield.) In preparation for this, I read hundreds of pages of anesthesia research. What I repeatedly found were decades of studies that started by saying that higher-weight patients' exclusion from drug trials created serious knowledge gaps, but then just moved on. Admitting that there is a problem is the first step, it must be followed by taking steps to solve the problem. The solution is not to cobble together what exists and keep creating guidelines based on shoddy research.Part of this issue is researcher bias, limitations of time and money, and perceptions that it's not worth studying fat people or that it's reasonable for fat people to be excluded from research (often under the guise that it's acceptable to make fat patients become thin before they can access ethical, evidence-based medicine.)Another issue is the massive amount of money that is earmarked only to study the prevention and/or eradication of fatness instead of researching how to actually support the health of fat people.It Seems Like A Lot…This happens when we actually do know what fat patients need, for example, in terms of dosage. But they are still under-medicated because the amount that higher-weight people need “seems like a lot” to those who are dosing the drugs and who are used to the dosage for thinner patients.When someone's education is focused on thin patients (including viewing thin patients as “normal” and higher-weight patients as “different/abnormal/extra” and the treatment protocols for thin patients are the focus, then those practitioners can balk at what higher-weight patients actually need.Risk predicated on sizeThis happens when patients who are higher-weight are given treatments that are more dangerous based on their size alone. In an example I wrote about more in depth here, thin patients with type 2 diabetes are not referred to weight loss surgeries that create a permanent disease state in their digestive systems, carry extensive risk, and have very little long-term term data. Patients with so-called “class 1 ob*sity” have the surgery offered if they can't reach their glycemic management goals. Those with so-called “class 2 ob*sity” have the surgery “recommended” if they can't reach their glycemic management goals. Patients with so-called “class 3 ob*sity” have the surgery “recommended” regardless of their glycemic management. Even if someone believes that these surgeries meet the requirements of ethical, evidence-based medicine, the reality is that they are risky and suggesting that someone with well-controlled type 2 diabetes have a dangerous surgery simply because of their size is another dangerous healthcare inequality.BMI-Based Denials of CareI've written about these, and options to fight them, quite a bit (this is a good place to start). This occurs when a fat patient is denied healthcare (often a surgical procedure) unless or until they change their height-weight ratio. These denials are often “justified” using rationale that comes from blaming fat bodies for the negative outcomes of weight stigma, weight cycling, and other healthcare inequalities (for example, as I wrote about above, higher rates of post-op complications) and they amount to holding healthcare hostage for a weight loss ransom (and a ransom that most people will not be able to pay.) While all of the denied procedures are important, in some cases (like some organ transplants,) the procedures that are denied are truly life or death.Saving Money Through Healthcare InequalitiesA common attempted “justification” for the healthcare inequalities that fat people face is the idea that fat people shouldn't get the resources they need if they happen to need more resources than the average thin person. When added to a general focus on profit (especially in the US healthcare system) this leads to staff-to-patient ratios that make it impossible to correctly care for fat patients (for example, having adequate staff to safely turn patients to prevent bed sores or help them ambulate to improve post-surgery outcomes.) It can also mean not having the supplies that these patients need in order to have the best outcomes. Some examples are InterDry to prevent/treat skin fold infections or Hoyer lifts so that they can use a commode and avoid bedpans and chuck changes (both of which are made more difficult and dangerous for the patient and more likely to create negative outcomes when staff-to-patient ratios don't allow for adequate care, even if the practitioners aren't coming from a place of weight bias.)All of this, in turn, can create practitioner bias when they blame higher-weight patients rather than the healthcare system that is leaving both patients and practitioners without what they need.   When healthcare facilities are allowed to decide that they don't want to spend the money to give higher-weight people the care they need, or they are not adequately funded to do so, then higher-weight patients suffer. Here again the negative impacts of this are often simply blamed on “ob*sity.” For example, research on post-operative complication rates will often suggest that “ob*sity” causes higher complication rates without exploring the ways that these size-based healthcare inequalities may actually be at the root of any elevated rate of complications.This is not an exhaustive list of healthcare inequalities that higher-weight people face (please feel free to add other examples in the comments.) I'll also say that this is made much worse because these harms are not adequately measured or remedied and the harms from them get attributed to “ob*sity” rather than the inequalities that higher-weight people face.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Part one of this was published on December 13, but this piece was pre-empted when the USPSTF put forth dangerous dieting recommendations for children (remember that the public comment period ends January 16.) In the past I've written pieces specifically about issues and mistakes that are made with terminology that is used…let's call it differently in weight science as well as common statistics mistakes and mishaps. In part 1 I offered some additional terminology troubles today in part two we're discussing statistics shenanigans. Using a percentage that seems high without proper context:In one example of this, early in the COVID-19 pandemic I saw a news report claiming that so-called “ob*sity”* was a risk factor for severe COVID because, in a particular city, 25% of severe negative outcomes were in people who are classified as “ob*se.”  At first, that might seem like a large number, but that doesn't justify calling being higher-weight a risk factor. In order to even begin to be able to draw conclusions from this, we have to at least know the total number of so-called ob*se people who live in the city - otherwise we have no way to know if 25% is higher or lower than the total percentage of this population. I looked it up and that number was 38%. Several things are issues here.First, if I were trying to draw conclusions from this (and I wouldn't, more on that in a moment) I would conclude that being higher-weight is protective, since 38% of the community is higher-weight, but only 25% of the people with severe outcomes were. (Said another way, people who weren't “ob*se” were 62% of the overall population but 75% of the severe outcomes.) That's the main statistical issue here. You can't use a percentage like this without contextualizing it.Moreover, I wouldn't draw conclusions from this at all. First, because “ob*sity” is simply a ratio of weight and height. Making assumptions that since a group of people have some physical characteristic in common (like, in this case, height-weight ratio) then that physical characteristic is the reason for the difference in outcomes is on extremely shaky ground, scientifically speaking. In this example, since there are many other factors that can impact this result (including the fact that higher-weight people are at the mercy of a healthcare system in which practitioner weight bias is rampant and, even if that's not an issue, the tools, best practices, pharmacotherapies and more, that are used are typically developed for thin bodies/excluding fat bodies) we don't know what number of those severe outcomes were due to healthcare inequalities or other factors.Relative vs Absolute RiskNovo Nordisk recently used this one in their manipulative press release about the possible cardiovascular benefits of Wegovy. Relative Risk Reduction is the percentage decrease of risk in the group who received an intervention vs the group that didn't receive the intervention. This number can be helpful to determine differences in outcomes between groups, but it's not that helpful in determining individual risk. For that you need Absolute Risk Reduction.Absolute Risk Reduction is the actual difference in risk between the group that got the intervention and the group that didn't. This helps us understand the likelihood that a given individual will benefit from an intervention.Relative risk reduction can often be a much larger number than absolute risk reduction and those who are trying to manipulate statistics (and those who don't know about this - like reporters quoting a Novo Nordisk press release) can use relative risk reduction to make people believe a treatment has a greater effect than it actually does.Let's use a super simplified example. Let's say that 200 people who have Condition X are enrolled in a study to see if Medication Y reduces death from Condition X. 100 of them are given the medication (the intervention group) and 100 are not (the control group). At the end of the observation period, 1 person in the intervention group dies and 2 people in the control group die. The relative risk reduction (percent risk of death in the intervention group divided by percent risk of death in the control group, in this case .01 divided by .02) is 0.5 or 50%. That seems like a lot – a company with incredibly poor ethics might issue a press release saying that their drug reduced death by 50% without mentioning absolute risk.Absolute risk is calculated by subtracting the percentage of risk reduction in the intervention group from the percentage of risk reduction in the control group, or 2%-1% which is a 1% reduction. A much smaller number that more accurately predicts individual experience.So when a weight loss company gives a percentage of risk reduction, it's important to ask if it is relative or absolute risk reduction they are talking about.For example, in the Novo Nordisk press release they wrote that their drug “reduces the risk of major adverse cardiovascular events by 20%”. That is the relative risk. The absolute risk reduction was less than 2%.These are the basics, if you want to really dig into relative vs absolute risk, there's plenty more to it. There's an interesting piece about it here for starters.LOCF vs BOCFLast Observation Carried Forward (LOCF) and Baseline Observation Carried Forward (BOCF) are two ways of dealing with dropouts in a trial to determine an endpoint value for those who dropped out.Let's look at another example with easy numbers. Let's say there is a weight loss intervention trial where weight is taken at the beginning, at 1 year, and at 2 years. They start with 100 participants and all 100 participate in the initial weigh-in and the 1-year weigh-in, but only 50 participate in the 2-year weigh-in (just fyi, this is not an uncommon dropout rate in weight loss studies.)When the study authors are trying to calculate the success of the intervention, how do they handle the 50% of people who dropped out?If they use LOCF, they take the person's weight from the 1-year weigh-in and use that as if it were the 2-year weigh-in number.If they use BOCF, they take the person's weight from the beginning of the study and use that as if it were the 2-year weigh-in number.Pop quiz – which do you think the weight loss industry typically uses?If you guessed LOCF, you are exactly right. And that's an issue.Absent actual follow-up to find out the reason that the participants didn't turn up for the final weigh-in (and that follow-up almost never happens) we don't know if they didn't show up because they regained weight that they had lost (and, given 100 years of research showing that this is the outcome for the vast majority of those attempting intentional weight loss that's not, like, out of the question). So using the 1-year weigh-in number for the 2-year weigh-in may very well artificially exaggerate the success of the intervention.Just to make the math easy, let's say that all 100 participants lost 10 pounds at the one year weigh-in. Then let's say that the 50 people who returned for their year two weight-in had regained 5 pounds (again, a super common occurrence.) Meaning that they were 5 pounds less than their baseline weight at the two-year weigh-in.Now the authors have three basic choices:They could just ignore the dropouts as if they never existed, and claim that the average weight loss was 5 pounds (ignoring both the dropouts and the fact that the participants' weight was climbing at the time that observation ended). Despite this being the kind of thing that would get you a solid “F” in your Freshman Research Methods class, it's a pretty common occurrence in weight loss research.But, if they use LOCF, they can use the 10-pound loss for the 50 people who didn't turn up at year 2. This will boost their total to an average of 7.5lbs per participant. This, again, is quite common in weight loss research.Now, if they used BOCF (which I would argue is far more appropriate given our base knowledge around weight regain and the fact that they should make every effort not to artificially inflate the success of their intervention) they would have an average of 2.5 pounds lost per participant. This is incredibly uncommon in weight loss research. And again, they should be honest that, in those who were weighed at year two, weight was being regained. In an ideal world, weight science research would be transparent and would not use terminology and statistics to mislead or obfuscate. Unfortunately, we don't live in an ideal world so it's up to us to know what questions to ask, and to ask those questions.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Aubrey Gordon – activist, author, and teacher – talks to us about anti-fat bias and the way it manifests in employment disparities, our healthcare system, our dinner table conversations, and our parenting. She teaches us about “concern trolling” and other ways anti-fatness hides inside of our “do-gooding.” Sharing her personal experiences, Aubrey illuminates the subtle and not-so-subtle ways that our culture perpetuates anti-fatness – and examines the roots of thinness as a system of supremacy. She points us toward a world where we are all safer and freer.  Plus, a heart-piercing voicemail from a concerned Pod Squader about their 11-year-old daughter's body image struggles. For more information on why BMI is horseshit, check out Ep 10 OUR BODIES: Why are we at war with them and can we ever make peace? About Aubrey: Aubrey Gordon is an author, columnist, and cohost of the Maintenance Phase podcast. She is the author of the New York Times and Indie bestseller “You Just Need to Lose Weight” and 19 Other Myths About Fat People, and What We Don't Talk About When We Talk About Fat. Her work has been published in The New York Times, Vox, SELF, Health, Glamour and more. Aubrey is also the subject of the new documentary film YOUR FAT FRIEND, which explores her journey from anonymous blogger to bestselling author and activist. TW: @yrfatfriend IG: @yrfatfriend To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

