Maintenance Phase

What's Our Deal?

October 11, 2020 Maintenance Phase
Maintenance Phase
What's Our Deal?
Show Notes Transcript

Welcome to Maintenance Phase! In our first episode, we tell our origin stories and talk about some of the basic ideas behind the show.

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Thanks to Ashley Smith for editing assistance and Doctor Dreamchip for our lovely theme song!

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Aubrey: Hi, everybody and welcome to Maintenance Phase. My name is Aubrey Gordon and I am here with my cohost, Michael Hobbes.

Michael: Hello. 

Aubrey: Yeah. Hi. 

Michael: Hi. We're doing a little overture episode. This is like a little teaser, because we know that when people find a new podcast, oftentimes, they scroll down to the bottom of the feed. 

Aubrey: That's what I do. 

Michael: Yeah.

Aubrey: [laughs] Yeah. We wanted to give folks a little introduction to who we are, what this podcast is, and what are some of the underlying critiques that are going to come up, and we're going to talk about our own experiences in relation to those.

Michael: False. I will be revealing nothing about myself, but proceed. [laughs] 

Aubrey: Ironically, the anonymous person here is going to be the vulnerable [crosstalk].


Michael: You are talking about our inspirations for the show and how we got the idea of doing it? 

Aubrey: Yeah, why don't you kick us off on this one? 

Michael: My desire to do a show like this came from a couple months ago. I was looking through the top charts on Apple Podcasts and health, it was one of the categories. I was scrolling through the top, I don't know, 50, hundred health podcasts, and very, very, very few of them were subversive at all or seems to be in any way skeptical of the wellness industry. So, I thought it would be a good idea to have a show that is curious about this stuff. If we find good ideas, that's fine. But also, I think it's important to be like, "Are we really becoming healthier with all this stuff?"

Aubrey: Totally. And we have very conveniently as a culture just collapsed our definition of health into our visual assessment of our own weight. 

Michael: That's a good way to put it.

Aubrey: Even really smart, thoughtful people accept fully that how fat you are is a direct measure of how healthy you are. The underpinning of that is that, it is your responsibility to be as healthy as possible.

Michael: Yeah. A lot of the other shows seem to have this our fat people, people vibe, where it’s like this very exotic concept. 

Aubrey: [laughs] 

Michael: So, we're just taking that as a starting point.

Aubrey: Yeah. We're going to assume that fat people are people.

Michael: You know what? 

Aubrey: [laughs] 

Michael: So, do you want to tell people, who are these millennials? How we [crosstalk] into my ears? 

Aubrey: Who are these millennials? Ushered me into the extended goop averse.

Michael: What's your deal, Aubrey? 

Aubrey: It is my deal. 

Michael: [laughs] 

Aubrey: I am a writer. You may know my work as your fat friend, if you have read anything by that person, that's me. I started writing about being fat, because I'm a fat lady and I have been a fat lady pretty much my whole life. When I graduated from high school, I was a size 24, which was at that point, the largest size available even in plus size stores. Yeah, a lot of high school spent wearing sweatshirts with polo collars sewn in, they are like, "If you're this fat, you must be 60 or 80."

Michael: Oh, God. 

Aubrey: That's why I started wearing menswear as we were talking about earlier. Anyway, pretty much every fat person, I tried every weight loss method that was available to me. As I did that, as I went on diets, and diet drugs, and detoxes, and cleanses, and lifestyle changes, and whatever else, the same thing pretty much always happened, which is that I would lose a little bit of weight 10, or 20, or sometimes as much as 50 pounds. I would lose that weight and then, I would reliably gain it back, and then, some. The more I tried to lose weight, the fatter I got.

Michael: It's a very rare experience that only happens to 99% of people, who go on extreme diets. 

Aubrey: Yes. [laughs] 

Michael: So, we're uncharted waters now.

Aubrey: [laughs] Totally. The only explanation that was available to me for that was a personal failure. 

Michael: Yes. 

Aubrey: That's the only message that we ever get. If a fat person is fat, especially, as fat as I am, it has to be their fault. Subsequently, we deserve whatever's coming to us. 

Michael: Yes. 

Aubrey: If people are shitty to you, sorry. [laughs] That's just what happens to fat people.

Michael: Yeah. Weight is the number one reason that kids are bullied at school. I feel a lot of people don't know that. 

Aubrey: Yeah. 

Michael: And it's generally something that we just accept like, "Well, she is pretty big." That tends to be the way that these kinds of bullying experiences get framed and it's gross.

Aubrey: Yes, absolutely. And it becomes such a big thing that there are some cases of children being taken away from their parents, because the kids are fat and that must be a failure of parenting. 

Michael: I know about that. That's bad. 

Aubrey: Ooh, yeah. We have taken this reasoning to such extremes that we are building social systems around it and that is really troubling to me. 

Michael: But look what you just did. We were talking about you and then, you got into academic research, which is what you do no matter what we talk about.

Aubrey: [laughs] 

Michael: I ask you something about yourself and then two minutes later, it's like, "According to a peer review journal in 1996--" Like, "Aubrey, Aubrey. Go back. Go back."


Aubrey: Listen, you and I are very well matched for a number of reasons and that is one of them. Part of what's so exciting to me about the podcast is that, it relates really closely to stuff that has helped me a great deal in making peace with my own size, but also thinking critically about how fatness, and anti-fat bias, and this idea that everyone owes it to everyone else to be healthy.

Michael: Because nobody gives a shit about the resting heart rate or the LDL cholesterol readings of someone who's skinny.

Aubrey: Right. I think people can genuinely believe that they are concerned for fat people's health and that that belief can be rooted in faulty information, and biased beliefs that they have been fed and consumed pretty uncritically for most of us for our whole life, right?

Michael: Yeah. Not all discrimination against a group manifest as shouting slurs at them from a pickup truck. It can very easily just be an overwhelming sense of paternalism or this fake concern.

Aubrey: Right. There is this noblesse oblige that happens within people, which is belief that like, "I have cracked the code on being thin and you have not." 

Michael: Yeah.

Aubrey: So, it is my duty to instruct you on how to have a body that is less like yours and more like mine.

