MARIA GODOY, HOST:
So imagine this. You see a flyer that says the psychology of shopping study.
JANET TOMIYAMA: We advertise the study as the psychology of shopping study. It sounds really fun, doesn't it? (Laughter).
TOMIYAMA: And it was not very fun to be a part of.
GODOY: That's Janet Tomiyama. She's a researcher at UCLA, and she ran the study. So you see the flyer. And you say, ooh, sign me up.
TOMIYAMA: And so you would arrive to our suite of lab rooms. And one of the rooms, the door's sort of halfway open, and there are clothes that you can see hanging on racks inside. And there's pop music blaring from there.
GODOY: You get there, and they tell you this study's about hormones and shopping. And guess what? You get to try on clothes donated by an up-and-coming designer. There's just one catch.
TOMIYAMA: But the first thing we need to do is make sure you'll fit into the clothes. And so we take them to another room down the hall, and we weigh them. And we say, OK, we got to crunch some numbers. Can you go wait in the waiting room?
GODOY: You go sit in a waiting room. And next to you on the couch is a really thin woman - I mean, like, really small. And you don't know this, but she's in on the study.
TOMIYAMA: And we beckon to the thin woman and say, great news. You've qualified for the shopping part of the study. You can go down the hall and start shopping with everyone. Then we turn to our participant, and we say, you know, unfortunately, your shape and size just aren't ideal for this type of clothing. And we really do want everyone to have fun and feel good. And we need to return the clothes to the designer in good condition, so we're just going to have you do this online shopping thing.
GODOY: Oh, God, that's cruel.
TOMIYAMA: It is cruel.
GODOY: Note, this study did get approved by a human subjects protection committee.
TOMIYAMA: You know, whenever I present this study to the public, half the people are horrified. And the other half, you know, usually the heavier half, they say, well, you know, this happens to me all the time. This is what I go through day in and day out.
GODOY: And this study, it actually tells us about how weight stigma hurts way more than just our feelings.
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GODOY: This is your NPR LIFE KIT for rethinking weight loss. If you came here to lose weight, take this episode as a moment to pause. Whether or not you want to lose weight, we want to help you understand how all the negative messages out there are actually harming our health. But hey, there's good news. There are things you can do to ditch the body shame in society and in your own head all in the name of good health. All of that and more after the break.
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GODOY: I'm Maria Godoy, and I'm a health and science editor at NPR. And like a lot of people, I've thought a lot about my weight. It's been up - way up. And it's been down. So I'm along for this ride with you. And weight is a super complicated issue, with health and appearance and discrimination all wrapped up together. But the constant cultural messages we hear about weight don't help.
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UNIDENTIFIED PERSON #2: I felt too heavy.
UNIDENTIFIED PERSON #2: This has been a 40-year struggle.
UNIDENTIFIED PERSON #3: Women aren't struggling to lose weight. Women are struggling to be accepted for exactly who they are.
GODOY: And all of this focus on weight, it's actually hurting our health. So let's talk weight stigma.
TOMIYAMA: It's the totality, I'd say, of negative attitudes, discrimination, prejudice, any sort of negative bias directed towards people who are perceived to be heavier.
GODOY: That's Janet Tomiyama. We heard from her at the top of the episode. She studies stress, dieting and weight stigma. She says people who experience weight stigma, they tend to internalize these feelings.
TOMIYAMA: The interesting thing about weight is that you do see these really high levels of internalization, meaning people buy into it. So a heavier person who's told, wow, you really have no willpower, and you're really lazy. How could you let yourself, you know, get to this weight? That person is more likely to to say, oh, my gosh, that's right. This is all my fault. And so it becomes even more insidious when you're getting it from society, and then you're also believing it for yourself.
GODOY: But the fact is it's not just a question of willpower. There are a lot of biological factors that can make it very hard for people to lose weight or keep it off. We'll talk about them in episode two. The point here is this stigma isn't just hurtful. It's actually bad for public health. And that's your first takeaway. Recognize that weight stigma can actually harm your physical health.
Janet says researchers have known that experiencing weight stigma, it can lead to low self-esteem and higher rates of depression. I mean, it makes sense. But Janet wanted to show what experiencing weight stigma does to your body, which is why she did that shopping study, where she kind of became a mean girl for research.
Wait, so what happened to the people who were fat-shamed, who were told the, I'm sorry, you're too heavy to be in our - part of our shopping experiment?