CPSolvers: Anti-Racism in Medicine Series Episode 23 – Anti-Blackness, Anti-Fatness, and Food Shaming Show Notes by Humza A. Siddiqui October 31, 2023   Summary: This episode highlights the culture of food shaming and anti-fatness as it relates to anti-Blackness. During this episode, we hear from Da'Shaun L. Harrison, a community organizer and trans theorist, and… Read More »Episode 309 – Antiracism in Medicine Series – Episode 23 – Anti-Blackness, Anti-Fatness, and Food Shaming

In this episode, Sophia continues the conversation on fat stigma and workplace discrimination. She discusses the flawed focus on weight and BMI in workplaces and the negative impact it has on fat individuals.Sophia shares personal stories that highlight the challenges faced by fat employees and the need for systemic change in workplace environments. She emphasizes the importance of refraining from commenting on appearance or food choices and urge leaders in positions of power to incorporate weight stigma into diversity, equity, and inclusion programs.The episode highlights the importance of knowing one's rights as an employee and the impact of workplace wellness programs that perpetuate fatphobia. We also explore the concept of the body hierarchy and Sophia advocates for breaking down barriers to promote equity.Sophia Apostol (she/her) is a Professional Certified Coach who specializes in leadership coaching. And, she's also a fat activist who created and hosts the podcast, Fat Joy with Sophia Apostol . The intersection of anti-fat bias and workplace culture is of particular interest to her, as she's both experienced and witnessed the deep harm caused by diet culture norms when adopted by workplaces. Sophia uses the art of storytelling to share stories of marginalized identities in hopes of creating more empathy, furthering representation, and deepening belonging.   Connect with Sophia on her website, and listen to her joyous liberation podcast, Fat Joy with Sophia Apostol (https://www.fatjoy.life/). Continue your learning journey with Aurbery Gordon (https://www.yourfatfriend.com),  Virgie Tovarhttps://www.virgietovar.com and Lindy West https://www.bitchmedia.org/article/lindy-west-shrill-fat-positive-representation-interviewWeekly newsletter | Ask Catherine | Work with me | LinkedIn | Instagram Big shout out to my podcast magician, Marc at iRonickMedia for making this real. Thanks for listening!

In this episode exploring anti-fatness, Sophia Apostol opens up about her personal journey of self-acceptance and how it led questioning prevalent fat-stigmatising practices in the workplace. She discusses her experience with body image and the influence of societal beauty standards, and shares her discovery of body positivity and the authors and activists who empowered her to challenge harmful beliefs.This episode discusses grown up topics and includes swearing so caution is advised.Sophia Apostol (she/her) is a Professional Certified Coach who specializes in leadership coaching. And, she's also a fat activist who created and hosts the podcast, Fat Joy with Sophia Apostol . The intersection of anti-fat bias and workplace culture is of particular interest to her, as she's both experienced and witnessed the deep harm caused by diet culture norms when adopted by workplaces. Sophia uses the art of storytelling to share stories of marginalized identities in hopes of creating more empathy, furthering representation, and deepening belonging. Connect with Sophia on her website, and listen to her joyous liberation podcast, Fat Joy with Sophia Apostol https://www.fatjoy.life/Continue your learning journey with Aurbery Gordon (https://www.yourfatfriend.com),  Virgie Tovar https://www.virgietovar.com and Lindy West https://www.bitchmedia.org/article/lindy-west-shrill-fat-positive-representation-interviewWeekly newsletter | Ask Catherine | Work with me | LinkedIn | Instagram Big shout out to my podcast magician, Marc at iRonickMedia for making this real. Thanks for listening!

Tracey Lindeman's (she/her) experience with decades of period pain and the complicated, frustrating, and futile-feeling process of getting an endometriosis diagnosis led her to writing “Bleed: Destroying the Myths and Misogyny in Endometriosis Care.” Tracey and Sophia share their own unique experiences of moving through the medical system's anti-fat bias and misogyny, and Tracey offers two suggestions for how we can better advocate for ourselves in any medical situation.Tracey Lindeman is a longtime freelance journalist and the author of the bestselling book, “BLEED: Destroying Myths and Misogyny in Endometriosis Care” (ECW Press, 2023). She is from Montreal and currently lives in western Quebec with her partner and her cat, Toast. Mentioned in this episode: therebelliousuterus and “What we don't talk about when we talk about fat” by Aubrey Gordon.Please connect with Tracey through Instagram (http://instagram.com/bleed_thebook) and her website (http://bleedthebook.com/). This episode's poem is called “From the First Water is the Body” by Natalie Diaz.Read the Fat Joy book review for Tracey Lindeman's book “Bleed: Destroying the Myths and Misogyny in Endometriosis Care.”After recording the interview, Sophia asks each guest 10 unexpected, unrehearsed questions designed to go even deeper. Check it out by subscribing through Apple Podcast Subscriptions or Patreon for as little as $2.You can connect with Fat Joy on our website, Instagram, and YouTube (full video episodes here!). Want to share the fat love? Please rate this podcast and give it a joyful review.Our thanks to Chris Jones and AR Media for keeping this podcast looking and sounding joyful.

I hate my fat body and I don't know whhhyyyy! Have you ever thought this? If so, you need to check out this episode where I share the 6 things you could be doing inadvertently that perpetuated anti-fatness and could harm your body confidence. Episode show notes: http://www.fiercefatty.com/175 Support me on Ko-Fi and get the Size Diversity Resource Guide: https://ko-fi.com/fiercefatty/tiers www.HAESHealthSheets.com

Hello again, fupas!! In this episode, the fatties share their dream ice creams and explore the pronunciation possibilities of different nuts. Then we pivot to a column from Dear Prudence about kink and the complexities of grappling with ~parental worries~ or external involvement in our romantic relationships. We get into fetishism, gaining, “pleasure politics”, edtwitter, autonomy, and, as always, desire. Grab a sundae and get into the first part of our conversation about fat kink.  P.S. We recorded this months ago before we got our audio sorted out. Sorry for any hiccups!  P.P.S Say hello to the many pets in the background of this episode!   This episode's advice column: Help! My Parents Seem Intent on Forcing Me to Reveal My Kink.   Media mentioned:  The Color of Kink: Black Women, BDSM, and Pornography by Ariane Cruz  Samuel Delaney's keynote talk “Aversion/Perversion/Diversion”  Revenge Body by Caleb Luna  Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun Harrison  No Health, No Care The Big Fat Loophole in the Hippocratic Oath by Marquisele Mercedes  Find us on social media! Unsolicited on Twitter Unsolicited on Instagram Find Da'Shaun: Twitter/Insta: @DaShaunLH Find Mikey: Twitter: @marquisele Insta: @fatmarquisele Find Jordan: Twitter/Insta: @jordallenhall Find Caleb: Twitter/Insta: @dr_chairbreaker Find Bryan:  Twitter/Insta: @blackqueeriroh

Does the size of your body have anything to do with your health? What does the word fat mean to you? Today's podcast is a conversation with Body Liberation Coach, Sophia Apostol about anti-fatness. Sophia shares her own lived experience and knowledge surrounding fat-phobia. We talk about how fat-phobia impacts every area of life, from access to healthcare, career opportunities, social settings and the intersectionality of racism and ableism. For more from Sophia head on over to her podcast Fat Joy with Sophia Apostol and her IG fatjoy.lifeIf you haven't already, jump over and follow me on IG @kylielately for even more, and check out my new website kylielately.com where you can sign up to receive texts from me!See you there!! xx For more from the I am. with Kylie Lately podcast - more personal reflections, more conversations with guests, & more juicy self-development inspiration, you can join our members only platform here... https://plus.acast.com/s/the-kylie-camps-podcast. Hosted on Acast. See acast.com/privacy for more information.