Michael: Yeah. But let's talk about your writing, because this is how I found you, this is a lot of other people found you. You started writing anonymously on the Internet, what, five years ago, four years ago? 

Aubrey: Yeah. I had gotten into an argument with a friend of mine, who I love dearly. She and I had gotten into this back and forth about a Cheryl Strayed quote of all things. 

Michael: Shut up. That's where it started? 

Aubrey: That's where it started. Where I had posted the Cheryl Strayed quote that was something like, "is there anything more boring than listening to a woman bemoan the size of her own body or something like that." I had this whole back and forth with my friend, who was like, "Well, but you don't understand how hard it is to state this." 

Michael: Oh.

Aubrey: We went down this road, where she was like, "You don't understand what it's like to be me." I was like, "Cool, but also, you don't understand what it's like to be me."

Michael: Right.

Aubrey: We have this back and forth, and I wrote her a letter, and send it to a friend of mine to take a look at, and I was like, "Hey, can you just tell me if I'm being a total industrial strength jerk in this letter or if I'm like, this is okay to send to someone." He was like, "It's okay to send to someone. And also, maybe you should post it somewhere online," because he was like, "I'd like to share it and I know a handful of people, who probably would like to share it." I was like, "Sure." So, I posted it online and then within about a week, I think 40,000 or 50,000 people have read it.

Michael: So, all this means that you were into systemic bias before it was cool, Aubrey. I think this is [laughs] what you're saying. You had the early EP.

Aubrey: [laughs] Anyway, so, I started writing for that audience, for people who were good, thoughtful, kind people, who had never really thought critically about the ways in which they think about, and interact with, and treat fat people.

Michael: Right. We are the same age, we have both read a billion Newsweek cover stories that are like, "The obesity epidemic, obesity among our kids," like the same framing around obesity our entire lives like, how many times have we just seen a random sentence in a random article that just like, "Da, da daa, fat people or unhealthy, da, da, dah." It's one of those presumptions that doesn't even need unpacking anymore. 

Aubrey: Yeah.

Michael: There's a lot of people who believe this because this is something we've all been told a million times and it's actually more complicated than that. Believe it or not, it's not as simple as every fat person is unhealthy, and every skinny person is healthy, and every fat person needs you to tell them that they're unhealthy constantly. And that will help them and "Oh, it's just like smoking. If we shame them, everybody will not be fat anymore." These are things that a lot of us believe without really interrogating them. 

Aubrey: Well, that's also part of what's, again, helped me pretty immensely in feeling okay in my body is doing this research and finding that actually those messages, those specific actual messages are part of what's making us fat and so, is trying to lose weight.

Michael: Should we talk about the science a little bit, I think?

Aubrey: Oh, except hang on, because I introduce myself, and then we started talking. I feel you should do a little intro of who you are and what brings you to this conversation, too.

Michael: I wanted to skip that part. 

Aubrey: [laughs] 

Michael: I was trying to keep the focus on Aubrey and the science.

Aubrey: I'm sure you were a reporter. 


Michael: This was like, I don't know, eight years ago or something. I was on a date with a guy, who was I think an anesthesiologist and I was like, "Oh, yeah, how has your job changed since you started doing it" or something relatively benign? He started complaining about all of the fat people that he has to see, and how it's hard to do anesthesia on them, and basically, complaining about the fundamental tenets of his job, which are finding out what an appropriate dose of anesthesia is for a patient. I was getting more and more angry at him and visibly annoyed on this fucking brunch date. He was very quizzical about why I was defending the basic humanity of fat people. Then, at one point, he stopped and he's like, "Wait, did you have a fat mom or something?" He's accusing me like the only reason why I would give a shit about this issue is because someone close to me is fat, right? The worst thing about it is that, he's fucking correct. 

Aubrey: No. [laughs] 

Michael: My mom was fat growing up and it was a huge part of my life growing up was that I saw how hard my mom was trying.

Aubrey: Yeah.

Michael: She was on a diet all the fucking time, which means the whole family was on a diet and we saw her make different food for herself. She would make the whole family a nice meal, and then, she would sit there, and eat raw carrots out of a bowl, because she was on the fucking Ornish diet, and it was a huge thing in the late 80s and early 90s. I saw how hard she was trying and I saw how shitty the world was to her. My friends made comments, we would be in public and people would make comments, waiters and waitresses at restaurants would make comments. If she asked basic questions about the food like, "Oh, is the salad included with that?" She'd get these eye rolls like, "Oh, the fat lady wants to know about the salad." It was so palpable to me. It's just what bullshit it was, because she was constantly being told that she should lose weight. Behind the scenes, I knew as young as five, six, seven that she's fucking trying her best, man, and it's not working. Everyone is shouting at her to do this thing that she is already doing and nothing is ever enough.

Aubrey: Right. And also, as a kid, I don't know, man. If you have a decent mom, like a mom who's that abusive or whatever, I don't know if there's anybody that you feel closer to in the world and more defensive of in the world. 

Michael: Yeah. Fuck that anesthesiologist.

Aubrey: Truly.

Michael: I also think it's worth busting one of the myths. I think one of the accusations of, I guess, the fat politics or fat activism community online is that, they're implying that there's no unhealthy fat people or that every single fat person is just as healthy as every single skinny person. That is not the argument. There are unhealthy fat people, there are unhealthy skinny people, there are healthy fat people. I think it's a fundamental argument of the fat activism community and the fundamental argument of this show is that, this is all individual. Weight and health are two distinct concepts and sometimes they overlap and sometimes they don't. 

Aubrey: Mm-hmm.

Michael: One of the most striking statistics I came across when I was researching a big long article that I wrote about this two years ago now, I think is that, one-third of "obese people" have completely normal health markers. They are not unhealthy. They do not have any of the risk factors. Around 25% of skinny people do have the risk factors. So, the whole point of this is that, individual variation in this matters and weight and health are not the same thing.

Aubrey: This is all one big scatterplot. 

Michael: Yes.

Aubrey: The idea of a healthy fat person existing is inconceivable.