TOMIYAMA: Yeah. So compared to people in the control group who weren't fat-shamed, their cortisol levels were higher.
GODOY: Quick primer here. Cortisol is a stress hormone. And when levels are too high for too long, it isn't good. One thing excess cortisol does is it tells your body to deposit fat in your belly region. And that's the kind of fat associated with greater risk of heart disease and type 2 diabetes. Cortisol can also make you eat more. And Janet says stress can change your brain's reward circuits to make high-fat and high-sugar foods taste better.
TOMIYAMA: No matter how you slice it, experiencing weight stigma can sort of trigger these processes that ironically make you gain more weight. And that could put you at even more risk for weight stigma.
GODOY: And there's one more thing the study found. This can affect you no matter what your size is.
TOMIYAMA: That's the craziest part of this, I think, which is that so many people who thought they were heavy actually - because we know this because we weighed them - were not by, you know, traditional body mass index standards. And so what that means is it doesn't matter what your objective weight is. What really matters is how you think about yourself.
GODOY: Were you surprised that the people who were, quote, unquote, "normal weight" experienced rise in stress - in cortisol levels, rather?
TOMIYAMA: Yes. In addition to being a scientist, I am a woman. And so (laughter)...
TOMIYAMA: ...You know, I'm fully aware of these messages. You know, I've had my days where I don't feel great about my body. And so part of me was not at all surprised.
GODOY: So weight stigma is bad for all of us. And it's not just stress. People who experience weight stigma are more likely to avoid going to the doctor altogether. One reason why is that their weight often becomes an issue even if they came in for something completely unrelated. And this brings us to takeaway No. 2 - when it comes to your own health, don't get too hung up on weight and BMI.
OK, BMI, that's body mass index. And it's used as an estimate of body fat based on your height and weight. But it's an imperfect metric of health.
TOMIYAMA: The place where we can get into a lot of trouble is when we assume that someone's BMI is the same thing as health.
GODOY: So, for instance, when you look at BMI alone, some pro athletes can be labeled obese because of all the muscle on their body. But even if you're not an athlete, you can have a higher BMI and walk into the doctor's office and have perfect health markers. Your blood sugar levels are fine. Your cholesterol is great. No cardiovascular problems.
TOMIYAMA: And I will say on the other end too, it's bad because we assume anyone whose BMI is low, meaning anyone who's thinner, must be super healthy. But that's not the case either. There are plenty of thin people - I'm sure you know them - who are not that healthy across many of these markers.
GODOY: And Janet says too much focus on BMI misses the broader health picture. She says zooming in on BMI alone can add to weight stigma and actually make people avoid behaviors that promote good health. People who experience weight stigma are less likely to take care of their sexual health or get cancer screenings or other preventative care.
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GODOY: There is a growing awareness in the medical community that too much focus on BMI might be doing more harm than good.
GARY BENNETT: The way that we think about health here in the U.S. is completely reductionist.
GODOY: That's Gary Bennett. He's a professor of psychology and neuroscience at Duke University and an obesity researcher. He works with patients with overweight and obesity mostly from low-income communities.
BENNETT: One of the problems that we have is that we don't think about health as also including one's emotions and one's mental health. And so if the stress and the strain and the stigma of obesity put you at really disadvantaged mental health, if it really changes your conceptualization of yourself and makes you limit yourself in ways that aren't really healthy, you know, that's a real problem. And one of the things I think we as a community need to talk more about is, you know, all this effort that goes into trying to change our shapes exacts a toll on our emotions that may be more risky than the health consequences of obesity.
GODOY: He agrees that weight should not be the sole focus when thinking about health. But he says that we can't discount weight altogether when it comes to assessing long-term health risks.
BENNETT: We are a society that is unaccepting of difference in all types of ways. And obesity is just one of them. And so - but, you know, there are real individual risks associated with obesity.
GODOY: Risks you've likely heard of - an elevated risk of cardiovascular disease, type 2 diabetes and some cancers. But I asked Gary, what would you tell a patient who's heavier but has good markers of health?
BENNETT: My job in a moment like that is to give you the full wealth of my knowledge in the area. And what we know right now from the science is that most people who aren't - don't have any health problems today are more likely to develop them tomorrow than people who are normal weight. And so in practical terms, that means that it's really up to you. If you want to try to prevent the onset of those types of conditions, then losing some weight is a good thing.
