Ragen Chastain is a terrific writer as well as incredibly powerful advocate against fatphobia. I appreciate her work so very much. I also appreciate how she credits others—like Black women who've written about the intersections between racism and fatphobia and other writers like Kate Harding, whose blog Shapely Prose was a milestone in fat-positive writing and advocacy, not to mention a place that built community among people questioning diet culture, exploring Health At Every Size (before that was even a well-known term), and generally pushing back against sizism everywhere. I highly recommend Kate's book, co-authored with Marianne Kirby, another great writer and blogger fighting the good fight against fatphobia, _Lessons from the Fat-o-sphere: Quite Dieting and Declare a Truce with Your Body_. Hard to believe it was published way back in 2009. Still a radical publication by any measure. And to add another name: Melissa McEwan, owner of the blog Shakesville, who wrote about fatphobia and its intersections with racism, sexism, and ableism many times over the years the blog was active. (Unfortunately and horrifyingly, she's no longer publishing online because her health was compromised after years of online abuse and threats to her life and that of her family.)
Please understand that I am not trying to troll - I really would like genuine replies and dialogue. I love and value this community and that's why I feel comfortable asking hard questions here.
"I don’t judge anyone who’s bigger, but, you know, there are real health considerations!" We should not be judging anyone on their size, and I agree that it's harmful to use that as a way to try and get someone else to lose weight. I experienced the fatphobia in the medical world and know how awful it is and how much junk science is out there and how so much of what we are told about health isn't scientific at all. I know what it is like to have improved my health while I was still obese so I know that weight isn't everything.
That said, we cannot ignore the real fact that some people have real health considerations that improve or even go away with dietary changes and weight loss. I know my story is rare - I not only fall into the 5% success rate of weight loss stories, but I have managed to greatly improve my chronic health issues (with some even going into remission). I am also aware these changes won't last forever - my pain will likely increase in time - but it's made it possible for me to live a better life now, and that is a victory worth celebrating.
(To give a direct example of how weight loss improved my health: I have Ehlers-Danlos Syndrome and as a result have a tendency to dislocate body parts. Losing weight caused a dramatic decrease of pressure on my hips, knees, and ankles, which not only caused fewer subluxations and sprains but also gave me the ability to start working out to strengthen my muscles so that I dislocate even less. How dietary changes improved my health: reducing sugar and starches dramatically reduced my inflammation in my joints and therefore the amount of pain I feel on a daily basis. Losing weight as a result of these changes also decreased pressure on them.)
I guess my attitude on all of this is that we can't come out and say it's a complete failure to want to try to lose weight for health benefits, because it can and does happen. I don't fully criticize Alcoholics Anonymous and other 12 step programs because they only works for 5% of people, because for the 5% it did work for, it was life changing and that matters and it's important to not invalidate their journeys. There are problematic aspects to 12 step programs (like the idea that only their way works) but we have to acknowledge that they do help a lot of people.
I don't think you're trying to troll at all, Wren, and I'm grateful that you took the time to write this out — and I think your experience is totally valid and makes sense to me!
Hi Wren, I definitely don't think that you are trying to troll, and the argument you are outlining is a very common one, but there are some pieces missing here that I want to fill in.
Predominantly, it's important to understand that It's not just that weight loss fails almost all the time, it's that failing at weight loss is not benign - it causes harm.
Weight-cycling (aka yo-yo dieting) which is, by far, the most common outcome of more than one weight loss attempt has been independently linked to most of the same health issues to which being higher weight is linked. So it's not just that the vast majority of people will fail at weight loss, it's that they will very likely be less healthy for having tried.
Those who are trying to lose weight as a way to deal with joint pain etc. should be aware that up to 66% of those who fail at weight loss actually gain back more than they lost, so if the belief is that body weight is the "problem," then intentional weight loss will make the "problem" worse up to 2/3 of the time.
While a few individuals may experience benefits of weight loss (and even for most of those folks , the benefits will only last until the weight is regained within 2-5 years,) the majority of people will, again, not only fail at their weight loss attempt, but be harmed by it both physically and psychologically.
For example, Bacon and Aphramor found that "Weight cycling results in increased inflammation, which in turn is known to increase risk for many ob*sity-associated diseases. Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia. Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk. Weight cycling can account for all of the excess mortality associated with ob*sity in both the Framingham Heart Study and the National Health and Nutrition Examination Survey (NHANES). It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself."