Michael: Right. You can go on Google Scholar. You can find a million studies that find a correlation. If you look at a population of a million people, you'll find that weight is correlated with poor health. For decades, what we've been told is that, one thing is necessarily causing the other and that all we need to know about is that like, "Fat people are unhealthy. So, people shouldn't be fat." Boom. We solved it. 

Aubrey: Yeah. 

Michael: But of course, it's not clear from those studies, if the same thing is causing people to be both unhealthy and fat. But there's actually more studies coming out now that are showing that, fat people who exercise regularly are healthier than skinny people, who don't exercise regularly. Diet and exercise do matter. No one is pretending that those things have nothing to do with health. But oftentimes, there are lots of people, who exercise a shitload and eat really well and they're fat. 

Aubrey: Yep. 

Michael: And there're a lot of people, who never exercise. We all know these people and they're skinny. So, we're not trying to transfer the stigma. Let's be shitty to people, who don't exercise regardless of their weight. It's more about like taking the actual the balminess out of the whole thing altogether.

Aubrey: And I would say, our research around fatness is very fundamentally shaped by our existing biases and beliefs about fatness and fat people. There was a big deal study in maybe 10 years ago from the CDC was the first time they had studied anything, funded any studies related to lesbians. 

Michael: What?

Aubrey: Oh, yeah.

Michael: [laughs] 

Aubrey: There are research question. The question that they decided to fund, the very first one was, "Why are lesbians so fat?"

Michael: No way. 

Aubrey: 100%.

Michael: Ah.

Aubrey: The fundamental research questions that we ask are not. "Hey, in what ways are fat people healthy and what these are fat people--?" You know what I mean?

Michael: Right.

Aubrey: What's the role of bias in all of this? What's the role of dieting in all of this? 

Michael: Yeah, the problem with these correlational studies is that fat people have a lot more in common than just their weight. Another thing that links the experience of fat people is worse medical care. Because fat people often delay going to the doctor, because they know that doctors can be extremely stigmatizing about their weight. I interviewed I think it ended up being 66 people for this article for HuffPost that I wrote two years ago. Every single fat person, who I interviewed has had terrible experiences with the doctor. Like, you go in for a migraine-- I talked to one woman, who was in a fucking train accident, and went in with a dislocated shoulder and the doctor said, "How long have you been this way?"

Aubrey: Yeah.

Michael: There are all kinds of studies about the fact that fat people do actually delay medical care. The idea that that would have some effect on their health over time is not totally nuts. I have spoken to fat people, who have had tumors like growths that show up on their x-rays and their doctors will tell them, "Oh, lose weight before we do anything about it" and it turns out to be cancer.

Aubrey: 100% and I would say, I had a doctor at one point, who I went in to get examined and he would not touch me.

Michael: Oh, my God.

Aubrey: He was too uncomfortable to make eye contact. 

Michael: Jesus Christ.

Aubrey: And he told me to come back when I lost weight. 

Michael: Oh.

Aubrey: It is often an indicator of the care that will follow.

Michael: Oh, yeah.

Aubrey: It is often an indicator that this doctor, or nurse, or whatever stripe of healthcare provider is not actually equipped to care for you, because their biases are so front and center, because this is the only thing that they can talk about and because doctors are frankly trained to assess patients on like, "What's the most likely cause of X and such thing?" 

Michael: Right.

Aubrey: For most folks, it is visually presents that you are fat. Therefore, whatever you were having must be a cause of that. I will say I also went in at one point. I am 36-year-old baby in that, my stress reaction is that, I have an ear infection. [laughs] 

Michael: Oh.

Aubrey: It's fully like an infant. [laughs] 

Michael: Okay.

Aubrey: Fully [crosstalk] I just need bubblegum amoxicillin or whatever [laughs] to get through these ear infections. I went in at one point and I had a double ear infection, so, one in each ear. The doctor was walking me through like, "You need to use these eardrops, you need to take these antibiotics." I was like, "Great. Is there anything else I need to know about aftercare?" He was like, "Well, you need to lose a lot of weight."

Michael: Oh, my God. 

Aubrey: I was like, "Cool. I'm talking to you about my ear for now, which definitely did not get fat."

Michael: Yeah.

Aubrey: He was so ingrained with this idea that every fat person needed to hear from him that they needed to lose weight in every interaction. 

Michael: This to me is the much more salient point. We could sit here, and do studies back and forth about the complexity of the relationship between weight and health, and various small studies and big studies, like, we could talk about the science for a thousand years, and we will eventually do an episode on the science around weight and health but it doesn't fucking matter. 

Aubrey: Yeah. 

Michael: Even if every single thing that your doctor and my anesthesiologist guy, even if every single thing that they think is true, every single fat person is unhealthy. Great. You are correct, sir. Congratulations. Now what? 

Aubrey: Yeah.

Michael: We know from a billion studies for a billion years that between 95% and 98% of attempts to lose weight, fail. We also know that out of many of those attempts, people end up gaining weight. 

Aubrey: Yeah. 

Michael: What do we do with that information? Because we know that telling people to lose weight does not help. We know that putting them on unsustainable diets makes it worse. Whenever I tell people that I wrote this article or that this is a really important issue to me, everybody wants to debate the fucking science and they're like, "Oh, what about calories?" You get into these technical scientific debates immediately and they don't fucking matter. Be nice to people. What fat people need is for their basic humanity to be acknowledged. They need a medical system that actually asks them what they need, like, "What's going on with your ear, Aubrey?" 

Aubrey: Yeah.

Michael: That's what people need. They don't actually need to be told for the 10,000,000,000th time lose weight, because that doesn't fucking work.

Aubrey: Well, it does do one thing, which is it makes us fatter. 

Michael: Oh, right. It just makes it worse. Good point. 

Aubrey: Totally. 

Michael: [laughs] 

Aubrey: The experience of anti-fat bias amongst fat people is extremely universal. 94% I think of fat people in the US report experiencing some form of anti-fat bias, recently.

Michael: Yeah, it's bad.

Aubrey: And most frequently, that comes from family, friends, partners. Folks will report about partners actually restricting their food intake or monitoring their food intake. But it also comes from people like their doctors, and their bosses, and strangers on the street, and coworkers. It just comes from all sides. What we know from research is that, that trigger is what researchers call obesogenic processes, my least favorite term.

