Undisciplinary
Undisciplinary
Beyond the Scales: Obesity Ethics and Weight Stigma
Chris and Jane kick off 2025 discussing their recent publication in the British Medical Bulletin titled "Obesity: Ethical Issues" and exploring how conversations about weight stigma have evolved in recent years.
• Jane shares her experience appearing on ABC Radio National's "God Forbid" program where the topic shifted from "thinness and morality" to focusing entirely on obesity
• Even as medical institutions acknowledge weight stigma is harmful, they continue to pathologize bodies outside narrow parameters
• Public health messaging has evolved from fear-based "toxic fat" campaigns to more positive approaches focused on movement and wellbeing
• Wonder drug narratives around Ozempic and other weight loss medications often ignore long-term risks including cardiac, gastrointestinal, and psychiatric impacts
• Challenging the pathologization of diverse body types remains more difficult than addressing overt stigma
• Chris teases an upcoming bioethics book project that will include interesting research tidbits
Let us know if you want us to discuss any particular topics - email us at undisciplinarypod@gmail.com or find us on Bluesky @undisciplinary.bsky.social
Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
Undisciplinary is recorded on the unceded lands of the Wadawurrung peoples of the Kulin Nation in Geelong and the Gadigal peoples of the Eora Nation in Sydney. We pay our respects to Elders, past and present.
Speaker 2:The world's first high-strung plant has been performed.
Speaker 1:Medical history has been made in South Africa.
Speaker 2:Reports of systemic racism in the healthcare system, and COVID-19 has made the issue even more urgent.
Speaker 1:Characterised as a pandemic. Welcome to Undisciplinary, a podcast where we're talking across the boundaries of history, ethics and the politics of health, co-hosted by Chris Mays and Jane Williams. How was the interview yesterday, jane?
Speaker 2:It was really interesting. It was a good experience. I didn't get to say a fraction of what I wanted to say. I guess I guess I probably overprepared, because I had a lot that I wanted to talk about, you know, because obviously this is the thing that we've been thinking about a lot yeah.
Speaker 1:So, jane, you went on ABC Radio National to talk about thinness and morality with James Carlton and we will be linking to that the God Forbid program with James Carlton. Who else was on the discussion? I mean, this will obviously be published or, you know, released before. I think tomorrow it's coming out, I think.
Speaker 2:I think it's next week's when they were double taping, yeah, so it was a really interesting experience. So, before I talk about the other guests, one thing that was super interesting to me is that I went onto it and had a run sheet that said that it was about morality and thinness. We didn't talk about thinness at all.
Speaker 1:We talked about fatness the whole time, interesting.
Speaker 2:It is interesting and I kept wanting to bring thinness into it because you know it's what was on the package. But no, from the excuse me, from the very beginning it was all about obesity, which is not the same thing, anyway. So it was with Kate McKay from Sydney Health Ethics.
Speaker 2:And also they said the whole way through that I was from Sydney Health Ethics and also they said the whole way through that I was from Sydney Health Ethics and he said at some point if I'm getting any of this wrong, just let me know. But he'd said it like five times at that point, so I guess I can just be from Sydney Health Ethics and Tess Royale, who is, I guess, a fat activist. They have a company called Radically Soft which is about essentially, I think, clothing exchanges and people making interesting clothes for lots of different body types and people making interesting clothes for lots of different body types, and they also have another I can't remember what it was called some sort of.
Speaker 2:Anyway, tess is an artist and does stuff about and with the fat and queer communities. And the other person I've forgotten their name, but I remember their instagram handle um, she's at the bodzilla, um, so she is, uh, um, she. She's a works for the butterfly foundation or as an ambassador for the.
Speaker 2:Butterfly Foundation and also a model. It was a really nice mix of people on the panel, noting that I was stepping in for you, chris, it would have been great to have you there. Essentially, I mean I was going to say to have a man on the panel. Um, I mean, I was gonna say to have a man on the panel, I mean tess is, tess is trans, so not female, but it felt very female.
Speaker 1:it felt like fatness as a female problem yeah which, um you know, would have been good to have a bit of difference, difference yeah, yeah, I mean, it's one of the the few areas where, um, yeah, certainly not wanting to center a male perspective, but it's one of the few areas I find where, like what you were saying about how thinness that it was labeled as thinness but really it was talking about obesity and fat bodies, and then also, I think, a lot of the body image and body positivity movement, largely because it's been led by women and that women have been sort of at the forefront of a lot of the sort of focus on the idea of conforming to certain both medically and aesthetically defined body standards.
