Navigating the Societal Impacts of Weight and Body Image

David:

Welcome to Disarming Data. We're looking at data and privacy from the perspective of two generations.

Paige:

I'm Paige Biderman. I'm a millennial who grew up in the tech generation.

David:

I'm David Biderman, I'm the boomer. I don't know anything about tech. I usually lose my cell phone rather than use my cell phone. I'm a tech novice. In this podcast, we'll be having conversations with cyber hackers, privacy experts, and guardians of security who can explain some of this to me.

Paige:

And Dad, you forgot about whistleblowers and other people who are interesting and influential to us.

David:

And Paige, you forgot to say thank you for listening to the show.

Paige:

Thanks for listening. Welcome to Disarming Data where we interview really interesting people from two different generational perspectives. Today on the podcast, we are very excited to have Dr. Sarah Nutter. She conducts research broadly related to weight related issues including weight stigma, body image, and eating disorders. I believe her primary research is focused on weight stigma and better understanding the cultural and ideological influences on weight stigma. And she's interested in better understanding the influence of weight stigma on healthcare and the attitudes of healthcare professionals. So welcome to the podcast. We always like to start off by asking our guests kind of where they're from and how they got into the field that they're working in.

Dr. Sarah Nutter:

Yeah. Well, thanks so much for the invitation. I'm so excited to be here and to have this conversation with you. So I guess I got to where I am as a weight stigma researcher because of the weight stigma that I experienced in childhood and the body dissatisfaction I experienced throughout my early years. So I grew up in a small town in southern Ontario about an hour and a half from Toronto. And there were many great things about growing up there. And as myself, as one of the only, a few larger bodied children in my school, I was bullied and teased for my weight. Thankfully, not all of the time and not from all of my peers. But these experiences definitely left an impact that led to a really awful relationship with my body. So I was dissatisfied with my weight throughout my childhood and teen years. I went on my first diet at about 10 years old-

David:

Oh, gosh.

Dr. Sarah Nutter:

Yeah, experiencing the shame that people can feel, especially young girls and women when their body doesn't measure up to what it should in our society. And so I experienced that yo-yo dieting from an early age. So what happens when we feel the success of losing weight and the excitement that comes with buying new clothes and compliments from other people, but then as people who've dieted and engaged in yo-yo dieting, we'll know the weight slowly climbs back on. And that's followed by another attempt at weight loss. And over time, my body just became less responsive to those dieting and exercise behaviors. And at about this time, I was also doing my bachelor's degree in psychology. And I've always been, I think partly because of my experiences with bullying, really interested in why people treat others differently or why people treat others the way they do.

And so in the context of doing this psychology degree, I guess I just realized that I essentially had a choice to make because my body wasn't responding to these dieting and exercise behaviors. I could continue to hate my body and experience the consequences to self-worth and self-esteem and everything that came with that, or I could reject the idea that these behaviors worked and were something that I needed to do and I could just learn to love myself for who I was. And I think that really was the first step to becoming aware of and rejecting diet culture that led me to the research that I did during my master's and my PhD and specializing in weight stigma research and now being at the University of Victoria, so.

David:

That's great. I forgot to introduce myself, I'm David. I'm the older one, obviously the younger people always forget about me. So that's-

Paige:

No, I said we come from two different generational [inaudible 00:04:46] And I feel like especially as women, it's always a really important topic because I feel like I was stubbier when I was growing up and I did ballet. And so it's a very harsh culture when it comes to size. And I mean Los Angeles is originally where I'm from, so Los Angeles is just like this melting pot of diet culture. And you'll sit down at a dinner table and everyone's like, okay, what's your diet this month? What's your diet this month? And then going to other places, it's not as extreme, but there's still such heavy stigma. And I actually read an article in the economists very recently that was published all about weight discrimination in the workplace. And I was wondering if you'd be willing to touch on that a little bit?

Dr. Sarah Nutter:

Yeah. Yeah, I think weight discrimination happens everywhere. And one of the places we know a little bit about is the workplace. I think it comes in different shapes and forms, if you will, in that people might experience weight discrimination in the form of not being hired for a job. Perhaps they don't have as much opportunity from say, upper management or supervisors for promotion or advancement in the workplace. And perhaps it might also come out in wage increases over time. So there was a research study conducted in Germany a number of years ago where they looked at weight-based wage differences for individuals across different age categories as well as depending on how long they had been in the workplace. After they controlled for job performance related factors for men, any weight-based wage difference disappeared. But for women, it held true and they found that regardless of a woman's age and regardless of how long a woman had been in the workforce, higher weight women earned statistically less. And as a woman's weight decreased, her wage increased.

Paige:

Wow.

David:

That's really interesting. We found your name because you've been quoted a lot because of these weight loss drugs and there's a lot of stuff we want to talk. We wanted to get your perspective because literally my secretary is on those drugs. He's a diabetic, but he's lost 40 pounds. And then Paige, you know a bunch of people that are on these things.

