All Fired Up

In this gripping 2 part episode of All Fired Up, I explore the shadowy world of "Bright Line Eating", a super extreme diet cult which cherry picks neuroscience to convince people that they are 'food addicts', and then sells one of the world's most restrictive (and expensive) diet regimes to keep people hooked on the dream of achieving 'goal weight'. Bright Line Eating is the lucrative brainchild of neuroscientist Susan Peirce Thompson, a charismatic saleswoman who holds nothing back when it comes to the hard sell. Join me as I ask the question, who IS Susan Peirce Thompson - a food addict who has finally found the answer to her addictions, or someone who is still desperately stuck in her eating disorder? We also speak with neuroscientist Dr Sandra Aamodt, who literally attended the SAME UNIVERSITY as Susan Peirce Thompson, and has also experienced eating and body issues, but found peace through mindful and intuitive eating and body acceptance rather than continuing to white knuckle the revolving door of weight cycling. Dr Aamodt has very different ideas regarding this whole idea of food 'addiction'. Spoiler alert: Food addiction models = Binge Eating Disorder rebranded!  DO NOT MISS this story, it's a ripper! But CW - these 2 episodes have a lot of talk about weight, details of diet rules, and eating disorders, so take care if you think you might be triggered.

Shownotes

• Hello listeners! Remember me? I’m back! What a year we’ve had. I am back from a break where I was taking care of life for a while. Now I’m back and angrier than ever. Today’s episode is a two-parter, and we’ll be keeping the energy and the rants going on a regular basis again.
• Remember the Crappy Awards earlier this year? One of the nominations has been gnawing away at me. This is from Dr Martina Zangger, who sent us a rant about Bright Line Eating, a program by Susan Peirce Thompson. Bright Line Eating is a severely restrictive diet, and a very expensive program. Martina shares with us that she experienced Orthorexia and was at risk of Anorexia while engaging with the program - she was obsessed with every bite of food that passed her lips, and says she became a ‘not very nice person’ while so hangry and feeling superior to other people. That feeling of being superior and special was encouraged within the program. After two years, Martina was able to move away from the program and regain the weight she lost, and that process was so disheartening. However, two years after leaving that program, Martina is so much more at peace with her body. She’s able to find enjoyment in food, and in sharing food with friends and family. Bright Line Eating  is making Susan Peirce Thompson rich and is such an unethical program from a practitioner who should know better. 
• I’m still simmering with rage over this Crappy nomination. The impact of programs like this is devastating on people’s lives. Martina lost two years of her life and experienced an eating disorder, and her story of recovery needs to be heard. How are programs like this still happening, and being sold at such enormous profit?
• After I heard Martina’s story, I’ve been neck-deep in Susan Peirce Thompson and Bright Line Eating. It’s more than a diet, it’s more like a cult. There’s a variety of techniques being used in it to sell problematic ideas and encourage eating disordered behaviour in an apparent attempt to free yourself from ‘disordered behaviour’ - a mindfuck of the next level. 
• So, I’ve been reading and researching and I’m ready to dive into a two part series - this episode is about Bright Line Eating and Susan Peirce Thompson. We’re going to talk about her story, her book, and more broadly talk about the topic of neuroscience as it applies to body weight, and also dive into food addiction models. In the next episode, we’ll talk more with Martina and her experience with the program, and we’ll round out the deep dive with a closer look at the incredible amount of money Bright Line Eating has made.
• I really need to preface this episode with a trigger warning, a content warning, about numbers and weight. If that’s particularly triggering for you, maybe these two episodes are ones to avoid. Usually we avoid numbers, and in this instance we’re using them as examples of the harm that diet culture can cause, and as examples of inaccuracies. 
• We’ll be talking with neuroscientist Dr Sandra Aamodt about addiction and regulating body weight.
• So, the book. I’ve read the whole thing. ‘Bright Line Eating: the Science of Living Happy, Thin and Free” by Susan Peirce Thompson, 2017. To begin with, Susan is a really good storyteller and has a compelling personal story of how she came to this way of living. And that’s the thing with so many of these diet gurus, isn’t it? They’re quite compelling, charismatic, often good writers. Susan is from California and her parents were reformed hippies. She grew up in a house which sounded super ‘healthy’. Her mother was thin and always dieting, and Susan recounts how she was doing diets with her mum when she was 10 years old - “neither of us had weight to lose, it was just about being maximally healthy”. Susan paints herself as a kid who was always interested in food, even addicted, compelled to compulsively eat food. What I get from reading this was that this child grew up in a house with little food choice around, no processed food, quite restrictive. We know from lots of research in this area that kids who grow up in households with little food variety and where ‘bad’ food is banned, those kids are quite likely to grow up as binge-eating adults. And kids who diet early have a higher risk of developing eating disorders. There’s also a genetic component with eating disorders, which makes me wonder about Susan’s mother and her own eating issues. 
• One thing that stuck out was the vivid descriptions of what restricting her food felt like as a child - powerful, a feeling of being in control. For most of us on a diet, we feel pretty crappy. For some of us, perhaps those with quite a restrictive relationship with food, that experience of restriction is quite elating. They describe that feeling of being in power, being in control, and get hooked on that feeling of not eating. There’s a disturbing description of Susan ‘going off sugar’ at age 12, of feeling empowered.
• She also related how, even with these feelings of being empowered, she would sneak food and hide food - which she reads as evidence of her ‘addiction’, but I read as being evidence of the severity of her restriction. 
• By the time Susan was 15, she described herself as ‘overweight’, and feeling ‘enormous’ compared to her thin mum. Again, she unquestioningly accepts that there was something wrong with her body at 15. My non-diet lens tells me that our bodies are changing when we’re 15. It’s perfectly normal to gain weight as you grow, maybe it was just growth? She continued dieting and stumbled into drugs, from ages 14-20, including acid, ecstasy, meth, crack. Quite serious. She talks about the impact on her weight - when you’re on drugs like that, you do reduce your weight. It’s a harrowing story, to be hooked on such terrible drugs for your adolescence.
• Susan found herself at rock bottom and in a 12 Step program at age 20, and found recovery from drug and alcohol addiction through the 12 Step model. That’s an amazing story! It is not easy to turn your life around like that, and she did it. But in the book, that victory didn’t bring her peace, because her weight increased and she felt terrible about it. She was also still thinking of herself as a food addict, and began attending 12 Step programs for overeating. Episode 30 of All Fired Up is about Overeaters Anonymous - check it out. It looks like Susan did stuff like that for years and years and years without reducing her weight. 
• It’s clear in the book that Susan is not perceiving herself as someone who has issues with her relationship with food, but as someone with weight to lose who is addicted to food. At times she received diagnoses of Binge Eating Disorder and Bulimia, but she did not receive any eating disorder treatment. In 2003, she joined a more extreme unnamed 12 Step, which I believe may be ‘FA’ or ‘Food Addicts Anonymous’. Like all the other 12 Step programs, they are free support groups to help people who perceive themselves as food addicts - and FA has very strict rules. No sugar, no flour. Three meals a day, absolutely no other food. You have to ‘commit’ your meal plan each night to a buddy, mentor, sponsor in the program for the next day. You weigh out each meal according to a strict meal plan. It’s intense, it’s extreme. There’s a lot of mentorship and buddyship to ‘support’ each other - but I would say it’s more like policing each other, to make sure they don’t eat. Susan was happy about finally losing weight in this strict program. 
• But she grew to be distressed with the amount of time the program was taking up - about 20 hours a week of planning, talking to mentors and more. She mentions that her husband considered leaving her, and she was annoyed with the lack of science around the food rules in the program. By this point, Susan had gone to university and studied cognitive science and was now a neuroscientist. She decided she was going to write a book and start an online program, combining her knowledge of the brain with the strict program. What she calls ‘bright lines’, I call ‘very strict rules’ or ‘diet prison’. 
• The ‘online boot camps’ she began offering took off very quickly, and eventually she hired a team and  published her book. The diet in the book is basically the same as the FA diet - but FA is free, and Bright Line Eating is for-profit. Her husband is now the CFO. The bootcamps are very expensive, as are all the add-ons in the program. Every level of support requires payment, and Susan justified charging this much money for the program by saying that it’s not just the FA program, it’s a community and it’s combined with neuroscience, and that her team is going ‘cutting edge research in the field’. So, not only has she monetised a popular 12 Step program, but she’s using ‘neuroscience’ and the cache of her PhD to help her ideas gain cred. 
• Susan talks a lot about the brain, and seems to understand that body weight is tightly controlled by our brain (particularly the hypothalamus) and understands that only a small percentage of dieters keep weight off long term. She understands that the hypothalamus is like a thermostat that controls body weight, and it’s out of our conscious control. So, she pays lip service to that, and then spends the rest of the book talking about how her neuroscience tips will fix that - as if it’s broken. 
• What’s being missed here? The science that shows us changes in body weight are countered by these established processes in our brain. She never mentions this - the ‘defended weight range’ - which is pretty fundamental science about how our brains defend body weight. In her whole book, she never mentions it. In a minute we’ll talk more with Dr Aamodt about that.
• Susan does talk a lot about leptin regulating our body weight. Leptin is a  hormone stored in fat cells, and as fat cells get larger they secrete leptin which tells our brain that we’re comfortable, we’re at the right weight, we don’t need to seek out more food. Susan claims that people in larger bodies have too much leptin that isn’t getting to our brains to tell us to stop eating - she says that larger bodied people are ‘leptin resistant’ and our brains think we’re starving and tell us to eat more. She claims that the cause of leptin resistance is insulin resistance, which is caused directly by processed food. Very sweeping generalisations - in essence she is saying that larger people are insatiably eating because leptin is being blocked by our brainstem, which causes us to mindlessly eat processed food all day. So basically, we are all ‘leptin resistant’ humans, mindless processed food eating machines.
• I’ve got some issues! Not all large people are insulin resistant. Insulin resistance is impacted by an enormous range of factors - genetic, environmental and social. It’s incredibly simplistic to say it’s just due to processed food. For Susan, anyone who is larger is by definition sick or deficient. She continually refers to the ‘right size body’, which is your ‘thin’ body. A complete disregard for body diversity, and lack of data to back up her claims about leptin.
• She’s also left out the impact of weight loss dieting on leptin. When we try and diet and lose weight, our leptin levels drop. This drop stimulates a huge increase in our appetite and interest in food. So, although she’s concentrating on this idea that larger people are leptin resistant, people may instead have lower leptin levels due to dieting and that’s what is telling our brains that we’re starving. So, leptin drops and interest in food is very well documented in neuroscience - because it’s a very primitive and important danger signal to the brain. 
• Let’s not forget Susan’s target audience of middle-aged women, who likely have dieted many times before and may have lower leptin levels due to this. She knows this. She even mentions the Biggest Loser study which notes how damaged people’s metabolisms were from strict dieting. She says that during the ‘weight loss’ phase of her bootcamp, your metabolism will slow down something like 80-90%, but in the next breath says that there’s no evidence that this will continue to happen - “we’ve never seen evidence of this in Bright Line Eating, there is no reason for alarm”. This really annoyed me. She has no evidence of it because she’s done no research on it. Simply because you don’t look for harm doesn’t mean there’s no harm. 
• Another claim from the book is that you can choose your goal weight based on the lowest weight you’ve ever been, and she pretty much guarantees you can reach it. This flies in the face of weight science and our understanding of all the factors outside of our control. There’s no evidence to say that Bright Line Eating is any different from any other weight loss program.
• Talking about cravings - Susan describes them as a “brain-based bingeing mechanism”, located in the nucleus accumbens which has become ‘overstimulated’ by the plentiful food in our current environment. She uses her own experience as a drug addict to paint this vivid picture, describing her need for higher doses of drugs to get the same high. That is tolerance - it’s well documented in addiction literature, especially for opiate receptors. Sarah says food behaves in the same way - flour and sugar in particular are acting in the same way as heroin in our brain. She doesn't have very much data to support this idea that flour and sugar behave like a drug. She mentions rat studies to back up some of her sugar claims, but even she admits there’s nothing in the research to show flour is addictive.
• Food addiction was excluded from the category “substance related and addictive disorders” in the DSM-V, due to lack of evidence. We’ll hear more from neuroscientist Dr Aamodt on this.
• One of the ways Susan is trying to convince us that sugar and flour are toxic poisons is pretty weird. She asks us to google images of flour, sugar and heroin and look at how similar they are. For the record - things that look like drugs are not necessarily drugs. In her view, processing things is what makes them drugs. In Susan’s view, the way sugar is processed makes it a more toxic drug. What about the way we process mint tea? Dried chillies?
• I think that this Bright Line plan will keep people in a state of deprivation and restriction, which increases those feelings of addiction. The longer we’re deprived, the stronger our desire will become for the forbidden thing. We know that if people are full when they’re doing an experiment where they’re exposed to food stimuli, their reward centres are less activated. When you think about it, you’re never going to be full on Bright Line Eating and you’re going to feel like an addict. And if you then go to a bootcamp or on one of the forums, it’s going to feel more real.
• Another bugbear - she repeatedly scares people by referring to food in this book as ‘drugs’, ‘toxins’, ‘poisons’. But then later she says it’s fine for children to eat them, because they’re ‘young enough to burn off the calories’. What?
• This is a woman who is desperately attached to thinness as a measure of self-worth. 
• If she really believes sugar and flour were toxic poisons, why is she recommending them to children?
• The rules she’s lifted from FA are full on, and she’s using neuroscience-talk to give them a sense of validation. 
• “It takes some willpower to set up and then little to none when it becomes automatic”. Susan has science-washed extreme deprivation and disguised it as normal. 
• Susan likens the automatic level of food behaviours to brushing your teeth - but our bodies and brains aren’t hard-wired to desire tooth-brushing as a survival mechanism, and feel under threat when we haven’t brushed out teeth in a while. Susan knows this. She wouldn’t have to set up such extensive support systems if permanent restriction truly was automatic.
• Introducing Dr Aamodt, who wrote the book “Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss”. She also has a much-watched Ted Talk about why she stopped dieting and switched to mindful eating, which has been watched by 4.5 million people.
• Before she was an author, Dr Aamodt was Editor-In--Chief of Nature Neuroscience, a leading scientific journal in the field of brain research.
• Dr Aamodt was pulled into neuroscience due to personal experience -  as a teenager she remembers her mother commenting that she was “eating like a fat person”. She was not at a higher weight at the time, and looks back at photos of that time and thinks “what was mum doing?”.
• Dr Aamodt began making complicated food rules for herself, like not being allowed to open the refrigerator herself. It was almost like that comment unlocked disordered eating for her.
• Sandra then spent about 30 years cycling through diets, and while she never met the definition for an eating disorder she veered very close. Sandra vividly remembers how difficult it was to force herself to move away from dieting.
• In her early 30’s, Sandra was exposed to some feminist writings about dieting which seemed to unlock some things she’d kind of known for years but hadn’t been paying attention to, such as weight being neurologically controlled. She hadn’t connected the dots that her own body would behave that way.
• We’re biological animals with physiological regulation, but we’re also social animals living in culture where we’re expected to look and eat a certain way. It’s as if one day someone said to Sandra, “you don’t have to do that”. A blog Sandra credits with some of these early moments of unlearning is ‘Shapely Prose’.
• The biggest advantage of not dieting for Sandra turned out to be psychological, not physical - the amount of mental space that weight and eating were taking up in her brain turned out to be unbelievable when it stopped. She describes it as like having ringing in your ears for your entire life, then one day someone turns the ringing off.
• In Susan’s experience, you can’t just tell people ‘don’t diet’ - you have to tell them what to do instead. The message of ‘don’t control your weight’ is too uncomfortable. 
• Sandra came across mindful eating, which gave some structure to make that transition away from dieting.
• Sandra initially didn’t know when she was hungry - how could she, after all those years of strictly regulating herself? 
• There’s a lot of psychological research showing that people who diet frequently are not good at picking up interoception signals from their bodies - such as feeling your heart beating. But even after many years of ignoring your body, you can reconnect and hear those signals again. Sandra is much better at it than she used to be.
• Unlearning takes time! All those neuroplastic changes can be reversed, if you take the time and energy to do it. For Sandra, moving from dieting to not dieting was a huge upgrade.
• What is the ‘set point’? Scientists call it the ‘defended range’ which Sandra says is a better term. It’s a small range of weight where your body is comfortable. When you’re within your defended range, weight works the way that random people on the internet think that it works all the time. You can make your lifestyle changes and nudge it a little up or down. It’s the range where your body and your brain are not fighting you. The body is comfortable.
• Once you get outside that range, in either direction, this is where the brain says ‘this is not right, we’re not regulating properly, we need to fix this’. And this is where calories in, calories out becomes unreliable and the way you process food starts to change in dramatic ways. Metabolism changes to try and get you back into that defended range. 
• It’s normal to be more hungry when you’re not getting enough food!
• It does seem as though the responses are asymmetrical - that the body’s compensatory mechanisms become more intense over time if you’re under your defended range, but will become less intense over time if you’re above your defended range. So, your brain is much more relaxed with being at a higher weight than being under your defended range. From an evolutionary perspective, starving is really serious and you should never take it lightly. 
• How do we know our defended range? It’s genetic to begin with - there are strong genetic influences on it. A number of life experiences can affect it, for instance people who didn’t get enough sleep as children generally have a higher defended range as adults. Also, children who had a lot of stress and/or trauma in their lives have a higher defended range as adults. 
• If your childhood environment is scary, unpredictable, like something bad will happen at any time - there’s a strong evolutionary argument that it would be okay for your body to store extra energy for future dangerous times. The body makes sense! Your body does its best to survive.
• There’s a genetic link as well in who is susceptible to constantly being invited to ignore their bodies, and whose bodies have such strong hunger and fullness signals that they seem to be completely immune to those kinds of external messaging. 
• And then dieting itself - attempting to get under your ‘defended range’. The brain desires that we stay within that defended range and functions 24/7 without a break - and we try to combat this with willpower, which we cannot do 24/7. We can do a lot of these things for a while, but at some point it gets to be like holding your breath. 
• The food addiction model - the idea that if we remove certain foods from our diet we can permanently change our set point, our weight, and our brains will relax and finally do what diet culture says they should do. What does Sandra think about that?
• Sandra thinks the food addiction model is basically a rebranding of Binge Eating Disorder. The restriction itself is what produces the sense of being ‘out of control’. The easiest way to see that is in experiments on rodents, who aren’t bombarded with media messages telling them their bodies are unacceptable. 
• Inducing Binge Eating Disorder in rats is actually done quite reliably - rats are starved to about 70-80% of their starting weight, then given high sugar foods. The rats will eat past fullness - they will ‘stuff’ themselves. If you make this a cycle and repeat several times, you can get rats to the point where they will binge on regular boring rat chow. They don’t even require the food to taste good to overeat it. That sounds familiar, right? We are those rats. We often miss the deprivation with Binge Eating Disorder and focus only on the eating.
• There are also changes in the brain’s reward system that are associated with that behaviour, but that doesn’t immediately jump out at Sandra as being that the solution is to restrict what we eat. If the restriction causes the disorder, it probably isn’t also the cure.
• If the rats weren’t starved, would they have this response to high sugar food? No. Rats who aren’t starved and are presented with novel foods will eat until full and then stop.
• These rats are not trying to diet, they’re not struggling with mixed cultural messages - they’re just having a straightforward biological response to a stimulus that suggests that maybe you should put away some reserves for the future because every so often, somebody comes and takes your food away.
• It’s quite a simple, elegant, neurobiological response to famine.
• So, the food addiction model is rebranded deprivation models, or Binge Eating Disorder models. Nobody has come up with evidence that is convincing Sandra that it’s any more than that. The scales that measure food addiction have a lot of overlap with the scales that measure Binge Eating Disorder.
• A definition of addiction that Sandra likes is ‘when we continue to want things that we do not like” being drawn to repeat behaviours that you don’t actually enjoy. And some people would describe Binge Eating Disorder in that way, but Sandra doesn’t think that implies that the treatment is doing more of what created it in the first place (restriction).
• Huge thanks to Dr Sandra Aamodt for sharing her experience and  bringing us some logic and more of a whole picture, not just a narrow view. In some ways, Dr Aamodt and Susan Peirce Thompson are quite similar. They both grew up in diet culture, both developed eating issues as a result of trying to control their body weight, and they’re both neuroscientists. However, one has chosen to monetize this in the Bright Line Eating program, and one has chosen to help people find real freedom. The idea of ‘freedom’ in Bright Line Eating is very, very different from the idea of freedom that Dr Aamodt and I (Louise) have. Ours is about laying down our weapons and learning to reconnect. 
• Next episode we’ll talk with Dr Martina Zangger about her experience with Bright Line Eating, and look at the economic reality of how enormous this machine is. And more dodgy research claims! It’ll be a zinger. 

