Food Psych #220: Why Health At Every Size and Weight Management Can't Coexist with Deb Burgard
Psychologist, fat activist, and Health At Every Size (HAES)® co-founder Deb Burgard returns! We discuss why HAES and weight management can’t co-exist, the social-justice roots of HAES, how weight stigma intersects with other oppressions, the politics of weight science, and so much more. Plus, Christy answers a listener question about how to navigate the food-shaming and fearmongering that’s often present in the world of food justice and environmental conservation.
Deb Burgard, PhD, FAED (Fellow of the Academy for Eating Disorders), is a psychologist and activist from the San Francisco Bay Area specializing in concerns about body image, eating, weight stigma, and relationships. She is one of the founders of the Health at Every Size model, the creator in the mid-1990s of the BodyPositive.com website, and the host of the Show Me the Data listserv, building communities where people can find each other and the resources to resist weight stigma, especially in medical and psychological treatment. Her activism includes working with healthcare providers to integrate an understanding of the social determinants of health and creating interventions that address structural oppression and support stigma resistance. She can be found at conferences sparking impromptu dance parties in the pool, and online at BodyPositive.com.
We Discuss:
What Deb has been up to since her first appearance on Food Psych
The increasing demand for Health At Every Size care
The social-justice roots of HAES
How to respond to the question of why HAES and weight management can’t co-exist
Weight stigma, and how it intersects with other oppressions
Why weight loss is not an effective way to reduce weight stigma, and in fact perpetuates it
Why HAES needs to be a collective movement
The effects of systemic oppression on health
Weight stigma and weight cycling as the potential causes of health concerns in higher-weight people, not weight or fat
Fundamental attribution bias, and its effect on current weight stigma research
The politics of scientific research
The research justice movement
The economics of liberation
Fatphobia in progressive spaces
Deb’s one-question test for whether research contains weight bias
Why only looking at recent research is problematic
The history of the “obesity epidemic”
Why media photos of larger bodies are not representative of the general population
Childhood “obesity,” and issues with its diagnostic criteria and treatments
Why framing eating disorders as a “niche concern” is harmful
Debunking the study that Kurbo is using to “prove” that dieting does not lead to eating disorders in children
The problem with diagnostic criteria for anorexia
The need for research about the lived experience of larger-bodied folks
Resources Mentioned
Some of the links below are affiliate links. Affiliates or not, we only recommend products and services that align with our values.
Submit your questions for a chance to have them answered on the podcast!
My online course, Intuitive Eating Fundamentals
My new book, Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating
Help spread the anti-diet message by subscribing to the podcast
Deb’s previous Food Psych® episode
Paul Ernsberger’s work
“Consequences of weight cycling in obese spontaneously hypertensive rats” (CW: o-words)
Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings
Dieter’s Dilemma: Eating Less and Weighing More by William Bennett and Joel Gurin
“Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta‐analysis” (CW: o-words, calorie and weight numbers, fatphobic language)
Poodle Science video
Questions to ask about research on weight and weight loss interventions:
1. Could the authors come to this conclusion based on this data if they did not already believe that fat is bad? For example, is there a different way to explain these data that builds on data we already have from other studies - like weight cycling or exposure to stigma? How do the authors control for the impact of the social determinants of health? Do they have any controls for SES?
2. Does the research span a long enough period to capture the entire relevant phenomenon? For weight loss studies, does the follow up period last long enough to pick up weight regain (usually 2-5 years)?
3. Does the follow up period actually capture most of the people (because drop outs are a big problem research in this area and we can assume people who drop out are more likely to be regaining weight)? How did they handle missing data? If it is to assume people are the weight they were when last measured (last value carried forward), the findings will be biased because they fail to capture regain.
4. Does the "follow up" period actually have the people who were followed up that whole time or is it "up to" that time, i.e., is the "follow up time" the minimum amount of time people were followed or the maximum? How many were actually followed for that period?
5. How are the outcomes operationally defined and how might there be selection biases in that definition? Do the measures to capture outcomes actually work for this population? Were they normed on this population?
6. Are these findings that are being generalized beyond the data? If this is a group of people seeking help, they are not necessarily going to be the same as fat people in general. If this is not a randomized sample, how might the way people happen to become participants affect whether you can see them as representative?
7. Many studies use a "matched control" group where all kinds of shenanigans can happen because the people who the researchers are using as the control group may or may not represent fat people in general, and therefore bias the results. One recent example was a study on bariatric surgery that used fat people who were hospitalized as the control group for surgery survivors who were hospitalized.
Listener Question of the Week
How can a person navigate eating what they want in spaces where people have loud opinions about how we “should” be eating, especially when those opinions are based in environmental justice? How can people talk about food-access issues and climate change without resorting to restrictive eating and shameful language? Why is food activism messaging often problematic? How much do individual behaviors contribute to health compared to social determinants of health? What would make a real difference when it comes to the environment? How can disordered eating affect political activism? Why is the idea of “voting with your fork” problematic?
Resources Mentioned:
My book, Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating
Food Psych episode #217 with Kendrin Sonneville
“Just 100 companies responsible for 71% of global emissions, study says” (news article)
Food Psych episode #121 with Emily Contois
Food Psych episode #196 with Sabrina Strings