Paige:

I know a bunch of people, but I also know people that are of normal weight that are taking them that clearly were not satisfied with where their bodies were at, but they would not be considered overweight. And I mean, I don't even know how they get prescriptions for them, honestly, because it doesn't seem healthy. I know it's helpful to some people, and I understand that some people do have weight to lose and it can be really helpful. But my understanding also is that if they stop taking the drugs, all the weight tends to come back on. And I was wondering if you could touch on that as well.

Dr. Sarah Nutter:

Yeah, I have, gosh, I have so much to say about these drugs and most of it isn't very good. Yeah, I do recognize that for some people with certain health situations and health conditions, these kinds of drugs might be really beneficial for them. But I also like to acknowledge, I'm not their healthcare provider. I don't know what's happening with their health and I don't know what decisions are best for them in their health. But I also know that there's a lot of people who aren't getting these medications from healthcare providers. I was at a conference just a couple weeks ago and heard somebody say that they heard people are getting it through medi-spas and other sort of back doorways of getting access to these medications, which is dangerous for a number of reasons. When we think about that individual's health, are they even, do they know of, are they following dosage guidelines? Should they even be on this medication? And I think what it really comes down to in the conversation around these weight loss drugs for me is why are we excited about these weight loss drugs and why are people using them?

And people might talk about these being breakthroughs for health, but I think when we use the word health, what we're really masking is how excited we are with regard to weight loss. And I think there's a lot of cultural confusion around whether or not weight is an indicator of health, which it's not, and how weight loss is perceived as healthy when in a lot of ways what people do to lose weight such as abuse, these kinds of drugs is incredibly unhealthy and can come with significant risks not only to physical health but to mental health as well.

Paige:

Do you know of the long-term side effects of these drugs or is it even hard to say because they are really so new, I think?

Dr. Sarah Nutter:

Yeah, I think it is really hard to say and we will definitely learn more as time goes on. I did take a peek at the website for the potential safety information for semaglutide, and there's some research studies with rodents that have showed an increased risk for thyroid cancer. And although that's studies done with mice for example, that doesn't mean that that's not true for humans. That means that biologically there's potentially a risk for us as well. A number of people have developed pancreatitis, which is really serious and can be fatal for some people. Gallbladder disease is indicated on the safety information, especially as noted when youth take the medication. So people over 12. Hypoglycemia, so low blood sugar, that's important for people with diabetes. So extra care and monitoring for those folks. Kidney injury has happened among people with and without kidney problems. Vision loss among a small subset of people with and without diabetes, yeah, and not necessarily full vision loss, but even if we're seeing decreases in the quality of vision just because of a medication, that's something to worry about.

And then we're also seeing, according to the safety information, resting heart rate increases of about one to four beats per minute. And when we see resting heart rate increases outside of the context of these kinds of drugs, people could start getting really worried about cardiovascular health pretty quickly. So what does this mean for blood pressure or risk of heart attack or stroke or other things? And so not to say that these drugs directly cause those cardiovascular conditions, but is that increase in resting heart rate something to worry about for those reasons? So I think there's a lot of unanswered questions. And then to your question earlier, Paige, about weight regain. Yeah, you stopped taking a medication, we're likely going to regain the weight. And so at what cost potentially long-term are people engaging in weight loss efforts that perhaps from a medical perspective, they didn't need to engage in the first place.

Paige:

Wow, I did not know about the vision loss or things like that. And it's interesting though because I guess I'm wondering why are, like particularly, I mean you're in Canada, but I would assume it's very similar in a lot of ways. Like why is that we're so obsessed with weight? I feel like it's such an obsession on both ends of the spectrum, like it's very, just like, but we have such big problems with different eating disorders I think that are not as high in other countries. And I'm just wondering why are people so obsessed with it?

Dr. Sarah Nutter:

Yeah, absolutely. I would say Canada and the US are very similar, but like cultural cousins if [inaudible 00:12:55]. Yeah, so why are we so obsessed with weight? That's such a good question. I think a cultural obsession with weight has been longstanding and has also grown over time, such that we used to not necessarily focus on thinness as this beauty ideal and this ideal of what it meant to be attractive to say the people we want to be attracted to us for our romantic relationships or what it means to be successful in the world. But this has been something that has become part of our culture, especially through say the 1970s. We can think about the cultural icon of Twiggy as an example, right David? Yeah.

David:

Yeah [inaudible 00:13:50] I'm the old generation. I can remember [inaudible 00:13:51].

