Factually! with Adam Conover - What is Weight Stigma? with Dr. Rebecca Puhl

Episode Date: January 6, 2021

Dr. Rebecca Puhl, Deputy Director of the Rudd Center for Food Policy & Obesity, joins Adam to deep dive into the concept of weight stigma and how often we misunderstand the science of weight gain. Rebecca covers the relationship between weight stigma and eating disorders, the role personal behavior does and does not play into weight gain, how “genes load the gun but environment pulls the trigger,” weight bias in the medical field, what to say to yourself when you look in the mirror, and more. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way. I don't know what to think. I don't know what to say. Yeah, but that's alright. Yeah, that's okay. I don't know anything. Hello, welcome to Factually. I'm Adam Conover. I hope you had a wonderful holiday. I did. I didn't go anywhere or do anything. I just sat on my couch as time passed. As the Lord intended, I think. But we're back at work now. We're back doing podcast episodes. So let's do one. Let's talk about my pot belly. I've always had it. It's always been with me. It's been my constant companion my whole life. You know, it's been bigger or smaller at certain points, but it's always just been there, you know, kind of a kind of a buddy. You know, when I stand a certain way in the mirror, you see a little pooching outwards and you'll never not see it. I was born with this thing and I will die with it. And I've also always felt bad about it.

Like I have a little self-consciousness, a little bit of guilt. Why is it there? Is it my fault? You know, all these bad feelings. And that's weird to me because, you know, when I think about it, take a 10,000 foot view, well, hey, it's just a part of my body. Again, it's been there since birth. I mean, this thing is literally in baby photos. Look at a photo of me at one year old. I look like Homer Simpsons. I swear. Okay. So it's not like I did anything to get it. It's there no matter what I do. You know, I eat healthy. I run quite a lot. It's just some cocktail combination of genetics, environment, and who knows what else that causes me to have this thing. It's just the way that my body is. So what else that causes me to have this thing.

It's just the way that my body is. So it seems ridiculous for me to judge it, right? To assign an emotive value to my body or anybody. And yet we do. If you live on earth as a human, you know that we do. In fact, it's not just emotional judgments we put on it. It's moral judgments. that we do. In fact, it's not just emotional judgments we put on it. It's moral judgments. Our culture is chock full of weight based moral stereotypes. Studies show that people believe that overweight folks are lazy, that they lack discipline, that they're not successful, and even that they're unintelligent. We believe that overweight people are just choosing to eat too much and not choosing to exercise. And therefore, it's their fault and there's something wrong with them. And the thing is, it's not true.

This is not the truth about obesity. In fact, we know that obesity happens due to a complex of genetic and environmental factors. But it is the truth of how we think about it and talk about it in our culture. This set of negative attitudes and stereotypes about obesity, obesity stigma, are dominant in our society. We see them reflected in our popular culture, in our schools, in our workplaces, and even our hospitals. I mean, imagine going to the doctor with Alzheimer's

and being told, well, you know, it's kind of your fault that that's happening to you. That is how our entire society treats overweight and obese people. And let me just remind you, that's a group that encompasses more than 70 percent of all American adults. And yet we're doing this to each other. We are being that mean not just to each other, but to ourselves. What the hell is going on here? is going on here? Well, look, I'm not just going to tell you, hey, let's be nicer. And it's nice to be nice because the truth is this problem is much deeper because it's not just that our attitude here is wrong and mean and bad, although it is all those things. Weight stigma also has real consequences, real health consequences for those that have to endure it. People who experience weight stigma are more likely to develop unhealthy relationships to food, whether it's binge eating or bulimia. Young people who are teased about their weight are less likely to engage in sports. Obesity stigma not only doesn't do anything to stop obesity,

it can actually make obesity worse. So look, again, if we take that 10,000 foot view, it becomes clear that this stigma we have about weight in other people and in ourselves is similar to other forms of discrimination in our society. Discrimination where we look at someone's appearance and we make a judgment about what that means in terms of their moral character and their likely behavior. And as we know and have somewhat accepted about those other forms of discrimination, it's totally unwarranted and it helps no one. Weight stigma is something our society needs to work to erase. It's pernicious bias and it's one that I know I've succumbed to myself more than I'd care to admit. Well, to talk about this topic today, to get into it with me

about weight stigma, our guest is someone who has done a huge amount of work to understand its impact. Dr. Rebecca Poole is Deputy Director for the Rudd Center for Food Policy and Obesity and Professor in the Department of Human Development and Family Sciences at UConn. Please welcome the wonderful Dr. Rebecca Poole. Rebecca, thank you so much for being on the show. Thanks so much for having me. So let's start real basic. What is weight or obesity stigma, as you put it? start real basic. What is weight or obesity stigma, as you put it? Yeah. So, so broadly weight stigma refers to negative societal attitudes or stereotypes and ultimately unfair

treatment that people experience because of their body weight. And, you know, we live in a society that really holds many negative stereotypes about people if they have a higher body weight. And these are stereotypes like being lazy or lacking in self-discipline or willpower or being unmotivated. And we live in a society that really blames people if they have a higher weight. There's a lot of emphasis on personal responsibility and personal control for weight. And it's these kinds of attitudes and views that are strongly ingrained in our culture and that reinforce stigma. Now, I think a lot of people are aware of that. I think we've heard the message, don't be mean to other people. And we've gotten some of that through the culture. And so people might hear this and say, okay, yeah, don't be mean. I know

not to be mean to people about their weight, whatever. But you study this as a public health issue, as a as a issue that actually affects people's health and their their physical health, their psychological health, et cetera. So can you talk to us a little bit about those impacts? I mean, these are definite impacts, right? definite impacts, right? Absolutely. You know, I think it's important to highlight that weight stigma is a legitimate form of social stigma, just like other stigmas we have in our society related to race or ethnicity or gender or sexual orientation. We know that stigma has a negative impact on health and the same is true for weight stigma. So when people are stigmatized about their weight, when they're treated unfairly because of their weight or even discriminated against because of their weight, this has a really negative impact on both their psychological well-being, but also their physical health. So, for example, we know that weight stigma leads to problems like depression, anxiety, poor body image, low self-esteem, even substance use.

poor body image, low self-esteem, even substance use. And from a physical health point of view, we also see that when people are stigmatized about their weight, that they often are more likely to develop unhealthy and disordered eating patterns like binge eating. They're less likely to engage in physical activity a lot of times because physical activity settings are where people feel vulnerable to being stigmatized about their weight. I also see that weight stigma actually predicts weight gain and obesity over time. And I think that's an important point to highlight because, you know, there tends to be a lot of kind of public perception that, you know, stigmatizable about their weight, shaming them about their weight will motivate them to lose weight. And we see the opposite. Yeah, tough love, Dr. Phil stuff.

