Episode 96 - Fatphobia with Kate Manne

Transcript

Ellie: 0:00

Before getting into today's episode, we just wanna mention that we will be discussing dieting and disordered eating.

David: 0:17

Welcome to Overthink.

Ellie: 0:19

The podcast where two philosophy professors connect big ideas with everyday life.

David: 0:24

I'm your cohost, doctor David Pena Guzman.

Ellie: 0:26

And I'm doctor Ellie Anderson. David, one thing I was really struck by is a Harvard study in 2019 showing that fatphobia is the only form of implicit bias they studied that has gotten worse since 2007. These researchers who started studying implicit bias back in 2007 investigated race, skin tone, sexual orientation, age, disability, and body weight. And they found that the implicit bias around body weight is the only one that's gotten worse since they started their study. In fact, the majority of people still harbored explicit antifat biases at the end of the study in twenty sixteen. So not only has this implicit bias towards fat people gotten worse since 2007. For a majority of the study participants, it's not just implicit. It's actually explicit.

David: 1:18

Yeah. So much for all those fantasies that we, liberals, like to entertain about the inevitability of social progress with time. The idea that people get increasingly included in our circle of moral concern. This gives us reason to think that maybe that's not the way things usually go down.

Ellie: 1:37

Yeah. And our interviewee of the day, Kate Manne talks about this in her book Unshrinking, which we're gonna be speaking to her about at length a bit later, But she notes that this study really reveals how it's also a fantasy that contact with members of a marginalized group reduces the biases that they face from the rest of the population because she notes that nearly three quarters of Americans are classified as overweight or obese according to BMI charts.

David: 2:04

Yeah. And, BMI by itself is just such a bogus concept. And, unfortunately, it is a concept that almost entirely dominates our cultural imaginary when it comes to health and fatness and weight. I still remember when I first joined a gym when I lived in Baltimore, Maryland when I was working at a bioethics center at Johns Hopkins University. I went to register for the gym, and the person at the front desk kept insisting that they assess my BMI as a way of channeling me into different kinds of workout routines and plans that they had. And I just remember already then thinking, I cannot accept the scientific validity of the BMI metric.

Ellie: 2:51

Did you end up getting it measured?

David: 2:54

No. I didn't. I refused to get my BMI. In fact, I don't know what my BMI is, and I do think it is a largely debunked metric that doesn't mean anything, especially when applied to particular individuals.

Ellie: 3:07

Yeah. But I wanna say I think it's also telling that you don't know your BMI, David. I don't know my BMI either, and I think that speaks to a thin privilege that we have. Because that speaks to the fact that the doctors that we go to are not concerned about our BMI. You don't have to be concerned individually about your BMI to be told that it is a question of concern for you. So you could tell the gym, f you, But if you were classified as obese, your doctor would probably hammer home your BMI and say that you need to bring it down. Yeah. This is a very problematic metric as you mentioned. Tell us a little bit about this.

David: 3:42

Yeah. The origins of the BMI concept are often traced to the early nineteenth century to the work of a Belgian astronomer by the name of Lambert Adolphe Jacques Quetelet, who originally came up with a way of measuring At the level of populations, wait in order to think about the relationship between that and population health. And at the time, he called it the Quetelet Index. It was not called the BMI index. And it was meant to be a way of tracking the mean or the average in a large group of people. And this is an important point because Quetelet, as a statistician and as a mathematician, believe that whenever you identify the mean in relation to any variable within a population, you have also identified the ideal. So he very quickly jumped from a kind of descriptive account of the mean to a normative conception of the mean. Nowadays, we have it a little inverse. When you talk about average, we almost think mediocre. But in the eighteenth and nineteenth centuries, as statistics is really asserting itself as a science, the mean really meant the highest expression of a particular variable. I mentioned that the origins are often traced back to him because the concept of BMI in its modern formulation was not really developed until the nineteen sixties and seventies. And it was popularized by a man by the name of Ancel Keys, who was a physician at Harvard who published the piece on BMI metrics and who became the face of this concept. And the problem with BMI, now to jump more into the details, is that in the cases of both and Keys, the pool of individuals they were working with originally when developing their theories about weight was extremely biased. For example, Quetelet in the nineteenth century was working primarily with a group of upper class, thin French and Scottish people, whereas Keys was primarily working with white men. So both of them begin with this already biased population and then try to extract the metric that they want to universalize across the board. And so already clear scientific problem with that. The second problem with BMI is that just the formula, is just honestly, really whack. The formula is you take somebody's weight and then you divide it by people's height squared. It doesn't take into account all the variables that, if you really wanted to talk about the connection between weight and health, you would have to take into account. For example, there is no way of incorporating into the formula information about the relative proportion that a particular body might have between bone, muscle, and fat. So the proportion between those variables doesn't enter at all into the formula. It also doesn't take into account frame size. Some people just have very big shoulders in a very wide frame, and so their relationship between weight and fatness would be very different based on that. And so mathematically speaking, it's a highly unreliable metric for thinking about fatness, which is why already in the nineteenth century, Quetelet made the point very clearly that this metric was meant to be used only for population analysis and never for thinking about the body fat build or health of any particular individual, yet that's how we use it today.

