Podcast appearances and mentions of fiona willer

Dr. Fiona Willer is an Advanced Accredited Practising Dietitian and Fellow of the Higher Education Academy renowned for her advocacy of weight-neutral practices in healthcare. Throughout the podcast episode, Fiona shares insights on why a weight neutral approach is necessary to progress population wellbeing, and how community health and food practitioners can identify weight stigma within programs and policies to challenge the obesity-centric language often used in these contexts. With a rich background in university lecturing, private practice, and clinical dietetics, Fiona's expertise extends across diverse domains, including dietetic private practice benchmarking and Health at Every Size (HAES) integration into dietetics. As the founder of Health Not Diets, Fiona pioneers professional development training and workshops aimed at integrating HAES principles into clinical practice.For further information, check out Fiona's website, researcher profile at QUT,  Linked In, and X profiles. Key links:Willer F. The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials. Health Promot J Austral. 2023. Fiona's Podcast: Unpacking Weight Science Book: If not dieting, then what? by Rick KausmanThis episode touches on topics that you may find distressing, including weight stigma and disordered eating. Please check who's listening in and take a break if you need to. If you are in distress and need help 24/7 in AustraliaLifeline (131114)13 Yarn (139276) for Aboriginal and Torres Strait Islander listeners Emergency services (000)If you need to talk to someone about an eating disorder The Butterfly Foundation (1800 33 4673, not a crisis line)CONTACT USSend us your thoughts or questions about the episode or the podcast in generalVia Instagram @fromfoodiesinthefieldVia X @foodies_fieldVia email foodiesinthefield@outlook.comAnd we'd love it if you left a review of the podcastCREDITSHost: Sophie Wright-PedersenWith thanks to Dr. Fiona Willer for her time and thoughtsThe Foodies in the Field podcast would like to acknowledge the traditional owners of the land on which this podcast was made, the Turrbal and Yuggera people of Meanjin, as well as where you may be listening from today. We pay respects to elders both past and present and acknowledge that Aboriginal and Torres Strait Islander people were the first foodies of this nation where food systems, knowledge and practices have always been deeply embedded in this country long before colonisation.Support the show

You may have seen on the news this week a lot of chatter about a 'ham ban' and a 'fairy bread ban' in Western Australian and South Australian schools. We've done some digging to get to the bottom of the headlines, what the actual situation is, why changes have been made and what it means. (Spoiler alert - ham is not even banned!) For more background of the 2016 classification of red/processed meats as carcinogenic check this article by Dr Tim Crowe of Thinking Nutrition. We also touch on some unfortunate reporting and commentary (from our own profession gah!) that decided to bring in 'overweight and obesity' rates into the discussion about the supposed ban. We mention a podcast episode by our colleague Dr Fiona Willer, it is super helpful for anyone interested in learning more about weight classification / BMI and health risk, you can watch it here or listen here. Finally our 'Helping Your Teen Eat Well in a Food Confused Culture' is ready and available for purchase. It's only $33 for over 90 minutes of practical help for parents to open discussions with their teens, look for red flags, help navigate social media diet messages and protect them from eating disorders. Click here for more information. Susan's favourite thing this week was from this amazing restaurant and this recipe is pretty close to Grandma's Carrot and Feta Lasagne.

Over half of us are trying to lose weight, and often we're told that diets are the way to do it. But is there any science behind cutting out food groups, or spending hours on a treadmill to try and outrun a can of coke? In this episode, Cosmos journalist Matthew Ward Agius lets loose on his love of donuts. Joined by Dr Evangeline Mantzioris and Dr Fiona Willer, they discuss if diets – especially the way we think of them – are actually a good idea. This episode was produced by Jacinta Bowler and edited by Helen Karakulak. Theme music by Will Berryman. For more science news, visit cosmosmagazine.com and follow us on Instagram @cosmosmagazine Love the show? Let us know by rating and leaving a review on Spotify or Apple Podcasts.  See omnystudio.com/listener for privacy information.

Today on the podcast I'm joined by Dr. Molly Moffat - A GP who practices medicine from a weight inclusive, neurodiversity affirming lens, celebrating both diversity of bodies and of minds. In this episode, we are talking about how Molly moved away from recommending diets and weight loss to her patients, towards an anti-diet, weight-inclusive approach, focused on treating individuals with care and compassion. We get into what exactly medical anti-fat bias is and why it's so harmful, and she has some really lovely suggestions for how to talk to patients who come in with the idea that they have to lose weight for medical reasons. Find out more about Molly's work here.Follow Laura on Instagram here.Subscribe to Laura's newsletter here.Enrol in the Raising Embodied Eaters course here.Here's the transcript in full:INTRO:Molly: Fat folk don't go and see their doctor when they need to. And you know, I don't need to explain why that is a concern. That is a concern. It means that diagnoses are missed, diagnoses are made late, and it absolutely contributes to stress, mental health, physical health and health inequity in an already marginalised group of people.Laura: Hey, and welcome to the Can I Have Another Snack? podcast, where we talk all about appetite, bodies and identity, especially through the lens of parenting. I'm Laura Thomas, I'm an anti diet registered nutritionist, and I also write the Can I Have Another Snack? newsletter. Today I'm talking to Dr. Molly Moffat. Molly is a GP with a special interest in learning disability and autism. She practices medicine from a weight inclusive, neurodiversity affirming lens, celebrating both diversity of bodies and of minds. She's neurodivergent herself and has three children. In this episode, Molly and I are talking about how she moved away from recommending diets and weight loss to her patients towards an anti diet, weight inclusive approach, focused on treating individuals with care and compassion. We get into what exactly medical anti-fat bias is and why it's so harmful, and she has some really lovely suggestions for how to talk to patients who come in with the idea that they have to lose weight for medical reasons. I really loved talking to Molly and I think you're going to enjoy this episode.But before we get to today's conversation, I want to tell you real quick about the benefits of becoming a paid subscriber to the Can I Have Another Snack? newsletter and community. Now, I know we're not used to having to pay for content on the internet. and why would you pay for something where 85% of the content is free anyway?Well, because without paying supporters, this work just wouldn't be possible. None of the newsletter, not the podcast. As well as supporting me in the time it takes to research, interview contributors, and write articles, your support goes towards paying guests for their time and their labour, as well as a podcast and a newsletter editor, so it's a whole team effort.You also help me keep the space ad and sponsor free, so I don't have to sell out to advertisers or exploit my kid for freebies. Plus, keeping the community closed to paying subscribers only means that we keep the trolls and the fatphobes out. I recently asked the CIHAS community why they support the newsletter, and this is what one reader had to say:“I'm a mum of one fairly adventurous, self proclaimed vegetarian and one theoretical omnivore. The latter survives almost exclusively on added sugar and butter, but mostly sugar. I consumed all the picky eating advice, some of it really well meaning and pretty mellow, but by seven years in, I was more frustrated, confused, and full of self doubt than ever.Enter CIHAS. The no nonsense, cut through the bullshit, science backed content is exceptional. The content about sugar is especially helpful to me, and the anti diet lens is an antidote to my extremely anti fat/diet culture conditioning. And as an American, the British references are just an added bonus. To say your work is actively changing my life is not an understatement. Thank you.”Well, thank you to the reader who sent that really lovely review. Becoming a paid subscriber is a fiver a month or £50 for the year. And you get loads of cool perks as well as just my undying gratitude for supporting my work. Head to laurathomas.substack.com to subscribe now.  All right, team, here's my conversation with Dr. Molly Moffatt. MAIN EPISODE:Hey Molly, can you start by telling us a little bit about you and the work that you do? Molly: Sure, yes. So I'm a GP, although I actually only do one day of general practice at the moment. I have a special interest in learning disability and autism. I've been working in that field for a few years, and I've recently started working in paediatrics, doing some neurodevelopmental assessments, and I also do some teaching for medical students. The reason I'm here is because I do my very best to practice in a weight inclusive manner, so I'm not worried about fat bodies, but I'm really worried about the way fat bodies are treated, particularly when they're trying to seek healthcare.Laura: Yeah, that's what you're here to talk about today, but I feel like we could probably have a whole other conversation about neurodivergence and feeding differences and all of that stuff, but I will try and rein myself in because, yeah, like you said, I really wanted to talk to you about how fat bodies are perceived and how they're treated in medical settings.So I'm wondering if you could kind of take us on a bit of a journey with you. Can you set the scene for us? You're a medic, straight out of training, going into your GP specialisation. At that point, what do you believe to be true about the relationship between weight and health?Molly: Okay. So I mean, all of my medical school teaching, all of my junior doctor training, and my GP training was absolutely based in this weight normative approach.So the idea that weight was a marker of health, and that we should be pursuing weight management for our fat patients. And there was never any discussion around where that came from. So, you know, it was just stated as a fact that ‘ob*sity' came with all of these comorbidities and put people at increased risk of X, Y, and Z.And, like I say, I never remember – and I'm really confident it didn't happen – any discussion around where the evidence behind those statements came from, and the fact that actually...it was really complex and that maybe there were some other factors at play that cause that association between body size and certain diseases.And I also never remember any conversation about weight stigma and the impact that that can have on people's health.Laura: Okay. Well, there's so much that I could kind of, like, tease out of what you just said there, but I think the sort of headline for me is just how this information was presented to you as complete certainty. I think if I'm kind of reading between the lines, or what I've even learned in my own training, that as weight goes up, the worse the health outcomes, right? Like in this linear sort of fashion. It sounds as though you learned something similar, but the evidence behind that was never really presented or unpacked or challenged in any way.And that's the part that I find most, like, terrifying because as medics you should be, like, challenging the evidence and not just, like, swallowing it whole and, you know, swallowing information whole and not kind of having any critical thought around it.Molly: I know, I agree. And of course there were things that we critically appraised and we were taught how to critically appraise, but the world of ‘ob*sity' was just something that was presented as a fact.And I feel so sad that I kind of missed out on all of those years of a greater understanding of how complex it was.Laura: You also mentioned weight stigma, which we'll come back to in a second, but coming back to this idea of how complex it is. So what were some of those messages that you received that oversimplified the relationship between weight and health?You know, I've kind of mentioned this idea that as weight goes up, that health invariably goes down. I'm wondering what other kinds of things that you picked up on that sort of reinforced those ideas.Molly: Yeah, I mean, absolutely kind of ‘eat less and move more' was something that we spouted. And, you know, when we were kind of practicing role play scenarios, one of the tick boxes was ‘give lifestyle advice'.Part of that was, you know, absolutely eat less and move more. And, you know, assumptions around a person's lifestyle and diet again was very much part of that message. That people were fat because they didn't exercise and they ate too much.Laura: And then they also lie to you, right, about how much they've eaten?That's…at least, that's the thread that we got in nutrition training, is that people who are higher weight, they're almost always lying about their dietary intake. And so you are already…I mean, think about how problematic that is, that you're already going in with the assumption that this person is lying to you about, you know, their lived experience, like, what does that do from the perspective of forming any kind of therapeutic relationship to go in with that understanding and assumption?Molly: Yeah, no, I agree entirely and, you know, let's think about when people are presenting to a healthcare setting, they're generally a bit nervous and anxious and feeling quite vulnerable and they are essentially quite powerless in that situation. And then imagine that they're also giving you information and telling you about their lifestyle and that's being doubted. It's horrible, isn't it?Laura: Yeah, it's really, really messed up when you slow it down and think about it. I'm wondering if there were any particular moments or specific patients that you remember that started to change that understanding a bit for you? That kind of threw a kink in that really simple narrative of ‘weight equals health', and ‘calories in equals calories out' and you know, we just need to go on a diet and then everyone will be thin?Molly: Yeah, I mean, my path towards kind of health at every size was quite convoluted. And actually it began with an interest in lifestyle medicine. So I was feeling quite…Laura: Oh, a detour into lifestyle medicine! Okay. The plot thickens.Molly: Yeah, the plot thickens. Absolutely. So. You know, I was feeling quite demoralised by the fact I was seeing a lot of chronic disease and that people were not getting any better and they were coming back to see me and I was giving them lots of medications and, you know, often those medications would come with fairly significant side effects. And so I guess what lifestyle medicine offered me, or what I thought it offered me, was the opportunity to really get to the bottom of those problems without the need for medication and the kind of idea that prevention was better than cure.And it appealed to me from a holistic perspective, you know, this was an opportunity to kind of see the person as a whole, rather than just focusing on an individual symptom. So I was actually really excited and really motivated. But what I found with time was that, first of all, I became more uncomfortable with the dynamic that was being played out, which was me as this middle class professional who carried a significant amount of privilege telling people how to live their lives that with time felt more icky.And also that people weren't able to do all the things we were discussing, or if they did do…follow the advice that I was giving them, it wasn't really making them feel any better because, hey, you know, there are these things called social determinants of health, which actually great…you know, carry a greater significance than personal behaviours.Laura: I'm just wondering for people who maybe aren't familiar with like, the world of lifestyle medicine, if you could say a little bit more about that and kind of the type of advice that you were giving people, like when you say lifestyle advice, what exactly does that mean? And I understand it's like a whole range of things, but yeah, I'm curious to hear how you applied that in your practice.Molly: So, I mean, it was looking at kind of core areas. Those core areas were: sleep, stress management, nutrition, and exercise and, you know, within the nutrition arm, I'm really sad to say that weight loss played a part of that. And, you know, whilst I tried to make that as individualised as possible to the person in front of me, inherently, there is an element of elitism really with lifestyle advice, I feel that, again, just didn't really quite sit right with me. And I actually found myself feeling a bit irritated. If I'm honest, I was feeling irritated that people weren't doing what I was asking. And luckily I had the insight to acknowledge that, you know, that was a me problem, not a them problem.What I realised was that I wasn't really irritated with them. I was just really frustrated that, you know, here was what I thought was this chance to really make people's lives better. And actually it wasn't having the impact that I thought it would.Laura: It's almost as though…and this is totally my perspective and my, I think, a little bit of prejudice against lifestyle medicine.But there…it's kind of this underlying assumption that people need you to tell them what to do because they don't know any better.Molly: Yeah, they don't know. Oh, it's so patronising. Laura: Yeah. And it's like a kind of a knowledge deficit. Molly: Absolutely. Laura: When most people, they do understand the importance of sleep and they do understand, like, it's helpful to, like, move their bodies in some way and to eat some vegetables.Molly: Absolutely. That rings true so much with me. You know, I hear these conversations where people are talking about healthy weight management and you know, the suggestions are, well, ‘let's teach people how to cook'. And I just think, oh, for goodness sake. You know, it's so patronising to assume that people don't know how to cook and that you're kind of…it's this kind of saviour complex that, well, let's teach them how to cook because they don't know that and therefore their life's going to be okay.They do know how to cook, but what if they've, you know, got three jobs because they need to work three jobs in order to pay the bills? They don't have time to cook.Laura: What if they just don't like…because they've got their own cultural background, they cook food in a very different way than how you cook food or like there's a whole number of reasons why like that might just not only fall flat but It could be problematic for some people. You know, especially if they're like, well, ‘my doctor is telling me I need to do this, but this doesn't really align with either my values or you know, what I'm able to access or have time for the competing messages that I'm getting from within my family' or whatever it might be.So there's a lot of idealisation I think that goes on in the lifestyle medicine community and not a deep enough understanding of social determinants of health, like you said.Molly: I think that's the big, big part that's missing in lifestyle medicine and the recognition…recognition of the social determinants of health.Laura: Absolutely. And even just like the understanding that even if everybody did eat whatever Rangan Chatterjee is spouting off that we should eat, it doesn't mean that our health will all kind of play out along the same lines. So we were going through your journey.Molly: Yeah, so I was talking about lifestyle medicine and feeling just a bit uncomfortable with the whole thing.And of course at that time I was nurturing a special interest in neurodiversity, kind of recognising my own neurodivergence and my children's neurodivergence. And so eating disorders were kind of very much on my radar. And so intuitively I just didn't like the idea of creating any kind of fear or anxiety around food that just felt wrong.And, you know, that's what we were doing when we were talking about nutrition, the world of nutrition is also extremely confusing. And it was confusing for me. You know, you have all these people giving really compelling arguments as to why their diet is the best. And they're able to give you all this evidence that backs up their claims.But the kind of general theme, yes, is that we are creating this fear and anxiety around, often, whole groups of food.Laura: I mean, wow. There's so much that we could say even about that. Like I got a message from a parent the other day who was like, I feel like I need to have a degree in nutrition to feed my child.I was just like, yeah, that's how fucking convoluted we have made nutrition with all the kind of competing expert voices who are shouting about, you know, their diet as being the best diet and even like among amongst paediatric feeding professionals and, well, just feediatric…did I just invent a new word?! Paediatric dieticians and nutritionists, there's, you know, there's a right and a wrong way.And like you say, it really creates a lot of fear and anxiety about messing up. And it plays into our fears about not being a good enough parent. And yeah, it really, like, tugs on a lot of different parts of us. Where did it go from there then once you had this kind of recognition of like, well, I don't want to be adding fuel to the fire of eating disorders, disordered eating and making food scary for, you know…I'm thinking about patients of yours that might be neurodivergent where food might already be really scary.Where did it go from there?Molly: Where it went from there is that I went on maternity leave.Laura: Get out of there!Molly: Yeah, exactly. So I went on maternity leave with this kind of feeling of disconnect and that something wasn't right and I needed to do something. And of course maternity leave provided me with the opportunity to listen to lots of podcasts and read lots of things while sat feeding a baby. So that's how I actually stumbled across health at every size. You know, the kind of the parenting path that I've chosen to take meant that I was already aware of, you know, division of responsibility and intuitive eating and kind of food neutrality and body neutrality. So I was already, already aware of those. And, you know, I was…again, intuitively the idea of the language that I was using around food and bodies with my children was very important.So I think I actually listened to a podcast. I think it might have been the Full Blooms podcast that I listened to. And I think was being interviewed on that. And that was the first time I heard the words kind of anti diet and health at every size. And yeah, when I have a special interest, I really have a special interest. So, you know, 158 podcasts later, um, yeah, there I was. And, you know, there I was in this state of…a combination of so many feelings of kind of frustration, guilt, sadness, anger, disbelief. Yeah, you know, I kind of had this very strong sense of justice and feel things very deeply and it…I found it very consuming to begin with. This feeling that I'd been getting it wrong and why are more people not talking about this? Why is this not more mainstream? And really, people should be talking about this. And I wanted to tell everybody I knew about this because this is so important.Laura: I've heard a similar version of that story from not just other medical professionals, but also clients of mine who are like, why, why isn't everyone talking about this?And they want to kind of. become these little social justice warriors and really just, like, shout it from the rooftops. But what I really appreciated, Molly, there, was just you talking about all the complexity of the feelings that came up for you, because I think oftentimes, particularly if you're in the medical profession or any kind of allied health profession, because you're in that caring profession, your automatic line of thinking is often, wow, I've caused so much harm.And, and you feel an immense amount of guilt for continuing to prescribe diets when you're learning that diets don't work and you think about all the encounters you've had with patients that might have inadvertently increased their experiences of stigma and harm. And again, we'll come to talk about that more in a bit.I suppose my point is really that…of course you're going to feel that way and that doesn't have to be where it ends being kind of stuck with those feelings of guilt. And so hopefully there was also like a glimmer of hope in there as well? Molly: Oh gosh, yes. Laura: Well, I'm wondering as well, because it sounds like you were quite disenchanted before you went on maternity leave. So did this feel like, okay, this is something that…this is a missing piece of the puzzle for me, for my practice going forward?Molly: Absolutely. Yeah. Yeah. And I have complete conviction about it. And I did at the time and I still have now, you know, this is absolutely the way I want to practice. And I do have hope.And I do think that in 20 years time, maybe even 10 years time, we are going to change the way we look at weight and weight management, well, weight management, you know, will not be a thing.Laura: Just abolish weight management. Molly: Yeah, absolutely. Laura: You've used the term health at every size and I'm wondering if you could just give a brief kind of like, explainer of what health at every size is for people who haven't encountered it before. Or weight inclusive healthcare, you know, like whatever feels more comfortable for you.Molly: Yeah, I mean, I guess let's talk about the kind of weight-inclusive, the weight inclusive approach, which is probably what I feel kind of most comfortable with. Laura: Same. Molly: Yeah. So the idea that weight isn't a marker of health, and that people of any size deserve good quality, compassionate, equal access to healthcare, that weight loss isn't possible for most people, and that actually trying to achieve weight loss brings with it lots of concerning things like, a, you know, problematic relationship with food, risk for eating disorders, and weight cycling, so weight going up and down, which again is bad for us, along with stress, and again, stress is not good for us.Laura: Yeah, so there's, there's a lot to even think about within there, but I think that even that first idea is really radical and it shouldn't be, right? That first idea of like, people of all sizes deserve equal access to healthcare and it should all be delivered with compassion and care. And I think most of us, at least those of us who have thin privilege, for us that's more or less a given.Although, you know, I've had plenty of shady encounters with doctors, but in general, you know, I am treated well, whereas, and certainly stories I've heard from clients and, you know, fat activists and people online is that that is…and that's, this is what bears out in the evidence as well, is that that is not guaranteed.That people of a higher body weight can walk into a GP surgery, maybe they're seeking care for, I don't know, a sore throat or a pain in their hand. And to call back to your earlier point about how you have to make these, like, lifestyle recommendations. Patients who are of a higher weight, regardless of what they present for, are almost often given a prescription for weight loss, or they might even be handed a coupon for Slimming World, right?Like the NHS partners with Slimming World too, and some other weight loss companies. But even if that's not what that person came in for, or even if that person said in no uncertain terms, I do not want to talk about weight loss. weight. That's not what I'm here for. I don't want to diet. The doctor generally won't respect that boundary. Um, yeah.Molly: And what's so sad is that I see patients preempting that. So I have patients that come to me who will say, ‘I know I need to lose weight', or ‘I know I'm a bigger girl', you know, it's almost like…because they are so anticipating me saying it and so nervous about that conversation, that they kind of want to say it, so it's out the way.Laura: Yeah. What do you think that's about? What do you think's going on there?Molly: Well, I mean, I think they're feeling vulnerable and anxious. And as I said, they are so used to their doctor saying something about their size that it's almost like they kind of just want to get it out of the way. If I say it, then they won't say it.Laura: Yeah, almost like a defence, it sounds like.Molly: Yeah, absolutely. And it, you know, it's so sad.Laura: And how do you approach that with a patient then if they, if they start a consultation off like that, I'm kind of jumping ahead of myself here a little bit, but thinking about, you know, how from this new perspective of, of being a weight inclusive doctor, do you approach that conversation and start to kind of, you know, take them on a, in a slightly different direction than, than they might have been accustomed to.Molly: So it's not easy and it's something that I'm still kind of trying to work out. And of course, you know, bearing in mind, I have 10-15 minutes with these people. And of course, it's not like they come to me and they say, Oh, you know, tell me what you think about my weight, or do you think I need to lose weight?They come to me with the assumption that I believe they should lose weight, and they, you know, usually they will come about something else like, you know, a chest infection or a sore throat, and their weight will... come up as part of that consultation. You know, that kind of respectful two way dialogue is a really important part for me of the weight inclusive approach.And, you know, in the same way that I feel very strongly that a weight centric consultation is horrible because it's that kind of didactic, this is what you must do. Similarly, you know, me just telling somebody, you don't need to lose weight equally wouldn't sit right with me. And of course, I'm very hyper aware in that scenario of my own thin privilege and how insensitive of me it would be to just kind of, you know, dismiss them and say, you don't need to worry about your weight because that would be really kind of minimising their experience.And of course they have had to worry about their weight because their size has meant that they have faced many obstacles and horrible things happen to them and discrimination and so I think it's really important to kind of acknowledge that. So what I try and do is to actually apologise and say, I'm so sorry that anybody has made you feel that your body is flawed and needs fixing. I don't believe that. And I explain my background and I say, you know, I spent the last few years learning a lot about weight science and reflecting, and as a result of that learning, I now don't see weight as a marker of health and I don't recommend weight loss to my patients and I explain the reasons for that. Laura: Oh my God. I feel kind of emotional hearing you say that just because of just how powerful it would be, I mean, for anyone to hear that who's, you know, had concerns about their weight, but particularly for, for fat folks and, and like, I'm thinking specifically of, of a couple of clients of mine in the past, who've just had horrendous experiences with their GP, even when I have preemptively written to the GP saying, like: ‘this person has a history of disordered eating and we're not pursuing intentional weight loss for these reasons. Here's all this science that you can read to say why this isn't a good idea', and then still had, you know, yeah, just horrendous experiences.  And so yeah, just to have a GP who is so compassionate and understanding. First of all, you're signalling that you're a safe person to them. And secondly, you're signalling that you can come and talk to me about this stuff. Like, even if they're not there about their weight, they want to get their antibiotics for their chest infection and just get out of there. But in the future, if that comes up, they know that they can come to you and approach you. And it's just, it feels like a really powerful thing to me.Molly: People do cry, actually. I've had a few people cry when I've said that.Laura: I bet they do. Yeah. I hope that any other GPs listening are frantically taking notes at this point of a little, a little spiel that they can say to their clients. And, and has that gone on to open up any other conversations with patients? Or kind of, you say that people get emotional, but what besides that is the response?Molly: like I say, emotional that that's not something they've ever heard anybody say before. And I guess kind of relief. I mean, at the same time, you know, I fully recognise that they will have had a lifetime of being told different things. So, you know, it will take a lot of time for them to completely change their thinking. But yeah, people do come back and have come back to speak to me about it.And, you know, normally what I say is, how would you feel about us instead thinking about certain health behaviours and how we can talk about those, but without weight loss being the goal? And I, I give them that to kind of think about really.Laura: And how do you make it so that that doesn't end up feeling like an earlier lifestyle medicine conversation?Molly: And I'm very conscious of that too. And I guess I make sure that I point out that the reason I don't want weight loss to be the goal is because when weight loss does become the goal, actually those behaviours... become quite unhealthy. As I said, I'm not quite sure I've got it right just yet. I'm constantly trying to think in my head how I can script these things in a way that does mean that people are going to come back to see me to talk about it because I want to talk to everybody about it and I want them to come back and see me, and like you say, for them to feel safe.Laura: Yeah. And I mean, fundamentally your job is to help people care for themselves and to offer them care. So yeah, you, you also can't be sort of, you can't completely ignore, you know, health promoting behaviours, but I suppose like, at least for me, it's eliciting from the individual what is important to them and what feels doable for them.So it's like really basic motivational interviewing stuff. Yeah. Yeah. How can we work from where you already are. And again, it speaks to that piece that a lot of times people already know the things that they need to do. And so it's just supporting them with the changes that they already want to make or not make and holding space for that as well. And offering them the medication if that's actually what they need.Molly:  And there being no shame around that, you know? Laura: Absolutely. Yeah. Wow. It's like a whole new way of doing medicine. So we've talked about a little bit around this concept of weight stigma, because there's a sort of very particular experience of weight stigma that happens in medical settings, or we could also use the words anti fatness to, I think, better describe weight stigma.And yeah, just a sort of side note, weight stigma tends to be a very, like, neutered term that is used in academia, whereas I think in, in critical fat studies and, and in fat liberation spaces, they're more and more using the word anti-fat bias, which really speaks to what that is. Can you explain a little bit more of what that means and how it plays out in a medical setting and how it is so harmful and damaging for people's health?Molly: Yeah. I mean, what we're referring to there is, as you say, the anti-fat bias that people who work in healthcare carry. So meaning a preference to thin bodies and kind of prejudice towards fat bodies. And that's experienced by fat people as weight stigma, that's really, really concerning and it can present in many ways, but it's, let's give you some examples of what that can look like in a GP surgery.So that can look like a fat person coming to see their GP and, as you said earlier, having every symptom put down to their weight, weight loss being the answer for everything. It can mean a fat person losing weight and that weight loss being celebrated, rather than that weight loss being considered the red flag that it should be and being investigated correctly. It can look like there not being the right equipment available, so therefore the necessary examination doesn't take place, the right investigations don't take place. It can look like the treatment options that are available for thin people not being available or accessible to fat people. And, you know, all of this means that fat folk don't go and see their doctor when they need to.And, you know, I don't need to explain why that is a concern. That is a concern. It means that diagnoses are missed, diagnoses are made late and it absolutely contributes to stress. Mental health, physical health, and health inequity in an already marginalized group of people. I find it so concerning.Laura: When you list it all out like that, it just puts it into perspective how healthcare for...fat people is anything but care. It's anything but health. It's, yeah, prejudice, and marginalisation and, yeah, violence. I think a lot of times. Yeah. Because it can kind of, I was just thinking of another example of what people have told me that they've had to go for like two or three oral glucose tolerance tests in pregnancy, because their doctors have, are just baffled that these people aren't…Molly: Couldn't possibly be diabetic…Laura: Couldn't possibly be diabetic... Because there's an assumption, I think made about what fat people's health should be. Molly: Absolutely. Laura: You know, I want to caveat this whole conversation by saying that nobody owes anyone health and yeah, health is, is morally neutral, right? Molly: Absolutely. Yeah. Laura: But there is a very pervasive idea that fat people cannot also have, you know, markers that we would traditionally consider to be within normal range or are healthy by virtue of the fact that they're fat. But I think what the evidence shows us over and over again, when we really dig through it, is that independent of your body size, you can have markers of health. Like, cardio respiratory health, low cholesterol, or like within the healthy range, not have type 2 diabetes, not have high blood pressure. But I think the assumption that I hear from medical colleagues is that people will invariably have those things if they're a higher weight.Molly: Yeah. And you know, when we think about children, I see that, that we have a child who, in terms of their kind of metabolic health markers is healthy. And yet because they are a certain weight that's pathologised and they are treated as if they are a pathology, whereas actually there is nothing wrong with them when you look at their blood results and their blood pressure.Laura: Yeah, because I did want to ask you a little bit about, about kids, if that's okay.I realize it's a bit of a detour, but I'm, I'm curious to hear if you were the parent of that child that you mentioned who might be a higher body weight, but you know, otherwise there's nothing there to worry about. Or even if there is something to worry about, you know, do you have any advice for parents of how to navigate health care and, you know, have these approach these conversations with their GP, you know, to say, like, ‘I don't want to focus on their weight. What else can we do to support this child?'Molly: Yeah, I mean, I think that's what you've just said is a really good way of framing it. Laura: I just realised I just answered my own question!Molly: And, you know, I really, really feel for parents in this situation because it must be such a horrible confrontation. To be faced with health care professionals who are telling you that you need to do something about your child's weight, and yet you have a child in front of you and you're worried about how they feel about their body, how they feel about themselves. And I guess, you know, the sad thing is that many parents do believe what a doctor says to them, and so would put their child on a diet, which just horrifies me and breaks my heart of what we're doing to children when we do that. But yeah, I mean, I think as you posed it perfectly, you know…'I'm happy to talk about health behaviours, but I'm not happy to focus on my child's weight and the reasons for that are that I don't want my child to develop an eating disorder and my child's relationship with their body and food is really important to me.'Laura: That's a really brave thing, a really brave thing to have to do as a parent. I mean, I know trying to like stand up to…I remember declining to be weighed at my booking appointment for the maternity pathway, and the nurse was just so aggressive with me. She was just like, ‘computer says no'. And I was like, but I don't have to do this. But I was in such a like, fragile state. Molly: Of course. Of course. Yeah. Laura: Trying to push back on a healthcare professional when they're not receptive to it. And also, like, there's some weird stuff there, but like, if you decline a test, which is basically what I did decline, they should respect that. And they didn't. So that's like a whole other thing. But my point is that pushing back on a, on a healthcare, an authoritative, an authoritative healthcare provider is really, really challenging.So I think to step into that space as a parent is, it's really hard.Molly: Really, really hard. Absolutely. I do not underestimate that at all. You know, I recently got told that I shouldn't be breastfeeding my two and a half year old and. You know, I approached that situation as a doctor with privilege, and I found that very difficult.Laura: Oh, so a healthcare professional told you?Molly: Yeah, yeah. What? That it currently wasn't offering any nutritional value. And so, yeah, I mean, you know, I'm not trying to compare that to how it must feel as a parent of a fat child, but, uh, you know, I understand that. Yeah. Confronting somebody in a position of authority is extremely, extremely difficult.And I wish people didn't have to have those conversations.Laura: Well, I hope you told them where to shove it with, with their comments about feeding. Molly: I pulled down my top and latched them. Laura: Love it. Okay. Well. Yes, as a still feeding a preschooler, I totally, totally respect your decision to, to keep feeding. And yes, also if you have any tips for how the fuck to get them to self-wean…! Molly: No, sadly not, no! Laura: Uh, he'll stop one day, I keep telling myself. We were just talking a bit about how anti fatness presents itself in the medical setting and how people are less likely to have their experiences believed, they are less likely to be offered the follow up…what's the word, the medical word, I'm struggling to find the medical word, like the assessments and…Molly: Investigations? Laura: Thank you, that they, they might need. Weight loss is often celebrated when it's a red flag for, you know, if it was a thin person, it would be definitely a red flag, but that just doesn't register. There's, I say ‘avoidance' kind of in quotation marks, avoidance of healthcare and kind of ‘noncompliance' again in inverted commas because they are such loaded problematic terms, because they put the blame on the individual instead of on the medical professional who is often perpetrating violence against that person. And so, yeah, I just want to kind of give that caveat. Yeah. And it can encourage…or it can mean that people die. Like it's, it's often a case of life, life or death because people understandably don't want to go see their GP.There's a really powerful piece, I'm not sure Molly, if you've read it, by Marquisele Mercedes in Pipewrench Magazine, where she's talking about not just the intersection of anti-fatness and medical care, but also anti-blackness because there's a another layer here when someone is racialised about assumptions made about like their pain threshold and, and tolerance. And it's a really eye-opening read if you haven't already read it. So I'm gonna link to that in the show notes just to give people like more, yeah, a kind of deeper understanding of some of these issues. I'm curious to hear, since you've adopted more of a white inclusive approach, if you've had any pushback from your colleagues and if you have, how do you handle that?Molly: So actually, I haven't. Not that I know about, not that anybody has spoken to me about, and actually, I...Laura: You're just keeping it under your hat because you're just alone in that GP room. You don't have to, like, deal with other doctors on a ward.Molly: I mean, that does help, absolutely, that I do have a lot of autonomy. And yes, I'm in my room and I see my patients. I did do a presentation to my colleagues about weight inclusive care, which I was really nervous about. And isn't that funny? Because... You know, I was thinking about the fact I was far more nervous doing that than I would be doing other presentations and, you know, these days I do a fair amount of presenting, and I kind of unpicked that. I thought, let's think about the crux of what I'm saying here and the crux of what I'm saying here is, you know, the point I made earlier that people of all sizes deserve compassionate, good, equal access to health care, which really, I would hope that most, yeah, doctors are on board with, members of the caring profession would be behind.But yeah, so the presentation went well and, you know, people came to speak to me afterwards and said, it kind of made them think, and they'd be really interested in knowing a little bit more. So that was positive. I mean, as GPs, the idea that weight loss isn't sustainable is something that we see day in, day out. And so I don't think that's too difficult for GPs to get behind. Laura: Okay. And just to kind of expand on that point a little bit, because I know we've, we've talked around this idea that diets don't work. And again, I'll link to a piece that I wrote about the diet cycle and, and this sort of why diets don't work, but just to give like a really quick overview of what the weight science literature tells us is essentially there are – and this is simplifying things, and Molly, feel free to jump in and like expand on anything I'm saying, but what happens when we go on a diet is sort of twofold. First of all, so we reduce the amount of food that we're consuming, right? That's the fundamental premise of any diet. They all work the same way, right? ‘Work' initially, at least initially. So you might initially see a little bit of. of weight loss, but then your body starts responding to that by dialling up your hunger and appetite hormones, because what it's trying to do is defend your genetically determined set point weight, right?This blueprint that we have for…I like to think of it as a kind of comfortable zone that our bodies will, like, prefer to be in because there's usually always some fluctuation within that, right? Like our weight just kind of goes up and down on its own through various, you know, stages of life. But overall it likes to stay within a window, shall we say.If we're trying to push it down below that comfortable window, our body will respond by amping up hunger and appetite hormones to drive up our appetite, to get us up off of our asses to go and find some food, right? Like it's an evolutionary mechanism. So that's why you kind of end up diving headfirst into a bread basket or, you know, I always say like you find yourself elbow deep in a tube of Pringles if you're, if you're on a diet, like that, that's what can happen. And it's because there are these biological mechanisms driving that. If for some reason you are able to kind of ride that out, you maybe develop some unhealthy coping mechanisms to sort of essentially ignore your hunger, then what can happen is that your body has another mechanism to try and make up for that, which is to slow down your metabolism. Right, so it can kind of…either you can get more food to defend your set point weight, or all the functions in your body can sort of slow down. It often starts with what are considered non essential functions, like reproduction. So you might notice that you're, if you're menstruating, that your period becomes irregular, your hair might kind of become less thick, your nails might get, I mean, your skin might get a bit dull, but then because your body can't sort of say, okay, turn off this system, but leave all the other ones on, you'll notice it kind of like playing out in, in other areas.So somewhere that I see kind of play out a lot is digestion, which I think we can all agree is an essential function, but you start to notice, you might notice it as like IBS type symptoms, constipation, bloating, diarrhoea, all of these things can be a function of not having enough to eat. So, as your metabolism is slowing down, you will obviously get this plateau in weight loss or your weight might start to increase or you could have both things happening kind of simultaneously where your metabolism is dialling down and then at the same time your hunger hormones are dialling up so you have what I call ‘the fuck it effect' where you know it's like the floodgates open and you're just raiding the fridge. And it's kind of funny but also it's a really distressing experience for people sometimes, if you don't understand what's going on, which is…it's your primal biological urge to eat is kind of overtaking you and you were just trying to meet your needs however you want, but it can feel really chaotic and out of control and oftentimes we label it as like food addiction or comfort eating sometimes, or like, yeah, we pathologise it somehow, even when that's not really what's going on.So that was…more of a detour than I wanted to go on, but I thought it was important to explain a little bit of the mechanics as to why diets don't work. Did you have anything you wanted to add to that, Molly?Molly: No, I think you have summarised that perfectly. My headline would be, bodies are very clever, don't underestimate them.Laura: Absolutely. Yeah, that is a way better way of putting it. But so, medical colleagues, they don't have too much difficulty understanding or kind of appreciating that weight loss is not sustainable. So they see that day to day in their practice. So they…it's an easy sell? Molly: Yes, it's an easy sell. Exactly. Laura: When you kind of go back and fill in, like, some of the stuff that probably should have been taught in medical school, but for whatever reason wasn't…I say probably should have been taught. I mean, definitely should have been taught in medical school, but wasn't. What other kinds of, like, questions or what things did you come up against when having these conversations with colleagues?Molly: So yeah, that is an easy sell. The harder sell is around the idea that, well, ‘ob*sity' being a thing and, you know, it's associated co-morbidities. Also, what is tricky…so even after I'd kind of finished the talk and had a conversation about it, the conversation turned to, but we do need to think about how safe it is to refer somebody with a BMI of over 30 for any replacement.So, you know, the kind of idea that the research that is at the core of, you know, our approaches and the weight centric approach is full of bias and quite frankly, fat phobia. And that's when I start to feel very conspiratorial, which I hate.Laura: I know exactly what you mean. Yeah.Molly: But I think it's a, you know, it's a really important part of the puzzle, and people really need to appreciate that, that actually research, you know, I think Fiona Willer described it as “a persuasive piece of writing”, which I think's a really important way to look at it, because that's what, you know, research really is. And that, you know, people are generally trying to prove a point when they start a piece of research. And because we live in this inherently fat phobic society, people are generally trying to prove that fat is bad.Laura: And so what you're saying is there, and there's a great paper that explores this, there's a BMJ paper that explores all the underlying assumptions in weight research, all these biases that Molly is describing.They filter through into the research that we get. So it becomes this like, circular, like, self fulfilling kind of thing, where we are looking for problems with higher weight and worse health outcomes. So we find them, right? Like it becomes this yeah, very… Molly: Confirmation bias. Laura: Exactly. That's, that's the right word I was looking for.So I'll link to a couple of papers that for anyone, for like medical students or even nutrition, any allied health professionals who are interested in learning more about this, because it's a lot to kind of take in. And we're, I feel like just getting to the tip of the iceberg here. Thank you for reading Can I Have Another Snack?. This post is public so feel free to share it.Molly: And I guess the other point to make about the research as well that people really need to appreciate is that it's, you know, I've said before, but it's really complex.And so, you know, let's take the example of post operative complications of a knee replacement. And by the way, I haven't really done a deep dive on this, so….I'm just kind of using it as an example rather than it being something I know a lot about, but, you know, let's imagine that there is an increased association between post operative complications in somebody with a high BMI after a knee replacement.Is that as simple as a person's fat and therefore they're going to be at risk of post operative complications, or is it that they are really stressed in a hospital because they know that they're going to be made to feel bad about their body size? Is it that they didn't have the right equipment available to carry out the operation or to, you know, anesthetise that person? Is it that anti fat bias has played a part in the treatment that they've received post operatively? We really, really need to be digging deeper and looking at the complexities around these kind of headlines that form the part of, yeah, our management.Laura: So yeah, what you, what you're talking about there is the sort of potential confounding variables that don't get measured for, that help explain the relationship between X and Y.Yeah. But we just…we see the X and the Y and we don't see all the – this is a terrible analogy – all the other letters, but we're looking for cause and effect, but we're not actually looking at all the other complicating factors that might result in that outcome. I think. Because our, like, primal monkey brains love simple explanations for things, right? They don't want things to be complicated, but they are way more complicated than they first seem. So, last thing I want to ask you about is...Whether you have any advice for medical students or even physicians who are bumping up against anti fat bias, either in their training or with their colleagues?Molly: Well, I guess I really hope there are people in the medical profession listening to this who do share our beliefs and, you know, I'd love to hear from you because solidarity is really important. You know, it can feel quite lonely. I guess my advice would be to kind of stick to your guns and hold on to those values and know that you are keeping people safe and you will mean that people feel able to come and see you who wouldn't otherwise have felt safe coming to see you. And that's really important. And you know, when I'm doubting myself or feeling a bit exhausted by swimming against the tide, what I tell myself is, well, let's think about the alternative. And the alternative is not something that I can entertain. In terms of conversations with colleagues, I mean, podcasts, I really find useful as a way of kind of signposting people to snippets of information and also talking about yourself. So, you know, people are more receptive if you kind of critique your own bias as opposed to critiquing theirs.Laura: Yeah, exactly.Molly: So, you know. A conversation like, you know, I'm thinking about a medical student sat in clinic with somebody saying something like, ‘Oh, I've been thinking about my own anti-fat bias, or I've been thinking about weight stigma and how I might be contributing to that and how that's something I'd really like to address'. You know, that kind of thing just plants that seed, doesn't it? And means that, whether they react perfectly in the moment may mean that that person then has to think about it themselves and reflects on it themselves and does a bit of reading.Laura: Mm hmm. Yeah, absolutely. And you can always, you know, if they are open to, to reading more, like, like I said, you could, I'll link to some papers that you could share with them doing a journal club around those papers or like you did, Molly, a presentation that can also be ways to open up conversations within a department or you know, a university setting or something like that, where you can all be kind of working through some of this stuff together, rather than sort of siloed on, on your own. Because I think it can feel really lonely if you're the only little salmon swimming upstream.Molly: It's really hard work, isn't it? Really hard work being the pariah.Laura: Yeah, absolutely. But I'm really grateful for everything that you're doing. And you know, even if we don't change anyone else's minds, just the fact that you're showing up for your patients the way that you are is so important. So yeah, thank you for that work. At the end of every episode, my guest and I share something that they have been snacking on. It could be anything you like, a show, a podcast, an actual little snack. So what have you been snacking on lately, Molly?Molly: So I have a television show that I've been watching that I'm actually able to share. I have a very specific criteria when it comes to television shows that I'm willing to watch because I'm such an empath that I can't bear watching anything that involves, you know, people being treated badly or humiliated or murdered, you know, anything like that. No, and it also has to be very relatable. I can't, my brain just cannot, you know, get into kind of wizardry and magicians and stuff. I have been watching Couples Therapy, which is a documentary on BBC iPlayer, which films couples going through therapy. And it's like reality TV, but without the vacuous….Laura: The drama. Yeah, okay.Molly: Yeah. And yeah, without the drama. So, I mean, there is drama, but it's a really kind of measured drama, and I just love watching the process. I love seeing the dynamic and seeing how it all pans out. I think the therapist is amazing. Oh. And it's fascinating. Laura: So these are real, these are real therapy sessions? They've not been staged?Molly: They've not. No. No.Laura: Oh wow. It's wild. It's real. I have no idea how they got that through any kind of ethics, but…Molly: Yeah. Yeah. Good point. But it's, but it's…Laura: I mean, it sounds interesting. Who doesn't want to listen in to other people's therapy sessions? Molly: Yeah. I mean, I didn't watch it thinking, oh gosh, I feel really bad that this person is doing this on didn't, it didn't feel like that. It actually felt really, you know, therapeutic.Laura: Like I did a documentary with BBC. a long time ago now and there was like a clinical psychologist on the support staff team so I figure that there has to be like someone…that person who's, yeah, just like making sure everything is contained and everyone is safe and yeah like, yeah, no one is, like, baring their soul on national TV who is gonna regret that they said those things. So that sounds really interesting. Okay, so my snack is sort of, I think, well, really related to what we have been talking about. So the book that I have been reading at the moment is called Sugar Rush: Science, Politics, and the Demonization of Fatness. It's by Karen Throsby, who is a sociologist and it is a bit more on the academic side, but it is so fascinating.Basically what she's done is a content analysis of like 500 odd different newspaper articles and books from about, I think just before the implementation of the sugar tax, or maybe when the sugar tax was being debated, all the way through to like 2020 with Boris Johnson's latest round of anti ‘ob*sity' policy.She's just tracing kind of like the history of the sugar tax and the way that the media talks about it and some like key anti sugar figures and some of the, like, the rhetoric around sugar and how it has been kind of like socially constructed. And it's also linking it to the demonization of fatness as, yeah, the subtitle suggests.But what I found really interesting is just how she talks a lot about these ideas that are written into policy documents that are so kind of assertive and confident and definitive that are the similar things that you and I have been talking about in this podcast about the relationship between weight and health that are just in all of these policy documents are just like, like, given at face value and there's no further sort of exploration of the science and I'm only kind of the first couple of chapters, but I'm really enjoying it.It's really good. It appeals to my, like, super nerdy nutrition brain where I want to understand the trajectory of all of these policies and how they all kind of interlink and build on one another. And it also has a fair amount of Jamie Oliver bashing. So I'm here for that. So yeah, Sugar Rush by Karen Throsby. So I will link to Couple's Therapy. Is that the name of your show? Couple's Therapy on iPlayer and Sugar Rush in the show notes. All right, Molly, before I let you go, can you let everyone know where they can find out more about you and your work?Molly: So I am on Instagram as @antidietGP, um, similarly on Facebook as Anti Diet GP. Be great to see you there. Laura: All right, I will link to both of those in the show notes so people can come find you and yeah, let us know what you think of this episode and thank you so much again for your work, Molly. It was really good to talk to you. Molly: Oh, thank you.OUTRO:Laura: Thanks so much for listening to the Can I Have Another Snack? podcast. You can support the show by subscribing in your podcast player and leaving a rating and review. And if you want to support the show further and get full access to the Can I Have Another Snack? universe, you can become a paid subscriber.It's just £5 a month or £50 for the year. As well as getting tons of cool perks you help make this work sustainable and we couldn't do it without the support of paying subscribers. Head to laurathomas.substack.com to learn more and sign up today.  Can I Have Another Snack? is hosted by me, Laura Thomas. Our sound engineer is Lucy Dearlove. Fiona Bray formats and schedules all of our posts and makes sure that they're out on time every week. Our funky artwork is by Caitlin Preyser, and the music is by Jason Barkhouse. Thanks so much for listening. ICYMI last week: When Your Friend Announces They're on a Diet… * Rapid Response: Why I don't like ‘this food does a little/this food does a lot'* Dear Laura... How do I stop wishing for the past and accept myself now?* Bandit Standing on the Scales is Not Even the Worst Part of Bluey This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit laurathomas.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!If you have read this newsletter for any period of time, you've read my accounts of how pharmaceutical company Novo Nordisk has been using extremely shady marketing practices (many taken from the playbook that Purdue Pharma used to push oxycontin) to promote their drugs for weight loss. Things likePutting doctors on their payroll to promote their drugs to the media without disclosing their ties to the NovoCreating astroturf organizations that claim to be advocacy groups for higher-weight people but are, in fact, funded by Novo and other pharma and weight loss surgery groups.Marketing their drug through Grand Rounds presentationsCreating PSAs and Sponsored Content using people who (you can't make this stuff up) play doctors on TVCo-opting the concept and language of anti-weight-stigma activists in order to sell their weight loss drugsAnd I'm far from the only person talking about this.Mikey Mercedes has publicly called this out. Louise Adams from Untrapped has been all over it  (I had the chance to join Louise Adams and Fiona Willer on Louise's Podcast All Fired Up to talk about this)Asher Larmie, The Fat Doctor, has also been talking about thisAnd there are plenty of others.Part of the issue is that in the United States pharma companies are allowed to market direct-to-consumers , and the rules and regulations that exist are often loosely enforced. That's why I was thrilled to learn that The Association of the British Pharmaceutical Industry (ABPI,) a trade association that works in England, Scotland, Wales, and Northern Ireland in partnership with the government and the NHS on behalf of their members, had suspended Novo Nordisk for being in breach of the ABPI code of practice.Interestingly, just a month ago, the president of ABPI was Novo Nordisk UK General Manager and Corporate Vice-President Pinder Sahota. Sahota stepped down from the board in February “to avoid an ongoing process around a Novo Nordisk ABPI Code of Practice breach becoming a distraction from the vital work of the ABPI.”The complaint was made to The Prescription Medicines Code of Practice Authority (PMCPA) which is “the self-regulatory body which administers the Association of the British Pharmaceutical Industry (ABPI) Code of Practice for the Pharmaceutical Industry, independently of the ABPI. It was established by the ABPI on 1 January 1993.”The complaint centers around a LinkedIn post offering practitioners a free “weight management” course. The only “weight management” treatment covered in the course was GLP1-RA drugs. Novo Nordisk was, at the time, the only company selling these drugs. The course was “sponsored” (paid for) by Novo Nordisk, but that was not clear in the LinkedIn Ad.Not only did this “course” offer information, but they also offered a free Patient Group Direction (PGD). Per the NHS a PGD is  “a written instruction for the sale, supply and/or administration of medicines to groups of patients who may or may not be individually identified before presentation for treatment. May or may not be identified means an individual can either be known to the service/have an appointment (e.g. a baby immunisation clinic) or not be known in advance of presenting at a service (e.g. a walk in centre).PGDs are not a form of prescribing. PGDs allow health care professionals specified within the legislation to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.”The complainant pointed out that the PGD was part of what was being offered to individual health professionals by Novo Nordisk, that it had a value, and that it was being given to individuals for their own personal benefit to run private clinics. The complainant suggested that this amounted to bribing health professionals with “an inducement to prescribe.”The complainant noted that on the website the course had been run several times, so it was likely that a large number of health professionals had received this offer.The ABPI review panel found that the training was provided by a third party, but attendees and PGDs were sponsored by Novo Nordisk. The training mentioned three drugs, the first two (orlistat and naltrexone/bupropion) were presented as having significant side effects and contraindications, while the third drug, Novo's Saxenda, did not include side effect information (though they are significant) and the training noted that Saxenda could be provided by an appropriate health professional with a valid PGD (which was provided by the course.)The training included 21 slides about Saxenda, but no such detail on the other two drugs.Sponsorship of third party trainings by drug companies are permissible by APBI “only if there had been a strictly arm's length arrangement with no input by the company and no use by the company.” In this case, the agreement between the training provider and Novo stated that “Novo Nordisk will be in attendance at training meetings and will be given delegates to follow up” and the panel found that “Novo Nordisk had reviewed the training materials used on the course for medical and factual accuracy.”The panel concluded that “the course (webinar and e-learning) was, in effect, promotional material for Saxenda for which Novo Nordisk was responsible”The Panel found that “the webinar, in effect, promoted Saxenda which Novo Nordisk was responsible for, and considered that Novo Nordisk's involvement in relation to such promotion, including that its medicine would be discussed in detail, was not made sufficiently clear at the outset. Therefore, a breach of the Code was ruled. Novo Nordisk's appeal on this point was unsuccessful.”The contract between Novo and the third party was signed in February 2020, with the intention that 13,000 professionals be trained over 2 years, each of whom were to be provided a PGD making Novo Nordisk's maximum contract £357,500 (about $455,578 USD). As of July 1, 2021, 4,399 health professionals had completed the training and 599 PGDs had been activated.The Panel found that “the provision of funding by Novo Nordisk for the PGD was clearly linked to the promotion of Saxenda; the Panel did not consider there could be any intention other than to directly increase the use of Saxenda. Furthermore, the Panel noted that the cost of the provision of the PGD to prescribe Saxenda was given to individual health professionals. Such funding to individual health professionals did not meet the requirements of the Code and was an inducement to prescribe, supply, administer and/or recommend Saxenda and the Panel therefore ruled a breach of the Code. Novo Nordisk's appeal on this point was unsuccessful.”“The Panel considered that the arrangements between Novo Nordisk and the training provider, particularly in relation to the PGD, brought discredit upon, and reduced confidence in, the pharmaceutical industry. A breach of Clause 2 was ruled. Novo Nordisk's appeal on this point was unsuccessful.”Novo Nordisk's decided to appeal on the basis that they didn't know it was a breach. This backfired spectacularly.The Appeal Board was “very concerned that Novo Nordisk did not recognise that this was a large-scale Saxenda promotional campaign which Novo Nordisk knowingly paid for and which was disguised. In the Appeal Board's view the gravity of the breaches was compounded by Novo Nordisk's failures to recognise that its own behaviour was not compliant with the Code…The Appeal Board was concerned about the potential impact on patient safety of providing unbalanced information to a wide audience, particularly given that the arena of weight loss was a highly emotional arena, and particularly given the lack of balance of Saxenda's safety profile and side effects when comparing it with its competitors.”The Appeal Board decided to publicly reprimand Novo Nordisk for “its failings and the potential impact on patient safety.” They also ordered an audit and decided that “the circumstances were so egregious that a report to the ABPI Board was the only appropriate course of action.”The ABPI Board unanimously decided that further action must be taken, and while they chose not to expel Novo outright, they noted that this option could be exercised at a later date. While a majority wanted to immediately suspend Novo Nordisk's membership, they didn't reach a 75% threshold and so decided to conduct an audit.Subsequent to that audit they determined that Novo Nordisk's actions were ““likely to bring discredit on, or reduce confidence in, the pharmaceutical industry” and suspended them for two years, with reinstatement pending a future audit.In Part 2 we'll talk about some investigative journalism that caught Novo Nordisk in more shady marketing practices. 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

