140: Mythbusting about fat and BMI with Dr. Lindo Bacon
This episode kicks off a series on the intersection of parenting and food.
We begin today with a conversation with Dr. Lindo Bacon, where we bust a LOT of myths about the obesity epidemic that is said to be plaguing people in the United States and other countries that follow a similar diet.
The messaging we get from government entities seems pretty simple: being fat is bad for you. It causes increased risk for a host of diseases as well as early death. If you're fat, you should lose weight because then your risk of getting these diseases and dying early will be reduced.
But what if this wasn't true?
What if this messaging had been established by people who own companies that manufacture weight loss products who sit on panels that advise international governmental entities like the World Health Organization?
What if body fat was actually protective for your health?
We dig into all these questions and more in this provocative interview.
We'll continue this series with episodes looking specifically at sugar, as well as supporting parents who have or continue to struggle with disordered eating, and how to support children in developing eating habits that will serve them for a lifetime, not just get the vegetables into them today.
Jump to highlights:
(01:00) Introducing Dr. Lindo Bacon and starting our series of episodes on the intersection of parenting and food
(02:22) Stripping the word ‘fat’ of it’s pejorative meaning and reclaiming the term while acknowledging that it may be jarring for some people
(03:09) Kicking off the conversation with how we measure health using BMI and how it might not be accurate
(05:03) The resistance to Katherine Flegal’s seminal research in weight and longevity
(05:49) The development of the Body Mass Index was with scientific bias to fit the bell curve
(07:30) Higher body weight does not necessarily mean a person has greater risk of poor health
(10:59) We actually know that the research is highly exaggerated in terms on the role that it plays on health
(13:16) Dr. Bacon’s turning point: When she found out that BMI was recommended by an organization funded by pharmaceutical companies who have the only weight loss drugs on the market
(17:35) Taking the issue one step further with the American Medical Association’s recommendation whether to categorize obesity as a disease or not
(19:19) The Obesity Paradox is an observation in the research that people who are obese who get the same diseases as those with ‘normal’ weight are living longer
(21:15) The concept of dieting just doesn’t work according to the data
(30:33) A story of Dr. Bacon’s and their father’s knee problems
(34:40) Individual factors only accounts to 25% to somebody’s total health outcomes and social determinants account to about 60%
(42:05) It is cool right now to be your authentic self but not everyone can so easily be their authentic self when their authentic selves are not valued by society at large
(45:48) Improving the health of individuals is more communal than individual
[accordion-item title="Click here to read the full transcript"]
Jen Lumanlan 00:02
Hi, I'm Jen and I host the Your Parenting Mojo Podcast. We all want her children to lead fulfilling lives, but it can be so hard to keep up with the latest scientific research on child development and figure out whether and how to incorporate it into our own approach to parenting. Here at Your Parenting Mojo, I do the work for you by critically examining strategies and tools related to parenting and child development that are grounded in scientific research and principles of respectful parenting.
Jen Lumanlan 00:29
If you'd like to be notified when new episodes are released, and get a free guide called 13 Reasons Why Your Child Won't Listen To You and What to Do About Each One, just head over to YourParentingMojo.com/SUBSCRIBE. You can also continue the conversation about the show with other listeners in the Your Parenting Mojo Facebook group. I do hope you'll join us.
Jen Lumanlan 01:00
Hello, and welcome to the Your Parenting Mojo Podcast. I'm very excited about our episode today because we're at the very beginning of what I hope is going to be quite an extended series of episodes at the intersection of parenting and food. And I'm hoping to look at ideas like eating disorders and intuitive eating and how sugar impacts our children and what we should do about that, if anything, how we should approach eating issues with our children more broadly and how we can all be a little bit happier in our bodies. And today we're kicking off this series with Dr. Lindo Bacon whose seminal book Health at Every Size was written over a decade ago now and which exposes how the ideas that most of us believe about body fat and weight are actually not grounded in scientific research. She followed that by co-authoring a book called Body Respect, and her most recent book is called Radical Belonging: How to Survive and Thrive in an Unjust World (While Transforming it for the Better). Dr. Bacon earned their PhD in physiology from the University of California Davis, where they currently serve as an Associate Nutritionist. They also hold graduate degrees in Psychology and Exercise Metabolism. Dr. Bacon is industry independent, which means they have pledged not to accept money from the weight loss, pharmaceutical or food industries, which makes them almost unique among non governmental researchers on issues related to weight and food. Welcome, Dr. Bacon. I'm so glad you're here.
Dr. Lindo Bacon 02:20
Thanks, Jen. I'm looking forward to talking to you.
Jen Lumanlan 02:22
And before we get started, I just want to acknowledge that I'm going to follow your lead in your books by using the word fat in this interview and using that in a way that's really been stripped of its pejorative connotations. And many people it seems who are fat, who are now reclaiming the term in this way. But I do acknowledge that it may be jarring to some listeners to hear if they aren't accustomed to hearing it like that.
Dr. Lindo Bacon 02:45
Yeah, I think it's important to name all of that. So thank you, Jen. And I also just want to note for the listeners that if you do feel uncomfortable when you hear the word, then that's something helpful to look at, because that really shows that you've absorbed the cultural ideas about that. And hopefully, we can start to normalize it so that you could feel better about it.
Jen Lumanlan 03:09
Yeah, and hopefully this conversation is going to be a big part of that as well. So I wonder if we can start at the beginning with what I know is a big topic as it were, which is how we measure health. And so this body mass index, or BMI for short, has become the standard measure of how much weight a person is carrying compared to their height. And it's best considered an indicator of how healthy they are in some way. And it's used by everybody from the Centers for Disease Control in the US to the World Health Organization. Is the BMI actually a good measure - I guess I should start by saying of anything at all and then we can go from there and to health.
Dr. Lindo Bacon 03:47
You right. I think that your question already answered itself, but it really does not play much of a role in health at all. And I think that its use has been quite damaging to people. So I wish that the medical industry would throw it out.