Dr. Sarah Nutter:

Yeah, of a cultural icon that really demonstrated an increasing obsession with thinness in our society. We can see models and entertainers and pictures in magazines and advertising getting slimmer and slimmer over time. And although that say has shifted with the way in which more recent celebrities like say the Kardashians have branded at attractiveness, there is still selective musculature sort of selected larger breasts, bigger hips, big butt, but the overall thinness is still there. And so in addition to this preference for thinness in our culture, there's also been an increase in beliefs around weight and the morality of weight. And so weight is something that not only is part of our attractiveness ideals, but is really connected to how moral we're viewed as human beings in our society.

So we have this really strong belief in our culture that weight is an indicator of health, that people are able to control their weight through their behaviors such as what they eat and how much they exercise, and that people have this moral responsibility to society and to their community to be in a quote, unquote, "healthy weight." Research doesn't support necessarily any or all of these beliefs or fully support them to any great extent, but these beliefs and attitudes persist in our society. And so because it's a moral responsibility, people who don't measure up to these health and beauty and body ideals are stigmatized and demonized, and all of this is referred to as diet culture. So essentially the beliefs we have in our culture around what it means to have a good body and the food and exercise and related beliefs and behaviors that we engage in to attain that beautiful body.

David:

Oh, that's really interesting. A couple, I'm going to back up a little bit. One is on these drugs and the side effects, how do those, do you know how those drugs work? I mean, they do something in their brain, right, or what, do you know what they do?

Dr. Sarah Nutter:

As somebody who's not a physician, and I don't have a strong biology background, I can't tell you the specific details of how they work, but my understanding is that a big way in which these drugs work for people is that they curb hunger. So people who struggle with say feeling hungry for different reasons because we can feel hungry for different reasons. Maybe we're bored, maybe we're feeling emotional and we're eating to cope. Maybe we actually are physiologically hungry. All of these are really valid reasons for being hungry, but the drug essentially lessens those feelings that we have so people don't feel the need to eat as much, but that comes with a cost of not only those potential long-term safety concerns, but really common side effects are gastrointestinal, right, for I could use some more colorful language there.

David:

We got it.

Dr. Sarah Nutter:

Yeah.

David:

Well then just backing up one thing, I read some of your articles and you're very firm that obesity is not an indicator of health. Maybe you could expand on that and are there exceptions to that rule or is that, just I wanted you to talk about that all if you don't mind.

Dr. Sarah Nutter:

Yeah, absolutely. I know. Well, and I think that's a really important question because of the way in which obesity and weight is talked about in our culture, right? What do you mean obesity isn't always a bad thing or obesity itself is potentially an unhelpful term, but it totally is and that researchers know that BMI is flawed. I read a really interesting chapter on the history of BMI recently, and it was never actually created to be an indicator of health. It was co-opted as an indicator of health.

So researchers that have tried to better understand the connection between body weight and physical health outcomes and risk of death have found that there's actually not the best correlation between those two things, and that people are healthy and unhealthy across the weight spectrum, that this idea of categorizing people as healthy or unhealthy based on their BMI is potentially pathologizing people as being unhealthy or diseased, that experience good health, and also potentially not indicating people in what we might call a normal body weight category as needing healthcare that they might need because we're maybe only screening or thinking about poor health in certain ways as associated with higher body weights, if that makes sense.

Paige:

It does make sense actually. It's interesting, and I felt, I really agree with that. BMI is not a great indicator because I date someone who would be considered very small and thin, but their BMI is still out of the range of healthy, and I don't know, it's just so bizarre to me.

Dr. Sarah Nutter:

Absolutely. Absolutely. And we know that also weight isn't easily controllable. So we have this idea that higher weights are unhealthy, lower weights are healthy, and that people have done it to themselves, right? Calories in versus calories out is this idea we have about body weight in our culture, but body weight is actually incredibly complex. And in 2007, there was this report released, and so I say 2007 because it's been how many years? This picture that was painted in 2007 is way more complex now because of research that has progressed. And these researchers found that weight was contributed to by over 100 different factors, and that these factors were highly interconnected and they were related to things like biology, of course, psychology and what we eat and how we move, but also broadly the environment that we live in, the culture that we live in, the food industry and the food culture that we live in.

And all of these different factors are interconnected to one another. So to say that weight is as simple as calories in versus calories out is hugely mischaracterizing weight. And so then to categorize people as healthy versus unhealthy is also potentially a serious mischaracterization of health. And so the idea that obesity is based on these BMI categories then becomes problematic because really what we should be focusing on is an individual's health, not whether or not they're at risk based on some arbitrary thing like body weight, arbitrary to me anyway, in my humble opinion.

David:

Well, you've studied it a lot, so you're entitled to your opinion.

Paige:

Have you done any research on why weight is so much more of an issue amongst, or I could be wrong, but it seems to be much more of an issue amongst women, and it seems to affect women, and you talked about women in pay and stuff like that, but it even seems from such a young age that young girls are affected by their body images much younger than boys are. And I'm just curious if you could touch on that because it's always interested me why it's so much harder for women than it is for men.