The post Rebroadcast: Unpacking Weight Science with Fiona Willer appeared first on Seven Health: Intuitive Eating and Anti Diet Nutritionist.

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I think that one of the more dangerous and disingenuous parts of the new American Academy of Pediatrics guidelines is their claims about eating disorders. These are claims that I am hearing echoed in other spaces as well, so I wanted to write about them in depth. In terms of the guidelines themselves, I wrote a deep dive about their three main recommendations around “Intensive Health Behavior and Lifestyle Treatment (IHBLT), weight loss drugs, and weight loss surgeries here. I also looked into undisclosed conflicts of interest here.When it comes to eating disorders they claim (in bold, title case) that “Evidence-based Pediatric Ob*sity* Treatment Reduces Risks for Disordered Eating.” Is this remotely true? Let's get into it.They begin by saying “concerns have been raised as to whether diagnosis and treatment of ob*sity [in the case of these guidelines starting at the age of two] may inadvertently place excess attention on eating habits, body shape, and body size and lead to disordered eating patterns as children grow into adulthood.”Well, let's examine the situation. They are “diagnosing” kids as having a “disease” based solely on their body size and shape, and then recommending “Intensive” interventions and dangerous drugs and surgeries that put significant focus on food and food restriction with the goal of changing the child's body size and shape. There is nothing inadvertent about this, it's about as advertent as it can get.They go on to claim “Cardel et al refer to multiple studies that have demonstrated that, although ob*sity and self-guided dieting consistently place children at high risk for weight fluctuation and disordered eating patterns, participation in structured, supervised weight management programs decreases current and future eating disorder symptoms (including bulimic symptoms, emotional eating, binge eating, and drive for thinness) up to 6 years after treatment. “I'll get to the research they cite in a minute, but I want to point out that in their list of current and future eating disorder symptoms, they left a few out including (from the AAP's OWN 2016 paper on eating disorders prevention in adolescents):“Severe dietary restriction, skipping of meals, prolonged periods of starvation, or the use of self-induced vomiting, diet pills, or laxatives”Let's remember that even if their “intensive” behavioral therapy recommendations don't devolve into disordered eating and eating disorders (and they certainly could,) their recommendations around pharmacotherapy and weight loss surgery literally induce all of these symptoms, sometimes for the rest of the child's life.It's pretty difficult to reduce eating disorders symptoms when you've created 100 pages of guidelines to literally recommend them. This reminds me of something the brilliant Deb Burgard says, which is that we prescribe to fat people what we diagnose and treat in thin people, and in this case the people are children.Now, I don't know if those symptoms are left out accidentally because the authors are so ignorant about eating disorders and higher-weight kids that they assume higher-weight kids aren't susceptible to these (potentially fatal) symptoms, or if they left them out on purpose because they know that being honest about this renders their claims of their “treatments” decreasing eating disorder symptoms not just false, but patently ridiculous. Either way, the fact that they don't even mention these symptoms means that, at best, they don't have the expertise necessary to even talk about this, let alone create guidelines.Ok, so let's look at the research they cite to back up their claims that ob*sity “treatment” reduces risks for disordered eating.Forkey H, Szilagyi M, Kelly ET, Duffee J; Council on Foster Care, Adoption, and Kinship Care; Council on Community Pediatrics; Council on Child Abuse and Neglect; Committee on Psychosocial Aspects of Child and Family Health. Trauma-informed care. Pediatrics. 2021;148(2):e2021052580Given that this clinical report doesn't mention supervised weight management programs, eating disorders, or eating disorder symptoms, I would suggest that it does not support their claims.Something interesting that it does talk about is that higher-weight children are “more likely to experience discrimination, both overt and as a series of microaggressions (small slights, insults, or indignities either intentional or unintentional) that accumulate over time” and that “the lifelong effects of toxic stress are statistically related to many adult illnesses, particularly those related to chronic inflammation, and causes for early mortality.”This is important because the authors of the AAP guidelines are ignoring it in order to uncritically assume that if higher-weight kids have these health issues then it is because of their weight without mentioning that (as explained in a study they, themselves, cited) it might not be their weight but, in fact, the weight stigma they experience that is the root.The next study is Jebeile et al., (2019) Association of pediatric ob*sity treatment, including a dietary component, with change in depression and anxiety: a systematic review and meta-analysis. We're getting warmer here, at least this study actually talks about “ob*sity” treatment. However, they do not examine eating disorder symptoms, they look at changes in depression and anxiety. They find that “structured, professionally run pediatric ob*sity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms.” First, note the use of “may result,” not exactly a clear conclusion. Beyond this, the studies offer follow-up between 2 weeks to 15 months. We know that weight regain typically starts around the 12 month mark, but this study fails to address (or even consider) what will happen to depression and anxiety symptoms during/after weight regain. I wonder if the study authors actually meant to cite this study, by the same authors:Jebeile et al.. (2019). Treatment of ob*sity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis. I noticed right away that there was a letter written about this study by Louise Adams. I know Louise, I have been a guest on her podcast All Fired Up (including recently with Fiona Willer to talk about the dangers of Wegovy and Saxenda). Her letter to the editor was behind a paywall, and while I could access it, I knew that if I wrote about it nobody else who wanted to read it could. So I reached out to her and I got something even better. I received the full text of the letter she wrote (not the shorter version that they published.) Here is the summary, the letter is re-printed in its entirety at the end of the piece. Her work is always spot on, you can check out her work and sign up for her newsletter here. Here is Louise Adams' summary of the issues with this study: Given the errors and serious omissions in Jebeile et al's article, the findings and conclusions of this review are unreliable. I am concerned that the overarching message of this paper projects an air of certainty regarding the long-term safety and efficacy of adolescent weight loss interventions on ED risk that does not reflect adequate data and places children and adolescents at risk of harm. I am concerned that this paper will be used as evidence to justify ever more invasive weight loss trials and products in vulnerable adolescent populations. The authors' conclusion that ‘structured and professionally run ob*sity treatment leads to a reduction in the prevalence of ED, ED risk, and ED-related symptoms for most participants' is extraordinarily misguided, given that (a) quality long-term data were available for only 7.5% of the sample, and (b) clear evidence of a subset of adolescents who developed ED symptoms was present in the longer term studies. Moreover, the high numbers of missing data due to adolescents lost to follow up is important to note and cannot be overlooked as a potential indicator of even higher risk.In our conversation, Louise pointed out that her concern that this study would be used to justify additional weight loss trials is exactly what happened here. She also mentioned that in the “conflicts of interest” section of her letter to the editor, the original study authors pushed for her to include “The author discloses that in addition to practicing as a consultant clinical psychologist in private practice, she derives income from an online anti‐diet program for adult chronic dieters.” She points out that their zeal for conflict of interest disclosures did not extend to their own study. In fact they claimed “no conflicts of interest”  despite the fact that they worked at the adolescent ob*sity clinic and that Baur didn't disclose her role as president of the weight loss industry-funded  World Ob*sity Federation. I discussed the issues with the false equivalence between anti-diet work and diet industry work here. The last study they cite is Cardel MI, Newsome FA, Pearl RL, et al. Patient-centered care for ob*sity: how health care providers can treat ob*sity while actively addressing weight stigma and eating disorder risk. J Acad Nutr Diet. 2022;122(6): 1089–1098The short story about this study is that it reads like a bunch of diet industry shills trying to co-opt the language of weight-neutral health in order to obfuscate the plain fact that intentional weight loss is incompatible with eating disorders prevention and treatment, so they can continue to market the same old failed “interventions” for “ob*sity”* and dodge responsibility for all the harm they create. I did a deep dive into this paper here.The challenges in diagnosing EDs in the context of the treatments recommended in these guidelines are due to the fact that the behaviors recommended by these guidelines (and created by the drugs and surgeries recommended) are consistent with eating disorders symptoms. Another way to say this is that the same behaviors that are considered red flags for an eating disorder in thinner children are being recommended as “healthcare” for higher-weight children bolstered by the dubious claim that they will reduce eating disorder symptoms.I do not think any of the research they cite comes close to supporting their claim that “evidence-based pediatric ob*sity treatment reduces risks for disordered eating.” In fact, I think significant research (which I wrote about here) shows that if the American Academy of Pediatrics guidelines are followed, they will create a generation of kids struggling with disordered eating and eating disorders , starting as early as two years old. Compounding the issue, since (by their own admission,) the “treatments” recommended by their guidelines almost never result in significant, long-term weight loss, these kids will still be higher-weight and, thus, have a more difficult time getting properly diagnosed with these life-threatening conditions (especially if their doctors read claims that the weight loss “treatments” the kids have survived supposedly prevent eating disorders.) This will do the most harm to higher-weight kids who are multiply-marginalized and/or under-resourced who, even if they can get a correct diagnosis, will have a very difficult time getting treatment. The top eating disorders organizations have come out unequivocally against these guidelines:International Federation of Eating Disorders DietitiansNational Alliance for Eating DisordersShame on the AAP for bending themselves (and the data) into pretzels to defend and recommend a dangerous and failed weight loss paradigm to children as young as two years old.Here is Louise's full letterProfessor David YorkEditor-in-ChiefOb*sity Reviews444 W Willis #307DetroitMI 48201Dear Professor York,I am writing to bring to your attention my significant concerns about an article recently published in Ob*sity Reviews:Jebeile, H, Gow, ML, Baur, LA, Garnett, SP, Paxton, SJ, Lister, NB. Treatment ofob*sity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis. Ob*sity Reviews. 2019; 20: 1287– 1298. https://doi.org/10.1111/obr.12866Please note that I send you this communication not with a view to being published in your journal (unless you believe this to be appropriate - I leave this decision to your discretion), but to ask that you consider the points I make below and consider retracting the article.This review sought to investigate the impact of ob*sity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in higher weight children and adolescents. The review analysed 29 studies, claiming data for 2589 adolescents. The authors concluded that ‘structured and professionally run ob*sity treatment was associated with reduced ED prevalence, ED risk, and symptoms'. I have three main concerns about the quality of this paper: (1) review methods, (2) follow up period definitions and (3) omission of dietary restraint analysis. These concerns are detailed below:1. Review Methods: Decision to Run a Meta-AnalysisThe fact that a meta-analysis was conducted rather than a narrative summary is troubling considering the heterogeneity of the studies included. The 29 studies involved interventions ranging from 1 week to 13 months. 11 of the studies had no follow up period. Those with follow ups varied considerably, ranging from 12 weeks to more than 5 years post intervention. The intervention types and locations were vastly different: including inpatient and outpatient hospital programs, school-based health clinics, and even an intervention in which adolescents attended a Jenny Craig program.A systematic review of 9 adolescent weight management interventions exploring the same subject - ED risk factors - by De Giuseppe and colleagues (2019) shared five papers in common with Jebeile et al (2019). However, De Giuseppe et al concluded that a meta analysis was not possible due to heterogeneity of the papers, and instead conducted a narrative summary of the findings. I believe that Jebeile et al should also have conducted a narrative review due to the heterogenity of the studies. Both Jebeile et al and De Giuseppe et al conducted a quality assessment, albeit using different assessment tools. Jebeile et al used the US Academy of Nutrition and Dietetics Quality Criteria Checklist (Handu et al 2016) and rated 11 of their included papers as ‘positive' and 25 as ‘neutral'. The De Giuseppe et al (2019) study utilised the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (Thomas et al, 2004). For 4 of the 5 studies in common, Jebeile et al 's quality ratings were higher than those assessed by De Giuseppe et al :Study Cited                                         Jebeile et al (2019)          De Giuseppe et al (2019)Cohen et al (2018)                           Positive                                                ModerateDeNiet et al (2012)                          Positive                                                ModerateHalberstadt et al (2016)                 Neutral                                                 WeakGoossens et al (2011)                     Neutral                                                 WeakSaverstani et al (2009)                    Neutral                                                 ModerateThere is clear disagreement between these authors as to the quality of the same studies, with Jebeile et al consistently producing more positive assessments.2. Follow Up Period Definitions 18 studies cited by Jebeile et al included follow up periods. In their Eligibility Criteria they stated that data at last follow up was ‘defined as a period in which there was no contact with study personnel and no intervention delivery' (pg 1288). Given this definition, the paper should have consistently referred to follow up periods from the end of intervention rather than baseline.However, throughout the paper and supplementary document, Jebeile et al (2019) repeatedly provide data reflecting time periods from baseline, often without explicitly stating that the period cited was taken from baseline and did not reflect their given definition.An example of this is on page 4 under “Prevalence of diagnosed eating disorders”, where Jebeile et al stated that “from 110 participants who completed the 24 month follow-up measures in the study by Braet et al…”. This should have been reported as a 14 month follow up.A further correction is needed in that the Braet et al (2004) study only had data on ED measures for 89 participants, not 110. Another example of this type of error in the reported number of participants occurred in the reporting of the De Bar et al (2012) study, where they stated that the intervention had n=100 in usual care and n=100 in the usual care control group, when in fact there were n=90 in the intervention group and n=83 in the control group. It is of concern that both of these errors overstated the number of participants in their dataset.Defining the follow up period in one way in the Eligibility Criteria and reporting it another way throughout the paper had the impact of making the included studies' follow up periods appear longer than they actually were. It is critical that the correct follow up period definition is adhered to, as Jebeile et al have used these to claim that a ‘strength' of their meta-analysis was that it ‘addresses concerns over longer term ED risk….with follow-up timepoints of up to 6 years from baseline, including seven studies with a follow up of >2 years” (p. 1295). If we use the correct definition for follow up periods as beginning from the end of an intervention period, only 3, not 7, of the studies in their meta analysis have a follow up period of 2 years or longer, representing just 7.5% of the total sample. This low number certainly does not adequately address concerns over longer term ED risk in adolescents, and represents a weakness, not a strength, of the meta analysis.3. Quality of the Analysis of Risk Posed by Adolescent Weight Loss InterventionsJebeile et al's claims regarding the safety of adolescent weight loss interventions is at odds with the widely held view, supported by theories of the etiology of ED development (Ahern, Bennett, Hetherington, 2008; Berge et al, 2018, Fairburn, Cooper, Doll, Welch,1999, Golden et al, 2016, Ouwens et al, 2009, Polivy & Herman, 1985, Stice & Presnell, 2007) and a substantial body of longitudinal research (Field et al, 2003,Neumark-Sztainer et al, 2007, Patton et al, 1999, Stice 2001, Stice et al, 2000, Stice et al, 2005, Urvelyte & Perminas, 2015) which demonstrate that over time, dieting is a major risk factor for both increased weight and increased risk of development of disordered eating and ED. In order to accurately assess the impact and potential harms of adolescent weight loss interventions, three conditions must be met:1) Quality data that captures disordered eating/eating disorder symptomatology for a period of at least 2 years, if not longer, after the diet intervention ends. This is because in childhood and adolescence eating disorders can take considerable time to appear; Stice and Van Ryzin (2019) have identified a 4-step pathway of eating disorder development which demonstrated that eating disorder symptoms did not appear until, on average, 26.8 months after youths began dieting.The need for longer follow up data has been apparent for a considerable time: over 20 years ago, Casper (1996) discussed this need to improve research standards and recommended even longer minimum follow-up durations of 4 years.2) ED instruments that have been developed and normed for higher weight adolescents. These measures should include an exploration of internalised weight stigma, so that researchers can untangle the apparent positive impact of weight loss from the experience of a reduction in internalised and external weight bias. Unfortunately such ED instruments do not yet exist. In the absence of such sensitive measures, quality studies must include follow up data for ED measurements of some kind.3) In order to determine the efficacy of weight loss interventions, best practice is to include a control group from the same population (Brown et al, 2019). It is even more important in youth, since BMI algorithms include the speed of growth, not just height and weight, and weight loss and gain are being assessed in relation to other youth. To answer the question of the impact of dieting, it is important to track the weight trajectories of larger bodied adolescents who do not diet. Phenomena such as regression to the mean (RTM) in higher weight adolescents and normal variations in growth spurts can impact significantly, and without control groups the true impact of weight loss interventions on larger youths will remain unknown. Brown et al (2019) have called for researchers to “clearly, and without reservation, acknowledge the distinct possibility that RTM could explain the improvements after intervention (p.4)”.None of the studies included in Jebeile et al's meta-analysis met all 3 of these requirements. None of the studies included a randomised control group with 2 year post intervention data. Only 3 studies - Braet et al (2000, 2006), and Goossens et al (2011) meet criteria for providing ED measures with a follow up period after the intervention of 2 years or longer. Once drop out rates and the number of adolescents with complete ED data at follow up are factored in, Jebeile et al's paper included quality data on 195 adolescents; just 7.5% of the sample.It is accurate to state that the meta-analysis revealed more about how much we do not know about the link between adolescent weight loss interventions and ED development, rather than claiming evidence of safety. I am concerned that the way this paper is written obscures the true message of the data. The authors' conclusions do not mention the dearth of meaningful long-term data, instead the opposite message - one that suggested a degree of certainty - was conveyed.A closer examination of the 3 studies with longer term data on ED is warranted. Braet et al (2000) conducted a three-armed intervention on 136 adolescents aged between 7 and 17 years. There was no control group. The intervention compared 3 conditions of a CBT based ‘healthy eating' program. A follow up was conducted 4.6 years after the intervention ended.ED data were available for only 53 of the original 136 participants (39% of the sample). A large number of adolescents did not return for follow up, and it is plausible that these youths may be experiencing negative impacts from the intervention. The authors called for “caution in interpreting these data” given the large amount of missing data.Participant data for the Dutch Eating Behaviour Questionnaire (DEBQ) was gathered at baseline and at follow up. The results of the DEBQ showed a significant reduction in external eating, a significant increase in restrained eating, and no change in emotional eating.Braet et al also administered the Eating Disorder Inventory (EDI) at the 4.6 year follow up. These results revealed that girls scored higher than average on the Drive for Thinness subscale, and boys scored significantly higher than average on the Body Dissatisfaction subscale. 9% of the sample had a score of five or more on the Bulimia EDI-subscale. Analysing a subsample of 76 of the youths, one had been hospitalised in an eating disorder unit.In terms of weight reduction, the Braet et al study showed that mean % overweight was 55% at the outset and 42% at follow up. Without a control group it is not possible to interpret these results. Further, almost half of the subsample reported that they had continued to seek weight loss after the intervention ended. This would impact on ED measurements: if adolescents are still dieting, some ED symptoms (eg binge eating) may not be apparent. This does not mean however that they have not been harmed, or that an ED will not develop in the future.It is important to note that other authors in the field have cited the Braet et al (2000) study as evidence for the emergence of ED symptoms after weight loss interventions.For instance, Goossens et al (2011) make the following statement: “results from a recent study...demonstrate that despite initial improvements (post-treatment and 2-year followup), eating pathology stagnated and even tended to increase in a subsample of youngsters at 3-year follow-up.”It should further be noted that the description of Braet et al's (2000) study presented in Table S2 in Jebeile et al's paper lists only the DEBQ and omits the EDI . Furthermore, the elevated Bulimia subscale scores in Braet et al's study were omitted in section 3.6.1. Bulimic Symptoms, despite the obvious relevance. In fact the Braet et al (2000) study is completely absent from this section, which is of concern. Jebeile et al state that “Two studies reported on participants with scores above a clinical cut-point for bulimic symptoms”. This should be corrected to say 3 studies, and include an overview of the Braet et al (2000) EDI data including that girls scored higher than average on the Drive for Thinness subscale, boys scored significantly higher than average on the Body Dissatisfaction subscale, 9% of the sample had scores above a clinical cut-off point for Bulimia, and one participant had been hospitalised for an eating disorder.The study by Braet et al (2006) followed 150 adolescents through a ten-month inpatient weight loss program. 2 years later, 110 youths provided weight data and Eating Disorder Examination (EDE) data was collected for 86 participants at baseline and follow up. This represents an absence of data for 43% of the sample.In terms of weight, the authors reported a 10% reduction in adjusted BMI, but without a control group it is not possible to ascertain the actual impact of the weight loss intervention. Of note, 75% of the sample were reported to be regaining weight after the intervention, even though 78% reported that they were engaging in further weight loss attempts after the study period ended.The overall EDE scores were reported as reduced at the 2 year follow up mark, but detailed subscale data was not reported. The same sample was discussed in a 2009 study by Goossens et al, where they reported increases in dietary restraint scores, and further warned that “in younger age groups, as was the case in this study, restraint attitudes have probably not yet reached their peak, and, as a consequence, full-blown eating disorders are still hard to detect.” The authors themselves are acknowledging that even a two year follow up is not enough time for ED symptoms to start showing in this population.The third study by Goossens et al (2011) was conducted on a sample of 108 adolescents aged between 10 and 17. There was no control group. The intervention was a 10 month inpatient program (the same program reported in Braet et al 2006). The follow up period was five years and two months after the intervention ended. Overall, 48% of the sample were lost to follow up, and the authors obtained complete ED measures (Child Eating Disorder Examination [chEDE] and the EDI) for 56 adolescents.No participants met criteria for binge-eating disorder (BED) at baseline. However, at follow-up, 5.4% met BED criteria. 8.3% of youths who did not report Objective Binge Eating (OBE) at baseline reported OBE at follow up. 8.5% of youths who did not report Subjective Binge Eating (SBE) at baseline reported SBE at follow up. Half of the adolescents who reported OBE at baseline still reported OBE at follow up.In summary, the data for studies with follow up periods of 2 years or longer show that from an initial pool of 394 youths, data on 195 were available, representing just 49.5% of the starting sample. Within this group, roughly 5-9% are showing signs of disordered eating and increased risk of ED following weight loss interventions. Disordered eating symptoms arise over time, and are easily erased when meta analyses include no or short term follow up periods. It is imperative that any research in this area focuses on long term outcomes, not allowing the shorter term data to obscure the big picture. We must also keep in mind the fate of the large group of adolescents (in this case, roughly half) who are lost to follow up. The fate of these youths is too often overlooked, and it is plausible that many of these people end up with disordered eating and ED.3. Omission of Dietary Restraint AnalysisJebeile et al's paper does not include a section reporting the impact of adolescent weight loss interventions on dietary restraint (DR) , a glaring omission given this is a central precursor to and symptom of eating disorders. In the studies included in the review, ample data was collected for DR and warrants further analysis.The differing frames between the eating disorder literature, in which DR clearly features as a central symptom of EDs, and the ob*sity research literature, in which DR is viewed as desirable for larger bodied people, is critically important to highlight. The treatment of ob*sity requires a practice that has been found to be a gateway to the development of eating disorders for people with eating disorders. For ob*sity researchers to omit any analysis of the impact of adolescent weight loss interventions on DR is a tacit admission that higher weight people should be prescribed what is diagnosed as disordered eating in thinner people.Many of the papers in the meta analysis demonstrated increases in DR soon after the intervention (eg, Braet et al 2000, Braet et al 2006, Brennan et al 2012, Goossens et al 2011, Halberstadt et al 2016, Saverstani et al, 2009). Several of the authors involved in these studies themselves raised the issue of dietary restraint as an important issue to study in adolescents, noting that it is important that interventions do not make DR worse. For example, Braet et al (2000) note that “ we wanted to avoid the type of dietary restraint that has been linked to the development of eating disorders” .In comparison, the De Giuseppe et al (2019) analysis discussed DR at length, noting conflicting results. Some studies found the interventions reduced DR, whilst others found they increased it. Regardless of whether DR is viewed as a precursor to both weight regain and the development of ED (Jansen et al, 2009, Stice et al, 2005), or viewed as a necessary and potentially useful method of weight control for larger sized adolescents (Smith et al 2018), this topic needs to be analysed, discussed and argued, not ignored.Given the errors and serious omissions in Jebeile et al's article, the findings and conclusions of this review are unreliable. I am concerned that the overarching message of this paper projects an air of certainty regarding the long-term safety and efficacy of adolescent weight loss interventions on ED risk that does not reflect adequate data and places children and adolescents at risk of harm. I am concerned that this paper will be used as evidence to justify ever more invasive weight loss trials and products in vulnerable adolescent populations. The authors' conclusion that ‘structured and professionally run ob*sity treatment leads to a reduction in the prevalence of ED, ED risk, and ED-related symptoms for most participants' is extraordinarily misguided, given that (a) quality long-term data were available for only 7.5% of the sample, and (b) clear evidence of a subset of adolescents who developed ED symptoms was present in the longer term studies. Moreover, the high numbers of missing data due to adolescents lost to follow up is important to note and cannot be overlooked as a potential indicator of even higher risk.I respectfully request that this paper be considered for retraction. Thank you for considering my submission, I await your response.Yours sincerely,Louise AdamsClinical PsychologistUntrappedSydney, AustraliaDid 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 appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing!As the diet industry works hard to co-opt the language of weight-neutral health and fat liberation and misuse it to sell weight loss interventions, I'm seeing more and more “anti-weight bias” trainings that are actually just diet industry marketing in disguise.Sometimes the trainers are very aware of what they are doing, sometimes they are actually well-meaning but simply duped by diet culture. Regardless, this is especially dangerous since the attendees leave thinking that they've learned how to reduce or eliminate weight stigma, when in fact what they've learned is how to be uncompensated, unwitting marketers for the diet industry, increasing weight stigma in the process.Here are some common red flagsThe trainer is one or more of the following:* Involved in “ob*sity medicine” * Paid to sell/prescribe/provide weight loss interventions* Taking payments from the weight loss industry* Represents an astroturf organization like the Ob*sity Action Coalition, Ob*sity Society etc.Taking the position that “I don't want to stigmatize fat people, but I want to dedicate my career to eradicating them and making sure that no more ever exist” is not an anti-weight stigma stance.You cannot be invested (ideologically or monetarily) in anti-fatness (aka anti-ob*sity) and be anti-weight stigma, they are mutually exclusive positions.The training uses pathologizing/person first languageThe words “ob*se” and “overw*ight” were literally made up to pathologize and medicalize higher-weight bodies. “Overw*ight” is inherently shaming (as it indicates that a body is “over” whatever is being considered a “correct” weight,) and “ob*se” comes from a Latin word that means “to eat until fat,” so much more stereotype than science there. Person-first language (saying person with ob*sity, person affected by ob*sity, person with overw*ight etc.) does NOT come from weight-neutral health community or fat liberation community. It was co-opted from disability community (where it is controversial) by the weight loss industry in the service of their goal of declaring that simply existing in a higher-weight body (regardless of any measure or concept of health) is a “chronic lifelong health condition” (that requires their profit-driving interventions.) This is not about reducing stigma, it's about increasing the bottom line of the weight loss industry.The training suggests that weight loss is a solution for weight stigmaIf they list bullying, lack of accommodation, or other types of weight stigma as a reason that people need access to weight loss interventions (including and especially drugs and surgeries) then they are inciting bias, not reducing it. While weight stigma is real and does real harm, and fat people are allowed to make whatever choices they want in dealing with it, in an anti-bias training it is wildly inappropriate to teach that oppressed people should have to change themselves (including risking their lives and quality of life with dangerous and/or expensive weight loss interventions,) to escape oppression. Teaching that oppressed people should change themselves to suit their oppressors is not an anti-stigma position. Even if someone believes that fat people are less healthy, healthism does not justify weight stigma.If the curriculum is not focused on creating a world that fully affirms and accommodates fat people, then it's likely diet industry propaganda.They suggest that the “real” injustice is a lack of access to weight loss interventionsI'm seeing this more and more from people who work for/take payments from the weight loss industry. They try to claim that the true injustice and stigma is that some people don't have access to their dangerous and expensive interventions. This has, actually, nothing to do with reducing weight stigma and, instead, is part of the weight loss industry's long game to get their procedures covered by insurance, which will vastly increase profits.Playing the Rename GameThere is definitely a place in anti-bias training for discussing language. However, if, instead of working to dismantle stigmatizing diet culture concepts, they are just renaming them (ie: instead of “willpower” use “commitment,” instead of “ideal weight” use “goal weight” etc.) then they are just repackaging diet culture.Reducing bias isn't about using different words for the same harmful concepts and practices, it's about dismantling the biased paradigm and using words that create a new paradigm (instead of “ob*se” use fat/higher-weight, stop conceptualizing weight as ideal, healthy, a goal etc.)They claim that the problem is that there isn't enough anti-fat educationIf they are claiming that healthcare practitioners and others should receive more education about pathologizing fat people and prescribing/recommending weight loss interventions, this is a weight loss marketing seminar, not an anti-bias training.  NovoNordisk is involvedHaving made (and continuing to make) a literal fortune from price gouging on insulin, NovoNordisk is bringing this same attitude (and the Perdue Pharma Oxycontin marketing playbook) to their weight loss drug Wegovy, which they promised their shareholders would be a massive profit-driver. I wrote more about this here. You can also check out this episode of the excellent podcast Untrapped during which I got to talk about this with the brilliant Louise Adams and Fiona Willer! Their message is “don't blame fat people, but do focus on eradicating them”If they are only admitting the fact that weight isn't a simple matter of calories in/calories out so that they can use that as a reason to promote diet drugs and weight loss surgeries then, again, you are not at an anti-stigma training, you are at a marketing seminar for the diet industry. (Even worse if they are acting like they just discovered this fact, when true anti-weight stigma and fat liberation activists have been screaming it from rooftops for literal decades.) Bottom Line:A true anti-weight bias/anti-weight stigma training de-pathologizes fatness and promotes a world that fully affirms and accommodates fat people. While there may be harm reduction models that fall short of this, if any of the red flags above are present, it tell me that I should do even more digging about who is creating/funding/providing this training, and who is profiting from the ideas presented. Please feel free to put other red flags that you have noticed in the comments below.Did you find this newsletter helpful? You can subscribe for free to get future newsletters delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button for details:Like this piece? Share this piece:More ResearchFor a full bank of research, check out 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

Big pharma are running a MASSIVE global marketing campaign, trying to convince us that weight loss drugs are A Good Idea. I'm looking at you, Novo Nordisk! Join me and my extremely outraged guests Dr Fiona Willer & Ragen Chastain, as we revisit the dastardly history of weight loss medications. Past experience has brutally demonstrated that far from improving human 'health', these drugs have proven to be (spectacularly profitable) human disasters - most of them have been removed from the market for harming or killing people. Big pharma cares about profits, not lives. Have we learned anything from the sins of the past? Frighteningly, it seems like history is about to repeat. Don't believe the hype - do not miss this two part deep dive into the devious and deadly world of weight loss drugs!

Anna Mackay and Anna Lutz have a conversation with Dr. Fiona Willer, an Australian advanced practice dietitian, academic, advocate, educator and organizational consultant on a mission to make the health sector a safe and inclusive place for larger-bodied people. They discuss: How Fiona decided to transition from being a weight-centric to a weight-inclusive practitioner, and how that affected her choices as an academic. The prevalence of weight stigma and weight bias in healthcare settings, and how this affects the decisions made by healthcare practitioners when treating patients.  The commonly held belief that losing weight will make someone a better person somehow and the ways we can push back against this idea. What the research tells us with regards to weight science. The ways we can effectively communicate weight-inclusive messaging to healthcare practitioners. Strategies for parents to manage negative messaging about weight and bodies. Links:  Support the Podcast -- Virtual “Tip Jar”! Fiona Willer Health Not Diets Sunny Side Up Nutrition Podcast  Lutz, Alexander & Associates Nutrition Therapy Pinney Davenport Nutrition https://thirdwheeled.com/ https://m8.design/ https://www.sonics.io/ Dr Fiona Willer (AdvAPD, PhD, FHEA, GAICD) is an Australian dietitian, academic, educator, non-executive board director and health advocate with a career straddling higher education and the nonprofit and private sectors.  She is a long-standing lecturer in Nutrition and Dietetics at Queensland University of Technology and is affiliated for research activities with the Healthy Primary Care team at Griffith University's Menzies Health Institute. Fiona's areas of expertise include the relationships between weight stigma, health consciousness, body appreciation and dietary quality, and the integration of inclusive weight-neutral lifestyle approaches (including Health at Every Size®) into healthcare practice and policy. Her business, Health, Not Diets, provides organisational consultancy and professional development resources for inclusive, weight-neutral healthcare practice and will be celebrating 10 years of advocacy in 2023. She is also proud to be the creator of the innovative Unpacking Weight Science professional development podcast. Fiona currently serves on the board of Dietitians Australia and has previously served on the boards of HAES Australia and the Association for Size Diversity and Health (ASDAH) in the USA.