This is the Weight and Healthcare newsletter! If you appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing!I've previously written a series about fat people and joint health, including joint pain, osteoarthritis, and resources to fight BMI-based joint surgery denials. I've added a new resource to the list thanks to Dr. Greg Dodell who let me know about this new study.Before I get into this particular study, I want to offer a reminder that even if higher-weight people didn't have the same outcomes as thin people:1.       That wouldn't mean that the patient's weight is the problem. There are any number of confounding variables (including the impact of weight cycling on the patient, practitioner weight bias impacting the procedure, structural weight stigma impacting the procedure - including tools, best practices, and other medical equipment being developed for thin bodies and often to the exclusion of fat bodies - and the impact of patients trying to lose weight prior to surgery and going into the surgery undernourished.) 2.       That wouldn't make weight loss the correct next step. First of all, because it's highly unlikely to work and second of all because it's possible that the weight loss attempt, even if it is successful in the short term, could negatively impact surgical outcomes as this study shows. 3.       That shouldn't automatically be a reason for denying the surgery. The idea that fat people only deserve healthcare if they have the same outcomes as thinner people is based in weight-stigma. It also means that the ways that the healthcare system fails to support and accommodate fat people then gets taken out on fat people, then subsequently used to justify more exclusion of fat people from care. Fat people getting a surgery to reduce pain or improve quality of life is a worthy goal, even if there might be more complications or different outcomes. If there is actually a higher risk for higher-weight people (and that would require good, unbiased research to detect) then, first and foremost, we should get better at performing surgeries and after care on fat patients and, in the meantime, the risk should be communicated accurately to the patient and then the patient should be allowed to make the choice. I want to note that that would require systemic change to the way that surgeons' performance/statistics are judged so that they aren't encouraged to cherry pick the easiest cases and deny care to those who might be (or whom they perceive might be) at greater risk for complications.With all of that said, let's look at this study - Differential Impact of Body Mass Index in Hip Arthroscopy: Ob*sity Does Not Impact Outcomes., by Suri et al published in The Ochsner Journal.This study reviewed the medical records of 459 patients who had undergone hip arthroscopy at a single facility from 2008 to 2016. They divided the patients into BMI-based weight categories of “underweight,” “normal weight,” “overweight.” and “ob*se.” (Note that the entire idea of categorizing people by BMI is unscientific and harmful.) Then they looked at their rates of improvement at 1 and 2 years after surgery.They utilized three metrics:The Harris Hip Score (HHS) which considers pain, function, absence of deformity, and and range of motion, the physical component score from the 12-Item Short Form Survey (PCS-12) and the mental component score from the 12-Item Short Form Survey (MCS-12).They found thatAt 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and ob*se cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively.They concluded:In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.Statistical significance is a measure of how likely it is that the effect was due to the intervention or rather than by chance, there is a more detailed explanation here.Interestingly, in follow up three years after surgery (which was the longest follow-up) the “ob*se” group had the highest overall score on all three instruments, followed by the “overweight” group, then the “normal weight” group, with the the “underweight” group showing the lowest overall improvement:There are limitations to this study including the small sample size, the single facility, the relatively short follow-up, and the lack of information about re-surgery rates.Still, this finding is important because, as the study authors point out, “the goals of hip arthroscopy are to alleviate symptoms, improve hip function, and delay the progression of hip osteoarthritis.”So if this surgery is denied based on BMI, then it would be expected that the patient's symptoms would continue to worsen, possibly leading to the need for a total hip replacement which is even more likely to be denied based on BMI. This leaves fat patients with completely unnecessary pain, suffering, and mobility issues.Again, even if higher-weight people had worse outcomes, reducing their symptoms, improving their hip function, and delaying the progression of hip osteoarthritis would still be worthy goals, and fat people would still deserve surgery, just like “underweight” people deserve surgeries.And again, this study has significant limitations, and, regardless of the results, people of all sizes deserve healthcare. Still, it is often suggested that all the research supports a narrative of higher-weight people having worse surgical outcomes and it's important that misinformation and commonly held misbeliefs in healthcare be challenged. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Like this piece? Share this piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.Note I don't link to everything I discuss in this post because I don't want to give traffic and clicks to dangerous media. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today's History Story: Our Hatred Of Fat Is Actually Anti-Black In many ways, the health and wellness industry is killing Black people. For our audacity to exist with melanated skin, we've historically endured subjugation, political and economic disenfranchisement, and centuries-long death. And it hasn't stopped yet. We'll talk about it with today's guest, Da'Shaun L. Harrison. Da'Shaun is a self-described Black, fat, trans, disabled, queer abolitionist, community organizer, writer, and editor at Scalawag magazine. Their award-winning book, Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, explores desirability politics, gender, policing, and the fallacies of healthiness. To learn more about their work and to purchase their book Belly of the Beast: The Politic of Anti-Fatness, visit www.dashaunharrison.com. Black History Year (BHY) is produced by PushBlack, the nation's largest non-profit Black media company. PushBlack exists to amplify the stories of Black history you didn't learn in school and explore pathways to liberation with people who are leading the way. You make PushBlack happen with your contributions at BlackHistoryYear.com — most people donate $10 a month, but every dollar makes a difference. If this episode moved you, share it with your people! Thanks for supporting the work. The BHY production team includes Tareq Alani, Brooke Brown, Tasha Taylor, and Lilly Workneh. Our producers are Cydney Smith, Len Webb for PushBlack, and Ronald Younger, who also edits the show. Black History Year's executive producer and host is Julian Walker. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Anti-fatness is everywhere, yuck! Do you know what weight bigotry does to our brains and bodies? If not you'll hear all about it in this episode. More importantly, you will also hear about what the science tells us about how to survive this sh*t show. It's good news, you're probably doing a lot of the good stuff already! Episode show notes: http://www.fiercefatty.com/172 Support me on Ko-Fi and get the Size Diversity Resource Guide: https://ko-fi.com/fiercefatty/tiers Study Looks At Ways To Protect Ourselves from Weight Stigma: https://substack.com/app-link/post?publication_id=534306&post_id=99410920&utm_source=post-email-title&isFreemail=false&token=eyJ1c2VyX2lkIjoyMDU1OTQwOSwicG9zdF9pZCI6OTk0MTA5MjAsImlhdCI6MTY3ODU1NzcwNSwiZXhwIjoxNjgxMTQ5NzA1LCJpc3MiOiJwdWItNTM0MzA2Iiwic3ViIjoicG9zdC1yZWFjdGlvbiJ9.pc8UxFO8zdkqH3qAKJRqnEoI1s6iY4aLsUtcCk71bEQ Challenging oppression: A social identity model of stigma resistance in higher-weight individuals: https://www.sciencedirect.com/science/article/pii/S1740144522001061?via%3Dihub Studies on weight stigma and body image in higher-weight individuals Angela Meadows and Rachel M Calogero . DOI: https://doi.org/10.1007/978-3-319-90817-5_28 Fat trans legal histroy: https://www.instagram.com/callmesj.theletters/ SJ donate: https://www.gofundme.com/f/help-sj-graduate-and-continue-their-work?utm_campaign=p_cp+share-sheet&utm_medium=copy_link_all&utm_source=customer Anti-Fatness and Public Health by Mikey Mercedes and Monica Kriete for New England Public Health Training Center https://www.patreon.com/posts/reconsidering-84517517?utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=postshare_fan&utm_content=join_link Sutin, A. R., Stephan, Y., & Terracciano, A. (2015). Weight Discrimination and Risk of Mortality. Psychological science, 26(11), 1803–1811. https://doi.org/10.1177/0956797615601103

Now that we've discussed anti-fatness in public health, Megan and Linsey talk about anti-fatness in our policies.  References: Estimating Deaths Attributable to Obesity in the United States The obesity wars and the education of a researcher: A personal account CDC Study Overestimated Deaths from Obesity Yes, You Can Still Be Fired for Being Fat State and Local Backgrounders: Soda Taxes by the Urban Institute   Engineered by Dreamstate Productions Music by Michael Conrad 

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Recently I was made aware of something that was happening with the National Eating Disorders Association (NEDA) helpline. For the past twenty years, NEDA has run a helpline providing support to tens of thousands of people a year via text, chat, and phone. That helpline was recently replaced with an AI-driven chatbot. Investigating this I learned that it happened around a labor action. As Vice reported, sourcing Abbie Harper's piece on LaborNotes, a group of four paid helpline staff, including Harper, decided to unionize because “they felt overwhelmed and understaffed.”Harper explains:“We asked for adequate staffing and ongoing training to keep up with our changing and growing Helpline, and opportunities for promotion to grow within NEDA. We didn't even ask for more money. When NEDA refused, we filed for an election with the National Labor Relations Board and won on March 17. Then, four days after our election results were certified, all four of us were told we were being let go and replaced by a chatbot.”For their part, NEDA claims that this was a “long-anticipated change” which, if true, means that for a long time NEDA thought it was a good idea to replace six paid staffers, supervisors, and up to 200 volunteers supporting people whose lives and health can be in serious peril, with an AI chatbot. I think that would have been an astonishingly bad idea even if this wasn't about union-busting.But it gets worse. Before I get into it, a bit of background. The National Eating Disorders Association (NEDA) has a long history of either ignoring higher-weight people (as well as others with marginalized identities) or treating us poorly. (NEDA tends to focus their attention on thin, white, cis girls and young women to the exclusion of others.) For a brief time, they brought on Chevese Turner, founder of the Binge Eating Disorder Association, and it looked like they might be turning things around in terms of intersectional work. During this time I was asked to become an official ambassador. Then Chevese was summarily fired without explanation, and I publicly left the organization. Since then, NEDA has faced a significant amount of controversy for their actions around higher-weight people. Recently they were one of the only eating disorders organizations that failed to clearly denounce the disastrous American Academy of Pediatrics Guidelines for higher-weight youth.I'm writing about this here because NEDA has significant funding (we'll get to that in a moment) spending, per their 2021 filing, over $800,000 a year on digital and social media support, and they have a tendency to delete or bury criticism, so it's easy to be unaware of this.Activist Sharon Maxwell decided to test the bot. Her experiences were chilling to anyone who is knowledgeable about the intersections of weight, health, and eating disorders. I have viewed the screenshots of the chat transcripts. Unfortunately, I cannot publish them here as NEDA's terms and conditions to use the bot state that “Any unauthorized use of text or images may violate copyright laws, trademark laws, the laws of privacy and publicity, and applicable regulations and statutes.” While I think reprint here would likely fall under fair use, I'm not a lawyer and I want to be as cautious as possible.In response to a question about how the chatbot (called “Tessa”) supports people with eating disorders, Tessa offered help with coping mechanisms, healthy eating, and a recommendation to seek professional support.In response to the follow-up question asking for tips around healthy eating, the chatbot offered several options, some of which included terms like “limit” and “avoid”  which is far from a best practice for someone dealing with an eating disorder as it can reinforce (and even create) restrictive thoughts and behaviors.Maxwell asked about eating the right foods to lose weight. This was a clear test for the bot. This question is a red flag under any guise, but when it is being asked by someone seeking support around eating disorders, it is a gigantic red flag, atop a tall pole, set ablaze and waving in a strong wind.The chatbot failed the test, offering up a heaping helping of diet culture including recommending (to someone seeking help from the National Eating Disorders Association) tracking calories and making sure to eat less calories than you burn. Then the bot recommended pursuing weight loss in a healthy way (ProTip: this is not truly possible for anyone, and is especially not possible for people dealing with eating disorders.) The bot recommended consulting a healthcare professional or dietitian only if the user had questions or concerns about their diet or weight loss goals. When asked point blank if there are ways to engage in safe and healthy weight loss without engaging one's eating disorder, the chatbot immediately answered yes.That is a dangerous answer. There is a body of dubious research being created (by people with deep and concerning conflicts of interest) that is trying to say otherwise, but I would hope that even they would agree that a blanket “yes” to this question, being asked by someone contacting an eating disorders helpline, without information about the person's current eating disorders diagnosis and symptoms has a massive potential for harm.The chatbot then said, incorrectly, that making gradual changes to diet and activity are sustainable and healthy ways to lose weight. The research that exists disagrees, but it would seem the bot doesn't know that and is handing out misinformation about weight loss to people who are, again, accessing an eating disorders help chat.Sharon Maxwell created an Instagram post about her experience. and Sarah Chase, the Vice President of NEDA responded: @sachaseinc: That is a flat out lie.@heysharonmaxwell: @sachaseinc would you like the screenshots from the conversation? @heysharonmaxwell Maybe you're truly blinded to the harm your own company causes. But girly, I have the receipts.@sachaseinc I'm open to being proven wrong. Please send the screenshots.@sachaseinc Yes please send the screenshots - and if this is happening in the program having the screenshots will be essential to fixing it - and I'll retract my previous comment. Afterward, Chase briefly apologized, then deleted the entire exchange, but Maxwell had a screenshot of the conversation which she subsequently published in her Instagram stories.Sarah Chase's behavior here is abhorrent but, honestly, precisely what I have come to expect from NEDA leadership. She had the option of beginning the conversation by believing Sharon or at least saying something like “do you have screenshots so I can look into this?”Instead, she led by calling Sharon Maxwell a liar and only when confronted with the existence of evidence did she become “open to being proven wrong” and willing to retract her blatantly false accusation. How magnanimous. So, because Sharon took screenshots, NEDA is now “investigating” this, but if she hadn't they would have simply called her a liar and gone on about their day as planned. Yikes.NEDA then posted to its Instagram account It came to our attention last night that the current version of the Tessa Chatbot, running the Body Positive program, may have given information that was harmful and unrelated to the program.We are investigating this immediately and have taken down that program until further notice for a complete investigation. Thank you to the community members who brought this to our attention and shared their experiences. “May have given”? They have the screenshots. While NEDA normally allows comments on their posts, they posted this with commenting turned off. To sum up, we have an organization that bills itself as “the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders” that:* Rapidly replaced their entire helpline staff (a helpline that received over 60,000 requests in 2021 according to their filings) with a chatbot just days after the helpline paid staff voted to unionize* Responded to concerns about the dangerous things the chatbot was saying by publicly calling the person bringing the concern to light a liar* Tried to erase the interaction when it turned out that it was the VP of the organization who was lyingTo me, these are not the actions of a reputable, ethical, non-profit organization. Again, NEDA was also one of the very few eating disorders organizations that failed to clearly denounce the disastrous American Academy of Pediatrics Guidelines for higher-weight youth (which had multiple conflicts of interest with weight loss industry funding) so I dug around their funding a bit. NEDA's 2021 Form 990  (the most recent I could find on record) showed the organization receiving $3,183,198 in grants and contributions and paid their leadership (including outsourced CEO and COO services) a total of $651,500. Their Schedule of Contributors fails to list their actual contributors and simply says “RESTRICTED.”So there is no clear funding from the weight loss industry though, again, that may have been part of the “RESTRICTED” information, or changed between 2021 and now.  A bit more background here - my first interaction with NEDA was 12 years ago when I started a petition asking them to end their partnership with the deeply anti-fat, weight loss industry-funded “STOP Ob*sity Alliance”. I had communicated with NEDA directly, explaining why issuing a press release in concert with an avowed anti-ob*sity organization, telling the media to: "Focus on the concept that weight status and the importance of maintaining a healthy weight is not about appearance, but about health" was harmful and offering to talk to them and/or connect them with other resources, but they refused. So I started the petition and they ended the relationship. Especially given the amount of money that Novo Nordisk and their Astroturf groups are throwing around, I'm definitely concerned that NEDA has or will jump back into relationships with the weight loss industry, and I'll continue to dig around on that.In the meantime, higher-weight people face significant barriers to receiving care for eating disorders, many of which stem from weight stigma and the weight-loss paradigm in which we now live. We can now add an eating disorders chatbot doling out diet advice to that list of barriers.You can sign onto the letter to boycott NEDA here If you are looking for eating disorders help, or organizations to support, you might try:ANADBody RebornFedUp CollectiveInternational Federation of Eating Disorders DietitiansMEDANational Alliance for Eating DisordersNalgona Positivity PrideProject HealPlease feel free to add organizations that I missed (with my apologies!) in the comments. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:If you liked this piece, you can share it!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

