“You Should Lose Weight” Isn’t a Diagnosis: An Interview with Amanda Levitt (GUEST CHAT)

“Health” research tells us that 60 to 70% of people in the Western world are overweight or obese. And they never say that like it’s a good thing.

If you, like me, are one of the many people living in a body considered fat, and you’ve ever been to your GP, primary care provider, or doctor for pretty much anything, only to be told to lose weight because apparently that’s a cure-all (spoiler alert: it’s not), this episode is for you.

In this conversation, I talk with Amanda Levitt, a sociology PhD candidate at Wayne State University in Detroit, Michigan, about fat phobia in medicine and healthcare.

We talk about BMI, medical bias, shame, bullying, accessibility, blood pressure cuffs that don’t fit, gowns that don’t close, being dismissed before you’ve even finished explaining what’s wrong, and the way fat bodies are so often treated as a problem before they’re treated as human.

Amanda’s work asks a vital question: what would healthcare look like if fat patients were actually listened to?

This conversation is thoughtful, funny in parts, frustrating in parts, and probably going to feel very familiar for a lot of people.

Plus puppies, kittens, sex, airplane tray tables, and the joy and danger of roller skating.

You can find out more about Amanda’s work here: https://clasprofiles.wayne.edu/profile/cl9811

And please follow her on Instagram. She shares incredible insights into fat phobia, along with some extremely cute puppy and kitten photos.

https://www.instagram.com/whimsicalfemme

Content Note
This podcast gets into bodies, panic attacks, trauma, sexism, mental health, and the occasional emotional sinkhole. Please look after yourself only listen when you feel safe to engage with potentially triggering material. 
Also, I swear.

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Credits
Recorded on the lands of the Ramindjeri and Ngarrindjeri peoples.
Sovereignty never ceded.

Recorded & edited at Ridley Farm Studio by Luke Ridley
https://ridleyfarmstudio.com.au...