In diet culture it's hard for most of us to feel comfortable in our bodies, let alone LIKE them. But what if it's possible to burst through this thin-ideal bubble and experience the joy, the light, the MAGIC of our bodies? My guest this week, artist and speaker Kathryn Max, has done just that, and you simply MUST hear their story! Kathryn's art is a powerful expression of tenderness, compassion & unconditional body acceptance. It's so beautiful - let's get all fired up with LOVE! Show Transcript Intro: Welcome to All Fired Up. I'm Louise your host, and this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal getting your knickers in a twist? Does fitspo make you want to SPITspo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. Welcome back to the podcast my delicious diet culture dropouts. Thank you so much for tuning in for yet another intriguing, deep dive down the anti-diet rabbit hole. I want to start with huge love to you all and thank you for continuing to listen and support this podcast, which as you know, is completely produced and put out by me on my lonesome, alongside a whole lot of editing. And I really appreciate your messages of love and support, especially during this year where things have become pretty rocky with getting the podcast out in a predictable way, I'm really pumped about 2022, and I've got big things of what I can't wait to share with you next year. But in the meantime, I really appreciate your listening. And if you love the All Fired Up podcast, help get the message out there by rating and reviewing. A five star review is always good, wherever you get your podcasts or preferably maybe with apple podcasts, because I'm really trying to target that. The more this message gets out, the more likely it is that diet culture falls onto its knees and I can go off and become a florist like I've always wanted. And if something about diet culture is pissing you off, let's get it off your chest, send it to me. Send your rage straight into my inbox - louise@untrapped.com.au. Tell me what's bugging you. It could be something that happening in your local community, could be a diet that's getting pushed in your social media or just something that you've heard around the traps that's really getting up your nose about living in diet culture. I want to hear it. I'm your agony aunt for all things diet, so send that to my email address. Free stuff, alert who doesn't love stuff that's for free. I have amazing E-Book called Everything you've Been Told About Weight Loss is Bull Shit, and that was co-written with the glorious Dr. Fiona Willer, dietician and amazing podcaster from the Unpacking Weight Science podcast. In this classic resource, we have stuff that's full of fun facts to help you push back against diet culture's bullshit. Essentially, we bust top 10 myths about the relationship between weight and health. And we give you heaps of scientific articles and resources and overviews, giving you the truth about the relationship between weight and health and just how much bullshit is being fed to us. It's an excellent resource. It's completely free. You can download it from the Untrapped website, untrapped.com.au. I encourage you, if you haven't already got a copy, to grab it and share as far and wide as possible; friends, family, health professionals, everyone needs to hear this message. More free stuff. If you have been living in diet culture and you find that you have found it difficult to be at ease in your body - ie. if you're a human living in diet culture, this eCourse called Befriending your Body is completely free. It's created by me and in it I send you an email once a day for 10 days. And it's like a little love letter to you every day for 10 days, giving you some small messages of self-compassion and practices of self-compassion, which are all designed to help you start looking at your body through a different lens, through the lens of compassion, support, friendship, appreciation, respect, and liberation. The befriending your Body eCourse is really easy, it doesn't take too much time out of your day, and as I said, it's completely free. So if you're tired of struggling and you're looking for something completely different and something pretty urgent; this can be with you in seconds. All you need to do to download the Befriending your Body eCourse is go to my Insta, which is untrapped_au and click on the link in the bio and you will see the Befriending your Body eCourse sitting there waiting to befriend you. Huge hello and big love to everyone in the Untrapped online community. Without Untrapped this podcast wouldn't be able to be produced. Untrapped is an online masterclass in the art of everything anti-diet. And it was co-created by me and 11 other health professionals working in this space. It's an incredible program. Very comprehensive, all online so you can do it at your own pace. And in it, we go through all kinds of stuff like recognizing and waking up from die-culture bull shit, reconnecting in with your body signals and repairing your relationship with food, with your body and with moving your body joyful ways. One of my favorite aspects of the Untrapped masterclass is the online community that we've created. We've been running since 2017. Can you believe it? And we have built up this incredible group of people we meet every week in a Q and A, and we've completely bonded. And I think most of the power of Untrapped is in this community. So if you are looking for a change and if you don't want to do it on your own, think about joining us in Untrapped. You can find out more from looking at untrapped.com.au and we would absolutely love to have you. So, on with the show, my guest this week, oh my gosh. I mean, this is a completely mind-blowing episode that I hope that you've got somewhere nice to relax and really take some time to absorb the awesomeness of what you're about to hear. So look, it's Christmas time, diet culture bull shit, no matter where you live on the planet, it's at an all time high at this time of year, the pressure is on. It is high season for the weight loss industry. And look, we are all feeling a little bit more fragile than usual, thanks to the ongoing bull shit of this year and living with this COVID pandemic. So it's been a complete mind-fuck, and look, you know, you all know how much I love to rant and complain about diet culture, but I think we need a bit of love, and that's what this episode is all about. In this Christmas season, let's pivot into something completely different. So my guess this week, Kathryn, formally Kathryn Hack, now known as Kathryn, or you might know her on Instagram as fat_mystic_art or Fat Mystic. This is an amazing human. Kathryn is a fat liberated artist and speaker, and they, sorry. And they are the pronouns. They have many intersecting identities including being fat, queer, disabled, poly, ADHD, lipedema and ex-evangelical. Are you fascinated? Because I certainly was completely fascinated by this human, when I saw their art in their Instagram feed. It took my breath away and like kind of hit me in many areas as you're going to hear about in our conversation. So, I really don't have more words and I don't want to give anything away, but I think your mind will be blown by this amazing episode interview individual. So without further ado, I give you me and the glorious Kathryn. Louise: So Kathryn, thank you so much for coming on the show. Kathryn: I'm very happy to be here, Louise. Thank you for having me. Louise: So tell me what's firing you up. Kathryn: Well, interestingly, I would say that being fired up, hasn't really been my lived experience recently with whether it's diet culture or any kind of oppressive systems. They definitely can feel discouraging, but I have a really deep practice of self-compassion. And what I have observed is that the more I live in a state of grace with myself, the more I am kind and consistently really gentle with myself, it's almost effortless for me to extend that kind of grace and compassion to other people while also having good boundaries. So I don't let people mistreat me because I live in a fat body or disabled body or because I'm queer or any of the identities that I live within. And yet, I don't feel fire about it. I don't feel anger exactly. I feel yeah, real contentment and peace and this journey and where it's brought me. And I feel a lot of joy in my life and the grace to handle the challenges that come in living in the body I live in. Louise: My goodness. Okay, everyone wants to know what cocktail is this self-compassion. This is so interesting. So you said you've got a really deep practice of self-compassion and that's what got you to this place of not being unimpacted, but not being affected in a negative way. Kathryn: And I think sometimes I might still be affected, but it's just that self-compassion is such an effective tool, that even if something does impact me negatively, I'm able to be present with that emotion with a deep resource of compassion and care, and so it just doesn't damage me. Like, I'll sort of let this emotion move through me. I'll feel it. I won't deny it. I won't suppress it. I definitely don't shove it down in my body like I used to. I just feel it, I'm present with it and then it sort of moves through. So the deep practice started a little while after I was first introduced to the fat liberation movement. It was intellectual information to me that, oh wow, some people are living in fat bodies and they're like, yeah, I'm fat, so what? And I was like, whoa, that was a revolutionary idea to me. I've lived in a fat body since puberty and I felt shame about it my whole life. Around the same time that I learned about fat liberation, I was also diagnosed with a chronic illness. The name of my chronic illness is lipedema. It's progressive, there's no cure for it, and it contributes to the size and shape of my body. It's understood to be a fat disorder, and it happens to accelerate during major hormonal changes. So most humans who have this experience, they see the onset around puberty. And then during childbearing years, during pregnancy specifically, there can be significant advancements, and then again around menopause. My experience was that I lived in a smaller but fat body for most of my life. And then after I had two kids, about 21 months apart, my body really changed radically. It impacted my mobility, I took up a lot more space in the world. And for the first several years, there was an incredible amount of shame there. Louise: I guess that built on the shame from puberty, you said like it had been there anyway. When were you diagnosed with lipedema? Kathryn: I was diagnosed in 2016. Louise: Okay, so that's fairly recent. Kathryn: It is actually. And that's kind of a fascinating thing. Like, I talk a lot on my art page about how much my life has changed, thanks to reconnect with my body and healing my relationship with my body. I would say that self-compassion is what helped do that. So first it was sort of the information, like there's humans out there and these brilliant activists that are brilliant feminist thinkers and like helping me to get new information about whether or not I'm allowed to exist as I am. I also want to say that humans in the disability justice movements are just so brilliant in how they articulate that dignity is not condition and ought not be. So, that was all really, really helpful information. And then what happened is I was able to apply the information by compassion, you know, like learning how to just sit with myself and feel my feelings and validate them and then genuinely out loud saying to myself, like "Kathryn, I'm so sorry." And then I'd be really specific; "I'm so sorry you don't deserve love because of the body you live in." And intellectually, I knew that sentence wasn't accurate, but in my body it felt true somewhere. And so, I would just acknowledge these things that were sort of limiting beliefs. And it was a limiting belief. I absolutely am worthy of love in the body I inhabit. And as I started to offer that specific lie, compassion and heal the pain that it caused, I suddenly was in relationships where I felt really loved and seen and valued and desired, and so it changed literally everything living in my body. Louise: How did you learn about self-compassion? Kathryn: Well, you know, it's interesting; it really first started with, with my body. So learning about fat liberation, I was reading everything I could get my hands on. And then also, I just am a very spiritually curious person. I spent most of my life inside Christian theologies. I was an ordained pastor for about a decade. And then I left that worldview because it was more and more confining, and I started to feel - even though I had sort of these incredible spiritual experiences, what I would now say is I think that divine doesn't care about dogma. I feel like the divine is willing to engage with us no matter where we are. And it really, really doesn't care about any dogma that we may bring into our desire to connect with whatever is out there, so as a Christian, and I was a Pentecostal Evangelical Fundamentalist Christian. Louise: Wow. Kathryn: Yeah, that's a mouthful, but yeah. And it's really rigid thinking, but also there's this Pentecostal element that is very metaphysical. There are a lot of interesting experiences. Things like speaking in tongues or getting sling in the spirit. And I had had an incredible experience after experience, after experience of feeling a sensation of being completely loved and accepted by what I would now call is just the divine or the universe, that something benevolent that loves me exists. And now I would even say like I'm part of it, like we're all sort of connected as consciousness, you know? I'm still very spiritual and I like to refer to myself as a Woo-Woo Bitch these days. Are we allowed to swear on this podcast? Louise: We encourage swearing on this podcast. Absolutely. Kathryn: That makes me happy. That was one of the first things that showed up when I stopped being a fundamentalist is I was aware of how much I had edited my language. And now swearing is my fucking favorite thing to do. Louise: It's my fucking favorite thing to do too. It's expressive. Kathryn: It is, and it feels freeing to me. So my body started to slow down kind of dramatically. I had had this outpatient surgery that was supposed to be a quick in and out kind of thing. And I had an incision rip and it meant that I was like literally in bed for about six or eight weeks. And then I finally am better enough that I can move around a bit, and then I immediately get vertigo. And it fascinating because in that particular window, I felt like my body was saying, "Kathryn, we're going to sit you the fuck down. We've got something to tell you." And it was an incredibly powerful time in my life where I stopped limiting my spiritual curiosity to what was sort of acceptable within Christian circles. And by that point, I was already no longer a fundamentalist, but I was still attending like a more liberal-minded Christian Church. And the person I was married to was a pre-devout kind of more liberal Christian. But I knew that Christianity was really important to them and our marriage. And it turned out if I allowed my evolution to take me beyond Christianity, that that relationship would end, and that is what ended up happening. But my body working so I could stop participating in culture, really. And I had two small kids, it was a really strange time. They had just kind of fend for themselves a bit more than their peers, because I just couldn't function. And my brain was like - my spirit, my brain, whichever was just curious. And we have like this amazing technology and our hands, and so I just was following my curiosity. Eventually, I mean, it took me lots of places. Like I did a little time of like, oh, I'm curious about tarot cards. And so I looked into that and then I was like, oh, I want to learn about like all of our chakras, and I even bought some like stones to like, you know. I took one of the online quizzes that talked about like, which one of my chakras needs more attention, you know, that's my clothes, I need to work on that. And so it was like a game. It was like fun. It was just following my curiosity. And in that space where I was just following anything that was shiny, I was reading more and more about self-compassion. And there was this very specific practice that I had read about and learned about that I started doing and telling my friends about and it was this thing where you literally say out loud to yourself, I'm so sorry. And then you be as specific as you can about the belief, even though intellectually, you know it may not true, but the painful thought and you just say, I'm so sorry, and you just hold space for yourself. And I don't know how it works, except that it does work and it just shifted those painful things. They just were allowed to move through me. Louise: Yeah. I love that because you're bringing like mindful kindness to the beliefs and thoughts that are happen in the moment, so I'm so sorry that you just thought, oh, I'm so disgusting. Kathryn: Yeah. Louise: And so you're pausing, you're not letting it kind of just sink in, and you're apologizing to yourself - so powerful. Kathryn: And it's really been the most affected, I would say, on the old beliefs that have sort of been sneaky. We've been very programmed by the cultures we grew up in. That's why fat phobia is so rampant, you know, anti-fat is everywhere. It it's like a global phenomenon that fatness is bad. That's kind of fascinating. What the hell? Louise: The world is wrong and fat is bad. Kathryn: Yeah. But actually, and I think that's so interesting, and one of the things I really love about the fat community is that we are an international global group of humans, that are going to push back on this really stupid presumption that our bodies are wrong. And I don't know, it creates this really interesting energy of when you choose your own inner knowledge over the projected information. It is powerful. It's an empowering transition. And so, you turn the volume up of your own inner space, above the chatter of culture and you start to realize, you can do whatever the fuck you want. You can have whatever. Louise: You can wear what you want, you can have sex, you can enjoy hell out of yourself. Kathryn: It's all of it. Absolutely. Louise: For how long has life felt like that for you? Kathryn: It just keeps getting better and better and better. So, when I was experiencing that period of time where I was recovering from surgery and then ended up with vertigo, that was like, it felt like explosions, like my body expanded and my brain and my spirit was expanding. And I'd had this sort of metaphysical experience where I had this profound sensation that my physical body that was inhabiting was an allegory to this spirit size I was meant to embody in this. And I don't actually even talk about that that much, but it was huge in shifting my thinking about like whether or not my body was allowed. And not only is it allowed, it's powerful. When people see me, it's not hard to see that I am also quite free, but I live in a body that we're used to people seeing shame. Walk around in bodies like mine and they there's just shame. I's hard not to, because of how much conditioning we've been taught about fat, but I just don't have that. I don't have that energy. And so, people interact with me and I'm not easy to forget. Louise: Do people just not know what to do with you if you don't kind of obey that is not expected shame. Kathryn: I don't know if they... I'm not having those kinds of conversations with strangers. The humans are that are close to me, like they just see me. I'm a full human person. I do have this deep spiritual practice, but like I have hard days too and I have sad days and I reach out for support when I need it. I get frustrated with my kids and I complain about that. So yeah, it's just the humans that are in my life really see me. And then when I'm out in the world, I just don't live. I just am not anticipating. I remember living in a way where I anticipated hostility for the body I lived in and I felt hostility. Now I just don't anticipate hostility directed towards me. It just doesn't occur to me anymore. I don't know how, except that it was all this self-compassion, but this very dramatic shift is, can move through the world and I'm not anticipating hostility. I just assume that I get to be treated with the amount of dignity and love and care that I treat myself with. And if that doesn't happen to be the case where someone doesn't treat me the way I want to or expect to be treated, it just doesn't wreck me like it would've before. It just is like, oh, that's an anomaly. Like, I'm sorry, that person, they must be having a rough time. Like, how sad that they would feel the need to project their shit onto me. It's very clear to me that that's theirs. It's not shit my. I'm good. Louise: Oh, that's it, right? Because the self-compassion has kind of sunk in and made you kind of unstoppable. Kathryn: And what's funny is like unstoppable how, because I have a lot of limitations living in my body. I have a lot of limitations moving through the world. Like, my body doesn't fit in most public seating. I've had to do the both end of doing this internal work of, I know that I'm allowed to exist in the world with full dignity and I'm also someone ADHD, and so sometimes I have low executive functioning. Which means, I can be overwhelmed with the amount of extra labor that's required for me to like, make sure that that restaurant I want to go to with my friends is going to have seating that's going to work for my body. And so, I've been able to like my circle of friends and people I date, I've been able to invite them into this sort of tender space of, hey, would you actually help do some of the labor here? And I was pretty tentative about it at first because it felt really vulnerable, and they were so happy to. They were just so happy to. They were like, "That is okay Kathryn, we love your presence in our life. And of course, we're going to try to streamline this and make it less hard for you. You shouldn't have to work this hard, just go out and be in the world." Yeah, and so it is the both end. Both things are at once; I am unstoppable and this world is still not built for, to welcome a body like mine, I have to do in a lot of extra labor. Louise: Which is terrifically difficult, but how nice that you can like share this with friends who will then go out and advocate and take care of everything alongside you; you don't have to do it on your own. Kathryn: Yeah. It's a really beautiful thing. I think the work of getting free and liberation is an internal spiritual work. And then what happens is we get to see it lived out in human relationships because we are social creatures and it's got to be the both end. We're not meant to be alone, most of us aren't. And so, yeah, and then that was just a really - that took some compassion too. It was very tender when I first started saying out loud to my circles, like I want to be out in the world a little more and I'm noticing I'm saying no to invitations because it will be too hard. And then I'm like, oh, actually I can ask for help. Turns out, asking for help is its own kind of superpower. And culturally again, especially in Western cultures, we have been taught not to do that. Louise: Yeah. Don't impose on people, don't have needs, don't... that's terrific. Out of interest, who were the fat liberation people that you read for inspiration? Who your community now that you...? Kathryn: Let's see. So Sonya Renee Taylor's work was really impactful to me and the book, The Body's not an Apology. I really liked what I read from the author who wrote Shrill and now Lindsay-Anne Baker, The Will author. I can't remember her first name. Louise: I can't remember it either. Kathryn: Yeah. And then I just started following like the hashtags on Instagram. Instagram was really helpful in my evolution as well, because I love how you can just follow hashtags, like disability justice and fat liberation, haze, so all of that was really impactful. So it became like this big, beautiful soup of just taking in everything that was sort of out there and allowing it to change how I thought about things. Louise: I love that; a big, beautiful soup, because Instagram can also be like a treacherous shark infested ocean. Kathryn: The thing is like curating our feed too. I mean, it can be. But I think that internet has served me so well because social media is can reflect back to us our own energy sometimes. And whatever you're drawn to are attracted to you, you can unfollow and start following the stuff that makes you actually feel good, so it doesn't have to be that. It doesn't have to be that. Louise: No, I love my little haze bubble that I have on Insta and social media, speaking of which that's how I found you. Because I think I was scrolling through Being Nourished, their feed, Hilary and Dana and I saw this amazing picture of lady and it was just lit up with flowers and it was glowing, like literally like no shit glowing. And I was like, I just stopped. And I'm like, that is the most beautiful thing I've ever seen. So since then, I was trying to find it and I couldn't find out anywhere. And then I found you and looked through your feed and your art and it was like how I think self-compassion looks like in art. I can't explain it very well, but it's like it moved me in my body. It was so beautiful see. And that's why I kind of tracked you down and finally found the beautiful painting, which is going to be up in my new office. Which ironically the new office is called Flourish at [unclear27:54]. Kathryn: Wow. Louise: And then the idea is that it's a big, beautiful like greenhouse full of plants and growth and beginning for people. And so, I wanted to feel it full of like art that showed that. That painting that I had seen is called Flourishing, so I can't wait to put it up there. I just want to talk about your art because it's just like a mind bogglingly awesome. How long have you been doing it? Kathryn: Not that long. I started really making body art, figurative art in 2018. I was sort of dabbling in 2017. I was sort of experimenting. I was 38. I'm 44, almost 44 now, but I was 38 before I could even call myself an artist. It just was things were, again, we have these limiting ideas sometimes. Like the idea that I was an artist felt so gatekeepy, like I wasn't fancy, I'm just up hot. Yeah, so I was 38 and I was like, oh my God, I've been calling myself crafty my whole life. But like the truth is, is that I am an artist. And then when, like I said, I describe how in the same window of time I had this lipedema diagnosis, this chronic illness and there's no cure, so my body will continue to evolve. And then they're just like, by the way, all of our bodies are continuing to evolve. We're in a constant change. And then fat liberation, that I was allowed to take space and have the body I lived in and I needed a way to marry these two ideas just to make peace with the fact that this is a reality of my life. My body is going to stay this way and progress. So up until that point, I just constantly was believing that like someday I would lose all the weight, you know, like most of us think, you know? So I had to decide, nope, if that never happens for me, I'm going to live my best life. So making art was the bridge and it was like, I wanted to see myself depicted beautifully in art and media, and so I just started playing around with it. And it's interesting because you know, you referenced the image flourishing and you said painting, it's actually not really a painting. It's digital. Louise: It's digital. I have no idea when it comes. Kathryn: We have these iPhones, and there's all these apps on there. I literally make all this art on my phone. Sometimes I like the aesthetic of mixed media, and so sometimes I'll do like mixed media art, like an abstract sort of thing. And then I can like take a photo of it and I can layer it into a silhouette. But yeah, we have all this software now where you can just like take a photo and then like strip away everything that's not the silhouette, and then I can layer and layer and layer. I can create a background, I can do all these things. I can just pull an image in and out of like 16 different phone apps, you know? And it was just plates. Something I can do while laying down and it doesn't require any art supplies that my kids are going to make a fucking mess out of. Louise: That is exciting. Kathryn: And it really helped me get into a state of flow where I could be like listening to an audio book and then like playing on my phone, making something beautiful. Here's the other interesting thing is that, in like summer of 2018, I started my Instagram and I was like, I'm going to make new art every day. I'm going to post something every single day, and I did that for six months straight. And there is really something powerful about adding creativity to whatever our work is. Like, what are you working on in your life human? Like, what's the thing that is asking for your attention, right? Is it body issue stuff, then find a creative outlet for that. It could be poetry. It could be writing short stories. It can be visual arts. It could be clay. I have this sculpture of myself that I made with, oh, I wonder if I can remember their name. There's this other, like the activist who I think is from Australia, actually. Louise: Yes, yes. And my God, what is happening to my brain? It's 6:00 AM. Ashley Bennett. It's Ashley Bennett from at bodyimage_therapist. Kathryn: She's delightful, and it was really fun to go to her class in San Francisco. And a bunch to us were in there with clay molding our own forms. And it was powerful to lovingly touch this clay, to like fill in where all of these fat roles are, you know, the volume of my big belly. It was just powerful. So whatever creative outlet attracted to, adding creativity to whatever your work is, somehow I think unleashes huge amounts of energy. It just opens us up in ways that I don't think just thinking about things could ever. Louise: I think you've nailed it. You're regularly visiting that place and reinforcing it, but just sort of intuitively finding this way of doing it. It shines out of it. I don't think I've seen art before, which embodies self-compassion, this stuff that you've done, I just love it. And I love how you've paired it with compassionate phrases, like be gentle with you. Kathryn: Yeah. Louise: And I love fat-trans queer loved, just full of love. It's too just incredible. And I particularly, yeah, I'll just keep blushing if I keep looking. I just encourage everyone to go and look at it. So this is really like a love story of you and your body. Kathryn: Well, okay. So maybe, right. My relationship, my body meant that my spiritual worldview shifted a great deal. How I interact with the world around me changed. It also meant that I ended a long term marriage that wasn't exactly a terrible marriage or anything, it's just we didn't resonate with each other anymore. I was no longer a Christian, that was really important to him. And as soon as I knew that that marriage was over, I was like, oh my God, I'm queer. Of course, I am. How did I not know that? You know? And so I spent so many decades in purity culture, I just was prohibited from exploring my own sexuality. And so, one of the things about being a late bloomer is the temptation to feel like a I've missed out on a lot of stuff. And again, like I felt all those feelings. I gave myself a lot of compassion. It would've been amazing to be having lots of gay sex when I was in my twenties, but that wasn't my experience. And so the cool thing is, is that I get to be a sexual being today in the body that I have, but as also as a person who's incredibly self-aware who is great communication skills, who is emotionally intelligent. And so, I'm navigating dating almost as if I'm a preteen or a teenager, but also I have all of this wealth of internal self-knowledge and self-compassion. Louise: So that's good make it like much more enjoyable than usual teen experiences. Kathryn: I'm having a fucking blast, yeah. And not that every date I go on is amazing. A lot of them are amazing. I'm also very interested in nontraditional relationship models, so I'm practicing solo polyamory. Another interesting thing to read about is something called relationship anarchy, which is just brilliant. It's just asking us to challenge all of these beliefs about what relationships are supposed to be and gender roles and like expectations we might have on a dynamic with another person. You actually get to invent that; you and that person get to make that up as you go, it gets to serve both of you, and it can be like anything you want it to be. I love that. I love the freedom of turning everything on its head. There's no external expectations on what my relationship with any one person needs to be. I get to decide that. They get to decide that with me. So yeah. Right out of the gate, you know, I came out as queer during the pandemic and then once enough of us were vaccinated, I'm out here dating, dating a lot. I'm having a good time. Louise: It's not easy to date in a pandemic. Wow, this is all so new. You're riding the wave. Kathryn: I'm riding this very big wave. Also one of the things that I've learned is that scarcity is a capitalist construct, and it fucks us up pretty bad, but we apply scarcity to everything. We definitely apply it to dating and it just doesn't feel true anymore. Like, people are coming out to the fucking woodwork to be like, hey, how you doing, can we date? And I'm like, yeah, let's go on date. Me and the body I inhabit, I'm a desired person that feels amazing. That feels amazing. Louise: Wow. That is the power of not limiting yourself. And that's the other kind of word that came to mind looking at your art is abundance. Kathryn: Yeah. Yeah. It feels so much better to live in this space. And I want to be really careful to say, it's not that I am in an elated state of being constantly. I really do have access to this like really high, high frequency sensation of joy and pleasure and abundance. But also, I still am inhabiting a human body that has chronic pain, that experiences big fatigue. I've had relationships end in a way that really hurt my feelings. And I've been afraid of things here and there too, you know? And so, it's just that in those times now I don't judge myself harshly. I can experience very, very big fatigue and just decide that everything I wanted to get done that day isn't going to get done and I'll go home and I will just rest and do whatever I need to do to get through that particular window. Louise: What would you offer yourself then? How do you stay compassionate in a moment like that? Kathryn: Well, what's interesting is that that's taken a while because I remember even just, I don't know, eight months ago I would have a fatigue spell and sometimes they would last up to like five days where it was just super hard to function for days. And the first day or two, I could be like, that's all right, I'm just going to roll with it. And then if it went on beyond that, it would start to feel scary because our brains have a tendency to be like, oh my God, this is my life now. And what I started to see though, was on the other side of a hard window, I felt more free somehow. And I don't know how to explain that. Sometimes we go through a hard time and then coming up out of it, there's just some kind of lift. And that had happened enough times that I started to trust it. So several weeks ago I had a rough spell and I didn't have that panic feeling. I just remembered like, oh, I've been through this before, like on the other side, I'm just going to feel more powerful. So in the time while I'm experiencing it, while I feel like really low energy, I just lay down as I needed to. My body is like, this is what's going to happen, this is how much rest we need and stop trying to qualify it. Like, I feel like I rest more than any human I've ever met, and I'm like, what? Really? More? How much more could I need? And my body's like, it doesn't need to be qualified like that. Like it's not about comparing it to other people, like you're going to need to lay down and rest somewhere. And so then I just keep myself occupied by listening to audio books or playing on my phone or meditating or whatever I want to do. That's a really powerful thing too. I stopped doing things that I was supposed to do. I literally only do what I want to do. Louise: I love this. Kathryn: There's some amount of privilege that comes with that. Like I'm separated, so I don't have to live with my ex anymore, but I was a stay-at-home parent before. And so, with child support and whatnot, I still get to like live as a stay-at-home parent and I have my art that I do and other things occupy my day and my time. I'm not needing to work 40 hours a week in order to live in the world, so I recognize that as a great privilege I get to have. But that being said, I still think being free on the inside is what's making me free. You know what I mean? Louise: Yeah, much more. I remember being at one of Hilary and Dana's retreats in 2016 and talking about how like... it was for embodiment, to be an embodied practitioner. About trying to get out of like the crowded city of our brain and down into the wilderness of our body - uncharted territory. And I remember us talking about that's where the freedom is, it's down there and it's not verbal, it's sort of felt. Kathryn: Yeah. And I would say that - like I said, I've been explaining who I am as a person, as someone who's quite spiritual, and that's true. But what I started to see is that in some spiritual communities, they would talk down about the body. They would say like, oh, this meat sack that we're in, you know, like your body is not who you really are, you are not your body. And I don't agree with that at all. I think our bodies are fucking magic. They hold so much intense wisdom. They will talk to us and teach us things. Our bodies have held all of our trauma our whole lives; just held it, just waiting for us to be ready to look at it again. And it has only ever been kind to us. And even when it's not working well or there's pain or any of those things, it's not out to get you, it's just trying to get your attention. And when we can turn into it and listen and believe that it's our friend I feel like it's multiverses within ourselves, like unending amounts of wisdom and love and compassion all in this physical form that we inhabit. Even if you just think about DNA, like our fucking DNA is ancient. You know what I mean? There's studies that talk about how like trauma can be passed down in your DNA. Like the stories that your body has, it's way more powerful than we give it credit for often. And so when we live our lives, we're not ruled completely by our minds, but we actually get to make decisions based on how does it feel in my body when I think about doing this thing? If we literally do the things that only make our body feel like, ah, expansive and open and relaxed, oh my God, your life will change. If you're constantly doing things to your body's like, "Oh, dread, dread, I don't want to, I'm going to make myself." Nope, nope, it doesn't serve you. Louise: This is an amazing conversation. I knew this would be an amazing conversation. There's so much in everything that you are saying, and it's learning how to do that I think that's difficult for people. Because like you said, we're so kind of stuck in our heads and so scared, and often I think it's that fear response that's in our body that stops us getting down or trauma cuts us off. So it is really interesting that you come to it in your late thirties and you come to it in a moment, like when your body just sort of calls it a day almost and says, oh, lie down for a few weeks, you're going to have to just be with me. Kathryn: Yeah. There's an account. I follow on Instagram called The Nap Ministry. And I can't remember who is in charge of it, but this really powerful black woman. And I just want to say too, like as a white woman in the privilege that I embody there, like the kind of freedom that I get to live in is absolutely because of the work of black women and fems and indigenous people. Like, I'm really grateful for all the labor and the work that they've done to help kind of illuminate the path forward. So this particular person who has the Instagram, The Nap Ministry, they just blew my mind when they talked about like rest as revolution. Capitalism has really indoctrinated us with the idea that our worth is connected to our labor or our productivity. And then we live in systems that you literally can't live unless you do labor for often someone else. And that's really wrong. Human beings are not designed for that. That's a system that we all have grown up in and it's impacted how we think about ourselves. There was a time where human beings existed without having to go to work and labor in order to just stay alive. So to nap, napping being resistance to those capitalist ideas was a revolutionary idea to me. And that rest was how we honored all the people that went before us that weren't allowed to rest. And it absolutely - I really do credit my body stopping working and requiring so much rest with my ability to disconnect with these systems that control our thinking. You know what I mean? So I was out in the world less because in my bed napping more. And what that meant is I was spending more time in my own energy and the things that I was just naturally feeling curious about. And then I could follow my curiosity to the next step and the next step. In a spirit paradigm, you might say like your higher self is always going to guide you towards enlightenment if that resonates with you. But I would also say that my body had a very key role in that. My body was the one that arrested me and got my attention, my body demanded rest and I said, okay. And before I said, okay, I spent years pushing through like most of us do. You like buckle in, you like buck up, you push through and that's stupid. We don't have to do that anymore. You know what I mean? The idea that you were good because you hurt your body in order to achieve some task is really stupid. We don't have to do that anymore. We don't have to hurt ourselves anymore. We can be kind to ourselves. Rest is revolutionary. Louise: I love that. Absolutely love that. And I think especially now, you know, the last two years have been pretty shit for most people on the planet. And I don't know if this happened over there, but as we are coming out here in Australia, there's a lot of like exhaustion and a lot of anxiety coming back into, and fear of what's going to happen next step. People do need to rest more. We can get these messages, like you said, from the structures and systems that we need to kind of pull up our socks and lose the COVID kilos and, you know, whatever. And I'm finding for my clients that that kind of message like let's get back to normal, just doesn't resonate as much, is maybe we've had a bit more time to spend in reflection. Kathryn: Normal was very toxic. It really was. Normal has never been good or kind to human individuals. It has served these systems that are oppressive and that's all. And I think the pandemic forcing most of us to slow down to some degree, it means that we get to become disillusioned with how it was really shit before too. And no, not fucking going back to that. No, thank you. No, we're going to have to create something new. A lot of the kind of things that I'm listening to and reading about now is all anti-capitalist stuff. And the idea that we're in late stage capitalism is a pretty widespread idea at this point. And so, how we going to cope with that? How are we going to cope end of capitalism? Those of us who are adults now are probably, I don't know that it's going to be easy or fun. And again, that's why we have to do the internal work of like, I'm actually, okay no matter what, I'm going to be okay, and I'm going to be really fucking gentle with myself, because I don't know what the future holds. And sometimes uncertainty can be very scary. And again, we can offer ourselves compassion for that, but the truth is the more I live in a state of genuine compassion for myself, I'm very present in this exact moment and you know, that's a spiritual practice that most of us had heard about like be present, be present in it; it didn't resonate until I started to live in a state of compassion. And it's not that I'm trying to be present; I just am. I just am here. I'm just present with myself because I'm so kind to myself. I don't have to escape into the future to think it'll be better then. Oh my God, I've spent years thinking it'll be better then, when my body is smaller - I would escape in the future all the time. I don't do that anymore. My life is beautiful because I am so fucking kind to myself. And when I am this kind to myself, somehow the world is just way less hostile. And it doesn't mean there's not still a ton of unknowns; I'm just not afraid of the unknown anymore. Louise: You're amazing. That everything you just said is just brilliant - so inspiring. No matter what, just keep doing what you're doing, because you are like your art. You're just like glowing. It's amazing. Kathryn: Thank you. And the thing that I kind of want to reiterate is like, I know I can speak eloquently about some of these things. I am very human too, right? There's the both end. But if I can come to this state of being, that means it's available, like the amount of freedom that I get to live in. I realized a long time ago that I kind of wanted to be of service to the world in some way, you know, I was in vocational ministry, and the world who I was a part of really made perpetuate to this savior complex. And then I had religious trauma and I had like childhood trauma and I was definitely someone who was codependent for a lot of years, was codependent in my relationship with my spouse. And I feel like I've lived a very normal life, but I've started to taste freedom, and then the freedom just brought more freedom. And then that freedom brought even greater freedom. And so, I would very much like to say that existing as I am in the world now, it feels like it's accessible to people. Like being alive and free in the body inhabit might convince someone else that, oh my God, what if I could be more free too? And now I no longer feel like it's my job to save anyone. It's just not. Like, I really trust people on their journey. I trust you to follow your own curiosity and see what path that takes you on. But I being free in the world, I think perpetuates the idea that freedom is available to all of us. Louise: Yeah. And I think that's why it's so lovely to speak to you, and to know that this conversation gets the listen to by so many people. I think this part like of like finding that freedom through self-compassion, connected to your body specifically and inhabiting - I think that's really tough for a lot of people, and that's a bit that we can get stuck on. Like, we can kind of talk about I love fat liberation, and I love haze, and I love anti-diet, but I still don't feel okay in my body. Like I still can't really accept it, let alone inhabit it, let alone feel freedom in it, let alone expand. What you're talking about is I guess, perseverance with that compassion until it doesn't feel like an innate trick, but it feels like it's the portal and then you just sort of go down and inhabit. Kathryn: Yeah. And our brains do change, right? So, like it's the default. It wasn't always, it took some time and I didn't make myself do it. Like, this was really born out of when I realized I was only going to do what I wanted to do. And so, my meditative practice is really like when I'm laying my bed, I'll just take some deep breaths and I'll let my brain just sort of wander. I don't like any kind of dogma or high structure at all. Some of that might be PhD, but also I spent decades in a lot of fundamentalism and so there was so much dogma. So, this is me sort of pushing all the way to the other extreme and it has served me. And I think the big message for anyone who's listening would be like, find out what serves you by following your curiosity and what you actually want. Sometimes we don't even know what we want because we're not embodied enough. But then you can try this little fun game of like think of something that you might want and then see how it feels in your body. Does it feel expansive? When you take a breath, do you feel like room or does it feel tight? And so, then we start to ask our body questions. Our body has our own individual truth. It really, really does. And what happens is you start to check in with your body more and more. Then you are sort of guided in your life. Eventually, it's not something you have to think about; it just happens. And then you will lead yourself to whatever is your best life. Louise: That is so cool. It's like the difference between thinking and knowing in your body, it's that language of knowing in your body or not the language, but it's that experience of knowing in your body that when [unclear52:02]. That is a cool trick. Kathryn: Yeah. They live in concert now, you know, so like our brains have been very subject to conditional cultural programming. Our brains are really susceptible to that because human beings want to belong and society tells you, these are the things you got to do to belong. And so you want to belong so you conform, right? And then when you are not in relationship with your body, again, that's why anti-fatness is such a destructive force because it separates us from our body, and it makes controlling your body the objective, and your body is not to be controlled. It's just to be loved and enjoyed and to be honored. So yeah, I think there's a lot of different ways we can just very gently, it doesn't have to happen overnight, but just a little to check in, like you just happen to be eating a meal and you just realize, oh, I'm going to take some deep breaths. I'm going to breathe really deep into my belly. And I'm going to experience this one bite of food and just relish every bit of pleasure. I'm going to feel it go down into my body. And then you you'll start to see you'll just do that a little bit more and more, and you can heal the relationship with your body by just actively engaging with it a little bit more and a little bit more until it becomes something you do without thinking Louise: So lovely. And all of that is stuff that we're not encouraged to do. Even a belly breath - oh gosh. You know, don't let your stomach pop out. Eating and feeling pleasure, like honestly, pleasure and eating is not something we even like - it's not on the radar. These things are radical, but so simple. And what is it that Dana and Hilary talk about body trust is our birthright. Kathryn: It is. It is our birthright. And you know, most of us have been around small children, they do not feel self-conscious in their bodies. Someone told me that they were having Thanksgiving dinner with a three year old. They were sitting next to the three year old and the three year old was going, "Mm mm." And so they were laughing about how, like, it almost sounded like orgasmic sounds from this toddler who hasn't been socially conditioned yet. And hopefully they get to live without that other stuff limiting their experience in the world. Louise: I'll [unclear54:13], right? Kathryn: Yeah, exactly. So as a parent myself, that's the thing I teach my kids more than anything is bodily autonomy and to make decisions based on what feels right to them in their body. That feels like the best gift I can give them. Louise: I couldn't agree more. And that connects to so many other experiences. Kathryn: It really does. Louise: Yeah. What a terrific conversation. I'm so grateful for you to come on and talk to me about all of this today, and I'm going to continue buying your work. Kathryn: Thank you. It's been such a pleasure for letting me share, and I really, really love talking about these things and thank you for getting up early so that the timing worked and all of that. Thank you for reaching out and finding me. I'm really delighted. Louise: Ah, right back at you. Thank you. Outro: What did I tell you? Is this an incredible interview and an amazing individual or what? I tell you what I could not stop thinking about that conversation for days afterwards. Kathryn's experience and way of expressing everything through their art, it's just mind blowing. So look, I'm a bit spent, I'm sure you are too. I feel little part of me feels like lighting up a cigarette and just laying back and just enjoying the after glow of that conversation. Thank you so much, Kathryn, for coming on and blowing all of our minds at a time when we really, really need some awesomeness. Thank you so much for delivering. If you like me are fascinated and a bit blown away by everything Kathryn-related, look at their Instagram, which is fat_mystic_art, and go to the Etsy shop and buy everything, which is kind of what I want to do as well. The Etsy shop is Fatmystic, and there's just so much terrific stuff there. Thank you everybody, and thank you, Kathryn. Look, we're going to sign off now and into the end of the year we go. Be very, very careful everyone, because like I said, it's diet culture high season, the weight loss wolves are after us. Remember that your body is awesome, magical, mystical and not something to feel ashamed about. There's just so much awesomeness sitting right here right now. Okay, so look everyone, I hope you take really, really good care of yourselves and I hope that there's some kind of break coming for most of us. I know I'm going to have a rest. I'm going to be back and absolutely raring to go early next year. We've got some, like I said, some really cool news and big news coming, but this All Fired Up podcast is going nowhere. You're going to be hearing from me a lot. I'm very, very pumped and excited. So look, look after yourself, everyone. And I'll see you in the new year. In the meantime, trust your body, think critically, push back against diet culture. Untrap from the crap!