We're so excited to be joined by Aubrey Gordon (she/her) for an episode about anti-fatness in the Harry Potter series. We begin with a quick review of disability studies, monstrosity, and sentimentality before jumping into a conversation about anti-fatness, body positivity and fat liberation. Aubrey is the co-host of (beloved podcast) Maintenance Phase and the author of What We Don't Talk About When We Talk About Fat and "You Just Need to Lose Weight" and 19 Other Myths About Fat People. With her help, we talk about the relationship between eugenics, white supremacy, mass media (specifically young adult fiction) and anti-fatness as it shows up in our relationships, the books we read, our political landscape and beyond.If you've been waiting for us to do a deep-dive on Dudley, then this episode is for you! What can we make of his forced dieting throughout the series? What ideology underpins the characterization of Petunia as it relates to her son's weight? Why do we read Molly Weasley's parenting differently? We also discuss Hagrid, Madame Maxime and Horace Slughorn as they align with familiar stereotypes of fat people. We love Aubrey and we figure you're already a super-fan! Still, it's worth noting that if you want more Aubrey you can learn more about her at her website, check her out on Twitter or Instagram, read her books, and listen to her incredible podcast with Michael Hobbes, Maintenance Phase.***HEY YOU! We're launching a new show! We've shared our pilot on Patreon to get the input of all our Patreon supporters as we develop the series which will launch this summer after we wrap up the Appendix Season. Join our Patreon today to listen to the first episode of our new show and to get access to a ton of audio perks like unedited audio, bloopers, comics, Q&As, and so much more! Become a supporter at patreon.com/ohwitchplease. If becoming a paying subscriber isn't in the cards right now, no stress! Please leave us a review instead — it truly helps sustain the show. Of course, you can always follow us on Instagram or Twitter @ohwitchplease to stay connected. Hosted on Acast. See acast.com/privacy for more information.

Megan and Linsey talk about their personal and professional experiences with anti-fat bias and stigma. If you struggle with disordered eating, please be aware that we will be discussing this and eating disorders.  This is the first of a series of episodes where we talk about weight discrimination, anti-fat bias, and how public health has contributed to this phenomenon. References:  Belly of the Beast: the Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison Maintenance Phase Podcast Sabrina Strings The Body is Not An Apology by Sonya Renee Taylor Economist Article: New drugs could spell the end to the world's obesity epidemic   Engineered by Dreamstate Productions Music by Michael Conrad 

This is a free preview of a paid episode. To hear more, visit virginiasolesmith.substack.comIt's time for the May Indulgence Gospel! Instead of answering your questions this month, we're reading Virginia's hate mail. Buckle up! If you are already a paid subscriber, you'll have this entire episode in your podcast feed and access to the entire transcript in your inbox and on the Burnt Toast Substack.If you are not a paid subscriber, you'll only get the first chunk. To hear the whole conversation or read the whole transcript, you'll need to go paid. It's just $5 a month or $50 for the year—and you get the first week free!Also, don't forget to order Fat Talk: Parenting In the Age of Diet Culture! Get your signed copy now from Split Rock Books (they ship anywhere in the USA). You can also order it from your independent bookstore, or from Barnes & Noble, Amazon, Target, Kobo or anywhere you like to buy books. (Or get the UK edition or the audiobook!) Disclaimer: Virginia and Corinne are humans with a lot of informed opinions. They are not nutritionists, therapists, doctosr, or any kind of health care providers. The conversation you're about to hear and all of the advice and opinions they give are just for entertainment, information, and education purposes only. None of this is a substitute for individual medical or mental health advice.BUTTER & BOOKS_____ Is a Breakfast Food by Marjory SweetThe Unhoneymooners by Christina LaurenThe Ex Talk by Rachel Lynn SolomonSabrina Strings' Fearing the Black Body: The Racial Origins of Fat PhobiaDa'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blacknesschapter one of FAT TALKOrder any of these from the Burnt Toast Bookshop for 10 percent off if you also order (or have already ordered!) Fat Talk! (Just use the code FATTALK at checkout.)OTHER LINKS@SellTradePlusThe Cut did a profileFresh Air interviewthe face shieldinterview with Aubrey Gordonyes, fat marathon runnersvery popular article in The Atlantic about how eating ice cream is associated with lower rates of Type Two Diabetesa tweet about Elizabeth WarrenCREDITSThe Burnt Toast Podcast is produced and hosted by Virginia Sole-Smith. Follow Virginia on Instagram or Twitter.Burnt Toast transcripts and essays are edited and formatted by Corinne Fay, who runs @SellTradePlus, an Instagram account where you can buy and sell plus size clothing.The Burnt Toast logo is by Deanna Lowe.Our theme music is by Jeff Bailey and Chris Maxwell.Tommy Harron is our audio engineer.Thanks for listening and for supporting anti-diet body liberation journalism.

The call for prison abolition has been popularized over the last decade of popular movements against police violence, many of which have operated under the banner of Black Lives Matter. But what does abolition mean, and who gets to define it? Thus far, much of the conversation has been steered and curated by mainstream media. A new initiative from Scalawag Magazine tentatively titled 'Project Abolition' seeks to disrupt the dominant narrative by platforming voices from within prisons themselves. Scalawag Editor-At-Large Da'Shaun Harrison joins Rattling the Bars to explain Project Abolition.Da'Shaun Harrison (they/them) is the Editor-At-Large of Scalawag Magazine. They are also the author of Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness.Post-Production: Cameron Granadino The Real News is an independent, viewer-supported, radical media network. Help us continue producing Rattling the Bars by following us and becoming a monthly sustainer: Donate: https://therealnews.com/donate-pod-rtbSign up for our newsletter: https://therealnews.com/nl-pod-rtbGet Rattling the Bars updates: https://therealnews.com/up-pod-rtbLike us on Facebook: https://facebook.com/therealnewsFollow us on Twitter: https://twitter.com/therealnews