Jen Lumanlan 04:03
Yeah. So where did it come from? How did we end up here?
Dr. Lindo Bacon 04:07
Well, it actually was written by or devised by someone who was a statistician looking at insurance, and that it wasn't meant or designed for health. And it was meant to look at what's going on in a population, not what's going on in an individual. And it's amazing when you start to look at the research of how it corresponds to health and you find some really surprising things. For example, it's pretty clear from the research that that the people that are in that category we call overweight are the people that are living longest. Most research studies are showing that and the people that are in the obese category, most of them are living as long as people in the normal weight category, or the I'm sorry that we call normal wait.
Jen Lumanlan 05:03
Dr. Lindo Bacon 05:03
Right. And it's only really at the very extremes that you start to see things that are different. Mm hmm. And but yet, the end, there was an expose a that was actually published just a few days ago by a former CDC researcher, who was her name was Katherine Flegal, and she actually did some of the seminal research in weight and longevity. And the history she said, of how she was shut down, and how all of people in industry were trying to discredit her, it was just amazing to see how much resistance she ran up against, and how people fought her.
Jen Lumanlan 05:49
Yeah, it's, I think that that seems to be quite pervasive. And I think we're gonna talk some more about how political issues impact the way that we think about these things. But I just want to really be crystal clear about this, we were talking about somebody who was a statistician who developed the original idea of the BMI and was looking to understand and define the characteristics of normal man. And we can insert the word white in the middle of there I assume. And fitting that distribution around the norm. He wasn't, you know, he's not looking to understand an individual person's health. He's trying to find this statistically interesting relationship that fits the bell curve. And somehow we've latched on to this idea, and we're using it to try to say whether an individual person is healthy or not?
Dr. Lindo Bacon 06:38
Right? I know, it's really interesting. I think about, like, if you did a height curve, you would come up with the same bell curve. And I would be all the way the extreme end in the 5%, because I'm rather short. But obviously, that doesn't indicate disease. You know, it's just, there will be some people who are on the extremes of the bell curve. That's the nature of bell curves.
Jen Lumanlan 07:04
Right. Yeah, somebody has to be there. Okay. And so I'm wondering if we can look at this sort of commonly accepted wisdom that people with higher body weight have a greater risk of poor health, and you've already sort of indicated implied and mentioned that that's not necessarily the truth.
Dr. Lindo Bacon 07:23
Jen Lumanlan 07:24
What's going on here? Why is the commonly accepted idea different from what the research is actually showing us?
Dr. Lindo Bacon 07:30
Right. Well, as I mentioned, with the suppression of the researcher, who came up with this, one of the things that was fascinating to me in that was, nobody debated her with actual data that challenged it. It was more just, you know, like, they didn't want it out. Right. And that that was what was fascinating. And still to this day, you'll see almost regular reports in the media about how damaging that is. And one of the things that I want to suggest is that every time we see a new research study, we've got a look at whether our belief system is so strongly entrenched, that we see through that lens, and we can't really see our data anymore. And that's what's happening. So for example, if you have a research study that shows that the majority of people that have diabetes are fat, then they'll make the conclusion that if you're fat, you're going to get diabetes. Right. And we do, in fact, have that research that shows that, but that research doesn't demonstrate that it's the fat that's causing the disease. There could be other mitigating factors that play a role. For example, there's one obvious factor that's going to play a role. And that's that the people that are fatter meet up with a lot of weight stigma, people don't treat them as well. And we know from the research that when people are stigmatized and disrespected, it wreaks havoc in their body and increases health problems. So it's very clear that that's an example of something that's a contributor, and we can come up with a lot of other contributors. But when we start to kind of tease everything out, we just don't have solid research that shows that it's causative of most of the diseases for which it's blamed.
Jen Lumanlan 09:39
Yeah, and I think that's such a super important point that there is a ton of evidence linking these two things, they are correlated, they vary together. And then there's, there are fun things you can find online to find completely unrelated things that happened to be co-correlated and you know, things that are wildly, wildly unrelated and could never be connected and they're correlated. So they must be, you know, one must cause the other right? When no that's not the case. It's entirely possible that diabetes may be maybe a contributing factor to increase body weight. That one of the other factors may be causing the body weight. We just don't know. I mean, I mean, and that's not the story we're told, right? The story we're told is, if you get fat, you're going to get these chronic diseases.
Jen Lumanlan 10:28
Dr. Lindo Bacon 10:29
And just to throw in a kind of a funny story there, I actually saw research that was showing that there are more drownings that happen among people that eat ice cream. Right.
Jen Lumanlan 10:44
I'm never eating ice cream again.
Dr. Lindo Bacon 10:44
Which doesn't make sense. You eat ice cream in the summer and you're more likely to be in the water. Right. But it's not the ice cream that's causing the drowning.
Jen Lumanlan 10:53
Yeah, thank you.
Dr. Lindo Bacon 10:55
That's just an example that shows that.
Jen Lumanlan 10:58
Thank you for that.
Dr. Lindo Bacon 10:59
And I should also say that we actually do know a lot about this, that the research that has tried to tease out a lot of these things, find that it is highly exaggerated in terms of the role that it plays in health. And so that's very clear from the research. But, of course, it's not what people are saying. And I think every time we see a disconnect between what's commonly believed, and what this data actually shows us that one of the big reasons that's going to underlie that is you have to ask, well, who benefits from us not understanding. And there is a huge industry of people that are making money off of our body hatred. It's not just the diet industry and certain aspects of the health industry and the bariatric surgeons, but it's also people that sell cars, can sell them off of the ability that you're going to be sexy, and, you know, fine, and everybody's gonna want you if you drive this car. So everybody seems to capitalize on our insecurity in order to make money. The more we hate ourselves, the more they can use it.