Resources

• Here's Dr Aamodt's wonderful Ted Talk
• And her awesome book
• You can get in touch with Dr Sandra Aamodt at [email protected] and on twitter at @sandra_aamodt

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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 

Hosted on Acast. See acast.com/privacy for more information.

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 

Hosted on Acast. See acast.com/privacy for more information.

It’s WAY overdue, but the 2019 Crappy Awards are finally here! 2019 was a SH*TTY year of diet culture BS, with countless examples of gaslighting opportunism from profit hungry snake oil salesman. From fashion brands and Big “O” stealing body positivity, to medical negligence and library invasions, NOTHING is sacred to the weight loss wolves hungry to make a buck off body misery! Our listeners have gathered together the MOST loathsome examples of these bottom feeding b*stards in a magnificent rant-fest of epic proportions! If you’ve had a gutful of COVID19, tune in for some truly furious take downs of the weight loss industry! I strongly advise a large quarantini and headphones for this ep as the swear-o-meter is set to high! Featuring guest judge Alyssa, our carry over champ from the 2018 awards ceremony. Who will win???

Show Notes

• Goodness me, we’re dealing with multiple layers of fear and uncertainty at this time. We’re going to get through this but bloody hell, what an absolute shit-fight. I hope you’re all staying safe, and that this episode and The Crappys give you a needed belly laugh.
• Announcement! Why should we wait until the end of the year for The Crappys? For the rest of 2020, we’re going to ‘rant as you go’. If you hear something from diet culture that really gets your goat and gets your blood boiling, you can submit a rant to me anytime. While it’s fresh, do a quick recording -  around two to three minutes – introduce yourself, rant about the thing that’s pissing you off, and send it to me as an .mp3 or .mp4 to [email protected]. I’ll save them up until the next Crappy Awards.
• A warning for this episode – plenty of swearing!
• And without further ado, I’m going to introduce the 2019 Crappy Awards! Grab a ‘quarantini’ and let’s rant about diet culture.
• Alyssa won our previous Crappy Awards in 2018 with a brilliant rant about the ‘cookie diet’ and so joins us as a guest judge this year.
• 2019 was a huge year for crappy diet culture crap. Huge. And it’s seeped into 2020 – just a quagmire of shit to rake through to pick the crappiest of 2019.
• Even as a non-competing judge, Alyssa couldn’t help but submit a rant herself. Alyssa nominates the book ‘How Not to Diet’ by Dr Michael Greger. It mentioned weight loss multiple times on just the cover blurbs, and the kicker – this book is about the “ideal weight-loss diet”. IDEAL WEIGHT-LOSS DIET. In a book called ‘how not to diet’. SERIOUSLY! “A timeless proactive approach that can stand up to any new trend” … even his own new trend? There’s too many of them! “Chock full of actionable advice and groundbreaking dietary research. ‘How Not to Diet’ will put an end to dieting and replace those constant weight-loss struggles with a simple, healthy, sustainable lifestyle”. We’ve got weight-loss, weight-loss, weight-loss, then ‘lifestyle’, hence a nomination for The Crappys.
• Some consistency here with her 2018 winning rant objecting to being mansplained at with the ‘cookie diet’! Dr Michael Greger is another thin white male entering the ‘how not to diet’ space. Is this a joke? A how-not-to-diet-step-by-step-diet?
• Alyssa has some judging criteria for the official 2019 entries – laugh factor, sarcasm factor, and WTF or ‘mind blown’ factor.
• Entry #1 – from Anna Hearn, founder of Haven Wellness. It’s a unique fat-positive fitness and yoga studio in Sydney, Australia. Haven focuses on helping members build a compassionate relationship with their bodies which is very different to typical gym culture, and to build a resilience against diet culture out in the ‘real world’. Anna wants to rant about body positivity being co-opted for marketing purposes. Anna had a conversation with a friend who reiterated the idea that fashion brands use thin bodies because ‘that’s what sells’. But, remember campaigns like the Calvin Klein underwear ads that featured some bigger bodies, like rapper Chika? You might then think that you could go and buy Calvin Klein underwear in larger sizes – nope! Anna learned from clients that brands like Everlane and Urban Outfitters also use larger-bodied people in their advertising campaigns but then don’t carry those sizes for customers. So, they’ll use larger bodies in their campaigns but then won’t even let you buy those sizes. Profiting off body positivity while not taking care of larger bodies.
• Brands want to jump on the bandwagon and profit from the body positivity movement without actually doing the work to create products for larger bodies.
• Remember when Lorna Jane got in trouble for advertising for a receptionist who had to be a size zero? They then tried to use body positivity in their marketing campaigns, but then quickly went straight back to their regular marketing of tiny women.
• Entry #2 – Belinda is here to talk about libraries. Belinda loves libraries! Sauntering into the 2020 display to find some new reads for herself, she was slapped in the face with a range of new-fangled diet books and health garbage. Why does this have to invade some of the safest spaces on the planet? Belinda used to live and breathe libraries as a child. Here’s an idea – put all of these lifestyle authors on ‘Diet Island’ where they can live out the Paleo dream! It’s hard to have all this rantiness and no power, but still we do our best. Belinda urges everyone to vote out these books and instead borrow Christy Harrison’s book ‘Anti-Diet’ – ask your library to get it in! Keep the booky places happy and booky. Libraries are where we play, read, learn, expand our minds – not contract our lives!
• High sarcasm levels on that rant! So many beautiful mic-drop phrases as well. It’s a rare gift to be able to simultaneously rile someone up and make them laugh, but that’s what just happened for Louise with Belinda’s rant.
• Entry #3 – from Caroline White, the president of HAES Australia, nominating Big Pharma for co-opting the concept of weight stigma for their own purposes. In 2018 we ended on a bit of a high, with the senate committee into the ‘o’ epidemic in Australia recommending the need to eradicate weight stigma from public health campaigns, and for health professionals to understand weight stigma better. During the year, Carolynne had the opportunity to have a conversation with someone from ‘Obesity Inc’. They talked about weight stigma during that conversation, and they said that their reason for addressing weight stigma was that it was a BARRIER TO WEIGHT LOSS TREATMENTS OR WEIGHT MANAGEMENT. To that I say “no, no, no, Novo Nordisk!” You do not get to coopt the concept of weight stigma that fat activisms, fat studies and feminist scholars and other social science researchers have been studying over decades for your own financial gain. You do not get to fund expensive research studies that are weight-biased and partner with cash-strapped public health organizations to push an agenda to have a body size classified as a chronic disease. This contributes to weight stigma and reinforces the notion that weight is under an individual’s control, if not by diet and exercise but now through medication and surgery, which is fantastic for your profit margins but from a public health perspective is horrendous. It risks people receiving treatment that is expensive, unnecessary, and associated with harmful side-effects. Weight stigma is common in our society and studies suggest it is increasing. Part of the reason why it’s increasing is because of the studies that you’re funding. The solution to weight stigma is not to make people in larger bodies smaller. Weight stigma is a social justice problem that needs social solutions. That’s why in HAES Australia’s response to the national ‘O’ strategy consultation, we’ve called for weight inclusive policy that recognizes size diversity and supports the physical, mental and social health and wellbeing of all people across the weight spectrum. We also argued for including physical features as a protected characteristic under human rights legislation, and health promotion and disease prevention policy and guidelines to be free from influence from treatment industries that profit from framing body weight as a disease. Thank you to everyone who filled out the public surveys for this ‘o’ strategy in Australia – it must have come at a cost to many in a world of weight stigma.
• Well done, Carolynne! Riled us up perfectly. The mention of Novo Nordisk prompted a HUGE wine sip from Louise. Louise calls Carolynne the ‘velvet hammer’ for sending out messages perfectly with calm and rationality. Big Pharma pretending to care about weight stigma, and brands pretending to care about larger bodies, is the theme of The Crappys for 2019 so far. It’s mind-blowing to think that there are humans out there who are actually behind that, who feel morally that there is nothing wrong with it.
• Louise also wants to thank everyone who answered the HAES Australia call-out to take part in that Australian ‘o’ strategy survey. There was weight stigma hidden in every corner of it.
• Entry #4 – Jo is an anti-diet Registered Dietitian in the UK doing their very best to spread this message with the blog and website antidietanswers.com and on Instagram. The diet culture demon that’s up Jo’s nose is January wellness challenges! The 30-day challenges that promise you will be a whole new person by the end of the month. You know – Veganuary, Whole30, burpee challenges, ‘grow a bum by the end of January’ challenges, you know the type. There’s two reasons Jo is so pissed by these, and the first is the word ‘challenge’. A challenge is defined as ‘a call to participate in a competitive situation to decide who is superior in terms of ability or strength’. So, by their nature, if you take on one of these challenges and you can’t handle it, you are by definition less able, weak. These challenges are dangerous for our mental health because they set up that dichotomous thinking – all or nothing. And you might not have even wanted to try being vegan, you just felt pressure from others on social media! It’s diet culture masquerading as wellness yet again.
• There’s been lots of these challenges popping up on social media feeds, not even just January now! Seems like every charity is jumping on the bandwagon asking us to give up something or continue using something. Louise saw one where you’re not allowed to drink any water! ‘Report ad’, we’ve had enough. You could almost get a repetitive strain injury from pressing ‘block and report’ on Instagram these days.
• Loved Jo’s point about a challenge meaning looking for someone superior. There was a beautiful pause for effect at the start there – she’s definitely nailing the delivery. And rage in an Irish accent is awesome! (Was it Irish? Sorry if we’re wrong, Jo!). It’s awesome to know that there’s people all over the world pushing back and not taking this bullshit anymore.
• Entry #5 from ‘Anonymous’. Three things. The first one is: qualified dietitians with a public profile who should know better - posting things like ‘detox soup’ recipes in the middle of January. It’s the same old recipe that my Grandmother would have cooked. Who wants soup in January? Give me a break. The second one is a real doozy from a Facebook mum’s group, where someone asked how to make a complaint about a doctor. She has a family history of breast cancer and went to the doctor to ask about the BRCA genetic test and instead got a lecture from the doctor about her weight and how she “needs to go and lose some weight to protect herself from cancer”. Are you fucking kidding me? So, that’s the second one – medical professionals who just blow my head off with their bullshit. And the third one is marketing themselves as a weight-loss thing in my area. For just under $800 you can go to a two-day hypnotherapy-for-weight-loss seminar where your weight troubles will be gone forever. I have a few acquaintances that have done this, and it comes with a ridiculously restrictive diet. On the website it has things like “what’s the cost of not attending?” – “the cost of not attending: nothing will change. You’ll continue down the same frustrating road that you’re on now. Are you sick and tired of that yet?”. It’s a bunch of infuriating gaslighting bullshit. So, that’s my trifecta of misery. Stuff diet culture!
• Phew! It’s like we’ve gone past rage and into eye-of-the-hurricane-calm, because there was just so much crap in that entry. A fucking dietitian selling detox soup? They should know better. They should be reported to the DAA and not be able to do that with their public profile. Numbing is an interesting response, like we have to shut down because “what the actual fuck?”. Alyssa remembers once making a horrendous raw broccoli soup and doesn’t even know what was possessing her at the time, but it was one of those weird January things. It ended up being a turning point because it was so awful. Australia in January is too hot for soup!
• It’s so important to get an early diagnosis for breast cancer, and the weight stigma observed here is a reason that people can end up dying of breast cancer (and other conditions and diseases). Absolutely awful.
• Louise went in and found the hypnotherapy two-day rip-off event online and now has a special place in hell reserved for them. This might end up being a special episode of All Fired Up! Gosh, it must be so hard to have people in your life who are taking part in stuff like this. The person who did this rant is not alone – so many of us have people in our lives who are taking part in diet culture. We know there’s big power in groups (i.e. cults) and you’re more vulnerable when you’re starving – it’s deliberate.
• Hypnotherapy for ‘weight loss’ doesn’t work. Don’t pay them any money, report them to the ACCC for this bullshit.
• Entry #6 from Mandy-Lee Noble, Accredited Practicing Dietitian from Nourished Approach in Queensland. You might think Mandy-Lee would nominate a pharmaceutical group as she’s been investigating this with Louise, but instead wants to take this opportunity to talk about a different aspect of diet culture that’s got her fired up. It’s a fad diet called the hCG diet. HCG stands for ‘human chorionic gonadotropin’ hormone, that we produce during pregnancy to sustain a foetus. It mobilizes energy to provide energy to the foetus while someone’s pregnant. The diet was developed by Dr Albert Theodore William Simeons in his 1954 book ‘Pounds and Inches’ and he also published an article about it in The Lancet. So, what do you do? You inject the hCG hormone (or use an oral spray that doesn’t work at all) every day for eight weeks in conjunction with a really rigid 500 calorie diet, with claims that you’ll lose quite a lot of weight every week from areas such as the stomach where people often wish to lose weight. But, due to the hormone, the claim is that you won’t experience the irritability and hunger that you would generally experience with weight loss, and that the weight would stay off. But when you look at the protocol and see the recommendations for when you start to plateau or gain back weight, they’re so rigid. It also recommends going completely ‘oil free’ including any oils in your makeup products. Since the 50’s there have been a dozen studies that found that it absolutely doesn’t work, and the FDA had to put out a disclaimer in the 1970’s saying that it’s not tested for safety and doesn’t work. It regained popularity when good old Dr Oz promoted it on his television show. What really pissed me off about this diet is that I know some people who have followed it, because it was prescribed by an actual GP. An AHPRA registered GP. There are GP’s and pharmacists actually pushing this diet in Australia.
• Another glass of wine for Louise! Bloody hell. Dr Oz?! GP’s?! Did they learn about this from Dr Oz, because that’s seriously concerning. Louise has also had clients whose doctors have recommended the hCG diet to them. Unbelievable. 500 calories a day is just so low, such a brutal level of calorie restriction. REPORT YOUR GP if they try to prescribe this extremely dangerous, ineffective, damaging diet. This could kill people. This is restriction on a whole new level, it’s very unsafe and totally unreasonable. AND it’s fuck-off expensive.
• Entry #7 – from Martina Zangger, a 58-year old lecturer at the University of Newcastle in health behaviour sciences. Martina is very pissed off and wants to rant about a diet called Bright Line Eating™ (BLE). It’s run by a woman called Susan Pearce Thompson who has almost become a guru and has tens of thousands of followers – mostly women in their just-pre- and post- menopausal years. The program is an eight-week bootcamp that costs $900 USD, which is probably about 13-1400 Australian dollars. It’s a diet based on no sugar, no flour, measuring meals, no snacks, and weighing everything. You become extremely hangry and Martina developed orthorexia and almost developed Anorexia when she was on it. Martina is fired up about paying a lot of money to this woman Susan Pearce Thompson who is a neuropsychologist and should have known better. The idea is that flour and sugar are addicting and you can’t have anything with those ingredients in it. Being on the diet made Martina a not-very-nice person who thought she was superior to other people. She was supported by the BLE community in thinking she WAS special and that she had found ‘the answer’. The weight regain that happened afterwards was quite disheartening, however she’s now two years out of that diet and feels so much happier. She does accept her larger body and enjoys all foods, enjoys sharing foods with friends and family, and is SO ANGRY at Susan Pearce Thompson and that stupid Bright Line Eating movement. Susan must be making about three million American dollars per year with all of her programs. So that’s the rant – sending everyone love and the hope that they can walk away from diet culture and embrace their natural bodies.
• No one is taking our Tim Tams! No one is taking our flour or our sugar. That was heartbreaking. We’re feeling for Martina. This flour-sugar bullshit is based on the food addiction models. There’s no such thing as food addiction! There IS such thing as an increased response to restraint, which is what happens when people try to restrict certain things – you will develop an unnatural drive relationship with that substance not because of restriction but because of restraint.
• How do these people sleep at night? They must be in this little bubble, either a numbing bubble or one where they have no freaking idea. Or … one full of cash? And surrounded by people who worship them because of that money and say positive stuff to them. We’re in a place in diet culture where weight loss at all costs is worshiped. Poor Martina ended up with an eating disorder that she paid dearly for, financially and psychologically. We’re in a new decade now and no one should have to fall for this bullshit, no matter how it’s packaged and sold. It’s dangerous stuff.
• Thank you to everyone who has taken the time out of their day to record a rant and send it in here to push back. These are really meaningful acts of rebellion, and we’re loving it. We’re riding a big wave of emotion – mostly rage, and a bit of heartbreak.
• Judging time! Let’s run back briefly through the candidates. First, we had Anna from Haven, who was fired up about body positivity being co-opted by marketing and was talking about Calvin Klein. Then we had Belinda, and she was talking about our libraries being infiltrated by diet and wellness books, and she was going to bring forth all the rage of Harry Potter (which Louise loved). Then we had Carolynne White, president of HAES Australia, ranting about how Big Pharma are pushing to get ‘largeness’ classified as a disease so they can sell drugs for weight loss. We have no words. And then we had the lovely Joanne and her beautiful rage and rant about 30-day challenges like Veganuary. Then we had our anonymous trifecta of misery, about dietitians and their detox teas, doctors prescribing weight loss instead of providing responsible medical care, and the hypnotherapist with the completely rip-off seminar on extremely low calorie diets. Again, no words. Then we had Mandy-Lee Noble with the hCG diet, and then Martina ending us on a real low point with the Bright Lines Eating evilness. What a totally Crappy line-up.
• OH my goodness, what is wrong with health professionals? This is gut-wrenching. We know from weight research that the vast majority of weight stigmatizing messaging comes from health professionals.
• We have shitty themes from health professionals, bullshit co-opting of body positive trends by the weight loss industry, and then we have just the real evil fuckery.
• Alyssa wants to give a special mention to Belinda for making her laugh-cry.
• Alyssa’s shortlist is Carolynne, the Anonymous submission, and Mandy (can’t get past those bloody injections!). And she’s kind of changed her criteria – how much rage came up in her while listening to the rant, and how much rage came through from the entrant. And there’s a kind of ‘mind-blown’ factor. Louise recalls learning about the ‘dry fast’ on Instagram (because ‘drinking water is an addiction’), and then finding a dude-bro drinking his own urine, and how those moments are a real ‘lowering the bar’, ‘going down another level’ experience. Never say never in diet culture.
• And the winner is (drumroll please) … Mandy-Lee Noble with the hCG diet! Bloody GP’s that are promoting it despite the FDA saying it’s a waste of freaking time. And the oil-free makeup thing! Jeez. Congratulations, Mandy-Lee!
• There’s a $100 cash prize this year, which seems like nothing after everything we’ve been talking about! Someone as awesome as Mandy-Lee will put it to good use.
• Alyssa is excited to pass on the crown to Mandy-Lee and move forward to ‘rage on’ in 2020. The mantle has been passed to someone of extreme strength of character, rage and sarcasm. Thank you, Alyssa, for holding us steady through the bullshit of 2019.
• And thank you to everybody who sent in these rants! It’s a beautiful thing to hear the rage, the push-back, the ferocity that everyone has displayed. Louise would give everyone first-place.
• Who would have thought ranting about diet culture would be a pleasant diversion from the rest of our lives during COVID-19? Please look after yourself and your families and loved ones, even if that has to be virtual for now.