In diet culture it's hard for most of us to feel comfortable in our bodies, let alone LIKE them. But what if it's possible to burst through this thin-ideal bubble and experience the joy, the light, the MAGIC of our bodies? My guest this week, artist and speaker Kathryn Max, has done just that, and you simply MUST hear their story! Kathryn's art is a powerful expression of tenderness, compassion & unconditional body acceptance. It's so beautiful - let's get all fired up with LOVE! Show Transcript Intro: Welcome to All Fired Up. I'm Louise your host, and this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal getting your knickers in a twist? Does fitspo make you want to SPITspo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. Welcome back to the podcast my delicious diet culture dropouts. Thank you so much for tuning in for yet another intriguing, deep dive down the anti-diet rabbit hole. I want to start with huge love to you all and thank you for continuing to listen and support this podcast, which as you know, is completely produced and put out by me on my lonesome, alongside a whole lot of editing. And I really appreciate your messages of love and support, especially during this year where things have become pretty rocky with getting the podcast out in a predictable way, I'm really pumped about 2022, and I've got big things of what I can't wait to share with you next year. But in the meantime, I really appreciate your listening. And if you love the All Fired Up podcast, help get the message out there by rating and reviewing. A five star review is always good, wherever you get your podcasts or preferably maybe with apple podcasts, because I'm really trying to target that. The more this message gets out, the more likely it is that diet culture falls onto its knees and I can go off and become a florist like I've always wanted. And if something about diet culture is pissing you off, let's get it off your chest, send it to me. Send your rage straight into my inbox - louise@untrapped.com.au. Tell me what's bugging you. It could be something that happening in your local community, could be a diet that's getting pushed in your social media or just something that you've heard around the traps that's really getting up your nose about living in diet culture. I want to hear it. I'm your agony aunt for all things diet, so send that to my email address. Free stuff, alert who doesn't love stuff that's for free. I have amazing E-Book called Everything you've Been Told About Weight Loss is Bull Shit, and that was co-written with the glorious Dr. Fiona Willer, dietician and amazing podcaster from the Unpacking Weight Science podcast. In this classic resource, we have stuff that's full of fun facts to help you push back against diet culture's bullshit. Essentially, we bust top 10 myths about the relationship between weight and health. And we give you heaps of scientific articles and resources and overviews, giving you the truth about the relationship between weight and health and just how much bullshit is being fed to us. It's an excellent resource. It's completely free. You can download it from the Untrapped website, untrapped.com.au. I encourage you, if you haven't already got a copy, to grab it and share as far and wide as possible; friends, family, health professionals, everyone needs to hear this message. More free stuff. If you have been living in diet culture and you find that you have found it difficult to be at ease in your body - ie. if you're a human living in diet culture, this eCourse called Befriending your Body is completely free. It's created by me and in it I send you an email once a day for 10 days. And it's like a little love letter to you every day for 10 days, giving you some small messages of self-compassion and practices of self-compassion, which are all designed to help you start looking at your body through a different lens, through the lens of compassion, support, friendship, appreciation, respect, and liberation. The befriending your Body eCourse is really easy, it doesn't take too much time out of your day, and as I said, it's completely free. So if you're tired of struggling and you're looking for something completely different and something pretty urgent; this can be with you in seconds. All you need to do to download the Befriending your Body eCourse is go to my Insta, which is untrapped_au and click on the link in the bio and you will see the Befriending your Body eCourse sitting there waiting to befriend you. Huge hello and big love to everyone in the Untrapped online community. Without Untrapped this podcast wouldn't be able to be produced. Untrapped is an online masterclass in the art of everything anti-diet. And it was co-created by me and 11 other health professionals working in this space. It's an incredible program. Very comprehensive, all online so you can do it at your own pace. And in it, we go through all kinds of stuff like recognizing and waking up from die-culture bull shit, reconnecting in with your body signals and repairing your relationship with food, with your body and with moving your body joyful ways. One of my favorite aspects of the Untrapped masterclass is the online community that we've created. We've been running since 2017. Can you believe it? And we have built up this incredible group of people we meet every week in a Q and A, and we've completely bonded. And I think most of the power of Untrapped is in this community. So if you are looking for a change and if you don't want to do it on your own, think about joining us in Untrapped. You can find out more from looking at untrapped.com.au and we would absolutely love to have you. So, on with the show, my guest this week, oh my gosh. I mean, this is a completely mind-blowing episode that I hope that you've got somewhere nice to relax and really take some time to absorb the awesomeness of what you're about to hear. So look, it's Christmas time, diet culture bull shit, no matter where you live on the planet, it's at an all time high at this time of year, the pressure is on. It is high season for the weight loss industry. And look, we are all feeling a little bit more fragile than usual, thanks to the ongoing bull shit of this year and living with this COVID pandemic. So it's been a complete mind-fuck, and look, you know, you all know how much I love to rant and complain about diet culture, but I think we need a bit of love, and that's what this episode is all about. In this Christmas season, let's pivot into something completely different. So my guess this week, Kathryn, formally Kathryn Hack, now known as Kathryn, or you might know her on Instagram as fat_mystic_art or Fat Mystic. This is an amazing human. Kathryn is a fat liberated artist and speaker, and they, sorry. And they are the pronouns. They have many intersecting identities including being fat, queer, disabled, poly, ADHD, lipedema and ex-evangelical. Are you fascinated? Because I certainly was completely fascinated by this human, when I saw their art in their Instagram feed. It took my breath away and like kind of hit me in many areas as you're going to hear about in our conversation. So, I really don't have more words and I don't want to give anything away, but I think your mind will be blown by this amazing episode interview individual. So without further ado, I give you me and the glorious Kathryn. Louise: So Kathryn, thank you so much for coming on the show. Kathryn: I'm very happy to be here, Louise. Thank you for having me. Louise: So tell me what's firing you up. Kathryn: Well, interestingly, I would say that being fired up, hasn't really been my lived experience recently with whether it's diet culture or any kind of oppressive systems. They definitely can feel discouraging, but I have a really deep practice of self-compassion. And what I have observed is that the more I live in a state of grace with myself, the more I am kind and consistently really gentle with myself, it's almost effortless for me to extend that kind of grace and compassion to other people while also having good boundaries. So I don't let people mistreat me because I live in a fat body or disabled body or because I'm queer or any of the identities that I live within. And yet, I don't feel fire about it. I don't feel anger exactly. I feel yeah, real contentment and peace and this journey and where it's brought me. And I feel a lot of joy in my life and the grace to handle the challenges that come in living in the body I live in. Louise: My goodness. Okay, everyone wants to know what cocktail is this self-compassion. This is so interesting. So you said you've got a really deep practice of self-compassion and that's what got you to this place of not being unimpacted, but not being affected in a negative way. Kathryn: And I think sometimes I might still be affected, but it's just that self-compassion is such an effective tool, that even if something does impact me negatively, I'm able to be present with that emotion with a deep resource of compassion and care, and so it just doesn't damage me. Like, I'll sort of let this emotion move through me. I'll feel it. I won't deny it. I won't suppress it. I definitely don't shove it down in my body like I used to. I just feel it, I'm present with it and then it sort of moves through. So the deep practice started a little while after I was first introduced to the fat liberation movement. It was intellectual information to me that, oh wow, some people are living in fat bodies and they're like, yeah, I'm fat, so what? And I was like, whoa, that was a revolutionary idea to me. I've lived in a fat body since puberty and I felt shame about it my whole life. Around the same time that I learned about fat liberation, I was also diagnosed with a chronic illness. The name of my chronic illness is lipedema. It's progressive, there's no cure for it, and it contributes to the size and shape of my body. It's understood to be a fat disorder, and it happens to accelerate during major hormonal changes. So most humans who have this experience, they see the onset around puberty. And then during childbearing years, during pregnancy specifically, there can be significant advancements, and then again around menopause. My experience was that I lived in a smaller but fat body for most of my life. And then after I had two kids, about 21 months apart, my body really changed radically. It impacted my mobility, I took up a lot more space in the world. And for the first several years, there was an incredible amount of shame there. Louise: I guess that built on the shame from puberty, you said like it had been there anyway. When were you diagnosed with lipedema? Kathryn: I was diagnosed in 2016. Louise: Okay, so that's fairly recent. Kathryn: It is actually. And that's kind of a fascinating thing. Like, I talk a lot on my art page about how much my life has changed, thanks to reconnect with my body and healing my relationship with my body. I would say that self-compassion is what helped do that. So first it was sort of the information, like there's humans out there and these brilliant activists that are brilliant feminist thinkers and like helping me to get new information about whether or not I'm allowed to exist as I am. I also want to say that humans in the disability justice movements are just so brilliant in how they articulate that dignity is not condition and ought not be. So, that was all really, really helpful information. And then what happened is I was able to apply the information by compassion, you know, like learning how to just sit with myself and feel my feelings and validate them and then genuinely out loud saying to myself, like "Kathryn, I'm so sorry." And then I'd be really specific; "I'm so sorry you don't deserve love because of the body you live in." And intellectually, I knew that sentence wasn't accurate, but in my body it felt true somewhere. And so, I would just acknowledge these things that were sort of limiting beliefs. And it was a limiting belief. I absolutely am worthy of love in the body I inhabit. And as I started to offer that specific lie, compassion and heal the pain that it caused, I suddenly was in relationships where I felt really loved and seen and valued and desired, and so it changed literally everything living in my body. Louise: How did you learn about self-compassion? Kathryn: Well, you know, it's interesting; it really first started with, with my body. So learning about fat liberation, I was reading everything I could get my hands on. And then also, I just am a very spiritually curious person. I spent most of my life inside Christian theologies. I was an ordained pastor for about a decade. And then I left that worldview because it was more and more confining, and I started to feel - even though I had sort of these incredible spiritual experiences, what I would now say is I think that divine doesn't care about dogma. I feel like the divine is willing to engage with us no matter where we are. And it really, really doesn't care about any dogma that we may bring into our desire to connect with whatever is out there, so as a Christian, and I was a Pentecostal Evangelical Fundamentalist Christian. Louise: Wow. Kathryn: Yeah, that's a mouthful, but yeah. And it's really rigid thinking, but also there's this Pentecostal element that is very metaphysical. There are a lot of interesting experiences. Things like speaking in tongues or getting sling in the spirit. And I had had an incredible experience after experience, after experience of feeling a sensation of being completely loved and accepted by what I would now call is just the divine or the universe, that something benevolent that loves me exists. And now I would even say like I'm part of it, like we're all sort of connected as consciousness, you know? I'm still very spiritual and I like to refer to myself as a Woo-Woo Bitch these days. Are we allowed to swear on this podcast? Louise: We encourage swearing on this podcast. Absolutely. Kathryn: That makes me happy. That was one of the first things that showed up when I stopped being a fundamentalist is I was aware of how much I had edited my language. And now swearing is my fucking favorite thing to do. Louise: It's my fucking favorite thing to do too. It's expressive. Kathryn: It is, and it feels freeing to me. So my body started to slow down kind of dramatically. I had had this outpatient surgery that was supposed to be a quick in and out kind of thing. And I had an incision rip and it meant that I was like literally in bed for about six or eight weeks. And then I finally am better enough that I can move around a bit, and then I immediately get vertigo. And it fascinating because in that particular window, I felt like my body was saying, "Kathryn, we're going to sit you the fuck down. We've got something to tell you." And it was an incredibly powerful time in my life where I stopped limiting my spiritual curiosity to what was sort of acceptable within Christian circles. And by that point, I was already no longer a fundamentalist, but I was still attending like a more liberal-minded Christian Church. And the person I was married to was a pre-devout kind of more liberal Christian. But I knew that Christianity was really important to them and our marriage. And it turned out if I allowed my evolution to take me beyond Christianity, that that relationship would end, and that is what ended up happening. But my body working so I could stop participating in culture, really. And I had two small kids, it was a really strange time. They had just kind of fend for themselves a bit more than their peers, because I just couldn't function. And my brain was like - my spirit, my brain, whichever was just curious. And we have like this amazing technology and our hands, and so I just was following my curiosity. Eventually, I mean, it took me lots of places. Like I did a little time of like, oh, I'm curious about tarot cards. And so I looked into that and then I was like, oh, I want to learn about like all of our chakras, and I even bought some like stones to like, you know. I took one of the online quizzes that talked about like, which one of my chakras needs more attention, you know, that's my clothes, I need to work on that. And so it was like a game. It was like fun. It was just following my curiosity. And in that space where I was just following anything that was shiny, I was reading more and more about self-compassion. And there was this very specific practice that I had read about and learned about that I started doing and telling my friends about and it was this thing where you literally say out loud to yourself, I'm so sorry. And then you be as specific as you can about the belief, even though intellectually, you know it may not true, but the painful thought and you just say, I'm so sorry, and you just hold space for yourself. And I don't know how it works, except that it does work and it just shifted those painful things. They just were allowed to move through me. Louise: Yeah. I love that because you're bringing like mindful kindness to the beliefs and thoughts that are happen in the moment, so I'm so sorry that you just thought, oh, I'm so disgusting. Kathryn: Yeah. Louise: And so you're pausing, you're not letting it kind of just sink in, and you're apologizing to yourself - so powerful. Kathryn: And it's really been the most affected, I would say, on the old beliefs that have sort of been sneaky. We've been very programmed by the cultures we grew up in. That's why fat phobia is so rampant, you know, anti-fat is everywhere. It it's like a global phenomenon that fatness is bad. That's kind of fascinating. What the hell? Louise: The world is wrong and fat is bad. Kathryn: Yeah. But actually, and I think that's so interesting, and one of the things I really love about the fat community is that we are an international global group of humans, that are going to push back on this really stupid presumption that our bodies are wrong. And I don't know, it creates this really interesting energy of when you choose your own inner knowledge over the projected information. It is powerful. It's an empowering transition. And so, you turn the volume up of your own inner space, above the chatter of culture and you start to realize, you can do whatever the fuck you want. You can have whatever. Louise: You can wear what you want, you can have sex, you can enjoy hell out of yourself. Kathryn: It's all of it. Absolutely. Louise: For how long has life felt like that for you? Kathryn: It just keeps getting better and better and better. So, when I was experiencing that period of time where I was recovering from surgery and then ended up with vertigo, that was like, it felt like explosions, like my body expanded and my brain and my spirit was expanding. And I'd had this sort of metaphysical experience where I had this profound sensation that my physical body that was inhabiting was an allegory to this spirit size I was meant to embody in this. And I don't actually even talk about that that much, but it was huge in shifting my thinking about like whether or not my body was allowed. And not only is it allowed, it's powerful. When people see me, it's not hard to see that I am also quite free, but I live in a body that we're used to people seeing shame. Walk around in bodies like mine and they there's just shame. I's hard not to, because of how much conditioning we've been taught about fat, but I just don't have that. I don't have that energy. And so, people interact with me and I'm not easy to forget. Louise: Do people just not know what to do with you if you don't kind of obey that is not expected shame. Kathryn: I don't know if they... I'm not having those kinds of conversations with strangers. The humans are that are close to me, like they just see me. I'm a full human person. I do have this deep spiritual practice, but like I have hard days too and I have sad days and I reach out for support when I need it. I get frustrated with my kids and I complain about that. So yeah, it's just the humans that are in my life really see me. And then when I'm out in the world, I just don't live. I just am not anticipating. I remember living in a way where I anticipated hostility for the body I lived in and I felt hostility. Now I just don't anticipate hostility directed towards me. It just doesn't occur to me anymore. I don't know how, except that it was all this self-compassion, but this very dramatic shift is, can move through the world and I'm not anticipating hostility. I just assume that I get to be treated with the amount of dignity and love and care that I treat myself with. And if that doesn't happen to be the case where someone doesn't treat me the way I want to or expect to be treated, it just doesn't wreck me like it would've before. It just is like, oh, that's an anomaly. Like, I'm sorry, that person, they must be having a rough time. Like, how sad that they would feel the need to project their shit onto me. It's very clear to me that that's theirs. It's not shit my. I'm good. Louise: Oh, that's it, right? Because the self-compassion has kind of sunk in and made you kind of unstoppable. Kathryn: And what's funny is like unstoppable how, because I have a lot of limitations living in my body. I have a lot of limitations moving through the world. Like, my body doesn't fit in most public seating. I've had to do the both end of doing this internal work of, I know that I'm allowed to exist in the world with full dignity and I'm also someone ADHD, and so sometimes I have low executive functioning. Which means, I can be overwhelmed with the amount of extra labor that's required for me to like, make sure that that restaurant I want to go to with my friends is going to have seating that's going to work for my body. And so, I've been able to like my circle of friends and people I date, I've been able to invite them into this sort of tender space of, hey, would you actually help do some of the labor here? And I was pretty tentative about it at first because it felt really vulnerable, and they were so happy to. They were just so happy to. They were like, "That is okay Kathryn, we love your presence in our life. And of course, we're going to try to streamline this and make it less hard for you. You shouldn't have to work this hard, just go out and be in the world." Yeah, and so it is the both end. Both things are at once; I am unstoppable and this world is still not built for, to welcome a body like mine, I have to do in a lot of extra labor. Louise: Which is terrifically difficult, but how nice that you can like share this with friends who will then go out and advocate and take care of everything alongside you; you don't have to do it on your own. Kathryn: Yeah. It's a really beautiful thing. I think the work of getting free and liberation is an internal spiritual work. And then what happens is we get to see it lived out in human relationships because we are social creatures and it's got to be the both end. We're not meant to be alone, most of us aren't. And so, yeah, and then that was just a really - that took some compassion too. It was very tender when I first started saying out loud to my circles, like I want to be out in the world a little more and I'm noticing I'm saying no to invitations because it will be too hard. And then I'm like, oh, actually I can ask for help. Turns out, asking for help is its own kind of superpower. And culturally again, especially in Western cultures, we have been taught not to do that. Louise: Yeah. Don't impose on people, don't have needs, don't... that's terrific. Out of interest, who were the fat liberation people that you read for inspiration? Who your community now that you...? Kathryn: Let's see. So Sonya Renee Taylor's work was really impactful to me and the book, The Body's not an Apology. I really liked what I read from the author who wrote Shrill and now Lindsay-Anne Baker, The Will author. I can't remember her first name. Louise: I can't remember it either. Kathryn: Yeah. And then I just started following like the hashtags on Instagram. Instagram was really helpful in my evolution as well, because I love how you can just follow hashtags, like disability justice and fat liberation, haze, so all of that was really impactful. So it became like this big, beautiful soup of just taking in everything that was sort of out there and allowing it to change how I thought about things. Louise: I love that; a big, beautiful soup, because Instagram can also be like a treacherous shark infested ocean. Kathryn: The thing is like curating our feed too. I mean, it can be. But I think that internet has served me so well because social media is can reflect back to us our own energy sometimes. And whatever you're drawn to are attracted to you, you can unfollow and start following the stuff that makes you actually feel good, so it doesn't have to be that. It doesn't have to be that. Louise: No, I love my little haze bubble that I have on Insta and social media, speaking of which that's how I found you. Because I think I was scrolling through Being Nourished, their feed, Hilary and Dana and I saw this amazing picture of lady and it was just lit up with flowers and it was glowing, like literally like no shit glowing. And I was like, I just stopped. And I'm like, that is the most beautiful thing I've ever seen. So since then, I was trying to find it and I couldn't find out anywhere. And then I found you and looked through your feed and your art and it was like how I think self-compassion looks like in art. I can't explain it very well, but it's like it moved me in my body. It was so beautiful see. And that's why I kind of tracked you down and finally found the beautiful painting, which is going to be up in my new office. Which ironically the new office is called Flourish at [unclear27:54]. Kathryn: Wow. Louise: And then the idea is that it's a big, beautiful like greenhouse full of plants and growth and beginning for people. And so, I wanted to feel it full of like art that showed that. That painting that I had seen is called Flourishing, so I can't wait to put it up there. I just want to talk about your art because it's just like a mind bogglingly awesome. How long have you been doing it? Kathryn: Not that long. I started really making body art, figurative art in 2018. I was sort of dabbling in 2017. I was sort of experimenting. I was 38. I'm 44, almost 44 now, but I was 38 before I could even call myself an artist. It just was things were, again, we have these limiting ideas sometimes. Like the idea that I was an artist felt so gatekeepy, like I wasn't fancy, I'm just up hot. Yeah, so I was 38 and I was like, oh my God, I've been calling myself crafty my whole life. But like the truth is, is that I am an artist. And then when, like I said, I describe how in the same window of time I had this lipedema diagnosis, this chronic illness and there's no cure, so my body will continue to evolve. And then they're just like, by the way, all of our bodies are continuing to evolve. We're in a constant change. And then fat liberation, that I was allowed to take space and have the body I lived in and I needed a way to marry these two ideas just to make peace with the fact that this is a reality of my life. My body is going to stay this way and progress. So up until that point, I just constantly was believing that like someday I would lose all the weight, you know, like most of us think, you know? So I had to decide, nope, if that never happens for me, I'm going to live my best life. So making art was the bridge and it was like, I wanted to see myself depicted beautifully in art and media, and so I just started playing around with it. And it's interesting because you know, you referenced the image flourishing and you said painting, it's actually not really a painting. It's digital. Louise: It's digital. I have no idea when it comes. Kathryn: We have these iPhones, and there's all these apps on there. I literally make all this art on my phone. Sometimes I like the aesthetic of mixed media, and so sometimes I'll do like mixed media art, like an abstract sort of thing. And then I can like take a photo of it and I can layer it into a silhouette. But yeah, we have all this software now where you can just like take a photo and then like strip away everything that's not the silhouette, and then I can layer and layer and layer. I can create a background, I can do all these things. I can just pull an image in and out of like 16 different phone apps, you know? And it was just plates. Something I can do while laying down and it doesn't require any art supplies that my kids are going to make a fucking mess out of. Louise: That is exciting. Kathryn: And it really helped me get into a state of flow where I could be like listening to an audio book and then like playing on my phone, making something beautiful. Here's the other interesting thing is that, in like summer of 2018, I started my Instagram and I was like, I'm going to make new art every day. I'm going to post something every single day, and I did that for six months straight. And there is really something powerful about adding creativity to whatever our work is. Like, what are you working on in your life human? Like, what's the thing that is asking for your attention, right? Is it body issue stuff, then find a creative outlet for that. It could be poetry. It could be writing short stories. It can be visual arts. It could be clay. I have this sculpture of myself that I made with, oh, I wonder if I can remember their name. There's this other, like the activist who I think is from Australia, actually. Louise: Yes, yes. And my God, what is happening to my brain? It's 6:00 AM. Ashley Bennett. It's Ashley Bennett from at bodyimage_therapist. Kathryn: She's delightful, and it was really fun to go to her class in San Francisco. And a bunch to us were in there with clay molding our own forms. And it was powerful to lovingly touch this clay, to like fill in where all of these fat roles are, you know, the volume of my big belly. It was just powerful. So whatever creative outlet attracted to, adding creativity to whatever your work is, somehow I think unleashes huge amounts of energy. It just opens us up in ways that I don't think just thinking about things could ever. Louise: I think you've nailed it. You're regularly visiting that place and reinforcing it, but just sort of intuitively finding this way of doing it. It shines out of it. I don't think I've seen art before, which embodies self-compassion, this stuff that you've done, I just love it. And I love how you've paired it with compassionate phrases, like be gentle with you. Kathryn: Yeah. Louise: And I love fat-trans queer loved, just full of love. It's too just incredible. And I particularly, yeah, I'll just keep blushing if I keep looking. I just encourage everyone to go and look at it. So this is really like a love story of you and your body. Kathryn: Well, okay. So maybe, right. My relationship, my body meant that my spiritual worldview shifted a great deal. How I interact with the world around me changed. It also meant that I ended a long term marriage that wasn't exactly a terrible marriage or anything, it's just we didn't resonate with each other anymore. I was no longer a Christian, that was really important to him. And as soon as I knew that that marriage was over, I was like, oh my God, I'm queer. Of course, I am. How did I not know that? You know? And so I spent so many decades in purity culture, I just was prohibited from exploring my own sexuality. And so, one of the things about being a late bloomer is the temptation to feel like a I've missed out on a lot of stuff. And again, like I felt all those feelings. I gave myself a lot of compassion. It would've been amazing to be having lots of gay sex when I was in my twenties, but that wasn't my experience. And so the cool thing is, is that I get to be a sexual being today in the body that I have, but as also as a person who's incredibly self-aware who is great communication skills, who is emotionally intelligent. And so, I'm navigating dating almost as if I'm a preteen or a teenager, but also I have all of this wealth of internal self-knowledge and self-compassion. Louise: So that's good make it like much more enjoyable than usual teen experiences. Kathryn: I'm having a fucking blast, yeah. And not that every date I go on is amazing. A lot of them are amazing. I'm also very interested in nontraditional relationship models, so I'm practicing solo polyamory. Another interesting thing to read about is something called relationship anarchy, which is just brilliant. It's just asking us to challenge all of these beliefs about what relationships are supposed to be and gender roles and like expectations we might have on a dynamic with another person. You actually get to invent that; you and that person get to make that up as you go, it gets to serve both of you, and it can be like anything you want it to be. I love that. I love the freedom of turning everything on its head. There's no external expectations on what my relationship with any one person needs to be. I get to decide that. They get to decide that with me. So yeah. Right out of the gate, you know, I came out as queer during the pandemic and then once enough of us were vaccinated, I'm out here dating, dating a lot. I'm having a good time. Louise: It's not easy to date in a pandemic. Wow, this is all so new. You're riding the wave. Kathryn: I'm riding this very big wave. Also one of the things that I've learned is that scarcity is a capitalist construct, and it fucks us up pretty bad, but we apply scarcity to everything. We definitely apply it to dating and it just doesn't feel true anymore. Like, people are coming out to the fucking woodwork to be like, hey, how you doing, can we date? And I'm like, yeah, let's go on date. Me and the body I inhabit, I'm a desired person that feels amazing. That feels amazing. Louise: Wow. That is the power of not limiting yourself. And that's the other kind of word that came to mind looking at your art is abundance. Kathryn: Yeah. Yeah. It feels so much better to live in this space. And I want to be really careful to say, it's not that I am in an elated state of being constantly. I really do have access to this like really high, high frequency sensation of joy and pleasure and abundance. But also, I still am inhabiting a human body that has chronic pain, that experiences big fatigue. I've had relationships end in a way that really hurt my feelings. And I've been afraid of things here and there too, you know? And so, it's just that in those times now I don't judge myself harshly. I can experience very, very big fatigue and just decide that everything I wanted to get done that day isn't going to get done and I'll go home and I will just rest and do whatever I need to do to get through that particular window. Louise: What would you offer yourself then? How do you stay compassionate in a moment like that? Kathryn: Well, what's interesting is that that's taken a while because I remember even just, I don't know, eight months ago I would have a fatigue spell and sometimes they would last up to like five days where it was just super hard to function for days. And the first day or two, I could be like, that's all right, I'm just going to roll with it. And then if it went on beyond that, it would start to feel scary because our brains have a tendency to be like, oh my God, this is my life now. And what I started to see though, was on the other side of a hard window, I felt more free somehow. And I don't know how to explain that. Sometimes we go through a hard time and then coming up out of it, there's just some kind of lift. And that had happened enough times that I started to trust it. So several weeks ago I had a rough spell and I didn't have that panic feeling. I just remembered like, oh, I've been through this before, like on the other side, I'm just going to feel more powerful. So in the time while I'm experiencing it, while I feel like really low energy, I just lay down as I needed to. My body is like, this is what's going to happen, this is how much rest we need and stop trying to qualify it. Like, I feel like I rest more than any human I've ever met, and I'm like, what? Really? More? How much more could I need? And my body's like, it doesn't need to be qualified like that. Like it's not about comparing it to other people, like you're going to need to lay down and rest somewhere. And so then I just keep myself occupied by listening to audio books or playing on my phone or meditating or whatever I want to do. That's a really powerful thing too. I stopped doing things that I was supposed to do. I literally only do what I want to do. Louise: I love this. Kathryn: There's some amount of privilege that comes with that. Like I'm separated, so I don't have to live with my ex anymore, but I was a stay-at-home parent before. And so, with child support and whatnot, I still get to like live as a stay-at-home parent and I have my art that I do and other things occupy my day and my time. I'm not needing to work 40 hours a week in order to live in the world, so I recognize that as a great privilege I get to have. But that being said, I still think being free on the inside is what's making me free. You know what I mean? Louise: Yeah, much more. I remember being at one of Hilary and Dana's retreats in 2016 and talking about how like... it was for embodiment, to be an embodied practitioner. About trying to get out of like the crowded city of our brain and down into the wilderness of our body - uncharted territory. And I remember us talking about that's where the freedom is, it's down there and it's not verbal, it's sort of felt. Kathryn: Yeah. And I would say that - like I said, I've been explaining who I am as a person, as someone who's quite spiritual, and that's true. But what I started to see is that in some spiritual communities, they would talk down about the body. They would say like, oh, this meat sack that we're in, you know, like your body is not who you really are, you are not your body. And I don't agree with that at all. I think our bodies are fucking magic. They hold so much intense wisdom. They will talk to us and teach us things. Our bodies have held all of our trauma our whole lives; just held it, just waiting for us to be ready to look at it again. And it has only ever been kind to us. And even when it's not working well or there's pain or any of those things, it's not out to get you, it's just trying to get your attention. And when we can turn into it and listen and believe that it's our friend I feel like it's multiverses within ourselves, like unending amounts of wisdom and love and compassion all in this physical form that we inhabit. Even if you just think about DNA, like our fucking DNA is ancient. You know what I mean? There's studies that talk about how like trauma can be passed down in your DNA. Like the stories that your body has, it's way more powerful than we give it credit for often. And so when we live our lives, we're not ruled completely by our minds, but we actually get to make decisions based on how does it feel in my body when I think about doing this thing? If we literally do the things that only make our body feel like, ah, expansive and open and relaxed, oh my God, your life will change. If you're constantly doing things to your body's like, "Oh, dread, dread, I don't want to, I'm going to make myself." Nope, nope, it doesn't serve you. Louise: This is an amazing conversation. I knew this would be an amazing conversation. There's so much in everything that you are saying, and it's learning how to do that I think that's difficult for people. Because like you said, we're so kind of stuck in our heads and so scared, and often I think it's that fear response that's in our body that stops us getting down or trauma cuts us off. So it is really interesting that you come to it in your late thirties and you come to it in a moment, like when your body just sort of calls it a day almost and says, oh, lie down for a few weeks, you're going to have to just be with me. Kathryn: Yeah. There's an account. I follow on Instagram called The Nap Ministry. And I can't remember who is in charge of it, but this really powerful black woman. And I just want to say too, like as a white woman in the privilege that I embody there, like the kind of freedom that I get to live in is absolutely because of the work of black women and fems and indigenous people. Like, I'm really grateful for all the labor and the work that they've done to help kind of illuminate the path forward. So this particular person who has the Instagram, The Nap Ministry, they just blew my mind when they talked about like rest as revolution. Capitalism has really indoctrinated us with the idea that our worth is connected to our labor or our productivity. And then we live in systems that you literally can't live unless you do labor for often someone else. And that's really wrong. Human beings are not designed for that. That's a system that we all have grown up in and it's impacted how we think about ourselves. There was a time where human beings existed without having to go to work and labor in order to just stay alive. So to nap, napping being resistance to those capitalist ideas was a revolutionary idea to me. And that rest was how we honored all the people that went before us that weren't allowed to rest. And it absolutely - I really do credit my body stopping working and requiring so much rest with my ability to disconnect with these systems that control our thinking. You know what I mean? So I was out in the world less because in my bed napping more. And what that meant is I was spending more time in my own energy and the things that I was just naturally feeling curious about. And then I could follow my curiosity to the next step and the next step. In a spirit paradigm, you might say like your higher self is always going to guide you towards enlightenment if that resonates with you. But I would also say that my body had a very key role in that. My body was the one that arrested me and got my attention, my body demanded rest and I said, okay. And before I said, okay, I spent years pushing through like most of us do. You like buckle in, you like buck up, you push through and that's stupid. We don't have to do that anymore. You know what I mean? The idea that you were good because you hurt your body in order to achieve some task is really stupid. We don't have to do that anymore. We don't have to hurt ourselves anymore. We can be kind to ourselves. Rest is revolutionary. Louise: I love that. Absolutely love that. And I think especially now, you know, the last two years have been pretty shit for most people on the planet. And I don't know if this happened over there, but as we are coming out here in Australia, there's a lot of like exhaustion and a lot of anxiety coming back into, and fear of what's going to happen next step. People do need to rest more. We can get these messages, like you said, from the structures and systems that we need to kind of pull up our socks and lose the COVID kilos and, you know, whatever. And I'm finding for my clients that that kind of message like let's get back to normal, just doesn't resonate as much, is maybe we've had a bit more time to spend in reflection. Kathryn: Normal was very toxic. It really was. Normal has never been good or kind to human individuals. It has served these systems that are oppressive and that's all. And I think the pandemic forcing most of us to slow down to some degree, it means that we get to become disillusioned with how it was really shit before too. And no, not fucking going back to that. No, thank you. No, we're going to have to create something new. A lot of the kind of things that I'm listening to and reading about now is all anti-capitalist stuff. And the idea that we're in late stage capitalism is a pretty widespread idea at this point. And so, how we going to cope with that? How are we going to cope end of capitalism? Those of us who are adults now are probably, I don't know that it's going to be easy or fun. And again, that's why we have to do the internal work of like, I'm actually, okay no matter what, I'm going to be okay, and I'm going to be really fucking gentle with myself, because I don't know what the future holds. And sometimes uncertainty can be very scary. And again, we can offer ourselves compassion for that, but the truth is the more I live in a state of genuine compassion for myself, I'm very present in this exact moment and you know, that's a spiritual practice that most of us had heard about like be present, be present in it; it didn't resonate until I started to live in a state of compassion. And it's not that I'm trying to be present; I just am. I just am here. I'm just present with myself because I'm so kind to myself. I don't have to escape into the future to think it'll be better then. Oh my God, I've spent years thinking it'll be better then, when my body is smaller - I would escape in the future all the time. I don't do that anymore. My life is beautiful because I am so fucking kind to myself. And when I am this kind to myself, somehow the world is just way less hostile. And it doesn't mean there's not still a ton of unknowns; I'm just not afraid of the unknown anymore. Louise: You're amazing. That everything you just said is just brilliant - so inspiring. No matter what, just keep doing what you're doing, because you are like your art. You're just like glowing. It's amazing. Kathryn: Thank you. And the thing that I kind of want to reiterate is like, I know I can speak eloquently about some of these things. I am very human too, right? There's the both end. But if I can come to this state of being, that means it's available, like the amount of freedom that I get to live in. I realized a long time ago that I kind of wanted to be of service to the world in some way, you know, I was in vocational ministry, and the world who I was a part of really made perpetuate to this savior complex. And then I had religious trauma and I had like childhood trauma and I was definitely someone who was codependent for a lot of years, was codependent in my relationship with my spouse. And I feel like I've lived a very normal life, but I've started to taste freedom, and then the freedom just brought more freedom. And then that freedom brought even greater freedom. And so, I would very much like to say that existing as I am in the world now, it feels like it's accessible to people. Like being alive and free in the body inhabit might convince someone else that, oh my God, what if I could be more free too? And now I no longer feel like it's my job to save anyone. It's just not. Like, I really trust people on their journey. I trust you to follow your own curiosity and see what path that takes you on. But I being free in the world, I think perpetuates the idea that freedom is available to all of us. Louise: Yeah. And I think that's why it's so lovely to speak to you, and to know that this conversation gets the listen to by so many people. I think this part like of like finding that freedom through self-compassion, connected to your body specifically and inhabiting - I think that's really tough for a lot of people, and that's a bit that we can get stuck on. Like, we can kind of talk about I love fat liberation, and I love haze, and I love anti-diet, but I still don't feel okay in my body. Like I still can't really accept it, let alone inhabit it, let alone feel freedom in it, let alone expand. What you're talking about is I guess, perseverance with that compassion until it doesn't feel like an innate trick, but it feels like it's the portal and then you just sort of go down and inhabit. Kathryn: Yeah. And our brains do change, right? So, like it's the default. It wasn't always, it took some time and I didn't make myself do it. Like, this was really born out of when I realized I was only going to do what I wanted to do. And so, my meditative practice is really like when I'm laying my bed, I'll just take some deep breaths and I'll let my brain just sort of wander. I don't like any kind of dogma or high structure at all. Some of that might be PhD, but also I spent decades in a lot of fundamentalism and so there was so much dogma. So, this is me sort of pushing all the way to the other extreme and it has served me. And I think the big message for anyone who's listening would be like, find out what serves you by following your curiosity and what you actually want. Sometimes we don't even know what we want because we're not embodied enough. But then you can try this little fun game of like think of something that you might want and then see how it feels in your body. Does it feel expansive? When you take a breath, do you feel like room or does it feel tight? And so, then we start to ask our body questions. Our body has our own individual truth. It really, really does. And what happens is you start to check in with your body more and more. Then you are sort of guided in your life. Eventually, it's not something you have to think about; it just happens. And then you will lead yourself to whatever is your best life. Louise: That is so cool. It's like the difference between thinking and knowing in your body, it's that language of knowing in your body or not the language, but it's that experience of knowing in your body that when [unclear52:02]. That is a cool trick. Kathryn: Yeah. They live in concert now, you know, so like our brains have been very subject to conditional cultural programming. Our brains are really susceptible to that because human beings want to belong and society tells you, these are the things you got to do to belong. And so you want to belong so you conform, right? And then when you are not in relationship with your body, again, that's why anti-fatness is such a destructive force because it separates us from our body, and it makes controlling your body the objective, and your body is not to be controlled. It's just to be loved and enjoyed and to be honored. So yeah, I think there's a lot of different ways we can just very gently, it doesn't have to happen overnight, but just a little to check in, like you just happen to be eating a meal and you just realize, oh, I'm going to take some deep breaths. I'm going to breathe really deep into my belly. And I'm going to experience this one bite of food and just relish every bit of pleasure. I'm going to feel it go down into my body. And then you you'll start to see you'll just do that a little bit more and more, and you can heal the relationship with your body by just actively engaging with it a little bit more and a little bit more until it becomes something you do without thinking Louise: So lovely. And all of that is stuff that we're not encouraged to do. Even a belly breath - oh gosh. You know, don't let your stomach pop out. Eating and feeling pleasure, like honestly, pleasure and eating is not something we even like - it's not on the radar. These things are radical, but so simple. And what is it that Dana and Hilary talk about body trust is our birthright. Kathryn: It is. It is our birthright. And you know, most of us have been around small children, they do not feel self-conscious in their bodies. Someone told me that they were having Thanksgiving dinner with a three year old. They were sitting next to the three year old and the three year old was going, "Mm mm." And so they were laughing about how, like, it almost sounded like orgasmic sounds from this toddler who hasn't been socially conditioned yet. And hopefully they get to live without that other stuff limiting their experience in the world. Louise: I'll [unclear54:13], right? Kathryn: Yeah, exactly. So as a parent myself, that's the thing I teach my kids more than anything is bodily autonomy and to make decisions based on what feels right to them in their body. That feels like the best gift I can give them. Louise: I couldn't agree more. And that connects to so many other experiences. Kathryn: It really does. Louise: Yeah. What a terrific conversation. I'm so grateful for you to come on and talk to me about all of this today, and I'm going to continue buying your work. Kathryn: Thank you. It's been such a pleasure for letting me share, and I really, really love talking about these things and thank you for getting up early so that the timing worked and all of that. Thank you for reaching out and finding me. I'm really delighted. Louise: Ah, right back at you. Thank you. Outro: What did I tell you? Is this an incredible interview and an amazing individual or what? I tell you what I could not stop thinking about that conversation for days afterwards. Kathryn's experience and way of expressing everything through their art, it's just mind blowing. So look, I'm a bit spent, I'm sure you are too. I feel little part of me feels like lighting up a cigarette and just laying back and just enjoying the after glow of that conversation. Thank you so much, Kathryn, for coming on and blowing all of our minds at a time when we really, really need some awesomeness. Thank you so much for delivering. If you like me are fascinated and a bit blown away by everything Kathryn-related, look at their Instagram, which is fat_mystic_art, and go to the Etsy shop and buy everything, which is kind of what I want to do as well. The Etsy shop is Fatmystic, and there's just so much terrific stuff there. Thank you everybody, and thank you, Kathryn. Look, we're going to sign off now and into the end of the year we go. Be very, very careful everyone, because like I said, it's diet culture high season, the weight loss wolves are after us. Remember that your body is awesome, magical, mystical and not something to feel ashamed about. There's just so much awesomeness sitting right here right now. Okay, so look everyone, I hope you take really, really good care of yourselves and I hope that there's some kind of break coming for most of us. I know I'm going to have a rest. I'm going to be back and absolutely raring to go early next year. We've got some, like I said, some really cool news and big news coming, but this All Fired Up podcast is going nowhere. You're going to be hearing from me a lot. I'm very, very pumped and excited. So look, look after yourself, everyone. And I'll see you in the new year. In the meantime, trust your body, think critically, push back against diet culture. Untrap from the crap!