Gaesser and Angadi also found that "weight cycling is associated with numerous adverse health outcomes including increased mortality"
And those are just a couple quick examples.
The risks of weight loss attempts are especially significant when we look at the fact that weight-neutral interventions consistently provide greater health benefits without the inherent risks of weight loss. (Matheson et. al, Wei et. al., Gaesser and Angadi, Bacon and Aphramor and more.)
For these reasons, intentional weight loss simply doesn't meet the requirements of an ethical, evidence-based health intervention.
Again, I really appreciate this question - it makes me realize that I haven't written specifically in my newsletter about about the harms of intentional weight loss attempts, I now have the on my list of topics!
Hi Ragen, thank you for taking the time to write out your detailed reply. Since I wrote my first comment this morning, I read several of your articles on your substack. I admit that I hadn't considered the harm that would happen with failed attempts, because you're right - it would leave 2/3 of people in worse shape than they started.
Before my current success, I had failed attempts, too. I guess I never really thought of them that way because the one time where I regained the weight and the three where I gained more were all directly related to me using food and binge eating as a response to trauma. My health issues all existed prior to these attempts, but could these attempts have accelerated them and/or made them worse? It's possible.
Something I'd like your input on: the more that I think about my past five years, I realize that my weight loss was ultimately not the primary focus - it wasn't a goal but a reasonable expectation to eating differently and moving more. I started this journey in 2017 specifically because my body was reacting poorly to diabetic medications (my body is super sensitive to medication in general). Now, according to the BMI scale I am 10 pounds overweight but I don't really care - I have gotten into running, cycling, swimming, strength training, and yoga and have general goals based on getting stronger and not based on a number on the scale or fitness machine.
My question is this: would you consider something like this to be a more weight-neutral practice? Where the focus is on getting stronger, using food and exercise as medicine, and if I lose weight, that's a happy benefit, but if I stay the same or gain weight, that's fine, too?
Hi Wren, thanks for sharing your story and asking these questions! I think something like what you are talking about is on its way to weight-neutral, but isn't quite there yet.
The core of a weight-neutral practice is that weight and weight changes are not seen as good/bad, happy/sad, or as a benefits.
So in a weight-neutral health/fitness practice (with the understanding that health/fitness are not an obligation, barometer of worthiness, or entirely within our control) we focus on health/fitness interventions to meet health/fitness goals - (whether that is to increase strength, stamina, flexibility, balance etc., or trying to influence metabolic health,) without putting a value or judgment on our sizes or on changes to our size.
The idea of weight-neutral practice is rooted in (and must remain inextricable from) intersectional social justice and fat liberation. When we value weight loss or a smaller body, we (even if unintentionally) invest in and perpetuate weight stigma, which is rooted in racism and anti-Blackness (see Sabrina Strings' Fearing the Black Body and Da'Shaun Harrison's Belly of the Beast for more on this) and harms people of all sizes, but does the most harm to people who are at higher weights and have multiple marginalized identities. I hope that helps!
That's a very helpful explanation - thank you, Ragen!
I appreciate you taking the time to explain this all to me. I want to do right by my 2.5 year old daughter as she grows up because I want her to love her body at any/every size and I don't want her to be sucked into toxic diet culture. When she's old enough to understand, I'll explain that Mommy sometimes eats differently because some foods make mommy's belly and joints hurt, but that I want her to enjoy those foods and all different kinds of foods. She already knows that I love running races because I think they're fun, and that'll extend to other activities, too.
Thank you so much for this conversation Wren. I think that's a lovely way to discuss things with your daughter, you are an amazing parent for thinking about this and I wish you both well!
Really excellent interview, thank you for the intro to Ragen's newsletter! The post about vaccine needle lengths is fascinating, alongside the point that "the healthcare system often fails to accommodate us in everything from chairs in the waiting room, to gowns, to MRIs, beds, durable medical equipment and more"
Yes! The amount of fatphobia in the healthcare system is striking. The big area that my husband and I encountered fatphobia is with medication and medical studies. Medications affect people differently at different body weights, and it's not always as simple as just upping or lowering doses. Sometimes it means taking different classes of drugs or taking drugs "off-label" because of how bodies of different sizes metabolize differently.
I really liked her take on privilege and trolls. Especially this: "if I cancel a talk due to death threats, I can expect death threats every time I plan to take the stage. It’s unlikely that they will follow through, but it is a possibility. I thought long and hard about it, and decided that it’s ultimately worth the risk to do this work."