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All Fired Up is back with a BANG for 2020! And we are SUPER fired up about this Netflix SHOCKumentary ‘The Game Changers’. Ebony McCorkell of EB Nutrition joins me to shout “WTF?” at the dude-bro-fear-mongering- pseudo-scientific thrust of this plant-based propaganda. As an ethical vegan and anti-diet dietitian, Ebony is NOT IMPRESSED with the doco's misleading oversimplification of nutrition science, and we’re both just flat out BEWILDERED at the relentless focus on masculinity (and erect penises!). It’s infuriating that thin white male doctors are apparently able to say ANYTHING without giving credible evidence to support their claims. If you’re tangled up in health knots after watching this doco, this is a must listen!

Show Notes

•       My guest is dietitian and chef Ebony McCorkell of EB Nutrition, and we’re talking about the Netflix documentary ‘The Game Changers’ (2018).
•       We’re back for our 2020 season, and this week we’re All Fired Up about SOCK-umentaries! There’s been a string of documentaries in recent years that glorify one particular way of eating while demonizing others. ‘The Paleo Way’, ‘The Sugar Film’ … ‘The Game Changers’ is the newest documentary in this vein, and Louise is seeing more and more clients coming in who have been all shook up by it. The documentary upholds a plant-based diet (or actually, veganism) as the be-all-and-end-all way to eat for hotness, athleticism, and not dying from terrible health problems. It’s got all the classic ingredients – raising fear, and condemning other styles of eating (such as eating meat).
•       Because ‘The Game Changers’ goes into the science of food and how it affects our bodies, Louise wanted to talk to a professional who works with food. This week’s guest is Ebony McCorkell, who not only is an Accredited Practicing Dietitian and chef (yum!), she’s also a long-term ethical vegan.
•       As a dietitian and a vegan, Ebony is fired up about ‘The Game Changers’ and the perceived benefits of eating a vegan diet that the documentary espouses. You’d think she’d be cheering for a documentary promoting vegan diets, no? No! The documentary makes far-reaching claims and doesn’t hit the mark on ‘good vegan information’.
•       Louise has seen in her clients, many of whom have an eating disorder background, just how much doubt watching a documentary like ‘the Game Changers’ can sow – even if they’ve been working on HAES ® and the non-diet approach for a long time. It speaks to how convincing this documentary seems.
•       Ebony has also had clients coming in telling her to watch it – just like when the previous vegan propaganda film ‘What the Health’ (2017) came out.
•       A successful documentary has to be thrilling, and unfortunately anyone who has done a nutrition degree can tell you that nutrition is not thrilling!
•       We both resisted watching the documentary for as long as we could, and when we did watch it, we came away really understanding why our clients are freaking out. The message throughout the documentary is that eating meat is very bad for your health and will kill you.
•       Using scientific terms and words a layperson might not understand helps to build fear, and also makes the documentary makers and the people they’re interviewing seem more intelligent if they’re talking about all the science without explaining what it means. The black and white ideas of ‘this is bad, this is good’ – anyone who has done a nutrition degree knows that nothing is as simple as ‘bad’ and ‘good’.
•       The opening sequence with documentary filmmaker James Wilkes bragging about how ‘deadly’ he is, is such a strange opening to a nutrition film – the hyper-masculinity and adrenaline gives a real feeling of ‘I’m in danger’.
•       While recovering from an injury, James Wilkes began researching (ie, he read some articles) and came across the ‘gladiator diet’ which claims that the Roman gladiator fighters were actually vegan. He went down a rabbit-hole exploring how a plant-based diet might speed up his recovery.
•       The Roman gladiators, while potentially super strong, were also slaves – not the pinnacle of health. They were forced to fight to the death for entertainment, and not necessarily super-fit. They may not have been fed a lot of meat because they were enslaved and meat is expensive.
•       It’s a strange flip to the paleo/‘caveman’ diet, with the idea that cavemen were strong and didn’t eat plants, therefore we don’t need to eat plants.
•       We then see elite and Olympic athletes in the documentary who are also vegan (and mostly men).
•       In a way, it’s good to see a challenge to the stereotype that vegans, particularly male vegans, are ‘weak’ and ‘wimpy’ – but the pendulum is swinging so far in the other direction to this hyper-masculinity.
•       Instead of saying that vegan athletes can and do exist, which is the truth, the message is ‘veganism makes you a superior athlete, the end’ – which is not the truth.
•       An example of vegan athletes being superior to meat-eating athletes used in the documentary is the Connor McGregor vs. Nate Diaz UFC fight. Ebony notes that Connor (the meat-eater) had to drop two weight classes to fight Diaz (the vegan), meaning he was calorie restricting. That’s an exhausting thing to be doing, especially while training. So, the documentary holds up a fight where Diaz won as an example of his superiority due to a vegan diet. In reality, McGregor won a fight against Diaz soon after the fight featured in the film.
•       The documentary goes so far as to feature Connor McGregor saying “I think maybe I ate too many steaks”, which McGregor may have meant as a joke.
•       Attributing changes in athletic performance to a switch to veganism is over-simplifying. It doesn’t take into account many other factors, including the placebo effect.
•       After watching these athletes, we start to hear from the scientists – and we hear science-y sounding words telling us that eating meat is terrible, and eating plants is wonderful.
•       One aspect of the documentary we’ve heard about more than anything else is the burrito experiment. Three athletes – one is given a bean burrito, one a chicken burrito, one a beef burrito, and then their blood is taken. The blood samples are shaken to separate blood from plasma, and the beef sample had ‘cloudy’ plasma. The scientists in the documentary say this is due to having fat in their blood and the endothelium not functioning properly, leading to poor cardiovascular health. What does Ebony think of this? The cloudiness of the plasma is a normal reaction to eating a meal with fat in it, and what is most likely is that the macronutrient content of the beef and chicken burritos was higher in fat than the bean burrito. If the meals had all been equal in fat content, the plasma would have been cloudy in each sample.
•       Remember – we need fat in our diets! Fat is an essential nutrient. We need it for nutrient absorption, hormonal regulation and more.
•       So, a perfectly normal adaptive human response to eating fat has been misconstrued by the documentary as being dangerous.
•       Louise felt the documentary cherry-picked studies to support their claims that eating meat causes ill health. The documentary maker dismisses research that contradicts his claims by saying it is all sponsored by ‘big food’ and therefore corrupt. As Ebony notes, it’s ironic studies cited as supportive in the documentary were definitely sponsored by ‘big food’. Just because the foods the companies represent are plant-based, doesn’t reduce bias!
•       Research is not infallible – we SHOULD be criticizing research and how research is interpreted. But we can’t be one-sided in how we critique research; we have to do it to all sides.
•       A study included cited that eating one hamburger increases inflammation by 70% - Ebony hasn’t looked up that citation, so many measures are unknown such as what inflammatory markers they are looking at. Inflammation is a normal part of eating – Ebony remembers learning from a PhD candidate who was studying inflammation who forewarned that everybody would be talking about inflammation in the future.
•       Inflammation is part of the digestive process. In order to be able to digest food, the body needs to recognise that it’s a foreign material and break it down. So, it has an inflammatory response to the food – it’s a normal response. ‘Inflammation’ as a catch-all term is unhelpful. We actually don’t yet know of anything we can do (e.g. eat a specific food) to reduce inflammation – there are foods and activities with associations to reducing inflammation, but we don’t have a causal link yet.
•       The documentary leaves out any discussion of inflammation being a normal physiological response. For example, exercise causes an inflammatory response, which is a good and necessary thing to help your body recover from activity.
•       “Whenever we eat any animal product, it’s highly inflammatory. Compounds are formed that corrode our cardiovascular system”. How scary is that! And no references here! They really start hitting us with that health fear.
•       When James the narrator is talking, they usually chuck some kind of reference in the corner – even if it doesn’t necessarily relate to what he is talking about. When the doctors are talking, however, they don’t use any references – they can seemingly just say whatever they want without references. Bold! And we note that it’s thin, white doctors talking. Just saying something doesn’t make it true. This is where Ebony started feeling the rage!
•       We start using the big words, we throw a few cherry-picked studies in there, we give partial explanations and then start raising the temperature of the health warnings. Throw in a thin, white doctor saying science words and we’re primed to buy into the fear.
•       Saying the same thing or making the same claim over and over is a cult tactic – it builds peer pressure. It’s starting to feel like a propaganda film now!
•       Louise found the documentary very male-focused, and here’s the section where the film turns to penises and erections. The bro mentality – it’s about masculinity, muscles and dicks.
•       A urologist(Dr Spitz) saying “the more meat men eat, the more they lose their manly manhood” – yikes! You have a model penis on your desk, you can say erection!
•       Looking at the impact of eating a meal on your erection – Louise wrote on her notes “what the fuck?!”. Ebony notes that it’s so outrageous it became a talking point for the documentary.
•       Dr Spitz conducts another burrito experiment with 3 college aged males.On night one, they all ate meat burritos, and a magic data-collecting cock ring measured the strength and frequency of their erections as they slept overnight. The next night they repeated this experiment with a plant-based burrito. There was no base-line taken for this experiment, it has a VERY small sample group, and HOW does measuring the strength and frequency of involuntary sleeping erections of young men relate to sexual performance? The results were bigger and longer erections on the night of the plant-based burritos. There are so many variables that weren’t controlled for in this experiment. You can’t conclude anything reasonable!
•       The doctor himself said “this was not a scientifically validated study”. So, they’ve included it as a joke, or for shock value. Either way, it’s not really telling us anything – but it might make us feel more insecure about our masculinity and sexual performance.
•       No discussion of vegan diets on women’s sexual function or fertility – so many aspects of health got ignored. It’s dumbed down to athletic performance and the number of overnight boners. It’s purposely targeting a particular market – most vegans are young women, so they’re trying to convert more ‘manly men’ to veganism. Louise has a real problem with health scare tactics that are not based on reality, and Ebony agrees – they could have made a documentary without the extreme messaging, showcasing the great plant-based athletes out there and shown how they train, how they adjust to nourish themselves, etc.
•       One of Louise’s clients thought the documentary was good because it didn’t talk about weight loss – and Louise’s reflection is that it kind of doesn’t have to. There’s not much size diversity in the documentary, and it’s focused more on the new world of ‘healthism’ which is implicitly fatphobic. Just because it doesn’t focus on weight loss, doesn’t mean it isn’t soaked in diet culture.
•       The sweeping statement that anyone who disagrees with the documentary must be working for ‘big food’ - ???
•       The ethical aspects of veganism were glossed over, even though this is a common pathway into veganism. Ebony notes that she doesn’t think James Wilkes is an ‘ethical vegan’, but rather a plant-based-for-health person. Ebony personally has been vegetarian since she was eight years old, and became a vegan later, due to concerns for animals. The plant-based-for-health fanatics might develop these concerns for animals by becoming part of the vegan community, but their primary motivation is not animal welfare or environmental concerns. As an ethical vegan, it’s hard to watch your community be clouded out due to a toxic diet-culture group. It’s a very polarizing and uncomfortable thing in the vegan movement at the moment.
•       There’s a parallel in the HAES and fat activist community. Fat activists have been doing the work for years, and suddenly ‘anti-diet’ is a *thing* in 2020 and becomes an encroachment and misrepresentation of the original values of the community.
•       This podcast isn’t about bashing veganism or people who eat plant-based, but highlighting how this documentary has a healthist agenda that misrepresents science.
•       Any mention of a downside to making such a radical nutritional shift is not mentioned in the documentary – such massive fear-based restriction comes with risks! The combination of restriction and guilt is straight from diet culture, and risks creating eating disorders in many people.
•       As an ethical vegan, if Ebony accidentally consumes something that contains animal products, she might feel a bit sad and remorseful but is able to move past it. If she believed that the food she ate would KILL her, it would be a different experience.
•       Let’s be critical and move beyond the messaging to find the meta – is this source fear-based? Is it cherry-picking? And what’s the agenda of the people making this?
•       If you want to explore eating a more plant-based diet, see someone like Ebony to give you some non-diet support!