Transcript

0:00

Hello, hello. This podcast is a series of conversations and observations about women's lives, bodies, nervous systems, about the sex we have, and about the specific challenges and issues we face as women in real time. Today I'm talking with Amanda Levitt about fat phobia, particularly the kind that exists inside medicine and healthcare. Where people in larger bodies can feel dismissed or reduced or judged before they've even finished explaining what's wrong. We talk about doctors, shame, assumptions, culture, bodies, and what it's like moving through a world that often thinks it already understands you on side. This conversation is thoughtful, it's funny in parts, it's frustrating in parts, and probably going to feel very familiar for a lot of people. Anyway, on with the show. Hello, hello, and welcome back to your new episode of The C-Word with Catherine Redman. Today's guest is Amanda Levitt, a sociology PhD candidate from Wayne State University in Detroit, Michigan. Amanda has described when we we had a pre-chat, and Amanda described herself to me as very direct and sweary, which made me trust her immediately. I think she was going to be an amazing guest for the C-Word. And she also wrote something that I haven't really stopped thinking about since I read it. And she said, fat people don't need to do anything to deserve equality. And I think that sentence gets to the heart of a lot of what we're talking about today. The body, medical fat phobia, public entitlement. And while certain bodies seem to become public conversation in ways others don't. Amanda, welcome to the pod. For having me. You're very welcome. Technology Hey, you're actually my first international guest. So I think that it's amazing that we're even talking together at the same time. One thing I keep thinking about is how body size gets treated as personality or morality instead of just a human body. What did you mean when you wrote that to me about how fat people don't need to do anything to deserve equality? Yeah, I mean, I think that often conversations around fatness create expectations for like how fat people are supposed to exist. And part of that is this discourse around the idea of personal responsibility and that fat people are somehow lacking in that, that they're not eating correctly, they're not exercising correctly, they're just not living right. And often when we have discussions about like discrimination or issues about fat people's humanity, people really say, well, if you lost weight, then things would be better, you'd be treated better, et cetera. And for me, it's really someone shouldn't have to change themselves in order to be seen with their full humanity. And for me, that really means for fat people that we should be able to live our lives however we want to, even if other people don't agree with it and still have equal access to society. Yeah, and I'd love you to say that bit again because I'm I think it might have cut out a little bit. But you said something like someone shouldn't have to change what did you say? Someone shouldn't have to change what they look like to be accepted as fully human. Yeah, they shouldn't have to act in a way that makes other people comfortable with their body in order to have like their full humanity intact. Exactly. That's an amazing phrase that I'm here at 6:30 on an Australian morning thinking about. Talk to me a little bit about what you study. Let's let the listeners know exactly what it is that you study. Yeah, so you know, I'm finishing my PhD in sociology. Um, I'm gonna be defending in the fall. And my dissertation is looking at fat patient experiences of primary care providers. Um, you know, I'm in the United States, so we referred to them as PCPs or primary care providers. Um, they might be referred to as like general practitioners or GPs in other places, but watch and see if there's anything coming up, you know, with the vitals testing and other things to really see what people's health status is and if there's any like early disease detection. Um, and so I really thought that that was a good place to kind of start with trying to find out like what are fat people's experiences when they go to the doctor. And how did you study it? How are you researching it in your PhD? Yeah, so I do qualitative research. So that's distinct from, you know, if we talk about quantitative, we're talking about like large data sets and doing like statistical analysis, qualitative research uses, you know, it is a little bit more in-depth. You know, you can do things like ethnography where you're like in the field observing things and really like doing research that way. You can do content analysis, like uh my master's thesis, I used um trolling messages online. And so I did a content analysis of like the words and language that was being used. But for this study, I did long or like semi-structured interviews. So they were interviews with individuals. Um, I interviewed 35 people overall, and it was about an hour. I think the longest interview that I had was two hours. But the semi-structured part is that, you know, you have an interview guide that you're going in with. And so you have a basic set of questions that you're asking everyone, but the conversation is really changes depending on how the person is answering those questions. And when you and I were talking before this interview, we talked about like what the definition of fat is and also how that informed who you interviewed. Do you want to talk a bit about that as well? Yeah. So there's a lot of different ways that research has really tried to define body size. Um, and often in statistical analysis, they'll use BMI, um, which, you know, we can talk for a really long time about the issues with BMI. I mean the fact that, you know, it's often used to define disease when it's not necessarily there. That's a really important point. So with the body mass index, often if you're over a particular number, your GP in Australia or your PCP in the US, I'm not probably just called your doctor if you're in the UK, will use that as an indicator that you're not well. Is that what you're saying? Yes. So yeah, body mass index. I mean, the history of it is kind of interesting. It started in the late 1800s, Adolph Culette, which I always am unsure if I'm pronouncing his last name properly, he was French. Um, he's defined as like an astronomer slash sociologist slash like quantitative, like the father of quantitative statistics or like quantitative methods. And he created what he called the everyday man scale, which was specifically centered on like French soldiers, and it was him really trying to find a way to create a quantitative methodology for or what we would refer to in like research is to operationalize body size. So, what that means is how can we turn something that we see in the world and and turn it into something that we can use within research? And so he really created this scale that he referred to as the everyday man scale. And then it started being used in the early 1900s in the US and maybe other places as well. Life insurance companies started using it specifically to really start to decide who got access to life insurance and where their premiums landed on that. Because that was really in the early 1900s, life insurance was a really big thing that was outside of because we didn't have health insurance in this in in any way. And instead, people would get life insurance policy. So if they died, that their family would get beat out for it. And I think it's important to note that it was based on a young French soldier. So yeah, but also white white men specifically a very specific body type. Yeah. Yeah, trying to really create a scale based on a very narrow segment of the population. And in the 1950s, we started having like heart studies that they started using BMI, and they did find that there was higher risk in certain areas for having heart problems. But the issue with BMI is that it doesn't, one, obviously, it's based on, you know, a very narrow standard of white men, but also it is being used now to imply disease when disease is not necessarily there. And it also is