My guest this week is the fierce and fabulous Lindley Ashline, fat-positive photographer and body liberation activist, who has literally BANNED the weight loss industry from using her stock photos. In this glorious episode, Lindley tells how she pushed back when a diet company tried to do just that! The AUDACITY of diet companies and the weight loss industry is next level, but they were no match for Lindley! Join us for a completely fired up, inspiring conversation with a woman who takes no bullshit, AND takes staggeringly awesome photos! Show Transcript Intro: Welcome to All Fired Up. I'm Louise your host, and this is the podcast where we talk all things anti-diet. Have diet culture got you in a bit of rage/ is the injustice of the beauty ideal? Getting your nickers in a twist? Does fitspo make you want to spitspo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. Hello, passionately pissed off people of diet culture. I am so excited for some episode of All Fired Up. And thank you to all of the listeners who send messages of outrage to me via email louise@untrapped.com.au. If something about diet culture is really getting your go, let me know about it, get it off your chest. And who knows, we might be able to rant about it here on All Fired Up. And if you are a listener, don't forget to subscribe, so you don't miss episodes when they pop out. And while you're at it, why not leave us a lovely five star review and rating wherever you listen to your podcast, because the more five star reviews we get, the more people listen, the quicker diet culture topples, and then I can go and become a florist. As the COVID crisis unravels, more and more people are banging on about the relationship between weight and health. And if that's really getting up your nose and you want a strong resource to help you push back against that, and you want something for free; look no further then now wonderful ebook, ‘Everything you've Been Told About Weight Loss is Bull Shit' co-written by me and the wonderful Dr. Fiona Willer, anti-diet dietician, and general all-round awesome person. In this ebook, we are busting wide open the diet culture bullshit myths about this relationship. Because when you look under the hood and scratch the surface just a tiny, tiny bit, we see that all of this BMI stuff is complete bullshit, and it's great to have a booklet in which all of the scientific evidence to support the health at every size and anti-diet approaches can be presented to people who are still upholding the greatest injustice when it comes to health. So have a look for the ebook, it's at untrapped.com.au, and a little popup will happen, and you can download it from there. Give it to all your friends and all your family. Put it in their stockings for people for Christmas, give it away, trick or treating for Halloween. Hell you know, give it away instead of Easter eggs, just get it out there to as many people as possible because just so over this groaning insistence that size is all accounts when it comes to health. If you're looking for more free stuff and you're struggling with your relationship with your body, because let's face it – who doesn't in diet culture. Have a look at the Befriending Your Body eCourse, which is completely free. You can find that on untrapped_au on Insta. In this course, basically you'll get like an email from me for 10 days. Every day for 10 days, you get a lovely little email from me talking through the wonderful skill of self-compassion, which is essentially literally learning how to become your body's best friend and become your own best friend as you wade through the of diet culture. So have a look for that course, as I said, it's on Instagram, it's completely free. What have you got to lose? Huge shout out to all of the Untrapped community. Untrapped is my online community and masterclass for all things anti-diet. Untrapped has been around since 2017. And we have built ourselves into this wonderful online group of fierce and fantastic people. If you are struggling with your relationship with food, with how you are moving, with your body, with just generally trying to get along in diet culture with all of the pressure that's heaped upon us every day and you're just absolutely sick of dieting; have a look at our Untrapped course and community because we would really love to have more people join us. You can find it at untrapped.com.au. Louise: Okay, let's get into the nitty-gritty. Shall we? I'm so excited in this episode, I'm having this awesome conversation with fat activist, photographer, author, and cat mom, Lindley Ashline. Lindley is the creator of Body Liberation Photos and does some really amazing ethically produced diverse stock photos of people in larger bodies. And, oh my gosh, how much do we actually need this kind of stuff. So I had the most amazing ranty conversation with Lindley. You are going to absolutely love her. So without further ado, here's me and Lindley. Lindley, thank you so much for coming on the show. Lindley: Oh, thanks for having me. I'm so excited to be here. Louise: Me too. So tell me, what's firing you up at the moment? Lindley: Well, when we were emailing back and forth talking about doing this podcast episode you had said, I want to hear what's firing you up, and I would love to hear you talk about stock photos, which are photos that can be used for marketing that people buy from other people. And also, wondering if you've experienced any diet culture co-opting of your work. And I immediately said, I have all that put together because I do have the stock photo website where I sell my photos. And most of my clients, my stock photo customers are health at every size oriented, or anti-diet, or body positivity folks who are marketing their small businesses. But the other day there is a diet that is probably familiar to you, that is very big here in the United States, that is called Whole30. Louise: Whole30, is that the Brene Brown one? Was she doing that? Lindley: Oh, I don't know. Louise: I'm sorry. Lindley: That's very, very trendy here. So, someone from Whole30, the company that runs that diet bought some of my stock photos. Louise: Oh no. Lindley: To use for an event. And I know this because I reacted to that. I'm a small business, so I do sell a decent number of stock photos, but I'm not at the point where I don't see every order as it comes in. So every time someone buys something from me, I get an email, of course, and I'm always curious, who's buying things. So I saw this such-and-such a name @whole30.com. And I said, wait a minute. Because not only do I not want… my photos are, they're mostly people in larger bodies or fat bodies. When I use the word fat, I'm using it as a neutral descriptor of people's bodies and not an insult. You don't have to use that word for yourself, but I have reclaimed it and many other people have too. Louise: That's such a beautiful way of putting it. Thank you. Lindley: Oh, thank you. Yeah, it's like saying that I'm a medium height, or if I were tall or short, I have long hair. It's just a descriptor. But the people who appear in those photos, they are in vulnerable bodies themselves. They are often people of color. They are people in very large bodies; people who experience a lot of discrimination and stigma just by living in their bodies. And not only do I not want those bodies being used to represent diet… Louise: Yeah, like they're not before photos. Lindley: Yeah. No, but also when I started creating stock photos, I worked with a lawyer to create my license that you are bound by when you buy these photos, you have to agree that you're going to respect this license to use the photos, and in the license, it specifies that you cannot use them to promote diets. Louise: You are terrific. So they're buying it in breach of your licensing already. Lindley: Yeah. If I'm going to set out to create body-positive and fat-positive stock photos, and work with people who are in marginalized bodies to start with; I can't allow those photos to be used in ways that will hurt people. Louise: How dare they. They have the audacity. Lindley: I was very fired up speaking into the theme. Oh, I was fired up and I said, no, how you. I immediately messaged my best friend and said, how dare they. And so, I emailed her, I issued her a refund. So here's what I did; I issued her a refund for the money that she's paid. I deleted her account. I couldn't delete the account, so I changed her password on her. I couldn't delete it, but I could change the password. And then I emailed her and said I have refunded your money, you may not use these photos, my license prohibits you from doing so. And that's that. Louise: So, did she respond to you? Lindley: Well, to make it even better, she had put her work email address in when she placed the order. But for her billing address, she was using a corporate credit card. So she had put as the email for the credit card, she had put in the corporate address. So I emailed her, but I CC'd the whole company. Louise: Oh my God. That's fantastic. Lindley: CC'd headquarters@whole30.com. I'm sure that maybe just a random assistance, someone deleted it, but like, I'm sure it didn't go to all the employees, but that was very satisfying. Louise: That is very satisfying. So she did email? Lindley: Yeah, she emailed right back and sent me kind of an indignant email. And she did say that they wouldn't use the photos. I keep meaning to go check and see if they actually did. But she was very indignant because she said we were going to use these for an event to promote body positivity next month, and I guess we won't. And I'm like, yeah, I guess you won't. Louise: What are you doing in the field of so-called body positivity if you're a diet company? Lindley: And that's the co-opting, that aspect of it. Because now, like Weight Watchers has changed its name formally to WW. What does that even mean? Like, we all know it's Weight Watchers, we're not stupid Louise: Well, they think that we might be. Do you remember in the eighties when Kentucky Fried Chicken decided to improve its brand by going to KFC, because then it wouldn't be fried. Lindley: But it's still fried chicken. Louise: Yeah. And this is still like, we want your money. Lindley: Yeah. And they've realized that people are wising up. Louise: We know that their diets are shit. Lindley: Yeah. They don't work, and in fact, they're worse for you, for your health than not dieting than being at a stable weight. Louise: Yeah. And then they're like, well, we can't have that, so let's launch into the field that grew around resistance to us, and let's nick everything, including their stock imagery. And how dare they run a body positivity event when they're in the business of shrinking bodies. Lindley: And as we move forward in time, you're going to see more and more of this because there is a lot of profit in telling people to love their bodies while selling them products because you made them hate their bodies. And in the body positivity movement, it's really rampant. If you look at Dove, Dove is one of the first companies to really monetize at a grand scale the body positivity movement. In the last decade, they've done a bunch of very high profile feel good, “love your body no matter what,” you can't see me, but I'm making really sarcastic hand gestures right now. Louise: Yeah, I'm loving it. Lindley: I mean, you can see me, but our listeners will be able to. But all these love your body just the way you are things, but at the same time, they're selling skin lightning cream to people of color. Louise: How dare they? Lindley: And they're selling wrinkle cream or whatever. Louise: Anti-aging, right? Lindley: Yeah, so it's very two-faced. Louise: Yeah, they were just changing the marketing where baiting and switching people on a global scale. And I agree. I think we're going to see more and more and more of it, but it's also like kind of core at the same time, because the fact that these big nasty wolves are coming to sniff at your door means that you are the one with the power, right. Body positivity movements are the ones who are driving the direction of – like the increasing level of diversity that's happening around the planet. I think they're just getting a bit desperate. Lindley: I mean, these are dinosaurs – that meteorite is coming. And I want to say too, for our listeners, I want to acknowledge, because you don't hear this stated enough, how traumatic, like full-on psychologically traumatic it is for both us as a culture and for people as individuals to be told for hundreds of years that their bodies, particularly fat bodies, and particularly women's bodies, but all bodies are bad in their natural states. And then have a generation of companies turn around and tell us that it's our fault for not loving those bodies. That's trauma. That is trauma – culturally and individually. So I want to be very clear that if you don't love your body, which most people don't, I have days I do and days I don't, but if you don't love your body, that is not on you, that is on hundreds of years of culture driving up and product power, so it's not you. Louise: It's the system. Lindley: Yeah. And you're not individually possible for fixing that, unless you want to. Louise: I'm so glad you're here. You are on fire and I love it. Lindley: I get so angry at the scam that's been perpetuated. Louise: Yes, that's exactly what it is. It's a giant gaslighting scam that turns us against ourselves and each other. And when we kind of hit body size as a measure of worth, it's really damaging and divisive. I really want to ask how you got to this point. Lindley: I got mad. Louise: Yeah, how did you get mad? Like, how did you come to have this amazing idea to start the body liberation stock photography stuff, and come to it with so much conviction to protect people who have been marginalized? Lindley: Well, it's been a process of about – it took about 10 years to go from being very, very sort of normal person invested in diet culture, sort of very mainstream, to being very passionately anti-diet and doing this activism work. In 2007, thereabouts, I discovered I had been on the website live journal for a very long time. At that point, it was like a pre-Facebook. Louise: The dark days of early internet. Lindley: Yeah. And I had stumbled across this group called Fatshionista. So like fashionista, but with fat folk. And it was such a revelation because here were these mostly women who were in large bodies in very large bodies who were being styling and confident and walking around in horizontal stripes. Louise: Oh my God. Lindley: And tight fitting outfits and colorful outfits and just living their lives confidently. And I just lurk for a really long time. But from there I started discovering… so the pre-cursor, these of foundation of the body positive movement is the fat acceptance movement, which started in the 1960s and has been the backbone of all of this. So this was a little bit before body positivity became a thing. And I found these fat acceptance blogs, where they were talking about the science of weight loss and why scientifically it doesn't work. And I had been in this state that I think many people sort of existed where they're like, well, it's fine to say, love your body, but my body is big. My body is not okay. Like, that might be cool for other people, like maybe other people deserve to be confident. But something about… Louise: Gosh, that is like, when you said that, that is like where so many of us are stuck. Like it's okay for everyone else and I love the idea of diversity and I love the idea that large and small and everyone in between can exist, but my body. I can't get there. Lindley: Yeah. And so, when I learned the science and the fact that somewhere around 98% of diets fail and that people gain the weight back, I started to feel like I'd been scammed. I'd been raised my whole life to believe that if I could just be good enough and strong enough and have enough willpower and do the right things for long enough, then I too would be thin and healthy and fabulous and have the life I'd always dreamed of and all those other things you see in diet ads, and it turned out none of that was true. Louise: It's bullshit. Amazing. Lindley: I started to get annoyed and then gradually I got mad, and then I got really mad. Louise: Excellent. Lindley: And then I started doing my own activism work because it was so tragic to see people that I love trapped in that system and be lied to. And so, I started speaking out – just a little bit, just a little bit. Like, I'd post something on my Facebook about, “Hey, we know that diets don't work because of science.” Louise: Yeah. I mean, like in tiny little writing. Lindley: Yeah. And that's really scary when you start doing it because it's so counter to what we think we know. So in about 2015, I was in a really crappy job, after a series of really crappy jobs, corporate full-time jobs. And I said, you know what, I got to a breaking point. And I said, “I'm done. I want to take my photography and turn it into a full-time business.” Louise: So you'd learned photography for a while. Lindley: Yeah. Well, I've done nature photography for many, many years, but I had never photographed people. Louise: Interesting. Lindley: So I took a year and I took a bunch of classes online and then I learned to photograph people. So in 2015, I quit that job. And I want to acknowledge my privilege here. I am a white cisgender straight woman who lives in the United States, and my husband is my financial safety net, so I was able to take that. I also have a part-time job as well, but I was able to take that leap because of my privilege. And so, I've always… Louise: Because you have some security, yeah. Lindley: There's not a lot of path that is open to everyone, and so I always want to acknowledge that. Louise: Yeah, it is really important, but I also think it's kind of fabulous that there are people who are able to do that because what you've done is create something for so many people. Lindley: And if you had asked me a decade ago, if you had said maybe in 10 years, how you feel about being a full time, small business person, photographer and activist, and I would've laughed in your face. Because at this point I have enough experience speaking out that I often sound very confident and powerful. Louise: You do, you sound really fired up and it's fantastic. Lindley: Which is wonderful, but that is not where I came from. Louise: So you took it on. Lindley: Yeah, I came from a very meek sort of very nice lady, southern sweet background, where you never disagreed with anybody to their face. Not to their face… Louise: Disagree behind their back with a cup of tea. Lindley: Yeah. That's how we do it in the south, the Southern US, we smile at your face and then snip at you behind your back. But like, I wasn't brought up in a way where I was allowed to access anger or to even believe that I felt it. Louise: It's part of the, like, part of the gaslighting of diet culture is that it uses other gaslighting of being raised female, and like, just be nice and shut up and don't rock the boat. And if you're mad, it's probably a period, right – it's not worthy. Lindley: Yeah. And it's very threatening to a lot of people, too, particularly when someone in a fat body is angry, that's very threatening because we are expected to shut up and take it. And so, I do get a lot of trolling. I've had some threats, but thankfully I'm not yet high profile enough to really be getting a lot of that. But it there's been some unpleasantness. Louise: It's really terrible. What you were saying about the science stuff and speaking up about the science, its that's sort of, my pathway was through the science as well, initially as well as like the massive sense of social justice and eating disorder work as well. But I'm so aware, and when I talk about the science, so if we were in the same room talking about the science, it's possible that my voice would be listened to more, even though we're talking about exactly the same thing, because our body sizes are different, which is ridiculous because actually you've got more lived experience alongside the science, so it's kind of like what the… Lindley: Yeah, yeah. We consider it culturally, we consider a thin body or a thinner body to be a credential, just like a degree. I was actually talking about this on Instagram literally last night that we consider thin body is to be a credential. So even though I live in this body and I have experience with this body, in general, I am considered as much of an authority on this body as someone who is in a more socially acceptable body. Louise: Which is so weird, it's like being like, oh, I'm the expert on same sex relationships, but I'm completely head show. Why would that credential be? Lindley: Yeah. Again, when marginalized people are allowed to speak and allowed to be angry and allowed to be believed, it's very threatening to the status quo. So it's easier to, I mean, again, both at a cultural level and an individual level, it's easier to assume that I am lying or that I'm exaggerating or that I am unacceptably angry or unacceptably sad or whatever, so that it blunts the impact of what I'm saying. Louise: Yeah, it's easy to dismiss something you don't agree with. Lindley: Right. I had someone who is in an average size body for here to the US. A maybe US 14, 16, which I think in Aussie size is about a 12. Louise: I have no idea because sizes confuse me. Lindley: I think the Aussie sizes run one size lower, I think. But anyway, at any rate, someone who is of average size here in the US. And often I find, again, I am speaking for my US experience. I'm not speaking for the whole planet, but I often find that folks who are of the average size because of the nature of our culture, think that they are much larger or much farther along that spectrum. So I often find that there's people who are of average size assume that the way that they are treated is the same way that people much larger than they are, are treated – which is not accurate. Louise: But it's about that unconscious, like they don't know the privilege they have. Lindley: Yeah, because it's a spectrum. I live in a very large body, but I am nowhere in near the extreme end of the fatness spectrum. There are many, many people who are larger than I am. And then I have privilege over those people because I can still get clothes that are… I can't get them in person. I mostly have to buy online, but I can still get clothing that's commercially made. Even if it's not the clothing I would prefer, and even if it doesn't fit very well, I can still find clothing somehow. But this was a person who I think wasn't quite ready to understand that that is a spectrum. Louise: And that's real. Lindley: And I had written this, I was recently diagnosed with a new to me health condition that has been quite challenging and that I am pursuing treatment for. And the treatment for that condition, it is a stigmatized condition. I'm not going to go into details, but it is a stigmatized condition, and it is a condition that is correlated with larger bodies. We don't have any scientific evidence that it is caused by being in a larger body, but it is correlated. And so, as someone who now has condition, there's sort of a double stigma and there it's been very challenging to get treatment. Louise: So you're stuck in the whole stigmatizing, like, medical condition stuff where they're like, “Oh, you've got this condition. If your body was different, you wouldn't have this condition,” Which is really not an interesting conversation, but it seems to be one that keeps on happening. Lindley: Right. Right. And so, this is something that I have been dealing with for a while now. Just pursuing treatment and it's taken much longer than it should have. And I was talking on my personal Facebook about the challenges of getting this health condition addressed and the ways in which some of those challenges have been caused by people reacting to my body size by fatphobia, plain and simple. And this person who has been listening to me speak for years and who is very earnest and was clearly trying very well intentioned. Because this was not the same experience that this other woman had had in her life, she approached me and wrote me a long message about how I was basically bringing all this on myself. Louise: Oh, bringing all of what on yourself? Lindley: That maybe I was just imagining that people were treating me poorly. Louise: Oh ouch. Oh dear. Lindley: Because I was putting out negative energy into the world, and so my poor treatment was my own fault. And there was a time in my life that I would've been devastated and I would've believed her. I would've gone, “Oh no, maybe because I'm in a fat body, maybe I am putting some kind of energy out into the world that maybe I just, oh no, it's all my fault.” Louise: Oh wow. Lindley: And my friend Brandy, calls this confidence magic. Louise: Good time. Lindley: Yeah. She said she calls it confidence magic because she is also in a very large body. And quite often, when we talk about the way we're treated it, the retort is, well, if you were just acted more confident, if you were just friendlier, if you just did X, Y, Z. But mostly, if you just acted more confidently, then people wouldn't treat you that way. And it's entirely possible that for someone who is in a smaller than ours body, that works. Maybe it does work if you're in a smaller body. But I want to be very that there is nothing I can do or not do that will make my body not an oppressed body. It doesn't matter what kind of energy I put out into the world, I don't deserve to be treated poorly, especially for the size of my body. Louise: It's putting emphasis back onto you, it puts it back onto you and it takes the focus away from the person who's being the dick head. Lindley: Right. My oppression is never my fault, period. And so now I asked her to sit down and really look at that discomfort because the problem was that she had reached a point where she couldn't imagine that people actually get treated the way that I was describing. And so, it was so uncomfortable to realize that her experience was universal, that she sort of flipped over into this default state of, oh no, you must have done it to yourself, because it it's so hard to think. It is hard to think about people you like being mistreated. And it's easier to think that it must somehow be under their control it, that it [unclear28:21] behavior. Louise: Exactly. I was going to say that it's a locus of control problem. If we can locate the problem within us, then we feel like it's controllable and that we can do something about it. But to actually kind of recognize that this is structural, this is big. And we can be as kind and nice and put as much positive energy crystals out to the universe as possible and it won't change fatphobia. Lindley: Yeah. And unfortunately, this particular person was not receptive to being asked to reevaluate what she was saying, and so she wandered off and I haven't seen her since. But it really illustrates that when we start learning about systems of oppression, it can be really uncomfortable. As an America, I have had to do a lot of work around racism and a lot of learning, and as a very white person, that is very uncomfortable. But also, I feel like it's part of my job on this planet. Louise: We're not always supposed to be comfortable. Lindley: Yeah. And it's okay to be uncomfortable, especially when you're learning; you have to learn to sit with it. Louise: Yeah. Gosh, like there's so much that you have to deal with, when all you're really wanting to do is get on Facebook and talk about it. Lindley: I just want to whine on Facebook, and now too, my personal Facebook, because I have so many professional connections there, it is up being a hybrid. It is a hybrid space. When I'm speaking there, half of the folks who are in my sphere are there because of my work, so it's never really personal. And that is a boundary that I chose. I could choose to maintain my Facebook to be much, much smaller and more closed, and so I do have to be aware that I'm sort of speaking to a hybrid audience there, but sometimes you just want to get on Facebook and gripe too. Louise: You want to have a good old Facebook page and just get supported. That's kind of what we want to. Lindley: Right. But yeah, it's so important that all recognize that when we are treated badly for something about ourselves or related to something about ourselves, that's not ever our fault. Louise: Ah, such a good message. And the solution isn't to be kinder to the person who's being the dick head. Lindley: Yeah. I don't owe someone who is oppressing me, who is treating me badly based on the size of my body. I don't owe them in anything. I don't owe them an explanation. I don't owe them kindness. I don't owe them education. The only thing I owe is to myself to minimize the harm done to me. And if I give them anything beyond that, that's a gift. Louise: Yeah. Ah, God, what you're saying is so important, it's going to resonate with so many listeners. I just know it. Lindley: I hope so. It's time to stop blaming ourselves for the way that we're treated. Louise: Yes. Yes. And just last week, one of my clients was talking to me about a health interaction here in Australia with yet another person who is kind of locating the problem, same story. There's a person who's lived for a very long time in a larger body, tried every diet under the sun, the body's not going to change size. Now there's a health condition that needs urgent attention, and this person has been told very nicely that the problem is their body size. And they're actually experiencing delays to the actual treatment, while they are referred to a “obesity clinic” to address the problem of their size. And the emphasis there for this person, this health profession was being kind – it was being said to me in a nice way, which was a revelation for this person, because they've been treated so unkindly, but people can still be kind and still be a dick head. Lindley: Yeah. Oh yeah. Like a doctor, many years ago now; the doctor who lied to me about my health numbers so that she could put me on an off-label medication to try to make me lose weight. And so, she told me I had a condition that I did not have so that she could prescribe me a medication to actually try to make me smaller. She was so nice about it. I assure you; she was kind and sweet and gentle while she lied to me and gave me an unnecessary medication for a decade. Oh, she was very nice though. Louise: I have no words, that is dreadful, but this brings us right back to that Whole30 thing, right. I'm sure their body positive event would be full of kindness and niceness and fairy wings. But what the fuck are they doing? They're selling a diet. Lindley: Yeah. And you can, you can put as much lipstick on that pig as you want, but it's still going to be a pig. And I understand that pigs are smart, sweet, intelligence animals, they're still going to be a pig. Louise: That's right. You know, shit rolled in glitter is still shit. Lindley: Yeah, it's still terrible. Louise: So I've looked at your website and there's the most beautiful photo of a woman in a larger body, in a chair, in a garden, and oh, it is stunning. It is such a beautiful photo. And there are many, many photos like that. And I really want to talk to you about your photography, like how you got… so you got angry at the science, you got all fired up, you started to take pictures of people and now ended it up in this body liberation photography. So tell me about that and how you feel that photographing larger bodies is such an important piece? Lindley: Yeah, there are two sides to the photography. The one side is the stock photos, and for that I'm finding people who most of those folks are not models. They're just regular folks that I find in various ways. And then I'd also do offer client photo sessions; boudoir photography and portrait photography and business branding like business photos, and so there's sort of the two sides of it. And I started out doing the client photography because when I quit my full-time job, that seemed like the most obvious path to take income-wise at the time. And a couple of years later, there's a stock photo company, a very famous one called Getty images, based out of New York – when you see red carpet photos and you see really high quality stock photos that big companies use, those are often from Getty. They are very large and powerful. And they released, I think it was in 2017, they released a special stock photo collection. That was a body positive collection. And it got a ton of press. And I got really excited because we need – the more of that in the world, the better. But I went to go look at the photos and it turned out that they were mostly people who are again, in the US average size, which again is much larger than model size body. It was still different, but it wasn't particularly representative. And also, the photos were very expensive and they were also for editorial use only. And in stock photo lingo, that means that you can't use them for marketing. Louise: Okay. Lindley: What on earth was the whole point of that? Louise: What are they folding? Lindley: What a wasted opportunity. And so once again, I got mad and I said, I can do that, so I did. Louise: And you went like the full spectrum of body sizes, and identities, and cultures and genders, it's like everything, basically humans. Lindley: Yeah. When I am looking for models for the stock photos, and again, most of these people aren't trained models, but when you pose, you become one. So now these folks can all say that they're, that they're models too, which is cool. But I am always looking for the largest possible bodies to represent because I'm the only one on the planet doing this work right now, photographing very fat people – the only one. And I look forward to the day when that's not true. I look forward to the day when I have tons of competition. Louise: When it's not a niche or a specialty. Lindley: Yeah. And it turns out that many of the people who come to work with me on that basis are also people of color, are also LGBT+, or they're folks, or they have a mental illness, or they have a disability. They bring these other identities with them, and so I have the honor of being able to represent those things as well. Lots of folks in eating disorder recovery. Louise: Yes. And so, how did someone, like, if someone wants to do a stock photo with you, do they approach you or do you like follow people in shopping centers and ask them? What do you do? Lindley: It's been a combination. I have an email list that I maintain. And if you would like to be on that list, I am in Seattle, Washington in the US. But if you're ever visiting or you want to be on my list just in case, you are welcome to contact. We'll put that in the show notes, but I do have an email list that I send out model calls to, at least in non COVID 19 times. And then, I did once follow a coworker into a work bathroom; I was doing a corporate contract at a big company, and I had kept running into this woman, she was just lovely and seemed, I don't like you can tell when you're washing your hands at a bathroom sink beside someone, but she seemed very nice. And she was right in the demographic I represent. And so finally I followed her into the bathroom one day and I said, “I'm so sorry if this is creepy, and you can tell me to leave at any point and I will leave and never talk to you again. But I do photography and I'd love to have you as a model.” And she came and modeled for me, and it was wonderful. Louise: That is so gorgeous. Lindley: But yeah, it's a combination. When I started out, I was finding people on Craigslist, which is an American website, the classified ads, so it is just been a combination. Louise: Fantastic. Have you heard of Obesity Canada? Lindley: I'm aware that they exist. I've tried not to get tangled. Louise: That's pretty gross. It's pretty eww. Well, actually, I'm not sure who has released it, but they're kind of like this O organization up there who have this stock photos collection. Lindley: Oh yeah. It's another one of those weird co-opting things. Louise: Yeah. Yeah. And they work very closely with our friends at Novo Nordisk who are releasing all the weight loss drugs, and trying to take over the whole world. Lindley: Of course. Louise: Yes. But those I guess they're competition for you in a way. Lindley: Well, yeah, in a way. There's also a free collection on a website called Unsplash of our own bodies. And those photos are lovely and they are free to use, unlike my photos, which are not free because I need to eat. Louise: Imagine that! Lindley: Yeah. My models have the choice of, they can either choose a living wage money or for every hour that they are modeling or they can choose to be paid in photos. Many of them are very poor and they need the money, so I'm happy to pay them. But everybody involved in mine gets paid a living wage, which is why the photos aren't free because I get paid a living wage too. But yeah, there are some collections out there that do compete, which is fine. Again, we need all the representation we can get. Louise: We too, but I guess it's ethics, isn't it? And because I think that some of the people who are being photographed for those stock photos associated with the O organizations use members of their so-called patient groups, who are people who – that's another kind of section of my podcasts, people who are being encouraged by the weight loss industry to promote body positivity in the name of getting better public healthcare for weight loss surgeries and the like. So, it's really nice to hear about the ethics of you treat the people that you work with. Lindley: Yeah. When I'm photographing people, because again, almost everyone who comes to me… now, sometimes I'll get people who are just like, I'm ready. Let's do it. I love my body. I'm ready to show it off. Let's do the thing. Louise: How often does that happen? Lindley: It's rare, but it's cool. That's fun too. But most of the people who come to me, they're nervous. These are bodies – we live in these bodies that are not considered okay. And now here's this girl with a camera pointed it at you going, “No, you're great.” That's very disconcerting. And so, we do a lot of coaching. We do a lot of… I tell people like they get to control when they're done, whether they need a bathroom break or they're hungry or they just need to not have a camera pointed at them. It's a very warm and friendly environment because that's the only way to be ethical about this. And if nothing else, if you're unhappy, it's going to show in the photos. Louise: Yeah, of course. Lindley: So I have a vested interest in keeping you relaxed too. But these organizations releasing these photos is another example of this smiling oppression because it doesn't matter. Louise: What a beautiful way of putting it. Lindley: It doesn't matter how nice you are about it; if you're trying to erase me, and if you're trying to get me to pay you for surgeries or drugs or meal plans or meals or whatever, or weigh-ins, whatever that are not evidence-based. And you can tell I'm all fired up about this, come back to our theme again, because it doesn't matter how nice you are about it. Louise: You're still a dick head. Lindley: I know all about nice, but nice is not kind and kind is not anti-oppressive. Louise: Yeah, we've got to stop this bullshit. Yeah, I love that term “smiling oppression”. Yeah, if people are being nice to you and trying to represent you, and simultaneously trying to eradicate you; that's bullshit. Lindley: Yeah. I mean, again, I talk about being Southern because it's very relevant here because I have an ancestor who owned a slave, who owned another human being. That was a couple hundred years ago, so I had no idea whether that person was nice to their slave. I wouldn't have any way of knowing. Louise: It doesn't matter. Lindley: Yeah, it doesn't matter. In the south, one of the things that I was taught in history classes in school was that slavery wasn't it really all that bad because people were nice to their slaves and let them live in the house, and I'm not going to repeat the rest of it. It is very… Louise: Oh my God, that's just, yeah. Lindley: Yeah. And I had to learn better as an adult. But just because, and I'm not comparing slavery and fatphobia, they are not the same thing. They are not the same oppression. It doesn't matter how nice I am to you' if I am hurting you, if I'm stepping on your foot while smiling and asking you about the weather, the proper response is, “Hey, get off my foot.” Louise: Yeah. Right. Oh God, so many people need to hear this, and it's so good to hear how fired up you are. Lindley: We're being lied to, and we're continuing to be lied to by people who want to present, particularly weight loss surgery is now the big new thing, but it's still not evidence-based. We know that the side effects are really horrific, that a lot of people die. And then most people who even have that surgery gain the weight back. I know somebody who's had it twice and the doctor is pushing her to have it a third time because it didn't work. I mean, she lost the weight and then she regained it right back because that's what human bodies do – they protect. Louise: Our bodies are amazing. They're smarter than the weight loss surgeons. Lindley: Yeah. My body says, “I see a famine coming. We're hungry, I need to protect you.” That's what our bodies are doing. Louise: And I love that the photography that you do highlights the beauty inherent in diversity. And like that picture of the woman in the backyard, she is by no means small and she is just absolutely, like, there is just such beauty in that photo. A lot of the people that I work with really can't see that beauty in their own body and really don't even look at their own body, and that's where I guess photography can open up. Like, what are you trying to do for people when you take their photo, when you're aware of that much, like avoidance or disgusted or all of that stuff that people get stuck on when it comes to their own body? Lindley: Well, again, there's, there's kind of two facets. There is often when client come to me, generally the folks who are modeling for stock photos, because they are aware that those photos will be used publicly and sold, so there's an extra layer there of not only being willing to see yourself, but to know that many, many, many other people are going to see these. So generally, the folks who model for stock photos are maybe a little more ready for that. But a lot of the clients who come to me, maybe they haven't had a photo of themselves since their wedding day, or maybe they haven't had one since high school, or maybe they're always in the back of photos, or they're the ones behind the camera because they can't stand to be in front of it. And for those people, when I started doing this, I didn't know the term for it, but the term is exposure therapy. This is not a process that I'm qualified to coach at this point, generally, this is ad hoc, people do it for themselves. But people will often take their finished photos, and we've always look at them together. We always go through them together, both from that's… I mean, it's part of my sales process. It's business, we look at them together because people are buying products with them. But also for support, I think your photos are amazing, and I know that you will too, but I'm still going to be there to metaphorically hold your hand while we look at them. But then people take them home, and they'll look at them for just a minute. And then the next day they'll look at them for two minutes, and they will expose exposure therapy themselves. That's the coolest thing because they're teaching themselves to look at their own bodies. And then the other facet of that is that you saw that photo of the woman in the chair, in my backyard. I'm very lucky to have overgrown backyard to put people in. Louise: You have a nice backyard. Lindley: And we had the behind the scenes of that photo is that I had sheets hung up all over around her because the back of my backyard is open to the next area behind, so I had sheets hung up all over for privacy because she is very nude. So, you saw that photo on the website and it made a difference for you. You remembered it. And so the other facet is that you can… I don't know what the verb is. You can expose your therapy yourself by finding photos of people who are either look like you, like have your similar body type or are bigger or have visible disabilities, or basically by exposing yourself to all kinds of bodies, not just the ones that you kind of get forced fed by the media. You can do this process for yourself without necessarily having to look at photos of yourself. Although eventually you will also want to look at your own body, but you can do so much just by looking at people of actual bodies; look at them. Louise: Not in a creepy way – maybe in a creepy way. Lindley: I mean, maybe don't go staring at people in the grocery store. Louise: Don't follow people into the bathrooms at pools. Lindley: Yeah, please don't follow people around staring at them, but the internet is a wonderful place to stare at other bodies. Louise: Yeah. And actually, you raise a really good point because I think it's, well, 20 years into my foray into like the non-diet stuff. And I think me, even in the mid two thousands, looking at that same photo, I wouldn't have had the same reaction of just like being struck by the beauty because I hadn't done all of that. Like, I do surround myself with lots and lots of pictures of, like we've got naked women all over this house and my kids make a point of warning their friends, and I'm pretty sure my dad does think I'm a lesbian, which is okay, because I'm exposing him to diversity, but it's the exposure, exposure to diversity. If we see ourselves everywhere, represented everywhere and see other people represented everywhere, nothing strikes us as wrong, and then the beauty can grow. Lindley: Yeah. You know, what we are exposed to inn our regular lives, without taking efforts otherwise is a very narrow slice of humanity. And the more we see people… the more we see all different kinds of bodies, the more normal they become. The more we can see the beauty in those bodies as opposed to those bodies and out of bounds, or wrong, or transgressive, and the more you can expose yourself, the faster it will work. Louise: Yeah. And do you think that the last place that that kind of appreciation happens is your own body? Lindley: I think it depends for people. I think for some people, yes. I think for some people, body is the least, like theirs is the last place that happens. And I don't know, you know, I'm not in other people's heads, so I don't know whether that correlates with how outside the mainstream your own body is or not. Louise: Yeah, I do think there's something in that, but to keep going. So you are basically encouraging us all to take modes of ourselves. Lindley: Oh, yeah. Take some new selfies, seriously. Start in the bath. Like if you have access to like a bubble bath, because then you can like take pictures of your toes, like pointing delicately up from the bubbles and it's the least offensive nude in the world and it's really safe. And then you turn that camera around or use your use the other camera on your phone. Don't electrocute yourself please. Louise: Don't live stream it. Lindley: You take a photo of like if you have cleavage and you want to see that cleavage, like you do the bubbles and the cleavage. Again, I'm making hand gestures that you can't see so you don't imagine. And you do like the coy bubbles and the cleavage and you like camp it up. And then from there, you get out the bath and you dry off or not, I don't know your life. And you start putting that camera on a timer and you do whatever makes you happy if that's nudes or a costume or a Godzilla suit, I don't care – as long as you're seeing yourself. Louise: I love it. It sounds really playful. Lindley: Yeah. It doesn't have to be… like, there is a lot. And if you are an eating disorder recovery there a chance that you have been exposed to some of these exercises already on body image. There is a ton of resources out there on things like mirror work, where you're looking into mirror and seeing yourself and lots of… like, I have a whole book of journaling prompts about body image. There's a ton of resources out there, but just taking a selfie and deleting it, you can delete it. You don't have to keep it. Louise: You don't have to put it on Facebook. Lindley: You don't have to share it. I know that some people will start like a secret Instagram that is just them sharing selfies just to have them out into the world, but you don't have to, you don't have to do any of that. Louise: You don't have to perform this. Yeah, this is fast, this is good stuff. Lindley: Just like anything you can do. But again, you're not obligated to, this is not a moral imperative. You don't have to do selfies. You don't have to do nudes. You don't have to love your body. It's great if you can respect your own body, but there's no particular moral good in it other than that, you deserve it. None of these – I'm not giving you marching orders. I'm giving you some options, but like we get to do you. Louise: Lindley, thank you so much. This conversation has been immense and everything and awesome. Thank you for everything that you're putting out there in the world and for being so fired up. Lindley: Yeah, thank you. Such a joy to get to come in and talk about what I'm really head up about. Louise: Yeah, it's truly terrific. And I hope that your health condition gets properly addressed and that you feel better soon. Lindley: Thank you. Louise: All right. Thank you. Outro: What a dead set legend. Thank you so much, Lindley, I just adored that conversation and thank you everybody for listening. So if you are looking to learn more about Lindley and all of her amazing work, you can find her at bodyliberationphotos.com or on Insta @ bodyliberationwithlindley. And don't forget that her name has a silent D in it. So it sounds like Lindley, but it's L I N D L E Y. Okay everyone, that's all for this week's episode, I will see you soon, I promise. Take really good care of yourself in the meantime, trust your body, think critically, push back against diet culture, untrap from the crap. Resources Mentioned Find out more about Lindley here Follow Lindley on Insta @bodyliberationwithlindley

Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

Louise Adams is a clinical psychologist and the Vice President of HAES Australia. Louise is also the director of UNTRAPPED, an online program for people with eating and body weight concerns. She is the host of the non-diet podcast, All Fired Up!.  Louise has written two books. The Non-Diet Approach Guidebook for Psychologists and Counsellors (2014, co-authored with Fiona Willer, APD) is a professional manual which guides psychologists and counsellors in the application of the non-diet approach. Her second book, Mindful Moments (2016) is for the general public, and teaches people how to apply self-compassion based mindfulness techniques in their everyday lives. We discuss topics including: The Damage caused by diets Social justice of HAES The prison of diet culture The reasons that people are terrified of letting go Misconceptions with eating disorder clients _____________________ If you have any questions regarding the topics discussed on this podcast, please reach out to Robyn directly via email: rlgrd@askaboutfood.com You can also connect with Robyn on social media by following her on Facebook, Instagram, Twitter, and LinkedIn. If you enjoyed this podcast, please leave a review on iTunes and subscribe. Visit Robyn's private practice website where you can subscribe to her free monthly insight newsletter, and receive your FREE GUIDE “Maximizing Your Time with Those Struggling with an Eating Disorder”. For more information on Robyn's book “The Eating Disorder Trap”, please visit the Official "The Eating Disorder Trap" Website. “The Eating Disorder Trap” is also available for purchase on Amazon.

Content Warning: Discussion of Weight Loss Surgery Fiona Willer, AdvAPD, FHEA, MAICD and PhD candidate, joins us today to discuss weight science. We talk about everything from bariatric surgery to the state of research around fatness. If you are interested in weight science, you will be interested in this episode!

The post 225: Unpacking Weight Science with Fiona Willer appeared first on Seven Health: Intuitive Eating and Anti Diet Nutritionist.

We can't escape the diet culture that surrounds us almost everywhere we go. Every year people start a diet as a new year's resolution. We also know that the majority of those have been abandoned by February. It leaves those who have dropped the restrictive program feeling like they've failed and possibly worse about themselves than before they started. This is because the messaging around health and weight is focussed on thin, muscular bodies that might be unrealistic for a lot of us.The dieting industry doesn't allow for diversity in body size. It tells us that higher body weight is a problem that needs to be fixed through restrictive dieting and exercise regimes. This is the message we've been told for decades. But the facts tell us it's not working. If it worked, wouldn't there be a massive reduction in obesity rates? Restrictive dieting can also be a trigger for eating disorders.Experts are now telling us that restrictive diets almost always result in overall weight gain in the long term. In this episode, we hear from leading dietitians and individuals with lived experience who are focusing on health rather than weight to help people with body image issues and eating disorders find long-term recovery.To find out more about our guests:Fiona Willer - https://www.healthnotdiets.com/Shane Jeffrey - https://www.riveroakhealth.com.au/Patrick Boyle - https://www.patrickboyle.com.au/Kate Reid - https://www.lunecroissanterie.com/contactShreen El Masry - https://beyoubefree.com.au/See omnystudio.com/listener for privacy information.

