BROOKE GLADSTONE On this week's On the Media, a whole lot of fat panic.
NEWS REPORT Fat is a metabolically and hormonally active organ. It may suppress the immune system.
KATIE LEBESCO We see it almost impossible to think that somebody could be fat and healthy. At the same time.
DR YONI FREEDHOFF People with obesity are treated differently by the medical profession.
KATHERINE FLEGAL That finding we had, that really perturbed people, was overweight, was associated with fewer deaths than expected compared to somebody with normal weight.
KATIE LEBESCO Whose privilege is being threatened by folks who didn't used to have power. What do those bodies look like?
JORDAN PETERSON All of a sudden, this non-athletic body is as beautiful as the standard swimsuit model for Sports Illustrated. The whole thing is a lie.
SABRINA STRING We're talking about the 18th century. It's not enough for us to be slender. We need models of beauty that speak to our values. We are going to create a hierarchy, a reinvention of what was known in the 16th century as the great shame of being.
BROOKE GLADSTONE How scary is fat? After this.
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BROOKE GLADSTONE From WNYC in New York, this is On the Media. I'm Brooke Gladstone. From almost the moment coronavirus began sweeping our shores in the spring of 2020, one group of Americans was declared to be among the most at risk no matter their age, medical history or general healthiness.
NEWS REPORT Before you open that pack of chips. Numerous studies link obesity to a higher risk of serious illness from the new coronavirus.
NEWS REPORT The overweight need to seek solutions.
NEWS REPORT It can double your chances of hospitalization and increase the risk of landing in intensive care by even more. [EN D CLIP]
BROOKE GLADSTONE Pretty stressful for the three quarters of Americans whose BMI's mark us as overweight or worse.
WOMAN I am overweight and I think I need to lose a bit of it so that in case I get infected, I'm not in the danger zone. [END CLIP]
BROOKE GLADSTONE Soon, the damning data followed.
NEWS REPORT A study by the World Obesity Federation finds almost 90% of COVID deaths are from countries with high rates of obesity.
NEWS REPORT Because fat is a metabolically and hormonally active organ literally in the body in terms of that tissue may suppress the immune system. Mechanical reasons makes it harder to ventilate or breathe.
NEWS REPORT The surprising part is that governments haven't really active obesity until now. So now we have this perfect storm of obesity Pandemic and a covid pandemic. [END CLIP]
BROOKE GLADSTONE Perfect is a word best avoided in science, especially since a deeper look into the storm surrounding weight and COVID reveals rather imperfect conclusions. Like how one of the first CDC reports linking BMI to worse outcomes from COVID didn't control for existing health issues. Everything from asthma to cancer. Or like earlier this year, when a paper published by Harvard Medical School, professor Fatima Cody Stanford found that for patients with and without obesity, the Pfizer, Moderna and Johnson and Johnson vaccines provided similar protection in clinical studies, not in the real world. While you may ask? A key question, we'll consider this our but not the only one. We'll also consider how fat figures in culture and politics, in medicine and history. But first, fat in the pandemic.
DR YONI FREEDHOFF What we know for sure is that obesity is associated with an increased risk of more severe cases of COVID and an increased risk of mortality. What we don't fully know is why.
BROOKE GLADSTONE Dr. Yoni Freedhoff is associate professor of family medicine at the University of Ottawa. He says that in looking for reasons why patients carrying more weight might more often experience severe COVID, we could be missing explanations that have nothing to do with biology.
DR YONI FREEDHOFF Maybe people with obesity have differences in the way their bodies respond to this infection from an immune response or from an inflammatory response. But there are other possibilities which might be more feasible, which is that perhaps we are treating people with obesity who have COVID, differently than we treat others.
BROOKE GLADSTONE What leads you to think that?
DR YONI FREEDHOFF With H1N1, which occurred over a decade ago now, people with obesity just like now were found to have higher risk of death and more severe courses of H1N1. However, after the fact, it turned out that patients with obesity were provided with antivirals, that later in the course of their disease, when they controlled for when antivirals were provided, there was no increased risk any longer as a consequence of their obesity. There's precedents in general that people with obesity are treated differently by the medical profession. With respect to COVID, they may be treated differently in terms of whether or not they're admitted to the hospital floors, when they're provided with medications, when they're transferred to the ICU or in mechanical efforts like proning, which is putting a patient on their stomachs. Patients with obesity might require more hands to help to do that, and it's certainly not a consequence of any physiology if their proning is later in the course of their disease during the more severe surges of COVID. There's also the issue that patients with obesity who likely have experienced discrimination by health care professionals, may present later in the course of their disease, which might affect their treatment course as a whole.