I find it fascinating I’ve never heard of Ragen until now. I also find it remarkable as a man how much I relate to issues commonly attributed to women & body dysmorphia. As a matter of fact, my current therapist is one who usually sees patients who struggle with disordered eating. And they were almost exclusively women. I didn’t set out to find a specific therapist this way, I just liked her bio & needed immediate help through a crisis (not related to weight).
I’ve lost 130 lbs & I'm healthier, but I’ve become disenchanted with the compliments I get. The attributes I receive about me being more confident, how I’m different, and that people see me as someone who can be a leader where all attributes I had when I was 330 lbs and at 42% bodyfat. Why being 200 lbs @ 24% shows this is unsettling. Why did it have to take such radical weight loss to be perceived as a strong confident person?
I can’t even explain on here how being a black man growing up shaped these observations & how I basically adapted to accept people’s projections on who I was supposed to be based upon my outwardly appearance. Being large and tall I could never express anger - lest I bring upon myself the label of big angry black man. So I had to be Mr. Velvet Teddy Bear. I’m so grateful for this newsletter & people like Ragen who take the time out to remind me that what I learned was nonsense & I don’t need to frame or own other people’s expectations anymore.
Thank you for this excellent interview. I found Chastain’s advice on trolling to be particularly brilliant and useful: why are we asked to center the troll? He is, after all, the one being cruel and abusive. How much more sensible and healthy to focus instead on our own needs and goals.
As for the discussion of fat phobia in healthcare, I find it depressing that so many doctors and nurses—who otherwise rightly follow and implement information from scientific research—will ignore or reject the mountain of evidence that dieting doesn’t work, and that some people will naturally become fat no matter what they do. And that goes even more so for our culture.
But then, I grew up in a family where my mom and brother were fat, and my dad and I were thin. We ate the exact same food, and if anything my brother exercised much more than I did. It just seems so obvious to me that fat and thin have more to do with inborn traits than with ingested food. Let us hope that writers like Chastain will make this fact obvious to everyone.
Ragen Chastain is a terrific writer as well as incredibly powerful advocate against fatphobia. I appreciate her work so very much. I also appreciate how she credits others—like Black women who've written about the intersections between racism and fatphobia and other writers like Kate Harding, whose blog Shapely Prose was a milestone in fat-positive writing and advocacy, not to mention a place that built community among people questioning diet culture, exploring Health At Every Size (before that was even a well-known term), and generally pushing back against sizism everywhere. I highly recommend Kate's book, co-authored with Marianne Kirby, another great writer and blogger fighting the good fight against fatphobia, _Lessons from the Fat-o-sphere: Quite Dieting and Declare a Truce with Your Body_. Hard to believe it was published way back in 2009. Still a radical publication by any measure. And to add another name: Melissa McEwan, owner of the blog Shakesville, who wrote about fatphobia and its intersections with racism, sexism, and ableism many times over the years the blog was active. (Unfortunately and horrifyingly, she's no longer publishing online because her health was compromised after years of online abuse and threats to her life and that of her family.)
Please understand that I am not trying to troll - I really would like genuine replies and dialogue. I love and value this community and that's why I feel comfortable asking hard questions here.
"I don’t judge anyone who’s bigger, but, you know, there are real health considerations!" We should not be judging anyone on their size, and I agree that it's harmful to use that as a way to try and get someone else to lose weight. I experienced the fatphobia in the medical world and know how awful it is and how much junk science is out there and how so much of what we are told about health isn't scientific at all. I know what it is like to have improved my health while I was still obese so I know that weight isn't everything.
That said, we cannot ignore the real fact that some people have real health considerations that improve or even go away with dietary changes and weight loss. I know my story is rare - I not only fall into the 5% success rate of weight loss stories, but I have managed to greatly improve my chronic health issues (with some even going into remission). I am also aware these changes won't last forever - my pain will likely increase in time - but it's made it possible for me to live a better life now, and that is a victory worth celebrating.
(To give a direct example of how weight loss improved my health: I have Ehlers-Danlos Syndrome and as a result have a tendency to dislocate body parts. Losing weight caused a dramatic decrease of pressure on my hips, knees, and ankles, which not only caused fewer subluxations and sprains but also gave me the ability to start working out to strengthen my muscles so that I dislocate even less. How dietary changes improved my health: reducing sugar and starches dramatically reduced my inflammation in my joints and therefore the amount of pain I feel on a daily basis. Losing weight as a result of these changes also decreased pressure on them.)