Michael: Not great.

Aubrey: Which is a series of processes that actually make us fatter. In some cases, it's the result of cortisol and other stress hormones that hang on to whatever energy you have got for your fight or flight response that we don't really think about the ways in which we are triggering these biological responses in fat people by the way that we treat them. To your point earlier about your article, one of the things that absolutely blew my mind about that article, I've read it, I'm going to say 10 times. [crosstalk] just go back to it all of the time and recommend it to people constantly. It's so good, buddy. It's so good. 

Michael: I tried to interview for it and you ghosted me on the internet. I am still mad about it you know what?

Aubrey: That was the year that I ghosted everyone.

Michael: [laughs] Fair enough.

Aubrey: Within the first year of writing as your fat friend, I was just like, "I don't know what to do with this level of attention. So, I'm going to fully hide and not respond to a single email." I don't know why I set up an email address. [laughs] 

Michael: Oh.

Aubrey: Anyway, one of the things that I pulled from that article and that I think about constantly is that, actually, the fatter you get, the less likely it is that you will become thin in your lifetime, which stands to reason. But particularly, for people my size and particularly for women my size, so people with what they call an extremely obese BMI--

Michael: Oh, these designations.

Aubrey: Yeah, or super morbidly obese is the other one I get. 

Michael: Oh. 

Aubrey: Cool, cool, cool. 

Michael: Yeah. 

Aubrey: Makes me feel like a supervillain is that for women my size, there is less than a one-tenth of 1% chance that we at any point in our lives get to what is considered a "healthy or normal BMI." We are talking about infinitesimal likelihood that this will succeed. All of our treatment of fat people is predicated on the idea that this is not only possible, but if you can't do it, it's because there's something wrong with you. 

Michael: And it's necessary. It's like, "No, you have to do this thing that is almost sure to fail and is likely to make whatever you have worse."

Aubrey: Totally.

Michael: And it's also, it's double dumb, because we know, again, there're dozens of studies on this that regardless of the weight that you are at, if you eat well and exercise regularly, that's going to do a shitload for your health. You might lose weight and you might not. It's much more important to focus on people's lifestyles and something that they actually can control rather than weight, which people can't really control to the extent that we think they can. A huge number of people are fat because of various medications that they took, or they can't walk around the block, because they're disabled, or they have a hip replacement, or there're a million reasons why people are at the weight that they are at, and there's not a lot that they can do about it. 

Aubrey: Yeah.

Michael: I also think that whole thing of lifestyle choices and stuff, that's basically a conversation between somebody and their doctor. I am not in the business of surveilling my friends to see how many minutes of exercise they're getting every day and how many fruits and vegetables they're eating. I'm saying that from an epidemiological perspective. We know that lifestyle changes affect health. On a personal level, it's really not up to you to monitor the lifestyle choices of your friend's fat or skinny.

Aubrey: Totally. And also the health concerns around fat people are also very restrictive. There's not general concern about the health of fat people. There is very specific concern about the weight of fat people and the weight related things that might happen to them. 

Michael: Oh, that's a good point. Yeah, because nobody's ever like, "Oh, fat people have higher rates of depression or higher rates of suicide," which are true. 

Aubrey: Yeah. 

Michael: Nobody's like, "Oh, we need to do something about this." It's just like, "Oh, we need to make them not bad anymore." That's the only extent to which we actually care about the health of fat people. 

Aubrey: Yes. I had an experience earlier this year in fact, I recently had to switch doctors, because I switched insurance. I went to a new doctor, who I found through the Whisper Network of fat people. She ran my bloodwork and she was like, "Hey, so, it looks like you are on a statin. Can you tell me why that is?" I was like, "I don't know. My last doctor said it was good to protect my heart, and my kidneys, and whatever." She was like, "Cool, cool, cool. So, your cholesterol is supposed to be between 100 and 200 as a range of healthy cholesterol." She was like, "That's a cholesterol medication and your cholesterol is 19."

Michael: Oh.

Aubrey: She was like, "It's the lowest number I have ever seen."

Michael: Whoa.

Aubrey: Looking at past bloodwork, she was like, "I'm guessing you already had cholesterol that was on the low side just based on how you eat."

Michael: Oh, wow. So, the last doctor just gave you a statin just because you were there. Just spray the fat lady with statins.

Aubrey: Right. I talked to a friend, who's a physician assistant, who said, "Actually, there is a school of thought in medicine that is you just put fat people on blood pressure medication, cholesterol medication, and blood sugar medication. Just do it straight out whether or not they're diabetic, they're going on metformin, whether they have high blood pressure, they're going on a blood pressure medication." That was part of what this doctor had done and it put me at a significant health risk. The risks of very low cholesterol are the same basically as the risks of very high cholesterol. So, I was at, super increased risk of stroke, of heart attack, of major, major problems and that was a direct result of being treated the way that a fat person is treated.

Michael: And not even telling you, too, that's fucked too, to be like, "Oh, I'm going to put Aubrey on this, but not just tell Aubrey. Hey, because you're fat, I'm going to put you on this medication." It's just like sneak in the statin. 

Aubrey: Right. 

Michael: What do you want, I guess, non-fat people to know about the history of all of this? 

Aubrey: Yeah. I think the thing that I think about most often is, we are in a moment of full moral panic about fat people. It bears repeating and is often left out of this conversation that like, "Despite the fact that we are all freaking out about fat people at this moment in our history, there have always been fat people." There may be more fat people now than there used to be, but people's bodies look different. There have also always been tall people and short people. There have also always been disabled people. We have to get out of this mode of envisioning a world, which I think many public health institutions do and many individuals do, which is the best and healthiest world doesn't have fat people in it.

Michael: I remember coming across, I haven't been able to find it again actually. But I remember very vividly years ago looking into this and coming across a European, a PDF from some European institution that was basically proposing that all public health messages should be geared toward health rather than weight. Knowing what we know about how ineffective diets are, we're never going to have a world where there's deliberately fewer fat people. So, what we can do is focus on health. Because honestly, diet-related disease is a real problem. Like heart disease is a problem, strokes are problem and I think I stole this from Cat Posey. I stole this from somebody. But it's like, "We've given up health to focus on weight." 