Speaker 1:But yeah, men also both contribute to part of and I think, that internal dynamic in the the of, you know, perceiving one's body as like even if it's not quote unquote perceiving one's body as sort of needing to be regulated and needing to conform to certain standards.
Speaker 2:But no, I think that's downplayed, if I'm honest, you know, and I don't think it's a zero-sum game, right, but I think we ought to take the pressures that boys and men experience around their bodies, needing to be a certain way perhaps more seriously than we do.
Speaker 1:When.
Speaker 2:I say we, I'm talking about the royal, we, rather than you and me.
Speaker 1:Yeah, yes, no, it is. Yeah, it's something I've been thinking about because, in addition to this radio engagement that you had, we and we need to talk about this. Actually, I know I needed to respond to your email, so we've had this abstract accepted to going to White Stigma Conference in Griffith University on the Gold Coast, which I'm excited about sort of going there and sort of it's been a while since I've been to sort of a sort of more fat studies kind of conference. So I'm interested in going along and presenting what we're going to be talking about, but also, yeah, just thinking about even in those and this is obviously I haven't been to this.
Speaker 1:So this is, if anyone who's involved with this conference is listening to this, it's certainly nothing to do with any kind of projection or expectation, but even in, I'd say, accepting communities, there are often also tensions around who is really fat, and I think this is part of you know what people like Paul Campos talked about with the obesity myth in his book and you know, and I think he it's sort of an unhelpful term, but I also think it is helpful in other ways talked about.
Speaker 1:I've forgotten exactly what the term was, but it was basically like we live in a sort of like anorexic society, like with this sort of total valuation of a skinny, skinny body and in a sense, like I think that regardless of your body, whether it conforms to the medical or aesthetic ideals or not, we still have been ingrained with these norms to look at our bodies in a certain way. So we all, in different ways, will have that guilt and shame. You know, obviously not all of us have it in the same way, but in a society that values these sorts of norms and expectations about bodies in ways that we've internalised it kind of regardless of what your body looks like, you will have internalized those norms and be applying them to yourself and others in different ways. Um, which kind of reminds me of, you know the, the idea that you know that a lot of feminists have said for a long time that sort of breaking down the patriarchy is beneficial for men just as much as it is for women.
Speaker 2:Yeah, fully. Yeah, yeah, no, I think so it can't be fun to be I was going to say it can't be fun to be Andrew Tate, but it hopefully isn't fun to be Andrew Tate, but it can't be fun to have all of these really negative, negative pressures and kind of quite just awful expectations around you as well. I don't know, perhaps I choose to believe that people are inherently not awful and so, I don't know, it would be freeing for everybody.
Speaker 1:Yes.
Speaker 2:Not that Andrew Tate is. The patriarchy is wider than Andrew Tate. Let me just say for the record.
Speaker 1:Yeah, unfortunately, or fortunately, I'm not sure. Okay, well, this conversation has started quite organically, actually, rather than any planned way. So this is the first episode for 2025. It has taken us a while to get into the year. We are a third of the way into the year, which is horrifying, which, for me, is kind of an indication of how this year has sort of crept up on me and mugged me in some respects. I don't know how you feel Like. Did it just come around?
Speaker 2:I don't know if I swear on this podcast, I don't remember, but I can't think of a better word really. But it's just, everything has been a total shit show.
Speaker 1:Yeah.
Speaker 2:Technical term.
Speaker 1:Yes, yeah, no, we have used shit. Well, we had that episode on bullshit.
Speaker 2:Oh, that's true. That's true, there's precedent, it's fine.
Speaker 1:Yes, but we are glad to be back. We've got some episodes coming up as well that have already been recorded, which we think will be of great interest. So, yeah, you were on this radio program. We're going to be talking a bit more about, I think, weight stigma and sort of obesity ethics in general both, I think, some of this sort of collaborative work that we're doing, but we also had a paper published not so long ago, so we can, instead of, I guess, interviewing someone else about their work, we will have a brief chat about our recent co-authored publication, which I'm trying to actually locate. I mean, it's simply titled Obesity Ethical Issues, isn't it?