Jen Lumanlan 12:22
Yeah, okay, so let's follow that thread for a minute, then, because there are some super concrete pieces to this as well and around following the money, which is a big reason that I wanted to talk to you, because you do not accept money from outside sources that are affiliated with the industry. And it seems pretty clear that when you look at research that's funded by industries, you know, soft drinks and juice and milk, the results are four to eight times more likely to be favorable to the funders product than when that study is not funded by the manufacturer of the product. And the same goes for the drug trials. And a lot of the weight loss drug papers, you know, the scientific papers are written by the very company that is trying to sell us this medicine. They supply the text to the researchers, and then the researchers publish it. It's almost mind boggling the extent to which this infiltrates what we think of as value neutral science.
Dr. Lindo Bacon 13:16
Right? And I tell you, it makes my job hard because I'm a scientist, right. I'm supposed to be looking at data. And I don't trust most of the research that's coming out, because I know what goes on behind the scenes and how much manipulation there is. And I'll give you an example of this, because I think it's really helpful to see and it's about BMI. And the reason I'm going to give this example is because it really marks the turning point in my career and why I'm talking about these issues today. So I'm going to take you back to 1998 when I was getting my PhD in physiology, with a specialty in weight science. And there was one magical day in June I forget the the actual date that millions of Americans, I think it was 21 million Americans went to bed and normal healthy bodies. And they woke up the next day with a medical designation of being fat and a prescription that they're supposed to try to lose weight. And that wasn't because everybody gained weight overnight. That was because the government lowered our standards for what they would be calling overweight and obesity. Now, I was shocked that they did that, because I was in the middle of my literature review. And what I was seeing was that if anything, we should majorly raise those numbers, not lower them. So I wanted to look at why they did what they did. And I found out which group had devised the government on this and a lot of the advice that they took came from the National Institute of Health advisory panel. And fortunately, I knew somebody that was on that. And I called her up. And I asked her, you know, why didn't you do this? And she laughed, because she said, I was expecting this call. And the reason I had easy access to her was because she was my PhD advisor at the time. And she was well recognized as one of the leading obesity researchers in the world. And so she said, Well, this is required for your dissertation anyway that you look at this, and I'm supposed to be training you to be on panels just like this. So why don't we use this as an exercise in your training. I want you to pretend that you were on that panel instead of me. And I want you to tell me what is the most important research we need to pay attention to, and then what conclusions we should draw from it. So that wasn't hard for me to do, because I'd already done most of that for my literature review. So I gave her my findings. And it was to recommend that we majorly raise the BMI standards of what we're going to call overweight and obesity. And, again, she laughed, and she said, You know what, we identified all the same research that you did. And we came to that conclusion, too. And when we submitted it, we were basically told, but we need to be in tandem with world health standards. And so they went against those initial recommendations that we came up with. So I was horrified knowing that this is what happens. So then I decided to get curious, I said, I was thinking, so how did this happen, that the world health standards are so low. And so I called the World Health Organization. And I found out that they relied on information they got from an organization called the International Obesity Task Force, which sounds great, but I never heard of them before. So I did my research. And what I found was that the two leading funders of that organization, were the two pharmaceutical companies that had the only weight loss drugs on the market. So my point here, you know, like, that was a very long winded way of saying, the pharmaceutical industry wrote our current BMI standards, and they've made a lot of money off of it.
Jen Lumanlan 17:29
It's almost mind boggling, isn't it?
Dr. Lindo Bacon 17:30
It is. So, okay. Can I take this one step further?
Jen Lumanlan 17:35
Dr. Lindo Bacon 17:36
Okay. So more recently than that, the American Medical Association was trying to decide, do we call obesity a disease or not? So they had their own panel of physicians who are experts in this look at all of the data and come up with a recommendation. And their recommendation was, no, we should not call obesity a disease. And that was overturned by the powers that be, and they called it a disease. So even in the American Medical Association, what we're seeing is that people are not willing to allow data to drive good decisions.
Jen Lumanlan 18:19
Okay. And so, when we think about that data, then we've talked a little bit about how the data shows that there's a correlation but no causal evidence that higher body weight causes greater disease and poor health. Is there...
Dr. Lindo Bacon 18:40
Can I just interrupt to say that, I'm not going to say that there's no causal relationship, but what I will say is that the idea that it plays a role in health is greatly exaggerated.
Jen Lumanlan 18:52
Okay. Okay. And is the same true if we're talking about disease there? Is the same thing true for the risk of dying? Is that same kind of relationship there?
Dr. Lindo Bacon 19:01
Do you mean that there's not a causal relationship...
Jen Lumanlan 19:04
Either not a causal relationship, or that it has been greatly exaggerated.?
Dr. Lindo Bacon 19:09
Well, actually, with longevity, what we're seeing, and this is been really, really clear, is that it's the people in the overweight category that live longest, and the people, most of the people that are obese, not the entire category are living as long as people in the normal weight category. So you know, what the scientists have done with this? We've seen this so many times, right. And we've also seen that even when someone in the normal weight category gets the same disease as somebody that's in the obese category, the people that are in the obese category, usually live much longer than the people that are in the normal weight category. And scientists were seeing this so much and across so many diseases, that they came up with a name for it. They called it the Obesity Paradox. You know, because they were so shocked that that could happen and not willing to believe it. And yet, it happens. And it's very clear across a long range of diseases, including cardiovascular disease and diabetes.
Jen Lumanlan 20:20
Yeah. And when I started looking at this, I quickly got into the sort of warring meta analyses, as it were, that seems to characterize this field where one set of researchers will look at a certain number of studies and say, you know, this is the conclusion. And another set will say, well, you chose the wrong studies. And if you look at it in this better way, then this is the conclusion. And it almost seems as though you can get to any result you want to get to with the data that we have. So how can we really understand what to take out of the entire body of the research?