You've heard us grapple with how diet culture has impacted us and shaped how we feed our families, but is talk of diet culture, body positivity, and intuitive eating a distraction from understanding the structures and systems of oppression (or worse: a tool that reinforces those structures and systems)? We talk to Jessica Wilson, MS, RD, and author It's Always Been Ours, to start unpacking this question — and more.Links from this episodeAll about Jessica WilsonJessica's book, It's Always Been Ours: Rewriting the Story of Black Women's BodiesJessica on Instagram, @jessicawilson.msrdBelly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison The AAP childhood obesity guidelines, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity”Find out how to become a supporting member to also get access to our recipes + bonus episodes: https://didntijustfeedyou.com/communityAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!One of the ways that the diet industry is trying to squash the weight-neutral health and fat liberation movements is by using their money, clout, and enmeshment in the healthcare system to re-brand themselves as weight stigma experts, including at conferences, panels, and other events. This can be done by large weight loss industry representatives like the Ob*sity* Action Coalition or by individuals.It is imperative that we do not let this happen, because their goal is to co-opt the concept of eradicating weight stigma and use it to sell weight-loss interventions that risk the health and lives of higher-weight people (which, in turn, increases weight stigma by perpetuating the idea that being fat is so terrible that it's worth risking fat people's lives and quality of life in attempts to make them thin.) So, here are four major red flags that an event that claims to be about ending weight stigma may actually be about co-opting anti-weight-stigma work to sell dangerous, expensive “treatments” for fat people.There are no (fat-positive) fat people speakingThere is absolutely no excuse for this, but that doesn't mean we don't hear them. I think my personal [least] favorite is “we are looking for experts rather than lived experience.” This is wrong in every way I can think of. First of all, lived experience of stigma gives one expertise that cannot be gained in any other way. Beyond that, unless by “experts” they mean “thin people” then there is literally no type of expert that does not include fat people. Doctors, academics, researchers, statisticians, whatever they are looking for, they could find a fat expert. The idea that someone is either an expert in weight stigma or a fat person is weight stigma. Bottom line: If there are no fat-positive fat people speaking at an event, then this isn't truly an anti-weight-stigma event. I will say that I have consulted with people in situations where they were speaking at such an event as a harm reduction tool after they tried to get a fat speaker booked and failed, but this shouldn't be happening.Representatives from the weight loss industry are speakingThey could be representing the weight loss industry directly, through one of their programs (like Novo Nordisk's absolutely ridiculous “It's Bigger Than Me” campaign,) or through an astroturf organization like the “Ob*sity Action Coalition.”This is also why in the first category I specifically said “fat-positive fat people.” Fat people are allowed to want to eradicate fatness in themselves, including as a way for them to try to escape weight stigma, but that doesn't make it an anti-weight-stigma view, especially if they are representing the weight-loss industry or claiming to represent all fat people. (To me, as someone who is both fat and queer, it would be similar to an anti-homophobia panel with a bunch of straight people and one gay panelist who was undergoing so-called “conversion therapy” to become an ex-gay and was representing the interests of the companies selling the therapy.)They are using stigmatizing terminologyIf they are using terms and/or aligning with concepts like “ob*sity,” “person with ob*sity” or “ob*sity epidemic then they are perpetuating stigma. The idea of pathologizing body sizes is, first and foremost, rooted in racism, weight supremacy, and anti-Blackness and I highly recommend reading  Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to understand more about that. Concepts like “overw*ight” and “ob*sity” were created to pathologize bodies based on shared size rather than shared symptomology or cardiometabolic profile. This has been largely architected and perpetuated by the weight loss industry. And while there is absolutely no shame in having a disease, simply existing in a higher-weight body doesn't qualify, and the diet industry's insistence that it does - and especially their use of “anti-weight-stigma” platforms to try to forward that message - harms and kills fat people.  They want to find a way to make fat people thin and stop future fat people from existingWeight stigma is so ubiquitous in our culture, that someone can publicly espouse the notion (in various nomenclature) that the world would be better without fat people in it, and still be considered (and booked!) as an expert on ending weight stigma. It is impossible to fight a “war on ob*sity” without waging war against fat people, and wars, inevitably, have casualties.You cannot be invested in pathologizing and eradicating fatness and also be effective at reducing the stigma against fat people, they are mutually exclusive.There are some people who produce research about weight stigma whose results can be helpful from a harm reduction perspective , even though they, themselves, and their research are still coming from a place deeply rooted in weight stigma. Still, the truth is that nobody who is pathologizing fatness is a qualified expert on ending weight stigma. For more on this, I've also created a handy guide to whether marketing/PR is anti-weight-stigma or just diet industry propaganda. You can find that here.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In my work around weight science and healthcare, I see a lot of confusion about, and misuse of, statistics. Today I thought I would point out the three of the most common issues that I experience.Sure, intentional weight loss fails 95% of the time, you just have to keep trying until you're in the 5%.I know not everyone took statistics, but I did, so let me assure you that this isn't how statistics work on the most basic level (remember that this is the “logic” that many people use when playing the lottery.) in fact, weight loss is worse than the lottery in this respect because repeated attempts can actually have decreasing odds of success. The body responds to weight loss attempts by changing physiologically to become a weight-gaining, weight-maintaining machine, which it continues to do even after the diet ends. This can make repeated attempts even less likely to result in significant, long-term weight loss. Moreover, many people regain more than they lost, meaning that if they (or their healthcare provider) had a specific weight/BMI in mind, they may end up farther from it than they started. Not to mention that “failure” (being clear that the diet failed the patient, and not the other way around) is not benign. Weight cycling (losing weight and then gaining it back) is linked to significant harm, including health issues that get blamed on being higher weight.But It's Statistically SignificantIn the most simplified explanation, if a study result is “statistically significant,” it means that it's more likely that the result was caused by the study intervention than by chance. So participants could have lost an average of one pound, but if it's determined that it's more likely that the one pound loss was due to the weight loss intervention being studied than by chance, then that one-pound loss is statistically significant.There are a couple of ways that this goes wrong.Sometimes people either think that “statistically significant” means “important” (or they hope that other people will think that's what it means,) so they'll say that a result in a study was “statistically significant” without mentioning that the actual effect (the amount of weight loss, for example) was very small (one might even say…insignificant.)Something else that happens with weight science is that the conclusion of a study (which is often the only part that is not behind a paywall) will state that participants lost “a significant amount of weight” when what they really mean is that they lost a small amount of weight, but that the weight loss was statistically significant. Whether accidentally or on purpose, due to the colloquial meaning of significant this misleads people (including healthcare practitioners) to believe that the intervention was far more successful than it actually was. So the conclusion might say that subjects lost a significant amount of weight when, if you get behind the paywall and dig into the study, you'll find that they lost 2.9% of their body weight (and often, had already started regaining it when the study ended.)Percent increase of complication risk vs percent of complication riskMany healthcare procedures have risks of complications. Typically (and, again, this is a simplified explanation) the decision to treat is based on the benefits of the treatment versus the risk of the procedure. The same procedure may have a different risk of complications for people with different circumstances. For example, people with hemophilia can have a higher risk of bleeding during surgery and a higher risk of poor wound healing and infection immediately following surgery than those who do not have hemophilia.To be clear, I'm not suggesting that higher risk justifies denial of care,  and I'm giving the most simplified possible view of this in the service of just explaining the statistical issue. It gets very complicated in everything from the methodology of the research used to determine the risk of complications to the structures of privilege and oppression that lead some people's lives to be valued more highly than others. Complication risk is often used as the “justification” for BMI-based healthcare denials (wherein healthcare is held hostage for a weight loss ransom and I wrote about that in more detail here. )I recently encountered an example of the issues with confusing these when I received an email from a patient who was facing a BMI-based denial of surgery. The surgeon insisted that there was a 100% complication rate for the procedure for people with a BMI over 40. That wasn't my understanding and it didn't strike me as likely, so I did some digging. It turns out that there was absolutely no research to back the 100% complication claim, but there was some research that showed that for people with a BMI over 40 the risk of complications increased by 100%.Herein lies the issue. A 100% increase in the risk of complications is absolutely not the same as a 100% risk of complications.The base risk of complications for the procedure was 1%, meaning that on average, 1 out of 100 people who have the procedure will experience complications.A 100% increase of a risk of complications of 1% gives us a risk of complications of 2%, meaning that, on average, for people with a BMI over 40, 2 out of 100 who have the procedure (and not 100 out of 100, as the surgeon thought) will experience complications.(I want to point out that when those of higher weight/BMI experience higher complication rates, there is a tendency to assume that body weight is the problem when, in fact, the problem may well be a system – research, tools, training, best practices, and biases etc. - that is created for thin bodies and fails to equally support fatter bodies, but that's the subject for another post.)Statistics help us make sense of data in ways that can be incredibly helpful. That said, it is certainly true that statistics can be manipulated and so we always need to be asking questions about who designed the analysis and for what purpose, and be on the lookout for these common issues. These certainly aren't the only issues if you have examples you'd like to share or questions about stats you'd like me to write about, please feel free to leave them in the comments!Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite.  Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities.  Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible.  Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were  26, the maximum amount of weight lost was only about 5lbs.   The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.]  was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was  3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost.  NICE's guidance:  Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner.  There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,”  pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants.  Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. Today we're going to take a deeper dive into the research that they used to try to support this request, and in part three will look at the research around harm and “efficacy,” as well as “cost effectiveness.” (I was originally going to write this in two parts, but I realized that it was just ridiculously long, and there is time before the WHO meets about this, so I've decided to break it into three parts.)Just a reminder that I don't hyperlink to studies or articles that come from a place of weight stigma, though I do provide enough information that someone could google them.In their ”Summary statement of the proposal for inclusion” they say“The use of GLP-1 RAs in the treatment of ob*sity has been well studied and meta-analyses of various GLP-1 RAs have demonstrated that this class of medications can lead to clinically significant weight loss. Compared to control groups, GLP-1 RAs were found to lead to more significant weight loss with a mean difference of approximately 7.1 kg as well as an improvement in glycemic control, with low concern for hypoglycemia[3].”The single paper they cite to back this up (Iqbal et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with ob*sity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials, 2022) looked at weight loss on these drugs among “ob*se” adults without type 2 diabetes (so hypoglycemia would have been unlikely anyway.) It included 12 trials with a total of 11,459 participants. 80% of the participants were white, 10% were Black or African Americans and 5% were Asians. It is concerning that they are making a global recommendation based on a study population that is overwhelmingly white. There is also the issue of follow-up. Some of the trials were as short as 14 weeks and the longest trial included was only 3 years. The average weight loss was 15.6 lbs more in the group taking the drugs than in control, but some subjects on the drugs lost as little as 5.5 lbs. Those on the drugs also experienced vomiting, nausea, dyspepsia (indigestion,) diarrhea, constipation and abdominal pain as common side effects. There is no way to know how much of this (short-term) weight loss is due to experiencing these common side effects. These drugs also have significant (possibly life-threatening) side effects and the short-term follow-up included here is not likely long enough to capture those. Also, remember that the recommendation is for people to take these drugs for the rest of their lives (since, if they don't, their weight shoots right back up and they lose cardiometabolic benefits,) and they are making that recommendation (globally) on just 14 weeks to 3 years of data.The authors of this study cite no conflicts of interest. Per LinkedIn, someone with the same name as the lead author is a product specialist at Novo Nordisk but I imagine that must be a coincidence or surely it would have been listed as a COI. The article was published in “Ob*sity Reviews” which is an official journal of the “World Ob*sity Federation” (WOF). The WOF took over $5.3 Million dollars from Novo Nordisk (whose weight loss drugs are covered by this recommendation) over three years. Their “members” include the Ob*sity Action Coalition (whose chief funder is Novo Nordisk.) Their current President has taken money to speak on behalf of Novo Nordisk and their past president is John Wilding who was implicated in the recent Novo Nordisk scandal for not disclosing his financial ties to Novo Nordisk while praising their weight loss drugs in the media.There are more issues with this meta-analysis but I'll just stop there and say that I don't think there is any way that 14 weeks to 3 years of data on 11,459 people who are mostly white justifies a global recommendation of these drugs as “essential.”Under “Treatment details (requirements for diagnosis, treatment and monitoring)”Here again they say “Ob*sity, a preventable disease” but offer no citation or support for this narrative that has been largely architected and marketed by the weight loss industry. They continue:“When used in supplement to life style modifications, including a decrease in caloric intake and an increase in exercise, liraglutide is indicated for adults with ob*sity (BMI >30.00) or overweight (BMI >27.00) with a weight-related comorbidity”I just want to note here that this indication (which wasn't created by those who wrote the recommendation to the WHO) predicates risk on body size and simple correlation. These drugs have very unpleasant common side effects and other, possibly life-threatening, side effects. So the fact that those who are “overw*ight” have to have at least one condition that is correlated with being higher weight (with no proof of causation, by the way) but those who are “ob*se” are recommended to risk these side effects based on size alone, with no required symptomology, is pure weight stigma.Next is a table “Excerpts from national and international guidelines on the pharmacological treatment of ob*sity”It is a list of organizations with quotes pulled from various publications that are intended to show support for the drugs. Almost every one of the organizations has financial ties to Novo Nordisk and/or Eli Lilly which doesn't prove that there is anything shady going on, but would be worth disclosing given their use to back up the request that these companies' drugs be considered “essential.” Let's take a deeper look:The American College of Cardiology (ACC)The recommendation that is cited is for the use of these drugs for Type 2 diabetes (T2D), and they mention weight loss as an ancillary effect. This will be a pattern in these recommendations and it matters because the risk/benefit analysis is different for people who have an actual health condition (Type 2 diabetes) rather than those who are simply living in a higher-weight body. Also, one might be misled by the title of the section to believe that these recommendations are specifically for the use of the drugs in the treatment of “ob*sity” which is not the case.The ACC has a partnership with Novo NordiskThey have also partnered with Eli LillySouth Asian Task ForceAgain, this is a recommendation for these medications for the treatment of T2D, not for weight loss.The paper's lead author, Sanjay Kalra has received honoraria for lectures and advisory boards from Eli Lilly and Novo Nordisk.International Diabetes FederationThis, again, is a recommendation of these drugs for the treatment of T2D.Novo Nordisk is a “platinum partner” and Eli Lilly is a “gold partner” (the website isn't clear about how much money they donate, and an email I sent has gone unanswered so far.)National Institute for Health and Care Excellence (NICE)This one actually is a recommendation for these drugs for weight loss, however, NICE was implicated in the recent scandal which found that “Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.”Position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)This is a statement of recommendations for prevention of cardiovascular disease in patients with diabetes.Here is a selection of the authors “competing interests” (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) ROM has received speaker honorarium from: Novo Nordisk and Eli Lilly.CMV has received honoraria as speaker from Novo Nordisk.SV over the last 5 years, has received honoraria for clinical research from Novo Nordisk; Advisory Board to Novo Nordisk; has received honoraria as speaker from Novo NordiskFT has received honoraria for medical lectures from: Lilly, Novo NordiskRDS over the last 3 years has received honoraria for consulting, research and speaker activities from Eli LillyThe Brazilian Diabetes Society (SBD) has collaborated with Novo NordiskThe Brazilian Cardiology Society (SBC) holds an annual congress that is sponsored by Novo Nordisk and