Speaker 2:It was published in the British Medical Bulletin. I want to say yes, a couple of months ago, yep, and this was a commissioned piece, wasn't it Chris?
Speaker 1:Yeah, so the origin, I guess, was that they asked me and then I asked Jane to be a co-author and yeah, so it was a commissioned piece where they wanted you know the idea is, I believe for sort of medical folks and medical trainees they want to. I think that's the audience for this journal, british Medical Bulletin. Yeah, so they wanted a sort of survey article on obesity and at first I was a little unsure as to whether I wanted to do that. But in talking with Jane and you know that it provided a potential, like in being a survey article you don't have as much control over saying all the things that you'd like to say about an issue, but it seemed like a good opportunity to perhaps bring in to an audience that may some ideas, may be new to them. Yep, exactly.
Speaker 2:I think also, when you think about this kind of thing a lot and when you have thought about this kind of thing for years and in whatever way, it's easy to forget that that kind of dominant narrative that is absolutely everywhere is just kind of seen as a bit of a no brainer. You know that well.
Speaker 1:Of course it's bad to be fat and of course you just do whatever you can to avoid that situation, even because that's what we're taught from when we're little yeah so yeah, what might have seemed really kept and obvious, I just don't think necessarily is to everybody and captain obvious is a phrase I haven't heard for a while, so that's nice to have that back. Yeah, so I mean I don't know if there's a whole bunch of stuff we need to talk about with this article. I mean I'd be interested if there's anything in particular that you would like to discuss from it. I have a couple of things, but I don't know, based maybe on your conversation yesterday, if there was anything.
Speaker 2:So, based on the conversation yesterday, there were a couple of things that I realized that, at least for the interviewer, were new ideas, and one of those was that, um, that obesity ought not to be addressed as a as an area of personal responsibility.
Speaker 2:And I said something. I don't remember exactly what I said and I will say that did keep me up last night. What did I say? Anyway, but the idea that there ought to be attention to the structural things that make it difficult for people to live the way they want to live in terms of the way they eat, the way they move their bodies or don't whatever. That that was not necessarily, um, an individual responsibility situation, but one way that, yeah, that is more around social structures. And he said something like but of course it's individual responsibility, you know, you eat too much, you don't exercise enough. Whose responsibility is that? So I guess one thing that I like that we've done in this paper is really consistently pointing out where those norms around personal responsibility are reinforced, often through a whole lot of different ways, and that actually they would be more usefully addressed if we need to address obesity, if we accept that obesity itself is a disease, which seems to be a thing that is agreed now. Well, isn't it? Because the WHO said it was therefore it is.
Speaker 2:Then sort of whole of government and structural things that look at the social determinants of the way that we live are going to be much better than things that just target an individual, perhaps in unrealistic ways.
Speaker 1:Yeah, I mean it is, I guess, yeah, a useful reminder of how entrenched some of these ideas are and how they keep coming back over and over again in different forms and different ways, and I guess this recent excitement around a Zen pic has just been another way for some people to rehash these ideas about personal responsibility. Yep, yeah, I mean something that I found so in doing this article as well. They wanted particular categories, so they wanted us to talk about areas of agreement, areas of controversy and areas for developing research, and I think one area of agreement that for me is interesting and well, for us it's interesting, and we're going to be talking about this more in this conference paper at Griffith University is weight stigma. Conference paper at, uh, griffith university is weight stigma, and that is something that, since I did my phd research um, I guess over 10 years ago now that seems to be an area that has shifted into an area of agreement where, by what, by what?
Speaker 1:What we mean is that a lot of sort of professional healthcare bodies have put out sort of joint statements. You know Obesity Coalition, all these other organisations that see and consider obesity to be a problem, but they have all put out these joint statements in the past sort of five years saying weight stigma is a real problem. We need to avoid stigmatizing individuals and communities. And that wasn't really present. I still remember being on a panel with Louise Boer, who's a pediatric sort of obesity specialist and she was kind of like at the vanguard for her um in her area of saying we shouldn't be stigmatizing these people and she was getting pushback from clinicians saying no stigma is a good way to kind of um how are they gonna know exactly?