BROOKE GLADSTONE They present later because they don't want to rush to the doctor.
DR YONI FREEDHOFF We know that patients with obesity do tend to avoid interactions with health care professionals if they have had experiences with weight bias. Weight bias is highly prevalent in society as a whole, in the medical profession, as part of society. Things have improved a great deal over the the course of even my career, and I went to med school in the 1990s, but there's still a lot of work to be done, that's for sure.
BROOKE GLADSTONE What is obesity?
DR YONI FREEDHOFF It's a fair question. Unfortunately, right now, the way we think of obesity is just a simple measurement, whether it's the number on the scale or the number on the body mass index table. It has been stated that people with obesity have body mass indices greater than 30. The thing is, is that scales do not measure the presence or absence of health and the body mass index table. It's literally a measure of bigness, not a measure of health.
BROOKE GLADSTONE Now, it's funny. I have a cat, an unusually large cat. Everyone is always commenting on the size of the cat. But when I took him to the vet, I said, Is there a problem? He said, "Like obesity" and I said, Yeah. And he said, No, he's just the big cat. He's like a like a football player.
DR YONI FREEDHOFF Football players are a great example. Over half of the NFL would be describable as having obesity on the basis of the BMI table.
BROOKE GLADSTONE Obviously, there are a lot of conditions that are associated with being overweight, type two diabetes being a big one. This is real.
DR YONI FREEDHOFF Oh, no question. And so knowing that there is a heightened risk of developing type two diabetes, at body mass indices greater than 30 is important for physicians and patients so that we can test and monitor for that in case it were to occur. But it isn't a guarantee that it's going to occur, nor should it be presumed that a patient who's coming in with a particular medical problem has that problem simply consequent to their weight, which sadly happens both at the hands of medical professionals. But also I've seen patients themselves attribute their concerns to their weight when really their concerns were not weight relatable.
BROOKE GLADSTONE So let's get to the Edmonton obesity staging system, which seems to be a far more useful way to determine how weight might influence a person's health.
DR YONI FREEDHOFF So this is a scale or a staging system that was published and developed in 2009 by Dr. Azaria Sharma and Robert Kushner. What it looks to do is to consider whether or not a person's weight is in fact having an impact on their health or quality of life. And we use that staging system, by the way, here in Canada, to help triage patients as to whether or not they need, for instance, bariatric surgery. So going through the stages briefly, somebody with stage zero obesity would have no physical symptoms, no functional limitations, no psychological symptoms. Nothing who I would not describe as having obesity in the sense of how people tend to understand obesity today. They do not have a medical concern as a consequence of their obesity. I may discuss things like lifestyle with them, but I discuss those things with anybody at any weight.
BROOKE GLADSTONE So the Edmonton Obesity Staging System uses the BMI to establish a baseline and then drills down on the symptoms.
DR YONI FREEDHOFF Yeah, so let's say you have a BMI of 30 or 31 or whatever you would be described as having class one. That's the World Health Organization Obesity classification. Stage zero obesity. If you were coming to see me to say, you know, should I be trying to lose weight, I would say no, unless it's affecting you in some other way. But stage zero truly has no effect. So I'd be strongly encouraging this person to keep on living their life the way they're living it. At EO Stage one obesity would be somebody with subclinical risk factors. So pre-diabetes, slightly elevated liver enzymes, borderline hypertension, or they might have some mild physical symptoms or mild impairment that they ascribe to their weight. We would not again describe this as a person who urgently needs any sort of medical attention. Stage two; we would have some established weight, responsive medical conditions. Type two diabetes, sleep apnea, high blood pressure, moderate functional limitations in a person's daily activities. If we go up to the Edmonton obesity stage three, they'd have significant problems and organ damage because of their diabetes or heart failure. Coronary artery disease with infarctions. Medicine is really bad at saying why a person has something. There's plenty of people with BMI, less than 30 with coronary artery disease. We can never really say why. What we can say is that people have conditions that are responsive to weight loss, high blood pressure, diabetes, etc.. Finally, there is stage four severely disabling functional limitation. End stage organ damage. An example might be somebody who's got a BMI extremely high and is in a wheelchair because they're unable to ambulate because of their arthritis hyperthermia, which they're not getting enough oxygen where weight loss might make their ability to live their lives better. If we think about the staging system, we're just trying to describe how severe the impact is that is possibly attributable to a person's weight or excess adiposity.
BROOKE GLADSTONE When was the Edmonton obesity staging system developed?
DR YONI FREEDHOFF It was developed in 2009.
BROOKE GLADSTONE In response to the uselessness of the BMI by itself.