Dr. Lindo Bacon 20:55
Well, I think one of the things that's really helpful is to consider personal experience. So for the listeners, how many of you have ever been on a diet? Well, Jen, what do you think, do you think?
Jen Lumanlan 21:10
My guess is, I'd say in excess of 50%.
Dr. Lindo Bacon 21:15
Yeah, I'm sure it's, the data is showing us it's well in excess of that, and that kids are starting as early as six years old. So yes, and what we're also seeing, and I'm sure all of the people that have dieted will also tell us their experience, which is that the vast majority of people lose weight at first. And then they hit this point, where, even if they're continuing their diet or exercise plans, it doesn't work for them anymore. And they also see that the same level of dieting can actually be causing them to gain weight. And then what we also see is sure there are people that can't maintain their diets, it's hard, right? If you're hungry all the time to do it. So what I want to say is that, if you just look at it, that piece alone, what it's saying is, regardless of what people are telling us, it's not working. People have tried that for so long. And it's consistent, the vast majority of people lose weight and beginning and then they regain it. And so when we see that, I think what we have to do is blame the concept of dieting, not the individual, right? Most individuals think, Oh, I had lousy willpower, I gave in and ate that cake. Well, if we go to the laboratory, as a scientist, I can show you what was under why you ate that cake. And it's because you were hungry, your body was giving you such strong messages, that it wouldn't let you concentrate on other things. It made you totally focused on food, because it was so desperate. You know, we can trace the hormones that do this to you that make people go off their diets. So there is so much that people can do by just trusting their own experience, rather than trusting what the experts are saying.
Jen Lumanlan 23:23
Okay. And and I want to come back to that idea of sort of personal responsibility for all this, because I think it's a super important point. But before we get there, this idea of weight cycling was something that I wasn't new to the idea of it, you know, I already get, I think, knew that if you lose a lot of weight, chances are, you're going to put it back on again. But what I didn't know was that this can have really big negative health impacts for people. And that it's possible that when we see an increased burden of disease, or potentially even mortality, what we might be looking at is the burden of weight cycling over and over again, as you know, even if these people are going from one study to the next saying, Oh, this study is going to help you lose weight, keep it off, and they go through the study bounces back out, I'm going to do the next study. Or if you're doing on your own, it's possible that that process is more damaging to your health, then just being in the overweight category.
Dr. Lindo Bacon 24:16
I wish I could give you a PhD, Jen, because I'm telling you, that kind of logic that you're talking seems obvious to you and I but the scientists are not doing that.
Jen Lumanlan 24:30
Dr. Lindo Bacon 24:31
They're so convinced that weight is problematic. That that's all that they see. Yeah. But you're right. You know, this should be obvious to all of us.
Jen Lumanlan 24:42
Yeah. And each scientist is looking at their own thing in isolation, right, I'm gonna test if my diet, my special program is the one that's going to make this big difference for everybody, completely ignoring the context of everything else this person has tried and everything else that comes afterwards, and expecting that we're going to see something magical
Dr. Lindo Bacon 24:58
Exactly, and To some degree, that's why I have three graduate degrees. In the first graduate degree, which was psychology, I expected to see that, you know, if people stopped eating emotionally and find better ways to take care of themselves, they're going to lose weight, right? I thought that I would solve the weight problem. And that's when I realized all these contradictions, that's not true. That, sure, it's going to improve your well being your health, but we don't have the research that's showing that it actually helps people to lose weight. So I realized that that field alone was not going to give me the answer to this. That's why my next degree was in exercise science, because that's the next thing that everybody sets. And the same thing is true there. The research studies are showing that even when we click people on exercise programs, and we have them coming into the laboratory and doing it on the treadmill. So we know that they're not lying to us. And we're recording their weight, we see the exact same thing in the beginning, everybody loses weight. And then the vast majority of people regain it, when you take a look at them, one year, two years, five years down the line. Okay, so I had to throw that field out. So then I decided, Okay, PhD delve into the research this time. And so I got my PhD in physiology, because that's the big thing that tries to tie this together, it's the big thing that looks at what's going on inside your body. And I just found the same thing there. My specialty actually was nutrition to make sure that I was covering, you know, the diet aspect of it. And I found the same thing in that field. It's the same disconnect. And by then I was completely convinced.
Jen Lumanlan 27:01
Yeah. And also, that you cite research in one of your books about how actually losing weight can potentially increase the risk of death. For some groups of people, which is completely counter to everything, we're told. We're told if you are carrying what is called excess weight, you should lose it, and then you will be healthy. And that's not what the data was showing.
Dr. Lindo Bacon 27:26
Right. And to me, that's in part because of our ridiculous way of looking at research. One of the things that we're doing is we compare fat people to thin people, and we say thin people don't get this disease. So fat people lose weight, they're going to have the health status of thin people. Now, that is a huge assumption. And it doesn't make sense to look at data that way, it would make a lot more sense. If you compare the data of fat people that stayed at their weight to the fat people that lost weight, to see if it actually improves people's health. But that's not happening.
Jen Lumanlan 28:10
Okay. And so I'm wondering, is there a point at which at either end of this spectrum, that excess weight or enough enough weight becomes problematic? And how can we know where that is? Where that point is or where that fuzziness is?
Dr. Lindo Bacon 28:27
Well, in terms of the top end of the scale, I think that the question is going to get us into trouble. Because suppose I come up with an BMI number where I think it's dangerous. Even if I did, we don't have any proven methods that are going to help people to lose weight and keep it off. Yeah. So it doesn't it's not effective anywhere on the spectrum to keep people to tell people to lose weight. Now, at the bottom end of the scale, I think there are very different issues with anorexia, that there are definitely some, like refeeding. Sometimes it's important, like, when you're dangerously starved, you can't make good decisions about your life. And so helping someone to gain weight, which is something that is much more possible, your body doesn't fight and doesn't resist that to the same degree. And it certainly doesn't resist it as much to people that need to gain weight. Right? So it's very different at the bottom end of the scale.