Exactly, exactly. And we see the opposite is true in research. We see that, in fact, when people are stigmatized or shamed, that this leads to unhealthy behaviors that promote weight gain and obesity. It actually creates more of a problem and continues the cycle. So this really is, as you were saying, it's a public health issue as well. So yeah, talk to me a little bit more about how that happens, like the connection that you drew there between eating disorders and weight stigma. I think that's a really clear health impact. And how does that happen? Just paint for me that picture a little

bit. Sure. So if we think about it, stigma is a form of stress. And we know that a lot of people react to stress and stressors with unhealthy coping responses like eating. There's a very large literature in psychology that shows that many people often turn to food in times of stress. You know, I've definitely been there. Most people have. Most people have. Even just work stress. You know, I've definitely been there. Most people have. Most people have. Even just work stress. Absolutely. And, you know, when we talk about weight stigma for many people, this isn't just a stressor that they experience once in a while. This is the chronic stressor.

They experience it in their daily lives in many different settings. And that takes a toll. And it often leads people to develop these unhealthy coping responses like engaging in unhealthy eating behaviors or avoiding physical activity because they don't want to be stigmatized in those settings. And those kinds of behaviors can really set the stage for increased weight gain over time. So I think it's helpful to think about stigma almost as like a psychosocial contributor to obesity. like a psychosocial contributor to obesity. Yeah. I mean, one thing I've learned from studying humans and psychology and human society in a lot of ways is, you know, we are social animals and our social selves impact our physical selves because the end of the day, we're all, you know, it's all the same self. We're cells that are operating, you know, and some of those cells react to people around us and what they're putting out. And it's real, you know, that I know there properly, but that is so tied up with so many different parts of the brain and the body and all of that would be like all tied up in that. If you're receiving something socially, it could really affect you physically.

Absolutely. And, you know, you just raised two really important issues that we've seen in research. The first is you mentioned kind of these experiences of stigma having a physical impact on even us at the cellular level. And one of the things that we've started to see in research is that weight stigma actually increases physiological stress levels. So things like cortisol levels, and that itself is also related to waking. So we know there's a link there. And then the other thing that you started to talk about is just how people react to these kinds of situations. And there's a lot of research now looking at something called internalization of weight bias. And this is when people become really aware of the negative societal stereotypes that

exist in our society, and they start to apply them to themselves. So they start to blame themselves for the weight stigma that they're experiencing. And this is a pretty common thing that happens in our society. And one of the reasons that is weight stigma doesn't really get challenged as much as it needs to be. It often remains acceptable and tolerable. And so there aren't very many voices speaking up against it. And people often internalize that. And why that's important for health is that we know, again, from increasing research here, that the more that people blame themselves for weight stigma, the more that they internalize this bias, the worse health outcomes they have as well, both for psychological well-being and for physical health.

And sometimes these health outcomes occur more strongly for the internalization of the stigma than for actually the experience of stigma itself. Wow. So once it really works its way into you, it's an entirely different animal in terms of how it affects you. Well, let's talk about what characteristics this stigma has, because I think, as you say, it has a very specific character in our culture that makes it a little bit more pernicious and a little bit harder to fight back against than, well, I don't want to say harder or less hard, but I think all of our different stigmas and stereotypes have different characteristics. Racism is different from sexism is different from, you know, anything else that you want to say in terms of how it's expressed and the sort of

beliefs that the culture has about it. And so I wondered if you could talk about the specific characteristics of weight stigma in our society, what, you know, what is put on to people and what our ideas about that stigma are. Yeah, that's a really great question. And, you know, one of the things we know about different social stigmas is that our beliefs about the causes of those stigmas really play a strong role in public attitudes and responses. And why that's important is that when it comes to weight stigma, there are very strong opinions about what causes obesity, what causes body weight. And, you know, we live in a society where we see a lot of messages that point to personal

responsibility, that if you are at a higher weight, it's your fault. That means you didn't try hard enough. You're not disciplined enough. You're not showing willpower. Those are fundamental beliefs that reinforce weight stigma. And, you know, what we know from science versus what we see in terms of messages that are communicated about weight in society are very different. And what I mean by that is the messages that we see about weight in society are very oversimplified compared to what we know about obesity and weight regulation in science.

to what we know about obesity and weight regulation in science. So what the messages that we see in the media and the news really emphasize, you know, personal behavior, eat less, exercise more, you know, we see messages from the diet industry that say, just try this latest diet program, and you can have flat abs in six weeks, you know, those are the kinds of messages that we're used to seeing. But in fact, body weight regulation is very complex and personal behavior is only one piece of this. So we also have genetics and biology and environment and psychology, and all of these pieces interact together and make it very complex. And that's not the message that we tend to see. And so I think when it comes to, you know, why do we have this stigma in the first place? What are the characteristics of it? You know, personal blame is such a foundational piece of weight stigma that and until we really have a much clearer understanding in the public of what causes body weight will likely continue to see the kinds of attitudes that we do. Yeah. Well, let's talk a little bit about, and you know, this is a, this is sort of difficult part of the subject. And when