Resources

•       Weird gladiator diet research article

Joe Rogan podcast with discussion of the Connor McGregor vs. Nate Diaz UFC fight.

•       Find out more about Ebony, who runs EB Nutrition in Chelsea, VIC and offers online consultations!

We’re not putting in a link to the actual Netflix doco, because it’s just exhausting!

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Don’t miss a FURIOUS FROLIC with my amazing guest, the Food Psych herself, Christy Harrison! Christy is COMPLETELY fired up about diet culture bullsh*t and all of the harm it perpetuates. In fact she’s so p*ssed off she wrote a book! Join us as we dissect the history of diet culture and reveal its bigotted roots in racist and sexist propaganda about what type of human belongs at the top of the food chain (spoiler alert: thin white men). Even the Suffragettes sucked! Christy has done some amazing detective work and quite literally, this book will change your life and get you MAD AS HELL! Do not miss this episode!

Shownotes

• My guest this week is Christy Harrison, intuitive eating coach, anti-diet dietitian, and host of the amazing Food Psych podcast. She is COMPLETELY fired up about diet culture and all of the harm it perpetuates.
• In fact she’s so pissed about it, she wrote a book! “Anti-Diet” has just come out, and it’s wonderful to see such an awesome HAES message coming out at Christmas, a time when diet culture ramps up the pressure. And here in Australia it’s not just the Christmas pressure, it’s also summer & so we’re all being doubly pressured with those “summer body” messages.
• Shape shifting diet culture messages keep on being rebranded & re-sold to us, but it’s literally the same old shit sandwich, as Christy is over it!
• This book has been a long time coming. Christy started her career as a journalist 17 years ago, but has wanted to write a book since she was a child. This book has had a very winding path, like many parts of her career.
• Around 10 years ago Christy decided she wanted to write a book about emotional eating. She’d just gone back to study public health & nutrition and wasn’t feeling fulfilled creatively. But before that she worked at Gourmet magazine, where she wrote a lot about food and culture and people’s relationships with food. But Christy had a very negative relationship with food, she had been a disordered eater since the end of college. This lead into her first career in food & nutrition reporting - and it wasn’t from a place of feeling at peace or balanced around food.
• Christy was obsessed, she wasn’t eating enough so constantly thought about food. She kept researching & falling down rabbit holes, and wanted to make use of it. She got very interested in Michael Pollan, Marion Nestle, and the politics of food. This was actually quite problematic and she writes about that in the book.
• Louise also remembers going through a stage of thinking that people like Pollan & Nestle were fantastic, but reflecting back she was coming at it from a disordered place - through a weight centric lens.
• It really caught Christy’s imagination, and she wanted to “End the o****ty epidemic”. So around 2009/2010 she started researching for the book. In many ways it did help inform her for the book she ended up writing, but it took a totally different direction.
• She started to research the cultural history of emotional eating. How did we get the idea of emotional eating - where does it come from?
• At that point Christy identified herself as an emotional eater, someone who ‘ate her feelings’ - not realising that actually it was because she was restricting herself and not eating enough.
• Through her research she discovered the work of Janet Polivy & Michael Herman, on the impact of restrained eating (basically they demonstrated that restriction leads to binge eating). She also came across a psychiatrist called Hilary Bruch who had some very offensive ideas on how children come to be larger bodied.
• Christy also discovered the book Intuitive Eating, and fell in love! It made so much sense as Christy finally saw that before she started to try to control her eating, she ate intuitively and was fine. Christy acknowledges her thin privilege which made it easier for her to accept that everything was fine before her disordered eating started. But this was the starting point for Christy’s formal recovery, and she worked with a therapist to address her eating issues specifically.
• She worked on healing herself, but she was working in nutrition education at the time & was often required to give people information that was not in line with how she was starting to think. Some of her “best” students started to remind her of her old disordered eating patterns. The cognitive dissonance was huge.
• So Christy went down a path of opening up to the Health at Every Size philosophy, and starting to specialise in helping people recover from disordered eating.
• Through her training in disordered eating it became very obvious to Christy that the HAES paradigm is a fantastic alternative to this diet-y paradigm that holds so much influence.
• Christy’s current podcast, the Food Psych, reflects her transition and commitment to the HAES path. It started in 2013.
• Christy had been trying for several years by then to write her book, but the pieces did not yet fit together. Which is great - imagine she had written such a fence sitting book!
• She even found an old email to a friend where she said her book was like the “Michael Pollan take on emotional eating” - her take away was going to be, “you have to eat emotionally the right way, by knowing your farmer!”
• It’s ok for this to be a huge, long process of un-learning. Some HAES concepts will make sense almost immediately, others will take time to take hold or even make sense.
• Because Christy was in a thin body, the intuitive eating side of things made sense easily. But because of that privilege the whole social justice and health side of things took much longer for her to come to understand on a deep level.
• Christy also grew up in diet culture, and HAES flew in the face of everything she had learned about body size and health.
• Now, 10 years later after having her book idea, it all finally makes sense and all of the pieces fit together.
• The podcast was a big part of Christy’s learning, she learned so much through researching and talking to people all about these concepts.
• So when it came to write the book, she already had a lot of information ready to go.
• There are a lot of fence sitting books in this space, as people in diet culture tend to write almost as soon as they have an idea. And there’s a lot of non-diet books which miss the nuance - for example, selling the idea that intuitive eating will “cure” emotional eating.
• There are people who don’t understand what they don’t yet understand. And publishers want to make money.
• The book is truly amazing - it has information about the history of diet culture, and weight science, how diet culture is just a life thief that takes our money - there are many awesome rabbit holes!
• In the book we meet the activists, researchers, and HAES community - it’s great to hear from them - even a few from Australia!
• So - what is diet culture?
• Diet culture is a system of beliefs and values that worships thinness, treating it as a marker of health and virtue, that promotes weight loss as a way of attaining higher status. Diet culture demonises some foods and elevates others. The whole system is oppressive and excludes those who don;t match up.
• Diet culture has a tremendously negative impact of people’s wellbeing and mental, physical, spiritual, and community health.
• Diet culture is endemic in Western culture. And it’s relentless - messages are constantly coming, from our media, from doctors, to our peers and families, teachers, books - everything! Everything is steeped in this way of thinking.
• There’s an awesome chapter in the book on the history of diet culture which is fabulous. Basically, diet culture stems from extremely racist & sexist origins.
• Diet culture is a system of oppression born out of other systems of oppression that already existed and then became its own system that reinforced all of the other systems of oppression.
• It became a way of policing people based on their body size. It’s so fucked up!
• Even Charles Darwin: flat out - fatphobe! And sexist, and racist.
• All of the evolutionary biologists had this fucked up view about bodies that categorised people on a moral hierarchy.
• This didn’t make it into the mook, but there was something called the “Great Chain of Being”, which ranked people according to how close they were to God. People from Africa were the lowest ranked on the Great Chain of Being (interesting as the authors of the Great Chain had a political interest in enslaving people from Africa!). The whole idea was a tool to justify slavery and white supremacy.
• And of course, white Northern European men were the closest to God - surprise surprise!
• From there the evolutionary models were born, and again people from Africa were the lowest on the chain of evolution, as well as Native American people - because again there was a political motivation to keep them oppressed and they needed to find a way to justify it.
• And again, white Northern European men at the top of the evolutionary hierarchy.
• And from these ideas came quasi-scientific practices such as phrenology, where they’d measure people’s head sizes, noses, ears, etc, and draw conclusions about temperament, criminality, etc. And from that it was determined that people of colour and women tended to have more fat on their bodies. And from that the idea that fat bad ‘bad’ because it was a marker of evolutionary inferiority!
• It is so useful to trace back our diet culture ideas to their roots, and to really understand how bigotted these roots were.
• So this idea of bigger bodies being “bad” actually pre-dated any kind of “health concern”.
• The medical establishment were actually late joiners to the “fat is bad” message.
• People who went to the dr at the turn of the 20th century seeking weight loss were told that gaining weight with age was normal & nothing to worry about. And weight loss was seen as taking dr’s away from serious medicine.
• It wasn’t until fatphobic ideas were solidly entrenched in society thanks to the efforts of the evolutionary biologists, and insurance companies started to hound drs about the relationship between weight and mortality (based on tiny data sets) that things started to change.
• So, the medical establishment followed the Zeitgeist.
• Even the Suffragettes were sizeist - the first women’s rights activists fighting for the right for women to vote. They got a lot of pushback and resistance from the dominant culture about this. One of the ways they’d be challenged was they were painted as larger bodied, masculine looking, “ugly” - as a way to undermine the movement & dissuade other women from joining in.
• Rather than pushing back against the whole ides of size or beauty being at all relevant to the fight for human rights, the Suffragettes caved, and began to cultivate an image of them as slim, wearing white, traditionally ‘beautiful’. This was effective in many ways (sadly), but women of colour and size were effectively excluded from the movement.
• It’s so fucked up. Here in Australia, white women got the vote around the turn of the century (1902), but it wasn;t until 1962 that all Aboriginal women in Australia could vote (Louise said the 1970’s in the podcast, this is incorrect!).
• It’s so sad, in the history of social justice movements it seems that small steps are made but a lot of marginalised people just get ignored.
• Size acceptance is becoming more mainstream around the world. But we’re a long way off achieving real equality in this space - and in the USA there’s still a long way to go before equal voting rights are attained.
• Size acceptance as a movement has been going since the late 1960’s, but in reality we’re just getting started - it’s a young movement.
• There’s definitely an upswing in mainstream attention to size acceptance now which is great.
• Size acceptance was started by activists with lived experience of being in the world in a larger body. Then they were joined by health professionals and eating disorder experts who also saw the need for greater equality.
• This was the groundwork for the Health At Every Size movement,which recruited more people in the health space with educational privilege and ability to influence research etc. We’re now at a point where a lot of people from a lot of different walks of life are talking about size acceptance.
• It’s even ‘the cool people’ talking about size acceptance now - not just outsiders. And that’s interesting because that’s what it takes to get an idea more mainstream.
• There are definitely challenges when a movement becomes more mainstream, but overall it’s so positive.
• We can use the ‘cool people’ to open the door, but then allow everybody to come through. Not like the suffragettes!
• Cool people like Jameela Jamil is very fired up about size acceptance, which is amazing! And how good is it that outdated crap, like the Victoria’s Secret lingerie parade, has been cancelled!?
•  Watching Lizzo perform at the VMA’s - just watching more diversity. Even in stores here in Australia, mannequins which are larger sizes are appearing in stores. And when we shop online, there’s increasingly models there who are not just a size 4 or 6!
• It feels like in fashion, and in the traditional “thin ideal” industries, there’s just more diversity appearing & it’s not even being commented on. But then in the health space it feels like it’s getting worse!
• Where are we in a world in which Victoria’s Secret is actually cooler than your local dr!?
• The diet industry is clinging on for dear life & doing its damnedest to survive. The diet industry is so scared by body acceptance because more & more people are walking away from weight loss.
• And the diet industry is built on selling weight loss.
• Diet culture now frowns on weight loss dieting - it’s now the “wellness diet”. We’re not supposed to be focusing on weight loss, but the modern scourges of vague healthy symptoms like brain fog, and ‘bloating’.
• All of these symptoms can be caused by restriction and dieting. And so for the diet industry to tell us to ‘solve’ these problems by becoming more restrictive or cutting out more foods - is so insidious and so shady - because they’re the ones who caused these problems in the first place!
• Diet culture got us into this mess of disordered eating in the first place - and now the ‘solution’ is cutting out more foods? I mean, talk about doing the same thing over & over again & hoping for a different result!
• In the book Christy talks about how HAES provides a completely new way to look after your health & body. One misconception of HAES is that it’s a “do-nothing treatment”. But it’s not - it’s self-care, not self-control.
• There’s a lot you can do to support your health that has nothing to do with weight change.
• Christy talks about emotional eating in her book. She found that people who self-identify as ‘emotional eaters’ don’t actually eat more than regular people in experimental settings. People who self-identify this way tend to be more worried about their health, tend to follow more rules about food, and are hard on themselves when they don;t measure up to their own standards of eating healthily.
• Also, people are much more likely to eat in response to feelings or when things feel out of control when they’re not eating enough.
• Unravelling your relationship with food means eating enough, and also working on things like letting go of internalised weight stigma, and letting go of food rules. When people do this, they tend to ‘eat emotionally’ less of the time.
• In diet culture if we don’t question this idea that we shouldn’t be eating very much, it’s easy to misunderstand out of control eating as a ‘problem’ that needs therapy to cure it, when really it’s all about not eating enough.
• And sadly so many therapists in diet culture co-sign this idea. Therapists are not trained nutrition professionals, so may take what a person says about emotional eating at face value, not questioning the basics. This is where it’s good to refer to a non-diet dietitian!
• If a therapist has his/her own implicit weight bias, they’ll be unlikely to see the red flags. In fact they might buy into diet mentality.
• Christy went to see a therapist who specialised in eating disorders, who told her that the calorie intake she was having was “enough” and “not disordered” even though Christy knew it was nowhere near enough for her!
• A HAES eating disorder specialist is your safest bet to go to for treatment in order to avoid blatant weight bias in treatment.
• There’s a whole chapter in Christy’s book about getting angry and why it’s absolutely ok!
• It’s about waking up and recognising how much impact diet culture has had on our lives, how much time, money, and life has been taken in this never ending pursuit of body change. It’s about pushing back and getting angry is part of that.
• Particularly women never get validated for feeling angry in diet culture, even though it is 100% valid! Diet culture encourages us to be angry at ourselves. But if we can turn it around & flip it over, that’s a huge shift all in itself!
• This also helps us make change in the world, because we’re now aiming our anger at the right place.
• In the “O****ty research” world, they are befuddled by the anger, and try to dismiss it. In New York there was an “O***ty conference” and one of the titles of the presentation was “Paediatric o****ty interventions in an era of outrage”, and they had a whole panel there talking about how angry people are. And they’re using the same tactics targeted at the Suffragettes - dismissing activists as these fat, angry people who can’t see what a great thing the researchers are doing. It’s the same attempt to silence by putting people in an ‘out’ group.
• Painting HAES activists as “angry” equates it with being “unfeminine” too. It draws on social norms in an effort to police this - you don’t want to “be like them”. It’s these emotional, hysterical women, we’re the rational ones with our science and logic”.
• When people dismiss anger and tone police they miss an important piece of the puzzle - why are people so angry? If anger is there it’s a signal of injustice.
• That’s important information. To just dismiss it and to think of ways to keep doing what they’re doing is just not ok.
• We are not going away!
• Christy is gearing up for some major backlash. But the HAES community is here for her.
• Christy does practice self care - trying not to look at comments, particularly recently when her New York Time Op Ed came out. Her editor screened the comments & sent questions to her that were relevant, shielding her from the abusive comments.
• Venting to husband and friends in the community helps. Not posting publicly and being choosy about where and who to reach for for support. Yoga, unplugging, meditation, being in her body, being in nature. All of it helps.
• There is something very healing about being in physical space, with nature, animals. Just stepping away from technology.
• The New York Times Op Ed pieces were Christy talking about the “WW” Kurbo app, the weight loss app for kids, they’re here in the shownotes below.
• Even the fact that this was in the NYT - kind of a big deal! One of the editors of the opinion section is a Food Psych listener. The fact that people with such influence listen to the podcast is a reflection of how much HAES awareness is growing.
• The book is called Anti-Diet and it’s out now to buy! Link is below!
• May you outsell every shitty diet book on the planet!
• Christy is coming to Sydney in June 2020 for the International Congress on Eating Disorders (ICED) and Louise will be on a panel with her - so cool!!
• Bring on 2020 and the downfall of diet culture!