really bad at, you know, it doesn't take into account comp like body composition. So it's not making a distinction between muscle, subcutaneous fat, which is the fat under the skin, or visceral fat, which is intra-abdominal fat that's around your, you know, things like your heart and your other organs. And so, you know, the way that it's used today, it really is trying to imply disease when disease isn't there. So when you go to the doctor, you take your weight, they take your height, they do a calculation, and it puts you into, you know, a mathematical equation that throws you somewhere on the BMI scale. And while there is research that shows that risk might be there, that doesn't imply that disease is there. I know that you haven't, um, and I'm gonna forget the right words, you haven't defended your PhD yet, which means you're not at the end. But like, I mean, I think we both know there I'm live in a fat body, and I can tell you there are gonna be themes in how we're treated in the doctor's office. But are you able to share a little bit of what's coming out in your research? Yeah, and I did want to go back because I realized I started talking about BMI, which is something that I'm gonna do, and I didn't answer your original question, which did I talk to? So um, I was really interested in talking to larger bodied fat people. Um, a lot of research around weight in health or weight and weight stigma in medical settings, um, tends to really create a monolith of people that if you have a BMI over 30, which is when you start going into, you know, obesity one through three categories, um, they really flatten it down so that you're really only looking at it as a monolith. And the reality is that someone with a BMI of 30 has a wildly different experience than someone that has a BMI of 40, 50, etc. In the doctor's office. Yes. Yeah. But also just in life in general, because you're, you know, someone with a BMI of 30 is probably still able to buy clothing in what, you know, we would call straight-sized stores versus plus size. You know, you're not going to be dealing with physical barriers. You're probably also in many cases, people aren't going to like think that you are fat in many ways. I mean, obviously you might still be dealing with interpersonal discrimination or other barriers, but it's just a very different experience. Um, and so the people I was talking to, um, I gave a couple of different ways to self-select. And one was that they wore a size 18 or above in women's clothing sizes. I gave measurements that were an average of that. And then I did use BMI at the request of people on my dissertation committee. Um, and so that BMI of 40 or above. Um, I did have a couple people that were, you know, there they told me their BMI was a little bit below that, but I had people that were wearing anywhere from a size 18 up to a size 32 plus, which in the US, we have larger clothing sizes than that, but that's where even plus sizes tend to start maxing out at and you start needing to get custom clothing made. And so, you know, I was really interested in looking at like what are those experiences for folks that are dealing with probably physical barriers at the doctor as well as dealing with, you know, interpersonal experiences of discrimination. And so going to your question, I found a lot of things. I mean, I found on one hand, you know, a lot of really bad experiences, but I also found good experiences. And so the way that my findings are kind of being laid out is what are the experiences of stigma that people have. A lot of it is, you know, people are coming in with a lot of medical trauma from doctors that might not be their primary care provider, but it still changes how they experience going to the doctor. There's a lot more fear and stress and anxiety of just being in a doctor's office and worrying about, you know, what could possibly could be said, experiences of people having their concerns being dismissed and being told that, you know, they just need to lose weight, or, you know, having weight loss be the thing that is kind of treated as like the gatekeeper to other types of medical care. But also things like accessibility barriers. So a lot of doctors' offices had more accessible like entrances and waiting rooms. But then once you get to the treatment room, they're smaller for participants that used wheelchairs. It often turned into like kind of musical chairs where their wheelchair didn't fit in the room. And so, like, they would have to, you know, nurses or other aides would have to kind of scramble to like make space. People had issues with getting onto treatment tables and then things like having blood pressure cuffs that didn't fit. And so they were choosing take blood pressure on forearms, which is, you know, we have research that shows that that's less, you know, less accurate than having the proper blood pressure cuff that fits larger arms. Same thing, medical gowns don't necessarily fit. And also like when they would go to or they would be referred to specialists, that there were barriers there where doctors were even aware of those barriers, that they knew that, you know, if they sent their patient that maybe they needed surgery, they sent their patient to like one doctor, you know, there's a chance that they were just gonna be denied because of their BMI, um, that the doctor wouldn't work on them, you know, and so there's that as well. Which is just when you think about it, you know, there's all of I'm just gonna use the language that I use. I feel like there's a lot of hysteria about fat people and health. Yeah, I mean, it doesn't even make much sense, does it? Because if there is this hysteria on behalf of the medical fraternity about fat people, and yet we we don't have ways to monitor blood pressure or be treated, like that's a big mismatch. Absolutely. I mean, I think that also one of the things that, you know, I'm still working through and writing the chapters for my dissertation, um, which, you know, at that point will be presented to my committee and I'll obviously defend it, but still kind of working through and and and this really comes from because I've been doing fat liberation work for, you know, over 20 years at this point. And so I've been in numerous debates and arguments with people that really just kind of accept what they've the, you know, the narratives that they've been told about fatness and particularly in access to medical care. And so one of the things I've really been thinking about is we tend to think that the barriers that are in medicine, it's because of biological reality that is placed the blame on fat bodies versus how medical practices are socially constructed to really exclude fat people from treatment. And so things like often, you know, fat people are denied surgery. And even if they want to get something like gastric bypass surgery, if they're above a certain weight, they might be told to go on a crash diet so that they can get lose enough weight to be able to qualify for it. And those barriers are not because they're fat, it's because the surgical tables that they work on do not have a high enough weight. The scans that they would need, those scanners do not have a high enough weight limit. Or it is an issue of training. And so doctors are not being trained on fat bodies or taught how to use weight-inclusive medical practices to create a more, you know, weight inclusive in accepting practice within their own work. And so again, the blame is really placed on fat people for not being able to access that care instead of on medicine for not creating weight-inclusive practices. And you know, as we're talking, I'm thinking again, I guess I identify as a fat person. People directly talk to my face about how they're worried about me. And I think you're not actually worried about me. You're projecting your own fear onto me. Because if you were worried about me, you would understand that it's very complex. And also like my weight might actually not be a health problem, and it's nobody's business. That's yeah. I think also, I mean, it's been a while since I've ever had anyone tell me that they are like worried about