Ellie: 7:26

Well, yeah. And there's like a whole story to be told here about How insurance companies use this against people. And this is by no means just oh, this is a weird thing we do because it has extremely racist effects. For one, Black people tend to have a higher level of bone mineral density The non black people, and they also tend to have higher muscle mass. And this is something that one of my favorite books that I've read in the past few years, Sabrina Strings's Fearing the Black Body talks about at length. David, you and I have discussed Strings's work before in our previous episode on fat feminism from a couple of years ago Amelia Hruby. So over thinkers, if you haven't checked out our Fat Feminism episode, it's also an interview based episode. That one was super fun and interesting, and we talk a lot about Strings there, I think, towards the end. But Sabrina Strings points out that not only does fatphobia have really damaging effects for black people today, it actually originates in anti black racism and colonialism. It's only in the mid eighteenth century that an association begins to be drawn between blackness, fatness, and immorality. Nowadays, we tend to think that fat people have lower levels of self control and all of these really damaging moral stereotypes that we'll talk about with Kate Manne in the interview that just do not at all map onto reality, and those association Strings argues come out of the burgeoning race science that starts to get established in the eighteenth century and that negatively affect all black people, but especially black women. There's this valorizing of muscular and or thin white women in contrast with this idea that black women are perceived to be fat. And that, not only is it junk science for many reasons, which Strings goes into, But it also is a really powerful tool of race based oppression. And in terms of its being bound up with colonialism, Manne points out, because she also discusses Strings's work in the book Unshrinking that we're gonna discuss with her, that fat phobia is largely a Western export. It's not as though fatphobia arose spontaneously in a bunch of different places all over the world. In fact, it has really been this export of western colonialism that then has trickled into all of these other cultures as well.

David: 9:44

Yeah. And I think the point here that really needs to be underlined is that it's not as if fatness was degraded and devalorized and then associated with blackness, it was first connected to blackness. And in that association, it came to be an object of disdain because it is through eighteenth and nineteenth century racial anthropological discourse that association is made, especially as philosophers and anthropologists try to talk about different racial categories and come to define Africans primarily through their fatness, their so called fatness at that time. And so from the beginning, fatness takes on this negative valence because it was already tied to race.

Ellie: 10:33

Or it was co constituting. Because there are some remarks from the from earlier times Of actually the thinness of African peoples, especially the Moors. It's all, I think, quite a complicated story here. And one thing that I think is related to the negative valuation of fatness, its association with a lack of self control, is the history of our own discipline, philosophy. Philosophy is a highly fatphobic discipline, both materially speaking, but also in terms of the thought experiments that we use and the narratives that we have around our discipline. And so I was really struck by this example that Manne gives in the book. A caption on a portrait of David Hume in a pretty recent philosophy textbook reads, the lightness and quickness of his mind was entirely hidden by the lumpishness of his appearance. Yeah. And then, David, I wanted to hear your thoughts on this one because Manne also points out that the standard example of weakness of will in contemporary moral philosophy is having a cake or a cookie or a piece of cake. You could also have a whole cake, but it's a piece of cake. And so there's this quote from the philosopher Thomas Nagel's essay, Free Will, very famous paper."Suppose you're going through a cafeteria line, and when you come to the desserts, you hesitate between a peach and a big wedge of chocolate cake with creamy icing. The cake looks good, it's fattening. Still, you take and eat it with pleasure. The next day, you look in the mirror or get on the scale and think, I wish I hadn't eaten that chocolate cake. I should have had a peach instead." David, what do you think about this example? How is it illustrative of fatphobia?

David: 12:17

Well, I think it's illustrative in the sense that it picks something that in itself is already deeply symbolically charged in a fatphobic society. We're talking about a dessert, which is often seen as the thing that you authorize yourself only when you have earned it. So there are questions of merit and deservingness but it's also something that is redolent of a hedonistic way of living. You have dessert out of pure pleasure rather than out of a fundamental biological need for nutrition. So it's seen as going beyond what is necessary for the maintenance and the preservation of the body. So it combines those two things, this kind of excessive gluttony with hedonism as a way of making us think that anybody who eats those things clearly would be not just an example of, but maybe the paradigm of akrasia or weakness of will. Right? The people who do that are the ones who can be trusted the least to control their impulses and their drives.

Ellie: 13:19

The idea being that if you eat the cake now, you're choosing a short term but fleeting pleasure and causing suffering down the line. Whereas if you choose to eat the peach, You are choosing something healthy for yourself, which really takes a very narrow view of health and pleasure into account. Now granted, I personally would, in most cases, prefer to eat a peach than a slice of cake. In part because I know it will make me feel better. So I'm, like, on the peach side here, but not because it's fattening. And so this is part of the problem too is the way that Nagel is drawing on this idea that the reason somebody shouldn't have the slice of chocolate cake, that's actually the only reason he gives, is because it's fattening.