Resources Mentioned

Link to Christy’s book!

Michael Pollan wrote a book “In Defense of Plants” which is totally elitist, but was the absolute bees knees at the time (do not read without a drink)

Marion Nestle wrote “Food Politics”, another fatphobic tome which was all the rage. (do not read without a drink)

The work of Hilde Bruch included some very offensive ideas on how children came to be larger bodied (Just do not read it, it’s awful)

The amazing book Intuitive Eating by Evelyn Tribole is a HAES classic.

Christy’s first New York Times Op-Ed on the WW Kurbo App.

Her Second New York Times Op-Ed after the first one went gangbusters

The “O****ty Society’s” Opening Session which was actually called “Treating Pediatric O****ty in an Era of Outrage”. (do not read without a stiff drink or 3).

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Nothing winds up my anti-diet nutritionist guest Tara Leong more than the influencer-led anti-sugar movement. She is in FITS of rage - to the point of goosebumps - about the mountains of misinformation being spread as liberally as nut butter. She’s LIVID about harm being done to innocent people who are being told that they’ll risk giving their kids cancer if they eat bananas. She is OUTRAGED by the misleading tactics being used by these for-profit companies who aren’t able to print the truth on their nutrition labels. She is f***ed off about fructose. And don’t even get her STARTED on the fruit pyramid! Join us for a much needed discussion about the anti-sugar movement, Tara’s attempts to reach out to Australia’s anti-sugar guru Sarah Wilson, and Sarah’s foray into mental health advice. This is one hell of a conversation!

ShowNotes

• My guest is Tara Leong from The Nutritionist & The Chef, and she is fired up to the point of GOOSEBUMPS about the influencer-lead I Quit Sugar (IQS) trend!
• Sugar is definitely public enemy #1 right now, and this global sense of fear is impacting everyone, from all ages and all walks of life.
• We’ve seen various foods demonised over the years, from fats, to carbs, and now sugars. And leaders of these food fad movements have historically been weight loss gurus or medical professionals. But the anti-sugar trend seems to be dominated by “influencers” spruiking their lifestyle brands. There have been some medical professionals - like Dr Lustig who loves to crow about sugar.
• But in Australia, the shiny beautiful people, like Sarah Wilson, are really heading up the anti sugar movement. Tara commends Sarah for raising awareness about how we can take care of our bodies, but the messages put out via her “I Quit Sugar” social media channels and in the book “I Quit Sugar” are not based on science and are destructive, especially with regards to the impact these messages have on people’s relationship with food.
• The whole Sarah Wilson/“I Quit Sugar” phenomenon traces back to 2011. Sarah is a journalist and was the ex editor of Cosmopolitan magazine, back then she was a judge on the first season of Masterchef. After that she moved to Byron Bay and began to freelance, writing articles for newspapers. She literally didn’t have a topic for an article one week, and had read David Gillespie’s “Sweet Poison” book (Gillespie is a lawyer). So she did an experiment quitting sugar, wrote about it, and the “I Quit Sugar” machine was born. She started to sell e-books and from there it became a massive empire.
• She caught the Zeitgeist - just at the start of the anti-sugar climate. Plus, she’s pretty and can write well, and is well connected.
• This also came at the tail end of the low-fat movement, when research began to recognise that fat wasn’t actually a villain - so we needed a new villain. Enter sugar!
• Wellness industry 101: 1. Find the villain, 2. Find very vague modern health symptoms like ‘brain fog’ or ‘bloating’, and blame this on the villain, 3. Use your own vague health symptoms to glowing health story as ‘proof’, 4. Sell people a rule-based program to rid themselves of aforementioned villain.
• I Quit Sugar (IQS) requires people to stop eating any added sugars for 8 weeks.
• This was beautifully skewered on “The Katering Show”, 2 comedians with a parody cooking show who did a great job of showing, through comedy, just how awful it is to quit sugar.
• Modern influencers are using this tactic of telling their own stories, of sharing their own tales of ‘recovery’ from vague health symptoms, to sell their ideas. Influencers use their humanity, their accessibility, they are friendly and you feel like you know them.
• Whereas health professionals are discouraged from sharing their own stories with clients as it is not seens as ‘professional’, especially in psychology where the space is created for the client, not the psychologist.
• Influencers use their stories as aspirations, as hope - and of course, thinness!
• “If you eat like me, you’ll end up being like me as I eat zoodles on my $20000 table!
• Some of the claims in IQS are quite strange. Sarah talks about having Graves disease, and then later on, Hashimoto’s hypothyroidism, which pricked up Louise’s ears, as she has Hashimotos’. She is of the understanding that this condition is largely genetic, and no-one is really sure as to why it switches on.
• As someone with the condition, Louise has to take a pill every day and has blood tests every 3 months. It is not an easy condition to control - it is something that is always changing.
• Louise knows that what you eat has bugger all to do with developing Hashimotos’. But on IQS Sarah implies - strongly - that quitting sugar will cure it.
• Sarah’s claim that a change in her sugar consumption ‘cured’ it ignores the fact that she also takes medication to control it. This is a confound - you cannot claim that autoimmune disease can be cured by not eating sugar if you’re taking meds at the same time.
• If you want to promote eating in a way that makes you feel good, there’s no issue. But if you want to demonise one thing - ie sugar - there’s an issue!
• Tara also recognises the wonderful array of nutrients that can be excluded when you promote something as stringent as IQS.
• A while ago, Tara found a very fancy looking ‘fruit pyramid’ which was presented in a similar way to the old ‘food pyramid’ which used to be promoted as a way to eat. A pyramid is where foods on the bottom are ‘eat lot’ and foods on the top are don’t eat’, or ‘eat very little of’.
• So the team at IQS developed a fruit hierarchy, and at the top there were bananas! And the fruits you can eat ‘every day’ are berries! Raspberries, lemons & avocados.
• Now Tara needs to unpack this. Firstly, avocados are not a fruit. Botanically, yes, but not nutritionally - they don’t provide carbohydrates, they provide more fats.
• Who’s going to slice up a lemon for a tasty snack?!
• “I really struggle with the ethics of telling people they can only eat raspberries”.
• Tara calculated that for a family of 4, in order to meet nutritional requirements, a family of 4 would spend around $250 per week on raspberries alone. This is privileged, ridiculous nonsense. To not have even thought of things like expense?
• And the comments from people thanking IQS for telling them that bananas were dangerous. Tara had a heartbreaking message from a mum who was having a huge panic attack because she was so worried she’s given her kids cancer.
• The no. 1 pathway into an eating disorder nowadays, for Louise’s clients anyway, is this huge fear of foods and what are considered ‘healthy’ foods.
• The pro-IQS community really seem to disregard the risk of eating disorder development. Like it’s ‘not a thing’.
• In preparation for this podcast, Louise has been reading Sarah Wilson’s latest book “First, we Make the Beast Beautiful”. This is her story and she really is open about her lifelong mental health struggles.
• In it she reveals she had a childhood diagnosis of severe anxiety and insomnia, in her teens severe OCD, and then bulimia, and then bipolar disorder.
• Louise admires Sarah for writing such a raw and real book about the reality of living with severe mental illness. She is clearly a very intelligent person. But you can see the anxiety in the pages. You can see the pressure of the bipolar.
• So here is the ethical question - should authors with diagnoses such as these be giving full disclosure before giving out ‘dietary advice’? Especially when one of the diagnoses is an eating disorder?
• So here we are in the land of the ‘influencer’. Sarah is a journalist who has gone & obtained a health coaching ‘credential’ with the Institute of Integrative Nutrition in New York.
• Tara has something to say about this Institute. This Institute looks pretty impressive. On their website it says you can study for 6 months and get the health coaching certificate. But you don’t study physiology, chemistry, or anatomy. You just study all the different types of diets out there and whether or not they’re ‘good’.
• “If I was running an Institute where I’m comparing diets I’d be like - let’s close, because none of them work”!
• So the degree should be - everything doesn’t work. Here’s your piece of paper! Go out & tell everyone why your diet won’t work - how good would that be!
• Tara has found that the IQS people always claim that it’s not a diet.
• They always claim that it’s not restrictive. But Tara cannot fathom how telling someone to cut out a whole food source for 8 weeks is not restrictive?
• Modern diet culture tells people, if you’re not counting calories it’s not a diet.
• The recipes are interesting, often full of rice malt syrup, which is of course, sugar.
• For a while, Louise remembers seeing a whole row of IQS baking products - cakes etc - in the supermarket. And they got in trouble for not being honest on their labels about how much sugar was in them. They only wrote down the sugar content before the rice malt syrup was added, which is of course totally misleading for consumers.*
• Tara finds this highly unethical & wonders how this was able to happen according to Australian laws surrounding nutrition panels.
• Rice malt syrup is sugar derived from rice. It does not contain fructose, but it is definitely still sugar.
• Louise went into a book shop to read IQS. There was a whole page on why you have to quit sugar: because of fructose. So what’s the deal with fructose?
• Fructose is found naturally in fruit. In the USA, it is manufactured from corn, resulting in what is called high fructose corn syrup (HFCS). This is a highly concentrated version of fructose. This is put into soft drink, in the USA - not in Australia. We use sugar cane syrup, so the fructose is at much lower levels of concentration.
• Research on the health issues linking consumption of HFCS has been done mostly on rats and mice, and they have been exposed to mega-doses of HFCS in these experiments. So we cannot say that the health problems are happening because of the HFCS or just the mega dose. We could all develop health problems if we mega dosed on broccoli!
• We also can’t generalise rodent studies to human health.
• So the problem we have is someone not trained in physiology reads these studies and jumps to enormous conclusions.
• Just because some American rats OD’d on high fructose corn syrup doesn’t mean we shouldn’t eat bananas!
• Most of the people spouting the IQS ideas are not adequately qualified or trained in the science of nutrition. There are some medical people talking about it, but they tend to be the exception rather than the rule. Many influencers are not reading the research thoroughly or just cherry picking research that supports their ideas, which is not in the spirit of science!
• Nutrition science is hard, and complex. The relationship between our health and what we eat is confounded by many factors. One important aspect which is never spoken about by these influencers are issues like poverty, oppression, and even the impact of dieting itself, and the anxiety and food guilt created by such nervous attention to food.
• What Tara doesn’t like is when a professional such as herself speaks up - in a calm manner - to enquire about the harm being potentially done - and they don’t engage.
• So with the fruit pyramid issue, Tara politely enquired if the IQS people could share with her the research to support the pyramid. They responded by saying there is ‘lots out there’, but also said that the IQS program is not based on science but a “gentle experiment”.
• This is mind blowing - telling people they can’t eat bananas, telling them to eat only expensive fruits, charging people $99 for this program, making promises to reduce weight and depression - but none of it is based on science? Tara cannot fathom how that is ok to do that to people.
• “You can’t give a rigid rule and then call it a gentle experiment” - that’s gaslighting.
• This is modern diet culture. Everything’s exactly the same. We’ve still got the rigid rules, we’ve still got the ‘this is the way to diet’. Except we’re no longer allowed to call it a diet, or pursue weight loss. We’ve got to talk about wellness or healing really ill defined things. And then use the language of self compassion to turn this into something loving and gentle. And its really not!
• So, IQS is huge - it has made millions of dollars. Last year Sarah decided to shut the IQS company and move on. She’s very much into the environment etc, reducing food waste. And she’s written the book, First, we Make the Beast Beautiful, a very detailed account of her complex mental health issues. And the question is, should she have disclosed this while she was selling IQS? Louise can understand why she wouldn’t have, this is very personal and private information.
• But if someone has a history of severe mental illness and an eating disorder, jumping on the food advice bandwagon is, in Louise’s opinion, of concern.
• In a recent article from the UK, Sarah was interviewed by a reported who had an eating disorder background herself, and the interview did not go well for Sarah. Through the reporter’s eyes, Sarah presented as someone who still had eating issues. And the interview did claim that Sarah had given up on quitting sugar, a claim which Sarah has since vehemently denied.
• Sarah has claimed she was misquoted, and IQS has done an interview with Sarah to present her side.
• Tara contacted Sarah on social media to ask her if she had quit the IQS movement, and also put some questions to her regarding the potential harm that IQS has caused.
• Sarah then posted that she had been bullied by Tara, and by the journalist. She also said that someone with mental health issues should never be bullied.
• Tara then apologised, and asked for clarification about what Sarah felt had been misquoted in the article. She offered Sarah the opportunity to detail what was wrong about the article and said she would share this with her followers in order to clear it up. She gave Sarah her phone, email and other contact numbers. But she did not respond, and actually went offline for a couple of days.
• Tara can see how this would have been hard for Sarah - being questioned in public, on social media, about your philosophy, is not easy.
• Tara gets it: she has her own lived experience with PTSD, and close family members are experiencing severe mental health issues. But Tara does not think this means it is ok to hide accountability behind. She believes it may be a reason, but not an excuse.
• This has not been easy for Tara either - many in her profession have commended her for having the guts to speak up, some have questioned her. But she doesn’t do it for ‘reputation’ - she does it for her clients. When you see such large numbers of people being harmed by the IQS messages, it’s impossible to stay quiet.
• It’s not about herself. It’s about all of the people out there who are suffering, and using her voice to stick up for them.
• "Sometimes I feel like I have an ethical duty to speak up for the general public".
• In the book, it is clear that Sarah has a big heart, and a big brain. She is genuinely trying to help people, and herself.
• It’s not easy to live with bipolar disorder, severe anxiety, OCD. But in the book Sarah also talks about being diagnosed with an eating disorder - bulimia - and for that, she has not had treatment. She has had all kinds of treatment for her anxiety. But not for the eating issues, which are very much absent from an otherwise very thorough exploration of her mental health.
• Louise is a biased too, with her eating disorder hat on, but surely that aspect of mental health has to come into this too? Understanding anxiety is important, and an eating disorder for many people is a way of controlling anxiety by controlling food.
• Sarah talks frequently about her anxiety as a constant grasping at things to give her a sense of safety in the world.
• So you can see how controlling what she eats, and having clear lists of foods to eat, could control her anxiety.
• This kind of connection is not made in the book. And for Louise, it’s a missing piece.
• People writing self help books are in a position of power. It’s not ok to put responsibility back into the lap of the consumer!
• Tara has copped criticism for calling Sarah out on this topic, even from fellow health professionals. But she asks: where do we draw the line? Do people have carte blanche to just say anything they like, and then withdraw responsibility by citing poor mental health?
• We’re grappling now with this question, if someone has a mental health issue can they say anything, cause harm, and that’s ok?
• Trump’s feelings are also potentially hurt, but people are much less upset about it! Is this a gender thing? What would have happened if it was Paleo Pete coming out with a history of severe mental health issues!?
• We don’t have the answers, but it is important to have this conversation. Tara has reflected and learned a lot from this experience. Maybe Sarah Wilson has, who knows?
• Tara’s hope is that if a nutrition professional reaches out to an influencer, they’ll at least listen and have that conversation.
• If Tara was told that some of her advice had caused harm, she’d be concerned and working at understanding the situation and make sure it doesn’t happen again.
• But we don’t see this with influencers. The Paleo Pete disaster when he wanted to publish a book with a ‘bone broth’ recipe for babies that was so dangerous it could cause death. Pete was contacted by hundreds of health professionals and organisations pleading with him not to do harm. So he self published the book anyway!
• Wouldn’t you at some stage check in with yourself? Or just blatantly double down?
• It reflects the strength of these people’s belief in their nutrition camps.
• Throughout Sarah’s book is peppered this assumption that sugar is bad. She even tells people that in order to fully recover from anxiety, you definitely need to quit sugar!
• And that’s not an interpretation, it’s down there in her book, in black & white.
• “You need to quit sugar. Down to 6-9 teaspoons a day”. That’s not a gentle experiment!
• This is written in a book for people who are living with anxiety. Because this comes from her belief system, in which anxiety is either caused or worsened by fructose, the book has all of these ideas which are very damaging and could ultimately increase people’s food anxiety.
• That fear of sugar will create or exacerbate the anxiety which the book is apparently all about alleviating. No-one with an eating disorder can read this book. Also, no one in a larger body can read this book - it’s very fat phobic.
• There is research on gut health to show that plant foods with lots of fibre can improve our gut health, and that can be linked to mental health. When you quit sugar, you likely eat more plant foods, and that increase is what’s responsible for any improvements, rather than the absence of sugar per say.
• In intuitive eating, it’s all about adding foods, not taking them away.
• What’s annoying is this increasing normalising of sugar as a bad thing across our society. Kids are picking up on it. Tara’s 5 year old daughter did a lesson in class on how much sugar was in a can of coke! She’s 5!
• The world that Tara & I live in - we work in the intensive care ward for eating concerns - and we are seeing people flood in, casualties of the anti-sugar crusade.
• Sugar is the “devil right now’, and as health professionals it is ok that we are concerned.
• We’re not picking on any 1 person, we’re talking about figureheads of a movement. We need to remember who we’re trying to protect. It’s our kids.
• Tara hopes that the influencers can see that nutrition professionals are genuinely helping people - we see genuine concern, genuine problems. Tara is not just a schill for Big Sugar!
• Tara was asked by “The Conversation” to write an article about the dangers of sugar. Instead, she wrote an article about the dangers of always talking about sugar in a negative way. It ended up being one of the most read articles The Conversation had ever published.
• Tara was blasted by anti-sugar people for ‘giving people diabetes’. All because she used her scientific knowledge to suggest a much less extreme approach to sugar. And of course people suggested she’s been paid off by “Big Sugar” to write the article. She wasn’t!
• Good things can happen when people push back and ask questions - for example at the end of last year, the Dietitians Association of Australia stopped taking funding from big food companies.
• But this absolute demonisation of one food group is just ill advised and short sighted.