Nicola Salmon on advocacy, fat positive healthcare & engaging in important conversations. In this episode, Nicola shares her journey to becoming a fat positive advocate and coach including her experience with PCOS, dieting, PTSD, conceiving naturally and finding the HAES & IE movement, what it was like training as an acupuncturist and naturopath, the obstacles and difficulties she faced being the first in the fat fertility space and her motivation to continue, why we need to reduce individual labour in healthcare and start conversations for our clients, what dietitians need to know when working with people in larger bodies asking for fertility support / treatment and how we can start helpful and thoughtful conversations if they are seeking weight loss. Here Fi and Nicola speak about:   Nicola’s journey to becoming a fat positive fertility coach and advocate; Her lived experience with PCOS and experiencing diet cultures firm grasp. A traumatic event which lead her to train as an acupuncturist and specialise in fertility acupuncture.  Experiencing a natural conception in a larger body and finding HAES / IE / non-diet.  Nicola’s experience as a student training in acupuncture and naturopathy, the skills she obtained and how it introduced new ideas around food and body.  Being the first in the fat fertility space; Nicola’s motivation to do this work and her ability to push through the obstacles and difficulties for her clients.   Individual labour in the healthcare systems; its burdening impacts and why we need to start conversations with other health care professionals and specialists for our clients. What dietitians need to know when working with people asking for fertility support / treatment, especially for those in larger bodies. The most helpful and do-no-harm approach to starting a conversation with a larger bodied client who is seeking weight loss for fertility. More about Nicola’s book ‘Fat & Fertile’ and how you can get in touch!   As mentioned in the podcast: Big Birtha’s UK Episode 25: Weight Loss is Not a Fertility Time Machine by Fiona Willer, Unpacking Weight Science Podcast More about Nicola:  Nicola is a fat-positive and feminist fertility coach and author of “Fat and Fertile”.  She advocates for change in how fat people are treated whilst accessing help with their fertility. Nicola supports fat people who want to get pregnant  using her unique FAT+ve fertility framework to find their own version of health without diets, advocate for their bodies, relearn how to trust their body and believe in their ability to get pregnant in their current body. Find out more: Website Instagram Book Twitter

Part 2 of our Covid Contiki tour is here! We're continuing our whirlwind trip around the world to see what the data tells us about the relationship between body size and COVID-19. Diet culture is busily creating a narrative that being larger is a huge risk factor for contracting, developing complications, and even dying from the virus, and our BS detectors are UP!  Alongside my fellow travel guides Jess Campbell (nutritionist and medical student) and Fiona Willer (anti-diet dietitian and statistical warrior), we're diving deep into the data to reveal the real picture - and the truth is VERY DIFFERENT from the headlines! In Part 1 we visited China and the USA, and in this episode we're off to France, Italy, and the UK. What we find will blow your mind! This is a MUST LISTEN! CW - this episode discusses severe illness and death, and mentions the "O" word multiple times. If you're finding it all a bit much, wait until you've got some gas in the tank. But if you're ready to get totally fired up about how weight bias is impacting our understanding of this pandemic, let's go!   Shownotes     We’re back, and we’re heading to France! There’s a study out of France that’s again being used to push this idea of BMI being related to not just hospitalisation but seriousness of the COVID19 illness, such as the need for intensive interventions such as ventilation. It’s a small study with the title “Obesity is an independent risk factor for severe COVID 19”. So, it’s upping the ante in this article to claim that body size is an independent risk factor for severity, or how sick you get with COVID 19. The study is of 124 patients who were admitted to the ICU in a hospital in Lille, France. What the New York Times article mentioning this study said was that nearly half of the 124 patients in this study were ‘obese’ (Louise is feeling some fatigue at saying the ‘o’ word). They say that this is twice the obesity rate of a comparison group admitted to ICU for other reasons last year. It also claimed that as people's body weight went up, so did their need for ventilation. Things to look at in this paper - who were the people being admitted? 73% were male, average age 60. The study controlled for age, diabetes and hypertension, but didn’t control for other factors which have been found to be really important here - things like  smoking, cardiovascular disease, cancer, chronic respiratory disease. There’s no mention either in this paper of social disadvantage. Lille in France is a working class city with a really high poverty rate, so 1 in 4 people in Lille live below the poverty line. That fact isn’t mentioned anywhere in the paper or in the New York Times article. If you read something about body size and COVID symptom severity, you are not being told the full picture when it comes to health and what impacts on our health and our ability to fight back and recover from an infection which we have no immunity for. Next stop, Italy! Italy has been hit so incredibly hard by COVID, we’re seeing a huge impact there and some horrible statistics on death rates. They’ve managed to get some data together and put out some papers, which is an amazing effort. A paper released recently on the 20th of April 2020 looks at outcomes (deaths) and is pretty heavy-going. It’s a large study, including 21,500 people who died. It digs into the relationship between body weight and death outcomes, seriousness of outcomes, demographics and things like that. Jess takes us through it - this study is of 21,551 COVID deaths, but the data that they had about coexisting conditions was based on a limited sample of 1,890 people. So, that’s the number of people they could access medical files for. We have no idea if what we’re seeing in this paper is actually representative of everyone who dies. There’s a lot of missing data, all we’ve got is 8.7% of the total reported. So, in the total (21,551), 35.5% were female. In the smaller coexisting conditions sample (n=1890), 31.9% were female. 12.2% of those who had died had a BMI of over 30, compared to the general population in Italy where 10.9% have a BMI over 30. They should have age-matched information because we know there’s a linear association between BMI and age through to 70 years. As a comparison, 21.2% of this group has chronic kidney failure, which is way higher than the population prevalence. It’s also notable that prevalence of a BMI over 30 is higher in the cohort of women compared to men, however we see here that men were dying much more frequently than women. If BMI related to increased risk of death, we would see that relationship. We’re not seeing it. Compared with other actual serious conditions like kidney failure and hypertension, heart failure, all of those conditions are a higher prevalence compared to that in the general population in those who died compared to the population prevalence of people with a BMI over 30. The weight relationship here is not even slightly interesting when you compare it with these other conditions. And the difference in gender stands out, which we’re seeing across nearly all of these studies that we’re looking at. Maleness and age. COVID can be caught by anyone, but those who progress to a more severe state are typically male and typically older. Comorbidities of various types can also factor in there. There’s a median of 10 days from onset to death in this study - how horrific. A UK paper we’ll be discussing soon looks at how many people were ambulatory - going about their daily lives without needing assistance or their ability to get around being compromised. 98% of the people in the UK data fell into that category before their admission to hospital. If we add that to our Italian data, we’ve got all these people who were out there working, doing grocery shopping, visiting their grandchildren, and then ten days later were dead. Diet culture tells us that if we eat, move, look a certain way we are protected from all sorts of scary stuff. This worry about BMI is that fear again on a larger scale. Following citations in the Malhotra sharticle, Jess went down the rabbit hole and found a paper from Italy published on 5th April 2020, titled “Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic”. It claimed “Being obese not only increases the risk of infection and of complications for the single obese person, but recent evidence indicates that a large obese population increases the chance of appearance of a more virulent viral strain, prolongs the virus shedding throughout the total population, and eventually may increase overall mortality rate of an influenza pandemic”. The paper then goes on to present three factors which make higher weight subjects more contagious than ‘leans’, one being increased viral shedding. The paper called for higher weight folks to participate in an extended quarantine period as part of COVID 19 response, based on an association that’s been observed in Influenza A. Jess went to look at the paper it sighted, and it notes a relationship between prolonged viral shedding time, Influenza A  and higher weight, but an inverse relationship with Influenza B. This increase in viral shedding time is about one day. When all Influenza strains were pooled together in this study, there was no relationship seen. This data should be extrapolated with caution because COVID 19 is not influenza. We do actually have information about the clearance rates of the virus coming out of China, saying that there’s no difference between BMI bands when it comes to viral clearance. The second factor in this paper that makes higher weight folks more contagious than the ‘leans’ is increased viral load and breath via fine aerosols. Again, Jess followed the citation to look at the primary reference, and after lots of scrolling to the supplementary table saw that there was no statistical association between viral RNA shedding and any of the BMI categories, unadjusted or adjusted. It’s not statistically significant. And yet, they are reporting that this has been a trend that has been observed. SO DODGY. And then the third factor that contributes to increased contagiousness is “obesity results in a more virulent disease with an increased virulence and morbidity”. This paper was citing three papers, two of which were mice models, and the third a cell culture study. They extrapolated findings from those studies back to a human population - big “uh oh”. This paints a picture of a higher weight body as a petri dish for a more virulent virus, and as something that should be feared. It’s a truly horrific paper, and a really dehumanising narrative. Why are these papers citing test tube and animal models? Because they can’t find the same evidence in actual humans. Actual humans get the flu - it’s not as if we can’t observe humans with flu and must instead turn to animal and test tube models to gather information. So much damage can be done with these studies - what are the real world impacts for people in larger bodies? Isolation is terrible for our mental health. If this paper was translated into some kind of public health policy, can you imagine the disaster? The limitations on people’s freedom of movement based on BMI? It makes our blood boil. The paper gives recommendations in their concluding remarks for higher weight folks - including “lose weight with mild caloric restriction”. They also recommend the use of metformin and other glucose modifying drug treatments, and to practice mild to moderate physical activity. The final country on our whistle-stop tour of the planet - the good old UK. Another hotspot for this dreadful virus. Also somewhere with some really fantastic data. The ICNARC (Intensive Care National Audit & Research Centre) has been releasing critical care data weekly, and we now have five weeks of reports to look at. Fiona has been reading these reports each Friday as they get released. We have data on people in intensive care units in a relatively wide are of the UK - who is being admitted to intensive care, who has required lower or higher levels of respiratory support, and who has died. They’ve also given us the background stats (including BMI) for the areas that particular intensive care areas serve. The US data showed us a 50/50 gender breakdown in infection rates. In the UK data we see a much higher rate of males being admitted to intensive care due to COVID - 71.8% of people admitted. We also have data on markers of social disadvantage, conditions that people came into intensive care with, BMI and age. We can see over the five weeks of reports how things have changed - and the reports are additive, so each week’s new data is added to the growing data pool. This means we can see mistakes and assumptions we were making early on as more is revealed. In terms of BMI, there’s no difference between any of the BMI bands until you get to the “over 40” BMI band where there’s a slightly higher representation of people being admitted compared with the background population. That is likely to be an artefact of weight bias - as we discussed with the US data, that admitting staff may be more concerned about higher weight people.` The proportion of people with a BMI over 40 being admitted is dropping every week as more data is collected. We’re looking at three main things with this data. We’ve got people who are admitted compared to the general population. We’ve got people admitted who are receiving advanced support versus basic support. And we’ve got BMI band information, where we can see who in which BMI band needed advanced versus basic respiratory support. In the BMI bands when we look at basic versus advanced support, it’s about 50/50 in all the BMI bands. That would mean that BMI is not driving whether you would need advanced support - it’s not a determinant. If a higher body size meant you needed more advanced support, that would be very clear in this data. Currently in this data we have over 300 people with BMI over 40. It's enough people to see there's no trend. In terms of deaths, we want to know whether larger bodied people receiving medical care die at a higher rate than people in smaller bodies receiving medical care. When the first weekly report came out, it looked like people with a higher BMI were more likely to die versus being discharged from critical care. As the weeks have gone on, that effect has blunted. It’s a phenomenon we call ‘regression to the mean’ in statistics. When you’ve got a small amount of numbers, things can look really significant, and as you add more numbers to that data things look more average. The Index of Multiple Deprivation - categorises people from least to most deprived in society. It’s important to note that the NHS is a public health system, compared to the US health system. In terms of admission based on deprivation in the UK, we’ve got a pretty linear relationship between admission and deprivation. People coming from the least deprived areas have a lower chance of being admitted to ICU (14.8%), and 24.7% coming from the most deprived areas. There’s also a linear relationship with renal support, and with requiring more intensive interventions. This speaks to a background of medical marginalisation. It’s likely these more deprived people are coming in with poorer health to begin with. This pandemic is really revealing inequities in health - it is a stress test on health disparity. That’s what needs to be front page news, rather than fear mongering about BMI. ‘Public health’ is not about health - it’s about housing. It’s about economic access to all things. Equality and safety and opportunity. Dr Malhotra - ‘the root cause of all disease is unavoidable junk food environment’. That’s his take on it. (dick)! From one of the letters to the editor in the Obesity Journal - “The COVID 19 pandemic is challenging the world in an unprecedented way. We at Obesity have been sounding the alarm about the obesity epidemic and now must take up the cause for our patients with obesity in the face of this dual pandemic”. Notice that they offer no advice, no call to action for health services to get better at treating larger bodied people? That’s not actually what they’re calling for. They’re calling for more ‘awareness’, which is a subterfuge for ‘let’s keep up the fat hate’. If they were actually concerned, they would be calling for detailed analysis of how outcomes can be optimized for larger bodied people right now. That's not what they’re doing - they just want the narrative that ‘fat is bad’ to be out there so they can continue selling medication and ‘treatments’ for this ‘equally terrible’ condition. To that we say, “fuck that shit”. Whew, we’re feeling a bit exhausted and jet-lagged from that world journey! Thanks to Fiona and Jess for their hard work, dedication and generosity in digging into all that data and sifting through those papers. (and a special shout out to Fiona who recorded with three children who at one point all stood in front of her having a screaming tantrum) What does this all mean in the bigger picture? Hopefully this has undermined the messages of fear. At the beginning of this recording, we talked about what was firing us up about the corona-crisis. After traversing this territory, what are the take home tips? Fiona says that her take home message is to keep in your sights those people who this is relevant for. If you or a loved one has a higher BMI, Fiona’s advice is to dismiss the headlines. Do not listen to the nonsense of people who have got an ulterior motive to keep you hating your body size. Know that your BMI, if you catch COVID, may be a determinant of whether you get hospitalised or not. But once you’re hospitalised, your chances are no better or worse than anyone else based on your weight. Don’t let anyone spin you the line that you’ve been placed on a ventilator because of your BMI, because based on the data we have right now that’s not true. Jess says her take home message is centered around health disparities and inequities. This is an incredible opportunity for us to dig in once the crisis is over and start to unpick and unpack the different ways in which universal health care like we see in NZ and with the NHS may contrast with the sort of care and access that we’re seeing in the US, such as the ability to pay for care and how it impacts on people’s ability to get treatment where necessary. We here in NZ and Australia are really bloody lucky. No one on the planet has immunity to this virus, and some places on the planet are suffering to a level we can’t even comprehend. Our hearts are going out to you, and we’re really hoping that this ends quickly. Look after yourselves - we will get through this with our bullshit antennas larger and more attuned than ever before. We’re all human, we’re all in this together, and we can do so much better. Resources The study from France The Italian study on deaths from COVID-19 The spectacularly garbage study from Italy claiming that larger people are more contagious than smaller people The UK ICNARC data The nephrologists’ website Find out more about Fiona Willer here Find out more about Jess Campbell here   

Part 2 of our Covid Contiki tour is here! We're continuing our whirlwind trip around the world to see what the data tells us about the relationship between body size and COVID-19. Diet culture is busily creating a narrative that being larger is a huge risk factor for contracting, developing complications, and even dying from the virus, and our BS detectors are UP!  Alongside my fellow travel guides Jess Campbell (nutritionist and medical student) and Fiona Willer (anti-diet dietitian and statistical warrior), we're diving deep into the data to reveal the real picture - and the truth is VERY DIFFERENT from the headlines! In Part 1 we visited China and the USA, and in this episode we're off to France, Italy, and the UK. What we find will blow your mind! This is a MUST LISTEN! CW - this episode discusses severe illness and death, and mentions the "O" word multiple times. If you're finding it all a bit much, wait until you've got some gas in the tank. But if you're ready to get totally fired up about how weight bias is impacting our understanding of this pandemic, let's go!   Shownotes     We’re back, and we’re heading to France! There’s a study out of France that’s again being used to push this idea of BMI being related to not just hospitalisation but seriousness of the COVID19 illness, such as the need for intensive interventions such as ventilation. It’s a small study with the title “Obesity is an independent risk factor for severe COVID 19”. So, it’s upping the ante in this article to claim that body size is an independent risk factor for severity, or how sick you get with COVID 19. The study is of 124 patients who were admitted to the ICU in a hospital in Lille, France. What the New York Times article mentioning this study said was that nearly half of the 124 patients in this study were ‘obese’ (Louise is feeling some fatigue at saying the ‘o’ word). They say that this is twice the obesity rate of a comparison group admitted to ICU for other reasons last year. It also claimed that as people's body weight went up, so did their need for ventilation. Things to look at in this paper - who were the people being admitted? 73% were male, average age 60. The study controlled for age, diabetes and hypertension, but didn’t control for other factors which have been found to be really important here - things like  smoking, cardiovascular disease, cancer, chronic respiratory disease. There’s no mention either in this paper of social disadvantage. Lille in France is a working class city with a really high poverty rate, so 1 in 4 people in Lille live below the poverty line. That fact isn’t mentioned anywhere in the paper or in the New York Times article. If you read something about body size and COVID symptom severity, you are not being told the full picture when it comes to health and what impacts on our health and our ability to fight back and recover from an infection which we have no immunity for. Next stop, Italy! Italy has been hit so incredibly hard by COVID, we’re seeing a huge impact there and some horrible statistics on death rates. They’ve managed to get some data together and put out some papers, which is an amazing effort. A paper released recently on the 20th of April 2020 looks at outcomes (deaths) and is pretty heavy-going. It’s a large study, including 21,500 people who died. It digs into the relationship between body weight and death outcomes, seriousness of outcomes, demographics and things like that. Jess takes us through it - this study is of 21,551 COVID deaths, but the data that they had about coexisting conditions was based on a limited sample of 1,890 people. So, that’s the number of people they could access medical files for. We have no idea if what we’re seeing in this paper is actually representative of everyone who dies. There’s a lot of missing data, all we’ve got is 8.7% of the total reported. So, in the total (21,551), 35.5% were female. In the smaller coexisting conditions sample (n=1890), 31.9% were female. 12.2% of those who had died had a BMI of over 30, compared to the general population in Italy where 10.9% have a BMI over 30. They should have age-matched information because we know there’s a linear association between BMI and age through to 70 years. As a comparison, 21.2% of this group has chronic kidney failure, which is way higher than the population prevalence. It’s also notable that prevalence of a BMI over 30 is higher in the cohort of women compared to men, however we see here that men were dying much more frequently than women. If BMI related to increased risk of death, we would see that relationship. We’re not seeing it. Compared with other actual serious conditions like kidney failure and hypertension, heart failure, all of those conditions are a higher prevalence compared to that in the general population in those who died compared to the population prevalence of people with a BMI over 30. The weight relationship here is not even slightly interesting when you compare it with these other conditions. And the difference in gender stands out, which we’re seeing across nearly all of these studies that we’re looking at. Maleness and age. COVID can be caught by anyone, but those who progress to a more severe state are typically male and typically older. Comorbidities of various types can also factor in there. There’s a median of 10 days from onset to death in this study - how horrific. A UK paper we’ll be discussing soon looks at how many people were ambulatory - going about their daily lives without needing assistance or their ability to get around being compromised. 98% of the people in the UK data fell into that category before their admission to hospital. If we add that to our Italian data, we’ve got all these people who were out there working, doing grocery shopping, visiting their grandchildren, and then ten days later were dead. Diet culture tells us that if we eat, move, look a certain way we are protected from all sorts of scary stuff. This worry about BMI is that fear again on a larger scale. Following citations in the Malhotra sharticle, Jess went down the rabbit hole and found a paper from Italy published on 5th April 2020, titled “Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic”. It claimed “Being obese not only increases the risk of infection and of complications for the single obese person, but recent evidence indicates that a large obese population increases the chance of appearance of a more virulent viral strain, prolongs the virus shedding throughout the total population, and eventually may increase overall mortality rate of an influenza pandemic”. The paper then goes on to present three factors which make higher weight subjects more contagious than ‘leans’, one being increased viral shedding. The paper called for higher weight folks to participate in an extended quarantine period as part of COVID 19 response, based on an association that’s been observed in Influenza A. Jess went to look at the paper it sighted, and it notes a relationship between prolonged viral shedding time, Influenza A  and higher weight, but an inverse relationship with Influenza B. This increase in viral shedding time is about one day. When all Influenza strains were pooled together in this study, there was no relationship seen. This data should be extrapolated with caution because COVID 19 is not influenza. We do actually have information about the clearance rates of the virus coming out of China, saying that there’s no difference between BMI bands when it comes to viral clearance. The second factor in this paper that makes higher weight folks more contagious than the ‘leans’ is increased viral load and breath via fine aerosols. Again, Jess followed the citation to look at the primary reference, and after lots of scrolling to the supplementary table saw that there was no statistical association between viral RNA shedding and any of the BMI categories, unadjusted or adjusted. It’s not statistically significant. And yet, they are reporting that this has been a trend that has been observed. SO DODGY. And then the third factor that contributes to increased contagiousness is “obesity results in a more virulent disease with an increased virulence and morbidity”. This paper was citing three papers, two of which were mice models, and the third a cell culture study. They extrapolated findings from those studies back to a human population - big “uh oh”. This paints a picture of a higher weight body as a petri dish for a more virulent virus, and as something that should be feared. It’s a truly horrific paper, and a really dehumanising narrative. Why are these papers citing test tube and animal models? Because they can’t find the same evidence in actual humans. Actual humans get the flu - it’s not as if we can’t observe humans with flu and must instead turn to animal and test tube models to gather information. So much damage can be done with these studies - what are the real world impacts for people in larger bodies? Isolation is terrible for our mental health. If this paper was translated into some kind of public health policy, can you imagine the disaster? The limitations on people’s freedom of movement based on BMI? It makes our blood boil. The paper gives recommendations in their concluding remarks for higher weight folks - including “lose weight with mild caloric restriction”. They also recommend the use of metformin and other glucose modifying drug treatments, and to practice mild to moderate physical activity. The final country on our whistle-stop tour of the planet - the good old UK. Another hotspot for this dreadful virus. Also somewhere with some really fantastic data. The ICNARC (Intensive Care National Audit & Research Centre) has been releasing critical care data weekly, and we now have five weeks of reports to look at. Fiona has been reading these reports each Friday as they get released. We have data on people in intensive care units in a relatively wide are of the UK - who is being admitted to intensive care, who has required lower or higher levels of respiratory support, and who has died. They’ve also given us the background stats (including BMI) for the areas that particular intensive care areas serve. The US data showed us a 50/50 gender breakdown in infection rates. In the UK data we see a much higher rate of males being admitted to intensive care due to COVID - 71.8% of people admitted. We also have data on markers of social disadvantage, conditions that people came into intensive care with, BMI and age. We can see over the five weeks of reports how things have changed - and the reports are additive, so each week’s new data is added to the growing data pool. This means we can see mistakes and assumptions we were making early on as more is revealed. In terms of BMI, there’s no difference between any of the BMI bands until you get to the “over 40” BMI band where there’s a slightly higher representation of people being admitted compared with the background population. That is likely to be an artefact of weight bias - as we discussed with the US data, that admitting staff may be more concerned about higher weight people.` The proportion of people with a BMI over 40 being admitted is dropping every week as more data is collected. We’re looking at three main things with this data. We’ve got people who are admitted compared to the general population. We’ve got people admitted who are receiving advanced support versus basic support. And we’ve got BMI band information, where we can see who in which BMI band needed advanced versus basic respiratory support. In the BMI bands when we look at basic versus advanced support, it’s about 50/50 in all the BMI bands. That would mean that BMI is not driving whether you would need advanced support - it’s not a determinant. If a higher body size meant you needed more advanced support, that would be very clear in this data. Currently in this data we have over 300 people with BMI over 40. It's enough people to see there's no trend. In terms of deaths, we want to know whether larger bodied people receiving medical care die at a higher rate than people in smaller bodies receiving medical care. When the first weekly report came out, it looked like people with a higher BMI were more likely to die versus being discharged from critical care. As the weeks have gone on, that effect has blunted. It’s a phenomenon we call ‘regression to the mean’ in statistics. When you’ve got a small amount of numbers, things can look really significant, and as you add more numbers to that data things look more average. The Index of Multiple Deprivation - categorises people from least to most deprived in society. It’s important to note that the NHS is a public health system, compared to the US health system. In terms of admission based on deprivation in the UK, we’ve got a pretty linear relationship between admission and deprivation. People coming from the least deprived areas have a lower chance of being admitted to ICU (14.8%), and 24.7% coming from the most deprived areas. There’s also a linear relationship with renal support, and with requiring more intensive interventions. This speaks to a background of medical marginalisation. It’s likely these more deprived people are coming in with poorer health to begin with. This pandemic is really revealing inequities in health - it is a stress test on health disparity. That’s what needs to be front page news, rather than fear mongering about BMI. ‘Public health’ is not about health - it’s about housing. It’s about economic access to all things. Equality and safety and opportunity. Dr Malhotra - ‘the root cause of all disease is unavoidable junk food environment’. That’s his take on it. (dick)! From one of the letters to the editor in the Obesity Journal - “The COVID 19 pandemic is challenging the world in an unprecedented way. We at Obesity have been sounding the alarm about the obesity epidemic and now must take up the cause for our patients with obesity in the face of this dual pandemic”. Notice that they offer no advice, no call to action for health services to get better at treating larger bodied people? That’s not actually what they’re calling for. They’re calling for more ‘awareness’, which is a subterfuge for ‘let’s keep up the fat hate’. If they were actually concerned, they would be calling for detailed analysis of how outcomes can be optimized for larger bodied people right now. That's not what they’re doing - they just want the narrative that ‘fat is bad’ to be out there so they can continue selling medication and ‘treatments’ for this ‘equally terrible’ condition. To that we say, “fuck that shit”. Whew, we’re feeling a bit exhausted and jet-lagged from that world journey! Thanks to Fiona and Jess for their hard work, dedication and generosity in digging into all that data and sifting through those papers. (and a special shout out to Fiona who recorded with three children who at one point all stood in front of her having a screaming tantrum) What does this all mean in the bigger picture? Hopefully this has undermined the messages of fear. At the beginning of this recording, we talked about what was firing us up about the corona-crisis. After traversing this territory, what are the take home tips? Fiona says that her take home message is to keep in your sights those people who this is relevant for. If you or a loved one has a higher BMI, Fiona’s advice is to dismiss the headlines. Do not listen to the nonsense of people who have got an ulterior motive to keep you hating your body size. Know that your BMI, if you catch COVID, may be a determinant of whether you get hospitalised or not. But once you’re hospitalised, your chances are no better or worse than anyone else based on your weight. Don’t let anyone spin you the line that you’ve been placed on a ventilator because of your BMI, because based on the data we have right now that’s not true. Jess says her take home message is centered around health disparities and inequities. This is an incredible opportunity for us to dig in once the crisis is over and start to unpick and unpack the different ways in which universal health care like we see in NZ and with the NHS may contrast with the sort of care and access that we’re seeing in the US, such as the ability to pay for care and how it impacts on people’s ability to get treatment where necessary. We here in NZ and Australia are really bloody lucky. No one on the planet has immunity to this virus, and some places on the planet are suffering to a level we can’t even comprehend. Our hearts are going out to you, and we’re really hoping that this ends quickly. Look after yourselves - we will get through this with our bullshit antennas larger and more attuned than ever before. We’re all human, we’re all in this together, and we can do so much better. Resources The study from France The Italian study on deaths from COVID-19 The spectacularly garbage study from Italy claiming that larger people are more contagious than smaller people The UK ICNARC data The nephrologists’ website Find out more about Fiona Willer here Find out more about Jess Campbell here   

Not even a global pandemic can stop the feverish hysteria of diet culture! As COVID-19 wreaks havoc across the world, there’s a sh*tload of truly hideous media articles and speculative research editorials proclaiming that higher weight people get sick more often, more severely, and even die at a higher rate than thin people. This narrative is largely being accepted as an unquestioned ‘truth’ by most media outlets. But where did this idea come from, and what does the data say? This week on All Fired Up we’re travelling around the world on a virtual COVID Contiki tour, visiting the COVID-19 hot spots, finding out where these narratives came from, and digging deep into the statistics to see what’s actually going on. I am joined by my fellow tour guides Fiona Willer, anti-diet dietitian and weight science expert, and Jess Campbell, anti-diet nutritionist and medical student, in an intrepid mission to uncover the truth! This is an epic 2-part series which is ESSENTIAL LISTENING. In such challenging times, we need objective and transparent information. It’s simply not OK to keep serving up weight biased BS. But be warned - this is obviously a very distressing topic, and this episode contains multiple uses of the “O” word (there was no way around it), plus we’re going into explicit discussions of disease, death, and BMI. Look after yourself!       Show Notes This week I have multiple guests in an incredible 2 part series! We are super fired up about COVID-19 and the BS weight-related outcomes being speculated about left, right and centre. Fiona Willer, fearless anti-diet dietitian and weight science expert, alongside Jess Campbell, anti-diet nutritionist and medical student join me to unpack the COVID-covert-crap! We’re in the midst of an epidemic, with a terrible virus taking over the world. On the day of recording (26th April 2020) there’s something like 200,000 deaths across the world and so many countries in lockdown and in crisis. And as usual, we’re pissed off - we’re hungry for data, to understand and unpack the fast-moving science behind COVID-19 and what’s making it tick. This whole podcast is about the impact of how weight stigma and weight bias impacts how we understand the world, and it’s clear now how weight bias is shaping how we understand COVID-19. So, I’m so happy we have two of the finest brains on the planet to join me on this massive research rabbit hole that we’ve been in for the last few weeks. Today we’re going to unpack the science and the published data that we’ve come across. Not all of it - there’s mountains of it - but we’ll try and do a bit of a whistle-stop tour around the planet of what kind of data is coming out of different countries, and compare and contrast that with what is being said in some of our media and our journals. What fun! A “COVID Contiki tour!” So, what are we seeing? There are some really hideous media articles around that are basically claiming this idea that higher weight people are at increased risk of catching Coronavirus, that they have more severe symptoms and a higher death rate. So our starting questions were about whether this is true, and what is it based on? I wanted to start with some examples of the really shitty media articles that are coming out that have really damaged and upset people in larger bodies. Two of them came out on April 16th, 2020 - there was an article in European Scientist from Dr Aseem Malhotra called “COVID 19 and the elephant in the room”. Fiona reckons that the use of this idiom is a bit of a litmus test for uninterrogated biases. A warning that this episode will likely mention the ‘o’ word several times, as we discuss these articles. The first page of Dr Malhotra’s hysteria-raising article says in capital letters “OBESITY - THE REAL KILLER BEHIND COVID”. Dreadful. It basically goes on to claim that being in a larger body is a risk factor for catching COVID-19, and then puts the blame straight back on people by claiming that it’s because of poor diet and body size that people are getting sick, and if only everyone went low carb, high fat immediately, everyone would be okay. He’s also insulting Boris Johnson by saying he got sick because of his weight. A complete ‘sharticle’. The very naive belief that somebody’s body size has any reflection of their current eating habits or physical activity habits needs to die. That’s the problem here. He also comes from a place of stating that the UK is the unhealthiest it’s ever been, based on body weight statistics. The whole sharticle is full of frightening stats, really running on fear, with little to back it up. He does this lovely sentence - “a recent commentary in Nature states that patients with type 2 diabetes may have 10 times greater risk of death when they contract COVID 19”. These are speculative, these articles - they’re commentaries, not based on actual data. But it still raises fear and gives a very suspicious so-called solution as well, because he’s basically recommending everyone changes their diet and they’ll be okay. And lo and behold, when you do a bit of digging into Dr Malhotra, he has a low-cal diet book! Completely unbiased, nothing to sell here! He got such a big platform for writing this article in European Scientist, giving him so much sciency-sounding cred. Articles like this do so much damage to people. And European Scientist is not a journal - it’s a magazine. Sneaky. Think of him as like the UK version of Dr Oz - he’s got the cardiology background but he’s deep into the ‘woo’ science. Then we have a New York Times article that came out on the same day, by Roni Caryn Rabin titled “Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients”. And it’s accompanied by the tried-and-true headless fatty shot. This article, it should come with a health warning for weight bias and weight stigma. Reading this article is actually what got me started on this podcast episode, because the article does reference some studies and data that were starting to come out which started the rabbit hole for us. This article implies a level of certainty that is not backed up when we actually look at the studies it is talking about. So, in addition to the media stuff, we also see this narrative being built in the academic journals that is really troubling. On April 1st 2020, there was a letter to the editor in the Obesity Journal from William Dietz, called “Obesity and its implications for COVID 19”. This letter claims a strong relationship between COVID and weight. On the same day in the same journal, The Editors Speak Out was published. It tries to make the case that this is a weight related problem and says speculative things like “we are likely to see a collision of the two public health epidemics in the US, with obesity and COVID 19 interacting to further strain our health system”. What’s interesting with that is that this is April 1st 2020, that this journal is posting with a very strong level of certainty that because COVID 19 is a weight related problem, that we need to focus our attention on people’s weight when we think about this illness. They’re pulling on information from previous pandemics too, from H1N1, SARS and MERS, and more broadly from others. They’re reporting lots of animal study outcomes for those, and then trying to project them onto humans - but in real life that needs a lot more clarification. Lots more study is needed to find out whether what we find in an animal model is also found in humans. The reliance on acute respiratory distress data, when we started to realise that COVID was presenting with an atypical ARDS - it’s apples and oranges, the data that they are relying on for those commentary pieces. So, it’s pulling stuff that’s not related and saying ‘it’s definitely going to happen in the same way’. It’s also ignoring the body of evidence of the protective mechanisms of a high BMI for ARDS as well - a lot of those articles say that increasing BMI is associated with worse outcomes with ARDS, and on balance that’s not what the evidence is either. It’s not a fair representation of the research. Whenever provided information about BMI, the tendency for journalists or research teams is to present it in a negative light no matter how borderline it is in real life. The bias goes unchecked. There’s also a perception that talking about body weight is ‘newsworthy’. It’s a topic that is exhaustingly everywhere all the time. And there’s this perception in the media that a negative result - where you test something and find no relation between the things you were looking at - people don’t want to publish that. They feel it’s not a ‘real’ result, and those studies don’t make it into the literature as much as they should. A ‘no relationship’ result should be making it into journals more often. These two opinion letters … let’s remember first of all that the name of the journal is Obesity, with a lens of ‘obesity is bad’. William Dietz is very well known for his weight bias agenda, and is very well paid off by Novo Nordisk and WW (Weight Watchers). So, shall we get started? We have a lot of ground to cover! We thought we’d do it by going around the world to figure out who is doing what research, and what is actually being found. First stop - China. We’re looking at “Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China” by Qingxian, Cai, et al. posted on April 1st 2020. This study looks at 383 people. From the title, you can see we’re going after the issue of obesity. This paper is amongst the earliest written about weight and outcomes for COVID, and in the time line it’s early in the world’s experience of coronavirus but far along in China’s experience of it. Something that’s different to other papers like it is that they talk about the types of treatment people have received, and the progression from hospitalisation through to intensive interventions like ventilation. It’s more information than we get from most of the other papers. This paper was the canary in the coal mine for the claiming a relationship between BMI and more severe outcomes. This was the first point at which the media stopped pontificating about what they ‘felt’ about BMI and had something concrete to use. But they found that there was not a relationship between BMI categorisation and severity of illness except in men. When we look at the weight information, we have 383 patients and only 41 have a BMI that China categorises as ‘obese’ (side note - China’s BMI cut off for ‘obese’ is 28). Of those 41 patients, 8 of them had liver disease. Liver disease is a condition where you can develop another condition called ascites, where there’s a lot of fluid sitting around the organs and guts and you’re not necessarily very good at getting off extra fluid. So, it may well be that a number of that 41 had a condition where they were fluid overloaded all the time. They may not then necessarily be in the ‘obese’ bracket if they did not have this liver condition at the same time. It’s not just ‘well’ humans who are in this bracket - and there are more people with liver disease in this bracket than the other BMI brackets. The liver disease is a much more serious disease to have co-occurring with COVID 19. Statistically significant in terms of progressing to severe disease is only seen in this small group of men with higher BMI. Even for a first-year undergrad, you get the message that statistical significance is great from a mass perspective, but it may not actually be clinically significant. If we know that there’s a statistically significant difference, what does that mean? What do we do with that information? If it’s not body weight, if it’s not a condition that’s highly stigmatised, then we say “oh, we should be doing better screening…” but with weight it’s like, “oh well”. Fiona is very keen to get a copy of the data in this study so she can run the numbers herself! The article concludes with the statement that “compared to individuals with so-called normal weight, obese persons were more likely to progress to severe pneumonia due to COVID 19”. And that statement hardly fits the data - they themselves only found that ‘obese’ men progressed to a more severe version! They’re spinning their own data. And THAT’S the only thing that we will hear out of that study. At one point, that paper does mention that people with higher body weight were treated later than the other patients, which might have impacted outcomes. But you couldn’t see clearly from the data what that actually did. We can’t assume that there isn’t a lot of jumbling in who got what treatment underneath the surface of these numbers, compared to a study of a more mature condition. Interesting that this study didn’t control for smoking, when something like half the population of men in China smoke? These things don’t make it into the sexy headline - this early Chinese data is the beginning point for the COVID and weight relationship. When we dig into it, it’s not so straightforward. No paper is complete - all we can do is look at the data from all the places we can get it, and look at the summary papers that have been published so far. We look for a pattern that keeps being repeated across different locations to see if it’s a real thing or not. Findings from these smaller papers could be a quirk of stats, or influenced by the author’s particular perspective. If a phenomenon is a real thing, it’s going to be repeated across many locations over and over again - it’s going to be really obvious that the effect is there. That’s what we’re searching for. More than just hysterical headlines - we need the ‘what then can we do to improve outcomes for this subgroup?’. We’d also expect dose-response with BMI, not just categories presenting with associations that aren’t held across other categories. The way that we treat BMI is nonsense in that we have a continuous measure (going from zero to infinity in a straight line). It doesn’t naturally lend itself to categorisation. Those cutoffs in BMI are to a degree arbitrary, because a human has decided them. They’re not based on something magical that happens overnight when you go from a BMI of 29 to a BMI of 30. Without a set of scales, you couldn’t measure that difference. So, the cutoffs are dodgy from that perspective. And different studies group BMI together in different categories, which means we end up with very different findings across studies. When you lump a group of people in a category, such as BMI of 30-40, we lose all the significant data of the people along the continuum within that group. They’re all treated as if they’re the same, whereas in real life they’re probably quite different in terms of their experience and health conditions. It’s not a fair treatment of the information - especially considering the study has the detail of each study participant’s BMI. Stats should be treating BMI as a continuous measure, otherwise it’s not a fair assessment. Another thing - is BMI being measured, or eyeballed, or estimated? There’s huge amounts of missing data in many studies. The Italian data (coming up!) only had BMI data on 8.8% of the people in their studies - and yet are extrapolating based on BMI. An early paper looking at cardiovascular outcomes from China got the world spinning on the BMI and COVID connection - a small cohort study of 112 patients. The study reported that of the 17 patients who died of COVID, 15 had a BMI of over 25. 15 of those 17 patients who died also had one or more of the following: hypertension, coronary heart disease or heart failure. So, whilst the paper observed an association, it did not establish causality nor did it tease out the relative contribution of each of those conditions to the outcome. This study was really used to push a direct link between BMI and COVID, despite it not standing BMI as an independent risk factor. We also have to remember that the relationship between cardiovascular disease and BMI is complex in its own right, often leaving out of the conversation the impact of weight stigma, weight cycling and medical marginalisation on folks that have heart disease and are also at a higher weight. Next stop - the USA. Published on April 8th 2020, it’s titled “Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City”. What a sexy title! As you might suspect, this paper looked at COVID patients in New York City. 7,700 people got tested, with 4,103 testing positive for COVID. This paper investigates what happened to them after testing - who got hospitalised, and who of the hospitalised became ‘critically ill’. We do find out that from this sample, 292 people have died and 417 are still hospitalised with nothing in particular happening to them. This is a situation, again, where things are being reported with a whole lot of data underneath that Fiona Willer would love to get her hands on to run the numbers. It’s interesting to find out from their sample who got hospitalised, and who became really sick - because the decision to hospitalise someone is a decision made by another human being. There’s bias built into the system. What we see from this paper is that people who are more likely to be hospitalised are people over 65, and with a BMI of over 30. Then you think okay, that’s because the people doing the admitting are clearly most worried about those two kinds of cohorts. There’s a lot of overlap - in the population we have a situation where BMI’s do increase with increasing age, so we can’t really unpick age and BMI from the other. Age is always going to be there behind other factors. Another part of that phenomenon is that it’s a particular cohort that’s aging - they had particular experiences and exposures in their childhoods, teens, adulthoods, etcetera. Today’s 65 year old is very different from a 65 year old in the 1950’s. We start seeing some more objective measures in this paper - who is progressing on to particular measures once hospitalised. What we want to see is that there’s an increase in the likelihood that people who are hospitalised progressing to ‘critical illness’ in those two categories. And we want to know what is associated with ‘critical illness’ so we can direct resources there. When things don’t go through peer review, we end up with tables that are all higglety-pigglety and driving Fiona Willer to distraction. We can see that yes, men are more likely to progress, and older people are more likely to progress to severe illness. But with the BMI categorisation, the way that it’s presented is not clear. The effect is much smaller for the relationship between BMI and progression to severe illness than it is for hospitalisation. There’s the potential for circular reasoning in this paper - weight/BMI being double-counted. And this paper is all over the place - if Fiona and Jess have to spend days getting their heads around it, the media isn’t going to have much luck. This paper is painful! Where did those 48 people go? What happened to them? A paper should present information in a way that means other research groups can understand it, and attempt to replicate it. That another group of researchers could go and run the same trial - because it’s not a ‘thing’ unless it’s replicated in multiple places. The whole point of a research paper is to illicit replication in another location, and there’s not enough information here in this paper. How did they do their multivariable regression? What did they add in? You can hear the pain in Fiona Willer’s voice here, there’s some sort of traumatic injury forming here with this paper! For those of us without a huge amount of statistical knowledge - this paper shows that you have a higher risk of being admitted to hospital if you have a higher body weight, but once you’re in hospital there’s no link between BMI and severity or risk of death. That’s clear in this data. But going back to that New York Times article we discussed earlier, the lead author of this paper is quoted as saying “obesity also appears to be a factor for higher risk of death from COVID 19”. And she’s saying that to the New York Times without any evidence in her OWN paper. This research article did not even discuss deaths. It did have death statistics noted in the flow chart, but no data was presented on who was more likely to die - let alone specific data to show a relationship between higher body weight and risk of death. This is a key example of how scientific data gets translated into a media message. And this is a pretty scary message - that if you’re higher weight you are more likely to die from COVID 19. And it’s not a message backed up by the science here. We can give these researchers a lot of leeway - there’s no peer review process here, they’re under clinical pressure, there’s a horrifying death rate in New York. There’s a push to get data out so they can work out what ‘best practice’ is for this virus. There’s no thought here that this is malicious - but it shows how important it is to be careful with what we print and to be careful with our data, and to be careful with what we say to the media. This is affecting human lives. At the very least, include the complete data set that you’re analysing so others can use it and go through that review process. Highlighting an article in Wired from Christy Harrison that talks about how troubling these articles are. She points out that this research was not controlling for any factors that we know have a massive impact on people’s health, such as cardiovascular health, diabetes, hypertension - factors like socioeconomic status, weight bias, race. She points out that BMI is quite a lazy tool and we can’t see all that inequality that happens with health risks and how we’re treated in health systems. BMI is used as a scapegoat for the disparities in African-American communities too - instead of digging deep into marginalisation, colonisation, socioeconomic status to see how they’re affecting outcomes. It’s easier to blame it on individual food choices - and easy to say that BMI is a simple, numerical measure compared to the messiness of factors such as marginalisation. There’s a Centre for Disease Control (CDC) report that is being used to back up this relationship between weight and COVID risk/severity. It looks at clinical data for people being admitted during March 2020, the first month that the US started surveying data. There’s 1,482 patients in hospital - 74.5% were over 50, 45% were male, rates were highest amongst people over the age of 65. They had data on people in this cohort for people with underlying conditions - the comorbidities these people might have - but they only have it for 12% of their dataset. Of those 12% - 89% have one or more underlying condition, most common being hypertension (49%), what they call ‘obesity’ (48% - in the US ‘obesity’ is classified as a disease). 34% had chronic lung disease, 28% had diabetes, and 27% had cardiovascular disease. What they’re concluding from this is that older people have higher rates of being hospitalised, and also that the majority of people being hospitalised with COVID have an underlying medical condition - but remember, we only have that data for 12%. Something else to take away - 48% of the 12% had what they call ‘obesity’. In the US, the prevalence nation-wide of ‘obesity’ is 42%. So, it’s only marginally higher in terms of bodyweight across the American population rather than being something statistically alarming. In the UK, we saw as early as the 23rd of March that we saw the first report out of the ICU units that ran in the media as ‘60%, 70% of admissions to ICU were in higher weight bodies’. But of course, this is not news - people showing up in the ICU were only reflecting the population distribution of BMI. Resources The horrible “Elephant in the Room” sharticle from Dr Malhotra The Editors of the journal “Obesity” “speaking out”/raising panic about the link between body weight and COVID-19 William Dietz, obesity researcher with massive links to Novo Nordisk & WW, and his speculation filled “Letter to the Editor” of the journal “Obesity” The New York Times article full of claims of a link between higher BMI and COVID19 Chinese article with data for 383 patients Chinese article for the first 112 Corona virus patients USA article on the New York COVID-19 patients Christy Harrison’s wonderful pushback article in Wired USA Centre for Disease Control (CDC) article on COVID-19 patients Find out more about Fiona Willer here Find out more about Jess Campbell here     