David: 14:03

Yeah. And think the further assumption there is that it would be clearly irrational to take actions willfully that would contribute to your weight gain. So there is a theory of rationality at work here where you know better and no rational being could possibly choose to want to gain weight. And that's also elided in this kind of lighthearted discussion about cookies and cake.

Ellie: 14:27

Whereas, what I think is actually the most irrational about this example Is Nagel's suggestion that the following day you look in the mirror and get on the scale and think, I wish I hadn't eaten that chocolate cake As though within that twenty four hour period, you would have demonstrable effects on your weight and appearance in the mirror by virtue of having eaten a single slice of chocolate cake.

David: 14:50

Today, we're talking about fatphobia.

Ellie: 14:53

How is that phobia evident in the very structure of our society?

David: 14:56

And what are the medical as well as the moral dangers of dieting?

Ellie: 15:01

How can we move beyond fat phobia in order to embrace bodily diversity and listen to the moral imperative of our own hunger.

David: 15:14

Doctor Kate Manne is associate professor of philosophy at Cornell University. She specializes in feminist philosophy, moral theory, and social and political philosophy. She is the author of a number of books, some of which we have talked about in our podcast in the past, such as Down Girl, The Logic of Misogyny

from 2017, and Entitled: 15:32

How Male Privilege Hurts Women from 2020. Today, however, she is here to talk to us about her brand new book,

Unshrinking: 15:43

How to Face Fatphobia.

Ellie: 15:47

We're so excited to welcome Doctor kate Manne to the podcast. Kate, thank you so much for joining us.

Kate: 15:52

Thanks for having me. I'm a big fan of the podcast.

David: 15:55

Oh, that's so great to hear. We're really excited to talk to you about this book that just hit the press. And I wanna begin by asking you a little bit about the role of dieting in it because it is very common to tell fat people that they need to diet to become healthier. But you point out in your book that dieting rarely leads to long term weight loss for the people who diet, and it doesn't really have very clear health benefits. In fact, for many fat people, the risks of dieting far outweigh the potential benefits such that one would be better off from a medical standpoint not dieting in the first place. What in your view are the most salient risks of dieting?

Kate: 16:40

Yeah. It's a great question. One thing to just maybe say at the outset for listeners who may not have read the book and maybe are still coming to these issues fairly fresh. When I use the word fat in this context, I'm using it not as a pejorative, but as a completely neutral description of somebody. So much as we describe ourselves as short or tall, I think we can ourselves as fat or thin or somewhere in between without apology, without shame, without embarrassment. So that's why I prefer to use terms like fat rather than potentially stigmatizing and at least medicalizing terms like overweight or obese and I certainly wanna avoid euphemisms like curvy or husky or whatever. I think we can just talk about fatness really without, apology or shame. So that's just one caveat so that listeners won't be put off by my using this language in this perhaps unfamiliar way. In terms of dieting, the studies are very clear on this. People can generally lose a modest amount of weight, often about between five and ten percent of their starting weight, on any number of diets. But the weight comes back almost inexorably over about a five year period. So when you do longitudinal studies of people who've been on strict diets, be they low calorie, low carb, low fat, some combination of those, What we find is that people are regaining that weight within five years, and often even overshooting their original starting weight. So between one third and two thirds of people will end up heavier than they started on these diets such that I think the best metaanalyses of all long term dieting studies are just very clear that the success stories, the quote, unquote says stories of people losing weight permanently on diets are virtually nil. This is very occasionally something that happens according to anecdotal reports. But when you look at population level studies, large longitudinal studies, this is not a phenomenon that you can bet on happening with any reliability in a large population. And so what we find in addition to that when you look at this data is that in addition to not being the key to long term weight loss, there are also these huge health ill effects of what is known in the literature as weight cycling. So weight cycling is what happens when people go up and down in weight, which as the empirical results I just mentioned indicate is the almost inevitable result of dieting for the vast majority of people. And weight cycling turns out to have all of these independent health problems associated with it, including cardiovascular risks including metabolic damage, which places people at higher risks for things like type two diabetes, including immune function damage and also including mental health effects that can be quite deleterious. So what a lot of this research is indicating is that people are better off even if they are classified as having a BMI that is over the ideal that is this incredibly retrograde product of nineteenth century astronomer Adolphe Quetelet's sense of what a body should be according to the men he was looking at Belgian military men in the nineteenth century. It that BMI standard, even if you are over that, there really isn't a good indication that you should be trying to lose weight. In fact, it may be detrimental. Another kind of fun fact to just note for readers who aren't familiar with the science on this is that statistics show that actually the lowest mortality risks are associated. Again, this is correlation not causation, so we should be careful. But The lowest mortality risks are associated with being in this so called overweight BMI category. That is having a BMI between twenty five and thirty without a simple equation based on your height and weight. That it really raises the question over what weight? Why do we call people overweight based on these very arbitrary and retrograde standards when in fact there's both no indication that they'll suffer greater health risks in this particular category. We even find statistics like so called mild "obesity" being no riskier mortality wise than being in the normal weight category of the BMI. And we find that when people do try to lose weight, they'll often end up weight cycling with which is independently risky for one's health. So I think a pretty clear picture is emerging that people just come in different shapes and sizes, and you can do a lot of damage to your body. A lot of, I think it's fair to say, violence to your body by following the seemingly near universal medical wisdom of dieting yourself down to an arbitrary size.