DR YONI FREEDHOFF Yes. Once we started to control for whether or not a person's weight was affecting their health, suddenly we saw that, for instance, people with an EO score of zero with higher BMI were not found to have a higher risk of mortality compared to the general population.
BROOKE GLADSTONE I'm sure that some listeners are thinking, okay, so grouping people by BMI isn't perfect, but we lumped together people in lots of big categories for research, for gender, race, age, income. We know that these groups are not monolithic, but we can also control for these things in research to try to find real odds of a disease.
DR YONI FREEDHOFF Mm hmm.
BROOKE GLADSTONE Why is it so hard to control for weight? Is it because we don't control for implicit bias?
DR YONI FREEDHOFF That's exactly it, actually. So, for instance, looking at the various studies on COVID risks, they do control for a whole host of things. But weight is a monolith. Society has been trained to believe that weight automatically carries risk. Society has not been trained to believe that there is systematic bias in the treatment of patients with obesity. Pointing back to the H1N1 research that was done. Eventually somebody looked at.
BROOKE GLADSTONE This notion that people with obesity must be at higher risk because they must be living unhealthy lives, which means that they must have problems of character.
DR YONI FREEDHOFF This notion that if a person has a higher weight, they absolutely have something that they can do about it. That this is something within their control, that this is something that they've chosen for themselves. And that is not the case. There is at least 5000 genes and 37 different hormones involved in weight's regulation. From metabolism to hunger and craving levels to how long it takes a person to feel full or how long they feel full for to the emotional impact food has on things like our bodies, cortisol levels. And we can't change those genes in hormones, let alone even really test for them right now. And yet people are still comfortable saying, Oh, you're this tall, you're supposed to be this much. And this idea that people can intentionally change their behaviors that actually can help with 80, 85% of all chronic non-communicable diseases. But there's only one that we moralize about, and that's obesity.
BROOKE GLADSTONE What happens in the doctor's office then?
DR YONI FREEDHOFF There's two answers. One is judgments. People with obesity are judged or blamed by their health care providers in a way that people without obesity are absolutely not. So that's number one. And number two is that people going into their doctor's offices with obesity who also have pain or a problem with some aspect of their body or their life, they're simply told it's because of your weight. And that does not happen to people who don't have obesity. We know it happens. It is a huge problem that's well researched.
BROOKE GLADSTONE We know there's a decrease in the amount of screening for certain diseases offered to people who have obesity. We know they come in to doctor's offices later in large part because of the weight bias they've experienced. And we know that showing up later can really change the outcome of a disease when it's finally diagnosed.
DR YONI FREEDHOFF All of those things are true.
BROOKE GLADSTONE There's been a lot of coverage of the risks of obesity in the pandemic. And you pointed to a CNBC headline that when CDC study finds about 78% of people hospitalized for COVID were overweight or obese.
DR YONI FREEDHOFF Well, I mean, that's roughly the percentage of the population who would be described on the basis of their BMI as people with obesity are overweight. So it was a very silly headline. But put in Google News, search the words obesity and COVID, and you will find all sorts of ridiculous statements and recommendations. I mean, it's easy to say that we should all be living healthy lives, but it is not clear that if somebody read one of these articles and then took on some means to extremely and rapidly reduced their weights, if being in an active phase of weight loss is a good place to be when facing an infection with COVID.
BROOKE GLADSTONE So this is a question we ask a lot of guests on this show. But if you had advice for the public just about the coverage of weight in general.
DR YONI FREEDHOFF There is a term that I coins in the early 2000's called best weight wear rather than talk about BMI tables or numbers on scales. A person's best weight is whatever weight they reach when they're living the healthiest life they actually enjoy. Whatever a person's weight is, when they're living the healthiest life they can actually enjoy, that's their best weight. And that's what our goal should be and our best change. So, for instance, our best during a pandemic in a surge is going to be very different perhaps than the best life we can live in the before times. So many things affect our lives and our behaviors. So many of which are circled by privilege. We forget that too much. Our job in life is to do the best we can, and that goes for healthy living, for being a parent, for being an employee. The list goes on and on. But we need to stop expecting to be doing better than our best, regardless of what a headline, a scale or a body mass index table tells you. Scales do not measure the presence or absence of health, and they never.
BROOKE GLADSTONE Dr. Yoni Freedhoff is associate professor of family medicine at the University of Ottawa.
Coming up, how the obesity epidemic has all the elements of a moral panic. This is On the Media.
BROOKE GLADSTONE This is On the Media, I'm Brooke Gladstone. Freedhoff suggests that the headlines linking obesity and COVID resonate because they slot neatly into a larger, long standing narrative that we are increasingly, terminally... deplorably...fat.