me. And that's probably because I people like don't exist in my life. Um love that. Tell us how to tell us how to make that happen. I mean, I don't engage in diet culture. I found fat community when I was very, very young. You know, I started reading like women's studies books in high school because I was a nerd and also like, you know, had a pretty horrific time in K through 12, um, particularly like once I was in middle school and then older, because being fat was apparently like the worst thing that I could be for people. And, you know, and dealt with a lot of really like what I would consider to be horrific bullying. And, you know, I mean, I have PTSD now, not just from that, but partially from that. And I was really trying to figure out why I felt the way that I felt about myself. And so women's studies books and like learning about body image and learning that the things that I was taught to feel about myself was one, incorrect, and also was based on these very ridiculous ideals that are unattainable for the vast majority of people. I think some of the videos that you've watched that I started putting on Instagram, like one of my favorite books is Unbearable Weight by Susan Bordeaux. And I just remember, like, you know, when she talks about like what an ideal body is, it's for women, it's one that's not just lean, but that it has no movement, it doesn't jiggle, there's no cellulite, they don't even have pores. It is so unattainable. And Susan Bordeaux's book was written pre-social media, and so we have so much more emphasis on what an ideal body type looks like now. And we see it in every place, you know, that we look. And so I found fat community very young. And I did spend like my early 20s surrounded by people because I worked as a waitress and like where I was, where I was just surrounded with people that like did not necessarily have my best interest at heart. It really meant cultivating friendships with people that accepted me for who I am now and didn't have an expectation for what they thought my body should be. But also, like, and we talked about this in the pre-interview, like, I don't necessarily talk to the vast majority of my dad's family. I mean, I think out of all of my family, they were the most fat phobic out of everyone. And not having to be around them has also meant that I don't have to have these weird conversations. The most places that I have weird conversations is at work. And I just kind of shut those things down, you know, pretty quickly. Yeah, because they are, and I know we've veered off topic a bit, but I I think it it's important to have these conversations because in my family, they still talk a lot about food and how food is bad, you know, and how if they could only lose 25 kilos, their life would be better. And I don't think people understand how damaging just those casual comments can be because they all the time, well, no, not all the time, I've got better at it, but they used to all the time make me feel like I needed to be different, like I wasn't good enough. And I think it's really common in friendship groups and families to talk, particularly among women, but I think even increasingly among men, to just have these casual conversations about. I mean, in Australia, there's this, it's very common if you see someone who's put on a lot of weight, it's very common for people to say, Oh, they ate themselves. Like it looks like Catherine has eaten herself, like has doubled in size. And it's just so horrific. Yeah, I mean, I think we normalize conversations about bodies and about other people in general and about looks and about how we perceive other people and how we perceive ourselves in a way that for me, like I think some of it is because I'm neurodivergent. Like, once I realized, oh, these are really dumb conversations to have, I just was like, it just turned that thing off. And I was like, why? I don't need to talk about it. And I think it is very gendered in a lot of ways. Although I will say, like, a lot of the fat phobia in my dad's family was very much pushed by the men in that family as well. But we often create social bonds by talking poorly about ourselves and other people. That is for me, I think, a really toxic way to have relationships with other people. Like, I want to have relationships with people because we are there for each other to support each other. To make sure that we are like caring for ourselves and that we are lifting each other up versus having a relationship that's based on cutting each other down, talking poorly about other people. I mean, it's not to say that I don't ever like have snarky comments about people, but it's about them and their actions. It's not about what they look like, you know. And I mean, and this can be extended to, you know, how we think about people based with on marginalized identity. So how do you talk about black and brown people, poor people, homeless people, disabled people, you know, all of these different identities that people can have. And again, so much of our even just the media that, you know, is based on really bringing people down instead of really celebrating difference and focusing on how can we like be happier versus making ourselves feel superior to other people. Yeah, I mean, especially if we're striving to be wasn't 19th century French soldier. Like that's what we're striving to be. I'm probably never gonna get there. And so absolutely. I mean, I think too, you know, looking just back at like the history of obesity epidemic rhetoric in the US specifically. I mean, you know, we had during the Obama administration the Let's Move campaign that was really kind of Michelle Obama's like central campaign that she did a lot of work around, which like I'm totally happy with finding accessible ways to get people to like move and engage in, you know, um, I don't want to, I mean, in health behaviors, but also just like being more community focused and creating more access to those things. I'm totally happy about that. But the reason that that campaign came around is because there was a report written by retired army generals that was called Too Fat to Fight Fight, that was all centered around that um America to fight. Sorry, we cut out too fat to fight, and it was centered around the idea, which again, this was not like an empirically based study. They just wrote this thing. I mean, you can find it, all centered around that, you know, American children are too fat to join the army, and they, you know, really centered their main argument around soda machines in school cafeterias. And so what happened with that is then, you know, you have government policy being centered around it. And so you really have this emphasis around thinness that is being pushed by not just the Obama administration. I mean, this has been a long-term government project in the US. And I would guarantee it's probably around the world as well. But now you see it in the US with Robert F. Kennedy Jr.'s Make America Healthy Again. And now is talking about, you know, removing Jell-O from hospitals, which is utterly ridiculous. But again, it's all about creating Americans that are ready for war and not necessarily even about health. So much of that isn't even about that they're quote unquote too fat to fight, but because there are these very specific expectations about what a soldier is supposed to look like and what clothing sizes they have available for them and how much food they actually want to feed them. So many other things that again is about conformity and not about health specifically. I read, not read, it was an article in something about how when Brad Pitt was cast to play his character in Fight Club, and I could have this completely wrong, happy to be corrected, but my recollection is the producers decided it was easier to slim him down than to bulk him up. It was quicker and easier for him to go on a diet to play this character than to make him really muscly. Yeah, I mean, I don't know about that. I mean, I do know that, you know, what we are seeing on television, particularly with men on TV that are incredibly like bulked up or or whatever. I mean, one, like often steroids