I think about it, it's, it's the part that I sort of have the most confusion about because, you know, there are such a thing, there is such a thing as people who change their personal behavior and lose weight as a result and, or not always both become healthier, right? Sometimes people lose weight and they become less or not always both become healthier. Right. Sometimes people lose weight and they become less healthy. Sometimes people become healthier and they don't lose weight. Right. You know, I've had the experience myself of living in a way that I would say was less healthy, changing things about my behavior, becoming happier and yes, losing, you know, 10, 15 pounds as a result. Part of that for me was quitting drinking, which is, you know, for me, a really transformative change in my life. And, you know,

if you go on, hey, go on Reddit or whatever and find, you know, one of the various forums where people talk about these things, you will find people who transformed their lives. You know, they said, I'm going to stop doing X. I'm going to start doing Y. You know, they, you're the sort of person who goes to a gym and oh my gosh, my life is so much better because I've now started doing this. Right. And that's an experience that people have. And it complicates our story of weight loss and weight gain and the reasons for weight gain. And I wonder if you could talk about those nuances a little bit, because clearly that's not everybody's story. It's not a story we should expect of everybody, but I think it helps contribute to what you're talking about, to this belief that, well, surely there must be something I can be doing. Yes, absolutely. So, so let's break this

down a little bit. So, you know, certainly no one is saying that personal behavior isn't important. It certainly is important and it has to be part of the solution and part of the prevention. However, where the issue becomes problematic is that's the only piece that is being focused on. So I find it helpful to think about obesity as a complex puzzle. And this is a complex puzzle that has many different pieces to it. Personal behavior is one of those pieces. There are many other pieces in the puzzle too. If we only focus on that personal behavior piece, we're not going to solve the puzzle. We have to focus on all of the pieces. And I think that's

a helpful way of kind of putting all this together because personal behavior certainly is important. It is one piece of this puzzle, but there are a lot of other pieces that happen. And those other pieces impact which people are going to be able to maintain weight loss over time. You know, many people can lose some weight. However, what we know from many, many clinical trials of different weight loss programs and treatments is that very few people are able to keep that weight off over time. Most people regain the weight. And that is not because of lack of willpower or lack of effort or lack of trying.

These are people who are trying extremely hard, who are putting in a lot of effort and have a lot of discipline. It speaks more to the complexities and the restrictions and the limitations that happen with our biology and our genetics. So I think that all of these stories have a place here. And one of the

things that we talk about in the obesity field is that there are obesities not just obesity there are many different types of obesity that really involve all of these different interactions of biology and genetics etc um so it is more complex that we are always going to hear these kind of success stories and for every success story there are also many stories that were not successful. Yeah. And there's the there's the biggest loser effect, which I've talked about on my television show. And we had Dr. Kevin Hall, I believe, on a previous incarnation of this podcast to talk about where, you know, that is that's a show that, you know, is about that. Oh, that personal transformation.

You really can do it. And it shows those effects. And the fact is, the majority of those people gain the weight back, not because they necessarily fell off the exercise routine, but because that is the effect of the exercise routine. You lose the weight temporarily. And then no matter what you do, it actually comes back. And I believe you're less healthy afterwards or there's a potential to be less healthy afterwards. And that might be the case when you look at Reddit as well. Those people aren't posting their, you know, their six-month updates, you know, after that six-month transformation. So, yeah.

Yeah, I'm glad you brought up the biggest loser because there are a couple of important points to make about that. And the first is what you were starting to talk about, which is we see this dramatic weight loss, and then we see weight gain after the show. And again, one of the reasons people lose so much weight during that show at a rate that, you know, isn't necessarily medically advisable is that they are isolated from their everyday environment. They have a team of people working with them, feeding them, you know, devoting all this time to exercise and lifestyle behavior. They're lab rats. Which is frankly not realistic. None of us have lives where we can do that. That's the first thing.

The second thing is there actually has been research studies done, people's views of The Biggest Loser before and after watching the show. And what we see is that people who are exposed to that show actually end up showing higher levels of weight bias after they have watched it. And I think because in some ways the show, as much as it's showing personal transformation, which might be motivating for some people at the same time, it's really, again, making this all about personal behavior and motivation and discipline. And those again, are the kinds of stereotypes that can really reinforce the stigma that we're talking about. Yeah. Well, so let's talk about, you said there's the personal behavior piece and then there's the other piece and let's just acknowledge the personal behavior piece exists. You know, I,

you know, started jogging in my twenties. I lost five pounds. That was the degree to which for me, personal behavior was going to contribute. And then 10 years later, I quit drinking and I lost another 10 to 15. You know, that's about it. But hey, I still have a you know, what some call a beer belly. I was born with it. I feel that I'll die with it. Right. And so let's talk about the other pieces of it. You said obesity. What are the factors, you know, just a couple perhaps of these that, you know, might contribute to weight gain? Well, for example, we know that obesity tends to run in families and that there are strong genetic components with this. We know that we live in an environment that really promotes behaviors that facilitate obesity. We know that, you know, biology and genetics play really strong

roles that really are outside of our personal control. And one of the phrases that has been used to talk about this is that our genes load the gun, but environment pulls the trigger when it comes to obesity. That we actually all are genetically predisposed to gain weight easily because that was very adaptive in times of famine where we need to be able to survive. We no longer live in times of famine. We live in times of abundance where we can get food 24-7, cheaply accessible and engineered to taste really good. So we have the opposite problem now. And we really couldn't have done a better job at creating a society that promotes obesity, right? So the issue is that our genes really haven't changed that much. So again, it's about recognizing that there is this interplay of complex factors and that, yeah, you can engage in personal health behaviors. Everyone should be engaging in personal health

behaviors, regardless of your body size. And that I think is really a fundamental message that we try to get across with our work, which is that we don't want to be targeting messages about the importance of being healthy only to people of a certain body weight. These are messages that everybody should be receiving and engaging in regardless of body size. We can't just look at someone based on their body size and know what their health indices are. And we have to be careful about making assumptions and doing that. And instead, we really want to be sending public health messages to all of the public, you know, across body weight categories and sizes with the messages that we think are important for improving health. Okay. I have a question on