Ellie: 21:56

Yeah. And I think the all of these really important points you're making about how dieting is not liable to make people healthier, and in fact, it may lead to people becoming less healthy by, all sorts of metrics is also related to a really interesting argument that you make in the book, which is that dieting is morally bankrupt as a practice. So this is in addition to that health argument, a moral argument for the uselessness of dieting, and, of course, you are a moral philosopher. And I'm curious, why is dieting a morally bankrupt practice in addition to being harmful for your health?

Kate: 22:36

Yeah. Totally. One way to look at it is that dieting just doesn't have the effects that people have long assumed it does of leading to long term weight loss as we've just discussed, and it costs people a lot in terms of happiness, in terms of pleasure, and in terms of for people like me at least who have suffered from disordered eating or even full blown eating disorders in more extreme cases, we're talking about real suffering engendered by the practice of dieting. So I think that just from a very simple kind of moral broadly consequentialist calculation. There are virtually no benefits. There are real costs, and there is a kind of suffering involved that I think we should take very seriously in people both trying to shrink themselves down to a certain size and really not getting that pleasure and joy and comfort from food and undergoing the suffering associated with simply being hungry a lot of the time. So taking that seriously as a moral philosopher means, I think, it's pretty easy to condemn the social practice of dieting. And in particular, I think diet culture is a morally bankrupt practice. Now that is not at all to condemn the individual people who may be caught up in dieting. I have indeed nothing but sympathy for people who are really, caught in this sense of themselves as under an obligation to diet and who really think of themselves as almost morally bound to diet. But a big part of my work and intervention in this book is to say, no. As a moral philosopher, I think that this is not only a pseudo-obligation to make yourself smaller for those who are fat, but it's also morally abhorrent to make people feel that they should be smaller when both we know that isn't generally possible for bodies. So under a broadly ought-implies-can principle, we can't do this, so it's not the case that it ought to be morally required. And we're leading to people suffering in the process, which leads to the practice being something we can morally condemn, I think, pretty easily. Where are the benefits? And there are real costs. So I think it's a pretty simple equation when you look at it from a kind of bird's eye philosophical perspective. What's the point? And we're causing people a lot of misery that would, begin to not completely evaporate, but it would be diffused If we had a more progressive, inclusive attitude towards bodies as just being something that, yeah, we come in different heights, and we also come in different sizes and shapes.

David: 25:24

Yeah. And that naturalizing maneuver, I think you're right would defuse a lot of the harms associated with this kind of compulsory dieting that happens under a fatphobic society. And in your book, you do a wonderful job of talking about those dangers. We've talked about the medical dangers. We've talked about some of the moral dangers, but there are also scientific and epistemic dangers that come from the way in which fatness gets transformed into fat phobia in social settings and medical settings, especially when it comes to medical error. Now as a philosopher of science, I'm really interested in this question concerning nonscientific sources of medical error, cases where medical practitioners, draw wrong inferences because of certain biases in the way in which they think about their patients or about their object. And in your book, you talk about how perceptions of fatness can be a driver of misdiagnosis in clinical settings. And you point out this, really stood out to me, how every clinical encounter between doctor and patient begins almost ritualistically with the doctor or the nurse weighing the patient on a scale. Such that from the very beginning, weight is front and center, and it starts mediating patient doctor communication. But it's front and center to such a degree that it can actually misdirect medical attention. Can you talk to us a little bit more about the ways in which fatphobia can lead to preventable medical error?