are involved in that. Yeah. Um, but also dehydration is part of it because if you have less fluid and less fat on the body, it really creates that striking, that muscle y look that they're often looking for. Yeah. You know, and I mean, all of this, this expectation, I mean, and we're starting to see it with like this new thing called looks maxing. Yeah, what is young boys? I've only like slowly started seeing that. I mean, it's body dysmorphia. Like, that's what this is. What would you say? What's body dysmorphia? Yeah. So I mean, any belief or distortion that you have around what your body looks like and unreal expectation on it is really, you know, what body dysmorphia is. I mean, and this is integral to when you're thinking about body image. I mean, often, and classically, obviously, we have thought about girls, and a lot of research has been centered around white girls. And so, you know, what that looks like across identity can be very different, but there are still these expectations for what bodies are supposed to look like. And often it is a very thin-toned body. Um, but for, you know, what we're starting to see in this rise of like looks maxing, and I would argue that like body dysmorphia for boys has been around for a very long time as well. It's just starting to become more prevalent. We have unreal expectations of what bodies are supposed to look like because we think that all bodies are supposed to look the same, and that there is a create a you know, hierarchy of what bodies we think are the most acceptable. And so for boys, it is often thin but muscly, a square jaw, you have a full head of hair, but also things like we can talk about penises if we want to be like, you know, totally about that too. That we, you know, we have this expectation that men have these like super ginormous penises that they're able to perform sexually in a way that is like comparable to like porn stars, yeah you know, you can just keep going forever when you know, even pornography is not real. I mean, you have fluffers that are there to like keep dicks hard and like all of that type of stuff, too. Do you think the porn conversation is really interesting? Because also, like in porn, they just perform continually. And in my experience, that's not real life at all. That is really interesting because I went out with a man for for quite a long time who was this I'm gonna describe what he looks like because I think it's important for this conversation. He was six foot three and had an athletic build, but he had lost quite a lot of weight. And this man was a fighter pilot, like he had the job that every little boy and a lot of little girls want to have. He said to me one day, are you more interested in men who look like the rock? And I just laughed at him and I said, You are the perfect man for me. Like, I don't give a shit about I don't care about that. But it's interesting that even people who I would think have bodies that they don't need to be quote unquote worried about this man was not fat at all. So to be quote unquote worried about, I worried about it. Well, and I think it is part of the downside to masculinity. I mean, I think gender norms, and when I would teach, I would say like gender norms, they hurt everyone. It's not just they hurt women, they hurt everyone because they also create an expectation of what masculinity looks like. And we often don't talk about how men also experience and struggle with body image and in extension and so many different things with that. I mean, obviously, you know, their physicality and what their body looks like, but also their ability to perform in and out of the bedroom, what that means. And because we don't talk about that, because there isn't an emphasis on men having mental health care and talking about body image, talking about, you know, how to feel more comfortable with your body, what that often means is that it's just something that, you know, is pushed down and not spoken about. At the same time, like if we were to talk to 18-year-old Amanda, I remember like very vividly that I worked in a candle store when I was in high school. And one of the girls that worked there that was like an assistant store manager, she was fat. I think probably around the same size I am now, maybe smaller for anyone that wants to know. I like I'm around like in a 2022 US, you know, so I'm fat person, a little bit above what in fat community we would call like a small fat. But I remember her, like, she was talking about a guy that worked at a store across the way that she thought was really attractive. And she's like, guys don't like fat girls, you know? And that to me was like that just was like embedded because I was really young, and so that really embedded in my brain for a very long time. Yeah, and and what I could tell you is like men like women, yes, and men like boobs and they like beats and they like balllies, and they in so many ways, like it, yes, there are men that are incredibly fat phobic, but they weed themselves out. I don't even have to deal with that, you know. Like for me, like I'm more interested in can we actually talk about it before we like hook up? Because I typically I am happily single. Um, and so if I'm hanging out with some, it's because I'm just hooking up with them. But like again, we just don't talk enough about how there are more than enough people in the world that are going to be happy with people's bodies at whatever stage or whatever state that someone looks like. For me, it has far more to do with is this a safe person that I want to be around. You're gonna have an open conversation with me about it. Are they not a shithead? You know, like that's pretty much my main standards of that, you know. Yeah, I'm the same. I bar, I mean I wouldn't say the bar is low, the bar is high, but it's honestly don't be a wanker and don't be aggressive, don't be aggressive, be able to I mean, let's say if the bar was low, that would mean that I wouldn't care how people treat me. Yeah. That's not where that bar is. That bar is I want to have a good time, but also I am very interested in making sure that like I know what's going to happen before I even get there. You know, I go through phases where, and particularly with being in a PhD program, like I have no energy for like social, my social battery is dead. But like I am more interested in making sure that this is like a consensual encounter and one that I know I'm not gonna feel yucky because someone is gonna say something disparaging to me in my body, which like has never happened. And if it did, I would like just put my clothes on and walk out, probably. And do you know it's it's never happened to me either. And I've lived in a fat body since my late teens, although I've always thought I was fat, but that is a whole other podcast. But I've lived in this body since my late teens and I've had a fair bit of sex, and not that it matters, but it's just I've never had anyone say anything disparaging about me during sex. I've had it said to me by men I'm on a date with, but I just leave. I just I learned that oh look, very early on I would have just stayed and cried, but now I mean I don't even get there really. Yeah, you can tell really early whether someone's fat phobic. I think. Yeah. And I don't even get there anymore. And I think I just do want to circle back and say I mean, I think the reason the conversation has gone into this branch is because I think a lot of at the core of what fat phobia is about is this kind of some inherent fear that we're not attractive and we're not good enough. And because I think that I think that a lot of people who say fatophobic comments are projecting because the worst thing in the world they can think of is to be fat. Well, I think also it is just so normalized. Like everything that we like thinking about the connection between weight and health is a normal thing, you know, that it is an everyday conversation. I work in a mental health organization and we obviously treat people with eating disorders. It is for an entire for Wayne County that covers the county that the city of Detroit is in, which is where I live in Michigan in the