Dr. Sarah Nutter:

Yeah, absolutely. There are differences based on gender in the experience of body image. Young girls and women do tend to pick up on messages about beauty and body ideals earlier, perhaps tend to engage in dieting at a younger age and engage in more efforts to meet beauty and body ideals throughout their lifetime. But that said, researchers have found that beauty ideals for men, so muscularity, leanness and muscularity has increased over time and that the gender gap may be closing in ways that are unhelpful rather than helpful.

Paige:

Do you know why that is?

Dr. Sarah Nutter:

Two ways that researchers measure beauty and body ideals for men have been looking at action figures. So GI Joe.

David:

Oh, wow. That's interesting. Oh, yeah.

Dr. Sarah Nutter:

And Joe has gotten more muscular over the decades.

David:

He's been working out.

Dr. Sarah Nutter:

Yeah. Well, working out and, or if we think about bodybuilding, has Joe been taking some steroids?

Paige:

-Some steroids.

Dr. Sarah Nutter:

Yeah. Yeah. Has Joe had some help along the way? And we can also look at magazines that are geared towards men and cover images, and those cover images have gotten more muscular over time as well. And so we now know that about 95% of people experience some sort of stable body dissatisfaction throughout-

Paige:

That's really high.

Dr. Sarah Nutter:

... adolescents or young adulthood. Yeah, it's so high that researchers in, I believe it was the early '80s, referred to body dissatisfaction as a normative discontent, like it's normal to be unhappy.

Paige:

Is it just the way human beings are built to feel unhappy about their bodies? I mean, this is such a weird question, but do you think people were wandering around in Shakespearean times feeling that way? Or do you think it's just because of pop culture and things like that growing so much?

Dr. Sarah Nutter:

Yeah, I have a lot to say about marketing and culture and media and the influence of celebrities. So people who are say, setting the standard for what beauty is aren't necessarily in my eyes, the best people to be influencing young girls and women in particular, but everybody in general. So yeah, I think a lot of this for women came from sexual objectification that happens in our society. So women being seen as objects to be looked at for the pleasure of men and then turning that objectification towards themselves and perhaps starting to think about themselves not as a body that's helping them to get through the day, but how am I looking for other people. Are other people looking at me and seeing something that is objectively beautiful?

Am I potentially a good mate for people that I want to attract? And so I think part of it has been gender socialization, how we're taught to be women in our culture, how we're taught to be men in our culture, and how we're taught to want to appeal to the ideals of the opposite gender, which then becomes a little bit more complicated if we bring in differences in gender and sexual identity into the conversation. But yeah, definitely a big impact has been that essentially patriarchy, if I may, and the way in which these sorts of desires and efforts of women have been co-opted by businesses to make money to keep us busy and focused on our appearance.

Paige:

And then when you were talking about male, have there been, or have you looked into at all? Have you seen a higher increase of steroid use? Because again, I'm from Los Angeles, so I knew there's this Gold's Gym culture there. And so I knew a lot of people, it wasn't even that they were on them, but they were very like, no, there's no side effects. They're fine. And I'm like, "Are you sure?" I haven't looked into this, but there definitely seems to be some issue. There must be a reason they're not legal.

Dr. Sarah Nutter:

Yeah, I would say that intuition is spot on. Steroids don't come without side effects. That's not my area of expertise within the body image literature, but I do know that steroid use is increasing, that pressure to gain muscle is increasing and that there's just the lack of realism in ideal body standards for both women and men. Nobody can achieve these ideal bodies without some sort of intervention or if they can, it's a very, very, very small subset of people.

And so yeah, I think not only does steroid use come with side effects associated with the drugs themselves, but also what sort of psychological issues might be developing in men who see their bodies as inadequate and are working hard and just the effort that people can spend to try to make their bodies look a certain way. I often think if we were to take that energy and put it into something more productive for humanity, where would we be? And that said, I definitely want people to make sure that we're taking care of our health and trying to optimize our health and success and longevity, but striving for these ideal appearance is not within what I would describe as striving for health.

Paige:

Yeah. And I think it's interesting because I feel like that's a lot of the weight loss drug or the issues that I've kind of had with what I understand of them is just that there's no talk about healthy eating or vegetables. It's just like, oh, you won't be as hungry, so you just won't, but you can eat whatever, but you're just not going to eat very much of it. And I'm like, that also just doesn't seem like you're going to get proper nutrients in the long run in my mind because you're able to just have a small cookie or something. It has nothing to do with getting nutritious food or anything. And so I think that's kind of part of the concern I was thinking about when I talk to people that have been taking them. And the rapid weight loss too, it just seems like overnight people are just tiny.

And I'm like, I don't know if that could be healthy either, honestly, in the long term. But I had read one of your studies about pregnancy and women being unhappy with their bodies during pregnancy, and I was wondering if you could tell me a bit about that or more about that because it seemed really interesting to me. And I have so many friends now that are starting the process of trying to get pregnant or being pregnant, and I definitely, you don't realize when you're little like a little kid or not in that kind of stage of life how much women are obsessed and concerned about their weight through pregnancy.