that point. That's a really wonderful point, but I just want to go back to something you said halfway through that answer. So do you, are you, cause I've always had this suspicion. Are you the, the type to blame, you know, government food policy and, you know, those sorts of, you know, what is creating our food infrastructure? You know, the, I think about, Hey, there's so much emphasis on personal choice, but we don't choose what goes on the supermarket shelves. We don't choose what prices those foods are. We don't choose what are the available restaurants in our areas. You know, well, let's take it off of restaurants because that's, you know, that's companies and chefs. Let's talk about what's on the supermarket shelves and what's cheaper. That comes from agriculture policy, things like that. I'm just curious. Are you know, is that part of the

equation for you? Well, I am the deputy director of the Rudd Center for Food Policy and Obesity. So, yes, it absolutely does. You know, and what you're talking about is 100 percent correct. You know, we do a lot of work at our center on the kinds of foods that the food industry is promoting and specifically the kinds of foods that they are marketing to children and adolescents. kinds of foods that they are marketing to children and adolescents. And believe me, you know, what we see is time and again and year after year is really unhealthy foods being targeted to young people to try to get their brand loyalty early on, even though we know that the health value of the products that are being promoted are of concern. So policy does have a role to play here. It has a role to play with the kinds of foods and beverages

that are offered in schools. It has to do with taxes on things like sugary beverages. There are a lot of different ways that that policy comes into play here. And again, I think that also is another example of factors that are important here that are really outside of personal control. outside of personal control. Well, okay. So good. Thank you. That's exactly what I hoped for. But yeah, so let's, let's go back to this other point that you, that you said that, that healthy behaviors, healthy habits, you know, exercise for health, that sort of thing should be available and promoted to everyone. And I wonder, is the fact that they're not a consequence of weight stigma? When I go to my yoga class and, you know, I think of yoga as being an exercise that is as practiced

in the United States, you know, primarily is, you know, extremely healthy. It's good in a general healthy way. It's not super weight lossy or anything like that. It's, you know, a gentle stretching and that sort of thing. And, you know, I look around the yoga studio and I'm like, there's a certain sort of body that's more predominant here than others. And is the reason for that stigma? I do think that stigma comes into play here. And, you know, I would say that we are starting to see somewhat of a shift in the focus of messaging in public health and in these kinds of settings to focus more on health behavior and health rather than on body size per se. childhood obesity management, where there's increasing concern about even the stigma that children experience because of their weight and how to really support kids in ways to improve their health without making it just about the number on the scale. And I think something to

kind of point out here is that, you know, we put so much emphasis on weight loss and what percentage of your body weight you can lose or how many pounds you lose. But if you're engaging in healthier behaviors, even if you don't lose very much weight, you can really improve your health and disease, whether it's getting a type 2 diabetes medication or lowering your blood pressure or cholesterol. And those really do affect mortality and longevity. And so, you know, I think it is an important approach

to really broaden this to health more than just focusing on the number on the scale. Yeah, I agree. I agree with that fully. And, you know, to me, that's the, you know, that's what I realized when I started, you know, exercising for the first time in my life is like, oh, this is an overall life upgrade. You know, this is I feel a little better. I sleep a little better. I look a little better. I can do a little bit more like it's just everything. So that book about about meditation, 10 percent happier, except I think it's a little bit less bullshitty, you know, like it's just like, oh, if I jog a couple times a week, I'm just like everything is like a little bit better. But but again, I feel that that message doesn't get through, that there is so much of an emphasis on health. And, yeah, it feels connected to those feelings of stigma and shame to me. Yeah. And I think, you know, the bottom line is we still live in a very thin, obsessed culture.

And, you know, those sociocultural values of thinness are very ingrained. You know, thinness has come to symbolize important values in our society. It symbolizes desirability and discipline and hard work and desire, all those things. And those messages are perpetuated through the fashion industry, through the mass media, through television and movies and film and social media. And so trying to shift societal attitudes in the face of all this is, is a big goal. And I think it is necessary though, to really make a dent in, in stigma when it comes to body weight. Yeah. Well, just, I mean, the effect of this stuff

can be so powerful on people. You know, I have a very dear friend who, you know, grew up overweight and, you know, got it from all sides. And, you know, just I won't, you know, try to tell her story, but, you know, from her parents and et cetera, and was, you know, sent to special camps and given special diets and, you know, developed eating disorders. And now it's, you know, it's like on top of everything else, she wrestles with that, right? With basically a complex of shit that was like shoved into her brain by all this stuff that, you know, it's a struggle with those ideas and with those internalized ideas and with those, you know, that sort of complex of stigma. And that's just to get happy and comfortable with herself in order to then, you know, say, hey, maybe I should, you know, to think about weight

at all, you know, to think about health at all. And I see that it's really it's really heartbreaking because it's a thing that is done to people that is very clear to me that it makes it harder, not easier. That stigma is not good for you. And, you know, I think the example you just shared is one that is very common. And it also highlights a couple of things that we know from research, which is that this is a stigma that has long lasting consequences. And it actually starts very early. that has long lasting consequences. And it actually starts very early.