Kate: 27:05

Yeah. Completely. I think that that centering of a person's weight at the beginning of a medical encounter, whether or not knowing a person's weight is medically relevant in any way, which oftentimes it's just not. It's actually rather rare that you would have to know a person's exact weight for the dosage of a particular medication, for example, that's the exception to the rule. Generally, it is this part of this ritualistic and a sort of very much a set of assumptions that someone's body size determines their health status in ways that are just scientifically inaccurate. So that's part of it, and part of what happens here is I wanna be very clear, not implicit bias, but explicit bias. So when you survey nurses, you find that a substantial proportion, nearly a quarter, say that they don't wanna touch fat patients. They find our bodies repulsive. When you survey doctors, they say on twelve out of thirteen indices that they view fat patients more negatively, view a fat patient as a waste of their time, view a fat patient as more likely to annoy them and say that they have less desire to help this patient. And this is for a note a notional patient who's coming in for a condition completely unrelated to weight that is a migraine headache. So people are in the medical field are just out there with these biases, which have the result that you find so many fat patients reporting that they have simply been told at a medical appointment to lose weight, which has completely misdirected attention from much more pressing actual problems with their health that have been missed, including things as dramatic as having bone marrow cancer in a case that I begin my chapter on fatphobia, it's nature, with a woman, Jen Curran, who had bone marrow cancer but was just told to lose weight. Another woman who, this was a woman named Jan, whose surname we don't know, who had the most enormous endometrial tumor that the surgeon who eventually operated on her, had ever seen and cancer that had invaded her lungs, her bladder, her pelvis, such that it was too late to save her life despite the fact that she had been trying to seek medical help for six months. Doctors had not looked past her weight. They had just told her to improve her diet and get more exercise instead of ministering to her pelvic pain, her postmenopausal pelvic pain and bleeding, which should have averted them to the presence of this cancer invading her body. So those anecdotal reports are then backed up by the alarming finding that patients upon autopsy who are fat are 1.56x more likely to have serious undiagnosed medical conditions with their heart and lungs such as endocarditis, which suggests that they're just not getting the medical care that they need during their lifetimes. So part of this is just explicit biases are meaning that medical practitioners are missing the cause of a patient's symptoms. Part of it too is that if you encounter such stigma at the doctor's office, patients who are living in larger bodies will often simply avoid seeking medical care in the first place. So some of the problem is misdiagnosis, and some of the problem is a lack of diagnosis altogether because patients will say, especially in proportion to their being larger that they are avoiding seeking medical care until they lose weight. So people are, we know, not getting as many screenings for things like breast and colon cancer as well as not getting routine kind of medical checkups because they're fearful of being shamed by the doctors. And they're right to be fearful of that because that's often what happens during a medical encounter. Yeah, I think we have really excellent evidence that fat phobia is manifesting itself out of a sort of moral panic about the supposed ill health of fat people in somewhat ironically and often tragically, fat people getting incredibly substandard medical care or no care at all. And so it is thus very unsurprising that we get some bad health outcomes with people who are at a very high weight, very likely, at least partly because they are getting such poor medical care and because they're not getting care at all.

Ellie: 31:56

Yeah. And especially when you think about those explicit biases that you mentioned in the medical field, that idea of, do I go into the doctor and face these biases and probably not get the medical care that I need, or do I just not go to the doctor at all so that I can avoid that kind of shaming practice. And then you have this ineffectiveness of dieting that you've mentioned and the negative mental health impacts that can emerge from restrictive eating, and all of these elements, both psychologically and structurally. And I think what we've been talking about so far speaks to a metaphor that is central to your book, which is that fatphobia is a straight jacket. I was really struck by that. You talk about it as a form of oppression that operates on institutional and psychological levels and gaslights fat people and encourages nonfat people as well to stigmatize and fear fatness. So tell us about this way of understanding fatphobia and how the straight jacket metaphor works for you.

Kate: 32:54

Yeah. One of the things I want to be navigating delicately in this book is that look, this is not just about body image. So many people, even people who are thin, have this fear of gaining weight and struggle with their body image or even sometimes, quote unquote, feel fat. And I want to recognize that people who are in larger bodies, especially people who are very fat. So I'm, someone who wants to own my privilege at this point in time in terms of being at the smaller end of the fat spectrum, I am someone who can fly comfortably on an airplane and so on. Whereas people who are at the very fat end of the spectrum who are often known in the fat acceptance community as infinifat will really face these material harms that mean they literally don't fit the world, that they can't travel on an airplane with any ease, that they can't sit at a restaurant and have a pleasant meal, that they can't be in a grandstand or a theater in ways that are incredibly stigmatizing and also just are an issue of basic accessibility. So part of what I wanted to do with the straight jacket metaphor is acknowledge that in some way fatphobia threatens all of us, no matter our body size with, oh, don't get fat, or for many of us don't get any fatter, you're already on the cusp of a problem. But for people who are over a certain size, it is a material reality that you are being forced into a size and shape where your body might just not be able to go there. And you can be subject to, horrifying things like being in terrible pain, having to sit in an airline seat that just doesn't fit you, left with bruises on your body if you can't afford to fly first class or if you can't afford to buy two seats, your body can be left in terrible pain in a way that does resemble this straight jacket that constricts your very flesh. So that's part of what I wanted to do with the straight jacket metaphor as well as noting how stigmatizing fatphobia is. The way that much like the proverbial straight jacket, fatphobia marks some bodies, I think, as undeserving of care, as beyond the pale of being compassionate, being caring, being inclusive, it marks some bodies as just, yeah. We don't trust these people. We don't like these people. We regard their problems as all their fault we can't just be dismissive of the reality of being in a very fat body that doesn't fit the world and faces material barriers that need to be faced squarely. And it would be inaccurate, as to call fatphobia the last acceptable prejudice because there are all sorts of currently super acceptable prejudices that are proliferating in alarming ways including transphobia and homophobia and misogyny and racism and all of the rest of it. Ableism, classism, I could go on and on. However, I do think there is a kind of truth to the idea that amongst progressives, fatphobia has attracted perhaps some of the least attention and mobilization because of a kind of tacit way in which fatphobia kind of serves as a proxy for racism and classism that is frowned upon amongst progressives, But fat bodies are seen as blameworthy and as a sign of having a certain stigmatized class and race. And so I think there's a way in which, as Paul Campos argues in his excellent book, The Obesity Myth from, I think it was two thousand five, There's a way in which our unexpressed implicit biases that have a kind of class and race aspect to them get expressed in fatphobia because the average progressive would feel really embarrassed to be looking down upon someone who is, say a Mexican American woman shopping at Walmart for that reason, but we're fine as progressives oftentimes with frowning upon a fat, make that quote, unquote, morbidly obese woman in that position shopping at Walmart. So his point is that our kind of unexamined class and race biases, which are largely, he thinks, implicit at this point in time, can be amply expressed in our fatphobia that allows us to stigmatize the very bodies who racism and classism targets.