Resources:

Find out more about Tara Leong, including her fabulous anti-diet merchandise, here.

The wonderful Katering Show & its wonderful IQS satire

The bizarre IQS Fruit Pyramid:

The now-closed “I Quit Sugar” empire, which still sells the books etc.

Sarah Wilson’s book “First, we Make the Beast Beautiful”

*Here is the article about the misleading food labels on the IQS range - note that the products were not actually removed from shelves, but they were discussed as misleading.

The Daily Mail article by Eve Simmons claiming that Sarah Wilson had quit quitting sugar (strongly contested by Sarah Wilson)

Paleo Pete & his baby killing bone broth

Tara’s amazing article in The Conversation about the dangers of talking about sugar as the new devil

Hosted on Acast. See acast.com/privacy for more information.

My guest this week is the incredible film maker, speaker & activist Kelli Jean Drinkwater, and she has a huge fire in her belly about how fat people are represented onstage! Fat people have been virtually invisible in the creative arts, but Kelli Jean’s mission is to bring them into the limelight! In order to combat weight stigma and create a world in which all bodies belong, it is VITAL that fat people are represented in the creative arts. And not just as a boring STEREOTYPE, but as fully rounded, amazing, positive and UNAPOLOGETIC humans! Join me for a fantastic conversation as Kelli Jean & I unpack how things are changing in the industry & what still needs to be challenged. And hear all about Kelli Jeans’ simply INCREDIBLE projects! This is a fabulous & inspiring episode from an artist who professionally BLOWS PEOPLE’S MINDS!

Shownotes

• My guest is Sydney based film maker, speaker and activist Kelli Jean Drinkwater, who is totally fired up about fat representation in the media.
• Louise talks about how she & Kelli Jean first met several years ago on the set of Insight, a tv program in which there was an ‘ambush’ of fat activists and Kelli Jean was in the front line of host Jenny Brockie’s fatphobia.
• Her anger acts as fuel to change how fat people are being represented.
• We can get fired up in 2 ways, because although on one hand representation and casting of fat characters are getting better, there’s still a long way to go!
• There’s been a recent spate of films and tv shows especially in the USA which feature fat narratives, but they are still centred around cis gendered, white, heterosexual perspectives, and also the smaller side of fat people being cast.
• We have stories like Shrill, where the character is fat and staying fat, and Dietland, adapted from the amazing novel by Sarai Walker, where it’s still very good & fat positive but still some decisions made in that process which reflect weight bias.
• Like in both Shrill & in Dietland the main fat characters had love interests or sexual partners that were just awful men!
• In Shrill, her love interest feels ashamed of her and makes her leave out of the back door. She’s meant to be this onto it fat woman and wh????
• So eventually he comes around and says ok meet my friends, and she doesn’t dump him.
• And in Dietland the main character is a virgin, and rather than having a good experience she has this awful experience with a fetishist and a feeder who then rapes her. And it’s like - “ok, so that’s the kind of sex we’re going to see?”
• It could be done differently, and that’s frustrating.
• And then there’s the movie “Dumplin”, which Louise liked, she never saw anything like that when she was growing up. And it’s lovely to see the thin character (the mum, Jennifer Aniston), as the one always dieting, miserable and insecure. There’s some great characters in this - the fat auntie, who is always supportive of her.
• But then the aunt dies, and we’re not told why but it’s implied it’s because she was fat!?
• The love interest in Dumplin was great, he’s the hot guy and he is also lovely, he has no qualms about being attracted to her, and they just get together and it’s all ok. This is a narrative we need to see.
• Love is possible no matter what you look like. The hot guy can want to be with the fat girl.
• Kelli Jean related to her love of Dolly Parton, and the camp friends!
• Also the swimsuit scene at the end - they were in swing dresses and not bikinis???
• There are things like that that we’re still not seeing, and Kelli Jean is keen as a film maker to push things further, to include more inclusivity and positivity to fat characters.
• Having a fat character in a story is not good enough, we need to see it handled properly.
• Kelli Jean’s first documentary was Aquaporko, all about the fat women’s synchronised swimming team that she started.
• The women are all extremely smiley, and they’re all in fantastic swim hats - which she got online from Esther Williams.
• Kelli Jean loved the beach and has always loved swimming and being in the water. But for years she did not go to the beach or swimming because of how she felt about her body. It’s such a basic thing, to swim and be in water, but for fat people this can be fraught.
• Aquaporko is a beautiful, fun, unapologetic and confronting story of fat people being in their bodies and loving it. And also of being in public, and taking up space.
• It was an important and transformative film for the people who were involved.
• That’s why she did Aquaporko, she did not want other people to not do things they love for years and years.
• The film came about after Kelli Jean got some friends together and at a Sydney public pool they taught themselves synchronised swimming, just for laughs. There was no agenda, but people would clap us when we got out of the pool. It got some traction and media attention, a chapter started in Brisbane & in Melbourne.
• The Melbourne team practised & became quite good. It got to the point where they were going to do a performance at the pool, Kelli Jean thought - well, I am a film maker, and so the film was born!
• It premiered at the Mardi Gras film festival in Sydney, and everyone loved it. It won the audience award. It’s colourful, it’s different, it’s a bit camp, it’s just very joyful.
• It’s shown in 47 countries now as part of different film festivals. It still gets requests to screen.
• Now Kelli Jean has made a feature film, Nothing to Lose, this also gets attention, but Aquaporko is just loved.
• Nothing to lose is Kelli Jean’s first feature film. She co-directed it, without funding. It’s the story - in 2013 she was approached by Kate Champion, a very well known choreographer and theatre director for Force Majeur. She wanted to a dance theatre production exploring the fat dancing body, body politics and explore why this is such a taboo subject.
• In clubs, Kate’s eye was always drawn to bigger people dancing. Realising that she is a very slim, trained dancer, Kate realised she needed to collaborate with a fat artist who understands not just the performance but also the politics. Kelli Jean was the perfect choice!
• Kelli Jean offered artistic direction on the production, and decided to make a film about it on the way.
• It took 3 years off and on to make the show, and the film goes from the auditions to opening night.
• The show and the film explore not just the choreography and what fat bodies can do, but also about the people involved and their relationship to their bodies.
• It was amazing to have this show, commissioned by the Sydney Festival, choreographed by an accomplished person like Kate Champion. This really is ‘mainstream’ art in Sydney!
• At the time, nothing like it had been done. Dance theatre isn’t just dance, it’s theatre as well. It was very well received, and there was lots of media attention on it from all over the world. Just the concept of fat people dancing blew people’s minds.
• In the film they talked about the level of interest - is that just ‘the freak show’ or are people genuinely interested? But it got really positive reviews, almost all positive. Which was a bit disappointing as no piece of art is perfect.
• On Kate’s advice Kelli Jean and the cast decided during the performance time not to read comments or reviews. To allow themselves to just do the shows without worrying about how it was being received.
• Which is a good idea - there is an underground, Reddit based group of people who almost professionally hate fat people for no apparent reason.
• The show toured to Melbourne but not internationally. It’s almost like the people putting on these shows are ok with it because it is very ‘of the moment’ - it is controversial, which gets attention and therefore money.
• But they are still very cautious about it. Which is why it was good to work with Kate because she is not cautious!
• So it’s the same thing: yes, you can do a fat story - BUT, it has to be a white woman, and fat but not massively fat - and not TOO happy. And of course that is part of the story - you don’t just go I’m fat & I’m happy about that, we carry all of this baggage around with us all of the time. And so it makes sense that the characters who are written also carry this around - it would be weird if they didn’t.
• But there is ways we can push. And to not tour internationally is a shame, because it would have gone off!
• But this is why it’s great that Kelli Jean made the film.
• Everyone who worked on the film did it for free, for years. Because they believed this story needed to get out, and because the show did not tour.
• The film premiered at a queer film festival in San Francisco in 2018 and a massive premiere at Quuer screen at Mardi Gras in 2018. It has gone on to have a number of international screenings too, so it is getting seen!
• Also SBS on Demand bought it, so Australians can view it for free (link in resources).
• The film is the legacy of the show, and they’re all so glad it’s having success.
• Louise was in the audience (again) for Kelli Jean’s TED Talk which she gave at the Opera House. That came about from a funny story: Kelli Jean was in the audience at the Festival of Dangerous Ideas at the Opera House in Sydney, listening to Sarai Walker, author of Dietland, who was talking about radical fat acceptance. Her talk was all about the need to stop distracting from ideas of pure, radical acceptance by talking about ‘health’. At the end of her talk all of the questions were about health!
• Kelli Jean got up and caused a scene! She got up and said - I don’t have a question, but I just want to say I am embarrassed that here we are at the Festival of Dangerous Ideas, and here we are again talking about health!
• It was very triggering for Kelli Jean, because of the Insight experience and how she was hijacked there.
• Kelli Jean was like, “oh my god it’s happening again”.
• Afterwards, Edwina Throsby who was the head of TEDx Sydney, came up and said I want you to do a TED talk.
• Kelli Jean got a standing ovation for her comment at Sarai’s talk (Louise was not brave enough to get up!). For Kelli Jean, it’s not a choice. “I can’t not say something.”
• Kelli Jean felt bad for getting a standing ovation and taking the focus off Sarai, but she thanked her later for saving her.
• Here we are, Festival of Dangerous Ideas, with an accomplished novelist with some amazing ideas. And people still could not let go of their bullshit around health.? The entitlement of that - the idea that they can say “no you’re wrong, this is a wrong idea” - rather than “I’m really challenged by what you’re saying”.
• It’s just “No, you’re wrong, and you’re going to die because you’re fat”. People cannot let that go, because letting that go challenges and threatens their whole way of being in their own bodies, and their own relationships with their bodies. If we go “Hey, we’re fat, we’re going to live in our bodies and wear bikinis and show our bodies and love them and have sexy time and eat whatever the fuck we want”, people can’t deal. A lot of people invest so much time into trying to maintain a thin body, that to suggest that time could be better spent is too much.
• Small people don’t have it easy either: they may feel they have to invest a lot into maintaining it, because of a belief that it maintains happiness or acceptance or health. Engaging in diet culture is tiring for all of us.
• If you challenge that, they freak out.
• People get defensive and don’t want to listen. Kelli Jean gets it - it’s a massive capitalist machine. There’s a lot of money to be made by making sure women hate their bodies. The sexist, [atriarchal structure of capitalism is a lot to challenge. But come on - if you’re paying for a talk which is specifically to challenge you, be challenged!
• Kelli Jean is sure that if TED talks had a question time, the exact same thing would have happened.
• The TED talk was one of the scariest things Kelli Jean has ever done. But if someone says to you hey, do you want to talk to potentially millions of people on the main stage of the Opera House about something that you love - you’re not going to say no!
• There were 2500 people at the Opera House, but there were also 20 000 people watching live around the world! And no auto cue - Kelli Jean had to remember the whole thing off by heart. She did have notes stuffed down her bra.
• This was also one of the first TED talks to ever address the topic of fat positivity. So it got picked up by TED.com - they call it “Big Ted” in the USA & put on their platform.
• So now nearly 2 million people have watched it!
• Of course, when the talk went up there was a huge number of hateful comments. Kelli Jean spoke to the TED people to say that this is really damaging for fat people who might read these comments, so they actually disabled the comments both here and in the USA. Kelli Jean never read them, but heard how awful and violent they were, and she didn’t want people exposed to that.
• Kelli Jean knows how awful it can be, and knows it’s coming if she puts something out there. But she feels for the people who may not know and be impacted by the vitriol and outright hatred.
• It’s awful to think there are people out there who have nothing better to do than hate on people, especially women, who are ok with themselves.
• That threatens the patriarchy, the status quo, and it freaks people out.
• Some people (??Dylan Meryn?) meet people who troll them & find out they are just sad or have difficult lives or whatever. Kelli Jean does not want to do that! But she does want people to understand that people who troll like that are sad & have their own issues.
• So the resistance to fat representation centres on 2 main ‘arguments’: 1) “but what about health”, and 2) hatred.
• Without doubt the most vitriol comes from straight men. But as a queer woman, Kelli Jean could not care less if they find her attractive or if she offends them visually. Which is possibly why they find people like her threatening!
• This trolling and hatred fuels Kelli Jean’s fat activist fire. And it doesn’t feel like a choice for Kelli Jean. and it’s wonderful to see how far activism has come. There are some really popular and mainstream artists, like Lizzo, and this is very different from when she grew up.
• Kelli Jean loves the fact that so many fat younger people are owning it, wearing crop tops etc and just unapologetic about their size. As a teenager she never ever saw stuff like that! She bought into it for ages - and then, just got jack of it!
• Although she’s been in this thinking and activism space for a long time, it is still a process. There are still hard times.
• Kelli Jean is now directing a short film called “The Rainbow Passage”, it’s about Cadence Autumn-Bell. It’s her story about her transition, and her girlfriend is also transitioning, and they’re in Bathurst (small NSW country town). While fat positivity is important, Kelli jean also wants to focus on body positivity overall, and all of the intersections and layers of this, affirming gender diversity, differently abled bodies, being intergenerational, holding space for people of colour and their stories. Because it’s all interconnected. Intersectional feminism is the only way really!
• The other project is top secret, and we’re super excited about it!
• All of these ideas of loving who you are and pushing back against the dominant narrative are interconnected.
• We talk about the Insight show & how people questioned whether or not Kelli Jean was a swimmer. She just is! At the end of the Insight taping, kelli Jean told them that they could not show any of the scenes from Aquaporko on the show, because they’d treated her so awfully.
• Kelli Jean is often asked to take part in shows like this and she usually says no, because she will not set herself up for another ambush.
• It’s understandable that many fat activists are wary about appearing in the media, because they are so often ambushed with the interviewer’s own internalised weight stigma.
• The host of Insight, Jenny Brockie, obviously has her own issues with weight, because we’d never seen her so un-objective and accusatory towards a guest on the show.
• Jenny Brockie really went for Kelli Jean, but as usual she handled it like a champ!