So, you know, as young as preschool, we already see three-year-olds who are expressing negative stereotypes related to weight, who can identify that this is a negative trait to have. And by elementary school and middle school and even high school, weight-based bullying is one of the most prevalent forms of bullying that kids experience. And it affects their psychological and their physical health just in the same ways

that stigma does for adults. And one of the things that I think is particularly damaging for kids is that, you know, the teasing, the stigma that they experience, it's certainly coming from peers at school, but coming from family members and parents. And parents are, you know, a frequent source of weight stigma that get reported. And I think that that is a really challenging experience to deal with. And in the example that you mentioned, you know, these are ideas that, you know, really happen early and that have a lasting impact over time. I think a lot of times parents, if they have a child who is struggling with weight, you know, they may have the best

intentions of mind and trying to support their child or help them become healthier. But sometimes those intentions can be communicated in ways that are very judgmental and critical and stigmatizing. And that has a really long impact on well-being. And in fact, even just talking about weight with kids, even if it's done in a more potentially neutral way, can be negative. You know, we've done some studies on what's called parental weight talk. And this is just making comments about their child's weight, or even making comments about their own weight in front of their child. And we know that, you know,

parental weight talk can have negative implications for their, their child's body image, their child's eating behaviors, their self-esteem. So we want to be, you know, we want to think carefully about, especially as parents, why we're talking about weight with our kids and what those messages are sending. Yeah, man, it's so it's so complex and so difficult because this is this is culture. Right. Like, I mean, we've been blaming the media. We've been blaming, you know, the biggest loser. Right. As a particularly malignant piece of media and ads and all those things. But the truth is, it's it's pervasive up and down through the culture.

Like we make that media because that story appeals to the cultural bias that we already have. That's why the biggest loser is successful is because it's already in people. And that is so hard to uproot. because it's already in people. And that is so hard to uproot. I mean, it's the thing of, you know, I've heard so many stories from friends who have kids that's like, man, my kids are, you know, they turn two and three years old and they start liking pink and blue and, you know, choosing boy and girl toys because the culture is so powerful, you know, and it's so hard to escape. And this is another one of those things that is just deeply embedded. And yeah, in terms of my own weight talk,

I walk, me and my girlfriend walk around the house and sometimes we're like, oh, I'm fat today. You know, it's just like, and we don't, you know, I would say we don't have those biases, but yeah, just in our pattern of speech, we say stuff like that because we're just letting a little bit of that bias out that's deeply in us. And of course, if we had kids, maybe we would do that in front of them. And it's, yeah, God, what a difficult knot of behaviors that are so up and down our society and our culture and ourselves. It is. And it's really pervasive on so many levels. And I think to the point that we're not necessarily even aware of the automatic biases or assumptions that we may be making about weight. We might not even be aware of it in the way we talk about weight. But that's how kind of implicit it has become. And some researchers out of Harvard who study bias have been looking at how different societal stigmas and biases have changed over time. And, you know, quite a few

have improved in terms of, you know, we see lower levels of racial bias, for example, than we did in certain years. However, when it comes to weight bias, we're not really seeing movement very quickly in the way that we should be. And, you know, I think, again, this really speaks to just the implicit nature of the values that we place on body weight in our culture and the message that have become so ingrained that really do operate at every fabric of society. Well, I really want to talk about what steps we can take to try to chip away at that boulder, but we got to take a really quick break.

We'll be right back with more Dr. Rebecca Poole. OK, we're back with Dr. Rebecca Poole. So I want to talk about what we can do to start alleviating this stigma. But first, I just want to ask, you know, we have listeners around the world, but we I am an American. We are here in America. How does America compare to other countries when it comes to weight stigma? Are we better or worse? I'm going to guess worse. You know, we're actually doing cross-country research on this right now. We've just completed some research with the U.S., Canada, Australia, the U.K France, and Germany. And, you know, what I can tell you, weight bias is present in many, many countries. It's not just a US phenomenon. It does tend to be kind of more pronounced in Western countries where, again, we see very prominent values of

thinness in society. So, in countries where those sociocultural values of thinness are strong, we see higher levels of weight bias. But the reality is, is that this bias is present all over the world, even in countries where you might not expect it. And and I think, you know, it shows that this form of stigma itself is a global issue. It's a global health issue as well. Well, now let me ask. I've often heard the sort of story or speculation that our bias towards thinness is, you know, specific to our culture, that it is not everywhere or that it was, you know, it's limited to our time. You know, you sort of have, oh yeah, didn't Renaissance paintings, there were a lot of, you know, Zoftig women in these paintings and, you know, that was

a value that was more popular during the, I don't know, the French crown or whatever the hell, you know, you hear these things. Is that the case or do you have any knowledge about that? Well, you know, there is some truth to that. So, you know, if we look centuries ago at the kinds of artistic representations of beauty and physical attractiveness, it was a larger body size. And there are different reasons for that. I mean, larger bodies signified wealth. It signified

fertility. You know, there were reasons why that was an ideal body type during different social and economic history. But as we've progressed over time, we do see a very clear change in those ideals shifting dramatically towards thinness. And really in the 1970s, we see all of a sudden kind of the stick figure ideal of physical attractiveness in women with iconic supermodels who were extremely thin. And those ideals have been perpetuated ever since. I would say it's really only in the last five, 10 years, maybe that we're really starting to see more of a push for diverse body sizes when it comes to how we perceive and define physical attractiveness and beauty. Is there a reason that you feel that that, you know, that that thinness became more of a held up attribute? I know you're not a social historian, but I'm just curious if you have a feeling on that.

the diet industry, a lot of industry influences have come into play here as well. And so I think it's hard to pinpoint just one factor. I think, though, that if we look closely at the kinds of not stereo assumptions we make about people of certain body size, that can also start to give us more clues. So, for example, again, when we talk about American values of individualism and, you know, working hard for success, those kinds of views come into play with body, body weight as well, where the idea is if you're thin and you have worked hard to achieve that physique, you, you know, you have discipline, you are, this is an individual kind of goal that you've set for yourself. And so those values, I think, interplay as well here. And that may be one of the reasons why we do see such strong levels of weight bias in the U.S. in particular.

Yeah, this is so much the story, like the conflict in the American psyche between hard work, like the conflict in the American psyche between hard work, doing it all yourself and those values. And those are positive values. You know, it's it's good to work hard. I myself have experienced, you know, the transformative power of saying, you know what, I'm going to do this and putting my mind to it and figuring it out and putting in hard effort over years, professionally, personally, all these sort of things. And I would never want to poo-poo that. However, I'm also aware there's like this flip side of the coin of there are so many things about your life that you truly cannot control, that you truly, truly can. Again, you cannot choose what food is on the shelves. You cannot choose the economy that you were born into. You cannot choose whether or not you get hit by a bus, right?