GODOY: In other words, Gary says you can't dismiss weight outright. Now, you should know that when Gary talks about weight loss, he's talking about relatively small amounts. He says as little as 3 percent of your starting weight. If you weigh 200 pounds, that means losing six pounds. Lots of evidence links minor weight loss to improved health markers like blood sugar levels.
But regardless, he's also concerned that our society and the medical community might be approaching weight the wrong way.
BENNETT: I really would like to believe that we could find a solution that helps people to manage their health risks and doesn't really cause them the kinds of stigmatization that so many people experience.
GODOY: Now, there are people who say, why can't we separate the issues of health and weight altogether? This is where Health At Every Size comes in. It's a health paradigm and a social justice movement. Its leading proponent is nutritionist and researcher Linda Bacon. And it aims to celebrate body diversity, challenge scientific and cultural assumptions about weight and teach more compassionate self-care, like finding joy in physical movement and teaching mindful eating. All of this without all the talk about weight.
LINDA BACON: What we know is that everyone can adopt self-care practices to improve health and well-being. We don't have to focus in on weight status. And the same practices that are going to help heavier people are also going to help people who are more slender.
GODOY: Health At Every Size has found a following among people who are just fed up with diet culture and the stigma that comes with it.
BACON: So we don't have to invoke weight stigma. We can just support everybody in taking good care of their bodies.
GODOY: I think we could all get behind that idea (laughter).
BACON: I know, which is interesting. I don't understand why that is so challenging to so many people. But for so many people, it's hard for them to conceive of the idea that you can work towards health without mediating it through weight.
GODOY: Some of the tenets of Health At Every Size are controversial in the mainstream medical community. For instance, Linda says medicalizing obesity by calling it a disease adds to weight stigma. She also says intentional weight loss is never a good idea. And we should say there is consensus that going on a restrictive diet, well, the statistics show you're likely to regain the weight. We heard from some listeners that getting caught in this cycle can leave them feeling really frustrated.
UNIDENTIFIED PERSON #4: I have tried everything.
UNIDENTIFIED PERSON #5: My doctor calls my body death fat, morbidly obese.
UNIDENTIFIED PERSON #6: I consider myself to be in recovery from dieting.
BACON: And, of course, we know the fallout from that too, that so many people feel terrible about themselves. They feel like it's their personal failure when, in fact, it's the diet that failed, not them.
GODOY: Now, I think most folks would agree that adopting healthy behaviors regardless of what the weight outcome is, that's a good goal. And that's takeaway No. 3 - focus on well-being by practicing healthy behaviors regardless of weight.
Health At Every Size is still relatively new. But there is some early evidence that this approach can help move some markers of health even when weight remains the same. Some of that evidence comes from a study Linda published in 2005. She enrolled a group of women who had obesity and were chronic dieters in a Health At Every Size intervention. So they weren't thinking about weight loss. Instead, they worked on body acceptance. And they learned to tune into their hunger cues, a concept that's known as intuitive eating.
BACON: In the research study that I conducted, we found improvements in blood pressure, improvements in self-esteem, in depression levels. And we didn't find anything that went wrong. And it was also really interesting when you look at the weight data. We found that people maintained a stable weight in the Health At Every Size program.
GODOY: The people enrolled in Linda's study were also encouraged to do things like throw basketballs around while socializing in group support meetings because moving more is good for health. And then Linda compared their outcomes to another group of women who enrolled in a typical weight-loss program.
BACON: And what we found was that at six months, the diet program was looking pretty good. People had lost weight, and they improved in a lot of the health parameters. But by a year, the people in the diet program had regained the weight and lost all the health benefits. And then at two years, some of the health benefits in the people in the diet program had actually worsened from baseline.
GODOY: Like which?
BACON: Well, depression levels, for example. Self-esteem was something else.
GODOY: Other researchers have found that having a positive self-image can also have positive health effects, like making people more likely to use contraception and protect their sexual health in other ways. And that brings us to takeaway No. 4 - a big part of well-being is learning to combat weight stigma with self-acceptance and compassion. But I know that's easier said than done.
BACON: I don't think body acceptance is just something you say to yourself you're going to do, and then you do.
GODOY: Don't beat yourself up if you're not loving your body in every moment. You're up against a lot, which is why we can't just give you a single neat and tidy takeaway for this part. Body acceptance is hard work. But we're going to run through some practical strategies. For starters, focus on building an environment of acceptance. That means finding community.