Eli Lilly. The Brazilian Endocrinology and Metabolism Society (SBEM) has partnered with Novo Nordisk on multiple occasions.Korean Society for the Study of Ob*sity Guidelines for the Management of Ob*sity in KoreaThis is not a study but guidelines put out by an organization that appears to represent those with a profit interest in “ob*sity treatment” (similar to the Ob*sity Action Coalition.) Their “recommendation” includes every drug that is approved for long-term use, fails to cite any evidence of efficacy (short or long-term) and they mention that “Not all ob*se people respond to ob*sity drugs, and there are a significant number of non-responders.”Novo Nordisk is a platinum sponsor for their conference. They are also a member of the World Ob*sity Federation which took over $5M from Novo Nordisk.European Medical Association[sic]Here they are citing a press release stating that the European Medicines Association (EMA) (the recommendation authors appear to have been mistaken on the name) has “recommended granting a marketing authorisation for Saxenda (liraglutide) for weight management in overweight or ob*se adults.” Per the EMA's website they are “a scientific body with the expertise required to assess the benefits and risks of medicines. However, under EU law it has no authority to actually permit marketing in the different EU countries. The role of EMA is to make a recommendation to the European Commission which then takes a final legally binding decision on whether the medicine can be marketed in the EU.”I could not find information about the panel that made the decision, or any conflicts of interest they may have had.Australia: NPS Medicine WiseThe citation they offer here is not to Australia: NPS Medicine Wise, but to a paper by a single author - Joseph Proietto who “has been on the medical advisory boards for liraglutide, semaglutide 2.4 mg and bupropion/naltrexone. He has been involved in educational sessions for ob*sity management for both Novo Nordisk (liraglutide, semaglutide) and iNova (phentermine and bupropion/ naltrexone) for which he has received honoraria.” In other disclosures it mentions that he was, in fact, chair of the medical advisory board for Saxenda (Novo Nordisk's brand name for liraglutide, the drug being recommended here.)In the paper he recommends all of the above weight loss drugs in general, but does not recommend the GLP-1 class of drugs over any of the others. The study he uses to recommend these drugs only follows participants for 68 weeks.Singapore HPB-MOH Clinical Practice GuidelinesIn the section on liraglutide they offer information for 56 weeks of follow up and conclude “The long-term safety of high dose liraglutide therapy is, however, unclear.”Canadian Medical Association Journal- Ob*sity in adults: a clinical practice guidelineFunding for these guidelines was provided by Ob*sity Canada, an organization that lobbies for the priorities of those who profit from “ob*sity treatment.” Specifically, the funds came from “Ob*sity Canada's Fund for Ob*sity Collaboration and Unified Strategies (FOCUS) initiative” Novo Nordisk is a supporter of this fund, as well as a sponsor for their annual summit.Here are excerpts from the 1,293 word competing interests statement for the authors (I've only included Novo Nordisk and Eli Lilly, the two main companies trying to sell this class of drugs for weight loss.) Sean Wharton reports receiving honoraria and travel expenses and has participated in academic advisory boards for Novo Nordisk, Eli Lilly. Sean Wharton is also the medical director of a medical clinic specializing in weight management and diabetes. David Lau reports receiving grants and research support from Novo Nordisk, speaker bureau fees from Eli Lilly and Novo Nordisk; and consulting fees from Eli Lilly and Novo Nordisk. Michael Vallis is a member of advisory boards for Novo Nordisk. Michael Vallis has also received consulting fees from Novo Nordisk and speaking fees from Novo Nordisk. Arya Sharma reports receiving speaker's bureau and consulting fees from Novo Nordisk. Laurent Biertho is a member of advisory boards for Novo Nordisk. Denise Campbell-Scherer reports receiving research funding from Novo Nordisk. She also reports receiving an unrestricted education grant from Ob*sity Canada, funded by Novo Nordisk Global. Jennifer Brown reports receiving nonfinancial support from Novo Nordisk, and personal fees Yoni Freedhoff is the co-owner of the Bariatric Medical Institute and Constant Health, which provide weight management services; Constant Health has received a grant from Novo Nordisk. Yoni Freedhoff also regularly speaks on topics related to ob*sity and receives honoraria and travel costs and expenses for same. Michel Gagner reports receiving consulting fees from Novo Nordisk. Marie-France Langlois reports receiving personal fees from Novo Nordisk, Eli Lilly. David Macklin reports receiving personal fees from Novo Nordisk. Priya Manjoo reports receiving personal fees from Novo Nordisk. Marie-Philippe Morin reports receiving speaker honoraria from Novo Nordisk, Eli Lilly and research subvention from Novo Nordisk, and consultation honoraria from Novo Nordisk, Eli Lilly. Sue Pedersen reports receiving personal fees from Novo Nordisk, Eli Lilly and grants from Eli Lilly, and nonfinancial support from Novo Nordisk and Eli Lilly.Megha Poddar reports receiving honoraria for continuing medical education (CME) from Novo Nordisk, Eli Lilly, education grants from Novo Nordisk, fees for mentorship from Novo Nordisk; fees for membership of advisory boards from Novo Nordisk. Paul Poirier reports receiving fees for consulting and continuing medical education from Eli Lilly, Novo Nordisk. Judy Shiau reports receiving personal fees from Novo Nordisk. Diana Sherifali reports receiving a grant from Ob*sity Canada to support the literature review process, during the conduct of the study. Shahebina Walji reports receiving consulting or advisory board fees from Novo Nordisk and speaker's bureau fees from Novo Nordisk.All of their recommendations around liraglutide are level 2a (Evidence from at least 1 controlled study without randomization) and Grade B ( Directly based on level 2 evidence or extrapolated recommendation from category 1 evidence) they suggest that these recommendations should use the terms “may” or “can” (as opposed to “should.”) The studies that they cite offer, at most, only 56 weeks of follow-up.Information supporting the public health relevanceIn this section they claim that “not only is the prevalence of ob*sity increasing, but the number of global deaths attributed to BMI has substantially increased from 1990 to 2017 (Figure 1) [23]. The global burden of disease of ob*sity study also found that though the age-standardized rate of high BMI related disability adjusted life years (DALY) increased by 12.7% for females and 26.8% for males, the actual global number of high BMI DALYs has doubled, despite sex”The study that they cite to support this (The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study, Dai et al., 2020) calculates these numbers based on the assumption that the health problems higher-weight people have are due to their weight (even though people of all sizes experience them). They also fail to control for the health impacts of weight stigma, weight cycling, or healthcare inequalities, despite the research that shows that they are confounding variables. The assumption that higher-weight people's health issues are caused by their weight coupled with the failure to account for (or even discuss) confounding variables suggests to me either near-complete incompetence of the study authors around basic research methods, or a desire for specific conclusions.The study is at least honest that they don't know if weight loss would change this, stating “Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases” [emphasis mine].Thus, this doesn't actually support the recommendation to the WHO. Without proof that these medications would reduce disease or increase life years long-term, there is no reason to consider them “essential,” and no such evidence exists.Next they claim that “Ob*sity also plays a role in health care related costs; for patients and families, total healthcare costs for patients with ob*sity were higher than that of patients who are overweight.”First of all, this begins to wade into the idea that higher-weight people should be eradicated because they are “too expensive,” which is heading down a bad road when it comes to ethics. Further, the study they use to support this is based on 97 Dutch people who filled out a survey. The study included costs such as “expenditures related to the respondent's weight, such as adapted clothing, gym subscription, diet books, parking permit, food, etc.” First of all, thin people also have gym subscriptions and parking permits, but, moreover, telling fat people that they should buy diet books and pay for various weight loss foods and methods (despite the near-total failure rate,) then blaming them for the cost of following those dubious recommendations (as well as the additional costs of living in a world where structural weight stigma creates a lack of accommodation in clothing etc.) as a justification for more expensive, more dangerous “interventions” is a long way from being ethical science and is a particularly craven marketing tactic. I'm just going to stop there, but to say that I've seen elementary school science fair projects with more rigorous methodology and I would be beyond embarrassed to cite this for any reason ever, other than as an example of the piss-poor state of weight science.They finish up the section with “Given the global burden of ob*sity and the goal of reducing preventable disease related deaths, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Let's rephrase this to reflect the evidence they provided: “Based on a survey taken by 97 people, a study that failed to control for any confounding variables and made wild assumptions about causality based on simple correlation, and their own research's acknowledgment that changing body size may not change health outcomes, it is evident that affordable and available pharmacotherapy for ob*sity is needed on a global level.”Which is to say, what they provided here does not come close to justifying their request.In part three we'll wrap this up with a look at the evidence they use to discuss harm, effectiveness, and cost-effectiveness.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!There are a number of different ways that bias can impact the healthcare that higher-weight patients receive. This includes provider bias and structural bias (when the healthcare system is created for thin bodies and/or to the specific exclusion of fat bodies.) Today I want to talk about what happens when these two types of bias intersect. It's a perfect storm that both supports and increases this bias. It doesn't have to be this way, and there is a simple first step (though it's certainly not the only step,) that healthcare providers can take to interrupt it. Let's look at some real-world examples (shared anonymously with permission):A fat patient arrives for a mammogram. They receive a gown but it doesn't fit, they ask for a larger gown and the tech says “If you're too big for that one I can give you a second one and you can wear both.”A fat patient needs an MRI. They get on the table, and it begins to move. But the patient's hips catch on the sides. The tech stops the table, and says “Your hips are too wide for the MRI, we wont' be able to do the scan.”A patient goes to the pharmacist to get Plan B for pregnancy prevention. The pharmacist asks the patient's weight and then says “Your weight is too high for this pill to be effective.”A fat patient calls 911 because they have symptoms of a stroke. The paramedics arrive and say “you are too wide to fit on our gurney, we're calling a special ambulance to transport you.”A fat patient gets a report back on a CT scan and it says that conclusions could not be drawn because of the “patient's body habitus.”A fat, pregnant patient arrives at an Ob/Gyn practice for their first pre-natal visit. The receptionist says “You are too heavy for our tables so we can't accept you as a patient.”A fat patient points out to the receptionist that all of the chairs in the waiting room are too small for them, the receptionist says “I'm so sorry but if you don't fit in the chairs you'll need to stand.”A fat patient is at the doctor for their annual pap smear. The gynecologist says “I'm sorry but you are too heavy for our largest speculum, if you want to make another appointment and bring your own, we can proceed.”A fat patient has injured their knee and sought care in the ER. The doctor says that “there is nothing he can do to help, you'll need to get an MRI and see an orthopedist and you should keep the knee immobilized and not put any weight on it or you could cause catastrophic injury. Unfortunately, your knee is too big for the immobilization braces we have, and your weight is too high for the crutches. We can let you use a wheelchair to get to your car but then you're on your own.”A fat patient has come to the ER for chest pains. An EKG has shown arrhythmias and blood tests show elevated troponin. The nurse explains that the patient is being admitted but says “I apologize but you are too heavy for our ER beds, we are waiting on a bariatric bed to be brought down.”Again, these are all true stories that have happened to higher-weight patients and there are a LOT of things wrong here that negatively impact patient care. But did you notice the one thing that all of these scenarios had in common? The one thing that, had providers done it differently, could have immediately reduced the weight stigma being experienced by the patient (even though many other steps are necessary to actually solve the problem)?Feel free to take a minute to think about it, or read on for the answer.The one thing that each of these scenarios have in common is that healthcare providers blamed the patient's body for the lack of accommodation. This is a common way that we see both implicit and explicit bias surface and intersect with structural weight stigma. The patient is already experiencing structural weight stigma that is impacting their care, the added stigma of being blamed for the healthcare systems' failure to accommodate them adds insult to injury and adds harm.Solving weight stigma can be difficult and involve a lot of action from a lot of different people, but this one can be solved by each individual provider at the point of care. The patient isn't “too big,” “too wide,” “too heavy,” etc. The equipment is too small. The patient is never the problem. Healthcare should be accessible to everyone and, if it's not, then that's a failure of healthcare, not a failure of the patient for existing in a body with needs that were completely predictable.One way to think about this is “Did the decisionmaker here not know that fat patients existed, or did they just not care if fat patients got the same care as thinner ones?” Either way it's an absolute failure of the healthcare system, not the patient.It's entirely possible that the lack of accommodation is not the fault of the provider who is currently working with the patient, but they can still be the one to apologize and make it clear to the patient that this is not their fault and shouldn't be happening.Again, this is only a first step, but it's not just a first step for the patient, it's also important for providers to consistently remind themselves that they are part of a system that too often fails their fat patients and that fat patients aren't to blame for that.Here is a guide to what to do if you aren't able to accommodate a higher-weight patient.For a deeper dive into how weight stigma shows up in healthcare, check out this piece.I also have a guide to creating a size-inclusive healthcare practice here.I wrote more about the patient who was asked to bring their own speculum here.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In Part 1 we talked about how Novo Nordisk got suspended from The Association of the British Pharmaceutical Industry for their shady marketing practices. Today, we're going to talk about an investigation by The Observer that found what so many of us have been saying for a looooong time - that Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo's weight loss drug to decide whether or not it should be made available.The Observer article by Shanti Das and Jon Ungoes-Thomas “‘Orchestrated PR campaign': how skinny jab drug firm sought to shape ob*sity debate” (Note: per my policy I'm not linking to it because it still comes from a place of weight stigma) found that in three years, Novo Nordisk had shelled out £21,700,000 (about $26,415,301.50 USD) over 3,500 transactions which were separate from their research and development spending.The Observer found:“The payments include donations, event sponsorship, grants and other fees to prominent ob*sity charities, NHS trusts, royal colleges, GP surgeries, healthcare education providers and universities - on top of £28m spent by the company on research and development. A further £4m in payments such as consulting and lecture fees went to health professionals, including experts on ob*sity. The business has also provided financial support for the running of the all-party parliamentary group on ob*sity - a cross party group of MPs and members of the Lords that lobbies the government on health policy.”I've written before about how major papers like the New York Times are writing articles that are, essentially, lobbying for Novo Nordisk's priorities where every expert quoted is on Novo's payroll with no disclosure. One question I get asked a lot is “how is that legal?” First I'll point out that legal and ethical are two different things. Beyond that, there is a tendency to believe that doctors and academics are somehow immune to industry influence (or to the ways that their promotion of the weight loss paradigm will support their careers) such that reporters and others (including those on the pharma industry's payroll) claim that disclosing these conflicts of interest isn't important.An excellent example of the ways in which those who are seen as “impartial” experts in academia are, in fact, on the payroll of these companies and actively shilling for them is Professor John Wilding. Professor Wilding is at Liverpool University, where he leads clinical research on “ob*sity.” He also serves as president of the “World Ob*sity Federation” (an astroturf organization similar to the Ob*sity Action Coalition) which took more than £4.3M over three years, per The Observer. Somehow, this did not make its way onto his conflicts of interest statement. Meanwhile, he was quoted extensively in the media recommending Novo's drug Wegovy. Jason Halford, who is the Head of the School of Psychology at the University of Leeds, told an audience of millions on BBC that Wegovy is “one of the most powerful pharmaceutical tools” for treating “ob*sity.” He did not disclose that he is also the president of the European Association for the Study of Ob*sity (EASO), another astroturf organization (which is to say, an organization that claims to advocate for marginalized people but, in reality, is predominantly funded by and acting as a lobbying arm of, the pharmaceutical/weight loss surgery industry.) The Observer found that the EASO received more than three-quarters of its income (more than £3.65m) from Novo Nordisk. He was also a previous member of Novo Nordisk's UK advisory board.I'm glad Novo Nordisk's lack of ethics are getting wider coverage (though, as I pointed out in part 1, people in fat liberation and weight-neutral health advocates like Mikey Mercedes, Louise Adams, Asher Larmie, myself and others have been talking about this for some time,) but I don't expect it to stop them until we can put enough pressure on them to force them to stop. This is a company that orchestrated aggressive price gouging on insulin, proving beyond a doubt that they will kill people for money. And as pressure in the US is forcing Novo to lower the price of insulin, they seem to have a lot of eggs in the Wegovy basket. Prior to launch, they promised their shareholders the “fastest ever” post FDA-approval launch and that they would double their “ob*sity” sales by 2025. In fact, The Observer found that Novo Nordisk's sales on their new “ob*sity treatments” rose 84% in 2022 to $2.4B – a figure Novo projects will “grow significantly” in 2023.And what will they do to grow this figure significantly this year? I think their behavior makes it clear – absolutely anything they can get away with.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