US. And I've started this job in January, and the conversations around food is ever present. I mean, luckily it's, you know, I make comments where if someone says something bad or they shouldn't have them, I'm like, okay, but it's delicious. But I think we had a person that's on the executive team that just came in and he's a very thin man, and he was like, oh no, I just like gained three pounds. Like, I can't have a slice of cake, you know, like, cause that is clearly gonna be the thing that's like tips the scale for you. But we just have, you know, so much of our social discourse around bodies and our everyday conversations are really centered around this idea that we need to make sure that we're not fat, that we need to control ourselves, that if we don't do that, then we are failing at something. And so that really creates on an interpersonal level where we're interacting with other people, it really creates this really toxic social interactions where we're speaking just poorly about fat people and fatness and fears about fatness, you know, but also things that I'm interested in as a sociologist is that we still have policies and social structures that also are benefiting people who are conforming to thinness. Doing that in a wide variety of ways too. Do you think when we go to the doctor that the doctors are blaming our weight for our health? Absolutely. I mean, sorry, and and I know you might not be able to answer this question, and do you think that's incorrect? I mean, I think it at any point, if you're just looking at someone's body and saying, well, that's why this is wrong with you, that is a failure of a medical professional to actually do their job. But also the way that research, if you actually look at research around body size and health, you do see that there are higher risk potentially for certain diseases. But those higher risk is also very similar to when we look at health and race data or health and class status or gender. That is where the issue is, is that if a doctor walks into a room and looks at a fat person's body and says, oh, this symptom that you're having is because you're fat, and they don't do any other types of testing. They don't think about if this was a thin person in front of me, like would I have that same reaction? And they're not like thinking about, you know, am I responding in a way that uses bias? It is a misappropriation of research to say higher risk means that any person who has this body type, well, they are inherently diseased because that's simply not what the research says. The research says that there's higher risk, and there are so many other things that can go into that. And this is where, you know, you talk about social determinants of health. So things like class status, what's your community that you live in? What type of access do you have? Places to safely move your body. Do you have access to fresh fruits and vegetables? And this is where, again, class becomes very much part of it. Things like race and gender as well. Um, you know, you really see that like population health, even if you do see at a population level that risk might be higher, that doesn't mean at an individual level that that disease is present. And so that's where I think that bias really comes into it and where people just misunderstand the research. Cause I often see people, and this is a conversation that we've had for a long time within fat liberation, that this idea that correlation doesn't equal causation. So, what that means is in research talk that, you know, just because body size and certain diseases, that there is a relationship between them, doesn't mean that that's a causal relationship. It doesn't mean that fatness is causing disease. It means there's a relationship and you have to pull it back to be like, okay, what are all of these other things that are happening? And I think if fat people are going into the doctor and their doctor's not doing testing and instead telling them, well, if you lose weight, it'll get better. Well, probably not. And also that means that you're not treating them. And so the next time you see them, they might be in worse condition than they were if you treated them properly the first time. You know, and there's also like some research out there that also shows that like even just using BMI and this idea of risk. Catherine Fliegel is a was a CDC researcher that was looking at morbidity and mortality statistics and looking at it based on BMI. And what she found was that people that were in a normal BMI range had a higher morbidity mortality risk than people that were in this like obesity one, which is like a BMI of 30 to 35. Harvard put on an entire symposium to try to denounce that research because there's so much money behind also the idea that fatness is inherently unhealthy and that we need to make people thin. And as we were talking about before, culturally it's so normal to talk about fat being bad. It's so normal. You know, I think if I say to my listeners, you know, go out in the world and just listen to how often people talk about fat being bad and food being bad because it might make you fat. And there are a lot of commerce is dependent on people not wanting to be fat. I mean, yeah, look listen to the conversations that you're having in your own household about food and bodies at family events and you know, where you should be enjoying the fact that you're like catching up with family and you might be instead disparaging the food that people brought because it's you know, quote unquote so bad for you. I mean, there's other things you can do too, like go to your local wherever you buy clothing and try to find clothes in like a size thinking in like sorry, I just started to laugh. If you like, so for Australian listeners, it's like go to Country Road and try try and buy a size 22. There's a better range at our shops like Target and Kmart, but they don't go much beyond a 26 or a 28. Well, and also the clothing that they sell are wildly different. You know, we have a store, because you know, I mean, we have like, you know, huge malls in the US, you know, there's a store called JCPenney that I swear has been selling the same plus-size clothing since I was like a teenager. Um, even Lane Bryant depresses me. I've seen some great memes and reels about, you know, Lane Bryant dressing. Because we don't have Lane Bryant in Australia, but my ex-mother-in-law is a fat woman as well. And she used to buy a lot of stuff from there. And there's so many memes about it. It really doesn't make you look like a semi-business casual that you had to wear when you're a teenager, you know, or younger. There is uh there's some things that I've seen on threads, and there's a person that I follow on Facebook that has started posting videos or photos of fat kids, and like, you know, they're dressed like they're 10 years old, but they look like a 40-year-old realtor. Um, they look like they're selling these cars, you know. Yeah, because there's a disparity in the type of clothing that is available for kids, you know, and that can be very, you know, when you're trying to be a child and fit in, and you have to be dressing in business casual to go to middle school, like that's while hilarious now as an adult, is can be incredibly traumatic in being able to be treated as just one of the kids that you go to school with, you know. I mean, I remember that. My mom got in sixth grade, you know, started dressing me in clothes that she liked. I don't even know if I have photos of myself then, but I just remember like wearing button-downs and shit. And it was just like a bad time. I remember going to a U12 social, which probably knows a prom. And I was pretty much dressed as a grandmother of the bride, you know, like I wore this thing with no shape, and I was 17, you know. Yeah, I mean, we can laugh about it now, and I think that's the privilege of older age. The privilege of age is to be able to laugh at it. But when you're a kid, that's incredibly fucking traumatic. And if we can help girls and boys and little humans to not have to go through that bullshit. Yeah, absolutely. I mean, so one of the things that I used to