Dr. Sarah Nutter:

Mm-hmm. That research project was, I supported that research project. It was led by a friend and colleague of mine named Tanya Nagpal. She is really interested in the experience of weight stigma in particular in pregnancy because it's such a specific time in a person's life focused on weight and weight gain. Are you gaining too much? Are you gaining too little? Every time a pregnant woman, a pregnant person goes to the doctor's office, they're weighed. And if somebody is told that if they're gaining too much weight, the amount of shame that they can feel being blamed indirectly or directly for say, having a negative impact on the health of their unborn baby that might impact their child as they continue to grow after they're born.

Paige:

It seemed really interesting too. It just seemed like something that, especially my generation now, everyone's obsessed with their body during pregnancy and then the bounce back body. That's kind of the big thing.

Dr. Sarah Nutter:

Yeah. Well, and I think there's a lot of discussion about what comes first, it's a chicken or egg question. Does body dissatisfaction come first or does it come last? And does gestational weight gain for pregnant people happen first or does it come first or does it come last? And I think that that study really helped to demonstrate that it could be that experiences with weight stigma, that experiences with body dissatisfaction can actually have an influence on the health of pregnant people and on say, weight gain, whether or not that's perceived as unhealthy during pregnancy. And so thinking about these not as outcomes, but as risk factors for poor health, I think is really important because we often think about higher body weights as causing body dissatisfaction, not as body dissatisfaction say, causing poor health that may or may not be weight related.

Paige:

Okay.

Dr. Sarah Nutter:

Because again, this idea of health and weight being intimately connected in our culture can also confuse how we're thinking about how body dissatisfaction and weight stigma are impacting people.

Paige:

A lot of your research has to do with the healthcare system and the way doctors view weight. Could you touch on that a bit? Because I remember, just from my personal experience, I remember being heavier when I was younger. I was technically still a healthy BMI, but I was on the edge of being an unhealthy one and then losing weight and getting so much praise from my doctor. And I remember being so ashamed when she told me that I was heavier than most kids my age and just not, I don't know if I just didn't realize it before that, but I remember the kind of shame of it. But also now thinking back on it, I was still in the healthy weight range. I just don't know if she had to do that. And I ended up just losing baby weight and it was fine. So I was wondering if you could touch kind of on the healthcare system and the way it used weight.

Dr. Sarah Nutter:

Yeah. Well, and I mean even in response to your situation, I think we as a culture have to think about children and development I think in different ways because you talk about yourself as being a healthy kid or being at a weight that was perceived as healthy. And I wonder if we looked beyond your weight in that medical exam, would we have found a reason for you to lose weight in the first place? Or was there this artificial idea that you were coming up to some kind of weight that was all of a sudden going to be unhealthy? What if we would've done some blood tests, say, and looked at cardiometabolic health indicators and been like, you're healthy, great. Keep doing what you're doing, keep being healthy. And so what did that specific experience with bad data of BMI, that's bad data, how did that influence how you felt about your body and about seeking healthcare?

And so I'll zoom out from your potential experience and talk more about the research. We know that people who experience weight stigmatizing healthcare encounters are more likely to have those feelings of shame to feel like they don't want to go back to the doctor unless it's absolutely necessary. And it might mean then that they are delaying care for poor health that they're experiencing and allowing, say, health conditions that really actually require attention to progress further than they otherwise would because they've had negative experiences in healthcare that make them not trust their healthcare providers. And so it's a really serious concern because we talk about, say COVID, for example. Let's take a quick dive. We know that weight was indicated as a risk factor for the severity of illness with COVID-19. That was all over the news for a long period of time. While that was a conversation that was happening in the news, I became aware of a research article that examined mortality with the regular flu.

So influenza from a number of years prior, when the researchers accounted for in their analysis of the fancy data when people presented for healthcare in hospitals, so whether or not people presented early after getting severe flu symptoms or late after getting severe flu symptoms, when they accounted for that, any weight-based differences in death from people who had contracted the flu sort of disappeared. And so these researchers came away with this idea that it's not necessarily that body weight is important to consider in whether or not people have an increased risk of death from the flu. It's perhaps their experiences with weight stigma and their avoidance of the healthcare system. This is why it's so important to think about how weight stigma is impacting healthcare. I have to recognize the context that healthcare professionals are coming from. They're not getting good information on weight. They're influenced by the culture we live in, as is their curriculum. And so big changes need to happen, and big awareness needs to happen of weight stigma and how it can unconsciously interfere with quality of healthcare.

David:

Two things. One, you had some comments. You actually have a pretty good comment about the diet industry, which was, I'll let you make it, but [inaudible 00:35:59] if it really worked, do those diets work? But you had the comment about the industry I wanted you to share with us.