Speaker 1:and then there was also that, uh, 10 years ago, that article by Dan Callaghan, the bioethicist, arguing for saying that stigma is a good way, you know, just like in tobacco, and even though it went against empirical research like. So they'd say, just like stigma worked for tobacco, it will work for obesity, which I believe the empirical research says that it doesn't work for tobacco and it certainly doesn't work in relation to obesity. So that's one thing that we will, I think. Looking at this, Sorry, chris.
Speaker 2:So in preparation for this interview yesterday, I revisited some of the mass media campaigns around obesity over the years, particularly the mass media campaigns around obesity over the years, particularly the um, the live lighter campaign that's been going on in wa since, I want to say, 2012. Um, that's the campaign that came up with the toxic fat ad I don't know if you guys yeah, no, I know that remember this, yeah, but like the mulching kind of heavy on sound effects and all of that um, which was a fear campaign.
Speaker 2:Right, it was around. Fat is bad. Basically, being fat is bad. Having toxic fat is worse, and I think that might be a quote from the ad, I don't recall yeah and so I was interested to know that that Live Lighter campaign is still around.
Speaker 2:So I looked at a more recent ad and it was really interesting and completely different, I will say so. The new campaign is called Move More and it was interviewing a guy, just a really regular-looking guy, old fella, my age, talking about him playing football with his friends and how they've kind of played on and off over over the years and how, um, getting out was really good for his mental health and you know, they weren't great, but just doing a little bit made them all feel better and it was a really nice way to connect with each other and sometimes their kids play with them too. Um, and you know there's so much lovely messaging in that you know, around, being outside being kind of not it wasn't about I will lose weight if I exercise, it was about being outside, being in community, moving your body just makes you feel good, you know, and that felt like a huge shift from toxic fat. So the I guess, chris, I'm agreeing with you. I do think things have changed.
Speaker 1:Yes. But importantly I want to say, before some people are pulling their hair out the hairs, the hairs are up is, yes, things have changed. Yes, there is this sort of almost sort of uniform agreement that stigma is bad. But what is really interesting is the way that has been. Those sort of, I would say, fat activist messages and sort of grassroots critiques and the people putting forward the drawing attention to the harms of stigma have been used and co-opted by the same, I want to say, industries, the same medical professions who are trying to conform bodies to a particular model. So the bariatric surgeons will also say, yes, weight stigma is bad, we're here to help. Yeah, just the same as in the previous episode or you know, last year or so, with Paddy Thal talking about the pharmaceutical approaches at a Zempic.
Speaker 2:they'll go yeah, weight stigma is bad and we're here to help. Yeah, exactly, exactly. You just need to stay on this drug for the rest of your life and you'll be sweet.
Speaker 1:Yes, which I guess is what you know, what we're going to be looking at in our conference paper, and if anyone has any suggestions, feel free to email them in at undisciplinarypod at gmailcom. But the underlying pathologisation, I think, needs to be tackled. So the medical bodies that are saying weight stigma is bad are still saying bodies outside of these parameters are pathological and we need medical intervention. And so I think the challenge now is to be able to articulate that these bodies aren't pathological, and I think that's what will really really gets difficult. I think, like I think you can eventually get through to somebody that calling a fat kid and like a doctor, this is an example Louise Bowie used. You know a doctor calling a fat kid and like a doctor? This is an example Louise Bowie is. You know a doctor calling a fat kid an elephant. I think we can all kind of agree that that's an awful thing to do. Oh my, God.
Speaker 1:But can we? You know the argument. To say that that fat kid isn't pathological or, you know, pre-pathological as they like, is perhaps a more difficult conversation to convince people of yeah, I agree um, whether we're going to be able to do that I don't know.
Speaker 1:But yeah, I mean, it's interesting as well what you said about the, your experience, because one of the other areas of agreement that we have, and obviously this sort of I guess reflects maybe some of the areas that we read and focus on. But I do also think that there is this general or we do because we say it in this article that there is this sort of in the move away from stigmatisation.
Speaker 1:There is a sort of general agreement that there needs to be a more than personal responsibility approach, which I would say yeah, from public health policy, and again, the self-interested views of bariatric surgeons would be that, yeah, we need a more than personal responsibility approach yep, yep.
Speaker 2:I just thought of something that was interesting about the um, the o Ozempic thing, which is obviously an area of personal responsibility if you can afford it, and that was in the interview yesterday, the announcer saying something about it being a wonder drug, and it made me think about all of the wonder drugs that we've had in the past.