BACON: Fortunately, there is a wonderful body-positive community out there that people can rest in and find. There are plenty of people that are supporting people of all sizes and appreciating, enjoying their bodies, taking good care of them, that doesn't buy into all of the cultural myths. It's not going to take away the knee-jerk reaction to shame and blame and feeling bad about yourself. But I think the more that you recognize that it's a cultural problem, the easier it is to recover.
GODOY: You can also foster an environment of acceptance in your own home.
JUDITH MATZ: So that you start to feel more at home in your body.
GODOY: Judith Matz is a clinical social worker and the author of "The Diet Survivor's Handbook." And she has this suggestion for finding acceptance even in your own closet.
MATZ: An example of that is looking at the clothes you have in your closet and making sure that you have clothes that fit you at the size you're at now and that you actually like.
GODOY: This is part of Judith's strategy about not waiting to feel good.
MATZ: Ask yourself what you're putting off until you lose weight. And make a list that completes the statement, if I were thin, I would - pick one activity from that list, and see if you can do that now. Remember, you deserve to live fully in the world in the body that you have now.
GODOY: So one example is planning a trip you've been putting off. Or if you avoid being in photos with friends or family, ask yourself what you can do to feel comfortable appearing in them.
MATZ: Years from now when you look back and when your children look back, what they care about is the smile on your face, the touch, you know, the hug you were giving them.
GODOY: And remember, how you talk to yourself matters. Here's one way Judith likes to reframe negative self-talk.
MATZ: So for example, if you're someone who goes around in the summer and says, my arms are too flabby, you might change that to saying, these are the arms that let me hug the people I love.
GODOY: Lastly, Judith says collect positive body experiences by noticing what feels good. Maybe you had a good walk outside or liked the feeling of a hot shower. It's important to take notice of the times you feel good rather than bad in your body. So try some of these tips to be kinder to yourself. It'll make you healthier and it might just feel good too.
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GODOY: Linda Bacon says when she talks to people who have begun to disentangle their self-worth from their weight, she keeps hearing one word over and over.
BACON: I think the No. 1 word that I hear is about freedom, that people who are used to being in the diet approach find their lives just so restricted. And it's like they're in prison all the time, having to filter what they do through this good-bad lens. And it becomes very empowering to recognize that they make better choices that way, when it's about celebrating and taking good care of their body as opposed to trying to change or control their body.
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GODOY: We just threw a lot of ideas at you about body positivity. But let's recap the three big ideas in this episode. No. 1, weight stigma can have bad health effects no matter what your weight is. No. 2, weight is an imperfect metric of health. It's not the only thing that matters. And No. 3, focus on well-being regardless of weight.
And here's one last takeaway. Even if you don't experience weight stigma in your daily life, ask yourself, am I actually helping to perpetuate it? This is actually something we can all be better at. So just keep it in mind.
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GODOY: For more LIFE KIT, check out the next episode in this guide. We get nerdy about the science of weight and explain how that might help you be kinder to yourself. If you like what you hear, make sure to check out our other LIFE KIT guides at npr.org/lifekit. And while you're there, subscribe to our newsletter so you don't miss anything. We've got more guides coming every month on all sorts of topics. And here, as always, is a completely random tip, this time from NPR's Elle Mannion.
ELLE MANNION, BYLINE: To increase productivity and reduce burnout at work or while studying, you can use the Pomodoro Method. You focus first that amount of time, say 25 minutes, then get a five-minute break. After completing a set number, you get to celebrate with a longer break, and then get back to focusing.
GODOY: If you've got a good tip or want to suggest a topic, email us that firstname.lastname@example.org.
LIFE KIT is produced by Sylvie Douglis, Alissa Escarce and Chloee Weiner. Meghan Keane is the managing producer. Editing help from Dr. Mara Gordon and Carmel Wroth. Our digital editor is Carol Ritchie. And our project coordinator is Clare Schneider. Music by Nick DePrey and Brian Gerhart (ph). Neal Carruth is our general manager of podcasts. And senior vice president of programming is Anya Grundmann. Extra special thanks to Stacey Goers, Clinton Walker, Alison Hofer, Dan Newman, and the entire digital team for all their support. We really appreciate your hard work.
Finally, we want to thank all the people who spoke with us to help us understand the science in this guide - Tiffany Powell-Wiley, Jean Thane (ph), Jennifer Kerns, Margaret Berman (ph), Victoria Catenacci, Danielle Austin-Dorr (ph), Virginia Ramseyer Winter, and especially Sherry Pagoto. I'm Maria Godoy. Thanks for listening.
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