Aubrey: Yeah.

Michael: That's the point of public health is to make us healthier. It should not be the point of public health to make us skinnier. I personally think that weight and weight-related messages should have no role in public health whatsoever.

Aubrey: I pretty strongly agree. I also think, if we really want to tackle the sets of issues that you're talking about here, diet-related disease, getting people moving regularly, getting people eating more vegetables, all of that stuff, then we need to create the conditions in which that is possible, right? 

Michael: Oh, yeah. 

Aubrey: We need to address the conditions that have parents and particularly, single parents working multiple jobs to make ends meet, which means there is no time to prepare food and there's often no money to buy fancy or fresher foods, right? 

Michael: Right. 

Aubrey: If we really want to get at a collective and healthier society, we actually paradoxically need to stop treating health as a mandate and as a moral obligation, and we need to stop believing that we can and should assess another person's health by looking at them.

Michael: If you really want to help somebody's health, build them a bike lane. 

Aubrey: [laughs] 

Michael: You know what? Get out there with cones.

Aubrey: Totally. If you really want to help somebody's health, make sure they have a living wage. 

Michael: Yeah.

Aubrey: Make sure they have a place to live. Make sure they have enough money for food. 

Michael: The corollary to my belief that public health should give up on weight and focus exclusively on actual public health is basically the idea that individual messages, and cajoling messages, and fucking billboard campaigns don't work. We've had 30, 40 years now of telling people that fruits and vegetables are healthy, that everybody should get 30 minutes of exercise every day. I don't know if there's an American alive, who doesn't know that. 

Aubrey: Yeah.

Michael: In the same way, telling people cigarettes were bad for them, did not work. To me, the primary goal needs to be changing the environment and only 10% of kids today walk or bike to school. It used to be 50%. Very few people live close enough to their work that they can walk. That's another thing. We need denser housing, there's all kinds of other policies that we need to make it possible for people to live healthy lifestyles. Right now, it's not really possible to buy a bunch of fruits and vegetables and to sauté broccoli for dinner unless you can afford it. To me, I really have no interest in telling any particular individual, you need to do X. It's really much more about like, "Well, let's just have a shitload of bike lanes to school and really wide sidewalks," so that kids who want to walk to school can. Some kids aren't going to want to, and some kids won't be able to, and that's fine. 

The first thing has to be focusing on like, "What can we do to help people?" I really don't think that there's any point in telling people for the 1,000,000,000th time, like, apples are better for you than Snickers bars.

Aubrey: Totally. And also, again, if we're looking at creating a world in which it's possible for folks to make individual choices, we really like to focus in on personal responsibility. It's this weird moment when everyone becomes a hardline Republican. 

Michael: I know.

Aubrey: We talk about that as everyone's like, "Personal responsibility, bootstraps willpower blah, blah."

Michael: Should we talk about vocabulary briefly?

Aubrey: Yeah. What do you want to say about vocabulary?

Michael: I mean, just one ever I talk about this. I do actually feel a little bit weird about this as a thin dude talking about fat people. I use the word fat, because I have been asked to and that is my understanding from people, who are in these spaces who prefer to use the word fat rather than euphemisms like curvy, or big boned, or overweight, or obese, which are really medicalizing. But it's also an interesting term, because in the process of being reclaimed, there are a huge number of people who do not feel comfortable self-identifying as fat.

Aubrey: Yeah, and some folks who are not fat who have ever been that, who are very uncomfortable even hearing those.

Michael: Totally, yes.

Aubrey: Yeah.

Michael: Yeah, can you just talk about that a little bit? 

Aubrey: Listen, the harm that comes to me as a fat person, it doesn't come because someone calls me fat. It comes much more often, because someone refuses to call me fat and then, treats me terribly anyway. 

Michael: Oh, okay. 

Aubrey: There's something that happens when I'm with a person, who is willing to say the word fat. I know that they are not so afraid of my body that they will just act out of their own weird biases. If someone is willing and able to say the word fat in good faith, that tells me that they are as much concerned with how I identify myself as they are with projecting their own beliefs about fatness and fat people on to me by calling me fluffy, or mortal love, or whatever, right? 

Michael: Right.

Aubrey: The challenges that fat people face don't come from a word, they come from the ways that we treat fat people. If we can't talk about that in a direct and honest way, we are always going to fall short in addressing what fat people need and if we can't take direction from fat people in a conversation that is fundamentally about us. Part of what we're talking about here is that, we have been talking for the last 30 or 40 years about flipping out about fat people existing and overwhelmingly that conversation has happened without fat people's participation.

Michael: How have you identified over the years? 

Aubrey: Oh, around my body? 

Michael: Yeah.

Aubrey: I just didn't for a long time. 

Michael: Oh, yeah.

Aubrey: I totally remember having this experience at work. I spent years as a community organizer and political organizer. I had this experience with a good, good friend of mine, who was a coworker at the time. We were loading out boxes of materials from the State Capitol and we had these huge boxes that we were carrying just in our arms. We didn't have a hand truck or anything. We had to go up two flights of stairs to get the materials to where they needed to be. I just looked at him and I was like, "Fuck it. I'm taking the elevator," and I went over and with my one free finger pressed the up button on the elevator, and he looked at me and grinned, "Is that why you're large?"

Michael: Oh, wow. 

Aubrey: [laughs] He was a good friend and he said it with a twinkle in his eye. Honestly, my first response was absolute terror that he had noticed. I was so terrified that he had said anything about my size that I felt my whole job in the world was to get people to forget that I was fat, which is an impossible task.

Michael: Yeah, I am 5'6". People are going to notice.

Aubrey: Right, totally. 

Michael: Mm-hmm.

Aubrey: There's just core physical characteristics that are going to follow us around, and I remember being first mortified that he had noticed, and then absolutely delighted that he had actually just said something.

Michael: That's interesting. 

Aubrey: But that was the first time that I really started talking about being fat. 

Michael: Did it feel really good? 

Aubrey: It felt immensely free. 

Michael: Yeah. 

Aubrey: I had spent 20 some years hiding from my own body. That is an impossible task. [laughs] Wherever you go, there you are. 