You may know Cara MacB (they/them) for their videos on social media of a call centre operator fielding complaint calls from fatphobic people. Cara's content is brilliant, hilarious, and one of the ways that they try to change people's beliefs that fat is bad. In this episode, Cara shares how they dismantled their own fatphobia, discovered that they could use their inner class clown for good, and how lazy it is to use marginalized identities as the butt of jokes.Cara MacB is non-binary, queer. They bring an anti-diet approach to fat positive content creation & comedy. Their super viral Overweight Bitches Content Creators Helpline sketches have made them a leading voice in the UK anti-diet online world.Please connect with Cara on Instagram and TikTok.This episode's poem, “after takeoff”, is by Maya Stein.Please connect with Fat Joy on our website, Instagram, and YouTube (full video episodes here!). And please also give us a rating & subscribe.Deep thanks for their hard work go to Hi Bird Designs and AR Media for keeping this podcast looking and sounding joyful.

Medical interactions are often deeply traumatic for fat and plus-size people. Anne McGladdery (they/she) is a medical student, fat, and became a squeaky wheel during medical school in order to shift the anti-fat bias prevalent throughout the curriculum. Anne shares about their stressful first couple of years (spoiler: their hair started falling out!), their weight stigma research project, and how they plan to be a different kind of physician for fat people.Anne McGladdery is a University of British Columbia (UBC) MD candidate 2023 based out of the northern program in Prince George, BC. They came to medicine through a very circuitous route, having a theatre degree and a masters in theatre history from the University of Victoria previously. Having worked as a medical office assistant while completing their graduate degree, Anne saw the many successes and failings of the medical system from a family medicine perspective. As they became more familiar with fat politics, they learned to identify how discrimination against fat people was treated as the norm by many health care professionals. Wanting to provide equitable care to patients with bodies of all sizes became a motivating factor for Anne, and so they returned to school to complete their science upgrading before being accepted to the UBC medical program. It has been difficult and alienating being a fat medical student, but with the support of amazing colleagues, allies, and friends, Anne is hopeful that there will be a new generation of physicians who are able to leave these biases behind.Please connect with Anne through email, and the UBC Weight Inclusive instagram account.In the episode, Anne mentioned Alexandra Shewan, Dr. Wind, and the She's All Fat podcast.This episode's poem is called “bless small things” by Elizabeth Paulette-Coughlin.Please connect with Fat Joy on our website, Instagram, and YouTube (full video episodes here!). And please also give us a rating & subscribe.Bonus content via Apple Subscriptions from your podcast player as well as via Patreon.Deep thanks for their hard work go to Hi Bird Designs and AR Media for keeping this podcast looking and sounding joyful.

Da'Shaun L. Harrison is an organizer, trans theorist, Editor-at-Large at Scalawag Magazine and winner of the 2022 Lambda Literary Award in transgender nonfiction for their book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. For our series Black.Queer.Rising, they share their understanding of the connection between anti-fatness and anti-Blackness, why and how they're able to show up as their full unapologetic self, and what they view as the limitations of liberation while existing within an oppressive system.  To read the full transcript, see above.

We're going full tinfoil hat in this two-part conversation with the brilliant Ragen Chastain (she/her). In this first episode, Ragen shares the details of how Weight Watchers, Noom, and other companies that promise weight loss manipulate their ‘research', accept conflict-of-interest funding from pharmaceutical companies, and unethically advise consumers on ‘health.' This episode will make you furious and much more critical of ‘health' information.Ragen Chastain is a speaker, writer, researcher, Board Certified Patient Advocate, multi-certified health and fitness professional, and thought leader in weight science, weight stigma, health, and healthcare. Utilizing her background in research methods and statistics, Ragen has brought her signature mix of humor and hard facts to healthcare, corporate, conference, and college audiences from Kaiser Permanente and the Diabetes Education Specialists National Conference, to Amazon and Google, to Dartmouth, Cal Tech and canfitpro. In her free time, Ragen is a national dance champion, triathlete, and marathoner who holds the Guinness World Record for Heaviest Woman to Complete a Marathon, and co-founded the Fit Fatties Facebook group which has over 11,000 members.We mention Sabrina Strings' book, Fearing the Black Body: the Racial Origins of Fat Phobia, and Da'Shaun Harrison's book, Belly of the Beast: the Politics of Anti-Fatness as Anti-Blackness.Connect with Ragen:Newsletter: www.WeightandHealthcare.comWebsite: www.SizedForSuccess.comHealth Sheets: https://haeshealthsheets.com/Instagram: https://www.instagram.com/ragenchastain/This episode's poem is Remember by Joy Harjo.All things Fat Joy can be found here on the website: http://www.fatjoy.lifeAnd if you're a Fat Joy Patreon supporter, be sure to go watch Some Extra Fat Joy: 10 Q's with Ragen Chastain.Deep thanks for their hard work go to Hi Bird Designs and AR Media for keeping this podcast looking and sounding joyful.