I guess my attitude on all of this is that we can't come out and say it's a complete failure to want to try to lose weight for health benefits, because it can and does happen. I don't fully criticize Alcoholics Anonymous and other 12 step programs because they only works for 5% of people, because for the 5% it did work for, it was life changing and that matters and it's important to not invalidate their journeys. There are problematic aspects to 12 step programs (like the idea that only their way works) but we have to acknowledge that they do help a lot of people.
I don't think you're trying to troll at all, Wren, and I'm grateful that you took the time to write this out — and I think your experience is totally valid and makes sense to me!
Thank you so much, Anne. That means a lot to me!
Hi Wren, I definitely don't think that you are trying to troll, and the argument you are outlining is a very common one, but there are some pieces missing here that I want to fill in.
Predominantly, it's important to understand that It's not just that weight loss fails almost all the time, it's that failing at weight loss is not benign - it causes harm.
Weight-cycling (aka yo-yo dieting) which is, by far, the most common outcome of more than one weight loss attempt has been independently linked to most of the same health issues to which being higher weight is linked. So it's not just that the vast majority of people will fail at weight loss, it's that they will very likely be less healthy for having tried.
Those who are trying to lose weight as a way to deal with joint pain etc. should be aware that up to 66% of those who fail at weight loss actually gain back more than they lost, so if the belief is that body weight is the "problem," then intentional weight loss will make the "problem" worse up to 2/3 of the time.
While a few individuals may experience benefits of weight loss (and even for most of those folks , the benefits will only last until the weight is regained within 2-5 years,) the majority of people will, again, not only fail at their weight loss attempt, but be harmed by it both physically and psychologically.
For example, Bacon and Aphramor found that "Weight cycling results in increased inflammation, which in turn is known to increase risk for many ob*sity-associated diseases. Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia. Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk. Weight cycling can account for all of the excess mortality associated with ob*sity in both the Framingham Heart Study and the National Health and Nutrition Examination Survey (NHANES). It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself."
Gaesser and Angadi also found that "weight cycling is associated with numerous adverse health outcomes including increased mortality"
And those are just a couple quick examples.
The risks of weight loss attempts are especially significant when we look at the fact that weight-neutral interventions consistently provide greater health benefits without the inherent risks of weight loss. (Matheson et. al, Wei et. al., Gaesser and Angadi, Bacon and Aphramor and more.)
For these reasons, intentional weight loss simply doesn't meet the requirements of an ethical, evidence-based health intervention.
You can find links the research I'm referring to (and more!) at www.HAESHealthSheets.com/resources.
Again, I really appreciate this question - it makes me realize that I haven't written specifically in my newsletter about about the harms of intentional weight loss attempts, I now have the on my list of topics!
I hope that helps. Very best to you!
I’m excited for that newsletter! It’s kind of brutal to realize how many of us start on the weight cycling path as children.
Hi Ragen, thank you for taking the time to write out your detailed reply. Since I wrote my first comment this morning, I read several of your articles on your substack. I admit that I hadn't considered the harm that would happen with failed attempts, because you're right - it would leave 2/3 of people in worse shape than they started.
Before my current success, I had failed attempts, too. I guess I never really thought of them that way because the one time where I regained the weight and the three where I gained more were all directly related to me using food and binge eating as a response to trauma. My health issues all existed prior to these attempts, but could these attempts have accelerated them and/or made them worse? It's possible.
Something I'd like your input on: the more that I think about my past five years, I realize that my weight loss was ultimately not the primary focus - it wasn't a goal but a reasonable expectation to eating differently and moving more. I started this journey in 2017 specifically because my body was reacting poorly to diabetic medications (my body is super sensitive to medication in general). Now, according to the BMI scale I am 10 pounds overweight but I don't really care - I have gotten into running, cycling, swimming, strength training, and yoga and have general goals based on getting stronger and not based on a number on the scale or fitness machine.
My question is this: would you consider something like this to be a more weight-neutral practice? Where the focus is on getting stronger, using food and exercise as medicine, and if I lose weight, that's a happy benefit, but if I stay the same or gain weight, that's fine, too?
Hi Wren, thanks for sharing your story and asking these questions! I think something like what you are talking about is on its way to weight-neutral, but isn't quite there yet.