Michael: Do you have a coming out process now? When you meet new people, do you have a way of telling them like, "This is a safe thing to talk about with me?"

Aubrey: Oh, I just lead with it. 

Michael: Oh, yeah. 

Aubrey: I'm just like, "Look, I'm fat and I'm queer." 

Michael: Yeah.

Aubrey: I try not to shoehorn it into conversations, but I do try and make sure that it is present in my first couple of conversations with someone to just let them know that I know that I'm fat and that I don't have weird baggage around talking about it. You know what I mean? It doesn't feel emotionally heavy to me to talk about being fat and actually, it feels incredibly liberating.

Michael: It is very interesting, because I feel we have in our brains this coming out narrative for gay people. But the cutting out process for a fat person is, there isn't really a script for fat people to do it and there isn't really a script for non-fat people to react to it.

Aubrey: Totally. We're totally not used to it. What usually happens in that moment, if you have a concerted conversation that is like, "Look, I'm fat. I'm not trying to lose weight, because that has never worked for me and I'm just going to be a fat person." What usually happens in that conversation, it feels very reminiscent of my light coming out conversations in the 90s around being clear, which is thin people will then unleash their many anxieties about becoming fat onto you.

Michael: Oh, my God, when I used to tell my teenage guy friends that I was gay and maybe sometimes I watch gay porn, man. I'm like, "I don’t need this, we don’t need to go there for this." 

Aubrey: [laughs] 

Michael: One time in boarding school, a dude gave me a hand job. I'm like, "I don't need to know." We are both interns. We don't need to share this. [laughs] 

Aubrey: I will say one crossover question that I get both for being fat and for being queer is, how do you have sex? 

Michael: Oh, my gosh.

Aubrey: There were people who just want to know, how does it work?

Michael: [laughs] 

Aubrey: It's truly just like people's id just jumps out and they're like, "Here's a thing that I can't control that I have to say to you right now." There's not really that script for coming out. There's not really a script for reacting to it. 

Michael: Because I feel people are used to this sort of fat person, who makes like self-deprecating jokes about being fat. That's a script that most of us are familiar with. But I think the thing that people find really threatening is, I am fat and I am not trying to lose weight. 

Aubrey: Yeah.

Michael: That as a concept is weirdly, like, really fucking triggering for non-fat people. It's fascinating.

Aubrey: People have such strong reactions to a fat person, who is not actively performing shame either in the form of self-deprecating jokes, or pratfalls, or any of that stuff. Or, in terms of, I promise, you ate a salad to reporting out to them. 

Michael: Yes. 

Aubrey: Thin people often expect that fat people will report out what we are eating, how we are exercising, how it's going, how much weight we've lost. Those are the first things that they need to hear from us in order to engage further at all. It's real. While I'm curious about you mentioned response to your article, here I am talking about coming out "as a fat person," I'm super curious about like, "What were the kinds of responses that you got?"

Michael: Oh, my God. Many of the responses were people sharing their personal stories, which were like, I was weeping, reading emails, I was writing people back, the emotional response from actual fat people was extremely gratifying. It seems it touched people, which makes me really happy. But then, the response from non-fat people, I don't know if you get these. But I got probably 50 or 100 emails from older 40 to 70-year-old dudes, all of which were like, "No, no, no, no, no, I haven't figured out." What the fat people don't know is there's actually this system and then they would walk through this baroque fucking clockwork diet thing that they had figured out and it was like, "Eat no more than 600 calories before 7 AM and then, switch to only carbs, and then protein at night. Some of them were eight pages long and all the diet plans were fucking nuts, dude. It was like eat nothing but venison on Wednesdays and then collard greens on Thursdays from 7 to 8."

Aubrey: Yeah. The other thing that I get and I don't know if you get this. I'm exploring this lately is the, "you've got blood on your hands." 

Michael: Oh, see, I didn't get that as much. 

Aubrey: I get a lot of like you're killing people.

Michael: Glorifying obesity. I got out of the glorifying obesity one. That was great which is fascinating, because nobody ever talks about glorifying thinness, which is what we do all the time. And we know how damaging it is to glorify thinness to the extent that we do. But no, that's like that's fine. Because thinness is healthy. All the eating disorders that fucking teenage girls are getting totally fine, because then, this is good. But glorifying obesity, that's really dangerous.

Aubrey: Yeah. And also, "glorifying obesity," that has a response to one of two things. It's either work like mine, that's like, "Hey, maybe, treat fat people more like people" or a fat person posts a picture of themselves at the beach on their personal Instagram account and it'd be more like, "You are a glorifying obesity" and I'm like, "I don't know, man."

Michael: It's literally Lizzo like riding a bicycle. Everybody relaxes. It just like Lizzo having an enjoyable day and then all the comments are just fucking poisonous.

Aubrey: Yes. Any picture of a fat person engaging in any physical activity, showing any kind of skin, or with any kind of food in frame with them are all glorifying obesity. [laughs] 

Michael: That's the thing of not trying to lose weight, though of just the image of a happy fat person. It's amazing to me how threatening people find it. I'm fat, I'm in a bikini, I'm on a beach, I got a hot dog. That is enough to send people into this spiral of rage. It's incredible.

Aubrey: Yeah, this is the white whale of my writing and research is to figure out what that is about.

Michael: What is your answer to that? Do you have a theory?

Aubrey: I've had a few theories over time. Early on, one of my thoughts was, "Oh, my God, you feel you have had to work so hard and be so vigilant to stay thin and you've been so terrified of being fat that you've done all of this work to avoid being fat." And now, you're seeing a person who actually is fat, and is doing fine, and it makes you mad. Another one of the theories was, this one feels closer to the mark to me, but not quite it that the way that people talk to me as a fat person, people like shout things from passing call. That's the level that we're operating at. I've heard from other fat people particularly, people who are fatter than I am, who will talk about people throwing trash at them. [crosstalk] 

I think in some cases, people are talking to me as their nightmare future self that they object so strenuously to my body that they get so strident and mean frankly, about like, "How to diet, and you have to do this, and da. da, da, da." There's such energy behind it that I'm like, "Oh, you are talking to yourself."