Dr. Sarah Nutter:

You wanted me to say that? Yeah, I-

David:

Yeah. That's really funny.

Dr. Sarah Nutter:

Yeah. What I like to say as you know David is if the diet industry really worked, it wouldn't be growing by millions and millions of dollars every year. And so this brings me back to marketing and businesses wanting a profit year over year. Do they care about our health? Do they care whether or not diets work? No, because they want their profits to grow. If diets worked, we'd all be thin because people don't like experiencing weight stigma.

David:

Yeah.

Dr. Sarah Nutter:

Yeah.

Paige:

I've never even thought about that, but it's like clearly, I mean, obesity rates go up, but the diet industry just gets bigger, but they're like, so we work so well for everybody. It's clearly not a industry that does a whole lot of good when I really think about it. And I know people who go on some special diet, but then the second they get off it, they've gained weight back. So it's not like these long-term solutions.

Dr. Sarah Nutter:

Well, remember before how I said 95% of people experience body dissatisfaction about the same number of people who lose weight via diet and exercise behaviors will gain that weight back in three to five years, and often they'll gain more weight back than they lost. And so when we engage in intentional weight loss efforts, sometimes we're actually really having a negative effect on our physiology. Back in World War II, Ancel Keys did a starvation study, this researcher named Ancel Keys, and it's called the Minnesota Starvation Experiment. He essentially found that when, he wanted to better understand the impacts of starvation on the body and on people, and was approached by, actually, I recently learned this in Malcolm Gladwell's podcast, Ancel Keys was approached by conscientious objectors to the war who wanted to do some good for humanity and said, "We know that there's going to be a lot of people who haven't had enough food for a long period of time, and we want to help better prepare for the efforts to come when the war ended."

And so these people voluntarily starved themselves for six months. And then after the starvation period, there was obviously a period of reintroducing food and examining what happened with the body. What they found back in the '40s was that the body is really, really efficient at gaining back fat cells and is less efficient at gaining back other kinds of cells. So muscle mass, for example. And so if we think about what research that was done decades ago can teach us about yo-yo dieting and physiology now and again, why are we losing weight? Are you really unhealthy or are you trying to achieve a beauty ideal through means that are actually less, like having more of an impact on your health than just continuing to live your life and love your body would be, right?

Paige:

Right, because I recently read something too that it actually isn't even extremely healthy for women to have six packs because all of our organs are on the inside where it's like male anatomy is on the outside, but it's actually you're crushing flat, flat. Stomachs are actually crushing the uterus and the ovaries and things like that, but it's such a cultural expectation of us to have these tiny, tiny tummies and so like that, but to learn that it's not even actually the healthiest long-term longevity body for a woman is really interesting. Because no one had even told me that, like I founded in a research study for school.

Have you seen a change kind of in culture since? Because I do think that there has been more body acceptance movements and body positivity movements than, like when I was younger in the early 2000s, it seemed like it was skinny, skinny, skinny, skinny, skinny. And when you would open up People Magazine and it would be all about celebrities gaining weight and stuff, and they can't really do that culturally anymore. So have you seen because of maybe a few changes in pop culture that in general, people are starting to become much more accepting or no, not as much.

Dr. Sarah Nutter:

I try to remain optimistic.

David:

Yeah.

Dr. Sarah Nutter:

Yeah. I do think that there's been a shift, even if not a big shift in attitudes. I think we're having more conversations like the conversation that we're having right now. I started doing this research just over 10 years ago when I started graduate school and time flies, and I think I see a lot more discussion of weight stigma and body positivity happening in mainstream media outside of the research space because people don't want to read boring research articles. We need platforms like this to have conversations with more people, right? I have hope for the future. I have hope that there's more critical discussions happening in and outside of research spaces about BMI and its weaknesses and limitations about health not being a proxy for weight. I'm seeing a shift, but it's not happening as fast as I would like it to, but I'm trying to have hope.

David:

I haven't thought about this issue as much as I should, but yet I do see at Lululemon and they have all different size mannequins now, and they didn't probably four or five years ago, but at the same time, I was just going to make this comment because you were talking about GI Joe.

Dr. Sarah Nutter:

Mm-hmm.

David:

As we speak the movie Barbie is reaping millions and millions of dollars so, and I understand that no one, that it's impossible for anyone to be the same shape as Barbie, that you just, that's physically, there's no one could have those proportions, but anyway.

Dr. Sarah Nutter:

Yes. Yeah, if Barbie were a real person, she wouldn't be able to stand upright.

Paige:

Really?

Dr. Sarah Nutter:

Yeah.

Paige:

I did not, I mean, I heard they were making more curvier Barbies, but then-

Dr. Sarah Nutter:

Yes.

Paige:

I mean, Margot Robbie is just the epitome of the beauty standard. Do you know what I mean? So it's kind of like the movie definitely didn't do the body inclusive Barbie style.