David: 37:38

Yeah. And I have to say, I really like this section of the book because often when I have thought about these issues and when I've taught a text about fat phobia and fatness to my students, I often foreground the depoliticization that we have in connection to fatness. All these other categories like race, ethnicity, sex gender. We do already have a political understanding of them, but it seems as if with fatness, we've resisted that politicizing move, but one of the arguments that really stood out for me from your work is that it's not just that it's depoliticized, it's that it's hyperpoliticized because it allows other prejudices to be expressed without the typical social censors that would get triggered through other mechanisms of their expression. And this focus that you've been talking about on the material consequences of fatphobia, like discrimination, exclusion from public space, as well as the psychological impact, like the stigma, the internalization, so on and so forth, add to what I would call a political take on diet culture. And in envisioning a way out of diet culture, you write about how important it is to take hunger very seriously as what you call a bodily imperative. And according to this way of thinking, feeding ourselves when we are hungry is not an admission of weakness. In fact, it's a moral imperative. Now how does this view of hunger as a bodily imperative intersect for you with popular approaches such as intuitive eating discourse when it comes to resisting the pressures of this diet culture that we live under.

Kate: 39:27

Yeah. Totally. I didn't want to speak for people in the intuitive eating tradition, but if what I'm saying about bodily imperatives was taken up as a kind of underlying philosophical explanation of why intuitive eating makes moral as well as bodily psychological sense, that would make me very happy. That's how I would ideally love to be read because a lot of what I'm doing is really saying, look. The body calls on us to do certain things for it in ways that are almost literal. Like, when you're in need of a deep lungful of oxygen, as many people learned during the pandemic, The bottling imperative to breathe is so demanding, so visceral. The desperation entailed by the need to take a full lungful of air when you can't breathe properly, it really is all consuming. Pun intended. Similarly, when you really need to sleep, it might be a little bit less immediately urgent, but that desperate need to sleep has that same kind of visceral quality where it's almost like your body is telling you get some rest, go to sleep. You need to just close your eyes, find a comfortable place, find a place to lay your head and rest. And that kind of inner voice can similarly be heard in hunger. We're seeing, quite, I think, borderline dystopian trends like that inner voice of need, of visceral bodily need being dismissed as so called food noise rather than, yeah, what our bodies call upon us to do and what it makes sense to listen to in order to resist self alienation. So I think of, yeah, intuitive eating as a practice that is very much in line with my philosophical impulses and the way that I've drawn on my metaethical views about the moral significance of these bodily imperatives to, yeah, yield the practical advice that I think are the rich tradition of intuitive eating clinicians and dietitians and nutritionists have made concrete by granting your body a certain kind of moral authority where when you're hungry, Responding as your body bids you to do. And in as much as you have access and, sadly, sometimes tragically, people can very much lack says to the means to do this. But when you do have access to the means to eat in ways that are in line with what your body calls upon you to do, that's what you should do. People also need comfort and pleasure and connection with other people that is sustained by things like feasting occasionally and having special family meals and traditions and so on. And also that private, intimate act just with yourself of the special snack, the PB&J at midnight. That's important too. That's an exercise in, I'm hesitant about this term, but it is an exercise in self care, which as Audre Lorde said, can, be a radical political act when seen not as, an act of self indulgence, but rather as a crucial act of self preservation in a world that particularly for the most vulnerable people wants to cut them down, wants to cut them down to size, wants to infringe and impinge upon their bodies.

Ellie: 43:02

Yeah. And in light of all of this, I think your book is coming out at a really interesting time, because just within the past year, this new class of injectable weight loss drugs called glucosides that includes Ozempic and Wegovy have exploded in popularity. And so as I was reading your book, I was like I like, oh, I want I wonder if she's gonna mention Ozempic. Because I think for some, we're approaching a future in which permanent weight loss is fast, easy and safe. And so there's almost this, like, why not approach or this idea that we are going to move beyond fatness. However, you write, and I'm gonna quote you here, that "even if these interventions were perfectly safe and costless and painless, which they're currently far from being," you'd still find them objectionable because they reduce human bodily diversity, which is something that we should value. And I'm curious because I wonder how you might defend this claim to someone who might be considering such drugs.

Kate: 44:04

Yeah. This is tricky because, again, Having written about the straight jacket of fat phobia, I have nothing but sympathy for someone who does want to shrink their body in order to better fit the world.

Ellie: 44:18

And you've been there yourself.