do when I taught is I would do a disability scavenger hunt in the US. I would teach my students about the Americans with Disability Act, um, because a lot of that, and this is partially like where my thinking about accessibility in doctor's offices came from is that, you know, the Americans Disability Act really sets the standards for what physical public accommodations are supposed to look like and the physical aspects of it so that someone who uses a mobility aid like a wheelchair is able to access those accommodations. And so it's things like, you know, entryways have to be 36 inches. Is which obviously I know I'm you can do the calculation for what that is. Divide by two and a half. Divide by two and a half. I like that you can do the math because I'm like, I have no clue what it means. But 36 inches or like, you know, curbs can't be like if you have to roll over it, anything that's like the threshold can't be over like three-fourths of an inch, you know, like that type of stuff. And so I would have my students go around buildings on campus that I knew were like horribly designed because they were built before the ADA was passed in 1990. And in part was to like show them how exhausting it is to have to learn about and how they don't even have to think about accessibility when you're able-bodied. And I think for thin people, if you have thin listeners, like this is something that I think is really important too, that when you were thinking about what it means to navigate the world, like if you've never had to think about if you're gonna fit in a chair, that's a really good example. If you've gone to the doctor and you've worn a medical gown and it closes in the back for you or even fits you in general, that's an accessibility thing. If you've never had to worry about blood pressure cuff fitting your upper arm, that is an accessibility issue. If you can get a medical scan and you're not told, well, your body isn't gonna fit, that is an accessibility issue. But also, if you can go to a clothing store and find clothes in your body that are on trend and timely for the period you're in seasonally or whatever, that is an accessibility issue too. So this is where it goes from being an interpersonal interaction to a structural policy issue where we're not bringing in and thinking about how we can make all of these different things accessible based on different body sizes. And I two that just spring to mind for me as well is if you've never had to ask for a seatbelt extender on a plane. Yeah. And you've never had to. I mean, you know, we had Southwest Airlines in the US that would let people get a second seat for free. And now they changed their decision on that. And so if you don't fit into one seat, you might have to buy a second airplane ticket just to fly somewhere. I can't, and I'm probably considered small fat, actually. Well, I don't know what don't have a fat community, but I can't put the fucking tray table down on the airplane. I mean, it's the reality is is airplanes specifically are trying to fit as many people as possible in the space that they have, and so they have consistently gotten more narrow of seats and less leg room, and they're just cramming people in there. And so what that means is that when people aren't comfortable, they're blaming the fat person next to them instead of airplane policies. You know, in the US, like the ADA really guides public accommodations, but then you have the air carrier access act that covers airplanes and other types of air travel. And, you know, this is an issue with disability community as well, is that while they have requirements for creating airplanes to be more accessible, there's no requirements around what seat size should be, how much space there is, and how to accommodate. You know, there's there's a real lack that legislation. I used to have a service dog, and that was something that I learned very early on. I mean, one of the things that I did, because she would fly with me to go to conferences and I sewed a mat for her to like curl up on to learn how to curl to make, you know, take up as least amount of space as possible while flying. But then I went on a spirit airline flight, which RIP they just like shut down like a week ago. Um, but there's such a small amount of space that even me teaching her to curl up didn't work. And luckily I had someone that was really kind sitting next to me and let her lay her head on his feet, you know. There's just not enough space. Often we tend to blame fat people for that and not the structural issues and the policies that are being created that are not thinking about body size as a form of diversity instead as an individual failure. We never blame the billionaires who are making money from these from from yeah, we never blame the fucking billionaires. You know, again, that that's probably another discussion. Actually, no, it's worth saying though, that we don't blame the people at the top who typically are already wealthy, yeah, and could never spend the money that they have, and yet at the other end of that, there is us trying to put down a food trade table so we can drink a fucking coffee, cup of coffee without spilling it on ourselves, you know. Yeah, absolutely. I mean, I think also like if people are generally invested in population health and community well-being and you know, making it so that communities are healthier, while in the US, that would mean, you know, supporting a very strong EPA to make sure that chemicals and toxins are not in our environments, that making sure that individuals are having living wages so that they can afford the foods that they need to care for themselves, but also making sure that everyone has access to fresh fruits and vegetables and other foods that are like culturally diverse and easily accessible to them, not just for them to cook, but also for their needs, so that, you know, disabled people also have access to those things, that there would be more emphasis on those structural barriers. But because in the US, in just a capitalist context specifically, we have really run with the idea that this is about personal responsibility, not about how individuals at the top of the food chain are creating a society that is impossible to conform to these ideals that we have created. You know, on one hand, we have RFK Jr. that's talking about people just need to eat more fresh fruits and vegetables and stop eating sugar, but we're not talking about how people don't have access to what is it. They don't have access to those foods. Don't have access to those foods, but also don't have access to equitable health care and and other things that have a huge impact on how well people are. Because if people can't even afford to go to the doctor, they can't afford their medications or all of those other things, that is gonna have a huge impact on their well-being in a way that eating an apple every day is not gonna change anything. No. I'm we're coming to the end of our interview, and I'm gonna ask you a question, which you know, given that we've kind of got to this point of talking about inequality and and how bleak it might be, my question is what what gives you hope? I mean, in your research or or in your life, like what what's giving you hope and joy right now? Yeah, I mean, I think that what I have seen over the last 10 to 15 years is that there is a lot more people that understand that body size is a relevant place for research and also people that want to do better. For a while, I was a coordinator at a conference in Detroit called Allied Media Conference that was really like a very like lefty community space that was created every summer. And I was part of what was uh Abundant Bodies Network Gathering. And, you know, we had a workshop that was around creating inclusive healthcare practices and talking about weight and health. And the majority of people that were there were doctors or medical professionals that really were interested in creating more accessible healthcare practices that are really meeting their patients where they are. And I also found in my dissertation a lot of people that had positive experiences with doctors. And