Dr. Sarah Nutter:

No. Well, and this is the thing, I think celebrities are under similar pressures, and so absolutely, if you think about the way they're going to choose to portray Barbie and Ken, of course, they chose who they chose. Those are beautiful people. And if we think about, say, the way that larger bodied characters are portrayed. If we think about roles that say people like Melissa McCarthy or Rebel Wilson have played, are those folks playing characters that are portrayed as beautiful and sexually attractive and right, or are they portrayed often as caricatures based on the appearance that they have? Are they caricatures of weight-based stereotypes? Another good example, but a dated example is Thin Monica versus Fat Monica on Friends, and the way that that character was portrayed in that show.

Paige:

That's so interesting. Yeah, because Rebel Wilson, I mean, Pitch Perfect is, I love that movie, but she was like-

Dr. Sarah Nutter:

So good.

Paige:

... her character was literally Fat Amy. That was the name of her character on Pitch Perfect. It was very much, her part was very much surrounding her size and how she was hilarious and funny, but also overweight. And then I've also read an interview with her because she lost a lot of weight, but she's not getting jobs anymore because they had already categorized her as the fat Stereotype role. And so no one's giving her the same work anymore, which is just so interesting because she is so funny. She is hilarious [inaudible 00:44:05]

Dr. Sarah Nutter:

Yes, super talented. But yeah, typecast for a specific kind of role that, why are people worried that we can't see past that or get past that? What is there to get past? Yeah. Well, it's ridiculous.

David:

Yeah. Speaking of medias, you actually wrote an article about The Biggest Loser.

Paige:

Oh, I was going to bring that up because [inaudible 00:44:31] watched that show growing up. My uncles and I were obsessed with The Biggest Loser when I was younger. Now thinking about it, but then you see it, I've heard so many of them regain the weight afterward, and also it's just they lose it so quickly. And then looking at the diets and the ex, I think they were exercising 10 hours a day on that show.

Dr. Sarah Nutter:

Mm-hmm. Yeah. So David, I have so many bad things to say about The Biggest Loser that I had to write a research article about it. Yes.

David:

[inaudible 00:45:01].

Dr. Sarah Nutter:

Yeah. So that article was inspired. So my good friend Dr. Jessica Saunders, who is a researcher in eating disorders and weight stigma alongside me, we do a lot of our work together. We were inspired to write that article when we saw a research article come out a couple of years ago that was focused on this idea that if we have higher weight women say watch segments of The Biggest Loser, maybe they will develop some kind of relationship to the character on the show, this connection to the character on the show, and maybe that will motivate them to lose weight. And I saw that article and I got mad. And so what we decided to do was to collect every article that researchers have published that looked at how watching The Biggest Loser might be impacting the viewers of the show, even people who only watch say a short segment of the show for the purposes of the research. And overwhelmingly, what we found was what we wanted to find thankfully, was that The Biggest Loser doesn't actually do any good.

It's not this beautiful mix of entertainment and public health that people want it to be. It's portraying really unrealistic efforts and really unsafe efforts at losing weight. People don't have the time and the resources to work out as much as they do to have chefs cook for them in their day-to-day life, and nor should they really in any way be trying to lose that much weight in a week. And so watching The Biggest Loser can, while it motivates some, the question I ask is it motivating people for the right reasons or is it motivating people who have bought into diet culture more and are more likely to be at risk for consequences, like say, developing eating disorders or really unhealthy relationships with their bodies and otherwise people just perceived it as quite negative and unmotivating and stereotyping and as not giving viewers health information, but portraying people kind of like a modern day freak show, right? Like the circus back in the day would have the freak show, The Biggest Loser feels like a reincarnation of that in the modern day.

Paige:

It's so funny. I haven't thought about that show in so long.

Dr. Sarah Nutter:

Yeah, it's awful. Yeah, I hate it.

Paige:

I mean, my question is, you talked a little bit about body positivity. How do people start to feel better about their bodies? Because if it's like 95% of people don't feel satisfied with their bodies, how does that change or how have you found that people start to feel better about themselves no matter what size they are?

Dr. Sarah Nutter:

That's a really great question that I think body image researchers have been struggling with for decades. I think there are a number of things that people can do to try to have an impact on how much we receive these kinds of beauty and body ideal messages in our everyday life. One is try to outsmart our social media algorithms. So I am very careful about the social media accounts that I follow, and if I find that an account I follow is posting too much content that is weight stigmatizing, I just unfollow that account and I follow some accounts that might be a lot more positive in that way. So more body positivity type accounts. I think we can, while we're trying to beat this algorithm, become a little bit more critical of the messages that we're getting in the media and who are we looking up to in terms of our exemplars of success in our life?