NEWS REPORT Eye opening new numbers tonight about America's obesity epidemic hitting a new high. The CDC now says 40% of American adults are obese and nearly 20% of children.
NEWS REPORT Opinion contributor Susan Pierce Thompson writes, quote, Obesity related illness kills 325,000 Americans every year. She continues, quote, It is the packaged, highly refined products marketed to us as food that are killing us. Established behavioral studies have shown that sugar can be more addictive than cocaine. [END CLIP]
BROOKE GLADSTONE That 325,000 number came from a 1999 National Institutes of Health study. In 2004, a CDC study claimed obesity related illness kills 365,000 of us each year. Epidemiologist Catherine Flegal was a senior scientist at the Centers of Disease Control when that 365,000 number came out. She and her team thought they could do better.
KATHERINE FLEGAL Well, we had a better statistical approach, and we had better data because the data from the studies we used were now so representative. And they had measured body mass index, measured weight and height data. And I think we did a better job of accounting for confounding factors like age and sex and smoking and alcohol consumption. And the previous estimates didn't really adjust for any of those things.
BROOKE GLADSTONE One year later, Flegal and her colleagues published their study, also sponsored by the CDC, with remarkably different results.
KATHERINE FLEGAL Overall, we came up with a number of 112,000 deaths associated with obesity and overweight. I think the finding we had that really perturbed people or alarmed people or impressed people in some way was that overweight was associated with fewer deaths than expected compared to somebody with normal weight. That was a surprise to a lot of people, although it shouldn't have been because there are actually many studies in the literature that show the same thing. But this was a very dramatic finding, and that's what I think got most of the interest.
BROOKE GLADSTONE In other words, if weight were directly correlated with death, Flegal would expect to see death rates rise along with a person's BMI. But she didn't. At first, the work got some good press, but then the critics came along who had no issue with the data or the methodology, just the conclusion.
KATHERINE FLEGAL Journalists would quote people saying that our article was rubbish and ludicrous. Like what makes it ludicrous? What makes it rubbish?
BROOKE GLADSTONE So in 2013, she decided to check her work and organized a meta analysis, a study of studies to see what the literature said about BMI and death.
KATHERINE FLEGAL Where real careful search of all the literature that's used these same categories of body mass index and see what they found. We were able to find 97 studies with almost 3 million people, and we combined the data from all those studies to get estimates.
BROOKE GLADSTONE That meta analysis confirmed the results she'd seen in 2005.
KATHERINE FLEGAL We are comparing people in different categories, like the overweight categories, a body mass index of 25 up to 29.9, and the grade one obesity categories a body mass index of 30 up to up to less than 35. And we found that compared to people of normal weight, which is a body mass index of 18.5, up to 25, we found fewer deaths than expected in the overweight category.
BROOKE GLADSTONE Grades two and three, obesity described as BMI is above 35 and 40, respectively, did have a slightly elevated mortality risk. But her conclusions pointed to a dramatically different reality than the big numbers we so often see. Weight and health exist on a spectrum, and yes, at the extremes there can be greater associated risks. But on most of that spectrum, people in a wide variety of bodies thrive. Why do you think the earlier studies didn't get the publicity or the blowback that yours did? The ones that found the same thing you found.
KATHERINE FLEGAL One thing I noticed with earlier studies is that probably people were reluctant and I could see why they were reluctant, now – reluctant to really present this. So sometimes you would see the number somewhere in the article which I had read, but it was tucked away. It wasn't in the abstract, it wasn't considered a finding, really. It wasn't mentioned prominently, and sometimes it was only in a table, or sometimes there was just no mention at all. I think people are reluctant. They're right to be reluctant because of what happened to us. Not to say, well, overweight is actually associated with lower mortality than normal weight. They're just not comfortable with that finding and they don't make any effort making the emphasis about it.
BROOKE GLADSTONE That reluctance to be specific about the alleged risks of obesity still plagues us. In 1995, when the World Health Organization published a very long report looking at body measurement and their relationship to health.
KATHERINE FLEGAL They were very cautious not to use the word obesity, and they developed three categories of overweight, which they called one, two and three. And they state very clearly that these are not measures of body fat.
BROOKE GLADSTONE The word obesity from the Latin meaning to eat oneself fat was not to be used, declared the W.H.O., because it refers to body fat composition, which BMI does not measure. The W.H.O.'s categories of overweight were meant merely as loose benchmarks because the ranges were too wide and health too complicated to say exactly when things got good or bad.