Jen Lumanlan 29:43
Okay, so I just want to make sure that I'm understanding you correctly. So what you're saying is that the bottom end of the scale, it is possible to be dangerously thin and that refeeding to bring a person up in accordance with what their body is actually needing asking for, is an appropriate treatment. At the other end of the scale, what you're saying is that when a person's body is carrying a lot of excess fat, that there may be some additional disease burden, mortality burden, but because we do not have any effective ways to support people in losing weight, or any evidence that losing that weight will actually benefit them or keep them from putting it right back on again afterwards, that telling them to lose weight, no matter how much they weigh, is not an effective way of improving their health or their lifetime outcome.
Dr. Lindo Bacon 30:33
Right. And let me give you an example that will make this really clear. I used to have really bad knee trouble. And I'm in the back category called normal weight. And I went to an orthopedic surgeon who determined that, yes, I have a big problem and first suggested exercise and like strengthening and stretching. When that didn't work to the effect that we wanted, he then suggested surgery, and my knees have been great since. Now, my father, who was in he's not alive anymore, but he was in that category called obese, he went to an orthopedic surgeon, and told him, he had the exact same problem of knee trouble. The orthopedic surgeon told him lose weight. Now, all that did was it triggered my father's eating disorder. It did not help him, it did not help his knees. He went to his death with knee trouble. Now, my father could have benefited from stretching and strengthening his knees, and so that his knees could support the body that he has. He also could have benefited from surgery. And he also could have benefited from getting help around his eating disorder. Like all of those things are true. But the one and the other thing that is definitely true in there is telling him to lose weight is not going to solve the knee problem, even if weight is what is causing the problem. And then I want to also add another irony to the picture. If anybody's to blame for their bad knees. It's me, I was training for a marathon. I was overtraining and just abusing my body in that way. And yet, nobody caught that. And because exercise is supposed to be a good thing. And it wasn't in that case. And so I brought it on myself. And nobody caught that. And that would have been really helpful in solving the problem.
Jen Lumanlan 32:47
Yeah, and I think what you're getting at is the weight stigma that fat people deal with every day, not just in society in you know, somebody look walking down the street, but when they go to the doctor, where the problem like my knees hurt, but pretty much the only thing they're told is lose weight. And when you've lost the weight, then we'll deal with whatever else is going on with you. And so firstly, they're not getting the problem that they have the reason they went to the doctor dealt with. And secondly, yeah, just like your dad, it's triggering all kinds of trauma that they've probably been dealing with for a long time. And I think the research has indicated that the doctors are the most the most likely source of this kind of weight stigma for people. And then we wonder why health outcomes are bad? Well, is it possible that you don't want to go to the doctor because you don't want to face that? You don't want to deal with that?
Dr. Lindo Bacon 33:37
Yeah, and there's research to support that. That fatter people delay, and avoid medical appointments, because as you're mentioning of the weight stigma that they often receive, which, of course is then going to contribute to disease.
Jen Lumanlan 33:57
The web of it all is almost too mind boggling to get your your arms around, isn't it?
Dr. Lindo Bacon 34:03
Jen Lumanlan 34:03
Because it all contributes and the different areas that it touches our ourselves and the way we see ourselves the way we see other people and how it affects our medical care and how we show up in the world. It's almost mind boggling to try to get your arms around it seems.
Dr. Lindo Bacon 34:20
Jen Lumanlan 34:21
Yeah. So one of the tools that you use is called a Health at Every Size framework. And I wonder if you can talk us briefly through that because we're actually going to hopefully spend a whole episode digging into that. And I know that it's a phrase that has become trademarked over the years but can you tell us how do you see Health at Every Size?
Dr. Lindo Bacon 34:40
Sure. And you mentioned the trademark and it's been trademarked by a really wonderful organization called the Association for Size Diversity and Health. And it was trademarked after my book of that title came out which is why you don't see the trademark on my book. And the general idea with Health at Every Size is, let's support everybody in compassionate self care across the weight spectrum, you know, its weight inclusive, rather than doing things differently for people based on their weight. Well, I wouldn't say that entirely. Because there are some helpful things to tell fatter people than thinner people, like for example, there's going to be different exercises that are going to be valuable to supporting different bodies. Okay, but an another really big part of the Health at Every Size framework, which is not something that I highlighted in my first book. But we made up for that in the second book is that this isn't just an individual thing. And that when we look at the data, what we see is that the major contributor to poor health outcomes is not individual behaviors, like what people eat amount of exercise they get, it's what we call the social determinants of health. Things like racism have a huge effect on our health. If you're poor, there's and you have a lot of stressors on you, there might be toxic mold in your apartment, because the landlord's not keeping it up, that makes you more vulnerable to getting things like asthma. And it's very clear in the public health research, that behavior should not be a big thing that we're paying attention to, because it's not the big contributor. If we really want to tackle population health, we should be doing things like increasing the minimum wage. That's probably going to have a much bigger impact than everybody eating their fruits and veggies. It's really hard to tease all of this stuff apart, but I think that the research is strongest at saying that if you were to combine all of the health behaviors together, like eating and exercise, stress management, etc, that that contributes about 25% to somebody's total health outcomes. And the social determinants, on the other hand, are about 60%. So I'm not saying that nutrition doesn't play any role. But it's clearly very exaggerated. And it's putting all the onus on the individual, when this is actually a problem of inequity.
Jen Lumanlan 37:29
Dr. Lindo Bacon 37:30
So that's another aspect of Health at Every Size.
Jen Lumanlan 37:32
Absolutely and super important to go into. And I think it really, it's kind of cuts to the heart of, particularly in the US, right, where there's such an individualistic culture. And if you you can do anything you want to do, if you just put your mind to it, you put the effort in the whole world can be your oyster, you can achieve anything. And if you're not achieving that, well, then there's something within you that needs to be fixed. And if a person isn't achieving, then yeah, they need to pay attention to themselves and and take that action and take responsibility for that, when what you're saying is that the far more powerful determinants are how we treat each other in society.
