New podcast examines health trends and myths — like weight equals wellness: NPR

NPR’s Sarah McCammon chats with “Maintenance Phase” hosts Micheal Hobbes and Aubrey Gordon about going where most health and fitness podcasts don’t go, assessing popular dietary advice and wellness trends. to be.

AUDIE CORNISH, HOST:

Many people will resolve to lose weight in 2022. In 2021, NPR’s Sarah McCammon spoke with two people who wondered why?

SARAH MCCAMMON, BYLINE: Millions of Americans go on a diet every year. Americans also spend billions of dollars on weight loss products. So why, despite all of this, do obesity rates in the United States continue to rise?

AUBREY GORDON: It’s an incredibly complex question that we don’t have the answers to, but we continue to use the increasing levels of fat in our culture as a cudgel to get people to lose weight.

MCCAMMON: It’s writer Aubrey Gordon. She co-hosts the “Maintenance Phase” podcast with journalist Michael Hobbes. And she says when they started, they wanted to focus on big questions. That other health and fitness podcasts didn’t necessarily ask for.

GORDON: It was worth having a conversation about, like, OK, well, what’s the science behind this? What are the motivations of people presenting all these fad diets, all these wellness trends? Like, what’s the story behind that?

MCCAMMON: I spoke with Aubrey Gordon and Michael Hobbes the other day, and we started by talking about the medical consensus that obesity can lead to health problems.

MICHAEL HOBBES: Yes, there is a very clear correlation between weight and health problems, but weight is not the only thing that is correlated with health. We know that poverty has a devastating effect on people’s health. Life expectancy in various counties in America can be up to 20 years difference. In the poorest and most marginalized counties in America, people live to be around 65 years old. And, I think it’s, like, Boulder, Colorado, or something, they live to be 85. we accept as correlations.

And yet, weirdly, when it comes to obesity, it’s like, oh, no, no, we know obesity is causing it, right? Like, people kind of jumped at this causal explanation. And there’s a very strong association, but there are very strong associations of all kinds of things with health outcomes. So the question is, why do we always put weight at the center of our understanding of health when there are actually much more sophisticated ways to help people be healthy and we don’t really do them?

MCCAMMON: You spend an episode watching how obesity has been defined not just as a risk factor for certain diseases, but ultimately as a disease in and of itself. Can you give us a brief version of how it happened?

GORDON: I mean, I think to talk about, in quotes, “obesity” as a disease, you have to talk about BMI, which I think we now see as a hard and fast measure and a goal measure size and health. In the United States, the first type of public policy definition of overweight BMI was that the fattest 15% of us should be considered overweight. It was not related to their specific health outcomes occurring at that time. It was just, let’s call the fattest 15% of us overweight.

Essentially, what happened here was that there was a public health person at the CDC who really and passionately thought that our conversations about weight and weight loss were terribly oversimplified. And he thought redefining obesity as a disease would make people realize that it’s a lot more complicated than this kind of self-responsibility narrative that we’re getting.

The challenge is that, as he did, a group of pharmaceutical companies began to support his efforts because if more people were defined as fat, they would have more customers for their weight loss drugs and surgery. That’s not to say that these products didn’t work for some people and didn’t produce weight loss for some people, but it does mean that it wasn’t a neutral medical decision that wasn’t influenced by capital, is it not? Like any other industry, right? – in the food industry and in the healthcare industry, profit motives are always in play.

MCCAMMON: I mean, isn’t the point of calling something a disease often to be more compassionate? I mean, you see that with the war on drugs – don’t you? – to consider addiction as a disease, which implies that it is not necessarily someone’s fault. It’s something that needs treatment, not punishment, not contempt.

GORDON: Yeah. I think that was the intention of that person at the CDC. Ironically, and sadly, what we’ve seen in the years since this redefinition is a skyrocketing prejudice against fat people. It happened among health care providers. It happened among social workers. It’s happened among the general public in the United States that we’re seeing, you know, a dramatic increase in levels of anti-fat prejudice. So despite the kind of best intentions behind this redefinition, it unfortunately produced the opposite.

MCCAMMON: I want to ask you both a question. You know, you talk a lot about losing weight shouldn’t be – probably shouldn’t be the goal of changing your lifestyle. You know, full disclosure, I’ll tell you my own experience. About four years ago I lost 60 pounds. I had gained weight during a stressful time in my life. It’s complex, isn’t it? A lot of things went into it. And so I had a much heavier weight than usual.

I started very slowly and carefully, without, you know, any type of extreme change, making small lifestyle changes in terms of improving the quality of my food, just taking a lot more walks. When I was heavier I was still pretty healthy, but all the objective measures of health, you know, like my blood pressure looks better than it did four years ago. And I’m just sharing this to say – and you won’t offend me because I want to hear your honest opinion – is there a healthy way to think about weight loss? Is it still acceptable for this to be a goal?

GORDON: I don’t want to take anything away from anyone, do I? I don’t want to tell people who, you know, are somehow looking to lose weight that it’s a bad or unworthy goal for them. I want to tell people that it’s a much more complicated business than we’ve been led to believe. The story you just told is that I changed the foods I was eating. I changed the quality of the food I ate. I changed how I moved and how much I moved. And then I lost weight. And then my health markers changed.

So you can still do all the other things. You can still produce altered health results by changing your behaviors, and it may or may not lead to weight loss. And that’s always a win for your health, right? I think we would all be doing ourselves a really big favor by just focusing on health markers and not the health marker proxy, which is weight.

HOBBES: We’re interested in systems. Public health – we shouldn’t aim for weight, we should aim for health. If we are talking about medical care, it is very important that doctors actually listen to patients. And if they want to have the conversation about weight loss, if a patient brings it up, I think that’s fine. What we find are really consistent stories of fat people going to the doctor with a migraine and being told by their doctor to lose weight. They enter with a car accident. Their doctor tells them to lose weight. They come in with a tumor. Their doctor tells them to lose weight. It’s something that’s, like, really, really devastating to the health of fat people that people basically don’t listen to.

MCCAMMON: What feedback, if any, have you received from the medical community for your podcast?

HOBBES: Oh, it’s like, incredibly – this is one of the most disappointing emails I’ve ever seen. Like, it’s like sentence by sentence. It is as if this bias did not exist. And, ah, here’s my bias. It’s fascinating to me, like a very basic thing – asking them about their diet and exercise habits before giving them boring advice like calories in, calories out. Like, there’s so much resistance to that.

GORDON: So Mike tends to get extremely biased emails line by line. I tend to get emails from health care providers that talk about things like, oh my god, I never thought about why I had to put BMI on every patient’s chart. Oh my, now we’re talking about training for fat bias and screening for eating disorders before making dietary recommendations to a patient. For example, every time Mike checks his e-mails, the message he receives is that the doctors hate us. And every time I get mine – I check mine, I’m like, everything changes and things get better.

HOBBES: I know. We have to trade one of these days just for morale reasons.

GORDON: (Laughs) Really. I don’t know if I can bear it.

MCCAMMON: Michael Hobbes and Aubrey Gordon host the “Maintenance Phase” podcast. Thank you both very much for speaking with us.

HOBBES: Thank you for having us.

GORDON: Thank you.

(SOUNDTRACK FROM THE SONG DATAROCK, “FA-FA-FA”)

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