Not even a global pandemic can stop the feverish hysteria of diet culture! As COVID-19 wreaks havoc across the world, there’s a sh*tload of truly hideous media articles and speculative research editorials proclaiming that higher weight people get sick more often, more severely, and even die at a higher rate than thin people. This narrative is largely being accepted as an unquestioned ‘truth’ by most media outlets. But where did this idea come from, and what does the data say? This week on All Fired Up we’re travelling around the world on a virtual COVID Contiki tour, visiting the COVID-19 hot spots, finding out where these narratives came from, and digging deep into the statistics to see what’s actually going on. I am joined by my fellow tour guides Fiona Willer, anti-diet dietitian and weight science expert, and Jess Campbell, anti-diet nutritionist and medical student, in an intrepid mission to uncover the truth! This is an epic 2-part series which is ESSENTIAL LISTENING. In such challenging times, we need objective and transparent information. It’s simply not OK to keep serving up weight biased BS. But be warned - this is obviously a very distressing topic, and this episode contains multiple uses of the “O” word (there was no way around it), plus we’re going into explicit discussions of disease, death, and BMI. Look after yourself!       Show Notes This week I have multiple guests in an incredible 2 part series! We are super fired up about COVID-19 and the BS weight-related outcomes being speculated about left, right and centre. Fiona Willer, fearless anti-diet dietitian and weight science expert, alongside Jess Campbell, anti-diet nutritionist and medical student join me to unpack the COVID-covert-crap! We’re in the midst of an epidemic, with a terrible virus taking over the world. On the day of recording (26th April 2020) there’s something like 200,000 deaths across the world and so many countries in lockdown and in crisis. And as usual, we’re pissed off - we’re hungry for data, to understand and unpack the fast-moving science behind COVID-19 and what’s making it tick. This whole podcast is about the impact of how weight stigma and weight bias impacts how we understand the world, and it’s clear now how weight bias is shaping how we understand COVID-19. So, I’m so happy we have two of the finest brains on the planet to join me on this massive research rabbit hole that we’ve been in for the last few weeks. Today we’re going to unpack the science and the published data that we’ve come across. Not all of it - there’s mountains of it - but we’ll try and do a bit of a whistle-stop tour around the planet of what kind of data is coming out of different countries, and compare and contrast that with what is being said in some of our media and our journals. What fun! A “COVID Contiki tour!” So, what are we seeing? There are some really hideous media articles around that are basically claiming this idea that higher weight people are at increased risk of catching Coronavirus, that they have more severe symptoms and a higher death rate. So our starting questions were about whether this is true, and what is it based on? I wanted to start with some examples of the really shitty media articles that are coming out that have really damaged and upset people in larger bodies. Two of them came out on April 16th, 2020 - there was an article in European Scientist from Dr Aseem Malhotra called “COVID 19 and the elephant in the room”. Fiona reckons that the use of this idiom is a bit of a litmus test for uninterrogated biases. A warning that this episode will likely mention the ‘o’ word several times, as we discuss these articles. The first page of Dr Malhotra’s hysteria-raising article says in capital letters “OBESITY - THE REAL KILLER BEHIND COVID”. Dreadful. It basically goes on to claim that being in a larger body is a risk factor for catching COVID-19, and then puts the blame straight back on people by claiming that it’s because of poor diet and body size that people are getting sick, and if only everyone went low carb, high fat immediately, everyone would be okay. He’s also insulting Boris Johnson by saying he got sick because of his weight. A complete ‘sharticle’. The very naive belief that somebody’s body size has any reflection of their current eating habits or physical activity habits needs to die. That’s the problem here. He also comes from a place of stating that the UK is the unhealthiest it’s ever been, based on body weight statistics. The whole sharticle is full of frightening stats, really running on fear, with little to back it up. He does this lovely sentence - “a recent commentary in Nature states that patients with type 2 diabetes may have 10 times greater risk of death when they contract COVID 19”. These are speculative, these articles - they’re commentaries, not based on actual data. But it still raises fear and gives a very suspicious so-called solution as well, because he’s basically recommending everyone changes their diet and they’ll be okay. And lo and behold, when you do a bit of digging into Dr Malhotra, he has a low-cal diet book! Completely unbiased, nothing to sell here! He got such a big platform for writing this article in European Scientist, giving him so much sciency-sounding cred. Articles like this do so much damage to people. And European Scientist is not a journal - it’s a magazine. Sneaky. Think of him as like the UK version of Dr Oz - he’s got the cardiology background but he’s deep into the ‘woo’ science. Then we have a New York Times article that came out on the same day, by Roni Caryn Rabin titled “Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients”. And it’s accompanied by the tried-and-true headless fatty shot. This article, it should come with a health warning for weight bias and weight stigma. Reading this article is actually what got me started on this podcast episode, because the article does reference some studies and data that were starting to come out which started the rabbit hole for us. This article implies a level of certainty that is not backed up when we actually look at the studies it is talking about. So, in addition to the media stuff, we also see this narrative being built in the academic journals that is really troubling. On April 1st 2020, there was a letter to the editor in the Obesity Journal from William Dietz, called “Obesity and its implications for COVID 19”. This letter claims a strong relationship between COVID and weight. On the same day in the same journal, The Editors Speak Out was published. It tries to make the case that this is a weight related problem and says speculative things like “we are likely to see a collision of the two public health epidemics in the US, with obesity and COVID 19 interacting to further strain our health system”. What’s interesting with that is that this is April 1st 2020, that this journal is posting with a very strong level of certainty that because COVID 19 is a weight related problem, that we need to focus our attention on people’s weight when we think about this illness. They’re pulling on information from previous pandemics too, from H1N1, SARS and MERS, and more broadly from others. They’re reporting lots of animal study outcomes for those, and then trying to project them onto humans - but in real life that needs a lot more clarification. Lots more study is needed to find out whether what we find in an animal model is also found in humans. The reliance on acute respiratory distress data, when we started to realise that COVID was presenting with an atypical ARDS - it’s apples and oranges, the data that they are relying on for those commentary pieces. So, it’s pulling stuff that’s not related and saying ‘it’s definitely going to happen in the same way’. It’s also ignoring the body of evidence of the protective mechanisms of a high BMI for ARDS as well - a lot of those articles say that increasing BMI is associated with worse outcomes with ARDS, and on balance that’s not what the evidence is either. It’s not a fair representation of the research. Whenever provided information about BMI, the tendency for journalists or research teams is to present it in a negative light no matter how borderline it is in real life. The bias goes unchecked. There’s also a perception that talking about body weight is ‘newsworthy’. It’s a topic that is exhaustingly everywhere all the time. And there’s this perception in the media that a negative result - where you test something and find no relation between the things you were looking at - people don’t want to publish that. They feel it’s not a ‘real’ result, and those studies don’t make it into the literature as much as they should. A ‘no relationship’ result should be making it into journals more often. These two opinion letters … let’s remember first of all that the name of the journal is Obesity, with a lens of ‘obesity is bad’. William Dietz is very well known for his weight bias agenda, and is very well paid off by Novo Nordisk and WW (Weight Watchers). So, shall we get started? We have a lot of ground to cover! We thought we’d do it by going around the world to figure out who is doing what research, and what is actually being found. First stop - China. We’re looking at “Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China” by Qingxian, Cai, et al. posted on April 1st 2020. This study looks at 383 people. From the title, you can see we’re going after the issue of obesity. This paper is amongst the earliest written about weight and outcomes for COVID, and in the time line it’s early in the world’s experience of coronavirus but far along in China’s experience of it. Something that’s different to other papers like it is that they talk about the types of treatment people have received, and the progression from hospitalisation through to intensive interventions like ventilation. It’s more information than we get from most of the other papers. This paper was the canary in the coal mine for the claiming a relationship between BMI and more severe outcomes. This was the first point at which the media stopped pontificating about what they ‘felt’ about BMI and had something concrete to use. But they found that there was not a relationship between BMI categorisation and severity of illness except in men. When we look at the weight information, we have 383 patients and only 41 have a BMI that China categorises as ‘obese’ (side note - China’s BMI cut off for ‘obese’ is 28). Of those 41 patients, 8 of them had liver disease. Liver disease is a condition where you can develop another condition called ascites, where there’s a lot of fluid sitting around the organs and guts and you’re not necessarily very good at getting off extra fluid. So, it may well be that a number of that 41 had a condition where they were fluid overloaded all the time. They may not then necessarily be in the ‘obese’ bracket if they did not have this liver condition at the same time. It’s not just ‘well’ humans who are in this bracket - and there are more people with liver disease in this bracket than the other BMI brackets. The liver disease is a much more serious disease to have co-occurring with COVID 19. Statistically significant in terms of progressing to severe disease is only seen in this small group of men with higher BMI. Even for a first-year undergrad, you get the message that statistical significance is great from a mass perspective, but it may not actually be clinically significant. If we know that there’s a statistically significant difference, what does that mean? What do we do with that information? If it’s not body weight, if it’s not a condition that’s highly stigmatised, then we say “oh, we should be doing better screening…” but with weight it’s like, “oh well”. Fiona is very keen to get a copy of the data in this study so she can run the numbers herself! The article concludes with the statement that “compared to individuals with so-called normal weight, obese persons were more likely to progress to severe pneumonia due to COVID 19”. And that statement hardly fits the data - they themselves only found that ‘obese’ men progressed to a more severe version! They’re spinning their own data. And THAT’S the only thing that we will hear out of that study. At one point, that paper does mention that people with higher body weight were treated later than the other patients, which might have impacted outcomes. But you couldn’t see clearly from the data what that actually did. We can’t assume that there isn’t a lot of jumbling in who got what treatment underneath the surface of these numbers, compared to a study of a more mature condition. Interesting that this study didn’t control for smoking, when something like half the population of men in China smoke? These things don’t make it into the sexy headline - this early Chinese data is the beginning point for the COVID and weight relationship. When we dig into it, it’s not so straightforward. No paper is complete - all we can do is look at the data from all the places we can get it, and look at the summary papers that have been published so far. We look for a pattern that keeps being repeated across different locations to see if it’s a real thing or not. Findings from these smaller papers could be a quirk of stats, or influenced by the author’s particular perspective. If a phenomenon is a real thing, it’s going to be repeated across many locations over and over again - it’s going to be really obvious that the effect is there. That’s what we’re searching for. More than just hysterical headlines - we need the ‘what then can we do to improve outcomes for this subgroup?’. We’d also expect dose-response with BMI, not just categories presenting with associations that aren’t held across other categories. The way that we treat BMI is nonsense in that we have a continuous measure (going from zero to infinity in a straight line). It doesn’t naturally lend itself to categorisation. Those cutoffs in BMI are to a degree arbitrary, because a human has decided them. They’re not based on something magical that happens overnight when you go from a BMI of 29 to a BMI of 30. Without a set of scales, you couldn’t measure that difference. So, the cutoffs are dodgy from that perspective. And different studies group BMI together in different categories, which means we end up with very different findings across studies. When you lump a group of people in a category, such as BMI of 30-40, we lose all the significant data of the people along the continuum within that group. They’re all treated as if they’re the same, whereas in real life they’re probably quite different in terms of their experience and health conditions. It’s not a fair treatment of the information - especially considering the study has the detail of each study participant’s BMI. Stats should be treating BMI as a continuous measure, otherwise it’s not a fair assessment. Another thing - is BMI being measured, or eyeballed, or estimated? There’s huge amounts of missing data in many studies. The Italian data (coming up!) only had BMI data on 8.8% of the people in their studies - and yet are extrapolating based on BMI. An early paper looking at cardiovascular outcomes from China got the world spinning on the BMI and COVID connection - a small cohort study of 112 patients. The study reported that of the 17 patients who died of COVID, 15 had a BMI of over 25. 15 of those 17 patients who died also had one or more of the following: hypertension, coronary heart disease or heart failure. So, whilst the paper observed an association, it did not establish causality nor did it tease out the relative contribution of each of those conditions to the outcome. This study was really used to push a direct link between BMI and COVID, despite it not standing BMI as an independent risk factor. We also have to remember that the relationship between cardiovascular disease and BMI is complex in its own right, often leaving out of the conversation the impact of weight stigma, weight cycling and medical marginalisation on folks that have heart disease and are also at a higher weight. Next stop - the USA. Published on April 8th 2020, it’s titled “Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City”. What a sexy title! As you might suspect, this paper looked at COVID patients in New York City. 7,700 people got tested, with 4,103 testing positive for COVID. This paper investigates what happened to them after testing - who got hospitalised, and who of the hospitalised became ‘critically ill’. We do find out that from this sample, 292 people have died and 417 are still hospitalised with nothing in particular happening to them. This is a situation, again, where things are being reported with a whole lot of data underneath that Fiona Willer would love to get her hands on to run the numbers. It’s interesting to find out from their sample who got hospitalised, and who became really sick - because the decision to hospitalise someone is a decision made by another human being. There’s bias built into the system. What we see from this paper is that people who are more likely to be hospitalised are people over 65, and with a BMI of over 30. Then you think okay, that’s because the people doing the admitting are clearly most worried about those two kinds of cohorts. There’s a lot of overlap - in the population we have a situation where BMI’s do increase with increasing age, so we can’t really unpick age and BMI from the other. Age is always going to be there behind other factors. Another part of that phenomenon is that it’s a particular cohort that’s aging - they had particular experiences and exposures in their childhoods, teens, adulthoods, etcetera. Today’s 65 year old is very different from a 65 year old in the 1950’s. We start seeing some more objective measures in this paper - who is progressing on to particular measures once hospitalised. What we want to see is that there’s an increase in the likelihood that people who are hospitalised progressing to ‘critical illness’ in those two categories. And we want to know what is associated with ‘critical illness’ so we can direct resources there. When things don’t go through peer review, we end up with tables that are all higglety-pigglety and driving Fiona Willer to distraction. We can see that yes, men are more likely to progress, and older people are more likely to progress to severe illness. But with the BMI categorisation, the way that it’s presented is not clear. The effect is much smaller for the relationship between BMI and progression to severe illness than it is for hospitalisation. There’s the potential for circular reasoning in this paper - weight/BMI being double-counted. And this paper is all over the place - if Fiona and Jess have to spend days getting their heads around it, the media isn’t going to have much luck. This paper is painful! Where did those 48 people go? What happened to them? A paper should present information in a way that means other research groups can understand it, and attempt to replicate it. That another group of researchers could go and run the same trial - because it’s not a ‘thing’ unless it’s replicated in multiple places. The whole point of a research paper is to illicit replication in another location, and there’s not enough information here in this paper. How did they do their multivariable regression? What did they add in? You can hear the pain in Fiona Willer’s voice here, there’s some sort of traumatic injury forming here with this paper! For those of us without a huge amount of statistical knowledge - this paper shows that you have a higher risk of being admitted to hospital if you have a higher body weight, but once you’re in hospital there’s no link between BMI and severity or risk of death. That’s clear in this data. But going back to that New York Times article we discussed earlier, the lead author of this paper is quoted as saying “obesity also appears to be a factor for higher risk of death from COVID 19”. And she’s saying that to the New York Times without any evidence in her OWN paper. This research article did not even discuss deaths. It did have death statistics noted in the flow chart, but no data was presented on who was more likely to die - let alone specific data to show a relationship between higher body weight and risk of death. This is a key example of how scientific data gets translated into a media message. And this is a pretty scary message - that if you’re higher weight you are more likely to die from COVID 19. And it’s not a message backed up by the science here. We can give these researchers a lot of leeway - there’s no peer review process here, they’re under clinical pressure, there’s a horrifying death rate in New York. There’s a push to get data out so they can work out what ‘best practice’ is for this virus. There’s no thought here that this is malicious - but it shows how important it is to be careful with what we print and to be careful with our data, and to be careful with what we say to the media. This is affecting human lives. At the very least, include the complete data set that you’re analysing so others can use it and go through that review process. Highlighting an article in Wired from Christy Harrison that talks about how troubling these articles are. She points out that this research was not controlling for any factors that we know have a massive impact on people’s health, such as cardiovascular health, diabetes, hypertension - factors like socioeconomic status, weight bias, race. She points out that BMI is quite a lazy tool and we can’t see all that inequality that happens with health risks and how we’re treated in health systems. BMI is used as a scapegoat for the disparities in African-American communities too - instead of digging deep into marginalisation, colonisation, socioeconomic status to see how they’re affecting outcomes. It’s easier to blame it on individual food choices - and easy to say that BMI is a simple, numerical measure compared to the messiness of factors such as marginalisation. There’s a Centre for Disease Control (CDC) report that is being used to back up this relationship between weight and COVID risk/severity. It looks at clinical data for people being admitted during March 2020, the first month that the US started surveying data. There’s 1,482 patients in hospital - 74.5% were over 50, 45% were male, rates were highest amongst people over the age of 65. They had data on people in this cohort for people with underlying conditions - the comorbidities these people might have - but they only have it for 12% of their dataset. Of those 12% - 89% have one or more underlying condition, most common being hypertension (49%), what they call ‘obesity’ (48% - in the US ‘obesity’ is classified as a disease). 34% had chronic lung disease, 28% had diabetes, and 27% had cardiovascular disease. What they’re concluding from this is that older people have higher rates of being hospitalised, and also that the majority of people being hospitalised with COVID have an underlying medical condition - but remember, we only have that data for 12%. Something else to take away - 48% of the 12% had what they call ‘obesity’. In the US, the prevalence nation-wide of ‘obesity’ is 42%. So, it’s only marginally higher in terms of bodyweight across the American population rather than being something statistically alarming. In the UK, we saw as early as the 23rd of March that we saw the first report out of the ICU units that ran in the media as ‘60%, 70% of admissions to ICU were in higher weight bodies’. But of course, this is not news - people showing up in the ICU were only reflecting the population distribution of BMI. Resources The horrible “Elephant in the Room” sharticle from Dr Malhotra The Editors of the journal “Obesity” “speaking out”/raising panic about the link between body weight and COVID-19 William Dietz, obesity researcher with massive links to Novo Nordisk & WW, and his speculation filled “Letter to the Editor” of the journal “Obesity” The New York Times article full of claims of a link between higher BMI and COVID19 Chinese article with data for 383 patients Chinese article for the first 112 Corona virus patients USA article on the New York COVID-19 patients Christy Harrison’s wonderful pushback article in Wired USA Centre for Disease Control (CDC) article on COVID-19 patients Find out more about Fiona Willer here Find out more about Jess Campbell here     

The road to Food Peace is not all rainbows and butterflies. Most will experience rejection, body hate, and complicated ways of eating. If you come from that place and journeying toward intuitive eating, you may crave more control in the process. I made this week's Love Food Podcast episode just for you. Subscribe and leave a review here in just seconds. This episode is brought to you by my courses: PCOS and Food Peace and Dietitians PCOS and Food Peace. You CAN make peace with food even with PCOS and I want to show you how. This episode's Dear Food letter: Dear Food, Our relationship has been complicated since before I can remember. I’ve been overweight my entire life and you have always been the one i put the blame on. I was very young when i was told you were bad for me. I knew to stay away from carbs and sweets before i went to grade school. My mother lived for diet culture. Every month it was a new diet and I was always forced to participate. The diets never worked. I couldn’t stay away from you. Although i knew i was overweight i never wanted to admit it. I was ashamed of the word fat. After my dad passed away our bond grew closer. We were now best friends. You were there for the tears and you were there for the laughs. I used you as my crutch to get me out of a dark place. After a year i realized that we needed a break. My clothes were tighter, i went up pant sizes, and the pictures from spring fling made me want to vomit. I didnt want to be the fat girl any more. At 16 years old i just wanted to fit in. So I lost Xlbs, i joined the dance team, and the cheer squad. I was still overweight but i felt good about myself and all of the new friends i made. I managed to keep the Xlbs off for 2 years until I graduated. That’s when i started working and could start to feed myself. I ate fast food every night after work. I loved it. I had never been able to experience this. As a child i rarely got fast food because our family was always on a diet. I couldn’t control myself. Sometimes I’d get fast food multiple times a day. Before i knew it the Xlbs were back.  I managed to not gain anymore weight for about 4 years. Then i married my husband and my relationship with food went sour. I gained Xlbs over the first year i was married. I remember hearing the doctor say my weight and i almost fell to the floor. How could this happen? Ive been overeating for years and i never gained anything. I knew a change needed to happen. But how? I started dieting. I would spend hours planning meals and snacks for the week but that grew tiresome fast. I figured I’d try keto everyone raves about how easy it is. It didnt matter what diet i did i always managed to overeat to the point of being sick. I heard about intuitive eating from a friend at the gym and she suggested i Look into it. Once again i find myself binging on unhealthy snacks. I’ve been desperately trying to rebuild a healthy relationship with food but some how i always find myself in the fridge eating until my stomach cant handle anymore. I’m lost and confused.  I am frustrated and desperate to get control of my life again.  Sincerely, Desperate For Help Show Notes: Julie Dillon RD blog Link to subscribe to the Love Food’s Food Peace Syllabus. Fiona Willer's Weight Science podcast Anti-Diet book (aff) Intuitive Eating book (aff) and website Find an Eating Disorder Dietitians near you. Do you have a complicated relationship with food? I want to help! Send your Dear Food letter to LoveFoodPodcast@gmail.com.  Click here to leave me a review in iTunes and subscribe. This type of kindness helps the show continue!

"Data Driven meets Client-Centered" with Fiona Sutherland & guest Fiona Willer (aka "Fi-Squared) In this episode, Fiona Willer joins Fi again for another "Fi-squared" episode and speak about: The essentials of weight science, and what every Dietitian needs to know about understanding research The problematic nature of Paediatric weight-focussed research, including lack of long-term follow up. The discrepancies between the way Dietitians identify their practice and their level of knowledge in weight-inclusive approaches. Fi’s favourite episode from her “Unpacking Weight Science” Podcast and what you can expect from signing up! If Fi was designing her own Dietetic program…..and her wishes for the profession Upcoming training in 2020   Fiona's Unpacking Weight Science Course Follow Fiona on Instagram or Twitter   More about Fiona: Fiona Willer is an Advanced Accredited Practising Dietitian who combines academic research, university lecturing and public speaking with creating professional development resources and training for health professionals through her business, Health Not Diets. Her research areas are dietetic private practice benchmarking, inter-professional learning and the integration of weight neutral lifestyle approaches (including Health at Every Size® and the Non-Diet Approach) into the practice of health professionals, particularly dietitians. Creator of the innovative Unpacking Weight Science professional development podcast, Fiona has great enthusiasm for both interrogating weight research and overusing food and eating metaphors in everyday life.  

This week my guest is the fierce and wonderful president of HAES Australia, Dr Carolynne White! A Facebook post from Headspace in Hervey Bay fired her (and many others) up when it claimed that eating sugary food causes mental health problems! As a mental health expert and anti-diet advocate, Carolynne knows how much this kind of messaging oversimplifies, stigmatises, and downright does damage. The fact that the SUGAR IS EVIL message is being spruiked by one of Australia’s leading adolescent mental health organisations is a worry. Particularly when it’s part of “The Push Up Challenge”, a fund raiser for Headspace which raises awareness about youth suicide by forcing people to do over a hundred push ups a day. Has anyone at Headspace heard of eating disorders? Why is encouraging excessive exercise in teens ok? Do they know how hung up young people are about body image and health? WHAT ON EARTH ARE THEY THINKING!? Join us as we rant about this extremely ill advised campaign. The truth is, mental health and physical health just can’t be separated, and we need to be doing a lot more critical thinking to avoid doing harm! CW: Discussions about suicide, mental illness & eating disorders.     Show Notes     My guest this week is Dr Carolynne White, occupational therapist and health promotion lecturer. Through her professional experience and her PhD research, Carolynne has formed the strong opinion that good mental health is absolutely necessary to support good overall health. Carolynne is also the president of HAES Australia. Carolynne got all fired up about a facebook post from Headspace at Hervey Bay in Queensland, about a ‘push up challenge’ to raise awareness about suicide and to raise money for Headspace. Headspace is a very well funded network of mental health treatment centres for adolescents and young people. Headspace enjoy a lot of government funding here in Australia, and also gather a lot of attention in the media. Their Mission is ‘to provide tailored and holistic mental health support to young people aged 12-25”. They focus on early intervention and prevention of mental illness, as well as focusing on physical health as well. According to the website, the ‘push up challenge’ was started by a ‘bunch of mates’ passionate about the topic. The challenge involves doing 3128 push ups over the month of August - one for each life lost to suicide in 2017. This is a LOT of push ups - over 100 a day. Louise’s first thought - why are headspace supporting an initiative that uses the symptoms of a major mental illness - ie the compulsive exercise aspects of an eating disorder - to raise awareness of mental illness? It just seems very ill advised. Particularly when you consider that eating disorder have the highest mortality rate, particularly from suicide, among young people. The man who started the push up challenge is Nick Hudson, he’s from Perth. He’s a white Aussie bloke in his thirties. Louise found 2 media articles about him which said slightly different things. One said he had heart surgery as a child, and when he got older his fitness declined and he realised he needed more heart surgery. This made him depressed, and one of the ways he came out of the depression was to start this push up challenge. But then another news article which came out about the same time (and was accompanied by a truly awful ‘Fitspo on steroids’ picture) said that his father had suffered from depression for many years but had never told him. When he discovered the depression, he ‘did some research’  on mental health. Then he and his mates, who do push ups as part of their regular fitness regime, decided to turn it into something more. So it’s odd to have 2 such different stories out there in the media, normally people have just one story, but there you go. There is a level of privilege reflected in the message that in order to come out of depression you need to do a few push ups. It’s great that this happened for him, but many people need a lot more help than just exercise to recover from something as complex as depression. Plus, particularly with people that Louise sees in her practice, the LAST thing they need is to focus on counting push ups! The Hervey Bay Headspace post was particularly problematic because he was posting about the evils of sugar as well. He claimed that high intakes of sugar increase the likelihood of developing mental illness, and more severe symptoms of depression. This of course caused a furore ! Having worked in mental health, Carolynne thinks of the impact a message like this would have on an adolescent who might be struggling with their mental health, and how unhelpful it would be. The person who made this claim was a personal trainer, and obviously way outside of their scope of practice or expertise making claims like that. This post did attract a lot of push back from mental health experts. Particularly considering the vulnerability and age of the audience of Headspace! Australian teenagers are really hung up on issues of body image, health, etc, and we are seeing very high rates of eating disorder symptomatology which is being overlooked in this ‘health obsession epidemic’ that we’re all suffering from. The latest Mission Australia Youth Survey (2018) found that 30% of young people reported feeling ‘very’ or ‘extremely’ concerned about their mental health and their body image. These were equal concerns. Younger women reported higher levels of concern than younger men. Gender dynamics play into this. Thinking of a bloke modeling the push up challenge and the impact that might have on a teenage girl…. A paper that has just come in in 2019 looks at the point prevalence of eating disorders in young people in Australia. Data from 5000 Aussie teens aged 11-19 showed that 22.2% met diagnostic criteria for an eating disorder. That’s 1 in 5 kids! 1 in 3 Aussie kids have high levels of concern about their body image and 1 in 5 have diagnosable eating disorders. In girls, the eating disorder rate is 33.3% and in boys it’s 12%. This is a huge concern and we need to centre this in our public health messaging. The push up challenge is an extreme fitness challenge. Looking through the Instagram for the push up challenge, a very narrow range (ie very muscular physiques) are represented. If we couple that with the facebook post which moralises food, it creates an environment which compromises recovery for those suffering with eating disorders. Are the people at Headspace really thinking this through? The Headspace demographic includes very young teenagers who are still very much black and white thinkers. If a 13 year old comes across the Hervey Bay page with its comments on sugar, they don’t have the cognitive capacity to see any nuance or think critically about it. This message is coming from an authority figure and they are highly likely to view it as: do not eat sugar under any circumstances. This is everywhere in Louise’s clinical practice at the moment: young kids developing eating disorders following exposure to well meaning messages about the nutritional value of food. Basically, no-one in high school should watch ‘That Sugar Film’. Adolescence is the THE highest risk time for development of an eating disorder. 14 years old is the average age kids can develop one. This is the exact demographic of Headspace’s audience and for these type of social media messages to be demonising sugar and pushing compulsive exercise, it’s really not on. Headspace have done a great job promoting themselves as a safe place for people with diverse identities to go. They need to incorporate body diversity into their messaging as well, many teens suffering from mental illness will be in larger bodies and need to feel safe and included. All of the eating disorder statistics from the paper on point prevalence we just discussed are higher in kids with higher body weights. People in larger bodies have eating disorders more often than smaller people, but if Headspace is full of gymbunnies doing workouts….hello!? Headspace’s own website discusses eating disorders & their symptoms, with sentences beginning with “Excessive exercise is a symptom of an eating disorder”…  The push up challenge has raised $2.5 million for Headspace, which is phenomenal. It’s a great job - but the methods of fund raising definitely need to be worked on! Headspace do a great job in our community, but they are well funded. There are 107 Headspace centres around the country. They get $95 million a year from the Government, and have just been given another $50 million. And when a psychologist at headspace sees a teenager, they bill Medicare for the appointment. Many of the psychologists are contractors, not employees of Headspace, so they take a % of the Medicare subsidised fee as payment. Headspace do great work, but they are well funded. In comparison we have a desperate shortage of hospital beds for people suffering from severe eating disorders. So many areas of mental health are severely underserviced. It seems that the ‘popular’ ideas get funded. So - if anyone listening wants to raise funds for mental health don’t give it to Headspace, they’re doing alright! This whole push up challenge for Headspace runs on the idea that exercise is always good for mental health. And there’s a real push in mental health to include ‘lifestyle’, or physical health. Carolynne started her career as an Occupational Therapist in a maximum security hospital - as did Louise! When Carolynne started, a report came out of Western Australia which found a huge disparity between physical health of people with mental illness and those without, and the gap in life expectancy. Working in a prison hospital, you see people from all walks of life. People who have experienced extreme poverty, severe trauma, and mental illness, and all of that mixed up together has a huge impact on their physical health. In the past few years there has been increased attention to the physical health status of people with mental illness. The National Mental Health Commission drafted up a consensus statement, and the stats are just astounding. In Australia, 1 in 5 people have a mental illness, and 16% of Australians live with both a physical health condition and a mental illness. If you have both, your life expectancy is reduced by 15.9 years for men and 12 years for women. This is conservative: around the world, the gap can be as much as 20 years. It’s staggering - much more than cigarette smoking. A few years ago Carolynne took part in Partners in Recovery, an initiative for people living with mental illness. During this period, 3 of the people involved died. Carolynne initially thought it might have been suicide. On of them had taken their own life, but one had a heart attack and the other died in their sleep of ‘natural causes’. This is the general case: People with a mental illness who die early, usually die from physical causes other than suicide. The main causes are cardiometabolic: heart disease, stroke, diabetes, and metabolic syndrome. All of the issues often attributed to higher weight. In the search to improve health and mortality outcomes, the focus has unfortunately of course landed on people’s weight. Because this is just what people with mental health issues need - a good push up! People with mental illness are more likely than the general population to have a BMI over 35. And that’s not to do with not eating the ‘right’ food or not getting enough exercise! A lot has to do with medication related weight gain. People taking medication to take care of their mental health is really positive, and if a side effect of that is weight gain, focusing on that and ‘blaming’ people for poor lifestyle habits is unfair. Antipsychotic medications, bipolar meds, and some antidepressant medications can have weight gain as a side effect. Many people Louise speak with could benefit a lot from medication, but often hesitate because of fear of weight gain. Or, people choosing to go off medication which is benefitting their mental health because of weight gain. This really brings home the reality of weight stigma. The drive for thinness in our culture is valued above everything else. Carolynne had an experience of gaining weight after being put on medication for depression, which she found confronting as she had previously lived in an always thin body. It’s very understandable, but it makes her sad, as in our culture people’s mental health might be compromised because of that societal pressure. Imagine if we lived in a truly weight inclusive society how the experience of mental illness might be very different? There’s already stigma around mental illness. If you’re going to lump weight stigma on top of that it just compounds the disadvantage that people experience. If someone gets well from taking medication, but then comes to live in a larger body, and experiences weight based discrimination, it’s yet another experience of oppression, exclusion, and marginalisation which is extremely weathering to physical and mental health. Many of the organisations that champion physical health don’t think about mental health whatsoever. So they don’t think about the impact of their campaigns on people’s mental health. The idea of perpetuating weight stigma and the health impacts of that (both physical and mental) - it’s just not thought of. Given the numbers of people suffering with mental illness, it is not ok that they are not considered in these campaigns. Particularly when you consider that people with mental illness are more likely to get these conditions, mental health should be people’s first consideration. The fact that they’re not is another example of entrenched stigma. They’re just erased, not visible anywhere. It’s depressing. This concept of the mind and body being separate goes back to the 16th century, with French Philosopher Descartes who championed the separation of the body from the mind. This is known as Dualism. This is where it all started but we need to get out of the 16th century and into the 2000’s! Mind and body are not separate, and physical and mental health are not separate either. It is super dangerous when we do. Carolynne & Louise first met at an Eating Disorders and Obesity Conference in the Goldcoast, where Carolynne got told off for being ‘irresponsible’ for talking about her non-diet community intervention, and Fiona Willer got pointed at and shouted down by Prof John Dixon. At the conference they had a presentation on the “Live Lighter” campaign. They had a speaker from the Cancer Council talking about the campaign, and a speaker from an eating disorders organisation talking about how they could change their messaging to make it more supportive for people with eating disorders. They used a slide with a stick figure with its’ head cut off, and then another with the head back on, to talk about how a combined approach - one that included mind and body - was much better! This is pretty naive when you consider that people with mental illness will get cancer at about the same rate as people in the general population, but are more likely to die earlier of cancer - because they’re not screened early enough, or their surgeries either don’t happen or are delayed. This separation between mind and body has deadly consequences. There is awareness growing that we need to do something to mend this separation. The Equally Well consensus statement is a good example of this. Equally Well is an initiative which started in New Zealand, as a collective effort to get people on board to improve the physical health of people with mental illness. Equally Well is very much led by people with lived experience of mental illness. In Australia, Equally Well launched in 2017, and many organisations have signed up in partnership with them. Earlier this year HAES Australia signed up. In terms of weight-neutral, non-diet content, Equally Well are not there yet, but we need to be in there in order to influence and give input, so that diet culture and weight centrism doesn’t sink its teeth in! The good news is, Equally Well is definitely NOT funded by Novo Nordisk, so there’s no Big Pharma agenda trying to sell weight loss drugs out of this! Caro Swanson is a champion of Equally Well and a person with lived experience of mental illness. Caro did a keynote speech at the first Equally Well Symposium in Melbourne earlier in 2019, alongside Helen Lockett (‘the other lady! - sorry!!). Caro spoke about her experience of having ‘experts’ come in and take away her power. She was worried that Equally Well would be just like other initiatives and leave people with lived experience out. Caro made the excellent point that people with mental illness are already under a lot of scrutiny, and with the introduction of physical health focus ‘now you’re going to scrutinise the rest of our lives too.’ Carolynne gives the example of a man with schizophrenia living in a group home, who was being judged for eating chips and drinking Coke late at night. But this was the only food available for him to eat after a night shift. We must hold back judgements about people’s choices, and make the effort to understand their lives. Eating ‘well’ is actually a privilege, which not all of us have. Lots of people are doing the best they can to just eat regularly, and everyone needs to just back off! It’s really annoying to hear the story of the man with schizophrenia being judged for his food choices (which is really a judgement about his weight). Taking anti psychotic meds means he could eat kale morning, noon and night and still gain weight! It is not a ‘choice’ and the gain is not under his control. He is doing well to take his meds and strive for improved mental health. No-one enjoys hearing voices, it’s terrifying. If taking meds means increased weight, that needs to be ok. Caro made the excellent point “monthly girth measurements don’t do anything for my mental health’. Equally Well is a collective, lived-experience led, aimed at helping people living with mental illness improve their physical health in an equitable way. Caro’s stand against the weight-centric attitudes is awesome. We really need to ensure that things like waist measurements aren’t just blindly given for no reason: people need to give consent, and have the right to say no if focus on their weight is not comfortable for them. It’s great that HAES Australia are part of Equally Well, so we can really fight for a weight-neutral, inclusive approach to improving physical health for people with mental illness. One of the Equally Well statements says: “obesity is a major contributor to a range of common diseases including metabolic syndrome, diabetes, and cardiovascular disease. People living with mental illness should be offered tailored support for weight management programs as part of routine care”. It doesn’t matter how ‘tailored’ the program is, weight ‘management’ does not work! This approach just ‘ticks the box’, but we really need to apply critical thought. Why are we doing this - what’s the efficacy? If it doesn’t work in the general population to lose weight long term, why on earth would they work in those with mental illness who may suffer multiple barriers, be more disadvantaged and live more disruptive lives? In mental health over the past few years there has been increased focus on recovery and hope. Dieting approaches are the opposite of that! They disempower and get people stuck in an endless cycle. There are so many beautiful pathways to improving health that have bugger all to do with weight. Health professionals need a lot more training in mental health, particularly trauma informed mental health care and an understanding of concepts such as social justice and privilege. It is very important that our efforts to help people don’t traumatise them further. We need to really listen to people’s lived experiences, because everyone is unique. We can’t forget how much awful stuff has been done to people in the name of helping their mental health! I think weight management programs are our modern day equivalent of “One Flew Over The Cuckoo’s Nest” style therapy. Naomi Wolf said that dieting is a powerful political sedative. Maybe one day Equally Well can face off against Obesity Australia! Medication research needs to be done to improve the metabolic side effects, the answer is not to just add in another weight loss medication to the mix. Donate to Equally Well - they will definitely not have a push up challenge! Health is so much more than doing a push up. Resources: The Headspace Hervey Bay FB post which stirred controversy (scroll to July 10th) HAES Australia website Dr Carolynne White’s research profile on the Swinburne University page. The Perth article which talked about Nick Hudson and his reasons to do The Push Up Challenge where he talked about his heart operations. The Triple White article which talked about Nick Hudson & his dad’s depression being the inspiration behind the Push Up Challenge (get a load of the extreme Fitspo image they chose to use…) The Push Up Challenge website The Mission Australia Youth Survey 2018 The Headspace website Details on Headspace funding The Lancet paper on the physical health of people with mental illness The eating disorder point prevalence in Australian adolescents paper The Equally Well Consensus statement An awesome interview with Caro Swanson and Helen Lockett. From Equally Well.  

This week my guest is the fierce and wonderful president of HAES Australia, Dr Carolynne White! A Facebook post from Headspace in Hervey Bay fired her (and many others) up when it claimed that eating sugary food causes mental health problems! As a mental health expert and anti-diet advocate, Carolynne knows how much this kind of messaging oversimplifies, stigmatises, and downright does damage. The fact that the SUGAR IS EVIL message is being spruiked by one of Australia’s leading adolescent mental health organisations is a worry. Particularly when it’s part of “The Push Up Challenge”, a fund raiser for Headspace which raises awareness about youth suicide by forcing people to do over a hundred push ups a day. Has anyone at Headspace heard of eating disorders? Why is encouraging excessive exercise in teens ok? Do they know how hung up young people are about body image and health? WHAT ON EARTH ARE THEY THINKING!? Join us as we rant about this extremely ill advised campaign. The truth is, mental health and physical health just can’t be separated, and we need to be doing a lot more critical thinking to avoid doing harm! CW: Discussions about suicide, mental illness & eating disorders.     Show Notes     My guest this week is Dr Carolynne White, occupational therapist and health promotion lecturer. Through her professional experience and her PhD research, Carolynne has formed the strong opinion that good mental health is absolutely necessary to support good overall health. Carolynne is also the president of HAES Australia. Carolynne got all fired up about a facebook post from Headspace at Hervey Bay in Queensland, about a ‘push up challenge’ to raise awareness about suicide and to raise money for Headspace. Headspace is a very well funded network of mental health treatment centres for adolescents and young people. Headspace enjoy a lot of government funding here in Australia, and also gather a lot of attention in the media. Their Mission is ‘to provide tailored and holistic mental health support to young people aged 12-25”. They focus on early intervention and prevention of mental illness, as well as focusing on physical health as well. According to the website, the ‘push up challenge’ was started by a ‘bunch of mates’ passionate about the topic. The challenge involves doing 3128 push ups over the month of August - one for each life lost to suicide in 2017. This is a LOT of push ups - over 100 a day. Louise’s first thought - why are headspace supporting an initiative that uses the symptoms of a major mental illness - ie the compulsive exercise aspects of an eating disorder - to raise awareness of mental illness? It just seems very ill advised. Particularly when you consider that eating disorder have the highest mortality rate, particularly from suicide, among young people. The man who started the push up challenge is Nick Hudson, he’s from Perth. He’s a white Aussie bloke in his thirties. Louise found 2 media articles about him which said slightly different things. One said he had heart surgery as a child, and when he got older his fitness declined and he realised he needed more heart surgery. This made him depressed, and one of the ways he came out of the depression was to start this push up challenge. But then another news article which came out about the same time (and was accompanied by a truly awful ‘Fitspo on steroids’ picture) said that his father had suffered from depression for many years but had never told him. When he discovered the depression, he ‘did some research’  on mental health. Then he and his mates, who do push ups as part of their regular fitness regime, decided to turn it into something more. So it’s odd to have 2 such different stories out there in the media, normally people have just one story, but there you go. There is a level of privilege reflected in the message that in order to come out of depression you need to do a few push ups. It’s great that this happened for him, but many people need a lot more help than just exercise to recover from something as complex as depression. Plus, particularly with people that Louise sees in her practice, the LAST thing they need is to focus on counting push ups! The Hervey Bay Headspace post was particularly problematic because he was posting about the evils of sugar as well. He claimed that high intakes of sugar increase the likelihood of developing mental illness, and more severe symptoms of depression. This of course caused a furore ! Having worked in mental health, Carolynne thinks of the impact a message like this would have on an adolescent who might be struggling with their mental health, and how unhelpful it would be. The person who made this claim was a personal trainer, and obviously way outside of their scope of practice or expertise making claims like that. This post did attract a lot of push back from mental health experts. Particularly considering the vulnerability and age of the audience of Headspace! Australian teenagers are really hung up on issues of body image, health, etc, and we are seeing very high rates of eating disorder symptomatology which is being overlooked in this ‘health obsession epidemic’ that we’re all suffering from. The latest Mission Australia Youth Survey (2018) found that 30% of young people reported feeling ‘very’ or ‘extremely’ concerned about their mental health and their body image. These were equal concerns. Younger women reported higher levels of concern than younger men. Gender dynamics play into this. Thinking of a bloke modeling the push up challenge and the impact that might have on a teenage girl…. A paper that has just come in in 2019 looks at the point prevalence of eating disorders in young people in Australia. Data from 5000 Aussie teens aged 11-19 showed that 22.2% met diagnostic criteria for an eating disorder. That’s 1 in 5 kids! 1 in 3 Aussie kids have high levels of concern about their body image and 1 in 5 have diagnosable eating disorders. In girls, the eating disorder rate is 33.3% and in boys it’s 12%. This is a huge concern and we need to centre this in our public health messaging. The push up challenge is an extreme fitness challenge. Looking through the Instagram for the push up challenge, a very narrow range (ie very muscular physiques) are represented. If we couple that with the facebook post which moralises food, it creates an environment which compromises recovery for those suffering with eating disorders. Are the people at Headspace really thinking this through? The Headspace demographic includes very young teenagers who are still very much black and white thinkers. If a 13 year old comes across the Hervey Bay page with its comments on sugar, they don’t have the cognitive capacity to see any nuance or think critically about it. This message is coming from an authority figure and they are highly likely to view it as: do not eat sugar under any circumstances. This is everywhere in Louise’s clinical practice at the moment: young kids developing eating disorders following exposure to well meaning messages about the nutritional value of food. Basically, no-one in high school should watch ‘That Sugar Film’. Adolescence is the THE highest risk time for development of an eating disorder. 14 years old is the average age kids can develop one. This is the exact demographic of Headspace’s audience and for these type of social media messages to be demonising sugar and pushing compulsive exercise, it’s really not on. Headspace have done a great job promoting themselves as a safe place for people with diverse identities to go. They need to incorporate body diversity into their messaging as well, many teens suffering from mental illness will be in larger bodies and need to feel safe and included. All of the eating disorder statistics from the paper on point prevalence we just discussed are higher in kids with higher body weights. People in larger bodies have eating disorders more often than smaller people, but if Headspace is full of gymbunnies doing workouts….hello!? Headspace’s own website discusses eating disorders & their symptoms, with sentences beginning with “Excessive exercise is a symptom of an eating disorder”…  The push up challenge has raised $2.5 million for Headspace, which is phenomenal. It’s a great job - but the methods of fund raising definitely need to be worked on! Headspace do a great job in our community, but they are well funded. There are 107 Headspace centres around the country. They get $95 million a year from the Government, and have just been given another $50 million. And when a psychologist at headspace sees a teenager, they bill Medicare for the appointment. Many of the psychologists are contractors, not employees of Headspace, so they take a % of the Medicare subsidised fee as payment. Headspace do great work, but they are well funded. In comparison we have a desperate shortage of hospital beds for people suffering from severe eating disorders. So many areas of mental health are severely underserviced. It seems that the ‘popular’ ideas get funded. So - if anyone listening wants to raise funds for mental health don’t give it to Headspace, they’re doing alright! This whole push up challenge for Headspace runs on the idea that exercise is always good for mental health. And there’s a real push in mental health to include ‘lifestyle’, or physical health. Carolynne started her career as an Occupational Therapist in a maximum security hospital - as did Louise! When Carolynne started, a report came out of Western Australia which found a huge disparity between physical health of people with mental illness and those without, and the gap in life expectancy. Working in a prison hospital, you see people from all walks of life. People who have experienced extreme poverty, severe trauma, and mental illness, and all of that mixed up together has a huge impact on their physical health. In the past few years there has been increased attention to the physical health status of people with mental illness. The National Mental Health Commission drafted up a consensus statement, and the stats are just astounding. In Australia, 1 in 5 people have a mental illness, and 16% of Australians live with both a physical health condition and a mental illness. If you have both, your life expectancy is reduced by 15.9 years for men and 12 years for women. This is conservative: around the world, the gap can be as much as 20 years. It’s staggering - much more than cigarette smoking. A few years ago Carolynne took part in Partners in Recovery, an initiative for people living with mental illness. During this period, 3 of the people involved died. Carolynne initially thought it might have been suicide. On of them had taken their own life, but one had a heart attack and the other died in their sleep of ‘natural causes’. This is the general case: People with a mental illness who die early, usually die from physical causes other than suicide. The main causes are cardiometabolic: heart disease, stroke, diabetes, and metabolic syndrome. All of the issues often attributed to higher weight. In the search to improve health and mortality outcomes, the focus has unfortunately of course landed on people’s weight. Because this is just what people with mental health issues need - a good push up! People with mental illness are more likely than the general population to have a BMI over 35. And that’s not to do with not eating the ‘right’ food or not getting enough exercise! A lot has to do with medication related weight gain. People taking medication to take care of their mental health is really positive, and if a side effect of that is weight gain, focusing on that and ‘blaming’ people for poor lifestyle habits is unfair. Antipsychotic medications, bipolar meds, and some antidepressant medications can have weight gain as a side effect. Many people Louise speak with could benefit a lot from medication, but often hesitate because of fear of weight gain. Or, people choosing to go off medication which is benefitting their mental health because of weight gain. This really brings home the reality of weight stigma. The drive for thinness in our culture is valued above everything else. Carolynne had an experience of gaining weight after being put on medication for depression, which she found confronting as she had previously lived in an always thin body. It’s very understandable, but it makes her sad, as in our culture people’s mental health might be compromised because of that societal pressure. Imagine if we lived in a truly weight inclusive society how the experience of mental illness might be very different? There’s already stigma around mental illness. If you’re going to lump weight stigma on top of that it just compounds the disadvantage that people experience. If someone gets well from taking medication, but then comes to live in a larger body, and experiences weight based discrimination, it’s yet another experience of oppression, exclusion, and marginalisation which is extremely weathering to physical and mental health. Many of the organisations that champion physical health don’t think about mental health whatsoever. So they don’t think about the impact of their campaigns on people’s mental health. The idea of perpetuating weight stigma and the health impacts of that (both physical and mental) - it’s just not thought of. Given the numbers of people suffering with mental illness, it is not ok that they are not considered in these campaigns. Particularly when you consider that people with mental illness are more likely to get these conditions, mental health should be people’s first consideration. The fact that they’re not is another example of entrenched stigma. They’re just erased, not visible anywhere. It’s depressing. This concept of the mind and body being separate goes back to the 16th century, with French Philosopher Descartes who championed the separation of the body from the mind. This is known as Dualism. This is where it all started but we need to get out of the 16th century and into the 2000’s! Mind and body are not separate, and physical and mental health are not separate either. It is super dangerous when we do. Carolynne & Louise first met at an Eating Disorders and Obesity Conference in the Goldcoast, where Carolynne got told off for being ‘irresponsible’ for talking about her non-diet community intervention, and Fiona Willer got pointed at and shouted down by Prof John Dixon. At the conference they had a presentation on the “Live Lighter” campaign. They had a speaker from the Cancer Council talking about the campaign, and a speaker from an eating disorders organisation talking about how they could change their messaging to make it more supportive for people with eating disorders. They used a slide with a stick figure with its’ head cut off, and then another with the head back on, to talk about how a combined approach - one that included mind and body - was much better! This is pretty naive when you consider that people with mental illness will get cancer at about the same rate as people in the general population, but are more likely to die earlier of cancer - because they’re not screened early enough, or their surgeries either don’t happen or are delayed. This separation between mind and body has deadly consequences. There is awareness growing that we need to do something to mend this separation. The Equally Well consensus statement is a good example of this. Equally Well is an initiative which started in New Zealand, as a collective effort to get people on board to improve the physical health of people with mental illness. Equally Well is very much led by people with lived experience of mental illness. In Australia, Equally Well launched in 2017, and many organisations have signed up in partnership with them. Earlier this year HAES Australia signed up. In terms of weight-neutral, non-diet content, Equally Well are not there yet, but we need to be in there in order to influence and give input, so that diet culture and weight centrism doesn’t sink its teeth in! The good news is, Equally Well is definitely NOT funded by Novo Nordisk, so there’s no Big Pharma agenda trying to sell weight loss drugs out of this! Caro Swanson is a champion of Equally Well and a person with lived experience of mental illness. Caro did a keynote speech at the first Equally Well Symposium in Melbourne earlier in 2019, alongside Helen Lockett (‘the other lady! - sorry!!). Caro spoke about her experience of having ‘experts’ come in and take away her power. She was worried that Equally Well would be just like other initiatives and leave people with lived experience out. Caro made the excellent point that people with mental illness are already under a lot of scrutiny, and with the introduction of physical health focus ‘now you’re going to scrutinise the rest of our lives too.’ Carolynne gives the example of a man with schizophrenia living in a group home, who was being judged for eating chips and drinking Coke late at night. But this was the only food available for him to eat after a night shift. We must hold back judgements about people’s choices, and make the effort to understand their lives. Eating ‘well’ is actually a privilege, which not all of us have. Lots of people are doing the best they can to just eat regularly, and everyone needs to just back off! It’s really annoying to hear the story of the man with schizophrenia being judged for his food choices (which is really a judgement about his weight). Taking anti psychotic meds means he could eat kale morning, noon and night and still gain weight! It is not a ‘choice’ and the gain is not under his control. He is doing well to take his meds and strive for improved mental health. No-one enjoys hearing voices, it’s terrifying. If taking meds means increased weight, that needs to be ok. Caro made the excellent point “monthly girth measurements don’t do anything for my mental health’. Equally Well is a collective, lived-experience led, aimed at helping people living with mental illness improve their physical health in an equitable way. Caro’s stand against the weight-centric attitudes is awesome. We really need to ensure that things like waist measurements aren’t just blindly given for no reason: people need to give consent, and have the right to say no if focus on their weight is not comfortable for them. It’s great that HAES Australia are part of Equally Well, so we can really fight for a weight-neutral, inclusive approach to improving physical health for people with mental illness. One of the Equally Well statements says: “obesity is a major contributor to a range of common diseases including metabolic syndrome, diabetes, and cardiovascular disease. People living with mental illness should be offered tailored support for weight management programs as part of routine care”. It doesn’t matter how ‘tailored’ the program is, weight ‘management’ does not work! This approach just ‘ticks the box’, but we really need to apply critical thought. Why are we doing this - what’s the efficacy? If it doesn’t work in the general population to lose weight long term, why on earth would they work in those with mental illness who may suffer multiple barriers, be more disadvantaged and live more disruptive lives? In mental health over the past few years there has been increased focus on recovery and hope. Dieting approaches are the opposite of that! They disempower and get people stuck in an endless cycle. There are so many beautiful pathways to improving health that have bugger all to do with weight. Health professionals need a lot more training in mental health, particularly trauma informed mental health care and an understanding of concepts such as social justice and privilege. It is very important that our efforts to help people don’t traumatise them further. We need to really listen to people’s lived experiences, because everyone is unique. We can’t forget how much awful stuff has been done to people in the name of helping their mental health! I think weight management programs are our modern day equivalent of “One Flew Over The Cuckoo’s Nest” style therapy. Naomi Wolf said that dieting is a powerful political sedative. Maybe one day Equally Well can face off against Obesity Australia! Medication research needs to be done to improve the metabolic side effects, the answer is not to just add in another weight loss medication to the mix. Donate to Equally Well - they will definitely not have a push up challenge! Health is so much more than doing a push up. Resources: The Headspace Hervey Bay FB post which stirred controversy (scroll to July 10th) HAES Australia website Dr Carolynne White’s research profile on the Swinburne University page. The Perth article which talked about Nick Hudson and his reasons to do The Push Up Challenge where he talked about his heart operations. The Triple White article which talked about Nick Hudson & his dad’s depression being the inspiration behind the Push Up Challenge (get a load of the extreme Fitspo image they chose to use…) The Push Up Challenge website The Mission Australia Youth Survey 2018 The Headspace website Details on Headspace funding The Lancet paper on the physical health of people with mental illness The eating disorder point prevalence in Australian adolescents paper The Equally Well Consensus statement An awesome interview with Caro Swanson and Helen Lockett. From Equally Well.  