Dr. Lindo Bacon 38:12
Exactly. And right, and I don't know how much I need, I can emphasize that point is, if that's why my last book was called Radical Belonging because if we create a more inclusive world, where everybody feels like they belong, they're treated well. That's how we solve all these problems.
Jen Lumanlan 38:35
Yeah, and I would love to spend some time talking about that. And I know that you wrote this during the pandemic, you must have been hunkered down in a very strange time in our world history. And you talk in the book about this evolution that you have made as well over what used to see this as more of a personal responsibility, and towards the collective focused approach that you see now. And I'm wondering if you can walk us through that maybe starting with the very first sentence of your prologue, which is it is hard to be yourself and feel belonging in a culture that is hostile to your existence. I mean, that just cut to the heart of it for me.
Dr. Lindo Bacon 39:13
It did, yeah, that parts of the book were really painful to look at looking at my history of feeling like I didn't fit in in the world and getting that reinforcement from the outside world. I'll give you just one example, which was pretty profound for me. It was right around my 13th birthday, when I grew up in a Jewish family, and as a girl, and I was about to have my Bat Mitzvah, which is the Jewish coming of age ceremony where a girl becomes a woman. And I remember the day that I was going to go shopping for a dress with my mother, and I hated wearing dresses. They just, I mean, it felt like drag to me. It just was not who I was. And in the morning on that day, my mother actually left the house with my father and my brother and I was alone in the house. And they were all shopping for suits for my father and my brother. And I went into my brother's room, he was older than me. And he had already had his Bar Mitzvah and went into his closet, and I found the suit that he wore to his Bar Mitzvah. And I put it on, and it felt so right to me, and this is how I want it to be coming into adulthood. And the next part of the story, though, gets gets really kind of depressing, because I was so caught up with seeing myself in the mirror. And I mean, that I saw myself, which is not something I usually saw when I looked in the mirror, but then I did. And I didn't hear my mother walk into the room. And my mother was just aghast that I would be doing this. And all throughout my life, it went against her values, she always had wished that I could be more of the girl that they wanted to be. And she felt a lot of shame that I wasn't that. And so it got drilled into me at a pretty young age that, who I was my authentic identity just isn't okay. And that the way I am safe in the world, is if I pretend to everybody that I'm a girl, and play that game, because I don't belong in their world. And it took a lot of trauma, before I finally got to the point where I realized that, hey, I don't have to fit into one of those binary genders. That's just not who I am. And to celebrate the non binary person that I am, and feel comfortable just living in my skin. And that's been so freeing to me.
Jen Lumanlan 42:05
Yeah, and that's a journey that I imagine it, it's very difficult to undertake. And another phrase that really stuck out to me in the book is the cult of authenticity, the idea that it's cool right now to be your authentic self to show up as your authentic self. But the point that you're making is not everybody's authentic self is valued in our culture.
Dr. Lindo Bacon 42:26
Right. Right. And so that becomes a very kind of class-based privileged attitude. Because it's a lot easier to be your authentic self, when your authentic self is valued. And, hey, if you're black,transwoman, I'm not sure that I'm going to right off the top of my bat, say be your authentic self show everyone, because black transwomen are getting murdered, for being who they are .
Jen Lumanlan 42:54
Yeah. Their authentic selves.
Dr. Lindo Bacon 42:55
So we all have to make choices about whether we're going to show ourselves in the world. And if you can't show yourself in the world, well, then you can't get love and appreciation for who you are. So that puts people in a pretty hard bind, of really feeling bad about themselves. And it becomes so important that all of us have to find our people. Find those places where we can feel safe being who we authentically are. And as a culture, we need to really learn what it is we need to do to make our world more inclusive so that people don't have to hide themselves, but that they get respect, regardless of who they are. And that's the point we're at in history right now, with all of the uprisings that are happening, where people, it's not like injustice didn't exist before George Floyd is killed, right? But finally, it's in the public eye. And hopefully, there's gonna be change that's coming from all of this upheaval that we're seeing right now.
Jen Lumanlan 44:16
It's just such a lot to upheaved. Right? There's so much new that's tied up in sort of this fundamental idea of what it means to be American of what our culture I say, our as an English person. But you know what it is to be an American person who has this Protestant work ethic, who works hard, who succeeds on their own merits, when that's the only true for a small group of people. I wonder if they're the sort of concrete steps that you you recommend or that you have taken or that you've seen other people take that can help us to make that shift in a way that's maybe faster or more effective or something than we're seeing right now?
Dr. Lindo Bacon 44:54
Well, that's a fantastic question. And I also just before I get there, I want to point out another learning tip from these times is we're recognizing that if we don't respect people, it affects everybody, that we cannot afford to treat people like crap anymore. And those, you know, look at who are the essential workers without those people, we can't make it. And so it shows that it's not just for our individual selves, that we need to make these changes. But everybody, or we have to help everybody to be able to be in our world, if we really want to feel safe ourselves as individuals.
Jen Lumanlan 45:47
Dr. Lindo Bacon 45:48
Jen Lumanlan 45:48
And do you think things like minimum wage, affordable housing and health care are the keys to that, and I just want to share an anecdote that I don't think I'll ever forget, from your book, where you were talking about a friend who had been told for years to exercise you need to exercise. And finally she got a small inheritance from a relative, and that freed up the time and allowed her to, I think, buy a treadmill so that she could start to exercise. I mean, you think you're telling somebody to exercise, they're going to do it but if you don't remove those structural barriers, there's no point to keep telling them to exercise. Right?