KATHERINE FLEGAL Now, fast forward just a couple of years. Suddenly there's another W.H.O. conference about this. And this conference was funded really by something called the International Obesity Task Force, which itself was funded by drug companies because drugs for weight loss have begun to be developed. And there was a huge market there, obviously, if you can just get something approved. So somehow in the second W.H.O. meeting, the words were changed. So now 25, up to 30.
BROOKE GLADSTONE That's a BMI of 25 to 30.
KATHERINE FLEGAL Was called overweight, but now 30 and above was called obesity. And that was not true of the previous W.H.O. report, although they only come out a few years earlier. And so it became government policy because it was from the World Health Organization. Now we got a definition of obesity in terms of body mass index, and that changed the whole picture because now there was a different kind of perspective. Not just being overweight, but obese is a more powerful word and that can be defined as a disease.
BROOKE GLADSTONE A disease, but a rather peculiar one.
KATHERINE FLEGAL And we're also publishing data on things like prevalence of hypertension, the prevalence of diabetes. Well, you have to have a medical encounter to have a diagnosis of hypertension. Someone has to measure blood pressure, diabetes. The doctor will decide or assess you to see if you have diabetes. We are publishing estimates of obesity based just on our own measure. We're diagnosing ourselves. You don't even have to have any medical encounters or anything to have a diagnosis of obesity. So that's a very strange kind of disease that really doesn't need any medical person to diagnose it.
BROOKE GLADSTONE That's what makes obesity so baffling. Just step on a scale, mark your height on a doorframe, check out a chart and you can see whether you're part of the great American obesity epidemic. Some decry the lack of science, others the insult as a diagnosis borne more of bias than data. Now that we have good research to back up more qualified conversations about weight, what gives the BMI still the power to sound the alarm? Why aren't Flegal's and the numbers so often cited on the nightly news?
KATIE LEBESCO A moral panic is kind of a cultural freak out.
BROOKE GLADSTONE Katie Lebesco researches food, pop culture and fat activism. Just a few years before, Flegal published her meta analysis, debunking the deathly data about Fat, Lebesco was probing our attitudes about it. She found a moral panic. In her 2010 essay Fat Panic and the New Morality, she argued that the current obesity epidemic was simply old fat panic in new sciency bottles. And like the red scare of the fifties or the Satanic panic in the eighties in the nineties. Well, here she likes to quote sociologist Stanley Cohen.
KATIE LEBESCO He said that a moral panic is a struggle to control the means of cultural reproduction. So in a moral panic, you see a bunch of common threads, some kind of concern that there's a threat, a consensus that something has to be done about the threat, kind of blown out of proportion, sense of the effect of the threat. And a lot of hostility toward the people who are responsible for it. And moral panics tend to like they emerge rather rapidly. So you'll see a huge escalation about something that people maybe two or three years ago, didn't really care so much about. And the obesity epidemic follows that same kind of pattern as the other moral panics you mentioned.
BROOKE GLADSTONE I hate fat panic, but I am susceptible to it. So help me with separating fact from fiction.
KATIE LEBESCO Let me take a stab at that. We can grant that there has been a slight increase in the body weight of the average American over the last 50 years. During that same time, there's also been an increase in the average height of an American. But certain shifts freak us out and other shifts are less likely to freak us out. We see headlines every week about obesity threatening women's fertility. Fat babies, fat toddlers, you know, fat time bombs, insurance costs going up, air travel being expensive because fat people are weighing down airplanes.
BROOKE GLADSTONE That's a sign that there's a moral panic going on.
KATIE LEBESCO Concern about an imagined threat is definitely one element of a moral panic.
BROOKE GLADSTONE And then there's hostility in the form of moral outrage towards the individuals and agencies responsible for the problem.
KATIE LEBESCO Yes, there's definitely hostility toward fat people or in fewer cases, toward the social structures that we think make people fat. So if it's the individual, we think, oh, that person's lazy or they're completely out of control.
BROOKE GLADSTONE And there are TV shows like The Biggest Loser, which personalizes the concern.
BIGGEST LOSER It comes down to what is your self worth? These 12 people will lose the fear....
BIGGEST LOSER COACH Don't carry this weight any longer.
BIGGEST LOSER The longer we lose the excuses.
BIGGEST LOSER COACH Being a leader, let's go.
BIGGEST LOSER And lose the weight. [END CLIP]
KATIE LEBESCO And if it's hostility not toward the individual but toward the social structures, maybe it's why is the government subsidizing corn and putting corn syrup in junk food? Why is the fast food industry so profit hungry? Or why do we have a culture that's based on cars and thus making people less likely to move?
BROOKE GLADSTONE A moral panic has to be an imagined threat, right?