The Fast Track Trial is a trial in Australia that is being done to determine the efficacy of intermittent fasting for weight loss in teens. My amazing guest, Louise Adams, has spent the last year actively trying to get the trial stopped because it is unethical. The connection between dieting, especially fasting, and the development of eating disorders is quite strong. This is particularly concerning in relation to young people. She has collected studies, letters of support from medical professionals and organizations in Australia, as well as over 20,000 signatures from around the world on a change.org petition opposing the trial. Unfortunately, her efforts have been unsuccessful and the trial is proceeding. Content Warning: This episode includes information about fasting, eating disorders, weight change, and a brief discussion of normal adolescent weight gain. In this episode, we discuss: A bit about who Louise is and how she started working with eating disorders and the HAES movement A description of the Fast Track Trial Reasons why dieting can lead to eating disorders, particularly in teens How Louise has been fighting against the trial going forward What risks are not being fully explained to participants What the initial results of an initial study mean in practical terms Who the people behind the trial are And much more! Resources: Untrapped website FB group for Stop the Fast Track Trial Parent information for the Fast Track Trial  That Time I Was in a Child Weight Loss Study link:  About Louise: Louise Adams is a clinical psychologist, the founder of Treat Yourself Well Sydney and the creator of the UNTRAPPED online program and community. She has written two books, Mindful Moments and The Non-Diet Approach Handbook for Psychologist and Counsellors (with Fiona Willer, APD). She has been practicing in this field for more than 20 years. Louise is Vice President of Health At Every Size Australia. She has a special interest in problematic eating, body image, and weight struggles. Louise fights to educate people about the cruel trap of dieting, which only sets us up to fail. She uses an evidence-based anti-dieting approach to empower people to achieve permanent lifestyle change. Louise is wholly committed to the Heath At Every Size (HAES) movement, and to spreading the word about shifting our attitudes about weight and health. Louise is determined to make a difference in changing society’s perceptions about health, diets, weight loss, and bodies. Louise believes that people can approach health and happiness without attaching it to weight changes. She is for body diversity and against fat prejudice. As well as her work with individual clients at her private practice, Louise conducts workshops and conferences for the general public and health professionals interested in changing their approach to weight issues. Louise is the host of the popular podcast All Fired Up!, and often turns up in magazines, newspapers, radio, and on television to spread her message. She blogs, she tweets, and she never shuts up about these issues!

It’s the 50th episode of All Fired Up! and we are delving into the Keto Diet craze!! Join me and my fabulous guest Jessi Haggerty, RD and nutritionist, as we set the record straight on all of this ketosis nonsense. As Keto fever sweeps the planet, we really need to stick on our critical thinking hats. Just what is ketosis, and why is everyone trying to do it? Is it really the answer to life, the universe, and everything, or is it just another fad? (Spoiler alert: the answer begins with the letter F).   Show Notes Urgent call for action - In Sydney and Melbourne, the “Fast Track to Health” trial is about to kick off, and researchers are planning to subject adolescents to a starvation diet for an entire year. Please sign the petition to get this stopped! Jessi Haggerty, RD and nutritionist, has had a gutful of all of the ‘hot diets’ around in January. She has a special pet hate for the Whole 30, which she talked about on her podcast recently. The sister diet to the Whole 30 is the Keto diet! Keto is THE hot diet right now. Jessi wrote a great blog on this topic - a Dietitian’s take on the Keto diet - which is really awesome. Jessi’s intern did a lot of the writing and heavy lifting for this blog, so a shout out to her. The Keto diet has taken the low carb movement to the next level. It’s not like going low carb/high fat is new - we saw it in the 90’s with the Atkins diet. Well, the Keto diet is Atkins 2.0, but it’s even harsher than Atkins! Keto started as a medical solution for children with epilepsy. Paediatric dietitians help kids with epilepsy follow a very high fat, medium protein & very low carbohydrate diet. Dietitians typically recommend that 40-50% of our intake be carbohydrate based, on a keto diet this goes way down to about 5%. The primary reason for doing this for kids is seizure prevention. It is an extreme measure that is only used when the medications don’t work. Because doctors and parents know how difficult it is to stick to such an extreme diet. But this is a last ditch effort in a very difficult situation. And for these kids, the keto intervention only works about 50% of the time. The mechanism of why this type of intervention might work to reduce epileptic seizures is unclear. Somehow, this diet was adopted by the mainstream as a way to lose weight. Go figure! Some people talk about using Keto for disease management, but overwhelmingly people are using it as a weight loss/fat loss tool. Like any weight loss diet, keto has major downsides. Restriction like this is not fun for people, and can lead to disturbed eating patterns and even eating disorders. Metabolic disturbance is also a serious consequence of dieting. How on earth did this diet get so popular! It’s really big in gym culture in Australia - it’s just so popular. We just keep going for fewer and fewer carbs - what’s next! There is a difference between ketoacidosis and ketosis. Ketoacidosis can happen if you are diabetic and your blood sugars get very low. Ketosis is when your body doesn’t have enough sugar in your system to keep everything running efficiently, so your liver creates ketones to keep your body going. Ketones are your bodys’ ‘back up’ mechanism which makes sure you can survive, and find food again. Ketones are not your bodys preferred source of energy, they are a back up system to take care of you when you don’t have enough carbohydrates. ...And this is being sold as a ‘healthy diet’ for people!? We literally hear people bang on about ketosis as if it is a superior way of living. Just because our body can use alternative sources of fuel, doesn’t mean that we should or need to be aiming for it! You’re just putting stress on the body in the name of weight loss. What is the impact on the brain of starving it of glucose and carbohydrates? Brains love these! Jessi’s blog post brought the ire of people who have tried Keto and say that it has ‘worked for them’. Jessi challenges them - what do you mean by ‘worked’ - (it’s going to mean weight loss!). A lot of people told Jessi that it helped lower their blood sugar levels. Which if course will happen, because you’re not eating any carbohydrates! Fiona Willer talks about the concept of ‘metabolic austerity’, where when your body is really deprived of food, it isn’t even well enough to be sick…It doesn’t mean that the underlying health condition has improved, it’s just being suppressed. For every negative response to her blog, Jessi got 10 messages from people who said the Keto diet had major side effects - they couldn’t think clearly, couldn’t concentrate in classes etc. It chips away at you little by little. Of course, not being able to poo is a problem because not enough fibre! This is a big deal! People are voluntarily not pooing? No thanks! Plus, the bad breath thing. It’s a side effect of the ketones having that specific smell. Gross! Keto diets have become so popular in Australia, that in some rural and remote areas the pharmacies have sold out of urine strips, so people with actual health condition can’t monitor themselves. Because gym dudes want to check they’re in ketosis! To be so obsessed with wee and to forget all about poo, doesn’t seem right to me. This diet is so unsustainable. Getting and staying in ketosis is really difficult. A lot of people who are doing this are torturing themselves and not even getting into this ‘glorified state’. It’s a lot of work for very little benefit. We have no solid research that this diet is helpful at all, aside from the evidence for kids with epilepsy. We don’t even do this treatment for adults with epilepsy. The research is only short term. And we know from 70 years of weight research that weight loss is likely to be temporary only, and the impact on metabolism is quite scary potentially. Although Jessi wrote the blog a while ago, she is still getting comments! One comment said that Jessi is “drowning in carb-tard cognitive dissonance”! WTF! The Keto people are a bit us and them - what is a carb-tard! If they’re saying there is something wrong with people’s brains because they eat carbs - that’s the pot calling the kettle black! If this diet makes you feel restricted and you’re struggling, it’s probably not for you. If it works for you, that doesn’t mean that the entire body of science is wrong. If the majority of people aren’t doing well, that means something - go elsewhere! Selling this as if there is no risk is the real cognitive dissonance. Won’t it be nice when we can go back to the high carb fads again! There will always be a fad to talk about. Louise tells her story about being scammed out of $300 with a ‘keto ultra diet’ pill! There is a lot of privilege involved in selling ketosis. It’s paying a lot of money to starve yourself. If you are tempted to diet, take a step back and ask yourself - what is the problem I am trying to solve here? Is there even a problem? A lot of the time, nothing is wrong. And these weight loss ‘solutions’ create a whole world of problems. And take a close look at the science. And always go non diet!!! Resources Mentioned: Starving Our Teens - Update on the Fast Track to Health” blog Sign the petition to Stop The Fast Track Trial The A Current Affair story about the Keto Diet pill scam A Dietitian’s Take on “Going Keto” by Jessi Haggerty - blog and podcast and Instagram  

It’s the 50th episode of All Fired Up! and we are delving into the Keto Diet craze!! Join me and my fabulous guest Jessi Haggerty, RD and nutritionist, as we set the record straight on all of this ketosis nonsense. As Keto fever sweeps the planet, we really need to stick on our critical thinking hats. Just what is ketosis, and why is everyone trying to do it? Is it really the answer to life, the universe, and everything, or is it just another fad? (Spoiler alert: the answer begins with the letter F).   Show Notes Urgent call for action - In Sydney and Melbourne, the “Fast Track to Health” trial is about to kick off, and researchers are planning to subject adolescents to a starvation diet for an entire year. Please sign the petition to get this stopped! Jessi Haggerty, RD and nutritionist, has had a gutful of all of the ‘hot diets’ around in January. She has a special pet hate for the Whole 30, which she talked about on her podcast recently. The sister diet to the Whole 30 is the Keto diet! Keto is THE hot diet right now. Jessi wrote a great blog on this topic - a Dietitian’s take on the Keto diet - which is really awesome. Jessi’s intern did a lot of the writing and heavy lifting for this blog, so a shout out to her. The Keto diet has taken the low carb movement to the next level. It’s not like going low carb/high fat is new - we saw it in the 90’s with the Atkins diet. Well, the Keto diet is Atkins 2.0, but it’s even harsher than Atkins! Keto started as a medical solution for children with epilepsy. Paediatric dietitians help kids with epilepsy follow a very high fat, medium protein & very low carbohydrate diet. Dietitians typically recommend that 40-50% of our intake be carbohydrate based, on a keto diet this goes way down to about 5%. The primary reason for doing this for kids is seizure prevention. It is an extreme measure that is only used when the medications don’t work. Because doctors and parents know how difficult it is to stick to such an extreme diet. But this is a last ditch effort in a very difficult situation. And for these kids, the keto intervention only works about 50% of the time. The mechanism of why this type of intervention might work to reduce epileptic seizures is unclear. Somehow, this diet was adopted by the mainstream as a way to lose weight. Go figure! Some people talk about using Keto for disease management, but overwhelmingly people are using it as a weight loss/fat loss tool. Like any weight loss diet, keto has major downsides. Restriction like this is not fun for people, and can lead to disturbed eating patterns and even eating disorders. Metabolic disturbance is also a serious consequence of dieting. How on earth did this diet get so popular! It’s really big in gym culture in Australia - it’s just so popular. We just keep going for fewer and fewer carbs - what’s next! There is a difference between ketoacidosis and ketosis. Ketoacidosis can happen if you are diabetic and your blood sugars get very low. Ketosis is when your body doesn’t have enough sugar in your system to keep everything running efficiently, so your liver creates ketones to keep your body going. Ketones are your bodys’ ‘back up’ mechanism which makes sure you can survive, and find food again. Ketones are not your bodys preferred source of energy, they are a back up system to take care of you when you don’t have enough carbohydrates. ...And this is being sold as a ‘healthy diet’ for people!? We literally hear people bang on about ketosis as if it is a superior way of living. Just because our body can use alternative sources of fuel, doesn’t mean that we should or need to be aiming for it! You’re just putting stress on the body in the name of weight loss. What is the impact on the brain of starving it of glucose and carbohydrates? Brains love these! Jessi’s blog post brought the ire of people who have tried Keto and say that it has ‘worked for them’. Jessi challenges them - what do you mean by ‘worked’ - (it’s going to mean weight loss!). A lot of people told Jessi that it helped lower their blood sugar levels. Which if course will happen, because you’re not eating any carbohydrates! Fiona Willer talks about the concept of ‘metabolic austerity’, where when your body is really deprived of food, it isn’t even well enough to be sick…It doesn’t mean that the underlying health condition has improved, it’s just being suppressed. For every negative response to her blog, Jessi got 10 messages from people who said the Keto diet had major side effects - they couldn’t think clearly, couldn’t concentrate in classes etc. It chips away at you little by little. Of course, not being able to poo is a problem because not enough fibre! This is a big deal! People are voluntarily not pooing? No thanks! Plus, the bad breath thing. It’s a side effect of the ketones having that specific smell. Gross! Keto diets have become so popular in Australia, that in some rural and remote areas the pharmacies have sold out of urine strips, so people with actual health condition can’t monitor themselves. Because gym dudes want to check they’re in ketosis! To be so obsessed with wee and to forget all about poo, doesn’t seem right to me. This diet is so unsustainable. Getting and staying in ketosis is really difficult. A lot of people who are doing this are torturing themselves and not even getting into this ‘glorified state’. It’s a lot of work for very little benefit. We have no solid research that this diet is helpful at all, aside from the evidence for kids with epilepsy. We don’t even do this treatment for adults with epilepsy. The research is only short term. And we know from 70 years of weight research that weight loss is likely to be temporary only, and the impact on metabolism is quite scary potentially. Although Jessi wrote the blog a while ago, she is still getting comments! One comment said that Jessi is “drowning in carb-tard cognitive dissonance”! WTF! The Keto people are a bit us and them - what is a carb-tard! If they’re saying there is something wrong with people’s brains because they eat carbs - that’s the pot calling the kettle black! If this diet makes you feel restricted and you’re struggling, it’s probably not for you. If it works for you, that doesn’t mean that the entire body of science is wrong. If the majority of people aren’t doing well, that means something - go elsewhere! Selling this as if there is no risk is the real cognitive dissonance. Won’t it be nice when we can go back to the high carb fads again! There will always be a fad to talk about. Louise tells her story about being scammed out of $300 with a ‘keto ultra diet’ pill! There is a lot of privilege involved in selling ketosis. It’s paying a lot of money to starve yourself. If you are tempted to diet, take a step back and ask yourself - what is the problem I am trying to solve here? Is there even a problem? A lot of the time, nothing is wrong. And these weight loss ‘solutions’ create a whole world of problems. And take a close look at the science. And always go non diet!!! Resources Mentioned: Starving Our Teens - Update on the Fast Track to Health” blog Sign the petition to Stop The Fast Track Trial The A Current Affair story about the Keto Diet pill scam A Dietitian’s Take on “Going Keto” by Jessi Haggerty - blog and podcast and Instagram  

Fiona is an Advanced Accredited Practising Dietitian (AdvAPD) and university lecturer in nutrition and dietetics. Her academic research areas are dietetic private practice benchmarking, interprofessional learning and HAES (Health At Every Size) integration into dietetics. Fiona has close to a decade of academic work under her belt and has been employed by Queensland University of Technology (QUT), Central Queensland University (CQU) and the University of the Sunshine Coast (USC). She will soon complete a PhD focusing on the clinical application of weight neutral approaches to weight concern in dietetics and it’s adoption into practice. Fiona’s mission is to empower health professionals to adopt weight neutral practice by providing support and training in how and why to do so. In This Episode We Discuss Defining Health At Every Size (HAES) Weight neutral program vs. weight loss program Benefits of non-diet approaches Long-term data on dieting Can obese patients still improve their health even if there is no weight loss? Problems with basing health status on bodyweight and/or BMI Striking the balance of knowing weight loss is beneficial with the potential that focusing solely on weight change can be contraindicated Intuituve eating   Access the Sigma Live Sessions: education.sigmanutrition.com  

Why do higher weight folks get denied treatment for hip replacements, IVF, and even adoption? Find out the ways our culture excludes fat people even when research contradicts our approaches. My guest is Fiona Willer, HAES dietitian, academic, educator and creator of the HealthNotDiets Digest. About Fiona Fiona Willer's mission is to empower health professionals to adopt weight neutral practice by providing support and training in how and why to do so. In short, she wants to destroy the perception and practice of 'dietitian as food police.' As an Advanced Accredited Practising Dietitian and university lecturer in nutrition and dietetics, she values nourishment, autonomy, authenticity and evidence based practice. Her academic research areas are dietetic private practice benchmarking, interprofessional learning and HAES integration into dietetics. A love for research and presenting has led Fiona into presenting professional development workshops for HAES integration into clinical practice since 2013. Fiona has close to a decade of academic work (unit coordination, lecturing, tutoring, marking, research assisting) under her belt and has been employed by Queensland University of Technology (QUT), Central Queensland University (CQU) and the University of the Sunshine Coast (USC). Fiona has also reviewed submissions for peer-reviewed academic journals including Appetite and Fat Studies Journal. After graduating from dietetics, Fiona initially spent three years as a clinical dietitian at The Wesley Hospital, Brisbane, working in a wide range of clinical areas in addition to coordinating and practising in The Wesley Hospital’s dietetic outpatient clinic, Dietitians Wesley. She also built a successful private practice, NutritionSense Allied Health, at Taringa in Brisbane from 2008 before selling it in 2014. Much of her private practice work was with chronic dieters with whom she frequently used the non-diet approach. Fiona’s PhD research findings have cemented her resolve that weight neutral approaches should be part of every clinician’s skill set and her research continues to inform the professional development workshops and training she provides through Health, Not Diets. She is the author of two non-diet approach guidebooks for health professionals and developed the Non-Diet Approach Model, which operationalizes the Health at Every Size (R) principals for clinical practice. FionaWiller.com | Health Not Diets | Unpacking Weight Science | Instagram | Twitter --- Get the Body Kindness book It's available wherever books and audiobooks are sold. Read reviews on Amazon and pick up your copy today! Order signed copies and bulk discounts here! --- Donate to support the show Thanks to our generous supporters! We're working toward our goal to fund the full season. Can you donate? Please visit our Go Fund Me page. --- Get started with Body Kindness Sign up to get started for free and stay up to date on the latest offerings --- Become a client Check out BodyKindnessBook.com/breakthrough for the latest groups and individual support sessions --- Subscribe to the podcast We're on iTunes, Stitcher, Spotify and iHeartRadio. Enjoy the show? Please rate it on iTunes! Have a show idea or guest recommendation? E-mail podcast@bodykindnessbook.com to get in touch. --- Join the Facebook group Continue the episode conversations with the hosts, guests, and fellow listeners on the Body Kindness Facebook group. See you there! Nothing in this podcast is meant to provide medical diagnosis, treatment, cure, or prevent any disease or condition. Individuals should consult a qualified healthcare provider for medical advice and answers to personal health questions.

Psychologist and author Louise Adams discusses why the Health at Every Size approach is essential in treating disordered eating, the problems with the "obesity epidemic" rhetoric, how trauma and body neglect shaped her relationship with food at a young age, why self-compassion is an essential antidote to shame, how to move from a deprivation mindset to an intuitive mindset with unconditional permission to eat, how to set firm and compassionate boundaries, and lots more. PLUS, Christy answers a listener question about how to handle feeling like you need to lose weight to manage a health condition, and how to stop judging yourself for eating "too much." This episode originally aired on July 24, 2017 Louise is an Australian clinical psychologist, author, podcaster, trainer, and speaker. She owns Treat Yourself Well Sydney, a specialist psychology clinic for weight-inclusive health and wellbeing. Louise founded UNTRAPPED, an online diet-recovery program, and hosts the All Fired Up podcast, where she meets with experts from around the world to debrief, rage, and unpack the (often misguided) messages we’re given about weight, food, exercise, and health. Louise has a special interest and expertise in weight struggles, eating disorders, and body image. Her practice is rooted in the HAES principles of equitable support for people of all shapes and sizes. Louise’s life goal is to dismantle the prison of diet culture and emancipate people to appreciate compassionate, joyful, relaxed relationships with food, movement, and their bodies. Louise has published two books. The Non-Diet Approach Guidebook for Psychologists and Counsellors (2014, co-authored with Fiona Willer, APD) is a manual for health professionals. Her latest book, Mindful Moments (2016) is for the general public, a practical guide to applying self-compassion for people who are time poor. Louise is a member of the Australian Psychological Society (APS), a member of the Clinical College of the APS, and treasurer of HAES Australia. In addition to everything else, Louise runs non-diet training workshops for other health professionals. She regularly speaks to the media on all issues health related, and has experience on radio, print and television. Read more about Louise at www.untrapped.com.au. Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to start your intuitive eating journey. If you're ready to give up dieting once and for all, join Christy's Intuitive Eating Fundamentals online course! Ask your own question about intuitive eating, Health at Every Size, or eating disorder recovery at christyharrison.com/questions. To learn more about Food Psych and get full show notes and a transcript of this episode, go to christyharrison.com/foodpsych.

Bek & Charlotte talk to Fiona Willer APD, AN (Author of The Non-Diet Approach Guidebook for Dietitians)about some of the research behind 'health at every size' vs. 'weight centric' approaches and how this can be utilised on our own clinical practices. See Fiona's website here: https://www.healthnotdiets.com/ Contact us at: justagppodcasting@gmail.com @gppodcasting on twitter Resources this week: Ending Medical Reversal https://www.booktopia.com.au/ending-medical-reversal-vinayak-k-prasad/prod9781421417721.html Raising Children Website: https://raisingchildren.net.au/ The Butterfly Foundation Website; https://thebutterflyfoundation.org.au/

This week Laura + Alan Flanagan, aka The Nutritional Advocate, dismantle a whole load of stuff that bloggers and influencers have been saying.  In this episode they discuss: ✨ The need to be sceptical of n=1 anecdotal evidence that pops up A LOT on social media + blogs ✨ The dumbf**kery of the carnivore diet ✨ The problems with conflating moral considerations with nutritional benefits when it comes to dairy ✨ The bizarre claim that gluten is "better" in Europe than America ✨ How the nocebo effect is a real thing ✨ Prolonged fasting + how it's so damn dangerous! Show Notes {Alan on Insta} {DSMG episode w/ Fiona Willer debunking the paleo diet} {Laura on Food for Fitness podcast} {Alan Clearing Up the Cow Controversy - Food for Fitness blog} {DSMG Summer Shorts w/ Pixie on carbs} {DSMG w/ Dr Oli Williams} {Nocebo effect in lactose intolerance} {Ken Burns' doc on the Vietnam war - Netflix} {The Handmaid's Tale} {Book in for Discovery Call w/ Jess at the London Centre for Intuitive Eating} {PRE-ORDER MY BOOK!! on Amazon | Waterstones | Foyles – I’ll share international links when they become available!} {Follow us on Insta!}

This week Laura's joined by Fiona Willer, HAES dietitian + PhD researcher, director of Health Not Diets + author of The Non Diet Approach Guidebook for Dietitians. They take a deep dive into the current evidence within the weight science arena, pulling it apart to figure out what we can learn from it + improvements that need to be made in research + clinical practice going forward.  In this episode they discuss: ✨ The historical inaccuracy of the paleo diet using Fiona's archeological knowledge ✨ Unpacking the evidence in weight science + how it's so important that we read it critically ✨ What "statistical unicorns" are + the problems w/ the National Weight Control Registry  ✨ Weight bias in the context of Tess Holiday's Cosmo cover + why the term 'weight bias' is probably not very accurate ✨ Nuggets of wisdom for what to do if you know that diets don't work but your doctor tells you to lose weight ... again Show Notes {Fi on Insta | Twitter} {Book in for Discovery Call w/ Jess} {PRE-ORDER MY BOOK!! on Amazon | Waterstones | Foyles - I'll share international links when they become available!} {Raising Intuitive Eaters Workshop} {Health, Not Diets website} {Unpacking Weight Science} {How to Respond When the Doctor Body Shames You + HCP card} {Critique of the National Weight Control Registry} {Combined Impact of Health Behaviours and Mortality study} {Follow us on Insta!}

Nothing winds up my guest Fiona Willer like a cargo cult conference - when it LOOKS like an academic conference, SOUNDS like an academic conference, but is actually an alphabet soup of questionable people pretending to be ‘experts.’ In the “obesity” conference circuit, it seems anything goes when it comes to weight loss, no matter how ludicrous and/or downright shifty the science is! At centre stage of the coconut fringe festival is ‘TAPPING’ for weight loss, seriously the ultimate in pseudoscientific balderdash. Don’t miss Fiona’s razor sharp review of EFT: you really won’t believe the outlandish claims of this overhyped ‘energy psychology’ trend.   Show Notes  

Nothing winds up my guest Fiona Willer like a cargo cult conference - when it LOOKS like an academic conference, SOUNDS like an academic conference, but is actually an alphabet soup of questionable people pretending to be ‘experts.’ In the “obesity” conference circuit, it seems anything goes when it comes to weight loss, no matter how ludicrous and/or downright shifty the science is! At centre stage of the coconut fringe festival is ‘TAPPING’ for weight loss, seriously the ultimate in pseudoscientific balderdash. Don’t miss Fiona’s razor sharp review of EFT: you really won’t believe the outlandish claims of this overhyped ‘energy psychology’ trend.   Show Notes  

For this weeks episode, I'm chatting with Fiona Willer, a practicing Dietitian and PhD candidate in Australia. We are discussing the topic of BMI as a metric in weight science research. For more information and resources from Fiona, find her on Instagram @fionawiller or on her website healthnotdiets.com.

Fiona Willer, AdvAPD, is the author of 'The Non-Diet Approach Guidebook for Dietitians', and co-author of 'The Non-Diet Approach Guidebook for Psychologists and Counsellors'. Her business, Health, Not Diets, provides online and face-to-face training and workshops for health professionals in the non-diet approach. Fiona's background includes clinical dietetics, private practice and university lecturing in nutrition and dietetics. She is currently conducting PhD research into HAES ® use in dietetics. As an advocacy leader in this field, she represented Australia in contributing to the HAES graduate curriculum for the Association for Size Diversity and Health (ASDAH), and has been an invited speaker at DAA, SDA, ANZAED, DC events and presented at a variety of academic conferences Fiona is a proud member of the DAA, current Vice-President International of ASDAH, and executive member of HAES Australia. Find her online at FionaWiller.com, UnpackingWeightScience.com, and HealthNotDiets.com.   Relevant links:  Unpacking Weight Science: www.UnpackingWeightScience.com  Health Not Diets (resources for health professionals in the Non-Diet Approach): www.healthnotdiets.com Twitter and Instagram: @FionaWiller Facebook: HealthNotDiets

Non-diet dietitian Fiona Willer joins to discuss why we need to be critical of current weight research, how the Health at Every Size paradigm can go viral, why weight-inclusive work is a life-saving endeavor, how fatphobia and weight stigma prevent compassionate medical care for people in larger bodies, and so much more! Plus, Christy answers a listener question about how to adjust to a different culture’s eating times when studying abroad. Fiona Willer, AdvAPD, is the author of 'The Non-Diet Approach Guidebook for Dietitians', and co-author of 'The Non-Diet Approach Guidebook for Psychologists and Counsellors'. Her business, Health, Not Diets, provides online and face-to-face training and workshops for health professionals in the non-diet approach. Fiona's background includes clinical dietetics, private practice and university lecturing in nutrition and dietetics. She is currently conducting PhD research into HAES® use in dietetics. As an advocacy leader in this field, she represented Australia in contributing to the HAES graduate curriculum for the Association for Size Diversity and Health (ASDAH), and has been an invited speaker at DAA, SDA, ANZAED, DC events and presented at a variety of academic conferences Fiona is a proud member of the DAA, current Vice-President International of ASDAH, and executive member of HAES Australia. Find her online at FionaWiller.com, UnpackingWeightScience.com, and HealthNotDiets.com. Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to start your intuitive eating journey. If you're ready to give up dieting once and for all, join Christy's Intuitive Eating Fundamentals online course! To learn more about Food Psych and get full show notes and a transcript of this episode, go to christyharrison.com/foodpsych. Ask your own question about intuitive eating, Health at Every Size, or eating disorder recovery at christyharrison.com/questions.

Fiona Willer, AdvAPD is a dietitian and academic who has devoted her career to empower health professionals to adopt weight neutral practice by providing support and training in how and why to do so. In short, she wants to destroy the perception and practice of 'dietitian as food police.' She does this though online and in-person training and is in the final stretch of completing her PhD. She is such an asset to the dietetics field!   In this podcast episode, Fiona and Paige discuss the history of weight research. Fiona breaks down the concept and history of BMI and dispels myths that have been perpetuated for decades about weight. She also gives an incredibly valuable insight into the biases in the research world. If you've ever wondered about the research that supports a weight-neutral approach to health and nutrition, listen in!   Links mentioned: Fiona's website: http://www.healthnotdiets.com/ Fiona's podcast: https://www.unpackingweightscience.com/ Low fat versus low carb study discussed in this episode Leave a review for the podcast here Positive Nutrition online course coming soon! Upcoming Webinar: A Dietitian's Role in Addiction Recovery (April 18, 11am) Join the Nutrition Matters Podcast Community on FB Donate to the podcast here

Don’t miss an utterly HYPNOTIC episode of All Fired Up! This week Fiona Willer is guest-hosting, interviewing an incensed Louise Adams about hypnosis, psychology, and weight loss. There are some seriously weird and inflated claims going around about hypnosis being the ‘Holy Grail’ for lasting weight loss, but wait til you hear what these outrageous claims are based on!! Here’s a clue – the 1980’s called, they want their dodgy data back! Before you or anyone you care about buy any hypnosis based weight loss products, please listen to this podcast, and save yourself the money!   Show Notes

Don’t miss an utterly HYPNOTIC episode of All Fired Up! This week Fiona Willer is guest-hosting, interviewing an incensed Louise Adams about hypnosis, psychology, and weight loss. There are some seriously weird and inflated claims going around about hypnosis being the ‘Holy Grail’ for lasting weight loss, but wait til you hear what these outrageous claims are based on!! Here’s a clue – the 1980’s called, they want their dodgy data back! Before you or anyone you care about buy any hypnosis based weight loss products, please listen to this podcast, and save yourself the money!   Show Notes

This week I’m back with the fabulous Fiona Willer from Health Not Diets, and we are SEETHING over the launch of yet another terrible diet! Join us as we dissect the outrageous claims of the “Number 1 Superfast Diet,” which is quite literally promising the world to anyone who’ll listen. Diet culture media has lapped up the bulls**t, without bothering to dig underneath any of the glitter. Fear not as me & Fi have DUG BABY – and you won’t BELIEVE what we unearthed! Don’t miss this fabulous dismemberment of diet world duplicity!

This week I’m back with the fabulous Fiona Willer from Health Not Diets, and we are SEETHING over the launch of yet another terrible diet! Join us as we dissect the outrageous claims of the “Number 1 Superfast Diet,” which is quite literally promising the world to anyone who’ll listen. Diet culture media has lapped up the bulls**t, without bothering to dig underneath any of the glitter. Fear not as me & Fi have DUG BABY – and you won’t BELIEVE what we unearthed! Don’t miss this fabulous dismemberment of diet world duplicity!

For our very first All Fired Up podcast, I'm chatting to the incredible Fiona Willer, dietitian, educator, and anti-diet researcher. We came across an article written in Time Magazine called "The Weight Loss Trap: Why Your Diet Isn't Working." As anti-diet health professionals we KNOW that trying to lose weight is a trap for the vast majority, so initially we were SO excited to see Time magazine admitting it! But then we read the article...and we got angry!! Because once again, the media is falling into the trap of calling weight loss a trap, and then pretending that it's not a trap in the very next breath. Fiona and I take you through why this article is mostly bulls**t, and how to protect yourself from further media bulls**t about weight science. UNTRAPPING from the weight loss trap means thinking critically and looking underneath the assumptions of weight science. Fiona talks sense about the relationship between health and weight, and dissects this constant message that the only way we can be healthy is to lose weight.

For our very first All Fired Up podcast, I'm chatting to the incredible Fiona Willer, dietitian, educator, and anti-diet researcher. We came across an article written in Time Magazine called "The Weight Loss Trap: Why Your Diet Isn't Working." As anti-diet health professionals we KNOW that trying to lose weight is a trap for the vast majority, so initially we were SO excited to see Time magazine admitting it! But then we read the article...and we got angry!! Because once again, the media is falling into the trap of calling weight loss a trap, and then pretending that it's not a trap in the very next breath. Fiona and I take you through why this article is mostly bulls**t, and how to protect yourself from further media bulls**t about weight science. UNTRAPPING from the weight loss trap means thinking critically and looking underneath the assumptions of weight science. Fiona talks sense about the relationship between health and weight, and dissects this constant message that the only way we can be healthy is to lose weight.

Psychologist and author Louise Adams discusses why the Health at Every Size approach is essential in treating disordered eating, the problems with the "obesity epidemic" rhetoric, how trauma and body neglect shaped her relationship with food at a young age, why self-compassion is an essential antidote to shame, how to move from a deprivation mindset to an intuitive mindset with unconditional permission to eat, how to set firm and compassionate boundaries, and lots more. PLUS, Christy answers a listener question about how to handle feeling like you need to lose weight to manage a health condition, and how to stop judging yourself for eating "too much." Louise is an Australian clinical psychologist, author, podcaster, trainer, and speaker. She owns Treat Yourself Well Sydney, a specialist psychology clinic for weight-inclusive health and wellbeing. Louise founded UNTRAPPED, an online diet-recovery program, and hosts the All Fired Up podcast, where she meets with experts from around the world to debrief, rage, and unpack the (often misguided) messages we’re given about weight, food, exercise, and health. Louise has a special interest and expertise in weight struggles, eating disorders, and body image. Her practice is rooted in the HAES principles of equitable support for people of all shapes and sizes. Louise’s life goal is to dismantle the prison of diet culture and emancipate people to appreciate compassionate, joyful, relaxed relationships with food, movement, and their bodies. Louise has published two books. The Non-Diet Approach Guidebook for Psychologists and Counsellors (2014, co-authored with Fiona Willer, APD) is a manual for health professionals. Her latest book, Mindful Moments (2016) is for the general public, a practical guide to applying self-compassion for people who are time poor. Louise is a member of the Australian Psychological Society (APS), a member of the Clinical College of the APS, and treasurer of HAES Australia. In addition to everything else, Louise runs non-diet training workshops for other health professionals. She regularly speaks to the media on all issues health related, and has experience on radio, print and television. Read more about Louise at www.untrapped.com.au. To learn more about Food Psych and get full show notes for this episode, go to christyharrison.com/foodpsych Ask your own question about intuitive eating, Health at Every Size, or eating disorder recovery at christyharrison.com/questions Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to start your intuitive eating journey. You can also text "7STRATEGIES" to the phone number 44222 to get it on the go :) Join the Food Psych Facebook group to connect with fellow listeners around the world!  

The Mindful Dietitian Interview Series:  Episode # 1 - Diplomatic Advocacy with Fiona Willer.    Inspiring Health At Every Size Dietitian Fiona Willer is truly a leader amongst Dietitians worlwide - here she shares her personal journey to being a HAES Dietitian, the book that changed it all and her dreams for our profession. In her typical diplomatic style, Fiona shares her tips for how to be more effective with what we're trying to do without being drawn into a two-sided debate or losing the essence of the message. Find out more about Fiona's FREE online course at: http://www.healthnotdiets.com/online-training Fiona's Comprehensive Non Diet Approach for Dietitian online training course here (equivalent of Day 1 of the 2-day training) http://www.healthnotdiets.com/online-training All workshops, courses and events for Dietitians in the calendar of events at: http://www.themindfuldietitian.com.au/calendar-of-events.html Online Food-Body-Mind Series available to do at your own pace: http://www.themindfuldietitian.com.au/online-learning.html   Join our closed Facebook Group The Mindful Dietitian for conversation, networking and support.