Michael: I actually think so much of the blame for that shit. Obviously, it goes to the people doing that. But also, to public health messaging. The basic presumption of every billboard eat five fruits and vegetables a day poster, we've ever seen in our lives is it is bad to be fat, and fat people are unhealthy. There really aren't any positive messages about like, "Leave fat people alone, or fat people are fine, or somebody else's health is none of your business." All of us have grown up in this just toxic sludge of like, "Being fat is the worst possible outcome for you."

Aubrey: We have been so careless with the way that we talk about fatness and fat people that we are now at the point that instead of, when we talk about health risks, we're actually talking about people. When we talk about people, we're talking about them as if they are health risks [crosstalk] health risks. And of course, that's going to have a huge impact on the lion's share of Americans who have BMIs that put them in the overweight or obese category. That's most of us at this point.

Michael: I have interviewed public health professionals about this and put this argument to them. The answer that I have gotten back and I think this has really become the standard answer from public health is this idea that like, "Okay, weight stigma is bad, but it's okay to stigmatize the condition. Obesity is bad, but without stigmatizing individual fat people." I think that that is impossible. I don't think that in a billboard campaign, that is presenting a very simple message. Eat vegetables or else you will become fat. There is no way to do that in a way that is not going to make people think that must mean that every single fat person refuses to eat vegetables. 

Aubrey: Yes.

Michael: There's no way to not send that same message at the same time.

Aubrey: There are so many parts of our conversation around fatness and fat people that feel echoes of our conversations around gayness and gay people and transness and trans people, which is we are spinning our wheels for so long on to very basic, very terrible strategies. One is love the sinner, hate the sin, right? 

Michael: Yes.

Aubrey: This belief that you can reject a core part of who someone is and how they move through the world, but still somehow embrace them. We have seen time and time again that this does not work and that it is deeply alienating and stigmatizing. The other one that we spend a ton of time on is this idea that it's a choice. Thin people will continue to behave terribly toward fat people until they feel personally convinced that it is not a choice and no amount of data will do that convincing. The only times that I have really seen thin people turn around on this is, like, the experiences that you're talking about of seeing someone very close to you diet for super long time, seeing how hard they try over the course of years, and how terribly they are treated. That is actually like the only thing that I'm aware of that meaningfully turns thin people around on this stuff.

Michael: That's dark. 

Aubrey: It's super dark and I know from being a queer person, who has done organizing around queer and trans rights for a decade plus that like, "We will spend years stuck on that conversation and it has absolutely nothing to do with whether or not it's a choice." It is a code word for, "I'm not comfortable with you yet."

Michael: Somehow people are convincing themselves that yelling at a fat person from their car is less of a moral transgression than being fat. You can maintain your self-conception as a good person even while you are literally as an adult bullying other people, you're like, "Oh, no." But her being fat, that's bad. Me, shouting at a random stranger from my car, that's chill.

Aubrey: Not only that's chill, but the number of people who say garbage things to me and then look so proud of themselves.

Michael: Oh, I know. Yeah. It's like, "I must. Oh, I would be remiss if I didn't tell this person to lose weight."

Aubrey: Right.

Michael: Ridiculous. 

Aubrey: I did my good deed for the day. I yelled at a fat person and that helped them. That is the belief here is that my abuse is to make you the best you versus what I'm doing is abuse. By any stretch of the imagination, shouting at people from a passing car, that is an abusive thing to do.

Michael: The only time that it is appropriate to do that is when somebody has a cute dog and you say, "Hello, little friend."

Aubrey: [laughs] I would love it. 

Michael: Then, it's okay.

Aubrey: I tweeted about this recently that I was wearing workout clothes when I went to walk my dog and someone stopped me to be like, "Good for you. You'll get there."

Michael: I know. I saw you tweeting about that and my entire face just collapsed in on itself with a cringe. I was just like, "Whoa, galactic cringe."

Aubrey: [laughs] Totally. And that was a person who was absolutely like, "She puffed out her chest and was smiling really big. We did it, we're doing it." You're working out. I'm complimenting you for working out.

Michael: Oh, my God.

Aubrey: This is not a workout ma'am. 

Michael: Don't.

Aubrey: I'm walking around two blocks. 

Michael: She should have said, "Hello, little friend." That's the key. 

Aubrey: Totally. Just say your dog is adorable, which he is. That would be correct. 

Michael: What did you say to that person, actually?

Aubrey: I just waved and kept moving. I didn't say anything, because I was just like, "I'm not going to see this person ever, again." There's a calculus, it's a little bit of organizer brain. It's like, how deep is my investment in this person in our relationship and how much energy do I want to put into it consequently? I also had a person a few years ago stop me on the street and without even saying hello just said, "Hey, have you heard about this weight loss surgery clinic? [crosstalk] they're really good."

Michael: Oh, my God.

Aubrey: That was another person who absolutely felt they were doing their good deed for the day. If that had come from a family member, or a close friend, or a coworker, or someone who I was going to see more often, and/or if I felt I was in a place of really being ready to tackle it, then, I would.

Michael: Yeah.

Aubrey: In both of those cases, I was like, "I am literally passing you by on the streets. I am not spending time on this or on you."

Michael: That's an emotional labor thing to of do you really want to stop and spend 45 minutes? Like "Actually, the peer reviewed literature doesn't indicate that weight and health are perfectly correlated." It's not your job, and it's exhausting, and you have other things to do today.

Aubrey: Totally. I will say there are times when I have done that with people on the street. A couple years ago, it was 106 or something in Portland, Oregon, which is where I live. I walked to work and was wearing a sleeveless dress, and I was walking past a coffee shop outside my office, and I would just walk past this guy and he just went, "Nobody wants to see that."

Michael: Ah.

Aubrey: And I was just like, "What?" First of all, like, "What are you doing? This is absurd." I turned around and I just said, "It's 106 degrees today. What do you think I should be wearing?" 

Michael: Yeah, fuck that guy. 

Aubrey: He got really sheepish and he just went, "Not that." I was like, "Okay."

Michael: Did you think about giving that guy a noogie, just getting on your arm and just rubbing his head his knuckles. I think that would be--

Aubrey: Just full wedgie. 