KATIE LEBESCO There's something real that is happening. The reports of harm in a moral panic are wildly out of proportion to what's actually going on. So in the fat panic. We see it almost impossible to think that somebody could be fat and healthy at the same time. We think that people who are fat have signed their own death warrant. Research suggests that people who are labeled overweight or obese actually don't increase their risk for early death until their BMI gets quite high in the upper thirties or higher. Why do we think then that being fat means you're going to keel over tomorrow if in fact that is not what we find at most of the cases of people who are fat.
BROOKE GLADSTONE You referred to sociologist Stanley Cohen, who was a popularizer of the concept of a moral panic. He said that successful moral panics owe their appeal to the ability to find points of resonance with wider anxieties.
KATIE LEBESCO Yeah, Cohen would definitely be interested in what the wider anxieties were fueling fat panic. And I think there are a couple of anxieties. One is about the changing bodyscape of privilege, whose privilege is being threatened by folks who didn't used to have power. What do those bodies look like?
BROOKE GLADSTONE Well, according to the professor and conservative culture warrior Jordan Peterson, that body looks like that of Yumi Nu, the full figured Sports Illustrated cover model.
JORDAN PETERSON All of a sudden, this non-athletic body type is as beautiful as the standard swimsuit model for Sports Illustrated. And it's not. The whole thing is a lie. [END CLIP]
KATIE LEBESCO I've seen the argument in media studies that there is a kind of crisis of masculinity, as white men in particular were seeing themselves threatened by the rising power of women, threatened by people who are black and brown. I think what you see in a kind of condensed struggle around fatness is over whose bodies signify privilege and whose don't.
JORDAN PETERSON And I'm also not willing to sacrifice these ideals for inclusiveness. It's like, no, not everyone's a genius. No, not everyone's Picasso. No, not everyone is young and healthy. And no, not everyone is a Sports Illustrated swimsuit model. Period. And F*** you if you don't like it. [END CLIP]
KATIE LEBESCO We have a lot of anxiety, both from a racial and gender political perspective. And it's a perfect opportunity for a moral panic.
BROOKE GLADSTONE I'm wondering if you were writing this essay today. Do you think that any of your conclusions might be different?
KATIE LEBESCO Something I wrote in the piece was whether the individual or the larger structure is targeted. The tone is typically hostile and morally righteous, like, how dare they? What I was talking about 15 years ago was almost these scolds, these finger wagging scolds. And I think that finger wagging has sort of gone on the down low. So it's still there, but it's taking different forms now. I think the way people in my part of the world, the fairly well educated, white, suburban, middle class or upper middle class crowd, the way we talk about fatness is a little bit less explicitly damning than it was 15 years ago. Friends in my community will never talk about diets anymore how you know, someone should go on a diet. But we talk about wellness and clean eating, and there's a whole host of new language that I think is doing a lot of the same cultural work that the old language was doing. But it's harder to pin people down.
BROOKE GLADSTONE Katie, thank you very much.
KATIE LEBESCO You're welcome.
BROOKE GLADSTONE Katie La Vasco is an author and researcher specializing in the study of food, pop culture and fat activism. Coming up. There wasn't always a fat panic, just in the last few centuries or so. This is On the Media.
BROOKE GLADSTONE This is On the Media, I'm Brooke Gladstone. Lebesco described fat panic as something with many tendrils tightly tethered to our culture, to our media. But the genesis of American ideas about weight occurred long before nightly news spots on the obesity epidemic. Back in the 16th century, a philosophical question was captivating Europe's artistic and intellectual elite. What is beauty? Proportions, facial features and fat were all scrutinized in a quest to define the divine ideal. The answers left for us in the form of Renaissance art offer portraits of a society that valued women of luminous variety and especially those of weight. But Sabrina Strings, sociologist at the University of California, Irvine, and author of Fearing the Black Body: The Racial Origins of Fatphobia saw something odd happening in both the brush strokes and philosophy ascendant at the turn of the 18th century. It seemed that European women of substance still held the focus in portraiture, but European men were getting leaner. Long enduring attitudes about beauty steeped in abundance were about to undergo a radical reassessment rooted in the quickly expanding slave trade. Bound up in race, obviously, and class and religion, but also consumption. Specifically of one commodity made available by expanding enslavement of black people. I'm talking about white gold.
SABRINA STRING Europeans were recreating their own cultural identities, often in opposition to how racial others appeared.
BROOKE GLADSTONE That's Sabrina Strings.