Why are women judged for their size? What if you decided that you had the right to remain fat? This episode explores: Our born desire to like ourselves as we are. How we get shamed out of that at such a young age, and so very quickly. How hard it is to re-learn how to like yourself. Why our cultural commitment to fat-phobia harms us all. A Discussion of the book You Have the Right To Remain Fat. Our guest is: Virgie Tovar, who is an author, activist, and a lecturer on weight-based discrimination and body image. She holds a Master's degree in Sexuality Studies with a focus on the intersections of body size, race and gender. She edited the anthology Hot & Heavy: Fierce Fat Girls on Life, Love and Fashion (Seal Press, November 2012), is the author of You Have the Right to Remain Fat (Feminist Press August 2018), The Self-Love Revolution: Radical Body Positivity for Girls of Color (New Harbinger Publications 2020), and The Body Positive Journal (Chronicle Books 2022). She has received three San Francisco Arts Commission Individual Artist Commissions as well as Yale's Poynter Fellowship in Journalism. Our host is: Dr. Christina Gessler, a historian of women and gender. Listeners to this episode may also be interested in: Fatty Fatty Boom Boom, by Rabia Chaudry What We Don't Talk About When We Talk About Fat, by Aubrey Gordon Belly of the Beast: The Politics of Anti-Fatness, by Da'Shaun L. Harrison Fearing the Black Body: The Racial Origins of Fat Phobia, by Sabrina Strings The Body is Not An Apology, Second Edition, by Sonya Renee Taylor Welcome to The Academic Life! On the Academic Life channel we embrace a broad definition of what it means to lead an academic life. We view education as a transformative human endeavor and are inspired by today's knowledge-producers working inside and outside the academy. Find us on Twitter: @AcademicLifeNBN. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Da'Shaun L. Harrison has penned one of my favorite texts in the past five years. I have read it three times in nine months and I have become more and more delighted with the person that I become absorbing these words. In Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness, Harrison presents theoretical frameworks that compel us to meaningful action. I will tell you now and I will tell you for free: belief that compels me to meaningful action is exactly my shit. I am grateful, to my bones, for theory. Blessed are the workers who make the way clearer with their weighty, weighty words. I relish texts like this.read the full essay (and join bookclub!) at ismatu.substack.comJazz songs of the episode:Skylark x Wynton MarsalisAbide With Me x Thelonious Monk SeptetFools Rush In x Teddy Wilson (this is what was playing when my mom interrupted me)My Romance x Gene Ammons (remastered by Rudy Van Gelder)Confirmation - Take 3 / Master x Charlie Parker QuartetCup Bearers x Tommy Flanagan, George Mraz, and Elvin JonesA Sleepin' Bee x Wynton Marsalis Stomping At The Savory x Red Gardland, Paul Champers, Art Taylor This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit ismatu.substack.com/subscribe

In this episode, I am joined by Kalpana Mohanty, writer, Ph.D. Candidate and Trudeau Scholar at Harvard University. She works on disability, colonialism, and gender in South Asia. Kalpana grew up in Portugal, Canada and India. Her proposed PhD topic focuses on the history of disability in India, particularly during high colonialism. Inspired by her own lived experience as someone with chronic illness who lives with a disability, Kalpana is passionate about accessibility in all forms, whether that be making academic spaces accessible for all students or making scholarly work engaging and interesting for a non-academic audience. She is committed to using the rigorous framework and theory of academia to address wider cultural issues ranging from the serious to the trivial as a cultural commentator. Kalpana reads and we discuss her incredible article, Beautiful Lies, where she asks why public discourse on beauty remains so shallow. Kalpana's Links:Twitter:  @kalpanamohantyWebsite: https://kalpanamohanty.squarespace.com/ Audio clips included: Now This News: Sabrina Strings Explains How 'Fatphobia' is Rooted in RacismIntersections of Disability Justice and Transformative Justice Ft. Elliott Fukui and Leah Lakshmi Piepzna-Samarasinha by Barnard Center for Research on WomenVenmo: Elliot Fukui @elliottseiji Buy Leah Lakshmi Piepzna-Samarasinha's books hereLinks Mentioned:Beautiful Lies | Kalpana Mohanty Mobeen Hussain is the Cambridge scholar who studies skin lightening in India. Jaclyn WongAfghan Girl Portrait by Steve McCurryConstant Cravings by Alice WongBook and other recommendations included:Fearing the Black Body: The Racial Origins of Fat Phobia  by Sabrina Strings | Thick: and other Essays by Tressie McMillan Cottom | Alok V Menon | The Age of Instagram Face by Jia Tolentino| Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison | Maybe Baby | Haley Nahman| The Right to Sex by Amia Srinivasan | What We Don't Talk About When We Talk About Fat by Aubrey Gordon| Maintenance Phase Podcast  | Perfect Me by Heather Widdows --- Support this podcast: https://podcasters.spotify.com/pod/show/ayandastood/support

A Conversation about Feminism and Reality TV It's no secret that there is a lack of diversity of bodies in reality tv… especially in the Bachelor. In 20 years The Bachelor has not changed their casting practices and we're over it. On today's episode, Rah chats with Jenna and Rach from the newly launched group Roses for Everybody. They're here to change the game with their Fat Bachelor Inclusion campaign and challenge you to get rid of your anti-fat biases.    SIGN THE PETITION HERE   Books Recommended by Roses for Every Body: Fearing the Black Body: The Racial Origins of Fatphobia by Dr. Sabrina Strings Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun L. Harrison Tipping the Scales of Justice: Fighting Weight-Based Discrimination by Sondra Solovay, J.D.  Shameful Bodies: Religion and the Culture of Physical Improvement by Michelle Mary Lelwica  One to Watch by Kate Stayman-London Support our guest and host: Follow Roses For Every Body: Instagram // Twitter // TikTok Follow Rah: Instagram // Twitter // TikTok   Beyond the Box: Our weekly round-up of blog and podcast content delivered directly to your inbox every Friday Check out our online community here!    This episode was edited by Claudia Neu and produced by Renee Powers on the ancestral land of the Dakota people.   Original music by @iam.onyxrose Learn more about Feminist Book Club on our website, sign up for our emails, shop our Bookshop.org recommendations, and follow us on Instagram, Twitter, TikTok, Facebook, Pinterest.

Vox's Anna North talks with Da'Shaun Harrison, the activist, author, and 2022 Lambda Literary Award recipient for their book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. Da'Shaun explains the ways in which society's anti-fatness is structural, and connected —historically and politically — to the structures of anti-Blackness that took root alongside slavery in America. Anna and Da'Shaun discuss common misunderstandings and myths about fatness, how these pathologies insidiously infiltrate the criminal justice system, and why Da'Shaun envisions a liberatory future in the idea of destruction. Host: Anna North (@annanorthtweets), Senior Reporter, Vox Guest: Da'Shaun Harrison (@DaShaunLH), author; editor-at-large, Scalawag References:  Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness by Da'Shaun Harrison (North Atlantic; 2021) "The past, present, and future of body image in America" by Anna North (Vox; Oct. 18, 2021) "The paradox of online 'body positivity'" by Rebecca Jennings (Vox; Jan. 13, 2021) Fearing the Black Body by Sabrina Strings (NYU; 2019) "CDC Study Overstated Obesity as a Cause of Death" by Betsy McKay (Wall Street Journal; Nov. 23, 2004) "Correction: Actual Causes of Death in the United States, 2000" (JAMA; Jan. 19, 2005) Killer Fat: Media, Medicine, and Morals in the American "Obesity Epidemic" by Natalie Boero (Rutgers; 2012) "The Bizarre and Racist History of the BMI" by Aubrey Gordon (Oct. 15, 2019) "Mama's Baby, Papa's Maybe: An American Grammar Book" by Hortense J. Spillers (Diacritics, 17 (2); 1987) Joy James: Captive Maternals Enjoyed this episode? Rate Vox Conversations ⭐⭐⭐⭐⭐ and leave a review on Apple Podcasts. Subscribe for free. Be the first to hear the next episode of Vox Conversations by subscribing in your favorite podcast app. Support Vox Conversations by making a financial contribution to Vox! bit.ly/givepodcasts This episode was made by:  Producer: Erikk Geannikis Editor: Amy Drozdowska Engineer: Patrick Boyd Deputy Editorial Director, Vox Talk: Amber Hall Learn more about your ad choices. Visit podcastchoices.com/adchoices

This week, jh and Tre'vell invite filmmaker Amber J. Phillips, and author Da'Shaun L. Harrison (Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness) to the show for a conversation about fatphobia (read: jh's fatphobia). Regular listeners may recall jh's response to an email calling him out for expressing satisfaction that his beard hid his “double chin”. The critique was that “double chin” was code for fat, and that jh's fatphobia was showing. Amber and Da'Shaun were both given permission to drag jh, so that he, and FANTI listeners, can confront their own fatphobia, which is Anti-Black as well. Strap in! Mentioned in the show:Author Sabrina Strings - Fearing the Black Body: The Racial Origins of FatphobiaUnsolicited: Fatties Talk Back podcastDIS/Honorable Mentions jhHM: Candice Marie Benbow's Red Lip TheologyHM: Lizzo's Watch Out for the Big GrrrlsTAM: Ralph Lauren unveils HBCU collection exclusively for Morehouse, Spelman College https://twitter.com/phil_lewis_/status/1503739113933000705?s=21HM: American Song Contest - Jewel, Sisquo, Michael BoltonBHIHEKetanji Brown JacksonFANTI: Amber J. Phillips and Da'Shaun L. HarrisonOur Sponsors This WeekMicrodose GummiesTo get free shipping and 30% your first order, go to MicrodoseGummies.com and use code FANTI.BrookLinenFANTI listeners can get $20 off a purchase of $100 or more by using the promo code FANTI.Go ahead and @ usEmail: FANTI@maximumfun.orgIG@FANTIpodcast@Jarrett Hill@rayzon (Tre'Vell)Twitter@FANTIpodcast@TreVellAnderson@JarrettHill@Swish (Senior Producer Laura Swisher)FANTI is produced and distributed by MaximumFun.orgLaura Swisher is senior producer Episode Contributors: Jarrett Hill, Laura Swisher, Tre'Vell Anderson,Editor: Will HagleMusic: Cor.eceGraphics: Ashley Nguyen