You cannot choose physical disability. You cannot choose the ideas about your race or ethnicity or gender or all these sorts of things. And that is a story that we simply tell less. And we don't know how to reconcile those two stories in our society. We do both things are true, but we don't know how to hold them both in our minds simultaneously and tell a single story about people that is coherent. Do you does that resonate for you? Yeah. And I think it just speaks to the complexity on many levels. And, you know, there have been different reactions to this, you know, so what we've seen from major

medical organizations in the past seven years or so is formally classifying obesity as a disease. And the idea being that this is a chronic condition that is very complex in its determinants and in its treatment, that this isn't just an issue of personal control or individual willpower. And, you know, I think that disease status has led, you know, some people to think that this will reduce stigma because it's not just about personal control. At the same time, you know, calling it a disease, many will have a BMI that would officially classify them as having obesity, but they are in great health. And so again, you know, there's, it's really, it's such a variable issue. And I don't think there's one kind of reaction to this that will simplify it.

I also think it's one of the reasons why policy becomes so challenging because there is so much individual blame when it comes to weight stigma that, you know, trying to pass policies to make it illegal to discriminate against weight, you know, have been sparse. And that's one area that I've really been trying to work more in to try to elevate policy level solutions to this issue. been trying to work more in to try to elevate policy level solutions to this issue. Oh, that's really interesting. Like, like actually trying to make it illegal to say, fire someone because of their weight, for example.

Exactly. So right now in the U.S., when it comes to weight discrimination, I mean, the current legal landscape is pretty barren. There are very few options. There's no federal laws. There's one state law. So Michigan actually passed a law back in the 1970s that prohibits weight discrimination in that state. And we now also have at least half a dozen cities across the country that have passed laws as well that essentially have added body weight to their civil rights statutes, for example. Massachusetts has been trying to pass a law like the one in Michigan really for 10 years now, and they are getting closer and closer to doing that. You know, so this is an issue that, you know, I've testified at these Massachusetts state hearings. We're seeing lots of support for it. We actually don't usually see very much backlash at all, but it's still, you know, taking a long time to really pass.

And, you know, we've been doing national studies to assess public support for different policies, and we see very high levels of support of Americans who say, yeah, we should prohibit discrimination. We should not allow people to be fired because of their weight. So the fact that we're seeing such high levels of support, I think is an indication that people are recognizing that this is an issue that we need to address. But it seems like we have a very long way to go still. I mean, what you're talking about now,

this puts me in mind of, say, episodes we've done on the disability rights movement on this show and on the ADA and how that's one of our great civil rights movements in America that is often not remembered as being such. You know, it's up, you know, the fight for the ADA is, you know, up there with the Civil Rights Act and everything else. And this strikes me as a parallel or at least a similar battle in many ways, but it's one that has less progress has been made on, quite frankly, both culturally and legally, it sounds like. So I would agree with you that, you know, progress in these kinds of areas takes a long time and shifting societal attitudes is a lofty goal. And that's something that's common

across all of these different issues. You know, I've been working in this area for a really long time. And when I started, this was not on the radar, weight stigma wasn't being talked about. I have, I have seen progress over time enough to make me feel optimistic. So for example, we know that weight stigma is common in the healthcare setting and that even healthcare providers express bias. What we've seen is, you know, increasing focus on education and training of healthcare providers in the area of weight stigma, you know, really providing sensitivity training and understanding about how weight stigma impacts their patients. You know, we've seen more attention to this in the media where

we're starting to see more diverse body sizes be portrayed. We're starting to see evidence of change in schools kind of addressing weight-based bullying as a legitimate form of bullying. And just even more attention to this issue in dialogues like this and in social media. I mean, we've seen, I would say in the past five years, quite a strong increase in the body positivity movement, which is directly challenging the weight stigma and the fat shaming that we so often see in formats like social media. So there are increasing voices. But this is a big, this is a big issue to try to change. And it does take time. And it means really tackling some of those really strongly ingrained attitudes that we've had for a

very long time in this society. Yeah. Like it's, it really is one where the, the change needs to come from ourselves on a, on a daily basis. basis but let's talk about i can't believe we didn't talk about this earlier medical discrimination in this area my friend again who i referenced has told me stories of being just utterly dismissed by doctors of going to the doctor and saying hey hey doc my arm hurts or whatever you know like there's a normal medical complaint and being told uh well you should really think about losing some weight. And she's like that. My my fucking arm hurts like that's not why I'm here or what. That's not a specific example, but you get it. And yeah. Can you talk a little bit about about what research shows us about that? Yeah. So, you know, within the health care setting, weight stigma can occur in a lot of

different ways. And, you know, the negative weight bias that we see in our society is sometimes shared and expressed by doctors and other healthcare professionals. And to the extent that some research has shown that the levels of weight bias that we see in the general population are very similar to what we see in doctors. And so I think it's helpful to, before we kind of talk about what that stigma looks like, to remember that healthcare professionals belong to the same society that we do. They are not immune to these negative weight biases that are so ingrained in the rest of us. And so we see evidence of, you know, negative stereotypes and biases being expressed, not just by doctors, but by nurses, dieticians, you know, medical students, endocrinologists,

like across different specialty areas of medicine and healthcare. And typically what these types are focused on are views that their patients who have obesity are again, lazy or lacking motivation or they're non-compliant with treatment. Now, I want to, you know, certainly say that many healthcare providers don't have these negative attitudes, but I think the fact that it has been evidenced in so many studies is very concerning. And this comes across in different ways. So, you know, research has shown that healthcare providers will spend less time in appointments with their patients who have higher body weight, or they provide less health health education or they express less respect for

those patients compared to patients who have a thinner body type. And from the patient's perspective, like the example you gave, we actually see that doctors are one of the most commonly reported sources of weight stigma that people talk about. And they talk about being judged about their weight, or like you mentioned that their weight is being blamed for whatever presenting problems they go to the doctor for. And this really does have an impact. So what can happen is it can make people really reluctant to want to talk about their weight or weight-related health issues with the provider, but it also leads them to switch doctors or to avoid future medical appointments

altogether. And that is really concerning when we start getting to the level of healthcare utilization, because, you know, if they are avoiding care because they've had a stigmatizing experience, whether it's a doctor saying something they shouldn't have, or, you know, even getting to a doctor's office and they're not being a patient gown that fits them or a blood pressure cuff that fits them. And there's a lot of different ways that bias can be experienced. And that's one of the ways as well. But when any of these kind of negative encounters can lead people to really feel that they don't want to repeat that negative experience, it's not worth it. So they're just not going to go back to the doctor.