Speaker 2:right, so I guess speed didn't turn out to be quite the wonder drug for the uh, for the ladies at home that uh was hoped. Um, whatever happened to alestra, you know where you had your, your anal leaking that probably wasn't quite quite the wonder drug that it was touted as. And you know, could be that Ozempic is or that semaglutides as a class are, but you know we're so desperate for a fix that anything that comes along. That I mean.
Speaker 2:I think that the weight gain that people experience when they stop taking these drugs is significant enough that it appears to be, I guess, in the public discourse that people plan to take them for life. Yeah, but obviously off-label for obesity. This is a pretty new thing to be doing. I don't know what the data are about its on-label use and how long you take it for, or anything like that, and that would be a thing for me to Google after we've spoken. But you know, is it a wonder drug? Is it a flesh in the pan? Is it a thing that's gonna be a permanent fix for all of us and we're not no longer gonna need to support fat people because there's not going to be any reason to be fat?
Speaker 1:well, that's, these, are these articles that people are putting out, that it's going to ruin the economy and all this sort of stuff, because people are going to stop eating. I mean it's.
Speaker 2:I haven't read that. Well, that's good, because, yeah, there was something. No one can afford it, you know because it's an appetite suppressant, isn't it?
Speaker 1:Yeah, so that you know the whole population is just going to stop eating food. I mean, where these get any kind of common sense from is beyond me, but um, we do talk about this and provide some references in this article about um, one of the sort of ethical and empirical questions that the sort of the two tied together with the pharmaceutical approaches, are that there are a lot of unknowns about how the long-term use of these weight loss drugs and their data that already has been shown their contribution to things like cardiac, gastrointestinal and psychiatric conditions. So it is interesting, without opening up a whole can of COVID worms and vaccine worms about you know, people's hesitancy about taking unproven vaccines and all of this sort of stuff. But, um, and and it also goes to show the I guess what some people would term the biopedagogies, the, the, the public pedagogies around bodies and such that having a body outside the norm is a frightful thing, both in terms of your health but also in terms of your looks and appearance and social acceptance that these kinds of risks are worth it.
Speaker 1:but to end uh, so we talk about other things. We won't go through the whole thing. You can read the article if you'd like to uh we will provide a link. It is a short, digestible um, so yeah, we go through. What do we go through? Areas of agreement, areas of controversy, areas of areas timely for developing what? Is it areas timely for developing research. So things like post genomics, epigenomics, personalized nutrition, stuff like that. It was fun writing it as fun as these things can be.
Speaker 1:There was, I think, maybe a moment of like why did I agree to this?
Speaker 1:um but so far so good yeah I guess the final thing, unless you've got anything else you'd like to bring up, jane. I mentioned this to you, jane, and I'm and I think I'm going to go through with it, which is so I am starting to write this bioethics book. I've been, you know, this is part of where I guess one aspect of the origin story of this podcast back with courtney was during covid. We started the podcast partly I mean, I guess the australian research council maybe paid for a microphone or two um and it was partly to sort of uh, talk about some of the history of bioethics stuff. So I guess I've been researching this for now seven years and I am now putting words on pages and writing things up. But I also have come across some little, to me at least, interesting tidbits that probably won't make it to the book, but I may sort of just have a little monologue here and there about this project um.
Speaker 1:So stay tuned for that if you're interested in outtakes and half-baked ideas, that won't get to it maybe, I don't know, we'll see yeah, um, but other than that, happy new year happy new year, happy new year and I guess we're still also trying to work out our comms, because Twitter is like I don't think there's any point like everyone's deactivating their Twitter accounts.
Speaker 2:I've been getting emails from? Are we on Blue Sky?
Speaker 1:We are, but I haven't gotten to the Blue Sky habit and I think maybe my life would be better not to develop a new social media habit.
Speaker 2:I am also on blue sky, but I always forget to go there. But when I do, I read interesting things yes, maybe we'll just um send unsolicited emails yeah, let us know if you want us to do anything. Talk about anything, good idea sponsor us corporate sponsorship yeah, pfizer, if you're listening or example about anything Good idea Sponsor us Corporate sponsorship.
Speaker 1:Yeah, pfizer, if you're listening. Novo Nordisk, cool All right, all right. Well, see you all and yeah, it's good to be back in your ear holes. Ha, thank you, so Thank you.