The core of a weight-neutral practice is that weight and weight changes are not seen as good/bad, happy/sad, or as a benefits.
So in a weight-neutral health/fitness practice (with the understanding that health/fitness are not an obligation, barometer of worthiness, or entirely within our control) we focus on health/fitness interventions to meet health/fitness goals - (whether that is to increase strength, stamina, flexibility, balance etc., or trying to influence metabolic health,) without putting a value or judgment on our sizes or on changes to our size.
The idea of weight-neutral practice is rooted in (and must remain inextricable from) intersectional social justice and fat liberation. When we value weight loss or a smaller body, we (even if unintentionally) invest in and perpetuate weight stigma, which is rooted in racism and anti-Blackness (see Sabrina Strings' Fearing the Black Body and Da'Shaun Harrison's Belly of the Beast for more on this) and harms people of all sizes, but does the most harm to people who are at higher weights and have multiple marginalized identities. I hope that helps!
That's a very helpful explanation - thank you, Ragen!
I appreciate you taking the time to explain this all to me. I want to do right by my 2.5 year old daughter as she grows up because I want her to love her body at any/every size and I don't want her to be sucked into toxic diet culture. When she's old enough to understand, I'll explain that Mommy sometimes eats differently because some foods make mommy's belly and joints hurt, but that I want her to enjoy those foods and all different kinds of foods. She already knows that I love running races because I think they're fun, and that'll extend to other activities, too.
Thank you so much for this conversation Wren. I think that's a lovely way to discuss things with your daughter, you are an amazing parent for thinking about this and I wish you both well!
Thank you, Ragen!
Really excellent interview, thank you for the intro to Ragen's newsletter! The post about vaccine needle lengths is fascinating, alongside the point that "the healthcare system often fails to accommodate us in everything from chairs in the waiting room, to gowns, to MRIs, beds, durable medical equipment and more"
Yes! The amount of fatphobia in the healthcare system is striking. The big area that my husband and I encountered fatphobia is with medication and medical studies. Medications affect people differently at different body weights, and it's not always as simple as just upping or lowering doses. Sometimes it means taking different classes of drugs or taking drugs "off-label" because of how bodies of different sizes metabolize differently.
I really liked her take on privilege and trolls. Especially this: "if I cancel a talk due to death threats, I can expect death threats every time I plan to take the stage. It’s unlikely that they will follow through, but it is a possibility. I thought long and hard about it, and decided that it’s ultimately worth the risk to do this work."
I find it fascinating I’ve never heard of Ragen until now. I also find it remarkable as a man how much I relate to issues commonly attributed to women & body dysmorphia. As a matter of fact, my current therapist is one who usually sees patients who struggle with disordered eating. And they were almost exclusively women. I didn’t set out to find a specific therapist this way, I just liked her bio & needed immediate help through a crisis (not related to weight).
I’ve lost 130 lbs & I'm healthier, but I’ve become disenchanted with the compliments I get. The attributes I receive about me being more confident, how I’m different, and that people see me as someone who can be a leader where all attributes I had when I was 330 lbs and at 42% bodyfat. Why being 200 lbs @ 24% shows this is unsettling. Why did it have to take such radical weight loss to be perceived as a strong confident person?
I can’t even explain on here how being a black man growing up shaped these observations & how I basically adapted to accept people’s projections on who I was supposed to be based upon my outwardly appearance. Being large and tall I could never express anger - lest I bring upon myself the label of big angry black man. So I had to be Mr. Velvet Teddy Bear. I’m so grateful for this newsletter & people like Ragen who take the time out to remind me that what I learned was nonsense & I don’t need to frame or own other people’s expectations anymore.
Thank you for this excellent interview. I found Chastain’s advice on trolling to be particularly brilliant and useful: why are we asked to center the troll? He is, after all, the one being cruel and abusive. How much more sensible and healthy to focus instead on our own needs and goals.
As for the discussion of fat phobia in healthcare, I find it depressing that so many doctors and nurses—who otherwise rightly follow and implement information from scientific research—will ignore or reject the mountain of evidence that dieting doesn’t work, and that some people will naturally become fat no matter what they do. And that goes even more so for our culture.
But then, I grew up in a family where my mom and brother were fat, and my dad and I were thin. We ate the exact same food, and if anything my brother exercised much more than I did. It just seems so obvious to me that fat and thin have more to do with inborn traits than with ingested food. Let us hope that writers like Chastain will make this fact obvious to everyone.
Excellent article