SABRINA STRING Sugar was an important part of the story. Now there's all this sugar available is sweets, alcoholic beverages. And people spend all of their time in these pubs drinking and eating themselves under the table. My God, no. If we are a Christian nation, we need to rein this in. There were elite European men, especially thinking about what does it mean to be an intellectual? What it meant to be an intellectual during the classical era. And then turning and ever so slightly to say, well, people who are lean and have a hungry look are they might, I said, conniving during antiquity, but let's say intelligent restraint of the so-called animal appetites. That's proof of intellectual capacity. Now, after this epic we're talking about the 18th century, the Enlightenment. Historical models of beauty don't really work. It's not enough for us to be slender. We need to have models of beauty that speak to our values. We are going to create a hierarchy from the highest beings to the lowest beings. A reinvention of what was known in the 16th century as the great chain of being.
BROOKE GLADSTONE And enslaved people were depicted as undisciplined and lazy and overindulgent and fat.
SABRINA STRING Race science is a fiction. It relies on the desire to keep a hierarchy in place. It didn't really matter too much that if you were to go to Africa, you would have seen people with all sorts of body types. The idea was that there was already a relationship between intellectual wisdom and refinement and slimness. And one of the prevailing narratives was that Africans were hypersexual and hyper oral. This is the time period before statistics were brought to use. It's not as if scales were everywhere. Right. It wasn't as if it was based on reality. It was based on a narrative.
BROOKE GLADSTONE Half these people may not have even seen them at all.
SABRINA STRING That's the most important part. It's hard for us to imagine a time period in which you simply did not see anyone of African descent. But that was quite plausible. If you were, let's say, living in Paris. It would have been very rare to come across an African or if you were living in London. That's why Sarah Baartman, when she arrived in the 19th century, was such a sensation.
BROOKE GLADSTONE The so-called Hottentot Venus.
SABRINA STRING That's right. The Hottentot Venus. So we have, for the first time, an actual black woman arriving in Europe for the express purposes of being seen by European populations. People were coming out by the droves to get a glimpse of the so-called perfect specimen of Africanity. One of the reasons why people came to see her was because the size and shape of her labia and buttocks were unusual compared to Europeans understandings of their own anatomy. They deemed this to be absolutely evidence of savagery and primitivity.
BROOKE GLADSTONE Let's jump back to 1780. There was already a conversation, this was in Britain, about the American physique that many white Americans were tall and lanky and really more beautiful than the Brits.
SABRINA STRING You know, there was a moment in which the British and the Americans were talking about their superior position in humanity. There was all of this conversation about what it meant to be a true Anglo-Saxon American. And it had a lot to do with height and weight.
BROOKE GLADSTONE And Protestantism.
SABRINA STRING Yes. Protestantism is an integral part of this story because there was this movement that was taking place in England to reform the dietary habits that had cropped up as a result of the slave trade. There was this sense among Puritans, for the most part, that sugar was actually deteriorating the moral fiber. And many of the people who were out proselytizing about this were involved with the church. On the ca se of George Shane, he wasn't formally ordained.
BROOKE GLADSTONE He was a preacher of the diet. And his view was, you should just drink milk, right?
SABRINA STRING Yeah. You know, you're on a diet of milk and seeds. This is supposed to remove any temptation to overly indulge in your appetite. You know, secondly, it will reduce your frame if it is too corpulent.
BROOKE GLADSTONE And Shane was his own best evidence because he had grown enormously fat and used this diet to lose 250 pounds or something.
SABRINA STRING He was wondering if he was eating in such. Away. That was contrary to Christian principles. And once he adopted this new diet, he found that he felt like he was doing the right thing for God and that he also lost weight. This is a very important part of the message that he was disseminating to audiences, and the people who showed up were largely women.
BROOKE GLADSTONE This transition, in the view of fat and thinness, you characterize it with the phrase ascetic esthetic.
SABRINA STRING Yes.
BROOKE GLADSTONE What do you mean?
SABRINA STRING So we think about asceticism usually as a form of monasticism. We renounce sex, we renounce food. This is a lot of the way in which Europeans were rejiggering their identity. They were not saying that they were fully renunciates. Only that as good Christians and racially superior beings, they were not invested in the low course appetites that other races were. It applied most fervently to Africans, for the obvious reason that the slave trade was behind it. But to the extent that colonization impacted other people of color, there was also a discourse about Asian fatness that was taking place at the time.
BROOKE GLADSTONE Italians are Eastern Europeans and so forth.
SABRINA STRING Yes. At a later period.
BROOKE GLADSTONE Irish.
SABRINA STRING Yeah. That was actually one of the more interesting early findings of the dissertation. When I first started doing the research into this, putting a little simple search terms coming back were a lot of references to Irish women and I thought, I don't know what's going on here.