Resources:

A link to the SBS Insight show which they called “Fat Fighters” (we did not know this was going to be the title, another aspect of the ambush)

The transcript from the SBS show Insight

Sarai Walker’s (author of Dietland) talk at the Festival of Dangerous ideas on radical Fat Acceptance

Shrill by Lindy West - the book.

Shrill the tv series.

Dietland the book and the tv series

Dumplin

Aquaporko

Aussie people can watch Nothing to Lose on SBS on Demand

Watch Kelli Jean’s Ted Talk

Find out more about Kelli Jean here

Hosted on Acast. See acast.com/privacy for more information.

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.

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DO NOT MISS this explosive episode of All Fired Up! The Obesity Collective is a sparkly new organisation gaining attention nationwide for its ostensibly ‘collaborative’ approach to ‘tackling’ obesity, whilst simultaneously erasing weight stigma (oh please how much of a mindboggle is that?!). But who are they really? My guest this week is Mandy-Lee Noble, anti-diet dietitian from Nourished Approach in Brisbane, and she has had a GUTFUL of industry interests penetrating our health narrative. Once we dug a little deeper into The Obesity Collective we found that the tentacles of Big Pharma have a firm hold on the goolies of all our so-called ‘independent’ Obesity organisations. You won’t believe how deep this goes. Next time you read a hysterical news headline highlighting the terrors of Obesity Epidemic, know who funded it!