That's really concerning. Yeah. And when we're talking about, you know, the negative health effects of weight stigma, I mean, that is obviously one. If you're not being regarded by a doctor or the doctor is not treating your issue, the doctor is saying, oh, well, the real problem is you need to lose weight. You know, if they're saying that 10 percent of the time when there's actually another issue, that obviously that's going to lead to, it's going to lead to worse health outcomes. It's very clear. When we talk about this stigma, it's so hard to avoid, you know, in ourselves. Like, first of all, I want to be clear. We've been talking about the effect of stigma on overweight people or people who would classify themselves as overweight or people who'd be medically classified as obese, but it also has harmful effects on people who are not overweight. You know, eating disorders on people who are, you know, already by, you know, medically thin, medically underweight. People who have very, you know, slim figures and look in the mirror and, and think

I am overweight. And even myself, I mean, I'm talking to you right now. I've done a television episode about this. And when people say to me, oh, hey, it looks like you've lost weight. I think, please don't tell me that, that, you know, that insults me a little bit. You know, I, I have that reaction. And still, when I look in the mirror, I find myself thinking sometimes like, hey, I look kind of thin. I feel proud of myself. You know, I have that judgment of myself despite knowing all this stuff.

And, you know, just having this conversation, I'm like, oh, yeah, that is me exhibiting that and turning it on myself. And hey, maybe that feels good today. But what happens if, you know, you know, that could be turned against me in a negative way tomorrow or years down the line. And so how, how do we fight that piece of it? Like that is such a pernicious thing. Cause I, I know more about this than most people. I would, I would venture to say, and I'm still doing it to myself. How do I fight that? Well, I think you've raised a couple of important points here. I think one that I want to highlight that you've kind of raised is that weight stigma really can occur for people at any body size.

And in fact, people internalize weight stigma at multiple body sizes. It's not just people with higher body weight who have these feelings and who internalize stigma or body related shame. In fact, you know, for women, there's been a term called normative discontent, which means that essentially so many women have negative body image that it's the norm, that it is the norm to be discontented with how you look. And I would say that's true. And that's, again, you know, a symptom of the societal and cultural messages that we have about body weight that are so strongly valued. So I think that, you know, first, that's a really important point to make that people can be having these experiences, these experiences and these feelings,

and this body related shame at any body weight, it's not something that is only limited to those of higher body weight. And the second issue is, and well, how do we fight back, right? How do we eliminate some of these harmful thoughts and feelings in our own lives? And I think the first is to really try to become aware of our own bodies and to think about the messages about weight that we see, the stereotypes about weight that we have. Again, these are so automatic that a lot of times we're not even really aware that we see, the stereotypes about weight that we have. Again, these are so automatic that a lot of times we're not even really aware that we have them. But we can assess our own bias in different ways. I think, you know, one way is to become aware of our own implicit bias. And that is the bias that we're not necessarily really consciously paying attention to, like the kinds

of assumptions we make about people because of their weight. And there actually is a really great website that it's really developed by researchers out of Harvard who have created something called the Implicit Associations Test. And it's this online quick survey you can take for all different kinds of social stigmas, but weight is one of them. And it helps you to become just aware of what your automatic associations are when it comes to body weight. We all have them. So I think that's an important first step.

But we can also kind of become more aware of our weight bias by, you know, asking ourselves questions like, okay, how do I feel about people who have larger bodies? What stereotypes do I make? You know, why do I feel about people who have larger bodies? What stereotypes do I make? You know, why do I have those assumptions? And then start to challenge those beliefs, start to challenge those stereotypes. Look for evidence of people that you know or people that you see in your community

or in the broader society or in the media who challenge those views and assumptions. I mean, we can all think of people who aren't very thin people, who have larger bodies, who really defy what have become, you know, very typical weight-based stereotypes. And then to think, I think even further, you know, how can these biases, how do they come out in our behavior? How do they come out in our communication, even if it's an unintentional. So practice

talking with yourself or your partner or family member, you know, how would you communicate more respect for yourself related to your body size or for somebody else? You know, I think you were mentioning before kind of how common it is for us to make comments about our own body weight if we're in the house or putting on an outfit that we don't think looks quite right. Or, you know, there's so many examples where this comes into our daily dialogue and to really ask yourself, you know, why, why am I doing this right now? What purpose does it serve? How can I engage in more self-compassion? How can I show more self-kindness rather than kind of reinforcing shame and blame that, that are already, you know, surrounding us. So there are a lot of steps that I think we can take,

but it kind of requires that active conscious practicing and thinking about how we talk to ourselves and to other people. Yeah. My friend who I've mentioned a few times is like a hero at that is, you know, like, you know, has put so much care into her own life of how she speaks to herself and,

and how she encourages other people to speak to themselves, you know, very active on social media, you know, spreading those messages. And it's like a very, it's funny because it's like self care, self compassion as an act of rebellion is what it comes across as,

as like, fuck you. I'm going to love myself today. And, and it's easy to, I think it's easy to, for like, fuck you. I'm going to love myself today. And, and it's easy to, I think it's easy to, for some people to sniff at that and say like, oh, that's a little, that's a little trivial until you really think about how your own thoughts about yourself are and how damaging they can be. Right. And, and think what a radical act it would be for you to,

to speak to yourself in a kinder way. Absolutely. And I think so often, you know, the voices, the messages that we hear from ourselves are worse than than a lot of other voices. And, you know, to simplify it and say, well, you know, how would you talk if you were a parent? You know, would you say this to your child? Would you say this to your best friend? You know, a lot of times we wouldn't ever consider saying those kinds of comments to somebody else. So the fact that we've given ourselves permission to say them to ourselves is, you know, is it tells us that we have a lot of work to do. And I think self-care and self-compassion is really important.