so while I am kind of spending a lot of time talking about the really bad things that people are experiencing on the flip side, I really think I have a good argument for how to create weight-inclusive healthcare practices that are really about giving agency to fat patients so that they are able to really consent to the way that their body is brought up within a medical context. And so, you know, some of the questions that I asked was what advice do you have for other fat patients that are when they are seeking health care? Like, what do you think that they need to do? And overall, like the majority of people were like, be an advocate for yourself. Don't be scared to fire a doctor if you need to find a new one. Be willing to push back if you feel like you're not getting the treatment that you have. And also if you're being simply just being told, like if you ask for a test and your doctor's like, well, you need to lose weight first and then we'll see. Like, tell them to put that in your chart and have them write it down so that it's documented that they are denying you care. You know, be very on top of the fact that you deserve medical care. And then other questions that I had was like for student doctors, like, what do you want them to know? And a lot of it was around, you know, have cultural competency and learn about fatness. And part of that question comes from my PCP is not perfect, but she, you know, works at a teaching hospital. So she often has med students that are following her. And whenever she sees that I'm on her schedule, she makes them come and talk to me. And they all come in and they're like, okay, she told us to ask you about your research. Most of them, by the time they leave, are very interested in it because their curriculum doesn't talk about fatness or weight in any way other than treating it as a disease. I taught medical sociology, same thing. All of my course reviews, they all wanted to learn more about it because of the fact that they weren't getting it anywhere else. So I think that there really is this thirst for knowledge that people in the medical profession want and they're simply not getting it because all of the medical practices are centered around weight loss. And then the last question that I asked is if you had a doctor that felt the need to bring up your weight, how do you want them to talk about it? That question was a really sticky question with a lot of the people that I talked to, because often people thought that that meant that they were going to talk about their body in a negative way or that they were gonna talk about weight loss specifically. And so, you know, I often had to, and I would tell people if you need me to give examples, let me know. And so some of the examples were they had to prescribe birth control, they would bring up the fact that birth control is not as effective if you're taking the pill, it's not as effective because it's absorbed into adipose tissue. And so that is a real barrier to care that has nothing to do with whether someone needs to lose weight or not, but because again, they have not created a birth control pill that is helpful for people, regardless of body size. Most birth control is an IUD, which is uh an implant in your uterus, which is for many people not something they necessarily want to do. But regardless, the things that people said was one, I want that conversation to happen with consent. So my doctor needs to be like, hey, I want to talk about this. Are you okay with us talking about it? Again, it really centers around patients being empowered to talk about what they want to talk about, their healthcare provider, that if they want to bring up their weight, that they need to come with research. And also, if their doctor wants to talk about it, are they gonna be talking about it in the same way that they talk to their thin patients about it? You know, again, really flipping the script and and making it so that it's not just this conversation about weight loss. It's not just dismissive, but instead is really creating cultural competency for providers to provide health care that acknowledges that fat bodies can be different. They can absorb medications differently, that their bodies exist in different ways. Our bodies function differently, we move differently, we exist in space differently. But it doesn't one mean that our bodies are inferior, it just means that they're different. So it's it sounds like we have hope with perhaps a new generation of medical practitioners. Yeah, I mean, I think that there's still a very long way to go. I mean, part of the reason I wanted to do this, and I think we talked about this in the pre-interview was um because there was a contingent of fat women, specifically on TikTok, that were talking about going to the doctor, not getting diagnosed, and then being told to just lose weight. And it turned out that they had cancer or something else that could have been caught earlier, and instead they were at a later stage of their cancer. Or, you know, the American Medical Association came out and and their guidance from weight stigma was to tell people they're fat and to call them persons with obesity using disability language around it, which again to me is just very tone-deaf and really is centered on the idea that fat people don't deserve to be listened to about what they want when they go to the doctor. And in my research, I'm really hoping kind of flips the script on that and really is creating a starting point to create policies that really centered on listening to fat people and creating doctors that are more culturally competent around weight stigma and in understanding fat experience and also creating inclusive healthcare practices. Is there anything that haven't asked you that you want to say about your research, about fat community? Is there anything else that you'd like to say? I mean, there's a lot we'd probably like to say. Yeah, I mean, you also asked, like, what brings me joy? I started roller skating again last year. That's like kind of my main thing. Although yesterday I tried roller skating outside for the first time and I fell twice within 10 minutes. So, do you wear knee pants? Oh, oh yeah, I had gear on, although I fell on my butt. My butt hurts a lot right now. That's a problem that I'm dealing with. But it's all right. Like finding joy in movement is something that makes me very happy. And like being able to roller skate has been my new thing. It might be something different next year. But for me, the things that make me the happiest is being around people that understand or at least are open to understanding what it means to live in a fat body and really kind of centering, finding joy in that and not feeling like I need to change myself. Yeah, I absolutely concur. Amanda, I want to thank you so much for coming on to my podcast. I think that we could talk and talk and talk. And so if you're open to it in the future, I'd love to have you back on because I genuinely, absolutely loved this conversation. So thank you very much for being here. I mean, I'm always open if you have listeners that have questions. I mean, I think for many people, even hearing the word fat being used in a you know neutral way is a brand new thing. A lot of times it is a very this one-on-one type of starting point, but I'm always happy to come on and be the voice of reason or talk about the history of fat liberation or whatever else. Oh, let's do that. That would be great. Um, well, have a great night. I know that it's your evening and that and thanks very much for being open to be interviewed at an unconventional time. So same to you because I couldn't even see you, and now I can actually see it. Yeah, it was a little dark when we first started. So and uh enjoy your skating in the spring. Oh, I r I'm roller skating. Uh I am now officially an indoor skater again. I'm gonna wait a little bit before I get back outside because that fall twice in ten minutes. That means you need to work a little bit more on the inside. So get those skills happening. Yeah. But yeah, it was great. It was really great. Really great. Thanks so much for coming onto the pod.