Dr. Lindo Bacon 46:22
Exactly. And so that what that means is those public health messages end up benefiting privileged people, but they don't support the real things that people who are less advantaged, really need. So you're asking them, what do we do about this? How do we solve this problem.
Jen Lumanlan 46:46
Campaign for the minimum wage.
Dr. Lindo Bacon 46:50
Well, that's a good point, that there are all these little battles that we need to be fighting to have more equity in the world, and to make sure that everybody has the resources to live the good life that we all want. So there's certainly a lot of changes that we can be making on that structural level. And I encourage everybody to get involved to get involved in politics, all of that stuff matters. And it's great that to get involved in helping with all of those safety nets that support people in their lives. And on a more individual basis, we can all look at our practices of how we let people into our world and how we treat other people. Look around that your friends, if your friends are all the same skin color as you that says something, right? It might say something about the neighborhood you live in, or the kind of work that you do. And it might also just say that you feel safe with among people that are in your culture. And if you don't have opportunity then to learn about other people and what you might be missing. And without knowing other people, it becomes really hard to include them in our worlds. So helping everybody to kind of expand their worlds and make sure that they're more diverse, which also is challenging, because I don't want to see White people just walking up to Black people and asking to be their friends, you know, using them for their own benefit. So, so don't think that such a simplistic thing. I remember when I talked about this on another podcast and the podcaster's conclusion from that was Oh, so we should all travel more, because then we'll be going to different cultures and learning. And that doesn't help so much, either because you're seeing people in this exploitative way where they're serving you. So anyway,
Jen Lumanlan 49:06
Yeah, you're an outsider. And you're always seeing them as an other person, right? Someone who's different from you. Stranger than you new maybe.
Dr. Lindo Bacon 49:15
Right? So expanding our world is not an easy thing. And yet, it's something that we have to keep pushing for and doing. And I'm sure everybody can look at their worksite and see who's missing from there. See who's missing from the top levels of management, and ask why. And see what you can do to make shifts there. Because there's always going to be a reason.
Jen Lumanlan 49:44
Yeah. And you want to sort of bring this back to well, what does this mean for parents because they're obviously the ones who are listening and I think there's sort of a couple levels on it. On the micro level you tell it a little story in Health at Every Size about your mother trying to convince your toddler to eat more, instead of it, you know, zooming the spirit into the mouth like an airplane, and I have a distinct memory of doing that with a friend's baby 20 years ago, when I was happened to be ever at their house at dinner time, and it's just sort of this cultural thing that we, we teach kids to override their their own body signals. So I think there's some aspect of it. But there's also this sort of broader anti racist work, which we've covered extensively on the podcast as well. Do you see those as being sort of the two main avenues that parents can follow? Or is there another path that you would add to that?
Dr. Lindo Bacon 50:31
I think that there are so many things that parents can be doing to help their kids. And probably number one is modeling this, right? Here's another example with so let's go back to that Bat Mitzvah, for example, I gave you. My mother did it all wrong at that time, right. But she was doing the best she can/she could, that's what she learned. And she absorbed. She loves me, and she wanted the best life for me. And she saw that the best life is if you blend in. But what if you don't have that attitude? If you believe that we should nurture kids in just finding themselves and being whoever they are? And I imagine what I would have wanted for my mother at the time. My mother could have said to me, wow, do you want to wear something like that at your Bat Mitzvah? And she could have said, you know, unfortunately, people don't treat girls so well, when they wear suits. So you're probably going to beat up with a lot of teasing and bullying and, you know, but we can work with that, you know, we can help support you. And maybe we can change minds. Or maybe we could find some compromise, if that's what makes you comfortable. So that way my parents can acknowledge that it might be different and not so accepted in society. But that that problem is not in me, the problem is out there. And then support me in trying to figure out ways to manage it. And that's what I think parents can be doing across this spectrum of how to raise a kid is let your kid figure out who they are. Let your kid figure out what the right amount is, in have the right amount of food is because kids have that message at a pretty young age, before you've been affected by all those games that your parents play with you. Kids eat when they're hungry, and they stop when they're full. You know, I remember my son, resolutely shutting his mouth and not allowing us to put food in, which is why we played that airplane game because we want we thought he should eat more. And we wanted to override it. Right? So trust your kids to figure all of this stuff out. And the only way to do it is by honoring who we are, and trying to get all of those cultural messages out of us. And also, the more we become aware of those cultural messages, they don't affect us as much. And we can form community around them. So for example, women can bond over the fact that if you hate your body, it's not because of you. It's because people don't treat women as well and they judge them based on their bodies. And the more we start to talk about this and bond together, then we have more power to actually change the culture. So finding community and building community can help to spark the revolution.
Jen Lumanlan 53:57
Oh, yeah. And so what I'm saying then is the stuff that you can do at home with your child, but if it stops there, it's only half done, right? There has to be this external facing part as well, where we look outwards and say, how is this impacting everybody else? Not just how is this impacting me and my family and my child, but how is it impacting everybody else as well? And where is my work needed on that aspect as well?
Dr. Lindo Bacon 54:23
Right. so it's very important.
Jen Lumanlan 54:26
Working towards radical belonging.
Dr. Lindo Bacon 54:29
Jen Lumanlan 54:30
Thank you so much for being here. Dr. Bacon, it was such a privilege to talk with you.
Dr. Lindo Bacon 54:33
It was so fun, Jen. Thank you.
Jen Lumanlan 54:35
And so all of the references for today's episode, and there are many of them, along with the links to Dr. Bacon's books can be found at YourParentingMojo.com/Eating.
Jen Lumanlan 54:47
Thanks for joining us for this episode of Your Parenting Mojo. Don't forget to subscribe to the show YourParentingMojo.com to receive new episode notifications and the free guide to 13 reasons your child isn't listening to you and what to do about each one. And also join the Your Parenting Mojo Facebook group. For more respectful research based ideas to help kids thrive and make parenting easier for you, I'll see you next time on Your Parenting Mojo.