And, you know, I've had some people respond to this and say, yeah, but if you're if you're telling people love themselves and that that lets them off the hook, they're not going to try to lose weight. They're not going to try to be healthier. You know, and again, you know, I go back to what we, what we know from science, which is that shame is not an effective motivator for change here. It makes it worse. It leads to worse psychological wellbeing. It leads to worse health behaviors. You know, the more that we feel good about ourselves, the more that we do want to engage in these healthier behaviors, the more that

we feel confident in our ability to do that. So, you know, I think self-care, self-compassion is important for so many reasons. And we need to be careful about dismissing it because we think it's going to somehow, you know, contribute to weight gain, which is ridiculous. Yeah. I mean, when you think about, hey, again, people who say, OK, I made a transformative change in my life, you know, which is something I still want to, it's something I still want to encourage people to do. And I'm not just talking about weight or exercise. I'm talking about anything in your life.

You know, I think that's, I think it's really important to have a sense of your own capacity and to realize your capacity is bigger than you might think it is. And, you know, that you can, you can put your mind to something and you can do it. I think that's a really important thing for humans to hold that it, that too, is an act of self-care and self-love. And that to me felt rebellious where, you know, I was at a point in my life where I was very down on myself and I said, no, you know what? I can fucking do shit. You know what I mean? And I think that comes from the same place. It doesn't come from a place of shame and hating yourself. It comes from a place of of recognizing your own capacity. And so I think those two things are intertwined. And I think I agree with you that that's and I want to go further and say that,

you know, loving yourself in that way and having a kind way of speaking to yourself can be the first step of then saying, now, what can I do? Exactly. Exactly. And, you know, for I think a lot of this resonates so much with me as a parent as well, because I think children today are just really getting bombarded with messages that their value in society has so much to do with what they look like and, you know, their skin color, their body shape, their body weight, their clothes, you know, there's so many messages about your value is based on your appearance. And I think, you know, if we as parents can really work on communicating those messages

of self-acceptance and self-love, regardless of what appearance is, and to say that, you know, as a child, you know, to our children that your value in society has so much more to do with your character and your contributions to society and how you treat other people and the goals that you set for yourself and not about what you look like. I mean, those are messages that we just are not hearing enough of and not seeing enough of. And I think that if those were the kinds of values that were more ingrained in our society, that this would be a much different issue that we're talking about. It would not be the big lofty goal that it is to try to reduce the weight stigma. So those kinds of values, I think, speak to a lot of people and they're fundamentally

really important. Yeah. So when you are talking to your own kids, I mean, do you have that experience of, oh my gosh, my kid got something from the wider culture that I've been trying to protect them from, or I've been trying to counteract, you know, in, in your work and, and what do you do in those moments? What, what do you say to them? How do you, how do you handle that? Well, you know, when it comes to messages about weight and food and eating, I mean, kids are bombarded with messages from media, social media, television, film all the time. So as a parent, I can, you know, proactively every day say something to counteract those messages, but that's me as one person. Maybe if I do that every day of

the year, that's 365 messages up against, you know, really strong marketing, advertising and industry, but they're on YouTube every day too, you know, like, right, exactly. So, you know, sometimes I think parents just kind of feel like, well, what impact is this going to have? But I really do think it can have an impact. And I think as parents, our influence is so strong and that we can be a voice that they hear every day that challenges these other harmful messages. And that really encourages them to be confident in who they are and to have self-love and self-acceptance. So, you know, it's a practice, I think, as a parent, we have to be really mindful of. We have to kind of make sure like, hey, did I say anything today or do anything that would help my child have self-acceptance? You know, we've got

to make it part of our job as parents to do that. And I think in general for ourselves as well, you know, we have to put that on our to-do list every day. And just tell me, that's wonderful. And now just tell me the same thing. What do I tell myself differently when I look in the mirror? You know what I mean? Well, I think for every person, that's going to be a different self-statement, but I would really encourage people to think about qualities that they like about themselves and about their bodies and to even write those on sticky notes if they have to, or put them in their phones, remember them as notes, because we all have moments where our body image may be negative, where we're, you know, associating our value with our appearance. And we need to have those other statements of self-affirmation present and there to remind

ourselves of. So, you know, I would encourage that as the first step. Rebecca, I want to thank you so much for coming on the show. This has been a really wonderful conversation. Yeah. And thank you for, thank you for working on this important issue and coming on to talk to us about it. This has been great. Well, thanks so much for having me.

Hey, thank you once again to Rebecca pool for coming on the show. I hope you love that conversation as much as I did. Hey, I want to remind you folks that we are doing some very special stitcher premium only episodes where I will be answering questions from you. So if you have a question, did. Hey, I want to remind you folks that we are doing some very special Stitcher Premium-only episodes where I will be answering questions from you. So if you have a question, please email me at factually at adamconover.net. I'm going to be bringing on some of your favorite comedians

to help me answer them. Should be a great time. Send me your questions at factually at adamconover.net. And that is it for us this week on Factually. I want to thank our producers, Kimmy Lucas and Sam Roudman, our engineer, Andrew Carson, Andrew WK for our theme song. I got to thank the folks at Falcon Northwest for building me the incredible gaming PC that I record this very podcast on,

and check them out, by the way, if you're looking for a gaming PC. You can follow me on Twitch at twitch.tv slash Adam Conover if you want to watch me play games on that PC, and at Adam Conover, wherever you get your social media. Until next week, we'll see you on factually. Thanks so much for listening. And don't forget to stay curious.

That was a hate gun podcast.