Kate: 44:20

Absolutely. I've been on extreme diets. I'm, some sixty pounds lighter than I have been at previous points in my life. And yeah. So I write this as someone who views all these trends as really sad and unfortunate and the overall social practice as deeply morally criticizable. But, again, I have no beef with someone who's like look, I just wanna fit the world better, and so I'm gonna take one of these drugs. However, I would point to a bunch of reasons to worry about them. One is that what we're seeing again at a general social level of analysis is they're partly distorting the way that we talk about hunger and appetite in these really, I think, quite dystopian ways. So one thing that has happened since I finished the book, and I do talk mnb bbbbabout, as you just quoted, Ozempic and Wegovy and how to think about them. But since I finished the book and since it was in press, the trend of talking about food noise instead of hunger, this kind of slick rebranding of hunger, appetite, craving, and the kind of call of that inner voice that says, do it. Eat the delicious PB&J. Eat the toast. Eat the apple, whatever it is you're craving that voice that kind of makes a particular food appealing to you at a particular moment when you're hungry, that voice is being derogated as, "food noise" with now nearly 1.9 billion views of videos related to food noise explained on TikTok. So it's this booming and sudden overnight trend where hunger has been rebranded as food noise thanks to the advent of social media and people's experience of having less in the way of that inner dialogue suggesting certain foods to them to eat and adverting to their hunger while on these powerful appetite suppressive drugs. And, rather than viewing hunger as food noise, I think we should view it as telling our bodies what they need and what we should honor. And the opposite of trying to not only ignore as in dieting, but silence that inner voice using appetite supressive drugs as an exercise in self-alienation. And I say this as someone who long tried to suppress my appetite using, as I talk about in the book, everything from over the counter supplements that were very ineffective to highly effective appetite suppressants like Adderall, originally prescribed for ADHD, but which I took mostly for the appetite suppressive effects. And that is serious stuff. It really takes you out of this deep connection that we can have with our own bodies and is a way of saying that hunger is something shameful and wrong. To call something mere noise is to go beyond describing a relative silence. It's to say that the presence of that soundtrack in our lives is somehow wrongful, shameful, and something which should be turned off. There was a little comment on a Twitter thread about this when Nigella Lawson, the famed English food writer who I absolutely love, said, I couldn't bear to live without food noise. And a commenter chimed in and said, I think the correct name for it is food music. And I really love that because the normative framing is so up for grabs. So that's part of why I'm critical of these drugs. Another part of it, of course, is the prevalent side effects. But as you just pointed to in that quote, even if the side effects were a thing of the past, even if these drugs got much better, I think in a way what a sad world if we all became, more in line with white supremacist, ableist, fat phobic, and misogynistic ideals of what everybody ought to look like. So the ideal that is, you know, so focused on thinness, smoothness, youth, and whiteness, There's a real shame, I think, in having an overall social trend of us all gradually conforming to that ideal. The idea of not having, people who are very large and have this amazing intimidating stage presence, people who have the kind of delicious heft of a burlesque dancer, people who have you know, like Nicole Byer, this amazing capacity to kind of mold their flesh into these incredible shapes in her gorgeous bikini poses. I don't know. I just think what a world, what a reduced world we would live in if we were all made to shrink, if we all chose to shrink ourselves via the advent of these drugs. And let's not forget too that we shouldn't exaggerate their effects. These drugs are going to take, on average, about fifteen percent of someone's starting weight off, which is much more than diet and exercise tends to do, but it's still not gonna make a very fat person thin. It's going to make them a bit less fat, but fat people, I think, the good news from someone from the point of view of someone who values body diversity, city, fat people will always exist even after the advent of these drugs, which at least in their current incarnation, will lead to a world that is somewhat more conformist, but let's not overestimate their power. And let's remember that a lot of what is happening right now is also the thin getting thinner and the rich getting richer rather than people who are very fat necessarily even having access to these drugs. And also, again we shouldn't overestimate their effects. For someone who is 300 pounds to lose fifty pounds is significant weight loss, but it will still generally leave them in the very high weight category of things like the BMI charts. So whatever the case, we're still going to need efforts to combat fatphobia. And I think that is one of the important take home messages that, yeah, even for readers who disagree with me that there's a real value in bodily diversity even for readers who, for whatever reason, embrace the advent of these drugs. We're still gonna have fat people, and they still need to be treated better. And, that is going to remain a pressing kind of political problem, I think, for as long as we have bodies and for as long as we don't have total control over our weight, which, seems very unlikely and to me, a rather dystopian possibility.

David: 51:05

Kate, this has been an amazing discussion. You gave us a lot to think about.

Ellie: 51:10

A lot of food for thought. I had to it say it.

David: 51:15

It was music to our ears keeping sonorous metaphor which I thought was beautiful, by the way thinking about the body as a source of music rather than noise.

Ellie: 51:26

Totally. No. It's been so so fun. I definitely recommend the book to just about anyone, it's such a great read and really such a needed intervention into this fatphobic world we live in.

Kate: 51:39

Thank you so much for having me. I've enjoyed the discussion and your amazing questions so much.