Michael: Was there a toilet nearby? Could there be a twister situation [crosstalk].

Aubrey: Surely. 

Michael: and Aubrey: Yeah.

Aubrey: [laughs] 

Michael: I think you have this in your arsenal.

Aubrey: We're talking a lot about weight stigma here and I also think there's something else that we're going to talk about here, which is the role that capitalism plays in our understandings of health and wellness, that a lot of the things that we think of as tried and true public health knowledge as just people out in the world is actually a direct result of advertising campaigns.

Michael: Yeah, electrolytes. It is Gatorade marketing that has taught you that you need to drink a sports drink. That's not real. You can have a banana or a glass of water. It's fine. 

Aubrey: Yes, probiotics are important in your digestive tract and we don't know how to change the bacteria composition in your gut. There's all this stuff that we so want to believe, we so want to believe that we can clear a level of control over our own individual health. What we know and what disability justice activists have taught us for a long time is that, health is a privilege, it is an accident, and it is necessarily transitory, right? 

Michael: Yes. I would also say that actual health advice like the things that we know from various peer-reviewed studies and don't have tens of millions of dollars in marketing campaigns behind them are extremely boring. There is a vast array of healthy diets in the world. There are healthy Japanese people, they're healthy Greek people, they're healthy Ugandan people. These are countries with wildly diverse diets. We know that humans can be healthy with very different mixes of food, mixes of macro ingredients. There's not going to be a single thing that is bad for you. There is no such thing as a superfood. 

In general, the most important thing is finding foods that you like and all of the stuff you already know is good for you is good for you, and all the stuff you already know is bad for you is bad for you. It's fine to eat stuff that is bad for you. If you want a brownie, have a fucking brownie. There's not going to be this acai berry. I'm probably mispronouncing that even. That's like some weird smoothie that you drink that is all sudden going to make you healthy or you're going to cut this one thing out of your diet unless you have a specific food allergy, cutting one thing out of your diet or only eating one particular thing is not going to be the road to wellness. That isn't really how our bodies work.

Aubrey: Well. It's also all very Ponce de León. It's all very fountain of youth.

Michael: Oh, yeah. 

Aubrey: What we are addressing is not our actual health needs. What we are addressing is not specific concerns about our own family history of X, Y, or Z condition. We are addressing our own fear of aging, we are addressing our own profound fear of disability and we are addressing our own fear of our own mortality, all of which are part of being human.

Michael: There's also the thing that people do not owe you healthiness. 

Aubrey: Yeah.

Michael: If you're interested in your health and you really want to eat the healthiest diet that you can, that's great. People have different hobbies, but I think the only extent to which we're going to give specific advice on this show is to not assume that your body is going to be relevant for other people's bodies. Maybe you have a vegetarian diet, and you love your vegetarian diet, and you have a ton of energy, and you're super happy with it, great. Other people are not going to feel that way. And just because you are really diligent about getting your five fruits and vegetables a day, it doesn't mean that other people want to be diligent about that or have to be diligent about that, or [crosstalk] can. Especially, the cost, but also for various disability reasons, a lot of people cannot do the things that you can do or don't want to do the things that you want to do. It's fine to tell people about the health behaviors that you have without thinking or implying that they should do those, too. It's completely fine for you to tweak, and mess with, and optimize your health as much as you feel fit. But other people don't want to do that. They have other things going on in their lives, or health means something different to them, or they're focusing on their mental health and they don't give a shit what they eat right now. So, the only 10 simple tricks, life hacks that we're going to give you is just like, mind, your own house and whatever other people are doing is really not any of your business.

Aubrey: Totally. I will say anecdotally, I have a good friend who is on Social Security Disability. She lives in low-income housing, where they do not have kitchens in their apartments. They just have microwaves and they have big roach problems in her building. She can't and doesn't keep fresh food in the house and also, she doesn't have the money for it. She is also diabetic, and she has found TV dinners that she can afford that don't spike her blood sugar. She eats banquet frozen meals. That is the healthiest choice that that woman could possibly make. 

Michael: Right. 

Aubrey: And that is a significant leap forward for her own management of her own diabetes and that is a big part of what all of our republic health campaigns are like, "Definitely don't do this. Under no circumstances, should you do this?" I'm like, "That's actually the best she's done in the 10 years that I have known her."

Michael: She does not need your seven-page long email about how has she tried switching to an all-meat diet from 6 PM to 8 PM every night like this is-

Aubrey: Totally. 

Michael: -not what people actually need. If that's your diet and you're all venison all the time, have a blast my friend. But that is not going to work for everybody.

Aubrey: Yeah. If this friend of mine pays her rent, pays her phone bill, and at the end of that has $40 left for the month for food. Yes, she will be eating banquet dinners and no, she can't make your cool zucchini noodles that you found in the New York times. 

Michael: Yeah. [laughs] 

Aubrey: Yeah. I say that as someone who makes a lot of zucchini noodles and a lot of New York Times recipes. [laughs] 

Michael: Putting a farmer's market in her neighborhood is not what she needs. 

Aubrey: Right.

Michael:  You now? 

Aubrey: She means food stamps that cover more than 18 bucks a month. 

Michael: Exactly. 

Aubrey: And she needs some fucking celebration of her accomplishment of figuring out how to manage an incredibly complex chronic illness on zero dollars. [laughs] She is fully dietary health MacGyver.

Michael:  Yeah, we are kidding. So, eat as much venison or as little venison as you require.

Aubrey: Enjoy however you eat as your hobby. 

Michael: Yeah, and leave Lizzo alone.

Aubrey: And tune it, I feel I'm so excited about the conversations that we have had that we're going to continue to have. On this podcast, I'm so excited to talk to you all about not just the world of weight stigma, but also the world of wellness companies that are making their money off of our insecurities, The ways that they are perpetuating those, I'm super interested it to have these conversations about, like again, the role of capitalism, and class, and race, and ability, and all that stuff on health and wellness, and I'm really excited to have a conversation that is pretty dramatically underserved.

Michael: Sorry, I wasn't paying attention to any of that. I had another window open where I'm ordering a jade egg off of, really sorry. You're just going to have to repeat that please.

Aubrey: [laughs]