Dr. Bacon’s books:
Bacon, L. (2008). Health at every size: The surprising truth about your weight. Dallas: BenBella.
Bacon, L., & Aphramor, L. (2014). Body Respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas: BenBella.
Bacon, L. (2020). Radical Belonging: How to survive and thrive in an unjust world (while transforming it for the better).
Adams, K.M., Butsch, W.S., & Kohlmeier, M (2015). The state of nutrition education at U.S. medical schools. Journal of Biomedical Education (Article ID 357627), 1-7.
Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal 10(9), 1-13.
Berrington de Gonzalez A, Hartge P, Cerhan J.R., Flint A.J., Hannan L, MacInnis R.J., Moore S.C., Tobias G.S., Anton-Culver H, Freeman L.B., et al. (2010). Body-mass index and mortality among 1.46 million white adults. The New England Journal of Medicine 363:2211-2219.
Centers for Disease Control and Prevention (2021). Body mass Index (BMI). Author. Retrieved from https://www.cdc.gov/healthyweight/assessing/bmi/index.html
Czerniawski, A.M. (2007). From average to ideal: The evolution of the height and weight table in the United States, 1836-1943. Social Science History 31(2), 273-296.
Eknoyan, G. (2007). Adolphe Quetelet (1796-1874) – the average man and indices of obesity. Nephrology Dialysis Transportation 23(1), 47-51.
Centers for Disease Control (n.d.). Adult obesity facts. Author. Retrieved from https://www.cdc.gov/obesity/data/adult.html#:~:text=The%20prevalence%20of%20obesity%20was%2040.0%25%20among%20adults%20aged%2020,adults%20aged%2060%20and%20older.
Diabetes Prevention Program Research Group (2009). 10-year follow up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374(9702), 1677-1686.
Doster, G.D., Wadden, T.A., Makris, A.P., Davidson, D., Sanderson, R.S., Allison, D.B., & Kessler, A. (2003). Primary care physicians’ attitudes about obesity and its treatment. Obesity Research 11(10), 1168-1177.
Flegal, K.M., Kit, B.K., Orpana, H., & Graubard, B.I. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. Journal of the American Medical Association 309(1), 71-82.
Flegal, K.M., Graubard, B.I., Williamson, D.F., & Gail, M.H. (2005). Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association 293(5), 1861-1867.
Gage, S.H., & Sumnall, H.R. (2018). Rat Park: How a rat paradise changed the narrative of addiction. Addiction 114, 917-922.
Ingram, D.D., & Mussolino, M.E. (2010). Weight loss from maximum body weight and mortality: The third national health and nutrition examination survey linked mortality file. International Journal of Obesity 34, 1044-1050.
Keys, A., Findaza, F., Karvonen, M.J., Kimura, N., & Taylor, H.L. (1972). Indices of relative weight and obesity. Journal of Chronic Disease 25, 329-343.
Kruger, J., Galuska, D.A., Serdula, M.K., & Jones, D.A. (2004). Attempting to lose weight: Specific practices among U.S. adults. American Journal of Preventive Medicine 26(5), 402-406.
Lantz PM, Golberstein E, House JS, Morenoff J: Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med 2010, 70:1558-1566.
Leser, L.I., Ebbeling, C.B., Goozner, M., Wypij, D., & Ludwig, D.S. (2007). Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med 4(1), e5.
MacLean, PS., Bergouignan, A., Cornier, M-A., & Jackman, M.R. (2011). Biology’s response to dieting: The impetus for weight regain. American Journal of Physiology – Regulatory Integrative, and Comparative Physiology, R581-R600.
Mann, T., Tomiyama, A.J., Westling, E., Lew, A-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist 62(3), 220-233.
Mello, M.M., Clarridge, B.R., & Studdert, D.M. (2005). Academic medical centers’ standards for clinical trial agreements with industry. New England Journal of Medicine 352(21), 2202-2210.
Montani, J-P., Viecelli, A.K., & Dullo, A.G. (2006). Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: The ‘repeated overshoot’ theory. International Journal of Obesity 20 Suppl 4, S58-66.
National Institutes of Health (1996). Methods for voluntary weight loss and control (Technology Assessment Conference Panel). Annals of Internal Medicine 116(11), 942-949.
Neel, J.V. (1989). Update to “The study of natural selection in primitive and civilized human populations.” Human Biology 61(5-6), 811-823.
Neel, J.V. (1962). Diabetes Mellitus: A ‘thrifty’ genotype rendered detrimental by ‘progress’? American Journal of Human Genetics 14(4), 353-362.
Puhl, R.M., & Brownell, K.D. (2012). Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity 14(10), 1802-1815.
Strohacker, K., & McFarlin, B.K. (2010). Influence of obesity, physical inactivity, and weight cycling on chronic inflammation. Frontiers in Bioscience 2, 98-104.
The Look Ahead Research Group (2013). The effects of intensive lifestyle intervention in Type 2 diabetes. New England Journal of Medicine 369, 145-154.
World Health Organization (2021). Body mass index – BMI. Author. Retrieved from https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
Wu, Ya-Ke, & Berry, D.C. (2017). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. Journal of Advanced Nursing 74(5), 1030-1042.
, K.D. (2012). Confronting and coping with weight stigma: An investigation of
overweight and obese adults. Obesity 14(10), 1802-1815.
Strohacker, K., & McFarlin, B.K. (2010). Influence of obesity, physical inactivity, and weight cycling on
chronic inflammation. Frontiers in Bioscience 2, 98-104.
The Look Ahead Research Group (2013). The effects of intensive lifestyle intervention in Type 2 diabetes.
New England Journal of Medicine 369, 145-154.
World Health Organization (2021). Body mass index – BMI. Author. Retrieved from
Wu, Ya-Ke, & Berry, D.C. (2017). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. Journal of Advanced Nursing 74(5), 1030-1042.