ShowNotes

• Content warning and Apology !! This episode contains multiple uses of the word ‘obesity’. This is a stigmatising term and not one I nor my guest Mandy Lee Noble are comfortable using. However, as the topic of this episode is all about an organisation called The Obesity Collective, there are a lot of “O” words used.
• There are also lots of swear words to make up for it!
• My guest, dietitian Mandy-Lee Noble is all fired up about conflicts of interest and vested interests in health care, and within weight centric research and industries in particular. Mandy & Louise fell down a massive rabbithole when they accidentally stumbled across a particularly troubling example of this, the subject of today’s podcast.
• During a HAES Australia leadership meeting, we came across the “Obesity Australia” website, and their “fact sheets” were rather hilarious.
• These fact sheets contained not just outdated, but frankly very bizarre advice regarding weight loss.
• “Obesity Australia” are ostensibly one of Australia’s leading ‘authorities’ on obesity, and many of the country’s leading researchers, practitioners etc, are involved. And yet the fact sheets look like they were thrown together by either a year 9 school boy or an elderly person with very little connection to the real world.
• One of the ‘fact’ sheets was about drinks you should be having to lose weight, written by former head of Obesity Australia John Funder, whose diet tips have come directly from 1935. He recommends “egg flips” and “Miss Muffett’s favourite tipple, curds and whey”.
• Does ANYONE know what an egg flip is? And what about curds and whey??
• He then goes on to rage against fish and chips, and goes on a bizarre rant telling us to strip the fish and chips of batter, and ‘put it amongst the pickled onion’.
• What is he even talking about here? Where did the pickled onion even come from? 1970?
• John also has a huge grudge against potato crisps, which he says are ‘lethal’. Now Mandy, being a bit of a rebel, has on several occasions since reading that thrown caution to the wind and deliberately and vigorously eaten said lethal crisps, and has lived to tell the tale.
• Another tip was to ‘drink coke zero’, to ‘fool yourself into eating slightly less’. This tip appears to have come from Weight Watchers in circa 1980. Mandy believes this may work through the process of being forced to eat slightly less because you have no teeth! Seriously what’s with the totally SHIT advice here? This is from a highly regarded and very knowledgeable researcher?
• It’s encouraging behaviours that overall are not hugely health supportive, all in the name of weight loss!
• John also ‘recommends’ that a ‘rule of thumb’ is to always weigh the same as you did at the age of 25, even if we have less bone and muscle mass as a result. All of the actual research would contest that: there is a plethora of evidence to show that as we age we do get heavier, and preserving muscle mass as we age is very health supportive. It’s quite literally the opposite of what science tells us. People at a higher body mass are actually often healthier than smaller people as they age.
• Some of the information in the fact sheets started to lead us down a rabbit hole. One of them, written by Professor Joseph Proietto (who does not reveal his association with multiple pharmaceutical companies), states that most people who lose weight will not keep it off, and will regain, so he recommends the use of appetite suppressing medication.
• As we read, it became apparent that an agenda was peppered throughout these ‘fact’ sheets’.
• Repeatedly given is the message that most people who lose weight will regain it; that obesity is ‘a disease process’. We experienced a growing sense of unease - just who are Obesity Australia, and who is behind these organisations that claim expertise and leadership in the area of so-called ‘obesity’?
• People right now may not be hearing from Obesity Australia as much as “The Obesity Collective”. Now, this might sound like a trendy cafe or a tragic boy band, but it’s actually them who have featured in the media quite a bit in Australia recently.
• “The Obesity Collective” was launched on 31 July 2018 (happy first anniversary!), at a swanky reception at the Charles Perkins Centre, the University of Sydney’s $500 million hub for the study of ‘lifestyle diseases’ such as obesity. Headed by Professor Stephen Simpson, who also happens to be the head of The Obesity Collective.
• The Obesity Collective describes itself as “a group of committed individuals and organisations from across the community, working together to take on the obesity challenge together, with empathy and a whole of society perspective”.
• Doesn’t that sound warm, fuzzy….and a little bit scary!
• Mandy thinks they’re a bit ‘fast and loose’ with words like empathy!
• So Stephen Simpson is the academic director of the Charles Perkins Centre, and the executive director of Obesity Australia.
• Professor Simpson’s research interests are probably not what you’d expect:
• “Developing an integrative modelling framework for nutrition using insects that has been applied to a wide range of organisms, from slime moulds to humans, and problems, including the dietary causes of human obesity and ageing. He has also revolutionised understanding of swarming in locusts, with research spanning neurochemical events within the brains of individual locusts to continental-scale mass migration.”
• How much has he studied empathy within locust populations? Potentially more than he’s studied it within humans!
• Professor Simpson has accomplished a lot in his career, he went to Oxford University, and he’s one of these charismatic figures. He is definitely bringing a hip, urban edge to the Charles Perkins Centre, and also to the Obesity Collective, really trying to make it look engaging, warm and welcoming.
• He’s trying to portray the Obesity Collective as a great collection of warm and wonderful people who are going to combat not only obesity but obesity stigma, which is...an interesting challenge.
• Professor Simpson recently appeared on ABC’s The Drum program, on a show about obesity and fat shaming. Professor Jenny Lee was on (academic and fat activist), as was someone with ‘lived experience’ who was actually one of the Nepean Obesity Service’s weight loss ‘success stories’.
• Sarah Harry from Body Positive Australia was also featured, but did not appear live and wasn’t given enough screen time as someone in a larger body not riddled with internalised weight stigma. Jenny Lee was also somewhat sidelined by Professor Simpson, who remained resolute in his attitude that body size is a disease.
• The message of the show was definitely skewed towards eradicating the ‘problem’ of obesity, but let’s be nice about it. No amount of empathic-sounding buzz words can disguise the true intention.
• Professor Simpson asked Jenny Lee to join the Obesity Collective, but she declined.
• So the Obesity Collective’s launch at the Charles Perkins Centre in 2018 was funded by Novo Nordisk, a pharmaceutical company traditionally known for its production of insulin, but with a flooded market, has recently turned its hand to producing weight loss drugs.
• The Collective is trying to recruit different organisations and individuals including: NGOs, Academics, Young Entrepreneurs, The Private Sector, Community Leaders, Government, Healthcare Providers and people with lived experience.
• We couldn’t see any evidence that people with lived experience are actually a part of the Collective, there’s just this statement on their website that they’re there.
• Novo Nordisk have described themselves to be ‘active members’ of The Obesity Collective. It’s very prominent on their website that Novo is the Collective’s main funder.
• So what have the Obesity Collective achieved in their first year? They’ve been really good at raising the panic button. They’ve been in the media - not just the Drum, but radio, and print media. So they’re getting attention.
• They released a report called “Weighing in: Australia’s Growing Obesity Epidemic”. The report outlines statistics around the prevalence of obesity in Australia and bangs on about how much fatter we’ll be at this rate and how many diseases are caused by fatness. The cheekiest part of the report is where they re-cycle the statistics on the apparent economic cost projections of obesity, which they took directly from Obesity Australia’s 2015 report which was prepared by Pricewaterhouse Coopers and sponsored by Novo Nordisk. (more about them later in the conversation). !!
• The 2019 report did not disclose any funding from Novo Nordisk, it said it was authored by The Obesity Collective without naming who actually wrote it. But substantial sections have been taken directly from a previous report which had unlimited funding from Novo Nordisk.
• The Obesity Collective have also released a ‘fact sheet’ in which they say that obesity is ‘not just about personal responsibility’.
• Obesity Australia & The Obesity Collective just don’t get that the very framing of obesity is stigmatising. They really don’t get stigma. They actually think weight stigma is their tool to try to get people to lose weight (like take weight loss drugs!).
• And weight loss drugs like Novo Nordisk’s Saxenda, if you can tolerate the side effects, will maybe give you very modest weight loss results - if you can believe their own industry funded research!
• In 2015 in Australia, Novo Nordisk got TGA approval for their new weight loss drug, Saxenda.
• Since then, they have been quite aggressive in their tactics in raising awareness of how ‘awful’ obesity is and how urgent it is that we ‘act’. Through avenues such as these organisations, Obesity Australia & The Obesity Collective.
• The Obesity Collective also provided a submission to the Senate Select Committee on the ‘obesity epidemic’ - as did HAES Australia.
• In their submission to the committee, they said ‘we are working to transform the way society thinks, speaks and acts on obesity to reduce the impact obesity has on all of us”.
• What a mind fuck of a statement! In one part, they claim to be working to de stigmatise obesity, in the next breath, they stigmatise it all over again.
• What they are aiming to do - eradicate larger people - is implicitly stigmatising.
• They think stigma is a barrier to weight loss.
• They want people not to feel stigmatised coming in and asking for weight loss drugs.
• Mandy & Louise have been blown away by how pervasive the industry funding is in this area. We don’t have enough time or woman hours to delve completely, but this rabbit hole is massive.
• In their submission, The Obesity Collective stipulate the causes of obesity to be genetic, epigenetic, and biological drivers. But on the next breath they say this does not excuse people from committing to try to lose weight. So again, in one breath stating how body weight is not within our control, in the next demanding that we as individuals keep trying to control it.
• This thread runs throughout: on the one hand, all of the recognition of the science is there, and an almost HAES-y style of writing, and on the other, we’re back to keep trying to lose weight!
• Same science: different conclusions.
• They also referred to the Novo-funded report from 2015 in their submission, saying that the overall direct costs of obesity to Australia in 2011-12 Australia were determined to be $3.8 billion, while indirect costs were calculated to be $4.8 billion (PWC 2015). But if you compare even this figure (which Mandy really doesn’t think is totally convincing), considering that our total health expenditure for 2011-12 was $150 billion, then it’s just a drop in the ocean of our health care spending, hardly the health sector crushing scenario we’re often given.
• The same report also argued that the costs incurred from the stigma of obesity, including discrimination across education, work, and social spheres, is ‘incalculable’. It’s so much more than the actual cost! They are using stigma for their own agenda.
• These ‘reports’ put out by bodies such as the Obesity Collective or Obesity Australia are always the same format: 1. Obesity is bad, and getting worse, 2. obesity causes all sorts of diseases, 3. obesity is going to cripple our health system, and 4. we MUST urgently act and do something.
• And - it’s not your fault and it’s hard to fix - so - here’s some thing (ie drugs, put them on the PBS).
• But who are The Obesity Collective? They are actually a subsidiary of Obesity Australia. Essentially, Obesity Australia are the parent company of the Obesity Collective.
• Obesity Australia are a registered charity, and they have been in operation since 2011.
• They describe themselves as “an independent, not-for-profit, legal entity’.
• The ‘independent’ angle is interesting, because Obesity Australia receives most of its funding from industry ‘partners’, including Weight Watchers, Allergan (a pharma company who make the lap bands), and other pharma companies including inova and Novo Nordisk, who gave around $200 000 to Obesity Australia between 2011 and 2015.
• In 2011, Allergan kicked in quite a bit of money to get Obesity Australia started - around $150 000. Over 3 years they kicked in around $300 000.
• Allergan had actually gained a lot of cred for helping to fund these organisations, it helped them to be seen as a company doing ‘good’. But it wasn’t all good: Allergan, and the Centre for Obesity Research (CORE) in Melbourne received negative publicity in the media when their plans to target poor and Aboriginal teenagers for their weight loss experiments were disclosed to the media.
• Between 2011 and 2015, Obesity Australia received just over $1 million in funding. Of this, 80% was spent on “Board Expenses” and ‘consultancy’. Of that, 30% was “Board expenses”. Tax concessions also apply as this is a charity.
• It’s a LOT of money for all of that independence. And what exactly are these ‘Board expenses”?
• Many of the Board members of Obesity Australia have also received other money (for consultancy fees etc) from the pharma companies.
• Since 2015, Novo Nordisk has provided Obesity Australia with ‘unrestricted grants’ to produce reports about how dire the obesity epidemic is, and the URGENT need for interventions, including - no surprises here - pharmacological medicines.
• It is an urgent need for Novo, because in 2015 they finally got their weight loss drug Saxenda approved by the TGA.
• They’re not even bothering to hide it - on the Obesity Australia website you can click through to a presentation by Novo Nordisk to Obesity Australia in which they blatantly reveal that Novo are committed to ‘create legitimacy and urgency for the medical management of obesity’.
• Really, what Novo are after is to have obesity declared a disease: if this happens, they can push their drugs more heavily and even get weight loss drugs on the PBS, a massive potential windfall for them.
• The principles of Obesity Australia and the principles of Novo Nordisk are very much aligned with each other. Even the Charles Perkins Centre refer to obesity as a ‘disease’, when actually it’s not. In Australia, the Australian Medical Association do not classify higher body weight as a disease, nor do the World Health Organisation. They do talk about weight being a risk factor, but not a disease within itself.
• There are many people in larger bodies with no or very few health issues, if we classify this as a disease suddenly a whole pile of people become suddenly sick.
• How we think about our health status can really impact on our actual health status.
• And the influence of Novo Nordisk does not end with funding for Obesity Australia, and the unlimited funding for their ‘reports’. In the newly formed Obesity Collective, 8 of their academics on their boards receive direct financial benefits from Novo Nordisk, for consultancy, travel costs, etc, another couple of academics work at an institutions that receive funding from Novo Nordisk and a further 4 people on the Board are employed by PriceWaterhouseCooper (PWC). Which is interesting, because Novo Nordisk is a well established and long existing client of the multinational auditors PriceWaterhouseCooper.
• One of the academics enjoying funding from Novo Nordisk is Professor Stephen Simpson himself - the head of The Obesity Collective, Obesity Australia, and The Charles Perkins Centre. He has just received a grant for his research Ancestral causes of obesity: Understanding epigenetic transmission by spermatozoa; with co-author Romain Barres, Professor, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark. Professor Barres enjoys unlimited research funding from Novo.
• This information is not being hidden, it is right there on the Charles Perkins Centre website on Professor Simpson’s information page.
• It’s hard to find academics involved in Obesity Australia who are not being paid by Novo Nordisk in some capacity.
• And this reaches beyond the Obesity Collective and Obesity Australia, because Novo Nordisk are busily paying our medical doctors and health professionals as well.
• According to a news article from Crikey, Novo have spent $3.2 million over 3 years on speaker fees and for experts to sit on its medical advisory boards. Novo’s declarations show 1300 separate payments to Australian GP’s, nurses and specialists over 3 years, with recurring payments to a handful of prominent specialists.
• Basically, Novo are hell bent on creating an air of scientific legitimacy to penetrate a potentially very lucrative market.
• The Obesity Australia website has a ‘response’ to ‘recent media attention’ which is really talking about the Crikey series of articles. They don’t actually refute anything that was said in the articles, they simply say that Novo is not their only funding source!
• They also said that Obesity Australia relies mainly on ‘unpaid volunteers’, which Mandy calls bullshit on! Unless these volunteers are working a million hours, this is simply not true! In their financial reports, there are less than a handful of individuals who are actually listed as volunteers.
• It said that they have strict guidelines about industry funding and that any engagement with ‘third parties’ are passed through their industry guidelines - “Obesity Australia is transparent around funding and projects that are funded by third parties are passed through our engagement with industry guidelines. These consider the nature of the project to be funded in relation to potential conflicts of interest (real or perceived), and the degree of alignment between the commercial interests of the funder and improving the lives of those living with obesity.”
• We do have to say that we don’t know the ins and outs of Obesity Australia’s funding from 2017 onwards as they have not posted any financial statements yet. From 2015 onwards Obesity Australia’s financial reports became a lot less detailed. In 2015, Obesity Australia changed and was taken into the Charles Perkins Centre: “Obesity Australia, founded in 2011 has now joined with the Charles Perkins Centre, which will be responsible for the day-to-day operations of Obesity Australia. Obesity Australia remains in independent legal entity and will continue to be governed by the OA Board.”
• So we now have a lot less detailed financial information about the ins and outs of funding for Obesity Australia & The Obesity Collective, but we know that Novo Nordisk are still a major player in The Obesity Collective. Their logo is all over the Obesity Collective website.
• It is interesting because the Charles Perkins Centre really pride themselves on actually researching the impact of industry funding on how research and how knowledge is produced.
• None of the Charles Perkins research on the impact of industry funding has been directed towards Novo Nordisk.
• In September 2018 there was a flurry of media attention to the Charles Perkins research which showed that industry funding had a huge impact on research outcomes.
• Basically, corporate funding will skew the results towards industry not the people.
• Disclosure of payments by pharma and industry is important.
• Professor Simpson himself has had a lot to say about industry funding, coming out against Coke funding research at the Boden Centre for Obesity Research at the University of Sydney.
• Professor Simpson said that the Charles Perkins Centre had ‘strict guidelines’ regarding engagement with industry. And Louise had a look at these, and they basically say it’s really important for the centre to engage with industry. So there you go!
• So they are saying as long as we are transparent about our engagement with industry, it’s ok.
• Professor Simpson is actually also the Director of the engagement with industry committee!
• To their credit, The Charles Perkins Centre are transparent on their websites about Novo Nordisk funding their launch, about Professor Simpson’s research grant, and the unlimited research grants from Novo to write a series of reports about how awful the ‘obesity epidemic’ is, but there is a lot missing as well.
• Off the back of these reports came a shit tonne of publicity. Louise counted 11 different news articles in which the contents of these reports were discussed by either Professor Simpson or one of the Obesity Australia board members, and not once is the industry link mentioned in any of these press releases.
• This means that for the average person, there is no transparency. The average person would need to visit the website and trawl around to see who is funding the Obesity Collective in order to know. This is NOT transparent.
• There is a narrative being created which is being orchestrated by big pharma.
• Mandy has been asked to become involved in this world, but as a completely independent dietitian she declined.
• We will do a whole podcast on Saxenda, because we don’t have time now! Because the way the research is being conducted needs to be discussed. Also, Novo have more weight loss drugs in the pipeline, and Australians are being targeted for their market.
• With sparkly shopfronts like The Obesity Collective, positioned in prestigious universities, it’s really hard for the average person to figure out what science is really saying, and what marketing and funding is doing to how we think about all of this.
• Sydney uni and the Charles Perkins Centre even put on an entire event called “fighting truth decay” which was all about how industry funding can get in the way of seeing the truth! And who hosted it - you guessed it - Professor Locust!
• What a great technique to build trust, to be a university who talk about the corrupting influence of industry funding. But then to still do it???
• Another of the Charles Perkins Centre events was about lived experience of ‘obesity’, but lo and behold they did not bother to record that!
• Speaking of lived experience, the Obesity Collective say they have this section called the “Weight Issues Network” which is apparently for people with lived experience ‘and their carers’ (condescending much??). But Mandy and Louise could find no evidence of this actually existing. Louise even emailed them asking to join, and so far - no response…
• In fact - CRICKETS!!
• How ironic that the lived experience of people in larger bodies is being erased by the Obesity Collective - who do not seem to have any larger people involved. There’s not even a picture of a larger person on their website, I mean COME ON.
• On the Obesity Australia website you can click through and see the members and they are all small. This is awful to see a committee writing about what they should do to solve the ‘problem’ of larger bodies…...with no one larger in sight.
• Maybe The Obesity Collective need to think about the reality of inviting people to be involved in a collective that wants to literally obliterate people who look like them.
• Representation is important, and this is not happening because this organisation cannot see past their own noses. Still stuck in 1935.
• We’ll end on a really scary quote from a Reuters story from 2017 about Novo where the CEO is talking about taking a ‘bet’ on obesity. “I see a huge opportunity in obesity and I don’t see a lot of competitors moving into the space,” he told Reuters during a visit to London.” “Saxenda only accounts for 2 percent of Novo’s overall sales but analysts expect it to sell more than $1 billion by 2023, according to consensus forecasts compiled by Thomson Reuters. “
• So - the big agenda is for companies like Novo Nordisk to provide funding to organisations like Obesity Australia and The Obesity Collective, to push to have Obesity declared as a disease, so they can increase the market for their weight loss drugs.
• If they can get their drugs on the PBS, there is huge profit involved.
• What has completely done our heads in throughout are the claims made by Obesity Collective - to be inclusive (no), to de-stigmatise (no), to be mindful of health inequalities (no), to be informed by evidence and prepared to innovate (oh my god), and to DISCLOSE POTENTIAL CONFLICTS OF INTEREST!
• Which they do - but only if you look really, really hard. The Obesity Collective is a lovely smokescreen, and media reports are still not disclosing the funding.
• Everyone - please post pics of you eating those ‘lethal’ potato chips!

Resources Mentioned

Find Mandy-Lee Noble on her website, on facebook, or email her at [email protected]

• The Obesity Collective website (also the Obesity Australia website)
• The 1935 factsheet about Curds ‘n Whey “Drinks That Make It Worse (!)”
• Serious prejudice against fish and chips
• The infamous potato chips as lethal ‘fact sheet’
• Joseph Proietto’s fact sheet about the need for weight loss medication
• All about Professor Stephen Simpson, head of the Charles Perkins Centre, Executive Director of Obesity Australia, and head of The Obesity Collective.
• The Drum Episode
• The “Weighing In: Australia’s Growing Obesity Epidemic” report from The Obesity Collective
• Negative news stories about Allergan targeting poor and Aboriginal teens for their weight loss experiments
• More negative publicity about conflicts of interest in Australian obesity ‘experts’.
• The Novo Nordisk presentation where they blatantly reveal their aim to penetrate the Australian market (look under ‘resources from the 2015 summit’).
• Professor Simpson’s research grant buddy Romain Barr and his Novo affiliation.
• Professor Simpson’s Charles Perkins Centre Information page with his research grant from Novo.
• Just some of the payments made by Novo Nordisk to Australian health professionals.
• The Crikey articles discussing Novo’s plans to infiltrate Australia - there are a series of 4 articles, read them all:
• https://www.crikey.com.au/2019/07/01/obesity-politics-money-company-novo-nordisk/
• https://www.crikey.com.au/2019/07/02/betting-obesity-benefits-disease-classification/
• https://www.crikey.com.au/2019/07/03/commercial-bet-obesity-designed-create-the-market/
• https://www.crikey.com.au/2019/07/04/betting-on-obesity-winning-hearts-minds-pockets-doctors/
• Obesity Australia’s response to the Crikey articles
• Sydney University research on the impact of industry funding on outcomes:
• https://sydney.edu.au/news-opinion/news/2017/02/21/industry-funding-biases-drug-study-findings-.html
• https://www.theguardian.com/australia-news/2019/jan/16/pharmaceutical-companies-spent-34m-on-patient-advocacy-groups-research-finds
• https://www1.racgp.org.au/newsgp/professional/anything-to-declare-corporate-influence-in-medical
• Professor Simpson being all fired up about industry funding with Coke
• The Charles Perkins centre transparency guidelines for working with industry
• 11 news articles featuring The Obesity Collective or its members in which Novo Nordisk funding was not mentioned:
• https://www.smh.com.au/national/that-was-the-most-heartbreaking-part-australia-s-obesity-epidemic-out-of-control-20190326-p517l5.html
• https://www.news.com.au/finance/economy/australian-economy/research-shows-australians-must-lose-weight-to-save-money-and-help-improve-the-economy/news-story/d4618d77c9d04d14d6f5d3eed04c6185
• https://www.huffingtonpost.com.au/2016/09/22/how-to-talk-to-a-loved-one-about-their-weight_a_21472370/
• https://www1.racgp.org.au/newsgp/clinical/‘we-can-really-call-this-an-epidemic’-obesity-rate
• https://www.smh.com.au/politics/federal/while-politicians-refuse-to-act-australians-become-more-overweight-20181113-p50fu9.html
• https://www.afr.com/leadership/fatness-debunked-as-obesity-expert-says-its-not-your-fault-20181113-h17trg
• https://www.smh.com.au/business/the-economy/personal-responsibility-not-way-to-fix-obesity-crisis-20180801-p4zuwu.html
• https://www.smh.com.au/opinion/lets-get-creative-in-the-fight-against-obesity-20151201-glcy0v.html
• https://www.huffingtonpost.com.au/2016/02/25/obesity-cost-in-australia_n_9199240.html
• https://www1.racgp.org.au/newsgp/professional/obesity-australia-summit-2018-a-new-approach-to-a
• https://www.abc.net.au/radionational/programs/drive/the-obesity-collective/10056982
• The Charles Perkins’ Centre event Fighting Truth Decay
• Scary story from Reuters about Novo and how it’s taking a ‘bet’ on obesity.

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