Is it the Kardashians? And if it is, can we look somewhere else please? I don't know if they'll like me saying that, but who are the influences in our life and why? And what is it about them that has an impact on us, and is that about what they look like or is it about another quality? We can think about ourselves as being so much more than what we look like. If we're aiming to have, say, a more neutral relationship with our bodies, what are the qualities that we love about ourselves that we can focus on more to lessen the influence of what we think about our bodies in our lives, but also can we think about our bodies as the vehicle that lets us live our life and do the things that we love to do with the people that mean the most to us?

And can we think about experiencing comfort in our bodies rather than thinking about what our body looks like to other people, or strength and feelings of capability in our bodies rather than, again, what our body looks like to other people. And back to tricking social media, because of the research that I do, I often get weight loss ads on social media.

David:

Oh, right, right.

Dr. Sarah Nutter:

It's like, well, you were just looking up obesity 20 minutes ago. So what I do is I say, hide add, and then you get the options. Well, why do you want to hide this? Because the algorithm is trying to learn, I like to say, "Well, this is inappropriate or offensive." And so if the algorithm thinks, "Oh, I'm going to find that offensive, I'm not going to give that to this user." And every once in a while I'll have to retrain my algorithms, but I think there are intentional efforts that we can make while trying to think about our culture and the way that it can influence us in critical ways.

Paige:

Do you think there's a concern, especially with young kids and the, because I remember there was even a whistleblower of Facebook or Instagram who talked so much about the anorexia content on Instagram and the promotion of anorexia for teenage girls in particular. Then I was looking at those accounts, because I was curious. I was like, oh my gosh, these are really, they really, literally, I thought, oh, it'll just be some skinny girls. But no, it's really promoting starvation. So I'm just curious, how do parents handle raising kids with all of this kind of, it's just constant. They go outside and I feel like they're just always are their home on their phones, and it's always kind of there.

Dr. Sarah Nutter:

Yeah, that's a really great question that I'm not sure I'm the best person to answer, but I will direct you towards a book that I was interviewed for along with many other people. So the author of Virginia Sole-Smith wrote a book called Fat Talk: Parenting in the Age of Diet Culture.

David:

Wow. Oh-

Dr. Sarah Nutter:

And so I think that will answer all of your questions and any questions that listeners might have. Overall, a lot of people who are interested in helping their children to develop more positive relationships with their bodies, recognize the harm that diet culture has done to them. I'm actually supporting a student working on a project where she interviewed mothers on why they are trying to develop more positive body image in their children. That was what she found was that everybody had a difficult relationship because of diet culture with their bodies and wanted to break that cycle with their children.

And so I think it comes down to the conversations we have about our bodies, how we talk about our bodies, how we talk about our children's bodies and about health and bodies. How were we talking about food? Are we really strongly controlling the quantity or what food our children eat? Or are we letting our children develop a sense of their own hunger and fullness cues and allowing them to explore that and say the consequences of ignoring their fullness cues and learning about how their body feels if say they're only eating food that isn't very good for them versus food that is good for them. I think giving children agency and to develop positive relationships with their bodies and with food, and that all food is good food and all bodies are good bodies. That's essentially, I think the gist of it all. But definitely check out Virginia Sole-Smith's book, if you want to read more.

Paige:

My parents actually didn't do this, but they were very, some parents would be like you have to finish your plate, or whatever. And I'm like, I feel like a kid can just kind of know, like that's when their hunger cues can develop for themselves, almost like why would they have to finish their plate to just be polite? You know what I mean?

Dr. Sarah Nutter:

Yeah. Well, and I think in our culture, we even as adults don't necessarily know how to listen to our bodies in that way because diet culture teaches, tells us not to in a way, right? So do we even know when we're hungry and what kind of hunger we're experiencing and what we might be hungry for? And is that something that we can even as adults put a little bit more effort into in developing that more positive relationship with our bodies?

David:

Well, we've taken an hour of your time, Sarah, and it's really been great, and I'm very sorry to hear about you being teased as a kid, but I will tell you, you've gotten over it. You've got such a great positive personality and a great smile. You just seem really, really happy with the way things are, so I'm so glad for that.

Dr. Sarah Nutter:

Well, thanks, David. Yeah, I've said in a number of other presentations before that I'm kind of thankful for those bullies because now I have a PhD and they don't, so.

David:

That's great.

Paige:

That's a good argument.

David:

Yeah, that's great [inaudible 00:55:13]. Well, thanks so much for the time.

Paige:

Thank you so much.

Dr. Sarah Nutter:

Yeah, no, thank you so much for the invite, and this was a really fun conversation. And yeah, I hope your listeners appreciate it.

David:

Oh, they will. They will.

Paige:

Thank you for listening to Disarming Data and thank you to Eric Montgomery for producing this podcast. To support the podcast, please rate, review and follow on Apple Podcasts or wherever you listen. If you'd like to learn more about the current state of data security, head on over to our website, disarmingdata.com.