Ellie: 51:50

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David: 52:11

Loved that interview so much.

Ellie: 52:14

So great.

David: 52:15

Yes. Okay. Ellie, get us started on our concluding thoughts and reflections.

Ellie: 52:20

Okay. So I want to imagine the position of somebody who came from our interview and was convinced by a lot of what Kate Manne said, but has the following

question: 52:31

okay, we shouldn't blame individual people for being fat, but isn't it case that humans in general are getting fatter for nefarious and problematic reasons, namely the existence of food deserts, which encourage people to get cheap and fattening fast food, the rise of hormones in our milk, which has an impact especially on women's bodies, etcetera, etcetera. And so I'm curious. I wanna think about some resources that Kate Mann's book has to respond to that. One of them is her noting that weight is in large part genetic, So not entirely genetic, but it is in large part genetic. But another thing I found really interesting about her book Is the fact that she points out that weight is at best a proxy for the health concerns that we can and should care about directly? We should care about so called food deserts. We should care about the rise of "bad stuff" in our food. And, of course bad stuff, let's take with a grain of salt because there are a lot of things that we think are quote, unquote bad that actually aren't. Nonetheless Manne holds that, yeah, health is something worth considering, and she does wanna hold on to the idea that, when it's not gonna be harmful for us, let's try and be healthy. But let's really distinguish that from weight because correlation is not causation, and we just cannot say with any level of confidence that weight in and of itself is a bad thing.

David: 54:05

Yeah. And I think there are a number of arguments that she makes that sort of give the lie to our so called health concerns about fatness and that reveal them to really be fatphobic judgments in disguise. So for example, she points out that a lot of the concerns that we express about health in connection to people who are bigger and fatter also apply to people who are very thin, yet, culturally, you never see that concern expressed on the same scale. And we also don't see the same BMI limitations on the lower end of the BMI scale that we see on the upper end scale even when technically they could be said to apply as well. Also, she talks quite a bit I believe it was in chapter two about type two diabetes, which is I think in the popular imagination, the condition that is most associated with fatness. And it's the one that people point to as a way of saying, look, no, fat bodies are objectively at a higher risk of being unhealthy because of type two diabetes. And she says we also have to be very careful here because after decades and decades of research, The causal connection between fat and insulin is actually not as clear as we've been led to believe Because we've been led to believe that you gain weight and then that causes changes in your insulin, whereas there is also plenty of research that shows that the inverse is often the case and might actually be the right explanation for the correlation between fatness and type two diabetes, which is that certain changes in the body related to insulin produce a slow accumulation of fat in the body so that the insulin changes come first, The fatness comes later, but then retroactively, we switch them around in our mind. And so I thought it was a really good and very accessible again to echo that point that you made, account of the ways in which in our head, we use the word fat to mean unhealthy without realizing the mistakes that we make in doing so.

Ellie: 56:10

Definitely. And I think your point about extremely thin people is well taken Both in terms of what you said and also in another area, which is this extremely Troublesome argument that you sometimes hear of people saying fat people are a drain on the healthcare system. And Manne points out, as you said, actually extremely thin people are also not quote unquote healthy and so you could Say a similar thing about them. We don't say that. That's telling that our reasons for saying that fat people are a drain on the health care system don't have to do with actual economic, let alone well-being concerns, but have to do instead with fat phobia. And also she points out that there are all kinds of risky behaviors that we don't judge people for. Somebody who routinely goes skydiving is...

David: 57:01

yeah, exactly.

Ellie: 57:03

At much greater risk than somebody who is fat for quote, unquote, being a drain on the health care system, but we valorize that person. We often imagine them as thin.

David: 57:14

Yes. Yeah. No. I think that's a really good point because this is an argument that's very familiar to all of us that fat people, as she says, are a strain on an anthropomorphized health care system. As if the health care system is just like this person that's carrying the weight of society on its shoulders.

Ellie: 57:29

Oh my god. Meanwhile, when it's like the biggest snake oil salesman in the world, our health care system.

David: 57:36

Yeah. Yeah. But notion that fat people are in some ways taking advantage of the commons. We all chip in, but they're taking more out because they carry a higher mortality risk or they need more services, whatever. But we never see that argument in connection to people who smoke. Nobody would say, oh they should pay more for health care or in connection to people who do intense bodybuilding, which also brings a number of health concerns or as you pointed out, skydivers. And when people often talk about individualizing people's contribution based on their health risks. That's really scary to me because that completely takes us out of any communitarian understanding of the role of health care as a social safety net, and it takes us in the direction of turning health care into an individual package that is always tailored to the individual and that punishes certain people over others because it's never equal. What gets factored as a risk?

Ellie: 58:35

Which is already enough to take down this argument, but the real nail in the coffin is that fatness, as far as we know, is not actually a cause of ill health to begin with.

David: 58:44

That's a call for us to resist the logic of unshrinking that we get from all sides in a fatphobic society and to work on learning to appreciate and cherish what Kate Manne calls the great diversity of human bodies that nature has given us.

Ellie: 59:01

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