SABRINA STRING Because I'm looking for representations of race and blackness and whiteness and body size, and I keep getting Irish women what is happening. So it took me a while to understand that the category of whiteness is always shifting. This is still true, and that's important because what it means is that whiteness is always aspirational. If it were settled, then we would know who belongs where at all times, and we might also have the ability to protest such standards. But if there's always the possibility of another group entering the coveted space of whiteness, people are less likely to protest it. And so this is one of the things that was happening with Irish people in the United States. When they arrived, there was this fear that they were overly fat, which is interesting given the context of their arrival right. Here they're fleeing famine, but the moment they arrive in the U.S., they're too fat. So this makes no sense at all. But this was the discourse. Discourse suggested that they were theorists would say "part negroid." This explained their swarthy skin and it also explain their fatness.
BROOKE GLADSTONE Fast forward to the early 20th century in the U.S., we had plenty of proselytizer too. A lot of them in the pages of ladies magazines.
SABRINA STRING Yes. When Americans started to try to create their own media, they relied heavily on information from France, from England. And so what you would see in early women's magazines were recapitulation of some of the very ideas that could have been seen for the last 100 years in British magazines. And the lore was that there was a proper way to eat for God, and there's a proper body size for Anglo-Saxons.
BROOKE GLADSTONE Why do you think we're always preaching fat or thin? I mean, even with the blatant racism aside, why is weight something we love to proscribe prescribe? Why?
SABRINA STRING If we look at earlier moments or even different regions of the world, you can find that people have different body size preferences. But what made the contemporary shift to the slender ideal difference was that it was placed within a hierarchy of humanity. Were it not for that, perhaps other individuals would have been able to say, You know what? I find different body sizes more attractive. And so I don't agree with this rendering. There could have been a greater conversation that could have shifted the aesthetic ideal or move the needle. But there was this economic imperative. There was a racial imperative. There was a religious imperative, and then later there was a medical imperative for people to be slender.
BROOKE GLADSTONE I want to ask you about today. A major study published in 2013 showed the risk for black women, quote, dying of obesity was far higher than any other group. Is the implication here that the risk of being above a particular weight is different for black women than for white women or men, for that matter?
SABRINA STRING That is one of the implications of much of the research that I have seen. Yes.
BROOKE GLADSTONE Given that we all know that there's more differentiation within races than between races, is that a likelihood that health for black women would be correlated differently with regard to weight?
SABRINA STRING It wouldn't be a biological issue so much as an issue of history in the United States. When we take a look at some of the factors that might contribute to a person being in the overweight or obese category according to BMI, which I think is deeply flawed. So when we look at the risk factors for those things, we come across issues like being food insecure, not having sufficient access to healthy fruit and vegetables, the definition of food insecurity, living in a place with environmental toxins, living in a place with the constant threat of police violence. All of these things are structural factors that contribute to a person's weight. And given the reality of the racial structure of the United States, they're more likely to be prevalent in communities where we find black women.
BROOKE GLADSTONE You mentioned violence. Levels of cortisol, a stress hormone have a lot to do with how we carry weight.
SABRINA STRING Yeah, social stress is another factor. I think it's important for us to understand all of the things that might contribute to a person's weight, even as we recognize that the goal shouldn't be changing these things so that people can lose weight. We should change these things so that people can live with a sense of dignity. We also have to recognize that there are some people who are fat, and that's fine. We don't have to reform everyone to try to make everyone slender. You know, we're not living in an episode of The Twilight Zone.
BROOKE GLADSTONE Sabrina, thank you very much.
SABRINA STRING Thank you so much for having me.
BROOKE GLADSTONE Sabrina Strings is associate professor of sociology at the University of California, Irvine, and author of the book Fearing the Black Body: The Racial Origins of Fatphobia.
Roxane Gay wrote that when you're overweight, your body becomes a matter of public record in many respects. Your body is constantly and prominently on display. People project assumed narratives onto your body and are not at all interested in the truth of your body. Whatever the truth may be. Fat, much like skin color, is something you cannot hide. No matter how dark the clothing you wear or how diligently you avoid horizontal stripes. But she wrote, My body offers me the power of presence. My body is powerful.
And that's the show. On the Media is produced by Micah Loewinger, Eloise Blondiau, Candice Wang and Suzanne Gaber with help from Savannah Collins. Rebecca Clark-Callender was the lead producer for this episode. Our technical director is Jennifer Munson. Our engineers this week are Adriene Lily and Andrew Nerviano. Katya Rodgers is our executive producer. On the Media is a production of WNYC Studios. I'm Brooke Gladstone.